1. Goodwin, Peter M.

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Increasing the availability of telemedicine consultations could become a powerful force for reducing cancer inequalities, according to findings from a large cohort study of American patients with gynecologic cancers reported in a poster session at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 1593).

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Extra efficiency gained by using video call methods, and also the telephone, for oncology consultations-instead of waiting to meet patients face to face-could help reduce inequity in access to cancer care irrespective of the patients' geographical locations, which the report found to be the leading cause of disparities.


"We found significant regional disparities in access to telemedicine in endometrial and ovarian cancer-with patients in the Northeast more than twice as likely to be able to use telemedicine for their gynecologic oncology care versus patients in the South and Midwest," said Anna Jo Bodurtha Smith, MD, MPH, MSc, co-author of the report and Gynecologic Oncology Fellow at the University of Pennsylvania Perelman Center for Advanced Medicine in Philadelphia.


She told Oncology Times that she had some clear messages for cancer teams. "As clinicians who overall believe that telemedicine has value to our patients, we really urge clinicians to take a look at their state policies-as well as their own ability to provide access to telemedicine-to make sure that more patients are able to take advantage of the service."

Anna Jo Bodurtha Smi... - Click to enlarge in new windowAnna Jo Bodurtha Smith, MD, MPH, MSc. Anna Jo Bodurtha Smith, MD, MPH, MSc

The study looked at how the rapid increase in the use of telemedicine during the COVID-19 pandemic had impacted cancer care disparities in a retrospective cohort study of patients in the U.S. with gynecologic cancers. Sociodemographic factors (including race and insurance status), differences among patients, health system issues, and factors relating to the specific type of cancer were all correlated with the use of telemedicine by member of the study cohort.


Data from patients with documented endometrial or ovarian cancer were then analyzed for any association between cancer disparity and telemedicine usage during COVID-19 pandemic from 2020 to 2021.


Out of 13,450 patients, 14.4 percent had used telemedicine during the study period. Having health care insurance was not found to be associated with the likelihood of receiving telemedicine consultations. But the region in which patients lived was found to be significantly associated with it. Patients living in the Northeast were more likely to use telemedicine than other parts of the country.


The report found that the regional disparities in cancer care were present across all gynecologic cancer types and all oncology settings. The marked regional inequity was greater than other correlates of care delivery such as race, which was also a risk factor for cancer care disparity. The researchers concluded that expanding access to telemedicine was a high priority, especially in the geographically deprived areas they had identified. They stated that improving access to telemedicine would be likely to improve geographical and other disparities in gynecologic cancer care.


Why Telemedicine?

"There's both a time efficiency for the clinician, as well as a real-time efficiency for the patient. To come into the cancer center here, there's the time to get here, there's parking, getting to the office, there's waiting in the waiting room. And with our patients' valid concerns about COVID-19 and being on active chemotherapy-or post-transplant-it is very valuable to be able to offer them that," said Bodurtha Smith, speaking from her office in Philadelphia after the ASCO conference.


In her own clinical experience, she said telephone calls and especially video calls were useful. "I do find as a clinician [that] it's very helpful to have the video calls-[partly] because you get to see how people are doing [by asking] them to move around," she said. She particularly valued the chance of talking with multiple family members during video consultations. "With our telemedicine system we can talk to anybody who is within the house. I've had very large family discussions. You get to involve the family, which is so valuable as part of cancer care," she said.


"If, as cancer doctors, we believe that telemedicine is a vital component of cancer care-which I think most cancer doctors would agree with-we have to think about how we make sure that every patient that we think would benefit from telemedicine access is able to use telemedicine," Bodurtha Smith noted. Her concerns include all barriers to using telemedicine are addressed, including access to broadband and appropriate devices.


"The real hope is that if we can identify how to make telemedicine work well, it could improve access to care during treatments for our patients," she concluded.


Peter M. Goodwin is a contributing writer.