Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study

Abstract

Background: Since the COVID-19 pandemic, we have seen rapid growth in telemedicine utilization. However, telehealth care and services are not equally distributed and not all breast cancer patients have equal access across U.S. regions. There are notable gaps in the existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in breast cancer patients and oncology services offered through virtual vs. in-person visits. Objective:We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among breast cancer patients and examined differential provisions of oncology services between virtual and in-person visits.Methods: Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and/or in-person visiting was defined as having had a virtual and/or in-person visit with a provider in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. McNemar's test was used to assess match-paired data on types of oncology services comparing virtual to in-person visits.Results: Of 1,163 patients, 36.0% (of these, 65.0% videoconference only, 22.7% telephone only, and 12.3% both videoconference and telephone) had a virtual visit in the past 12 months. Higher ADI scores were associated with a lower likelihood of telemedicine utilization (adjusted odds ratio 0.89; 95% CI: 0.82-0.97). There were no significant differences in providing treatment consultation (45 vs. 55; P=0.317) or cancer genetic counseling (11 vs. 19; P=0.144) between virtual and inperson visits. Telemedicine users reported 95.8% somewhat-to-extreme satisfaction, and 61.8% were likely or very likely to continue using telemedicine.Conclusions: In this study of multiethnic cohort of breast cancer patients, our findings suggest neighborhood-level socioeconomic disparities in telemedicine use and that virtual visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations.