Telehealth in cancer care during COVID-19: disparities by age, race/ethnicity, and residential status

Jewett, Patricia; Ghebre, Rahel; Hui, Jane Yuet Ching; Parsons, Helen; Rao, Arpit; Sagaram, Smitha; Blaes, Anne

doi:10.1007/s11764-021-01133-4

Cited by 45 publications

(53 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…"All of us are called to do everything we can to save as many lives as possible during the ongoing pandemic," Robert W. Carlson, MD, chief executive officer, NCCN, said in a statement. 2 "Vaccination is our most effective approach for avoiding serious COVID-19 complications, including hospitalization and death. However, research shows many immunocompromised people develop inadequate immune responses from vaccines," Carlson said.…”

Section: Joseph Alvarnas MDmentioning

confidence: 99%

“…1 Zanubrutinib, sold as Brukinsa by BeiGene, is a second-generation BTK inhibitor that has fewer off-target effects and less cardiotoxicity than ibrutinib, a first-generation BTK inhibitor. 2 According to the updated guidelines, zanubrutinib is now a preferred therapy for first-line treatment of patients with CLL/SLL who do not have the deletion(17p) / TP53 mutation; the recommendation was given a grade of 2A, which means it is based on lower-level evidence but there is uniform consensus that the recommendation is appropriate.…”

Section: Mary Caffreymentioning

confidence: 99%

“…The ability to remotely access health information has become increasingly important for the patient experience, particularly during the COVID-19 pandemic when [the] ability or willingness to travel for cancer care may have been impacted," Mark Stadler, CEO of AccessHope, said in a joint statement from AccessHope and Emory Healthcare. 2 "As we continue connecting plan members and their local treating oncologists with these world-renowned specialists who can review their cases, our primary goal is to share insights they can use to optimize cancer treatment plans and improve clinical outcomes," Stadler said.…”

Section: Sp73mentioning

confidence: 99%

“…"We are extremely pleased that Cullinan has received breakthrough therapy designation from the FDA for CLN-081, a distinction that underscores the urgent need to bring improved targeted treatments to this patient population and further supports the differentiated clinical profile of CLN-081," said Nadim Ahmed, CEO of Cullinan Oncology. 2 "We look forward to ongoing, productive regulatory discussions with the FDA, which are further enabled with this designation," he added. ◆…”

Section: Ajmccom | Eboncologymentioning

confidence: 99%

“…An estimated 42,230 new cases were diagnosed last year. 2 Mortality rates from HCC and IHC also continue to rise, despite the growing availability of screening for HCC and improved prevention and treatment of diseases that lead to liver cancer (ie, hepatitis B, hepatitis C, nonalcoholic fatty liver disease).…”

Section: Astro Offers Guidance On Ebrt For Primary Liver Cancersmentioning

confidence: 99%

See 4 more Smart Citations

Alternative payment models can stabilize and improve practice radiation reimbursement

2022

Am J Manag Care

View full text Add to dashboard Cite

HEALTH CARE landscape has created a challenging environment for radiation oncologists-one that makes revenue streams unpredictable and increases the administrative hassle associated with the delivery of quality care. Medicare radiation reimbursement rates declined 24% from 2008 to 2017, with an initial 7% to 8% additional payment cut projected for 2022 based on an American Society for Radiation Oncology (ASTRO) analysis of the 2022 Medicare Physician Fee Schedule, 1 which was subsequently mitigated by The Protecting Medicare & American Farmers from Sequester Cuts Act signed in December 2021. 2 Cuts to radiation therapy reimbursement are recommended yearly by CMS. IMPORTANT SAFETY INFORMATION Severe and Fatal Immune-Mediated Adverse Reactions• Immune-mediated adverse reactions, which can be severe or fatal, can occur in any organ system or tissue and can occur at any time during or after treatment with a PD-1/PD-L1-blocking antibody, including JEMPERLI. • Monitor closely for signs and symptoms of immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function tests at baseline and periodically during treatment. For suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. • Based on the severity of the adverse reaction, withhold or permanently discontinue JEMPERLI. In general, if JEMPERLI requires interruption or discontinuation, administer systemic corticosteroids (1 to 2 mg/kg/day prednisone or equivalent) until improvement to ≤Grade 1. Upon improvement to ≤Grade 1, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reaction is not controlled with corticosteroids.

show abstract

Section: Joseph Alvarnas MDmentioning

confidence: 99%

Section: Mary Caffreymentioning

confidence: 99%

Section: Sp73mentioning

confidence: 99%

Section: Ajmccom | Eboncologymentioning

confidence: 99%

Section: Astro Offers Guidance On Ebrt For Primary Liver Cancersmentioning

confidence: 99%

See 3 more Smart Citations

Alternative payment models can stabilize and improve practice radiation reimbursement

2022

Am J Manag Care

View full text Add to dashboard Cite

show abstract

Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection

et al. 2023

View full text Add to dashboard Cite

ImportanceThere is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical.ObjectiveTo evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection.Design, Setting, and ParticipantsThis retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022.ExposuresRace and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis.Main Outcomes and MeasuresDelayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy.ResultsA total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals.Conclusions and RelevanceThe findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.

show abstract

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

Tilhou,

Jain,

DeLeire

2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportancePrimary care (PC) receipt is associated with better health outcomes. How telehealth expansion and internet speed are associated with PC use is unclear.ObjectiveTo examine the association of telehealth and internet speed with PC use across sociodemographic determinants of health.Design, Setting, and ParticipantsThis cohort study performed difference-in-differences regression of the change in in-person and telehealth PC visits between pre–COVID-19 public health emergency (PHE) (June 1, 2019, to February 29, 2020) and an initial (March 1, 2020, to May 31, 2020) and prolonged (March 1, 2020, to December 31, 2021) PHE period among continuously enrolled nonpregnant, nondisabled Wisconsin Medicaid beneficiaries aged 18 to 64 years. Data were analyzed from March 2022 to March 2023.ExposurePHE-induced telehealth expansion.Main Outcomes and MeasuresChange in PC telehealth (using Current Procedural Terminology codes) visits: (1) count; (2) visit share completed by telehealth; (3) percentage of PHE-induced visit decline offset by telehealth. High-speed internet (HSI) defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater (June 2020 Federal Communications Commission broadband data); other census block groups classified as low-speed internet (LSI).ResultsIn the total cohort of 172 387 participants, 102 989 (59.7%) were female, 103 848 (60.2%) were non-Hispanic White, 34 258 (19.9%) were non-Hispanic Black, 15 020 (8.7%) were Hispanic, 104 239 (60.5%) were aged 26 to 45 years, and 112 355 (66.0%) lived in urban counties. A total of 142 433 (82.6%) had access to HSI; 72 524 (42.1%) had a chronic condition. There was a mean (SD) of 0.138 (0.261) pre-PHE PC visits per month. In the pre-PHE period, visit rates were significantly higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than LSI, and patients with chronic disease than patients without. In the initial PHE period, female participants had a greater increase in telehealth visits than male participants (43.1%; 95% CI, 37.02%-49.18%; P &lt; .001), share (2.20 percentage point difference [PPD]; 95% CI, 1.06-3.33 PPD; P &lt; .001) and offset (6.81 PPD; 95% CI, 3.74-9.87 PPD; P &lt; .001). Non-Hispanic Black participants had a greater increase in share than non-Hispanic White participants (5.44 PPD; 95% CI, 4.07-6.81 PPD; P &lt; .001) and offset (15.22 PPD; 95% CI, 10.69-19.75 PPD; P &lt; .001). Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants (35.60%; 95% CI, 25.55%-45.64%; P &lt; .001), share (8.50 PPD; 95% CI, 6.75-10.26 PPD; P &lt; .001) and offset (12.93 PPD; 95% CI, 6.25-19.60 PPD; P &lt; .001). Urban participants had a greater increase in telehealth visits than rural participants (63.87%; 95% CI, 52.62%-75.11%; P &lt; .001), share (9.13 PPD; 95% CI, 7.84-10.42 PPD; P &lt; .001), and offset (13.31 PPD; 95% CI; 9.62-16.99 PPD; P &lt; .001). Participants with HSI had a greater increase in telehealth visits than those with LSI (55.23%; 95% CI, 42.26%-68.20%; P &lt; .001), share (6.61 PPD; 95% CI, 5.00-8.23 PPD; P &lt; .001), and offset (6.82 PPD; 95% CI, 2.15-11.49 PPD; P = .004). Participants with chronic disease had a greater increase in telehealth visits than those with none (188.07%; 95% CI, 175.27%-200.86%; P &lt; .001), share (4.50 PPD; 95% CI, 3.58-5.42 PPD; P &lt; .001), and offset (9.03 PPD; 95% CI, 6.01-12.04 PPD; P &lt; .001). Prolonged PHE differences were similar. Differences persisted among those with HSI.Conclusions and RelevanceIn this cohort study of Wisconsin Medicaid beneficiaries, greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.

show abstract

Telehealth in cancer care during COVID-19: disparities by age, race/ethnicity, and residential status

Cited by 45 publications

References 30 publications

Alternative payment models can stabilize and improve practice radiation reimbursement

Alternative payment models can stabilize and improve practice radiation reimbursement

Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

Contact Info

Product

Resources

About