Comparing Trends in Telemedicine Use and Geographic Disparities in Utilization Among Patients With Cancer in the United States.

Abstract

Studies have shown that rural populations were less likely than urban populations to use telemedicine during and after the COVID-19 pandemic. These trends are not well characterized nationally for patients with cancer. This cohort analysis, using 2 years of Medicare fee-for-service claims (2020-2021), identified patients with incident or prevalent lung or colon cancer in 2020. Rurality of patient residence was classified using rural-urban commuting area codes as metropolitan, micropolitan, or small town/rural. We used generalized estimating equations to model outpatient (telemedicine and in-person) visit trends in 2020 and 2021 by rurality, adjusting for local COVID-19 rates, US region, and clinical and demographic factors. We identified 355,868 patients (66% lung, 34% colon). Median age was 76 years (standard deviation [SD], 7). 78% of patients lived in metropolitan areas, 85% were White, and 53% female. 44% had at least one instance of chemotherapy, surgery, or radiation treatment in 2020. In 2020, compared with patients residing in metropolitan areas, small town/rural-residing patients were less likely to use telemedicine (1.28 visits per year [95% CI, 1.27 to 1.29] <i>v</i> 2.34 [95% CI, 2.33 to 2.35] for metropolitan patients), had fewer total outpatient in-person visits (12.37 [95% CI, 12.34 to 12.41] <i>v</i> 13.71 [95% CI, 13.70 to 13.72]), and had more emergency department (ED) visits (0.85 [95% CI, 0.84 to 0.86] <i>v</i> 0.48 [95% CI, 0.48 to 0.48]) while inpatient utilization was similar. Similar trends were seen in 2021 and by cancer type. Lower rural telemedicine use continued beyond the pandemic onset. Relatively lower in-person and higher ED use suggests that telemedicine expansion did not improve overall access to care for rural patients with cancer.