Public interest technology for cancer survivorship in Texas: A survivorship tech bundle.

Abstract

In Texas, over one million individuals are living with a history of cancer, yet survivorship outcomes remain deeply shaped by inequities in access to digital health technologies. Tools such as telehealth, patient portals, electronic patient-reported outcomes, and interpreter or proxy services have become essential to symptom management, care coordination, and quality of life. However, access and benefits are unevenly distributed. Racial and ethnic minorities, rural residents, those with limited English proficiency, and low-income populations consistently face structural barriers, including limited broadband, device scarcity, and lower digital literacy. Caregivers shoulder substantial, often invisible, burdens by managing portals, troubleshooting devices, and navigating insurance authorizations, compounding inequities. Evidence from Texas highlights these disparities at multiple levels, from county-level broadband and insurance gaps to variable Medicaid coverage. Although initiatives such as the Texas Cancer Plan and Cancer Prevention and funding from the Research Institute of Texas provide critical opportunities, survivorship support is too often delivered as fragmented pilot projects rather than durable infrastructure. The author proposes that survivorship technologies be conceptualized as a baseline tech bundle, including portals, telehealth with interpreter integration, electronic patient-reported outcome, broadband connectivity, devices, caregiver supports, financial navigation tools, and features such as language access and accessibility design. Framing survivorship technology as essential infrastructure, rather than discretionary innovation, shifts the focus from individual uptake to structural design, policy alignment, and sustainability. Doing so would reduce hidden caregiver burdens, close access gaps, and establish survivorship technology as a public good, ensuring that all Texans living after cancer can navigate survivorship with dignity and support.