Telemedicine as a gateway to early-phase oncology trials: lessons from 14 000 patients and future directions for global access and equity.

BACKGROUND

Telemedicine expanded rapidly during the COVID-19 pandemic, but its role in early-phase oncology trials remains uncertain. We evaluated its impact on recruitment, enrollment, equity, and access in a large phase I program.

PATIENTS AND

METHODS

We retrospectively analyzed patients seen for first consultation in the MD Anderson Phase I Program (2016-2023). Recruitment (consent) and enrollment (treatment initiation) were compared by visit type, race/ethnicity, and geography across pre-pandemic (2016-2019), pandemic (2020-March 11, 2023), and post-public health emergency (PHE; March-December 2023) periods. A chart review of 400 patients validated findings.

RESULTS

Of 14 085 patients, 7247 were evaluated post-pandemic, with 36% (n = 2616) of first visits by telemedicine. Recruitment and enrollment rates were comparable between telemedicine and in-person visits (61.5% vs 62.6% and 37.5% vs 39.6%, respectively) in the post-2020 period. Hispanic patients used telemedicine more often than non-Hispanic (NH) white patients (43.8% vs 35.9%; P = .0002) and had higher enrollment (54.2% vs 39.4%; P < .0001) during this period. Rates were similar for NH Black vs NH White patients. Texas residents were more likely to use telemedicine than out-of-state patients (48.5% vs 22.8%; P = .0001). After the PHE ended, telemedicine increased among Texas patients (48%→56%) but declined among out-of-state patients (26%→12%).

CONCLUSIONS

Telemedicine is a feasible and equitable strategy for early-phase oncology trial enrollment, with strong uptake among Hispanic patients. However, use declined among out-of-state patients after the PHE, underscoring cross-state licensure and reimbursement barriers to equitable access. Policy reforms are essential to preserve telemedicine as a permanent gateway to clinical trials and to broaden diversity in cancer research.