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

PURPOSE: 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.

METHODS

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.

RESULTS

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] v 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] v 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] v 0.48 [95% CI, 0.48 to 0.48]) while inpatient utilization was similar. Similar trends were seen in 2021 and by cancer type.

CONCLUSION

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.