ArticleJAMA network open2025
Telehealth and Health Care Contact Days Among Patients With Advanced Cancer After COVID-19.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Time toxicity among patients with cancer: a scoping review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Time Toxicity in Advanced Breast Cancer: Psychological Burden, Psychiatric Vulnerability, and Implications for Patient-Centered Decision-Making.Medicina (Kaunas, Lithuania) · 2026Review
- Accuracy of patient, care partner, and clinician health care contact day recall.The oncologist · 2026Article
- Understanding financial toxicity in cancer care through a social-ecological lens.Current opinion in oncology · 2026Review
- Time-Toxicity Indicators and Mitigation Strategies in Cancer Care: A Scoping Review.Journal of multidisciplinary healthcare · 2026Review
- Patient-, care partner-, and clinician-proposed solutions to address the time toxicity of cancer care.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- A Comparison of In-Person and Telehealth Personalized Exercise Programs for Cancer Survivors: A Secondary Data Analysis.Cancers · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: The COVID-19 pandemic led to widespread telemedicine adoption, but its impact on time toxicity, ie, the time burden of interacting with the health care system, among patients with advanced cancer remains unclear. Objective: To evaluate the association of the COVID-19 pandemic with time toxicity for patients with advanced cancer who died within 1 year of diagnosis, focusing on changes in health care use, including telehealth. Design, Setting, and Participants: This retrospective cohort study included patients with stage 4 cancer who died within 1 year of diagnosis, with follow-up limited to 1 year. Patient data were provided by an integrated value-based health care system across Kaiser Permanente Northern California. Patients were grouped by diagnosis date into a pre-COVID-19 group (January 1, 2015, to February 29, 2020) and a post-COVID-19 group (March 1, 2020, to June 30, 2022, followed up through June 2023). Exposure: Health care use before and after the onset of the COVID-19 pandemic. Main Outcomes and Measures: Time toxicity was measured as the percentage of health care contact days over survival days. Types of health care use included outpatient visits (in-person and telehealth), emergency department visits, and hospitalizations. Multivariable negative binomial regression was performed to assess use changes by care type. Results: The study included 9643 patients (median [IQR] age, 74 [66-81] years; 5119 men [53.1%]), with 6558 in the pre-COVID-19 group and 3085 in the post-COVID-19 group. Patients spent a median 32.5% (IQR, 21%-50.0%) of their days in contact with the health care system. In the post-COVID-19 group, in-person outpatient visits decreased (adjusted prevalence ratio [APR], 0.71; 95% CI, 0.69-0.74), while telehealth increased (APR, 2.01; 95% CI, 1.94-2.07). Overall contact days increased slightly (APR, 1.04; 95% CI, 1.02-1.07), as did emergency department and/or acute inpatient days (APR, 1.09; 95% CI, 1.04-1.15). Conclusions and Relevance: In this cohort study of patients with advanced cancer, time toxicity remained high in the postpandemic era. Although telehealth increased, so did emergency department visits and hospitalizations. These findings highlight the need to integrate telehealth into time toxicity assessments to optimize patient-centered end-of-life care.
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