Telehealth utilization during the COVID-19 pandemic: comparing breast cancer survivors to non-cancer patients and implications for current practice.

backgroundDuring the 2019 coronavirus (COVID-19) pandemic, in-person medical visits changed due to social distancing guidelines. Breast cancer (BC) patients, needing ongoing treatment or surveillance, faced increased challenges in accessing care. Telehealth became essential for providing convenient and cost-effective care while minimizing COVID-19 transmission. BC survivors, however, often value in-person visits for clinical exams. This study aimed to compare telehealth participation between patients with a history of BC and women without cancer history.

methodsAdults aged 18 and older, including cancer patients, survivors, caregivers, and healthy volunteers, primarily from Ohio, were recruited with attention and inclusion of underserved and minority populations to complete a survey about COVID-19-related beliefs, practices, and knowledge. Recruitment involved (1) re-contacting participants from previous OSU studies (2) outreach via community partners and listservs to invite additional participants and caregivers. Sociodemographic characteristics by BC status were calculated using Chi square tests. Univariable and multivariable logistic regressions modeled association between the outcome of interest, telehealth participation, and BC status accounting for race, ethnicity, age, education, marital status, rurality, and insurance status.

resultsThe final sample included 2265 participants, with 43.7% having a history of BC. Significant demographic differences were observed between participants with and without a history of breast cancer. Those with a previous BC diagnosis were younger on average (55.6 vs. 57.9 years, p < .001), had higher levels of educational attainment (p < .001), were less often married and more often divorced/widowed/separated (p = .037), and were more likely to have private insurance only and less likely to have both public and private coverage (p < .001). Telehealth use was lower during COVID-19 among BC survivors (41.5%) vs. those without cancer (63.9%) (p < 0.001). In a multivariable model, factors that were statistically significantly associated with increased utilization of telehealth were Black race (OR = 1.90, p-value 0.036), having some college education (OR = 1.50, p-value 0.034), being married (OR = 1.61, p-value 0.009), and being currently employed (OR = 1.25, p-value 0.050). BC diagnosis or survivor status was associated with decreased odds of telehealth use (OR: 0.72, p = 0.023). Among breast cancer patients with complete data (n = 645 of the 989 total), more than half used telehealth, with video visits being slightly more common than phone visits. Logistic regression analyses revealed increased telehealth use among patients with a history of BC was associated with age > 70, while decreased participation in telehealth was associated with higher educational status and having undergone surgical treatment.

conclusionWe found that Black race, having some college education, being married, and being employed were significantly associated with increased telehealth participation during the COVID-19 pandemic. Interestingly, BC diagnosis was associated with reduced odds of telehealth use. Subgroup analyses of patients with a history of BC showed decreased use of telehealth to be associated with higher education and recent surgery for BC. Further investigation is needed to understand the acceptability and barriers to telehealth among BC survivors, as this modality continues to play an expanding role in oncology care delivery in the post-pandemic era.