Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Brian De; Shuangshuang Fu; Ying Shiuan Chen; Prajnan Das; Kimberly Ku; Sean Maroongroge; Kristina D. Woodhouse; Karen E. Hoffman; Quynh Nhu Nguyen; Valerie K. Reed; Aileen B. Chen; Albert C. Koong; Benjamin D. Smith; Grace L. Smith

doi:10.1002/cam4.4555

Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Brian De, Shuangshuang Fu, Ying Shiuan Chen, Prajnan Das, Kimberly Ku, Sean Maroongroge, Kristina D. Woodhouse, Karen E. Hoffman, Quynh Nhu Nguyen, Valerie K. Reed, Aileen B. Chen, Albert C. Koong, Benjamin D. Smith, Grace L. Smith

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background: Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. Methods: Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. Results: Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (p_trend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national “Opening Up America Again” guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03–4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1–5 fractions (OR = 4.49, 95% CI 2.29–8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). Conclusion: Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount—and not exacerbate—barriers to quality cancer care.

Original language	English (US)
Pages (from-to)	2096-2105
Number of pages	10
Journal	Cancer medicine
Volume	11
Issue number	10
DOIs	https://doi.org/10.1002/cam4.4555
State	Published - May 2022

Keywords

COVID-19 pandemic
disparities
policy
radiotherapy
telemedicine

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1002/cam4.4555

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De, B., Fu, S., Chen, Y. S., Das, P., Ku, K., Maroongroge, S., Woodhouse, K. D., Hoffman, K. E., Nguyen, Q. N., Reed, V. K., Chen, A. B., Koong, A. C., Smith, B. D., & Smith, G. L. (2022). Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care. Cancer medicine, 11(10), 2096-2105. https://doi.org/10.1002/cam4.4555

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title = "Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care",

abstract = "Background: Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. Methods: Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. Results: Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national “Opening Up America Again” guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03–4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1–5 fractions (OR = 4.49, 95% CI 2.29–8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). Conclusion: Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount—and not exacerbate—barriers to quality cancer care.",

keywords = "COVID-19 pandemic, disparities, policy, radiotherapy, telemedicine",

author = "Brian De and Shuangshuang Fu and Chen, {Ying Shiuan} and Prajnan Das and Kimberly Ku and Sean Maroongroge and Woodhouse, {Kristina D.} and Hoffman, {Karen E.} and Nguyen, {Quynh Nhu} and Reed, {Valerie K.} and Chen, {Aileen B.} and Koong, {Albert C.} and Smith, {Benjamin D.} and Smith, {Grace L.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.",

year = "2022",

month = may,

doi = "10.1002/cam4.4555",

language = "English (US)",

volume = "11",

pages = "2096--2105",

journal = "Cancer medicine",

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T1 - Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

AU - De, Brian

AU - Fu, Shuangshuang

AU - Chen, Ying Shiuan

AU - Das, Prajnan

AU - Ku, Kimberly

AU - Maroongroge, Sean

AU - Woodhouse, Kristina D.

AU - Hoffman, Karen E.

AU - Nguyen, Quynh Nhu

AU - Reed, Valerie K.

AU - Chen, Aileen B.

AU - Koong, Albert C.

AU - Smith, Benjamin D.

AU - Smith, Grace L.

PY - 2022/5

Y1 - 2022/5

N2 - Background: Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. Methods: Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. Results: Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national “Opening Up America Again” guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03–4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1–5 fractions (OR = 4.49, 95% CI 2.29–8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). Conclusion: Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount—and not exacerbate—barriers to quality cancer care.

AB - Background: Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. Methods: Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. Results: Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national “Opening Up America Again” guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03–4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1–5 fractions (OR = 4.49, 95% CI 2.29–8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). Conclusion: Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount—and not exacerbate—barriers to quality cancer care.

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KW - disparities

KW - policy

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Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

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