Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits:Quantitative Study

Background: Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth careand services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There arenotable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use inpatients with breast cancer and oncology services offered through telehealth versus in-person visits. Objective: We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use amongpatients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits.Methods: Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higherscores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-personvisit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the associationbetween ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology servicescomparing telehealth and in-person visits.Results: The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58% (52/1161) identified asAsian, 19.72% (229/1161) as Black, 3.01% (35/1161) as Hispanic, and 72.78% (845/1161) as White. Overall, 35.96% (416/1157)had a telemedicine visit in the past 12 months. Of these patients, 65% (266/409) had a videoconference visit only, 22.7% (93/409)had a telephone visit only, and 12.2% (50/409) had visits by both videoconference and telephone. Higher ADI scores wereassociated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95% CI 0.82-0.97). Black (AOR 2.38,95% CI 1.41-4.00) and Hispanic (AOR 2.65, 95% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients.Compared to patients with high school or less education, those with an associate's degree (AOR 2.67, 95% CI 1.33-5.35), abachelor's degree (AOR 2.75, 95% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95% CI 1.31-5.04) had higherodds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1% vs 55/405, 13.6%; P=.32) or cancer genetic counseling (11/405, 2.7% vs 19/405, 4.7%; P=.14) between telehealth andin-person visits. Of the telemedicine users, 95.8% (390/407) reported being somewhat to extremely satisfied, and 61.8% (254/411)were likely or very likely to continue using telemedicine. Conclusions: In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-levelsocioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation andcancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achievetelehealth equity for their patient population