In a recent study published in the journal PLoS One, researchers analyze telehealth provisions and oncological services available in hospitals throughout the United States before the onset of the coronavirus disease 2019 (COVID-19) pandemic, in addition to examining the sociodemographic and geographic correlates of telehealth access.
Study: Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States. Image Credit: JPC-PROD / Shutterstock.com
Geography plays a major role in determining access to high-quality care and treatment for cancer patients, with the outcomes of cancer patients in rural areas in the U.S. worse across all phases as compared to those residing in non-rural areas.
Several studies have identified correlations between geographic barriers and reduced access to high-quality oncologic care for patients with lung, colon, breast, esophagogastric, rectal, and gynecologic cancers. A mismatched distribution of oncologists and cancer care professionals with respect to patient populations, along with the concentration of complex cancer care facilities in high-volume centers, has been attributed to discrepancies in oncological treatment availability.
Telehealth plays a prominent role in alleviating this discrepancy by providing cancer patients in rural areas with outreach facilities. These services also allow oncologists in rural areas to connect with cancer specialists in other regions for consultations.
While telehealth facilities expanded significantly during the COVID-19 pandemic, little is known about the involvement of telehealth in cancer care.
About the study
In the present study, the researchers conducted a retrospective cross-sectional analysis of data from the 2019 Annual Hospital Survey and Information Technology Supplement by the American Hospital Association (AHA), the U.S. Department of Agriculture’s Urban Influence Codes (UIC) from 2013, and the Area Health Resources Files for 2018 from the Health Services and Resources Administration (HRSA).
Depending on the availability of telehealth and oncology care in hospitals within their boundaries, counties were categorized based on low, moderate, or high access. Furthermore, a geospatial information mapping system was used to map access to cancer-care-related hospital-based telehealth. Statistical analyses were used to determine correlations between sociodemographic factors and access to oncology care and telehealth at the hospital and county levels.
For the identification of geographic regions with county-level accessibility to telehealth and oncology care, hospital-level telehealth and oncology services were aggregated, with counties classified into three groups.
Low-access counties had no hospitals within the boundaries that provided oncology care or telehealth facilities. Moderate-access counties included those with hospitals that had either telehealth or oncology care, but not both, while high-access counties had hospitals providing both oncology care and telehealth services.
The sociodemographic factors against which access to telehealth and cancer care was analyzed included age, sex, race and ethnicity, English proficiency, broadband access, and health insurance.
Inequitable access to oncology care and telehealth
About 45% of the 4,540 hospitals included in the study were categorized into the high-access group, thus signifying that they had oncological care facilities and offered telehealth services. The moderate-access group, which provided either telehealth or oncological care services, constituted 6% of the examined hospitals, while 18.6% of hospitals offered neither telehealth facilities nor cancer care.
Out of the 3,152 counties examined in this study, 1,288 distributed over 41 U.S. states had no access to telehealth services or cancer care facilities in the hospitals. These counties have a total population of 26.6 million.
In low-access counties, the mean population for each primary care physician was 3,447, which is much higher than that in the moderate-access and high-access counties which had a mean population of 2,714 and 1,706 per primary care physician, respectively. Furthermore, the likelihood of oncology care facilities being present was higher in larger accredited hospitals, as well as hospitals with a higher ratio of Medicaid and Medicare inpatient days.
Alaska Native and American Indian populations had a lower availability of high-quality cancer care and telehealth services. Unsurprisingly, cancer mortality rates also had the highest rural-urban disparity among these two ethnic populations. The distribution of American Indian and Alaska Native populations across the low, moderate, and high access group counties were 10.6%, 6%, and 3.8%, respectively.
The study findings emphasize the need to advocate for rural hospitals to connect through telehealth services with referral centers to improve subspecialty consultation benefits without the need to travel long distances. Furthermore, health equity advocates at state and federal levels must enable mechanisms to improve local care facilities for residents in low-access counties and provide access to facilities in adjacent counties.
Telehealth facilities can help provide high-quality diagnostic services, even if oncology care is not available in these counties, to enable better decision-making regarding treatment.
Overall, the availability and distribution of high-quality cancer care facilities and telehealth services varied significantly across the U.S., with 8.4% of the population not having access to proper cancer care due to geographic barriers. Thus, equitable access to oncology facilities and care is urgently needed to reduce geography-based disparities.
- Shalowitz, D. I., Hung, P., Zahnd, W. E., & Eberth, J. (2023). Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States. PLOS ONE 18(1); e0281071. doi:10.1371/journal.pone.0281071