Medical College of Wisconsin, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Milwaukee, Wisconsin, USA.
Medical College of Wisconsin, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Milwaukee, Wisconsin, USA.
Gynecol Oncol. 2021 Jul;162(1):4-11. doi: 10.1016/j.ygyno.2021.04.037. Epub 2021 May 11.
The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability.
Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance.
African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable).
Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.
COVID-19 大流行迅速改变了医疗系统，扩大了远程医疗的应用。过去一年突显了免疫抑制癌症患者的风险，并表明弱势群体需要实现健康公平。在这项研究中，我们描述了妇科恶性肿瘤患者使用虚拟就诊的情况，并评估了他们的社会脆弱性。
通过查询队列发现工具，获取了 2020 年 3 月 1 日至 2020 年 8 月 31 日期间一家机构的 270 名妇科肿瘤患者的虚拟就诊数据。通过地理编码，利用疾病预防控制中心社会脆弱性指数（SVI）为每位患者分配社会脆弱性指数，并分析趋势和统计显著性。
非裔美国人患者的脆弱性最高，中位数 SVI 为 0.71，亚洲人为 0.60，西班牙裔人为 0.41，白人为 0.21。本研究中 87%的患者为白人，8.9%为非裔美国人，3.3%为西班牙裔，1.1%为亚洲人，这与机构妇科癌症患者的基线人口统计学数据相当。当将患者与美国所有普查区进行比较时，普查区 SVI 平均值为 0.31（范围 0.00 为最不易受影响，0.98 为最易受影响）。
不同年龄和妇科癌症类型的患者都使用了虚拟就诊。非裔美国人是该队列中最脆弱的患者。远程医疗是大流行期间及之后癌症护理在社会脆弱性方面的有效平台。为了确保持续获得医疗服务，需要进一步开展研究和宣传工作。
