Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
Patient Advocate Foundation, Hampton, VA, USA.
Support Care Cancer. 2022 Sep;30(9):7665-7678. doi: 10.1007/s00520-022-07204-1. Epub 2022 Jun 10.
Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic.
We conducted a cross-sectional analysis of nationwide survey data assessing telemedicine use in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) in December 2020. Patients were characterized as financially distressed by self-reporting limited financial resources to manage out-of-pocket costs, psychological distress, and/or adaptive coping behaviors. Primary study outcome was telemedicine utilization during the pandemic. Secondary outcomes were telemedicine utilization volume and modality preferences. Multivariable and Poisson regression analyses were used to identify factors associated with telemedicine use.
A convenience sample of 627 patients with cancer responded to the PAF survey. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (19-35 age compared to ≥ 75 age) (OR, 6.07; 95% CI, 1.47-25.1) and more comorbidities (≥ 3 comorbidities compared to cancer only) (OR, 1.79; 95% CI, 1.13-2.65) were factors associated with telemedicine adoption. Younger age (19-35 years) (incidence rate ratios [IRR], 1.78; 95% CI, 24-115%) and higher comorbidities (≥ 3) (IRR; 1.36; 95% CI, 20-55%) were factors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95% CI, 1.03-1.05).
The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially distressed patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.
在新冠疫情期间，经济困难的癌症患者使用远程医疗的情况，包括采用远程医疗的决定因素和使用模式，仍有待描述。我们旨在系统地描述新冠疫情期间经济困难的癌症患者使用远程医疗的情况。
我们对 2020 年 12 月由患者倡导基金会（Patient Advocate Foundation，PAF）收集的评估新冠疫情期间癌症患者使用远程医疗情况的全国性调查数据进行了横断面分析。患者通过自述有限的经济资源来支付自付费用、心理困扰和/或适应性应对行为来确定为经济困难。主要研究结果是大流行期间的远程医疗使用情况。次要结果是远程医疗使用量和模式偏好。多变量和泊松回归分析用于确定与远程医疗使用相关的因素。
PAF 调查共收到 627 名癌症患者的便利样本。67%的患者在大流行期间报告采用了远程医疗，其中大多数（63%）更喜欢视频访问。与≥75 岁年龄组相比，较年轻的年龄（19-35 岁年龄组）（比值比[OR]，6.07；95%置信区间[CI]，1.47-25.1）和更多的合并症（≥3 种合并症，而不是仅癌症）（OR，1.79；95% CI，1.13-2.65）是与远程医疗采用相关的因素。较年轻的年龄（19-35 岁）（发病率比[IRR]，1.78；95% CI，24-115%）和更高的合并症（≥3）（IRR；1.36；95% CI，20-55%）是与更高的使用量相关的因素。随着地区贫困指数增加 10 个单位，就诊次数减少 3%（IRR 1.03，95% CI，1.03-1.05）。
远程医疗的快速采用可能会加剧现有的不平等现象，特别是在脆弱的经济困难的癌症患者中。需要在政策层面进行干预，以公平有效地提供这项服务。
