Yale Cancer Center Study Reveals Disparities in Telemedicine Use in Patients with Hematologic Cancers

Natalia Neparidze, MD

New research led by Yale Cancer Center revealed White patients had significantly more telemedicine visits compared with Black patients for hematologic cancer care during the COVID-19 pandemic. Also, in-person visit rates for Black patients were unchanged regardless of treatment category. The findings are being presented today at the 2021 ASH Annual Meeting and Exposition in Atlanta, Georgia.

“We were not surprised by these findings,” said Natalia Neparidze, MD, Associate Professor of Internal Medicine (Hematology) at Yale Cancer Center and lead author of the study. “The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine, but it also heightened the differences in access to technology and care for our patient populations.”

Yale researchers used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with a confirmed diagnosis of acute myeloid leukemia (AML), mantle cell lymphoma (MCL), follicular lymphoma (FL), chronic lymphocytic leukemia (CLL), or Multiple Myeloma (MM), and documented race in the EHR as Black/African American or White. Patients were categorized into treatment types within lines of therapy: Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g., no documented therapy, surveillance).

The analysis included 17,621 patients (2,225 Black, 15,396 White) diagnosed with AML, FL, MCL, CLL, or MM. Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18 percent statistically significant reduction in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories.

“These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors,” added Neparidze.

Yale author Scott Huntington, MD, MPH, also contributed to the study.

About Yale Cancer Center and Smilow Cancer Hospital

Yale Cancer Center (YCC) is one of only 51 National Cancer Institute-designated comprehensive cancer centers in the nation and the only such center in Connecticut. Cancer treatment for patients is available at Smilow Cancer Hospital through 13 multidisciplinary teams and at 15 Smilow Cancer Hospital Care Centers in Connecticut and Rhode Island. Comprehensive cancer centers play a vital role in the advancement of the NCI’s goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment.