Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic

The Impact of a Digital Cancer Survivorship Patient Engagement Toolkit on Older Cancer Survivors' Health Outcomes

Cancer predominantly affects older adults. An estimated 62% of the 15.5 million American cancer survivors are 65 years or older. Provision of supportive care is critical to this group; however, limited resources are available to them. As older survivors increasingly adopt technology, digital health programs have significant potential to provide them with longitudinal supportive care. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit for older adults, Cancer Survivorship Patient Engagement Toolkit Silver. The study examined the preliminary impact of the Cancer Survivorship Patient Engagement Toolkit Silver on older survivors' health outcomes. This was a 2-arm randomized controlled trial with two observations (baseline, 8 weeks) on a sample of 60 older cancer survivors (mean age, 70.1 ± 3.8 years). Outcomes included health-related quality of life, self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. At 8 weeks, the Cancer Survivorship Patient Engagement Toolkit Silver group showed more improved physical health-related quality of life (P < .001, effect size = 0.64) and symptom burden (P = .053, effect size = -0.41) than the control group. Self-efficacy (effect size = 0.56), mental health-related quality of life (effect size = 0.26), and communication (effect size = 0.40) showed clinically meaningful effect sizes of improvement. Most participants reported benefits on health management (mean, 19.41 ± 2.6 [3-21]). Further research is needed with larger and more diverse older cancer populations.

Prioritizing Patient-Centered Care in a World of Increasingly Advanced Technologies and Disconnected Care

With more treatment options in oncology lead to better outcomes and more favorable side effect profiles, patients are living longer-with higher quality of life-than ever, with a growing survivor population. As the needs of patients and providers evolve, and technology advances, cancer care is subject to change. This review explores the myriad of changes in the current oncology landscape with a focus on the patient perspective and patient-centered care.

Disparities in Telehealth Offer and Use among U.S. Adults: 2022 Health Information National Trends Survey

Objective: Understanding the sources of telehealth disparities can inform efforts to ensure equity. This study examines disparities in telehealth offer and use to understand the role of health care providers in increasing telehealth access. Methods: This cross-sectional analysis of the 2022 Health Information National Trends Survey (n = 5,295) used survey-weighted proportions to characterize telehealth use and multivariable logistic regressions to test associations of sociodemographic and social determinants with (1) telehealth offer and (2) use among those offered the option. Results: Among U.S. adults, 57% were offered telehealth, 80% of whom used it. Technology difficulties and privacy concerns were barriers for 15%-20% of U.S. adults. Compared to telehealth users, most nonusers preferred in-person care (25% versus 84%). Age, education, geographic location, and broadband internet access were related to telehealth offer, whereas no significant disparities emerged in telehealth use. Conclusions: Telehealth use is widespread, but structural and provider-level engagement are needed to achieve equity.

Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study

BACKGROUND

Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied.

OBJECTIVE

The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician's perspective.

METHODS

A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform's registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets.

RESULTS

Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change.

CONCLUSIONS

This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions.

Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System

BACKGROUND

Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic.

OBJECTIVE

This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges.

METHODS

A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations.

RESULTS

A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits ("Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?") was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73).

CONCLUSIONS

During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.

Experiences participating in a telehealth exercise program among older adults with cancer: a qualitative study

PURPOSE

Telehealth delivery of exercise programs has rapidly increased in recent years; yet, little is known regarding older cancer survivors' (OCS) experiences participating in telehealth exercise. The purpose of this study was to determine OCS barriers and facilitators to participation in telehealth-delivered exercise.

METHODS

OCS who participated in a 12-week, one-on-one telehealth exercise program were recruited to participate in one of three focus groups. Focus groups were conducted virtually using a semi-structured interview guide. Focus groups were audio recorded, transcribed verbatim, and analyzed utilizing thematic analysis with Atlas.ti.

RESULTS

Fourteen OCS (age range 65-79 years) participated in the focus groups, five (35.7%) of which had not completed a telehealth follow-up assessment. The most common cancer type was breast (n = 6, 42.9%), and all cancer stages were represented. Three overall themes were identified: having adequate space to exercise, meeting OCS physical and psychosocial needs, and OCS learning throughout the exercise program. Within these themes, five facilitators and two barriers were identified. Facilitators included the individualization of the exercise program, no travel, accountability, learning to exercise, and support from staff and family. The barriers identified were having limited space to exercise and a learning curve with technology.

CONCLUSION

OCS viewed telehealth exercise positively. Identified barriers aligned with those in younger cancer survivors (≥18 years), indicating that OCS are able to engage with telehealth exercise programs alongside their younger counterparts.

IMPLICATIONS FOR CANCER SURVIVORS

Telehealth exercise mitigates exercise barriers in OCS and should be used as a strategy to support exercise participation among cancer survivors, regardless of age.

Telehealth and Technology: New Directions in Cancer Care

ABSTRACT

Telehealth is a broad concept that refers to any delivery of health care in real time using technologies to connect people or information that are not in the same physical location. Until fairly recently, telehealth was more aspiration than reality. This situation changed radically due in part to the COVID-19 pandemic, which led to a near-overnight inability for patients to be seen for routine management of chronic health conditions, including those with cancer. The purpose of this brief narrative review is to outline some areas where emerging and future technology may allow for innovations with specific implications for people with a current or past diagnosis of cancer, including underserved and/or historically excluded populations. Specific topics of telehealth are broadly covered in other areas of the special issue.

The impact of digital inequities on laryngeal cancer disparities in the US

OBJECTIVES

To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide.

METHODS

DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders.

RESULTS

With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03-1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04-1.08), and radiation therapy (OR 1.02; 95 % CI 1.00-1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94-97).

CONCLUSIONS

Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.

Critical healthcare for older adults post Hurricane Ian in Florida, United States

We highlight critical public healthcare inadequacies for older adult populations resulting in fatalities after Hurricane Ian. We summarize whether a fatality was a result of the storm directly, indirectly, or not at all. Massive destruction from Ian eliminated critical life-sustaining health care for the week following the hurricane. This disproportionately affected the older adult population, with most elder deaths attributed to a lack of some form of health care. To prevent further unnecessary deaths following a disaster event, we recommend that public health policy practitioners, medical practitioners, and state officials consider how to provide managed opt-in emergency care services, mobile elderly care until restoration of power and services, and revisions to community-based critical care provider building codes to include generators and fuel. We offer this viewpoint to generate discussion among public health and emergency planners.

Racial Differences in Patient-Reported Access to Telehealth: An Important and Unmeasured Social Determinant of Health

PURPOSE

The COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify barriers that might limit access to telehealth video services.

METHODS

First, retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center during the pandemic (March 2020 to April 2022). Second, a prospective, cross-sectional study was conducted of patients with known or suspected malignancy over a 6-month period (November 2021 to April 2022). A survey regarding video telehealth accessibility was verbally administered to patients at their clinic visit.

RESULTS

Administrative data demonstrated that although Black patients comprised 43% (n = 9,021) of all patient visits (n = 20,953), the proportion of telehealth visits conducted among Black patients was significantly lower compared with White patients (29% v 71%; P < .0001). Of the prospective, cross-sectional study cohort (n = 148), 51.4% of patients (n = 76) were Black, 38.5% (n = 57) resided in a rural county, and 8.1% (n = 12) were Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% v 90.4%; P < .01) and were less likely to report having access to or actively using a patient portal (29.0% v 47.2%; P < .001) compared with White patients. The independent association of race and internet access (P < .05) and patient portal use (P = .001) persisted after multivariable analysis.

CONCLUSION

Black patients disproportionately underparticipated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal compared with White patients. Ensuring equal internet access and digital literacy will be critical to reduce disparities in cancer care among racial minorities.

Telehealth use and perceptions among prostate cancer survivors

BACKGROUND

Reasons underlying disparities in telehealth use among cancer survivors are unknown.

METHODS

We surveyed a sociodemographically diverse population-based cohort of 487 prostate cancer survivors regarding their use and perceptions of telehealth during the COVID-19 pandemic.

RESULTS

Overall, only 28.5% of survivors had used telehealth at the time of survey and just 10% felt care through telehealth is comparable to that of an in-person visit. Still, over 55% felt telehealth is a good option for initial consultations or basic care and 15% felt more likely to use telehealth since the pandemic. After adjusting for other socioeconomic factors, survivors with lower education (≤high school vs. any college) had marginally lower use of telehealth (risk ratio [RR], 0.65 [95% CI, 0.42-1.01]) and lower probability of feeling more likely to use telehealth since the pandemic (RR, 0.39 [95% CI, 0.20-0.77]).

CONCLUSIONS

Differences in survivor perceptions of telehealth by education level highlight new insights underlying disparities in telehealth use and potential targets for interventions.

Use of Electronic Communication with Clinicians Among Cancer Survivors: Health Information National Trend Survey in 2019 and 2020

Purpose: To describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. Methods: Secondary analysis included cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the past 12 months. Bivariate analysis and logistic regression were conducted to examine factors associated with e-communication use. All analyses considered the complex survey design using the jackknife replication method. Results: The prevalence of e-communication use was 64% among cancer survivors. The overall e-communication use slightly increased after the start of the COVID-19 pandemic (63% vs. 64%, p = 0.79). Older adults (≥65 years old) were less likely to use e-communication (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.36-0.86); survivors who were white (OR = 2.30; 95% CI, 1.36-3.86), living in a metro area (OR = 2.47; 95% CI, 1.44-4.27), diagnosed with breast cancer (OR = 2.03; 95% CI, 1.06-3.88), seeking cancer-related information previously (OR = 2.89; 95% CI, 1.83-4.58), or having a regular health care provider (OR = 2.07,; 95% CI, 1.10-3.88) were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use (p = 0.053) when other variables were controlled. Conclusion: This nationally representative survey analysis has identified disparities in e-communication use among cancer survivors and revealed the potential increase in e-communication use under the impact of the COVID-19 pandemic. Additional support is clearly warranted for those older, nonwhite, living in rural areas, or without a regular provider, to promote their e-communication use for the delivery of optimal and high-quality cancer care.

Adult Hematology/Oncology Patient Perspectives on Telemedicine Highlight Areas of Focus for Future Hybrid Care Models

Introduction: Telemedicine use expanded rapidly during the COVID-19 pandemic, but publications analyzing patient perspectives on telemedicine are few. We aimed to study whether patient perspectives offer insights into how best to utilize telemedicine in the future for hematology and cancer care. Methods: A modified Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) was sent to adult hematology/oncology outpatients at the University of Minnesota Masonic Cancer Clinic who had ≥1 prior phone and/or video visit between March 15, 2020, and March 31, 2021. Two focus groups were subsequently conducted with volunteers who completed the survey. We evaluated dichotomized TSUQ items using logistic regression, and focus group data were analyzed qualitatively using constant comparison analysis. Results: Of 7,848 invitations, 588 surveys were completed. Focus groups included 16 survey respondents. Most respondents found telemedicine satisfactory, easy to use, and convenient, with the majority preferring a hybrid approach going forward. Oncology patients, females, and higher income earners endorsed decreased telemedicine satisfaction. Concerns were voiced about fewer in-person interactions, communication gaps, and provider style variability. Discussion: Adult hematology/oncology patients had varied perspectives on telemedicine utilization success based on gender, income, and disease burden, suggesting that a one-size-fits-all approach, as was implemented nearly universally during the COVID-19 pandemic, is not an ideal approach for the long term. Given that telemedicine use is likely to remain in some form in most centers, our findings suggest that a nuanced and tailored approach for some patient subgroups and using feedback from patients will make implementation more effective.

Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study

BACKGROUND

Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited.

OBJECTIVE

Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID.

METHODS

Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID.

CONCLUSIONS

Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities.

CLINICALTRIAL

Not applicable.

Factors Associated with Telehealth Utilization among Older African Americans in South Los Angeles during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors.

METHODS

Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use.

RESULTS

Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization.

DISCUSSION

Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.

Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection

IMPORTANCE

There is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical.

OBJECTIVE

To evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022.

EXPOSURES

Race and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis.

MAIN OUTCOMES AND MEASURES

Delayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy.

RESULTS

A total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.