Factors Affecting Telehealth Availability Among Breast Centers During the Pandemic

Doernberg, H.; Hsiang, W.; Marks, V.; Pak, I.; Kim, D.; Galal, B.; Umer, W.; Haleem, A.; Chagpar, A. B.

Introduction: To provide breast cancer care during the COVID-19 pandemic, many centers shifted toward offering telehealth visits. We sought to determine the availability of telehealth services at Commission on Cancer (CoC)-accredited centers in the United States and factors associated with this virtual accessibility. Methods: Using a secret shopper model from June-September 2020, we contacted 371 CoC-accredited centers providing breast cancer care to determine whether they offered telehealth appointments. We analyzed factors associated with telehealth availability using bivariate and multivariate logistic regression analyses. Results: There were 316 of 371 (85.2%) hospitals that reported having telehealth capacity for breast cancer patients. Facility type (p=0.027), teaching hospital status (p=0.0001), geographic location (p=0.014), and hospital size (based on bed number, p=0.036) were all associated with telemedicine use on bivariate analysis (see table). For-profit vs not-for-profit status and the population base in which a center was located did not affect telehealth availability. On multivariate analysis, controlling for facility type, teaching hospital status and hospital size, only geographic location (p=0.004) was found to be an independent predictor of telehealth access, with centers located in the West being more than 6 times more likely to offer this provision than other regions, including the Northeast (OR:6.38;95% CI:1.27-32.00, p=0.024). Conclusion: While several hospital characteristics, including CoC designation, size, and teaching hospital status affected availability of telehealth visits, significant geographic disparities remained in telehealth provision independent of these factors. As COVID-19 forces medicine to increase its telehealth focus, particular attention should be paid to the geographic variation that may exacerbate access disparities. [Formula presented]