Integration of Telemedicine Consultations into a Tertiary Radiation Oncology Department: Predictors of Treatment Yield and Changes in Patient Population Compared to the Pre-Pandemic Era

PURPOSE/OBJECTIVE(S): The COVID-19 pandemic has proven telemedicine to be an efficient and safe method of healthcare delivery with the potential to increase accessibility for underrepresented groups. Given the anticipated permanence of telemedicine in radiation oncology practice, we aimed to understand the demographic and treatment characteristics of patients presenting for consultation via telemedicine, the predictors of patients opting to receive radiation therapy (RT) at our center, and the differences in patient and treatment characteristics compared to 2019, when consultations were exclusively in person. MATERIALS/METHODS: We included all patients who had telemedicine consultations from March 2020 to February 2021. Treatment yield was calculated by dividing the number of patients who ultimately received RT by the total number of consults. New consultations seen in 2019 were reviewed and compared to the telemedicine cohort. Chi-square tests were used to identify differences. RESULTS: From 2020 to 2021, a total of 1,069 patients had telemedicine consultations (86% video, 14% phone). Most (64%) were male. Median age was 63 years. The most common disease sites included genitourinary (GU) (41%), breast (14%), and CNS (9%). Six-hundred forty-five (60%) had private insurance, while 424 (40%) had Medicare/Medicaid. Patients lived a median of 241 miles (IQR 96-481 miles) from the radiation oncology center. Forty-four percent of telemedicine patients ultimately received RT. These patients underwent photon RT (54%), proton RT (35%), brachytherapy (7%), stereotactic radiosurgery (3%), or intraoperative RT (1%). No differences were noted in age, sex, race/ethnicity, or insurance type between patients who did and did not receive RT. Patients who received RT lived closer to the center (median 287 vs. 189 miles, p<0.001). For patients within 100 miles of our center, 58% received RT, compared to only 32% of those who lived at least 500 miles away. Patients with gynecologic (76%) and hematologic (72%) malignancies were most likely to receive RT. Compared to 2019 when all 6,116 patients were seen in person, treatment yield was lower with telemedicine (67% vs. 44%, p<0.001). Telemedicine patients were more likely to be male (56% vs. 64%, P<0.001), white (93% vs. 95.0%, p=0.024), have private insurance (55% vs. 60%, p=0.0053), have a GU malignancy (24% vs. 41%, p<0.001), and live further from the center (median 241 vs. 139 miles, p<0.001). CONCLUSION: Patients seen in telemedicine consultations lived further away and were less likely to receive RT at our tertiary care radiation oncology center. Telemedicine visits did not appear to improve healthcare access for underrepresented groups. Further analysis is warranted to identify gaps and opportunities in remote care.