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Ko G, Naganathan G, Reel E, Cleland J, Covelli A, Wright FC, Cil TD. The Impact of COVID-19 on Breast Cancer Care: A Qualitative Analysis of Surgeons' Perspectives. Clin Breast Cancer 2024; 24:494-500.e1. [PMID: 38806320 DOI: 10.1016/j.clbc.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION While studies have documented delays in breast cancer (BC) care during the COVID-19 pandemic due to healthcare restrictions, there have been no studies on the experiences, and, particularly, the challenges with providing care faced by breast surgeons during this unprecedented time. This paper aims to understand the perspectives of breast surgeons regarding the impact of the COVID-19 pandemic on BC care. METHODS We used purposeful and snowball sampling to identify breast surgeons in Ontario, Canada. One-on-one qualitative semi-structured interviews were conducted exploring the impact of the pandemic on BC treatment, psychosocial well-being of patients and providers, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and analyzed using Thematic Analysis. RESULTS A total of 10 breast surgeons (5 community and 5 academic) were interviewed. Breast surgeons reported that the pandemic led to increased multidisciplinary collaboration and innovations in delivery of BC surgery (e.g., increased use of regional anesthesia). Multiple surgeons identified that the pandemic created disparities in BC care based geographic location and that existing disparities in care based on ethnicity or marginalization were exacerbated. Last, surgeons identified that virtual care improved, but also created some challenges to how BC care was delivered, with many hoping for this to be continued after the pandemic was over. CONCLUSIONS In this study, breast surgeons identified unique challenges and solutions to BC care delivery during the pandemic. Concerns regarding disparities in care based on geographic location and marginalized patients require further study to improve future BC care.
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Affiliation(s)
- Gary Ko
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gayathri Naganathan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reel
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jordan Cleland
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Andrea Covelli
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
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Rousset-Jablonski C, Lortal B, Lantheaume S, Arnould L, Simon H, Tuszynski AS, Courtier M, Debbah S, Lefrançois M, Balbin S, Kably AS, Toledano A. French national survey on breast cancer care: caregiver and patient views. Breast Cancer 2024; 31:633-642. [PMID: 38635135 PMCID: PMC11194201 DOI: 10.1007/s12282-024-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To improve the quality of care for patients with breast cancer, an analysis of the health-care pathway, considering feedback from both health-care practitioners (HCPs) and patients, is needed. METHODS Between 2020 and 2022, we conducted a survey at French breast cancer centers and analyzed information from questionnaires completed by HCPs and patients. We collected information on center organization, diagnostic processes, treatment decisions and modalities, supportive care, patient advocacy groups, and work issues. RESULTS Twenty-three breast cancer centers were included and questionnaires completed by 247 HCPs and 249 patients were analyzed. The centers closely followed the legal French framework for cancer treatments, which includes formal diagnostic announcements, multidisciplinary tumor boards, personalized treatment summaries, and supportive care access. HCPs and patients were satisfied with the time to diagnosis (≤ 2 weeks as evaluated by 75% of patients), time to surgery (mean 61 days), time between surgery and chemotherapy (mean 47 days), and time between surgery and radiotherapy (mean 81 days). Fertility preservation counseling for women under 40 years of age was systematically offered by 67% of the HCPs. The majority (67%) of the patients indicated that they had received a personalized treatment summary; the topics discussed included treatments (92%), tumor characteristics (84%), care pathways (79%), supportive care (52%), and breast reconstruction (33%). Among HCPs, 44% stated that reconstructive surgery was offered to all eligible patients and 57% and 45% indicated coordination between centers and primary care physicians for adverse effects management and access to supportive care should be improved, for chemotherapy and radiotherapy, respectively. Regarding patient advocacy groups, 34% of HCPs did not know whether patients had contact and only 23% of patients declared that they had such contact. For one-third of working patients, work issues were not discussed. Twenty-eight percent of patients claimed that they had faced difficulties for supportive care access. Among HCPs, 13% stated that a formal personalized survivorship treatment program was administered to almost all patients and 37% almost never introduced the program to their patients. Compliance to oral treatments was considered very good for 75-100% of patients by 62% of HCPs. CONCLUSIONS This study provides an updated analysis of breast cancer care pathways in France. Overall, the initial processes of diagnosis, announcement, and treatment were swift and were in agreement with the best care standards. No barriers to accessing care were identified. Based on the study findings, we proposed several strategies to improve the quality of care for patients in supportive care, coordination with primary care physicians, reconstructive surgery, and fertility preservation access.
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Affiliation(s)
- Christine Rousset-Jablonski
- Centre Léon Bérard, Lyon, France.
- Unité INSERM U1290 RESHAPE, Lyon, France.
- Hôpital Femme Mère Enfant, Bron, France.
| | | | | | | | | | | | | | | | | | | | | | - Alain Toledano
- Institut de Radiothérapie et de Radiochirurgie Hartmann - ELSAN, Levallois-Perret, France
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Mohanna M, Herrán M, Dominguez B, Sabbagh S, Msheik A, Itani M, Saba L, Iska S, Liang H, Diaz CM, Nahleh Z. "You matter": patients perceptions and disparities about cancer care and telehealth during and after COVID-19 pandemic. Support Care Cancer 2024; 32:236. [PMID: 38506939 PMCID: PMC10954847 DOI: 10.1007/s00520-024-08433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Disparities in cancer care have been exacerbated by the COVID-19 pandemic. The aim of this study is to establish how telehealth mitigated the effect of COVID-19 on the healthcare sector and to identify potential disparities in perception and experience with telehealth in cancer care during and after the pandemic. METHODS We identified individuals with an established cancer diagnosis who received treatment at a comprehensive academic cancer center with a diverse patient population between 2019 and 2021, during the COVID-19 pandemic. Participants were asked to complete a self-administrated survey intended to collect patient-reported outcomes on socioeconomic and mental health challenges incurred during the pandemic as well as participants' experience with telehealth. The assessment was adapted from a 21-question-based survey applied for mental health. Descriptive statistics were used to summarize participant characteristics and the response to the survey items. Multivariable logistic regression was performed to assess and analyze the contributing factors to the survey responses. RESULTS A total of N = 136 participants were included in this analysis. The majority of participants (60.6%) reported increased anxiety, stress, or experience of distress as a direct result of COVID-19. However, among 54.1% of survey responders participated in a telehealth appointment and 84.4% agreed it was an easy and effective experience. CONCLUSION Elderly, male, and black participants reported the worst impact related to the pandemic. The majority of patients had a positive experience with telehealth. The results of the study suggest that telehealth services can serve as a tool for patients with cancer during and beyond active treatment to access supportive services.
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Affiliation(s)
- Mohamed Mohanna
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - María Herrán
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Barbara Dominguez
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Saad Sabbagh
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Ali Msheik
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mira Itani
- Department of Family Medicine, Emory, Atlanta, Ga, USA
| | - Ludovic Saba
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Sindu Iska
- Department of Hematology and Oncology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Hong Liang
- Department of Research, Cleveland Clinic Florida, Weston, USA
| | - Caroline Metzel Diaz
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Zeina Nahleh
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Freeman JQ, Khwaja A, Zhao F, Nanda R, Olopade OI, Huo D. Racial/Ethnic Disparities in Telemedicine Utilization and Satisfaction Among Breast Cancer Patients During the COVID-19 Pandemic: A Mixed-Methods Analysis. Telemed J E Health 2024; 30:651-663. [PMID: 37676974 PMCID: PMC10924050 DOI: 10.1089/tmj.2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Telemedicine has expanded rapidly during the COVID-19 pandemic. Data on telemedicine utilization are lacking, and racial/ethnic disparities in utilization and satisfaction are unknown among breast cancer patients. Methods: This was a longitudinal study, with two surveys conducted in 2020 and 2021, among patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Telemedicine utilization was modeled using mixed-effects logistic regression. Telemedicine satisfaction, assessed using a 5-point Likert scale, was modeled using mixed-effects proportional odds regression. Qualitative data on satisfaction were coded and analyzed using grounded theory. Results: Of 1,721 respondents, most (70.3%) were White, followed by 23.6% Black, 3.1% Asian, and 3.0% Hispanic. The median duration from breast cancer diagnosis to survey was 5.5 years (interquartile range: 2.7-9.4). In 2020, 59.2% reported telemedicine use; in 2021, 64.9% did, with a statistically significant increase (p < 0.001). Black patients had greater odds of telemedicine use than White patients (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI]: 1.17-2.05). In 2020, 90.3% reported somewhat-to-extreme satisfaction; in 2021, 91.2% did, with a statistically significant, although clinically small, increase (p = 0.038). There were no racial/ethnic differences in telemedicine satisfaction between Black (AOR = 1.05, 95% CI: 0.81-1.35), Asian (AOR = 0.63, 95% CI: 0.34-1.16), or Hispanic (AOR = 0.63, 95% CI: 0.33-1.21) and White patients. Major themes emerged from the respondents that explained their levels of satisfaction were convenience, safety, specialty dependence, and technical issues. Conclusions: Telemedicine utilization and satisfaction were high among breast cancer patients over time and across races/ethnicities. Telemedicine could have great potential in reducing barriers to care and promoting health equity for breast cancer patients. However, patients' perceived challenges in accessing high-quality virtual care should be addressed.
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Affiliation(s)
- Jincong Q. Freeman
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Arnaaz Khwaja
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Fangyuan Zhao
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Rita Nanda
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Olufunmilayo I. Olopade
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
- Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
- Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois, USA
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Banbury A, Taylor M, Caffery L, Der Vartanian C, Haydon H, Mendis R, Ng K, Smith A. Consumers' experiences, preferences, and perceptions of effectiveness in using telehealth for cancer care in Australia. Asia Pac J Clin Oncol 2023; 19:752-761. [PMID: 37712136 DOI: 10.1111/ajco.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/06/2023] [Accepted: 08/27/2023] [Indexed: 09/16/2023]
Abstract
AIM COVID-19 accelerated telehealth (video and telephone) use for cancer care to reduce disease exposure and transmission. Understanding consumers' health service delivery needs is required to sustain telehealth activity and develop new models of care. We explored consumers' experiences of telehealth in cancer care and their perspectives on improving and sustaining telehealth uptake in the future. METHODS Exploratory design mixed-methods study using the Model for Assessment of Telemedicine (MAST) framework. Consumers affected by cancer completed an online survey and semistructured interviews. Quantitative data were analyzed using descriptive statistics and chi-square. Qualitative data from the MAST consumer domain were thematically analyzed. RESULTS There were 1162 survey respondents and 18 interview participants. Video and telephone were used in cancer care with various providers. Telephone was used more frequently. Most respondents (85%) had reliable internet connections for video, however, 36% were not offered a video consultation. Video compared with telephone users were statistically significantly more likely to be satisfied with the quality of their treatment and perceived their consultation achieved as much as an in-person consultation. Telephone users (51%) compared with video users (31%) were more likely to perceive their concerns would have been better understood by their care provider if they were seen in person. Five themes emerged from the qualitative data. Consumers want modality choice, video provides superior experiences versus telephone, consultation mode preference is fluid, and consultation scheduling and administration need further consideration. CONCLUSION Consumers support telehealth in cancer care. Consumers want consultation mode choices based on their needs and purpose of consultation.
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Affiliation(s)
- Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Helen Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Roshni Mendis
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kawai Ng
- Cancer Australia, Sydney, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Dunwoodie L, Tiwari V. Telemedicine Use for Oncology Clinic Visits at a Large Medical Center During the Onset of COVID-19. Telemed J E Health 2023; 29:1186-1194. [PMID: 36493388 DOI: 10.1089/tmj.2022.0294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: The COVID-19 pandemic created an unprecedented surge toward telemedicine. This project investigated oncology clinic telemedicine utilization across the Vanderbilt University Medical Center (VUMC) from January to October 2020. Poorer prognosis and care of oncology patients is expected to be associated with increased emergency department (ED) visits. Methods: January to October 2020 clinic visits were identified from the VUMC's Electronic Data Warehouse (EDW). Oncology patients were identified by ICD-10 code and their EDW ED visit data were extracted. Joinpoint piecewise linear regression evaluated trends in tele-oncology visits. VUMC ED visits were compared for patients who did versus did not use telemedicine for oncology clinic visits. A Welch's two-tailed t-test investigated differences in ED visits/patient between these cohorts (α < 0.05). Results: A sharp increase in tele-oncology clinic visits from January to April 2020 (Monthly Percent Change = 396.26%) was followed by a steady decrease from April to October 2020 (Monthly Percent Change = -20.93%). The difference between these two trends was significant (p < 0.002). Of 18 cancer sites, breast cancers had the highest proportion (29.04%) of tele-oncology visits. There was no significant difference in January to October 2020 ED usage for oncology patients who did (0.40 ED visits/patient) versus did not (0.38 ED visits/patient) utilize telemedicine (p = 0.69). A total of 9.64% of oncology clinic visits from January to October 2020 were telemedicine visits, just below the 13.0% institutional average. Discussion: At the VUMC, tele-oncology spiked in March and April 2020 before decreasing from April to October 2020. Breast cancer clinics were most likely to use tele-oncology. Telemedicine use was not associated with increased ED visits for oncology patients, suggesting telemedicine as an alternative for routine oncology clinics. Oncology clinic telemedicine usage was 18th-highest among 33 specialties at our institutions, and among the lowest of nonsurgical specialties.
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Affiliation(s)
- Leland Dunwoodie
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vikram Tiwari
- Department of Biomedical Informatics and Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mustafa E, Jadoon EK, Khaliq-uz-Zaman S, Humayun MA, Maray M. An Ensembled Framework for Human Breast Cancer Survivability Prediction Using Deep Learning. Diagnostics (Basel) 2023; 13:1688. [PMID: 37238173 PMCID: PMC10217686 DOI: 10.3390/diagnostics13101688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Breast cancer is categorized as an aggressive disease, and it is one of the leading causes of death. Accurate survival predictions for both long-term and short-term survivors, when delivered on time, can help physicians make effective treatment decisions for their patients. Therefore, there is a dire need to design an efficient and rapid computational model for breast cancer prognosis. In this study, we propose an ensemble model for breast cancer survivability prediction (EBCSP) that utilizes multi-modal data and stacks the output of multiple neural networks. Specifically, we design a convolutional neural network (CNN) for clinical modalities, a deep neural network (DNN) for copy number variations (CNV), and a long short-term memory (LSTM) architecture for gene expression modalities to effectively handle multi-dimensional data. The independent models' results are then used for binary classification (long term > 5 years and short term < 5 years) based on survivability using the random forest method. The EBCSP model's successful application outperforms models that utilize a single data modality for prediction and existing benchmarks.
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Affiliation(s)
- Ehzaz Mustafa
- Department of Computer Science, Comsats University Islamabad, Abbottabad Campus, Islamabad 22060, Pakistan; (E.K.J.); (S.K.-u.-Z.)
| | - Ehtisham Khan Jadoon
- Department of Computer Science, Comsats University Islamabad, Abbottabad Campus, Islamabad 22060, Pakistan; (E.K.J.); (S.K.-u.-Z.)
| | - Sardar Khaliq-uz-Zaman
- Department of Computer Science, Comsats University Islamabad, Abbottabad Campus, Islamabad 22060, Pakistan; (E.K.J.); (S.K.-u.-Z.)
| | - Mohammad Ali Humayun
- Department of Computer Science, Information Technology University of the Punjab, Lahore 54590, Pakistan;
| | - Mohammed Maray
- Department of Information Systems, King Khalid University, Abha 62529, Saudi Arabia;
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Brugioni E, Cathcart-Rake E, Metsker J, Gustafson E, Douglass L, Pluard TJ. Germline BRCA-Mutated HER2-Negative Advanced Breast Cancer: Overcoming Challenges in Genetic Testing and Clinical Considerations When Using Talazoparib. Clin Breast Cancer 2023:S1526-8209(23)00091-5. [PMID: 37246120 DOI: 10.1016/j.clbc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/30/2023]
Abstract
Genetic testing is essential to the diagnosis and management of patients with breast cancer. For example, women who carry mutations in BRCA1/2 genes have an increased lifetime risk of breast cancer and the presence of these mutations may sensitize the patient to treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. Two PARP inhibitors are approved by the US Food and Drug Administration for patients with germline BRCA-mutated advanced breast cancer (olaparib and talazoparib). The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer (Version 2.2023) recommend that all patients with recurrent or metastatic breast cancer (mBC) be assessed for the presence of germline BRCA1/2 mutations. However, many women eligible for genetic testing do not receive it. Here, we provide our perspectives on both the importance of genetic testing and the challenges patients and community clinicians may face when trying to access genetic testing. We also present a hypothetical case study involving a female patient with germline BRCA-mutated human epidermal growth factor receptor 2 (HER2)-negative mBC to highlight potential clinical considerations on the use of talazoparib, including the decision to initiate therapy, dosing considerations, potential drug-drug interactions, and managing side effects. This case illustrates the benefits of a multidisciplinary approach to managing patients with mBC and involving the patient in the decision-making process. This patient case is fictional and does not represent events or a response from an actual patient; this fictional case is for educational purposes only.
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Affiliation(s)
| | | | | | | | | | - Timothy J Pluard
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO
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11
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Joseph A, Shour AR, Lasebikan NN, Jimoh MA, Adegboyega BC, Nwachukwu E, Awofeso O, Ajose A, Ibraheem A, Fatiregun OA, Ali-Gombe M, Aliyu UM, Kotkat AE, Biyi-Olutunde OA, Oboh EO, Zubairu IH, Haider MR, Olatosi B, Puthoff D, Onitilo AA. Examining Cancer Patients' Perceptions of the Impact of COVID-19 on Teleoncology: Findings From 15 Nigerian Outpatient Cancer Clinics. JCO Glob Oncol 2023; 9:e2200221. [PMID: 36921242 PMCID: PMC10497253 DOI: 10.1200/go.22.00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 12/16/2022] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To examine cancer patients' perspectives on the impact of COVID-19 on teleoncology in Nigeria. METHODS Data from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant. RESULTS The majority of the 1,097 patients with cancer were female (65.7%) and age 55 years and older (35.0%). Because of COVID-19, 12.6% of patients' routine follow-ups were converted to virtual visits. More patients who canceled/postponed surgery (17.7% v 7.5%; P ≤ .001), radiotherapy (16.9% v 5.3%; P ≤ .001), and chemotherapy (22.8% v 8.5%; P ≤ .001), injection chemotherapy (20.6% v 8.7%; P ≤ .001) and those who reported being seen less by their doctor/nurse (60.3% v 11.4%; P ≤ .001) reported more follow-up conversions to virtual visits. In multivariate analyses, patients seen less by their doctors/nurses were 14.3 times more likely to have their routine follow-ups converted to virtual visits than those who did not (odds ratio, 14.33; 95% CI, 8.36 to 24.58). CONCLUSION COVID-19 caused many patients with cancer in Nigeria to convert visits to a virtual format. These conversions were more common in patients whose surgery, radiotherapy, chemotherapy, and injection chemotherapy treatments were canceled or postponed. Our findings suggest how COVID-19 affects cancer treatment services and the importance of collecting teleoncological care data in Nigeria.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abdul R. Shour
- Cancer Care and Research Center, Marshfield Clinic Health System, Marshfield, WI
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | | | - Mutiu A. Jimoh
- University College Hospital, Ibadan, Nigeria
- Lakeshore Cancer Center, Lagos, Nigeria
| | | | | | | | | | - Abiola Ibraheem
- Division of Hematology & Oncology, University of Illinois College of Medicine, Chicago, IL
| | | | | | - Usman M. Aliyu
- Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | | | | | | | | | - Bankole Olatosi
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - David Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A. Onitilo
- Cancer Care and Research Center, Marshfield Clinic Health System, Marshfield, WI
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
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12
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Prodhan AHMSU, Islam DZ, Khandker SS, Jamiruddin MR, Abdullah A, Godman B, Opanga S, Kumar S, Sharma P, Adnan N, Pisana A, Haque M. Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:51-89. [PMID: 36733464 PMCID: PMC9888303 DOI: 10.2147/bctt.s390296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients' conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient's mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.
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Affiliation(s)
| | - Dewan Zubaer Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, 1342, Bangladesh
| | - Shahad Saif Khandker
- Department of Biochemistry, Gonoshasthaya Samaj Vittik Medical College, Dhaka, 1344, Bangladesh
| | | | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Sylvia Opanga
- Department of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, Madhya Pradesh, 474006, India
| | - Nihad Adnan
- Department of Microbiology, Jahangirnagar University, Dhaka, 1342, Bangladesh,Correspondence: Nihad Adnan, Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh, Email ;Mainul Haque, The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, Kuala Lumpur 57000, Malaysia, Tel +60109265543, Email
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
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13
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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14
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Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic. Curr Oncol 2022; 29:8565-8578. [PMID: 36421328 PMCID: PMC9689494 DOI: 10.3390/curroncol29110675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented without previous evidence. The ONCOTELEMD study aimed to evaluate the opinion of patients attended via telemedicine during this period and to study factors that condition patient preferences on its use. Included patients had a confirmed cancer diagnosis and were contacted by telephone between 13 March and 30 April 2020, in the Medical Oncology Service of Hospital Parc Taulí, Sabadell. A 12-question survey was presented to them between 4 February and 19 April 2021. Statistical analysis was carried out using chi-square and multivariable logistic regression tests. Six hundred forty-six patients were included; 487 responded to the survey. The median age was 68 years (27-90), 55.2% were female. Most patients had a surveillance visit (65.3%) and were diagnosed with colorectal or breast cancer (43% and 26.5%, respectively); 91.8% of patients were satisfied, and 60% would accept the use of telemedicine beyond the pandemic. Patients aged more than 50 years (OR 0.40; 95% CI, 0.19-0.81; p = 0.01) and diagnosed with breast cancer (OR 0.45; 95% CI, 0.26-0.69; p < 0.001) were less predisposed to adopt telehealth in the future. Patients agreed to be informed via telehealth of scan or lab results (62% and 84%, respectively) but not of new oral or endovenous treatments (52% and 33.5%, respectively). Additionally, 75% of patients had a medium or low-null technologic ability, and 51.3% would only use the telephone or video call to contact health professionals. However, differences were found according to age groups (p < 0.0001). In total, patients surveyed were satisfied with telemedicine and believed telehealth could have a role following the COVID-19 pandemic. Moreover, our results remark on the importance of individualizing the use of telehealth, showing relevant data on patient preferences and digital literacy.
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15
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Stavrou E, Qiu J, Zafar A, Tramontano AC, Isakoff S, Winer E, Schrag D, Manz C. Breast Medical Oncologists' Perspectives of Telemedicine for Breast Cancer Care: A Survey Study. JCO Oncol Pract 2022; 18:e1447-e1453. [PMID: 35671420 PMCID: PMC9509057 DOI: 10.1200/op.22.00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The COVID-19 pandemic forced rapid adoption of telemedicine (TM) for breast oncology visits in the United States, but the appropriate role of postpandemic TM is uncertain. We sought to understand physician and advance practice practitioner perspectives on the use of TM for outpatient breast cancer care through an electronically administered survey. METHODS Breast medical oncology clinicians at two academic cancer centers and five satellite locations affiliated with the Dana Farber Cancer Institute and the Massachusetts General Cancer Center were invited to respond to a 21-question survey administered in September 2021 about clinicians' perceptions and attitudes toward TM during the previous 12 months. RESULTS Of the 71 survey invitations, 51 clinicians (36 physicians and 15 advance practice practitioners) provided survey responses (response rate = 72%). Ninety-two percent of respondents (n = 47) agreed that TM visits enhance patient care. Ninety-two percent of respondents (n = 46) also agreed that TM is valuable for early-stage breast cancer follow-up visits. Most respondents felt that there was no difference between TM and face-to-face (F2F) visits when it came to patient adherence, ease of ordering tests, ease of accessing patient records, and workflow outside of the visit (82%, 82%, 78%, and 53%, respectively). Fifty-one percent of respondents (n = 26) said that TM was better for timely access to follow-up appointments. Most respondents said that F2F visits were better for seeing physical problems, personal connection with patients, overall quality of visits, and patient-physician communication (100%, 75%, 65%, and 63%, respectively). CONCLUSION Breast clinicians believe that TM is a valuable tool to enhance outpatient breast cancer care. TM was felt to be appropriate for routine follow-up visits and second opinion consultations and is as good as or better than F2F visits for several routine aspects of breast cancer care.
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Affiliation(s)
| | | | - Affan Zafar
- Dana Farber Cancer Institute
- Harvard Medical School
- Brigham and Women's Hospital
| | | | - Steven Isakoff
- Harvard Medical School
- Massachusetts General Cancer Center
| | - Eric Winer
- Dana Farber Cancer Institute
- Harvard Medical School
| | | | - Christopher Manz
- Dana Farber Cancer Institute
- Harvard Medical School
- Brigham and Women's Hospital
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16
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Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia. Curr Oncol 2022; 29:4199-4211. [PMID: 35735444 PMCID: PMC9222084 DOI: 10.3390/curroncol29060335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Patients have had their cancer care either postponed or changed to telehealth visits to reduce exposure to COVID-19. However, it is unclear how these changes may have affected their experiences. We aim to identify patient characteristics that affect telehealth experiences and evaluate their preferences for using telehealth in the future. Methods: Patients who completed the Outpatient Cancer Care (OCC) Patient Experience Survey were invited to participate. They comepleted the modified OCC Survey, which focused on telehealth during the pandemic. Linear and logistic regression analyses were used to identify patient characteristics that influenced telehealth experiences and preferences for future telehealth use. Results: Perceived ease of participation in telehealth is a significant predictor of the change in patients’ ratings of their telehealth experience. We found that cancer patients had lower preferences for using telehealth in the future if they were older, female, or non-white; resided in an urban area; had no previous telehealth experience; had lower education; and had poorer mental health. Conclusions: To optimize cancer care and improve equitable access to high-quality telehealth care during the pandemic and beyond, clinicians and policymakers will need to consider patients’ self-reported experiences and their personal characteristics.
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