JMIR Publications

ABSTRACT

Background:

There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors who are disproportionately older.

Objective:

To identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of older cancer survivors.

Methods:

Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10, 2020–July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (non-skin) cancer diagnosis and a usual source of care (N=2,044). Dichotomous outcomes included: (1) technology ownership, (2) internet access, (3) internet use for communication, and (4) telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, Census region, and self-reported comorbidities.

Results:

Over half (53%) of cancer survivors reported using the Internet for communication purposes and 62% reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28% vs. 46%, p<.001), and for Hispanic and Black survivors compared to non-Hispanic Whites (29%, 31%, and 44% respectively, p<.01). Rural survivors reported lower telehealth availability (53% vs. 63% p<.001); no differences in telehealth availability were identified by race/ethnicity (p>.05).

Conclusions:

During the COVID-19 pandemic, our findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for older cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities; supporting telehealth implementation among providers that serve populations with known health disparities; raising awareness of providers’ available telehealth services among patients; and screening for technology use and provision of telehealth-related technical assistance among older, Black and Hispanic, dual Medicare/Medicaid enrolled, and rural cancer survivors.