JMIR Publications

ABSTRACT

Background:

Telehealth has been widely promoted as a way to reduce travel burden for patients with cancer, particularly after the rapid expansion of virtual care following the COVID-19 public health emergency. However, national evidence remains limited on whether telehealth meaningfully broadens the geographic reach of outpatient oncology care or reduces persistent rural-urban disparities.

Objective:

To quantify whether telehealth expands the geographic reach of outpatient oncology care in the United States and whether expansion differs by rurality and region.

Methods:

In a cross-sectional analysis of Medicare Fee-For-Service outpatient oncology-related encounters (2021-2023) in the CMS Virtual Research Data Center, we calculated great-circle distance between beneficiary residential ZIP centroids and provider practice ZIP centroids for telehealth and office visits. We summarized distances by rural-urban commuting area (RUCA) strata and U.S. Census region using medians/IQRs and cumulative distributions; d80 is the distance containing 80% of visits within each RUCA stratum.

Results:

Among 858,813 beneficiaries and 16,669,868 visits, 40.9% had at least 1 telehealth visit; telehealth accounted for 6.6% of encounters. Distances increased with rurality. Telehealth closely tracked office visits, with modest upper-tail expansion; d80 was 8-14 miles higher for telehealth (urban: 130.4 vs 116.0 miles). Across regions, telehealth medians were 0.8-3.6 miles higher than office visits.

Conclusions:

Telehealth extends reach for a minority of oncology encounters but largely operates within local catchments and preserves rural-urban distance gradients. Equitable travel relief may require broadband affordability, digital navigation supports, and cross-state licensure reciprocity.