2135 - Telephone Utilization by Older Adults with Cancer Presenting for Radiation Oncology Consultation

Y. Sharifzadeh¹, W. S. Harmsen², J. F. Burlile¹, A. Amundson¹, M. R. Waddle¹, D. M. Routman¹, A. E. Garda¹, K. W. Merrell¹, C. L. Hallemeier¹, A. Kollengode¹, E. J. Cleveland¹, N. N. Laack II¹, K. S. Corbin¹, and W. Breen¹; ¹Department of Radiation Oncology, Mayo Clinic, Rochester, MN, ²Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN

Purpose/Objective(s): Although about half of older adults report using telemedicine (TM), one-third report lack of readiness to use advanced TM platforms, causing barriers to care. Patient characteristics associated with TM use among older adults with cancer requiring radiation therapy have not been studied. We examined older adults who presented to a large comprehensive cancer for consultation in-person (IP), by phone (PH), or via video (VI) during the COVID-19 pandemic. We hypothesized that older age, higher area deprivation index (ADI), and farther distance from clinic would be associated with use of phone as opposed to video technology and that phone visits may be associated with lower patient satisfaction scores (PSS). Materials/

Methods: New patient consultations 65 years or older from March 2020 to December 2021 were identified. Visits were categorized as IP, PH, or VI. Sex, age, race, ethnicity, private insurance versus Medicare, distance from clinic, and ADI (1 (least deprived) – 100 (most deprived)) by zip code were collected. PSS (top box: percentage of patients giving 5 out of 5 for a question) from April 2020 to December 2021 for 628 IP, 15 PH, and 226 VI were available. Yield, or receipt of radiotherapy at our institution, was also analyzed.
Results: Among the 5,679 patients analyzed, 4,524 (80%) were IP, 165 (3%) were PH, and 990 (17%) were VI. The population was 64% male with an average age of 73.5 years, 66% had Medicare, and yield was 66%. IP patients had the highest yield (71% IP, 50% PH, 46% VI), highest percentage of female patients (39% IP, 22% PH, 24% VI), and lived closest to clinic (median miles 96 IP, 195 PH, 266 VI). PH visits were oldest in median age (73 years IP, 74 PH, 72 VI) and had the highest median ADI (49 IP, 52 PH, 42 VI). PH patients had the highest Medicare utilization (66% IP, 71% PH, 66% VI). Multivariable logistic regression (LR) comparing VI to PH patients showed that PH patients were significantly older (OR 0.60, p < 0.001), lived significantly closer to clinic (OR 1.08, p < 0.001), and had higher ADI (OR 0.88, p < 0.001). Multivariable LR for assessment of yield showed higher ADI to be associated with higher yield for those presenting on VI and PH but not for IP patients. On average, PH patients had lower PSS (81 PH, 86 IP and VH), with the lowest and most significantly different scores in “ease of contacting” (77 IP, 65 PH, 76 VI) and “ease of scheduling appointments” (80 IP, 70 PH, 74 VI).
Conclusion: Twenty percent of older cancer patients presenting for consultation utilized TM services. PH patients were older, had higher ADI and Medicare use, lived farther from clinic, and reported lower PSS. This suggests that TM services, especially availability of phone visits, may have improved older adult access to care by reaching patients at greater distances and with higher healthcare deprivation. However, our conclusions also show need for technological education and video visit infrastructure development to improve patient satisfaction and care access for medically underprivileged older adult patients.