Abstract
Video telehealth visits (VTV) have emerged as a critical tool for oncology care delivery, with potential to address longstanding access disparities. We examined the association between broadband internet availability, individual digital literacy factors, and VTV utilization among patients with cancer. In a retrospective cohort of 13,897 patients across a multi-site practice, VTV utilization was significantly lower in areas with ≤1 internet service provider (ISP) offering download speeds ≥25 Mbps (p = 0.0009). Validation in a regional cohort (n = 6665) confirmed lower VTV utilization in low-broadband areas. Among 1134 surveyed patients, higher digital literacy was the strongest predictor of VTV use (OR 2.5; p < 0.001), even where broadband was limited. This study demonstrates that while both broadband availability and digital literacy independently influence VTV utilization, individual digital skills can partially offset structural limitations, underscoring the need for concurrent investment in broadband infrastructure and targeted digital literacy initiatives to advance access to care.
Data availability
The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and confidentiality considerations (for example, geographic residences of participants), but are available from the corresponding author on reasonable request.
Code availability
Code developed for this study is not publicly available but may be shared upon reasonable request at the discretion of the study authors.
References
Pritchett, J. C. et al. Patient- and provider-level factors associated with telehealth utilization across a multisite, multiregional cancer practice from 2019 to 2021. JCO Oncol. Pract. 19, 750–758 (2023).
Zon, R. T. et al. Telehealth in oncology: ASCO standards and practice recommendations. JCO Oncol. Pract. 17, 546–564 (2021).
Pritchett, J. C., Patt, D., Thanarajasingam, G., Schuster, A. & Snyder, C. Patient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity. Am. Soc. Clin. Oncol. Educ. Book 43, e390678 (2023).
Doshi, S. D. et al. Perspectives on telemedicine visits reported by patients with cancer. JAMA Netw. Open 7, e2445363 (2024).
Boucher, A. A. et al. Adult hematology/oncology patient perspectives on telemedicine highlight areas of focus for future hybrid care models. Telemed. J. E Health 29, 708–716 (2023).
Haemmerle, R., Paludo, J., Haddad, T. C. & Pritchett, J. C. The growing role of digital health tools in the care of patients with cancer: current use, future opportunities, and barriers to effective implementation. Curr. Oncol. Rep. 26, 593–600 (2024).
Wood, B. R. et al. Advancing digital health equity: a policy paper of the Infectious Diseases Society of America and the HIV Medicine Association. Clin. Infect. Dis. 72, 913–919 (2021).
Morris, B. B., Rossi, B. & Fuemmeler, B. The role of digital health technology in rural cancer care delivery: a systematic review. J. Rural Health 38, 493–511 (2022).
Pandit, A. A. et al. Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic. J. Telemed. Telecare 31, 41–48 (2025).
Kelpin, S. et al. Increasing digital equity to promote online smoking cessation program engagement among rural adults: a randomized controlled pilot trial. Commun. Med. 4, 194 (2024).
Pew Research Center. Mobile Fact Sheet. Tech Adoption Trends. https://www.pewresearch.org/internet/fact-sheet/mobile/ (2024).
Haynes, N. et al. “Can you see my screen?” Addressing racial and ethnic disparities in telehealth. Curr. Cardiovasc. Risk Rep. 15, 23 (2021).
Tilhou, A. S., Jain, A. & DeLeire, T. Telehealth expansion, internet speed, and primary care access before and during COVID-19. JAMA Netw. Open 7, e2347686 (2024).
Sharma, P. & Patten, C. A. A need for digitally inclusive health care service in the United States: recommendations for clinicians and health care systems. Perm. J. 26, 149–153 (2022).
Richardson, S., Lawrence, K., Schoenthaler, A. M. & Mann, D. A framework for digital health equity. NPJ Digital Med. 5, 119 (2022).
Adedinsewo, D. et al. Health disparities, clinical trials, and the digital divide. Mayo Clin. Proc. 98, 1875–1887 (2023).
FCC. Federal Communications Commission. FCC National Broadband Map. https://broadbandmap.fcc.gov/home (2025).
Acharya, M., Shoults, C. C., Hayes, C. J. & Brown, C. C. Association between broadband capacity and social vulnerability factors in the United States: a county-level spatial analysis. Popul. Health Manag. 25, 798–806 (2022).
Nelson, L. A., Pennings, J. S., Sommer, E. C., Popescu, F. & Barkin, S. L. A 3-item measure of digital health care literacy: development and validation study. JMIR Form. Res. 6, e36043 (2022).
Sharma, P. et al. Development and initial cognitive testing of the Digital Equity Screening Tool (DEST): community participatory approach to assessing digital inequality. J. Clin. Transl. Sci. 6, e117 (2022).
GFOA. Government Finance Officers Association. Infrastructure Investment and Jobs Act (IIJA) Implementation Resources. https://www.gfoa.org/the-infrastructure-investment-and-jobs-act-iija-was (2021).
Landrieu, M. President Joe Biden Building a Better America. Build.gov. A Guidebook to the Bipartisan Infrastructure Law for State, Local, Tribal, and Territorial Governments, and Other Partners. https://gfoaorg.cdn.prismic.io/gfoaorg/0727aa5a-308f-4ef0-addf-140fd43acfb5_BUILDING-A-BETTER-AMERICA-V2.pdf (2022).
Cooper, T. Broadbandnow. Broadbandnow Research. How the government defines broadband: analysis and history. https://broadbandnow.com/report/fcc-broadband-definition (2018).
Bauerly, B. C., McCord, R. F., Hulkower, R. & Pepin, D. Broadband access as a public health issue: the role of law in expanding broadband access and connecting underserved communities for better health outcomes. J. Law Med. Ethics 47, 39–42 (2019).
Ko, J. S. et al. Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities. J. Rural Health 39, 617–624 (2023).
Shih, K. K. et al. Telehealth preferences among patients with advanced cancer in the post COVID-19 vaccine era. J. Pain. Symptom Manag. 67, 525–534.e1 (2024).
Parameswaran, V. et al. Telemedicine trends in ambulatory surgical oncology: a five-year analysis of visit volume and utilization at a high-volume academic center. Ann. Surg. Oncol. 32, 6829–6837 (2025).
Parameswaran, V. et al. Impact of telemedicine on access to care in surgical oncology clinics: distance and time to visit analysis for new patients at a multispecialty cancer center. J. Clin. Oncol. 43, e23345–e23345 (2025).
Parameswaran, V. et al. Comparing trends in telehealth utilization by medical oncology practices at Stanford Medicine and Mayo Clinic from 2019–2023. J. Clin. Oncol. 43, e13890–e13890 (2025).
GSA. General Services Administration. data.gov Data Catalog. Rural-Urban Commuting Area Codes. https://catalog.data.gov/dataset/rural-urban-commuting-area-codes (2024).
Powell, W., Sheehy, A. & Kind, A. J. H. Scientifically validated social exposome tool available for policies advancing health equity. https://www.healthaffairs.org/content/forefront/area-deprivation-index-most-scientifically-validated-social-exposome-tool-available. Health Affairs Forefront. (Accountable Care for Population Health) https://doi.org/10.1377/forefront.20230714.676093 (2023).
Acknowledgements
Funding/Support: Noaber Foundation Digital Health Award (J.C.P., P.S., T.C.H., C.A.P.); Wohlers Family Foundation Grant (T.C.H., J.C.P.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, through the Kern Scholar Program (J.C.P.). Role of the Funder/Sponsor: the funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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J.C.P. and T.C.H. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: J.C.P. and P.S. Drafting of the manuscript: J.C.P., P.S., C.A.P., and T.C.H. Statistical analysis: M.H., R.D., P.A.D., R.J., and B.J.B. Obtained funding: J.C.P., P.S., C.A.P., and T.C.H. Acquisition, analysis, or interpretation of data and critical review of the manuscript for important intellectual content: J.C.P., P.S., M.H., R.D., T.A.B., J.P.M., C.C.K., H.A., P.A.D., R.J., J.T., N.K., L.C.B., J.C.T., B.J.B., C.A.P., and T.C.H.
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B.J.B. discloses consulting for Boehringer-Ingelheim on unrelated health economics and outcomes research projects. T.C.H. discloses grant funding to Mayo Clinic from Takeda Oncology and Puma Biotechnology, unrelated to this project. All other authors declare no financial or non-financial competing interests.
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Pritchett, J.C., Sharma, P., Huang, M. et al. Impact of broadband availability and digital literacy on video telehealth use among cancer patients. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02397-9
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DOI: https://doi.org/10.1038/s41746-026-02397-9
