Abstract
We examined telemedicine use across 38,883 surgical oncology visits (2021-2023) at a Northern California cancer center. At ≥20 miles from clinics, Hispanic (OR = 0.76, 95% CI [0.68,0.85]), Asian/Pacific Islander (OR = 0.75, 95% CI [0.66,0.84]), interpreter-needing (OR = 0.67, 95% CI [0.59,0.77]), and Medicaid patients (OR = 0.85, 95% CI [0.76,0.96]) had lower telemedicine use, while low-income patients showed higher utilization (OR = 1.67, 95% CI [1.46,1.91]). At <20 miles, no differences were observed for Hispanic, interpreter-needing, Medicaid, or low-income patients, but Asian/Pacific Islanders showed higher use (OR = 1.16, 95% CI [1.04-1.30]). Geographic distance modifies telemedicine access patterns.
Data availability
The data contain protected health information and are available from the corresponding author upon reasonable request.
References
Health Resources and Services Administration. Telehealth policy updates. https://telehealth.hhs.gov/providers/telehealthpolicy/telehealth-policy-updates (2026).
Paro, A. et al. Telehealth utilization among surgical oncology patients at a large academic cancer center. Ann. Surg. Oncol. 29, 7267–7276 (2022).
Xiao, K., Yeung, J. C. & Bolger, J. C. The safety and acceptability of using telehealth for follow-up of patients following cancer surgery: a systematic review. Eur. J. Surg. Oncol. 49, 9–15 (2023).
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. https://link.springer.com/10.1245/s10434-025-17592-3 (2025).
Waseem, N., Boulanger, M., Yanek, L. R. & Feliciano, J. L. Disparities in telemedicine success and their association with adverse outcomes in patients with thoracic cancer during the COVID-19 pandemic. JAMA Netw. Open 5, e2220543 (2022).
Hsueh, L. et al. Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic. JAMA Netw. Open 4, e2133129 (2021).
Roberts, E. T. & Mehrotra, A. Assessment of disparities in digital access among medicare beneficiaries and implications for telemedicine. JAMA Intern. Med. 180, 1386–1389 (2020).
Osmanlliu, E., Johari, R. & Scheinker, D. Health and healthcare disparities associated with the digital divide. http://deepblue.lib.umich.edu/handle/2027.42/166083 (2021).
Adepoju, O. E., Chae, M., Ojinnaka, C. O., Shetty, S. & Angelocci, T. Utilization gaps during the COVID-19 pandemic: racial and ethnic disparities in telemedicine uptake in federally qualified health center clinics. J. Gen. Intern. Med. 37, 1191–1197 (2022).
Marcondes, F. O. et al. Racial and Ethnic Differences in Telemedicine Use. JAMA Health Forum 5, e240131 (2024).
Grenda, T. R., Whang, S. & Evans, N. R. I. Transitioning a surgery practice to telehealth during COVID-19. Ann. Surg. 272, e168 (2020).
Hilty, D. M. et al. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 6, 20 (2020).
Swenson, W. T. et al. The role of income and rurality in US cancer mortality: a SEER analysis. JCO 43, e13828 (2025).
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).
Kruse, C. et al. Utilization barriers and medical outcomes commensurate with the use of telehealth among older adults: systematic review. JMIR Med. Inf. 8, e20359 (2020).
Shao, C. C. et al. Inequity in telemedicine use among patients with cancer in the deep south during the COVID-19 pandemic. Oncologist 27, 555–564 (2022).
Osmanlliu, E. et al. Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic. Am. Heart J. https://www.sciencedirect.com/science/article/pii/S0002870323001667 (2023).
Ranji, U., Frederiksen, B., Salganicoff, A. & Long, M. Women, work, and family during COVID-19: findings from the KFF Women’s Health Survey. Women’s Health Policy. (2021).
Cunha, A. S., Pedro, A. R. & Cordeiro, J. V. Facilitators of and barriers to accessing hospital medical specialty telemedicine consultations during the COVID-19 pandemic: systematic review. J. Med. Internet Res. 25, e44188 (2023).
Lazar, M. & Davenport, L. Barriers to health care access for low income families: a review of literature. J. Community Health Nurs. 35, 28–37 (2018).
Cyr, M. E., Etchin, A. G., Guthrie, B. J. & Benneyan, J. C. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv. Res. 19, 974 (2019).
Moen, E. L. et al. Cross-state travel for cancer care and implications for telehealth reciprocity. JAMA Netw. open 8, e2461021–e2461021 (2025).
Centers for Disease Control and Prevention. Patient Navigation. https://www.cdc.gov/cancer/php/interventions/patient-navigation.html (2023).
Larson, K. E. et al. Are patients traveling for intraoperative radiation therapy? Int. J. Breast Cancer 2017, 6395712 (2017).
Silverwood, S. M. et al. The relationship between travel distance for treatment and outcomes in patients undergoing radiation therapy: a systematic review. Adv. Radiat. Oncol. 9, 101652 (2024).
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VP (Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing), ST (Data curation, Formal analysis, Methodology, Writing – review & editing), YBZ (Data curation, Formal analysis, Methodology, Writing – review & editing), MM (Data extraction and curation), JP (Conceptualization, Writing – review & editing), BD (Conceptualization, Writing – review & editing), LR (Conceptualization, Writing – review & editing), CS (Conceptualization, Writing – review & editing), BL (Conceptualization, Data curation, Writing – review & editing), SS (Conceptualization, Data curation, Methodology, Writing – review & editing). All authors have read and approved the manuscript.
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Parameswaran, V., Tsung, S., Zeng, Y.B. et al. Distance-stratified sociodemographic differences in telemedicine use in surgical oncology clinics at an academic medical center. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02411-0
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DOI: https://doi.org/10.1038/s41746-026-02411-0
