Introduction:

The COVID-19 pandemic accelerated existing efforts to provide remote clinical care via telehealth platforms. We aimed to characterize availability and contemporary time trends in telehealth services for urological cancer care across the United States in the context of COVID-19.

Methods:

We performed a cross-sectional study of Commission on Cancer (CoC) accredited hospitals using a secret shopper scenario. From March to July 2020, two investigators randomly selected and called 293 CoC-accredited hospitals as part of an ongoing study to assess access to urologic oncology care. We excluded hospitals that did not accept new patients (N=2). Posing as an adult patient with a presumptive kidney tumor, investigators used a standardized script to assess the availability of telehealth services at each hospital’s urology department. We assessed the availability of telehealth for both new and follow-up visits. We compiled characteristics at the facility level including facility type and median household income of the hospital’s zip code. We assessed time trends in the availability of telehealth. We compared characteristics between facilities that did or did not provide telehealth using univariable analyses and multivariable logistic regression. This study received exemption from Yale University’s institutional review board.

Results:

The study sample consisted of 291 U.S. hospitals from March 1 to July 9, 2020. Of the hospitals contacted, 137 (47.1%) offered new patient telehealth visits with a urologist and 238 (81.8%) offered telehealth visits for follow-up appointments for established patients. Community cancer program hospitals had the lowest availability of telehealth visits for new patients (27%), while National Cancer Institute designated cancer hospitals had the highest (92.9%). The availability of telehealth visits for new patients increased over time from 40.0% in March to 62.0% in July (p<0.01). In multivariable logistic regression models adjusted for facility designation, income at the hospital zip code was not associated with availability of telehealth (p=0.30).

Conclusion:

Although telehealth availability increased rapidly for urologic cancer care in response to the COVID-19 pandemic, we identified substantial gaps in access, particularly among community cancer hospitals. Additional investigation is warranted to clarify and address barriers to telehealth implementation for cancer care.

Funding: AUA Herbert Brendler Medical Student Research Fellowship