Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic prompted a surge in telehealth utilization. However, language barriers have emerged as a potential obstacle to effective telemedicine engagement, impacting millions of limited English proficient (LEP) individuals. Understanding the role of language spoken in telehealth outcomes is critical, particularly in cancer care, in which consistent follow-up and communication are vital. The primary objective was to assess the impact of telehealth utilization and primary language spoken on clinical outcomes in cancer patients.

Methods: This study utilized a retrospective cohort design, encompassing cancer patients seen at the Chao Family Comprehensive Cancer Center between March 1, 2020, and December 31, 2022. The study incorporated both in-person and telehealth visits, examining the association between encounter type and clinical outcomes.

Results: The study included 7890 patients with more than one outpatient visit during the study period. There was decreased telehealth utilization in non-English speaking cancer patients throughout the pandemic. Increased telehealth utilization was associated with higher rates of admission, irrespective of cancer type. Additionally, telehealth visits were associated with longer duration of subsequent admissions compared to in-person visits. Spanish-speaking patients utilizing telehealth had higher rates of re-admission compared to English speakers utilizing telehealth. Patients who died had higher rates of telehealth utilization compared to patients who survived.

Conclusions and relevance: This study demonstrates that primary language spoken is associated with differences in telehealth utilization and associated outcomes in cancer patients. These differences suggest that the interplay of telehealth and language could contribute to widening of disparities in clinical outcomes in these populations. The study underscores the need to optimize telehealth usage and minimize its limitations to enhance the quality of cancer care in a telehealth-driven era.

Keywords: COVID‐19; cancer; health disparities; language barrier; telehealth.

FIGURE 1

Differences in telehealth utilization in different language groups during the COVID‐19 pandemic. (A) Percentage (%) of telehealth encounters across all patients stratified by primary language spoken. The top three languages from the cohort are shown. Two‐sided student's t‐test was performed to compare groups. (B) Percentage (%) of telehealth visits across all patients displayed as a running monthly average across all months included in the study. Each line represents the telehealth encounter rate for either English‐speaking, Spanish‐speaking, or Vietnamese‐speaking patients.

FIGURE 2

Association between telehealth utilization and admission. (A) Dotplot depicting the association between the percentage (%) of telehealth visits and number of admissions per patient. Each dot represents a single patient in the cohort. (B) Admission duration (days) between admissions following either in‐person or telehealth visits. Mean admission duration 5.8 days versus 6.5 days for admissions following in‐person and telehealth encounters respectively (student's t‐test, p‐value <0.001). (C) Bar plot showing the fraction of admissions that were re‐admissions (within 30 days of a discharge) following either in‐person or telehealth encounters stratified by language spoken.

FIGURE 3

Rates of telehealth encounters between patients that lived versus died during each year of the COVID‐19 pandemic. Patients were only included each year analyzed if they were actively seen (had more than one outpatient visit) during that year.