The Impact of Telehealth on Treatment Decision-Making in Prostate Cancer

Telehealth utilization has increased since the COVID-19 pandemic. Studies show patient satisfaction with telehealth in managing prostate cancer (CaP); however, data are limited on how telehealth affects treatment decision-making. This study investigates whether appointment type-telehealth vs in person-influences CaP treatment selection, specifically active surveillance (AS) vs definitive therapy.

This was a retrospective analysis of CaP treatment selected by patients at a National Cancer Institute-designated multidisciplinary genitourinary oncology center between March 18, 2020, and December 31, 2022. Telehealth and in-person visits were compared using χ² and t tests. Logistic regression identified variables impacting AS selection.

Nine hundred sixty-eight CaP patient visits were evaluated-290 telehealth and 678 in person. In unadjusted analysis, telehealth patients were more likely to be White (68.6% vs 57.1%, P < .001), to live outside Philadelphia (63.1% vs 45.4%, P < .001), to select AS (30.4% vs 19.1%, P < .001), and to be discussing adjuvant (21.4% vs 12.2%) or recurrent treatment (25.9% vs 16.8%, P < .001). Regression analysis demonstrated telehealth did not affect AS selection for initial treatment of Gleason 6 (66.7% vs 62.5%, P = .72; odds ratio = 0.90, P = .86) or 3 + 4 = 7 disease (20% vs 13.3%, P = .26; odds ratio = 2.37, P = .09).

Telehealth provides an opportunity to expand access to multidisciplinary CaP care. We demonstrate that appointment type did not significantly affect decision-making for initial treatment of low and low-intermediate risk CaP. Telehealth patients overall were more likely to select AS, likely due to baseline differences and factors unaccounted for by this study (eg, comorbidities and socioeconomics). It is important for physicians using telehealth to consider any associated implications.