Disparities in Patient Portal Messaging Among Oncology Patients Enrolled in the Patient Portal

Previous studies have consistently reported disparities in electronic health record portal enrollment. Among patients enrolled in a portal, it is less clear whether there are disparities in usage. We investigated whether disparities existed in portal usage among enrolled oncology patients regarding both sending portal messages to and receiving messages from oncology providers.

This retrospective cohort study included patients ≥18 years old with cancer who were seen at an urban academic cancer center between January 2011 and February 2025 and enrolled in the patient portal. We developed Cox proportional hazards models for the outcomes of patients sending portal messages to and receiving messages from oncology providers as the first message in a thread. Time measurement began with the first cancer center visit or portal enrollment, whichever was later. Models were adjusted for demographic, socioeconomic, disease, and administrative visit variables.

Among 101,678 patients, the median age was 62 years (IQR, 51-71), and 68,527 sent and 42,242 received messages. After adjustment, age ≥50 versus 18-29 years, Latinx and Pacific Islander versus White, single and widowed versus partnered, non-English preferred language, and Medicaid and Medicare versus private insurance were associated with reduced likelihood of sending and receiving messages. Black and American Indian/Alaska Native were associated with reduced likelihood of sending messages. Female provider was associated with increased likelihood of sending and receiving messages. Women were more likely to send messages.

Among oncology patients enrolled in the patient portal, disparities existed in sending and receiving portal messages. Given the association of messaging with better survival among oncology patients in previous studies, future studies should determine how best to minimize messaging disparities beyond just addressing disparities in portal enrollment.