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Telehealth Utilization for Prostate Cancer Management in the Veteran Affairs Healthcare System: A Study from 2016 to
Amin Nakhostin-Ansari1, Zain Khera2, Daniel Becker3,4
1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Background:
There are limited studies on telehealth use patterns among patients with prostate cancer.
Objective:
We assessed the patterns of delivery of care for prostate cancer management in the Veterans Health Administration (VHA).
Design:
A retrospective observational cohort study from January 2016 to February 2023.
Participants:
Data were from the VHA's Corporate Data Warehouse (CDW). Veterans with a new diagnosis of prostate cancer were included in the study. Those who died within 1 year of diagnosis, had missing staging information, or had no prostate-specific antigen (PSA), biopsy, or treatment recorded within 2 years of initial diagnosis were excluded.
Main Measures:
Veterans were categorized into watchful waiting, active surveillance, and active treatment management groups based on subsequent care received and categorized into National Comprehensive Cancer Network (NCCN) risk categories. We categorized outpatient urology or oncology visits as telephone-based, video-based, or in-person using administrative stop codes. We used logistic regression models to evaluate the characteristics associated with at least one video/virtual visit.
Key Results:
In total, 60,381 Veterans were included in the study (20.3% low risk, 49.8% intermediate risk, and 29.8% high risk). Even during the COVID-19 pandemic, less than 6% and 9% of Veterans had at least one urology or oncology video visit, respectively, in the first year after diagnosis across all management groups. In the regression model, Veterans aged 60 and older were less likely to have video visits for both urology and oncology. In contrast, living in urban areas, being diagnosed during the COVID-19 pandemic, and being in the intermediate NCCN risk group were associated with higher odds of having at least one video visit in both specialties.
Conclusions:
Despite improvements in telehealth use among Veterans with prostate cancer, telehealth utilization, particularly video visits, remains low, warranting attention from leadership and policymakers.
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