Sustained use and determinants of telehealth in metropolitan cancer care: a multi-centre retrospective study beyond the COVID-19 pandemic

Introduction: Telehealth use expanded rapidly in oncology during the COVID-19 pandemic, but determinants for ongoing use in metropolitan cancer care after the pandemic remain unclear. Methods: A multi-centre retrospective cohort study of 271,889 oncology outpatient consultations (face-to-face, telephone, video) from 1 January 2019 to 30 June 2024 across four cancer centres in Sydney, Australia was conducted. Consultations were divided into pre-COVID, during-COVID restrictions and post-COVID restriction time periods. Multivariable generalised estimating equations modelled the odds of telehealth use in the during and post-restriction periods, testing interactions between time periods and key covariates. Results: Across 271,889 consultations with 21,125 patients the proportion of telehealth consultations was negligible pre-pandemic (0.4%), peaked during restrictions (24.7%) then reduced but was sustained post-restrictions (11.4%). Post-restrictions, telehealth use was more likely for follow-up consultations (vs new, p < .001), medical oncology consultations (vs radiation, p < .001), patients enrolled on a clinical trial (p < .001) and primary tumours including brain and genitourinary (vs breast, p < .001). Patients from the most socioeconomically disadvantaged quintiles (vs highest, p < .001), those who required an interpreter (p < .001), those receiving active treatment in the cancer centre (vs not on treatment, p < .001) and with primary tumours including head and neck or skin (vs breast, p < .001) were less likely to undergo telehealth consultations. Conclusions: There is modest but sustained use of telehealth in oncology post-pandemic restrictions particularly for follow-up consultations, with less utilisation in populations experiencing disadvantage. Strategic, equity-focused policies are needed to ensure that telehealth use enhances, rather than exacerbates, disparities in access to cancer care.