Predictors of Telehealth Use Among Cancer Survivors: Retrospective Study.

Background: As the number of cancer survivors continues to grow, optimizing long-term survivorship care models has become increasingly important. Telehealth has the potential to improve access to health care for survivors; however, studies evaluating telehealth in this population remain limited. Additionally, concerns persist regarding equity in technology access and digital literacy. Objective: This study aimed to examine demographic factors and patient attitudes influencing telehealth use among cancer survivors compared to the general population. Methods: Adult participants were identified from the nationally representative database Health Information National Trends Survey 6 (HINTS 6). Multivariable logistic regression was used to calculate the predictors of telehealth use among cancer survivors. χ2 tests compared the prevalence of reported reasons of not using telehealth in the last 12 months between cancer survivors and the general population. Results: A total of 5793 (weighted n=239,557,883) individuals were included in this study, 7.7% (weighted n=18,545,434) who are cancer survivors. 5092 individuals from the general population and 701 cancer survivors were included. Older age was associated with lower telehealth use (adjusted odds ratio aOR 0.11; 95% CI 0.02-0.59 for patients aged ≥65, compared to those under 40 y old). Higher education (aOR 2.55; 95% CI 1.24-5.27) and heart disease history (aOR 2.52; 95% CI 1.20-5.28) were associated with increased telehealth use. Employed (aOR 0.46; 95% CI 0.22-0.97) and retired (aOR=0.37; 95% CI: 0.18-0.77) cancer survivors were less likely to use telehealth than unemployed individuals. Of the nonusers, over 60% reported that telehealth options were not offered, and 80% preferred in-person visits. Technical issues and privacy concerns were not major factors in utilizing telehealth. Conclusions: Despite greater telehealth use among cancer survivors, a negative association between older age and telemedicine utilization persists. Efforts should focus on improving access for older cancer survivors and addressing employment-related factors, patient attitudes, and telehealth availability. Future studies should explore personalized approaches to enhance cancer survivors' health care experiences. Our findings emphasize the need to address specific factors including age and employment related disparities, patient preferences and telehealth availability to optimize equitable access to telehealth and enhance the delivery of cancer survivorship care.