What is the clinical evidence from this study?

Study design: Cohort. Population: Cancer at end-of-life (n=10767407). Intervention: Cancer diagnosis vs. No cancer diagnosis. Primary outcome: Telehealth use in the last year of life.

What does this research mean for the field?

Telehealth use at the end of life is significantly higher among Medicare decedents with cancer compared to those without, though utilization is disproportionately lower among older, racial minority, and socially vulnerable populations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research examines the differences in telehealth use between Medicare decedents with and without cancer at the end of life.

May 30, 2026

Telehealth use at the end of life among Medicare decedents with cancers.

Key Result

Telehealth use in the last year of life was persistently higher among Medicare decedents with cancer compared to those without, reaching 47.8% vs 34.4% in 2023.

Key Points

This research examines the differences in telehealth use between Medicare decedents with and without cancer at the end of life.
Conducted a retrospective cohort study using 100% Traditional Medicare and Medicare Advantage claims from 2019-2023.
Included Medicare beneficiaries who died within the study timeframe and had continuous enrollment for 12 months before death.
Analyzed telehealth use categorized by synchronous, asynchronous, and remote monitoring encounters.
Telehealth use among cancer decedents increased significantly from 2.7% to 47.8% between 2019 and 2023.
Synchronous video encounters were the most common, with usage rising from 1.2% to 41.2% during the same period.
Older age, racial and ethnic minority status, and high social vulnerability were associated with lower telehealth use.

Study Design

Type

Cohort (n=10,767,407)

Multicenter

Yes

Structured PICO

Does telehealth use at the end of life differ between Medicare decedents with and without cancer?

Population

10,767,407 Medicare beneficiaries who died in 2019-2023 with continuous Traditional Medicare or Medicare Advantage enrollment in the 12 months preceding death, average age 81.56, 51.8% female, 33.1% with cancer diagnosis.

Intervention

Telehealth use (synchronous patient-provider, asynchronous, and remote physiologic or therapeutic monitoring) in the last year of life.

Comparator

Medicare decedents without cancer.

Outcome

Telehealth use (overall and by service type) in the last year of life.

Telehealth use at the end of life is significantly higher among Medicare decedents with cancer compared to those without, though disparities exist based on age, race, and social vulnerability.

Main Result

Absolute Event Rate: 47.8% vs 34.4%

Abstract

e23120 Background: Telehealth use has surged since the COVID-19 pandemic. For individuals with cancer approaching end-of-life (EOL) facing high symptom burden, declining mobility, and increasing reliance on caregivers, telehealth may enhance access to specialty and palliative care services. National evidence comparing EOL telehealth use between cancer and non-cancer populations remains limited. Methods: We conducted a retrospective, population-based cohort study of telehealth use using 100% Traditional Medicare (TM) and Medicare Advantage (MA) claims. We included Medicare beneficiaries died in 2019-2023 with continuous TM or MA enrollment in the 12 months preceding death. Patients with cancer were identified by 1 inpatient or 2 outpatient visits with cancer diagnosis codes in the last year of life. Telehealth use in the last year of life was identified using procedure codes and modifiers and classified into synchronous patient–provider (audio-only and audio–video), asynchronous, and remote physiologic or therapeutic monitoring (RPM/RTM) encounters. Telehealth use, overall and by service type, was compared between Medicare decedents with and without cancer; multivariable logistic regression examined patient characteristics associated with telehealth use after COVID-19 onset. Results: Among a total of 10,767,407 Medicare decedents, average age was 81.56, with 51.8% female, 9.7% Non-Hispanic Black, 2.3% Hispanic, and 33.1% with cancer diagnosis. Telehealth use among decedents with cancer increased from 2.7% to 47.8% in 2019-2023, peaking in 2021 (70.0%), which was persistently higher than those without cancer (2.4% to 34.4% in 2019-2023). Synchronous video encounters (1.2% to 41.2%) were most common, followed by synchronous audio only encounters (1.6% to 20.9%) in 2019-2023. RTM/RPM was limited but increased from 0.1% to 2.0% in 2019-2023. Decedents with cancer were consistently more likely to use all telehealth modalities than those without cancer. In adjusted analysis, older (85+ vs. 66-74 years: -6.10 percentage points ppts), Non-Hispanic Black (vs. Non-Hispanic White: -3.27 ppts), and beneficiaries in counties with a higher social vulnerability index (Q4 vs. Q1: -0.92 ppts, p-values<.001) were less likely to use telehealth. More comorbidities (14.70 ppts), multiple hospitalizations in the prior year (5.18 ppts), and counties with better broadband internet access (80%+ households with 25+ Mbps internet connection vs. ≤40%: 13.98 ppts, p-values<.001) were associated with higher likelihood of telehealth use. Conclusions: EOL telehealth use differs meaningfully between cancer and non-cancer decedents, which may reflect greater care intensity and more frequent clinical contact. Telehealth use was lower among older, racial and ethnic minority beneficiaries, and those living in more socially vulnerable areas, and higher among patients with greater medical complexity and better broadband access.

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