In-Person Visits for Patients With Hematologic Neoplasms Decreased During Early Stages of COVID-19 Pandemic

In-person medical visits for patients with hematologic neoplasms declined during the early months of the COVID-19 pandemic, while telemedicine use ticked up slightly during the same period and was used persistently in the latter half of 2020 but was still low overall, according to a new study published in the Journal of the American Medical Association.

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“We observed a significant decline in in-person visit rates for oral therapy and outpatient infusions during the early pandemic period in all hematologic neoplasm subtypes, which later returned to forecasted rates after June 2020,” the investigators said.

The study, which used health records of 24,261 active patients from a national database, found that for those receiving oral therapy or outpatient infusions for hematologic neoplasms, in-person visits declined between March and May 2020. However, the researchers observed no significant difference in in-person visits for patients receiving inpatient infusions overall.

Using historical data to forecast what the rate of in-person visits would be if no pandemic had occurred, the visit rate averaged across oral therapy and outpatient infusions was 1.6 visits (95% PI, 1.4-1.7 visits) per patient per month, whereas the actual rate was 1.3 visits, according to the study. This showed a 21% reduction in in-person visits (95%, 12%-27%).

When specifically analyzing visit rates for patients with multiple myeloma, reductions pertaining to each treatment type were significant, the study shows. For those receiving oral therapy, the rate of in-person visits was 29% lower (95% PI, 21-36%) than the forecasted rate (P = .001).

Similar declines were seen in outpatient infusions, with an 11% decrease (95% PI, 4%-17%) compared to the forecast rate (P = .002), as well as inpatient infusions, with an observed decline of 55% (95% PI, 27%-67%) compared to the forecasted rate (P = .005). Declines were also seen in those with other diseases under the hematologic neoplasms umbrella, investigators found.

Patients with chronic lymphocytic leukemia had reductions in visits for oral therapy in April and May 2020 (28% [95% PI, 12%-39%]; P = .003) and outpatient infusions in April 2020 (20% [95% PI, 6%-31%]; P = .002). Patients with mantle cell lymphoma who underwent outpatient infusions had a 38% reduction in visit rates during April 2020 (95% PI, 6%-54%).

After the early pandemic months, in-person visit rates returned to normal compared to the forecasted rate across most diseases and treatment types, the researchers stated. Only patients with multiple myeloma had sustained decreases in in-person visit rates, with a 16% drop in oral therapy visits observed from July to August 2020 and January 2021 (95% PI, 2%-27%) and a 1% decrease in visits for outpatient infusions in June 2020 and January 2021 (95% PI, -9%-9%).

With pandemic restrictions in place for most of the country from March 2020 to February 2021, telemedicine use increased slightly, especially in the early pandemic months, the researchers observed. Across all diseases together, mean telemedicine visit rates were greatest in those who received oral therapy (0.07 [0.03] visits per patient per month) and inpatient infusions (0.07 [0.03] visits per patient per month), followed by outpatient infusions (0.05 [0.01] visits per patient per month).

Previous studies analyzing how in-person procedures and hospitalizations were affected by the COVID-19 pandemic have shown a decline in relation to conditions such as stroke or myocardial infarction. An overall decline in in-person visits has also been found in emergency, preventive, and ambulatory care.

As the investigators explain, studies connecting the pandemic and cancer care have been limited in scope, especially regarding patients with hematologic neoplasms.

“Although several studies have evaluated changes in cancer care delivery during the pandemic, most have focused on solid organ tumors and did not evaluate visit rates in relation to therapy type,” the researchers said.

The study noted that the low use of telemedicine in the observed cohort of patients requires further investigations, specifically in relation to whether socioeconomic barriers based on race, ethnicity, or sex have prevented broader access to telemedicine resources. In postulating their results, the researchers spoke of numerous variables being responsible for the decrease in in-person visits over the pandemic period.

Chief among these were changing national guidelines at the onset of the pandemic, in conjunction with the strain on health care systems due to the spread of the virus.

“An understanding of how global health crises like pandemics can affect health care delivery models and the role of tools such as telemedicine is critical to minimize future disruptions in oncologic care,” the investigators concluded.

Reference

Goyal G., et al. (2023) The COVID-19 Pandemic and In-Person Visit Rate Disruptions Among Patients With Hematologic Neoplasms in the US in 2020 to 2021. Journal of the American Medical Association. Available at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805573. Accessed June 14, 2023.