Purpose Telehealth has become a mainstay of modern healthcare, post-COVID-19 pandemic era. Telehealth has increased access to healthcare providers across various regions, potentially reducing access disparities. Currently no studies exist evaluating the impact of telehealth on access equity in thoracic surgery. This paper aims to assess if telehealth increases access to thoracic oncologic surgery in disadvantaged communities.

Methods A retrospective single institution review of thoracic surgery patients with an oncologic indication from March 2018 to November 2022 was conducted. Patients were stratified into office or telehealth groups based on the type of their first preoperative consultation visit. Patients being assessed for esophageal malignancy or mediastinal staging alone were excluded. Demographic data included age, sex, location by county, and state. Primary outcomes were median Area Deprivation Index (ADI) for state deciles and national percentiles for in-office and telehealth patients. The Area Deprivation Index (ADI) is a ranking of socioeconomic disadvantaged neighborhoods at the state or national level with consideration for factors such as income, education, employment status, and housing. Mann-Whitney U tests were used to analyze the ADI difference between groups.

Results 759 patients met inclusion criteria, including 376 in office and 383 telemedicine. All telemedicine visits were audio only and conducted over the phone. There were no demographic differences between groups based on age (p=0.3) or sex (p=0.9). There was a total of 62 unique counties represented among all patients in this cohort. The majority of patients resided in Oregon (628/759, 82.74%) and Washington (108/759, 14.23%). Median ADI for national percentiles and state deciles can be seen in Table 1. The median ADI of telehealth patients was significantly higher than that of in office patients (34 v. 32, p<0.01). Similar results for telemedicine and in-office patients were found when evaluating Oregon specific ADIs (5 v 6, p<0.01). There was no difference in State ADIs for patients from Washington (p = 0.156).

Conclusions Overall, patients in the telemedicine group had a higher disadvantaged rating than their in-office counterparts nationally and in Oregon. Telemedicine improves access to thoracic surgeons for patients from socioeconomically disadvantaged neighborhoods, addressing the unequal distribution of physicians and healthcare systems in these areas. Further studies should be conducted to evaluate the role of telehealth in increasing health equity in thoracic surgical cancer care.