Bridging the divide: Impact of remote expert oncology opinions on populations facing socioeconomic and geographic inequalities.

214 Background: Oncology second opinions have been shown to improve cancer care by aligning treatment with evidence. However, which patients benefit most from remote expert opinions is unclear, particularly in relation to socioeconomic status and geography. Methods: AccessHope provides remote, asynchronous, expert opinions by oncologists at National Cancer Institute-designated comprehensive cancer centers as a supplemental benefit to payers, including employer self-funded plans. We conducted a population-based, retrospective analysis to evaluate evidence-based expert recommendations provided through this service. We used Area Deprivation Index (ADI) as a measure of patient socioeconomic status, categorized into three groups: least, medium, and most disadvantaged. We used Rural-Urban Commuting Area (RUCA) codes to assess geographic classification of patient residence (urban vs. non-urban). We used logistic regression to analyze the relationship between recommended changes in care, ADI, and RUCA while adjusting for age and gender. Results: Between 1/2020-12/2024, we reviewed cases from 5137 patients living in 50 states. Median age was 57, and 48% were female. The most common cancer diagnoses were colorectal (15%), breast (11%), and lung (10%). Expert opinions recommended a change in cancer treatment in 52% of cases. Changes in supportive care were recommended in 32% of cases. Recommendations for tumor testing, including comprehensive molecular profiling, were made in 28% of cases, and germline testing was recommended in 11% of cases. Clinical trial options were identified in 34% of cases. Recommendations for next steps upon cancer progression or recurrence were made in 46% of cases. ADI scores were available for 69% of the cohort (n = 3569). Of those, 42% were categorized as least disadvantaged, 30% medium, and 28% most disadvantaged. RUCA codes were available in 45% of the cohort (n = 2296). Of those, 79% were urban and 21% were non-urban. Changes to the cancer treatment regimen were more frequently recommended for the most socioeconomically disadvantaged vs. less disadvantaged patients (OR 0.23; 95% CI 0.07-0.39; p < 0.01), and for patients living in non-urban areas vs. urban areas (OR 0.29; 95% CI 0.09-0.49; p < 0.01). Supportive care changes were more frequently recommended for patients living in non-urban areas vs. urban areas (OR 0.29; 95% CI 0.08-0.49; p < 0.01). Conclusions: More than half of remote expert opinions recommended changes in cancer treatment, and nearly a third recommended changes in supportive care. Remote expert opinions for patients living in socioeconomically disadvantaged or non-urban settings were most likely to recommend changes in care. These findings highlight remote expert opinions as a vital tool to reduce socioeconomic and geographic disparities in cancer care.