Telehealth use and end-of-life care outcomes among Medicare decedents with cancers.

11012 Background: Telehealth has become an increasingly important care modality following the COVID-19 pandemic. For patients with cancer approaching end of life (EOL), telehealth may be particularly relevant given their substantial symptom burden, need for frequent healthcare services, and declining functional status. Telehealth may facilitate convenient access to care and enhance EOL care quality. However, limited research has examined associations between telehealth use and EOL care among patients with cancer. Methods: We conducted a retrospective, population-based cohort study of EOL telehealth use using 100% Medicare Traditional Medicare (TM) and Medicare Advantage (MA) claims. We included beneficiaries aged 66+ years with cancer who died in 2020-2023 with continuous enrollment in TM or MA during the 12 months preceding death. Patients with cancer were identified by at least 1 inpatient or 2 outpatient claims with relevant diagnosis codes. Telehealth use during the first 6 months of the last year of life was identified using procedure codes and modifiers. We examined validated claims-based EOL care outcomes, including hospice use and place of hospice care, and indicators of potentially burdensome transitions (e.g., late hospice enrollment ≤3 days of death, multiple hospitalizations and emergency department visits ≤30 days of death). Separate multivariable logistic regression models assessed associations between telehealth use and EOL outcomes. Results: Among a total of 2,897,720 Medicare beneficiaries with cancer who died in 2020-2023, mean age was 79.8 years; 44.9% were female, 9.4% were non-Hispanic Black, and 1.7% were Hispanic. Telehealth use in the first 6 months of last year of life was 30.0% in 2020-2023, with utilization peaking in 2021 (47.1%). Among all decedents, 60.7% enrolled in hospice; among hospice users, 73.1% received hospice care at home and 18.6% enrolled ≤3 days of death. In the last 30 days, 11.2% and 13.4% experienced multiple hospitalizations and ER visits respectively. In adjusted analyses, telehealth use was associated with 2.38 percentage points (ppts, 95%CI=2.25 to 2.50) higher likelihood of any hospice use. Among hospice recipients, telehealth use was associated with 5.45 ppts (95%CI=5.31 to 5.60) higher likelihood of home hospice use. Telehealth use was also associated with 2.18 ppts (95%CI=-2.31 to -2.05) lower likelihood of late hospice enrollment. Associations with multiple hospitalizations and ER visits were small and statistically non-significant. Conclusions: Telehealth use among Medicare decedents with cancer was associated with higher hospice use, particularly home hospice, and a lower likelihood of late hospice enrollment, suggesting potential improvements in EOL care transitions. These associations may reflect enhanced care coordination and continuity facilitated by telehealth during the EOL.