Telehealth Versus In-Person Visits in Routine Oncology Care: Comparing Patient-Reported Symptom Outcomes

Background: Evidence is limited on how patient-reported symptoms relate to telehealth use and whether telehealth visits yield comparable symptom outcomes to in-person care in routine oncology practice. Methods: An observational cohort of adult patients who received cancer treatment 6 months to 3 years prior to a scheduled oncology visit across two academic medical centers and their affiliated community sites in North Carolina and Michigan was recruited. Pre- and postvisit telephone surveys were linked to electronic health records and geocoded data. Surveys assessed being offered a telehealth visit option and six symptoms (fatigue, pain, insomnia, anxiety, sadness, and discouragement). Chi-square tests were used to compare patient-reported symptoms by visit modality, and logistic regression was used to examine symptom associations with being offered and accepting telehealth visits. Propensity score–weighted changes in symptom composite scores pre- to postvisit were compared by visit modality. Results: Among 610 patients (496 in-person and 114 telehealth visits), symptoms were common (fatigue 79.7%, pain 73.9%, insomnia 65.9%, anxiety 62.5%, sadness 64.4%, and discouragement 35.1%). A telehealth visit option was offered to 24.8% of patients, among whom 66.2% accepted it. Patients reporting sadness were less likely to be offered a telehealth visit than those without sadness (22.1% vs. 29.5%; p = 0.04) and, if offered, were less likely to accept a telehealth visit (59.8% vs. 75.0%; p = 0.03). In contrast, patients reporting pain were more likely to be offered telehealth than those without pain (26.6% vs. 19.5%; p = 0.04). Changes in composite symptom scores from pre- to postvisit were small and not statistically significant for either in-person (95% confidence interval [CI]: −0.05, 0.01) or telehealth visits (95% CI: −0.12, 0.05). Conclusion: Although access to telehealth oncology visits varies by symptom presentation, routinely offered and accepted telehealth visits appear to lead to near-term symptom outcomes similar to in-person visits.