Disparities in Cancer Patients’ Portal Usage During Hospitalizations

Background and objective: Patient portals are crucial for successful transition after hospitalization, especially for cancer patients with complex treatment plans. This study aimed to identify inequities in hospitalized cancer patients’ portal use. Methods: This retrospective analysis assessed portal usage at a high-volume cancer hospital in 2022 and 2023. We assessed whether patients ever logged in, and their login rates, during hospitalizations and Intensive Care Unit (ICU) admissions. Multivariate logistic and Poisson regression models evaluated relationships between demographic and care characteristics and inpatient portal usage. Results: Of 28,386 patients, most were female (15,107, 53%), non-Hispanic (24,177, 91%) and White (20,643, 77%); the median age was 65 (IQR 54,75) and the median length of stay was 4 days (IQR 2,8). 65% (18,588) logged in at least once during hospitalization. Patients who were Black (OR=0.68, 95% CI (0.62, 0.74), p<0.001; IRR=0.68, 95% CI (0.62, 0.73), p<0.001), single (OR=0.80, 95% CI (0.75, 0.86), p<0.001; IRR=0.88, 95% CI (0.83, 0.93), p<0.001), and with Medicaid insurance (OR=0.79, 95% CI (0.71, 0.87), p<0.001; IRR=0.86, 95% CI (0.8, 0.94), p<0.001) were, respectively, 32%, 20%, and 21% less likely to use the portal at least once, and their login rates were 32%, 12%, and 14% less, compared to white, partnered, and commercially insured patients. Of the 1,782 patients with ICU admissions, 971 (55%) logged in at least once during hospitalization. Black patients were 41% (OR=0.59, 95% CI (0.43, 0.80), p<0.001) less likely to use the portal at least once and their login rates were 41% less (IRR=0.66, 95% CI (0.51, 0.85) p=0.001) than white patients. Conclusion: We uncovered disparities in hospitalized cancer patients’ portal usage by race, insurance, and partnership status. Future work should explore the underlying reasons and leverage these insights so that portal onboarding processes and interface designs address the needs of all patients.