Telemedicine follow-up in oncology: real-world participation, utilization, and end-of-life hospitalizations

Background Telemedicine, including secure messaging and electronic patient-reported outcomes, is increasingly integrated into oncology for home dwelling patients, yet real-world uptake and usage documentation vary. Selective participation may limit population-level impact and risk widening inequities. Evidence on non-participation in routine cancer care and how use relates to end-of-life (EOL) hospitalizations remains limited. Methods We conducted a retrospective study at a secondary cancer department on a hospital-based telemedicine program that integrated structured symptom assessments and secure chat messaging with the oncology unit. The primary objective was to characterize participation in the telemedicine program and to describe patterns of platform utilization among participants, with particular focus on secure message use. The secondary objective was to explore end-of-life hospitalization patterns, including (i) the interval between last hospitalization and death and (ii) in-hospital death among decedents. Data were derived from telemedicine platform logs, electronic health records and administrative registry data. Analyses summarized participation, usage, and associations with key patient and clinical characteristics. Results A substantial proportion (36%) did not participate. Among participants, secure messaging was more frequently used than structured symptom assessments, suggesting a preference for low-threshold, interactive communication. Message utilization was lower among older adults and males and varied by cancer diagnosis. Patients receiving intravenous systemic anticancer therapy were more likely to utilize secure messaging, possibly reflecting greater supportive needs. In exploratory analyses of a subset of deceased patients with available data, higher messaging utilization was associated with a shorter interval between last hospitalization and death, but not in-hospital death. Conclusions The value of telemedicine oncology depends on context-sensitive, equity-oriented implementation. Programs should be tailored to patient characteristics and treatment phases, combine low-threshold communication with streamlined symptom monitoring, and be embedded within broader care networks with clear escalation pathways and interoperability with primary and community care. Prospective mixed methods and time sensitive analyses can clarify temporal relationships between telemedicine and hospitalizations and evaluate integrated hospital–community models using outcomes beyond service use, including responsiveness, continuity, and goal-concordant care.