Variations in patient portal enrollment and use by cancer site.
Authors: Morris Bonny , Topaloglu Umit , Bell Ronny A. , Strowd Roy E. , Weaver Kathryn E. , Falk Derek Sean , Lesser Glenn Jay 
Published: June 2022

e14013

Background: Patient portals support self-management, including symptom reporting and control, patient engagement, care coordination, and patient-provider communication, yet not all patients may be deriving the benefits of such digital health tools. Prior studies have not considered how enrollment or use may vary by cancer site, particularly among patients with rare and/or complex diagnoses like malignant brain tumors. Methods: We retrospectively examined portal enrollment and use at an NCI-designated comprehensive cancer center from January 2015 - February 2022 among patients 18+ years old diagnosed with cancer during this time period. We used multivariable logistic regression to generate odds ratios (ORs) for portal enrollment, and Poisson regression to determine incidence rate ratios (IRRs) for number of logins and number of healthcare team interactions (portal messages or appointment requests) by cancer site. Cancer site was categorized using ICD-10-CM codes C00-C96 as brain, breast, colorectal, endocrine, gynecologic, head/neck, leukemia, liver, lung, lymphoma, male genitourinary, melanoma, multiple myeloma, non-melanoma skin, pancreas, soft tissue, upper gastrointestinal (GI), urinary, and other. Regression models controlled for gender, race/ethnicity, relationship status, age, rurality, residential distance from the cancer center, and time since diagnosis. We conducted a subset analysis among patients with a malignant brain tumor diagnosis. Results: We identified 10,365 cancer patients, with 39% enrolled in the patient portal. Enrolled patients had a median of 203.5 total logins and 20 total healthcare team interactions. Enrollment and use significantly varied by cancer type. Patients with lung (OR: 0.24 [0.19 - 0.29]) and liver (OR: 0.27 [0.18 - 0.40]) cancers were the least likely to enroll in the portal. Patients with malignant brain tumors (IRR: 0.74 [0.73 - 0.76]; IRR: 0.57 [0.54 - 0.60]) and upper GI cancer (IRR: 0.64 [0.62 - 0.66]; IRR: 0.46 [0.41 - 0.51]) had the lowest login and interaction rates, respectively. In malignant brain tumors subset analyses, being single (OR: 0.14 [0.04 - 0.53]) or older (OR: 0.94 [0.90 - 0.97]) was significantly associated with lower portal enrollment. Rural residents (IRR: 0.90 [0.86 - 0.94]), divorced (IRR: 0.18 [0.16 - 0.21]) or single patients (IRR: 0.50 [0.47 - 0.52]), and older patients (IRR: 0.98 [0.97 - 0.98]) had lower login rates, while men had higher login rates (IRR: 1.95 [1.88 - 2.01]). Divorced, widowed, and single patients had lower portal interaction rates (IRR: 0.15 [0.08 - 0.26], IRR: 0.47 [0.29 - 0.76], IRR: 0.84 [0.73 - 0.96], respectively), while men had a higher interaction rate (IRR: 2.71 [2.39 - 3.10]). Conclusions: Interventions to support portal enrollment and use among patients with lung, liver, and upper GI cancers and subsets of patients with malignant brain tumors may enhance care quality among these patients with complex diagnoses at high risk for poor outcomes.