Digital Transformation, Equitable Access To Cancer Care, and Cancer-Related Financial Toxicity: Scoping Review (Preprint)
Authors: Sheehan Sarah M , Centra Jacob , Dudek Karrie , Ashing Kimlin , Beg Shaalan , Burgener Doug , Cooks Eric , Cordovano Grace , Doczi Robert , Gonzalez Brian , McCarter Joanna F , Farmer Miller Melissa , O'Reilly Cate , Pittinger Dawn N L , Wolff-Hughes Dana L , Wood WA , Zhang Connie , Goldsack Jennifer C , Leach Corinne R 
Published: April 2024

BACKGROUND

The use of digital health solutions by providers, health system staff, patients, and caregivers promises more equitable access to comprehensive cancer care and a positive impact on out-of-pocket costs for patients.The use of digital solutions within healthcare systems to improve equitable access to care and prevent or reduce costs that cause financial toxicity also has positive implications for health system cost savings, driven mostly by increased efficiency and revenue generation.

OBJECTIVE

To examine and document the impact of digital health solutions on access to cancer care, access to cancer clinical trials, and cancer-related financial toxicity, as well as any barriers and facilitators to digital health solution uptake.

METHODS

We searched PubMed for peer-reviewed articles published between 2018 and 2023 that described the effect of digital health solutions on access to cancer care, access to cancer clinical trials, and cancer-related financial toxicity. We included US-based studies written in English and pertaining to adult cancer patients. Articles were analyzed to document the effect of digital health solutions being used in oncology to impact access to cancer care, access to cancer clinical trials, and cancer-related financial toxicity, as well as any barriers to solution uptake. We reported findings in accordance with the PRISMA- ScR checklist.

RESULTS

Our search identified a total of 1009 unique records and we selected 136 after a title and abstract screen and full-text review. The vast majority of articles that studied the relationship between digital solutions and access to care (approximately 88%; 116/132) found that access to high-quality cancer care is potentiated by the purposeful implementation of digital health solutions. 93% (39/42) of articles examining the relationship between digital solutions and the cost dimension of patient financial toxicity found a positive impact. In this review, we discuss end-user characteristics, solution types, and the dimensions of digital health solution impact on patient access and cost, such as expedited access to cancer care and cost savings associated with averted travel and fewer work disruptions.

CONCLUSIONS

When cancer care is appropriately available to patients through digital interactions and integrated into patient and family life, access to high-quality care can be enhanced at a lower overall cost. To ensure that the positive effects of digital transformation in cancer care extend to all patient subsets, it is essential to address the factors that drive inequitable patient access to both digital health solutions and care. Going forward, a focus on health ecosystem policies to overcome identified barriers to uptake, including technology and internet access, and effective education to ensure technical proficiency, is essential.