The Impact of Telehealth Visits on Access to Transplant Care for Recipients of Allogeneic Hematopoietic Cell Transplantation in the State of Oregon

Background Oregon Health & Science University is the only center for allogeneic hematopoietic cell transplantation (HCT) in the state of Oregon and nearby region, with the closest next center almost 200 miles away. Patients are required to relocate within 30 miles from the transplant center through day 100 and then transition back to their area of residence. Patients are encouraged to follow-up in person at specific time points after day 100, however, this was not feasible during the COVID19 pandemic. Rapid adaptation of telehealth across state lines during the pandemic allowed for this alternative modality of care. Methods We conducted a retrospective study to evaluate the use of telehealth and its impact on access to care and survival by sociodemographic characteristics of adult patients 18 years and older who underwent allogeneic HCT between 2019 and 2022 for high-risk hematologic malignancies. Patients were included if they were discharged from the hospital from their transplant admission and were alive after day 100. Data collected included age, biological sex, race/ethnicity, disease type, insurance, and zip-codes. Zip-codes were used to estimate poverty level as defined by American Community Survey, rural-urban continuum codes and distance to the treatment center. Results There were 268 patients with high-risk hematologic malignancies including MPAL (2%), MDS (27%), AML (48%) and ALL (23%) who underwent allogeneic HCT using matched related (19%), unrelated (66%), or haploidentical (15%) donor grafts. Median age was 57 years (18-76) with 31% older than 65 years, 48% female, 16.4% were non-White, 9.7% Hispanic and 6.7% non-White/non-Hispanic. 36% of those younger than 65 years had public insurance, 78% of those over 65 had Medicare and 1.5% were uninsured. Most patients were from metropolitan areas (84.7%), while 31% lived >60 miles and 14.9% lived >120 miles from our institution. 51% lived in neighborhoods at or below the poverty level. A total of 137 (51%) patients had telehealth visits between day 100 and 1-year post-HCT (median 4, range 1-22 visits). Use of telehealth was not statistically different by age, gender, race/ethnicity or type of insurance. Patients who lived >30 miles, in nonmetropolitan areas or in areas at/above poverty level were more likely to use telehealth than their counterparts (Table 1). On univariate model, use of telehealth did not result in a negative impact to overall survival or non-relapse mortality (Figure 1). Conclusions The incorporation of telehealth is feasible and potentially safe in allogeneic HCT patients after day 100. Older age, gender, poverty or ethnicity did not represent barriers to telehealth use and may have resulted in improved access for those living in areas remote to the transplant center. Future prospective studies could validate our findings and identify a comprehensive model for telehealth for HCT survivors.