The Digital Divide in Cancer Care: The Main Problem Is Access, Not Use
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The First-Step Crisis in Cancer Patients' Digital Journey
How do the most vulnerable patients use digital health systems? Is the barrier using them, or getting through the door?
A quiet but profound shift is occurring in oncology: treatment is moving from hospital infusion units to patients' homes, and from intravenous therapy to oral targeted drugs . Although this home-treatment era offers comfort and freedom, it creates a new blind spot for clinicians.
Oral anticancer medicines require strong adherence and close symptom monitoring. Are patients taking them? Can they contact their doctor promptly when side effects begin? At this point, patient portals (digital health records) become a safety necessity rather than a luxury. But is technology equally accessible to every patient?
On November 19, 2025, the American Society of Clinical Oncology's respected publication JCO Oncology Practicepublished research led by Dr. Yenong Cao addressing precisely this problem. It shows how vulnerable patients risk exclusion from this digital component of modern cancer care.
Study Design and Methodology
This retrospective analysis at Tufts Medical Center in Boston examined digital behavior among patients starting oral anticancer treatment. Its details were:
- Sample: Among patients starting oral cancer treatment between October 2022 and March 2024, 280 patients were examined.
- Analysis Criteria: Researchers assessed "active use"—sending at least one message—and "meaningful use"—two-way patient–provider messaging.
- Proxy Analysis: English messages sent by patients who did not speak English, or message content, helped determine whether the patient or a family member used the portal.
Criteria for "Vulnerable" Patients
56% of the population met at least one of these criteria:
(20%)
(Language Barrier 26%)
(Medicaid 30%)
1. The Problem: Registering for the System (Getting Through the Door)
Vulnerable patients had substantially lower initial registration rates. Statistical analyses showed that, rather than age or insurance, the language barrier was the biggest obstacle.
A Surprising and Encouraging Finding
The key point: once vulnerable patients registered and overcame the barrier, their portal use and meaningful interactions were similar to other patients'. 31% of registered patients used the portal specifically to discuss oral medications.
Hidden Heroes: "Proxy" Users (Family/Companions)
Older patients and those with language barriers rely heavily on family members as proxies to use technology. This demonstrates that gaps in digital literacy can be overcome through social support .
Use through another person
Use through another person
👨⚕️ DROZDOGAN Academy Commentary:
From a health informatics perspective, this study shows that designing technology is not enough: we must also provide "digital navigation" support to help patients take the first step.
Especially for patients over 75 or facing language barriers, integrating not only the patient but also family members (children, grandchildren) into the system is key to improving adherence. When digital tools are accessible, even the most vulnerable patients can use them competently.
Source: Cao Y, Bate Baiyee MN, Ching J, et al. Epic Patient Portal Adoption Among Vulnerable Oncology Patients in the Era of Oral Anticancer Medications. JCO Oncol Pract. Published online November 19, 2025. doi:10.1200/OP-25-00630 Article Link
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