DISPARITIES in the use of patient portal messaging remain prevalent among oncology patients, even among those who are already enrolled, according to a large retrospective study from an urban academic cancer center.
The analysis included over 100,000 adults with cancer, all of whom were registered on the institution’s electronic health record portal between 2011 and 2025. Researchers evaluated disparities in portal-based messaging behavior, specifically whether patient-initiated messages to, or received messages from, their oncology providers as the first entry in a message thread. Cox proportional hazards models adjusted for demographic, socioeconomic, and clinical factors were used to assess likelihood of messaging activity.
Findings revealed consistent disparities across several dimensions. Patients aged 50 or older, those who identified as Latinx or Pacific Islander, individuals who were single or widowed, and those preferring a non-English language were all less likely to initiate or receive provider messages. Insurance type also played a role: patients on Medicaid or Medicare were less likely to engage in two-way messaging compared with those with private insurance. Additionally, Black and American Indian/Alaska Native patients were significantly less likely to send messages to their oncology teams.
Interestingly, provider gender was linked with messaging likelihood. Patients with female providers had a higher probability of both sending and receiving portal messages. Women, regardless of provider, were also more likely than men to initiate communication through the portal.
Although prior studies have focused on disparities in portal enrollment, this study highlights that disparities in digital communication persist even after patients have enrolled. As secure messaging has been linked to improved outcomes in cancer care, including better survival rates, the authors underscore the need for strategies that go beyond improving enrollment to ensure equitable use of communication tools among diverse oncology populations.
Reference:
Alexander J, Beatty AL. Disparities in Patient Portal Messaging Among Oncology Patients Enrolled in the Patient Portal. JCO Clin Cancer Inform. 2025;9:e2400234. [Online ahead of print]
