Connected care in a digital world: Engagement and telehealth use in older cancer survivors.

INTRODUCTION: As the number of older cancer survivors (OCS) grows in number, telehealth can enhance their healthcare access, yet uneven digital engagement may exacerbate existing gaps in survivorship care. We aimed to describe digital technology and telehealth use among OCS and assess how sociodemographic and psychosocial factors are related to digital health and telehealth use. MATERIALS AND METHODS: We analyzed the Health Information National Trends Survey 7 (HINTS 7; March-September 2024) respondents aged ≥60 years (N = 691; analytic N = 638). Survey-weighted logistic regression models with multiple imputation were used to evaluate relationships between sociodemographic and psychosocial factors and digital engagement and telehealth use. RESULTS: Digital engagement was common but variable among OCS. Most reported frequent internet use (81.5%; n = 571) and smartphone use (78.9%; n = 545), while fewer used tablets (41.2%; n = 285) or participated in telehealth visits in the past year (33.1%; n = 229). However, 63.7% (n = 440) expressed willingness to use telehealth in the future if it were offered. Compared with ≥$100 k, income $50 k-$99 k and < $50 k were associated with lower odds of broadband access (aOR 0.28; 95%CI: 0.11-0.75 and aOR 0.38; 95%CI: 0.17-0.86), and viewing test results online (aOR 0.20; 95%CI: 0.08-0.51 and aOR 0.14; 95% CI: 0.05-0.38). Lower education was associated with reduced desktop/laptop use (aOR 0.30; 95%CI: 0.11-0.79 and aOR 0.24; 95%CI: 0.08-0.71) and provider messaging (aOR 0.34; 95%CI: 0.18-0.64). Black OCS had lower odds of broadband access (aOR 0.43; 95%CI: 0.20-0.95) but higher odds of cellular internet use (aOR 2.70; 95%CI: 1.21-6.05). Depression/anxiety was associated with lower odds of viewing test results (aOR 0.40; 95%CI: 0.19-0.84) but higher odds of technology frustration (aOR 4.44; 95%CI: 1.79-11.03). Female participants had higher odds of willingness to use telehealth (aOR 2.15; 95% CI: 1.19-3.90). DISCUSSION: Digital engagement among OCS is widespread but uneven, with persistent gaps by income, race, and education. Addressing gaps in access, connectivity, and digital literacy will be essential to ensure improved telehealth-enabled survivorship care.