STATA dataset and do file.

During the COVID-19 pandemic in Rwanda, Partners In Health Inshuti Mu Buzima collaborated with the Butaro Cancer Center of Excellence (BCCOE) to mitigate disruptions to cancer care by providing patients with free transportation to treatment sites and medication delivery at patients’ local health facilities. We assessed the relationship between facilitated access to care and self-reported wellbeing outcomes. This cross-sectional telephone survey included cancer patients enrolled at BCCOE in March 2020. We used linear regression to compare six dimensions of quality of life (EORTC QLQ-C30), depression (PHQ-9), anxiety (GAD-7), and financial toxicity (COST) among patients who did and did not receive facilitated access to care. We also assessed access to cancer care and whether patient wellbeing and its association with facilitated access to care differed by socioeconomic status. Of 214 respondents, 34.6% received facilitated access to care. Facilitated patients were more likely to have breast cancer and be on chemotherapy. Facilitation was significantly associated with more frequent in-person clinical encounters, improved perceived quality of cancer care, and reduced transportation-related barriers. Facilitated patients had significantly better global health status (β = 9.14, 95% CI: 2.3, 16.0, p <0.01) and less financial toxicity (β = 2.62, 95% CI: 0.2,5.0, p = 0.03). However, over half of patients reported missing or delaying appointment. Patient wellbeing was low overall and differed by patient socioeconomic status, with poor patients consistently showing worse outcomes. Socioeconomic status did not modify the association between facilitated access to care and wellbeing indicators. Further, facilitation did not lead to equitable wellbeing outcomes between richer and poorer patients. Facilitated access to care during COVID-19 pandemic was associated with some improvements in access to cancer care and patient wellbeing. However, cancer patients still experienced substantial disruptions to care and reported low overall levels of wellbeing, with socioeconomic disparities persisting despite facilitated access to care. Implementing more robust, equity-minded facilitation and better patient outreach programs during health emergencies may promote better care and strengthen patient care overall and effect better patients’ outcomes.

在卢旺达新冠疫情期间，健康伙伴组织因舒蒂·姆·布齐马（Partners In Health Inshuti Mu Buzima）与布塔罗卓越癌症中心（Butaro Cancer Center of Excellence，BCCOE）合作，通过为癌症患者提供免费就医交通服务以及在患者本地医疗机构配送药物的方式，缓解诊疗服务中断问题。本研究旨在评估便捷就医帮扶与患者自我报告的健康结局之间的关联。本次横断面电话调查的研究对象为2020年3月在BCCOE入组的癌症患者。我们采用线性回归方法，对比了接受与未接受便捷就医帮扶的患者在生活质量（欧洲癌症研究与治疗组织生活质量问卷C30，EORTC QLQ-C30）、抑郁症状（患者健康问卷9项版，PHQ-9）、焦虑症状（广泛性焦虑障碍7项量表，GAD-7）以及经济毒性（经济毒性量表，COST）六个维度的差异。我们同时评估了癌症诊疗服务的可及性，并分析了患者健康状况及其与便捷就医帮扶的关联是否因社会经济地位而异。在214名受访者中，34.6%的患者接受了便捷就医帮扶。接受帮扶的患者更易罹患乳腺癌且正在接受化疗。帮扶措施与更频繁的线下临床就诊、更高的癌症诊疗感知质量以及更低的交通相关就医障碍显著相关。接受帮扶的患者总体健康状况显著更佳（β=9.14，95%CI：2.3，16.0，p<0.01），经济毒性更低（β=2.62，95%CI：0.2，5.0，p=0.03）。然而，超过半数的患者报告称错过或推迟了诊疗预约。整体而言，患者健康状况不佳，且因社会经济地位不同存在差异：贫困患者的健康结局始终更差。社会经济地位并未改变便捷就医帮扶与健康结局指标之间的关联。此外，帮扶措施并未缩小贫富患者之间的健康结局差距。新冠疫情期间的便捷就医帮扶与癌症诊疗可及性及患者健康状况的部分改善相关。但癌症患者仍面临较为严重的诊疗中断问题，整体健康状况自评水平较低，且即便实施了便捷就医帮扶，社会经济差距仍持续存在。在卫生紧急事件期间推行更完善、兼顾公平的帮扶举措，并优化患者外展服务（patient outreach）项目，或可进一步提升诊疗服务质量，改善整体患者诊疗体验，进而优化患者结局。