**Background:** The COVID-19 pandemic severely disrupted cancer care globally, with particularly severe consequences expected in low- and middle-income countries (LMICs) where cancer care infrastructure was already constrained. In Rwanda, Partners In Health/Inshuti Mu Buzima (PIH/IMB) collaborated with the Butaro Cancer Center of Excellence (BCCOE) to mitigate disruptions by providing free transportation to treatment sites and medication delivery to patients' local health facilities. This study aimed to assess the relationship between facilitated access to care and self-reported wellbeing outcomes among cancer patients, and to evaluate whether the association differed by baseline socioeconomic status.
**Methods:** This cross-sectional telephone survey included adult cancer patients enrolled at BCCOE by March 22, 2020, who resided in Rwanda, had a telephone number in the EMR, and were alive at data collection (August 2021). Stratified simple random sampling was used to select patients who did and did not receive facilitated access to care. The study was powered to detect a 10-point increase in EORTC QLQ-C30 quality of life (80% power, 5% type 1 error), requiring a total sample of 214 (86 facilitated, 126 non-facilitated). Data were collected via 35-minute phone interviews between September 6 and October 6, 2021. Quality of life was assessed using EORTC QLQ-C30, depression using PHQ-9 (range 0–27), anxiety using GAD-7 (range 0–21), and financial toxicity using COST (range 0–44). Linear regression was used to compare outcomes between groups, with crude, minimally adjusted (controlling for baseline characteristics associated with facilitation at p ≤ 0.20), and fully adjusted models. Secondary analyses assessed disparities by wealth quintiles and whether wealth modified the association between facilitation and wellbeing.
**Key Results:** Of 343 patients contacted, 214 (62%) participated; non-response was due to unreachability (25%) or death (12%). Of 214 respondents, 34.6% received facilitated access to care. Facilitated patients were significantly more likely to have breast cancer (56.8% vs. 35.7%, p < 0.01) and be on chemotherapy (90.5% vs. 64.0%, p < 0.01). Over half of all patients (53.3%) reported missing or delaying appointments, and 26.6% had no in-person oncology encounters during the first 17 months of the pandemic. Only 9.8% reported any telemedicine consultation. Facilitated patients had significantly more in-person clinical encounters (87.8% had at least one vs. 64.7%, p < 0.01), were more likely to perceive improved quality of care (37.8% vs. 21.4%, p = 0.03), and reported fewer logistical barriers to transportation (24.3% vs. 42.9%, p < 0.01). Overall wellbeing was low: mean global quality of life was 37.5 (SD ± 22.4), mean PHQ-9 was 8.4 (SD ± 6.7) with 63.1% scoring ≥ 5, mean GAD-7 was 6.4 (SD ± 5.9) with 55.9% scoring ≥ 5, and mean COST was 9.3 (SD ± 7.9) out of 44. In the minimally adjusted model, facilitation was significantly associated with better global health status (β = 9.14, 95% CI: 2.3–16.0, p < 0.01) and improved COST (β = 2.62, 95% CI: 0.2–5.0, p = 0.03). No significant associations were found for depression, anxiety, or other quality of life domains. Socioeconomic disparities were significant across most wellbeing dimensions, with poor-middle patients consistently reporting worse outcomes than the richest patients. Wealth category did not significantly modify the association between facilitation and wellbeing, and facilitation did not eliminate disparities between richer and poorer patients.
**Clinical Implications:** This study provides evidence that facilitated access to care during the COVID-19 pandemic was associated with some improvements in access to cancer care and patient wellbeing, including better global quality of life and reduced financial toxicity. However, the overall low levels of wellbeing, high prevalence of depression and anxiety, and persistent socioeconomic disparities indicate that current interventions are insufficient. The findings highlight the need for more robust, equity-minded interventions—such as improved telemedicine infrastructure, holistic nutrition assistance, and broader eligibility criteria for social support—to promote better outcomes for cancer patients, particularly during health emergencies. The study's limitations include potential selection bias due to differential non-response and death, possible misclassification of exposure, and reliance on self-reported data via telephone surveys.