Connecting care-telemedicine breaks barriers for low-income Brazilians battling breast cancer: a prospective cohort study.

Abstract

Background: Telemedicine may help advance healthcare equity, particularly in low-income communities, by reducing economic burdens and mitigating geographic barriers to specialized care, including transportation costs, time away from work, and long travel distances to referral centers.

Objectives: This study aims to evaluate the impact of a remote consultation protocol on healthcare access among predominantly low-income patients with breast cancer in Brazil.

Design and setting: This prospective cohort study was conducted at a tertiary public cancer center and included 946 women with breast cancer.

Methods: Sociodemographic characteristics, teleconsultation-related data, and patient satisfaction measured using a validated Likert-based questionnaire were collected. The study was approved by the local ethics committee, and all participants provided informed consent.

Results: The mean age was 57.3 years. Overall, 51.6% of participants identified as white, and 64.4% reported a family income below two Brazilian minimum wages. Over one-third (34.3%) had not completed elementary school. Despite this socioeconomic vulnerability, 93.5% reported internet access, 90.3% owned a mobile phone, and 52.7% had an email address. During the study period, 946 appointments were scheduled and screened for teleconsultation eligibility. Among these, 229 patients met predefined eligibility criteria and were offered teleconsultation, and 117 completed the remote visit, corresponding to an uptake of 51.1% among eligible patients. Regarding hospital visits, 57% relied on public transportation, with a mean cost of $ 4 per visit, representing a substantial financial burden. Travel time exceeded 90 minutes for 19.4% of patients. Satisfaction with teleconsultation was high, with a mean Likert score of 4.65/5 and a Net Promoter Score of 79.8.

Conclusion: Among patients eligible for telemedicine, more than half completed teleconsultation, indicating that implementation is feasible even in socially vulnerable populations with limited digital literacy. The remote care protocol improved access, reduced financial burden, and achieved high patient satisfaction, supporting telemedicine as a strategy to promote equity in breast cancer care in Brazil.