Patient navigation (PN) support to timely access to radiotherapy in the Brazilian public health system

• Published in: Supportive care in cancer Vol. 31; no. 3; p. 182
• Main Authors: Vieira, Carolina M., Diniz, Paulo H. C., Dizon, Don S., Nogueira-Rodrigues, Angélica
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2023; Springer; Springer Nature B.V
• Subjects: Biopsy; Brazil; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chronic diseases; Continuity of care; Health care access; Health care industry; Humans; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Patient Navigation - methods; Patient satisfaction; Pilot Projects; Public Health; Public services; Radiation therapy; Radiotherapy; Rehabilitation Medicine; Retrospective Studies; Brazil; Patient navigation; Obstacles to treatment; Vulnerability
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-023-07615-8

Purpose Patient navigation (PN) is a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to integral care. Considering the complex difficulties in accessing treatment and the positive results of PN in high-income countries, our group decided to evaluate this tool to improve radiotherapy (RT) access in the public system in Brazil. Patients and methods This pilot study took place in a public school hospital, with a historical cohort as the control arm. The primary endpoint was the time from histologic diagnosis and RT initiation among cancer patients receiving RT with curative intent in a PN program. The secondary objectives were the following time frames: referral to the first consultation by the RT team; first consultation up to RT beginning; RT beginning to RT end; referral to the end of RT and identifying/describing obstacles to the treatment; and assessing patient satisfaction with PN program. Results A total of 124 patients were included in the retrospective arm and 73 in the navigation arm. Most had the loco-regionally advanced disease from the esophagus, head/neck, and rectum. PN decreased the median time from the biopsy result to the beginning of RT from 108 to 74 days ( p  < 0.001). PN reduced the time between biopsy results and referral to RT (53 to 40.5 days, p  = 0.011), between the referral and the first consultation in the RT (25 to 13 days, p  < 0.001), and between the referral to the end of the RT (98 to 78 days, p  < 0.003). Conclusions Proper identification of barriers, especially in a low-resource setting, is mandatory to guide PN programs in LMICs. In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely RT.