A patient navigation program to enhance access to care for undeserved patients with a suspicion or diagnosis of cancer in Mexico City.

Abstract

6544 Background: High cancer mortality rates in developing nations are partially driven by advanced stages at diagnosis and limited access to care. In Mexico, the interval from problem identification to start of treatment can be up to 7 months, mostly due to healthcare system delays. We implemented a patient navigation (PN) program aimed at reducing time to referral to cancer centers for patients (pts) with a suspicion or a diagnosis of cancer seen at a public general hospital in Mexico City. Methods: Pts age > 18 seen at Hospital General Ajusco Medio in Mexico City who required referral to a cancer center were enrolled. Baseline demographic, economic and psychosocial data were collected. A Patient Navigator assisted pts with scheduling; paperwork; obtaining results in a timely manner; transportation; and with other cultural barriers. The goal of the PN program was for at least 70% of enrolled patients to obtain a specialized appointment at a cancer center within the first 3 months from enrollment. Results: 53 pts (median age 54, range 19-80; 51% female) were included between 01/16 and 12/16. 19% (n = 10) had breast/GYN, 19% (n = 10) GU, 19% (n = 10) endocrine, 19% GI (n = 10) and 14% (n = 13) other tumors. All the pts were uninsured, 59% (n = 30) had less than middle school education, 80% (n = 41) were unemployed and 96% (n = 49) had a monthly household income of < $360 USD. 54% (n = 28) reported deprivation in at least one basic living need (education, running water, toilet, electricity or flooring). The most commonly identified barriers to healthcare access were financial (73%, N = 37), lack of transportation (47%, N = 24), fear (37%, N = 19) and poor communication with healthcare workers (35%, N = 18). Mean time to referral was 11 days (range 0–46, SD 11.2) and mean time to cancer specialist appointment 26 days (range 1–94, SD 21.18). 92% of pts successfully obtained appointments at a cancer center in < 3 months. Conclusions: Compared with previously reported data, this PN program shortened time to referral to a cancer center for pts with a suspicion or diagnosis of cancer in Mexico City. PN represents a potential solution to overcome barriers to healthcare access for underserved pts with cancer in developing countries.