Improvement of the "Law of 60 Days" by Implementing Patient Navigation Within the Breast Cancer Program: Pilot Project in Rio De Janeiro

Abstract

Background: Patient Navigation Program (PNP) assists patients to reduce delays in diagnosis and treatment. A study was conducted on how PNP in Rio de Janeiro, Brazil, could promote adherence to the "Law of 60 Days", which states that all patients with cancer within the public system should start treatment within 60 days after diagnosis of cancer. Materials and Methods: From August 2017 to May 2018, 105 patients aged 33-80 years (mean 59 years) were recruited for Patient Navigator. Follow-up was by phone, email, or text message. PNP implemented at Rio Imagem was designed to: 1) collect important data on specific barriers, and 2) ensure that at least 70% of the patients recruited with breast cancer initiate treatment within the mandatory 60-days period. Results: Patients presented with stage 0 (4%), I-IIA (38%), IIB-IIIB (48%) and IV (5%). These included barriers to compliance with the law: fear and fatalistic thoughts (99%), financial burden (79%), uncoordinated health care (76%), attitudes towards providers (75%), duplicity of pre-treatment exams (52%), patient-provider communication (52%), transport (42%), scheduling (24%), and queues for surgical treatment (12%). PNP had 100% patient satisfaction and in 52% of the cases it helped the patients to start treatment within the period established by law. Conclusion: PNP in Rio did not reach the success rate a 70% to comply with the law, as intended (it reached 52%). However, the barriers that PN did not manage to overcome the lack of human resources and medical supplies, were informed to the health authorities and to the hospital managers.

Patient navigation: fighting for the rights of breast cancer patients in Brazil

“…The help of the navigator was important to reduce the barriers encountered by patients. The solutions found include: explaining the health system, educating patients about the diagnosis and medical procedures, and showing the importance of attending appointments and taking exams (educational barrier); providing more details about the treatment of the disease and referring patients to support groups or individual psychological support (emotional barrier); explaining about the diagnosis and treatment and advising patients about not being alone in this process and communicating the individual needs of each patient with the medical staff (cultural barrier); coordinating appointments for treatment services and ensuring that the tests needed to start treatment are available to doctors (health system barrier) 10 . Historically, cancer is perceived as an intractable and devastating disease, with an outcome directly associated with death.…”

“…The main barrier reported by patients was fear and fatalistic thoughts (93%), as seen in the pioneer study in Rio Imagem in 2018 10 and of Latino populations in the United States 17 . In this sense, the feeling of hope must be encouraged to be part of the patients' trajectory.…”

“…This law establishes that treatment for any type of cancer for patients in the public health system must start within 60 days of the definitive diagnosis 9 . In a recent initiative in Rio de Janeiro (RJ), the effectiveness of patient navigation in the public health system from a diagnostic center was proven through an increase in the rate of compliance with the 60-day Law from 10% to 52% 10 . This study showed the main factors that contribute to compliance with the Law in Rio de Janeiro 11 : • improvement in the structure and processes of diagnostic services (histopathological report with the identification of the molecular subtype, delivery of the report in a medical consultation, direct insertion into the system regulation, performance of staging exams); • patient navigator acting on the main barriers (fear and fatalistic thoughts and uncoordinated health care); • treatment outside the capital of Rio de Janeiro.…”

Patient Navigation Improved Breast Cancer Outcomes Among Women in the Public System in Rio de Janeiro, Brazil

“…Rio de Janeiro has the lowest compliance rate with the "60-Day Law". Ministry of Health data show that in Rio de Janeiro over 90% of women do not start treatment within the mandatory 60-day period 6 .…”

The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study

“…In Brazil, navigation for patients with chronic diseases is still under development, with no published studies on patient navigation for individuals with type 1 diabetes mellitus (T1DM). However, a navigation program for cancer patients has already been developed [ 11 , 12 ], and a pilot project, which lasted one year and included 105 patients, showed an increased referral rate of patients before 60 days of diagnosis from 6 to 52% in cases of breast cancer [ 11 , 13 ].…”