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

Abstract

Introduction: The content of this article deals with the experience of the navigation program for patients in a breast cancer diagnosis center of the State Health Department of Rio de Janeiro. The objective was to show how the patient navigation program can allow the proper application of the 60-day Law, being a topic of interest for the planning and evaluation of actions to control this cancer in Brazil. Methodology: The patient navigator accompanied women from the Unified Health System (Sistema Único de Saúde — SUS) with a diagnosis of breast cancer to start treatment at a specialized center within 60 days. Information on the clinical characteristics of the patients, clinical dates and barriers encountered were collected. Univariate logistic regression was used to assess factors associated with starting treatment within 60 days. Results: From January to July 2020, 301 breast biopsies were performed, 126 (42%) of breast cancer. The mean age was 54 years (26–88). 75% of the lesions were diagnosed in advanced stages (IIB to IV). The mean time to start treatment was 39 days (11–108). The main barriers found were: fear (93%), difficulty in communicating with the medical team (81%), uncoordinated health care (37%). Being treated outside the city of Rio de Janeiro (RJ) was the main factor associated with treatment within 60 days (79.5% vs. 20.5%, p < 0.001). Conclusion: The integration of the patient browser into work processes contributed to compliance with the 60-day Law in 86% of cases. In the context of a complex and fragmented healthcare system for a population in a situation of socioeconomic vulnerability, the patient navigation program proves to be a tool to increase the rate of law enforcement in Brazil.

Evaluation of clinical, pathological and epidemiological profile of patients with breast cancer in the microregion of Lavras – MG

“…In our study, it was found that the mean time between the first visit to the mastologist and the histological diagnosis of BC was 63.2 days, and the mean time between histological diagnosis and the beginning of treatment was 39.6 days. In a recent study conducted by Gioia et al in Rio de Janeiro, Brazil, the mean time to start treatment was 39 days 35 . It can be perceived in our study that the beginning of the treatment is within what is recommended by law; however, as observed in other studies, a delay is identified concerning the time of diagnosis of BC, with reports of the average delay reaching 142.5 days in other Brazilian surveys 36 .…”

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

“…It aimed to help women diagnosed with BC in the public system to start treatment at a specialized center within 60 days of diagnosis. As part of the BC PNP program, a trained social worker facilitated patients' navigation through the health care system by providing services such as diagnostic consultation scheduling, follow-up assistance, referral facilitation, and coordinating communication between patients and healthcare professionals 6,8 .…”

“…The central pillar is recognizing the importance of understanding the patient's experience to advance towards patientcentered care 8 . The problem of accessing healthcare services requires better solutions and for populations in areas where healthcare access is fragmented, and healthcare systems can be fragile and underfunded 8 .…”

“…Recent initiatives in Rio de Janeiro showed the effectiveness of BC patient navigation in the public health system at two diagnostic centers of SES RJ: Rio Imagem 6 and Heloneida Studart State Hospital 8 . The compliance rate with the "60-Day Law" increased from 10% to 52% in 2017 and from 22% to 86% in 2020, respectively.…”