Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer

Abstract

Background Interventions aimed at improving access to timely cancer care for patients in low‐ and middle‐income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. Materials and Methods From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. Results Seventy patients (median age 54, range 19–85) participated in this study. Ninety‐six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0–49), and time to specialist appointment was 27 days (range 1–97). Ninety‐one percent of patients successfully obtained appointments at cancer centers in <3 months. Conclusion Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. Implications for Practice A patient navigation program for patients with suspicion or diagnosis of cancer in a second‐level hospital was feasible and acceptable. It reduced patient‐reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

Patient navigation services for cancer care in low-and middle-income countries: A scoping review

“…Yet, few studies have focused on the role that patient navigation might play in cancer care in LMICs or on how these services can affect health outcomes in countries with fragmented or fragile health systems. In the 14 studies included in the review, the types of patient navigation services that were offered mirrored those provided in HICs, notably facilitating linkages to follow-up services [6, 31–35], providing counselling [6, 33, 34, 36–39], providing financial support [40], coordinating appointments [32, 33, 35, 39–43], and maintaining communication with patients and families [40, 41, 43].…”

“…While over half of the papers reported on all three types of outcomes (clinical, process and implementation), none of the outcomes demonstrated whether the patient navigation intervention increased the likelihood of survival or improved long-term health outcomes for the patient. For example, articles consistently reported on outcomes such as rates of follow up [6, 31, 33, 38–43], reach or uptake of the patient navigation intervention [6, 31, 38, 40–42], and treatment adherence and/or retention [37, 38, 40] and screening rates [38, 40, 41]. This has been a research challenge in HICs as well; data is limited regarding the impact of patient navigation interventions on cancer-specific survival [47, 48].…”

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

“…18 30 60 88 These publications were from the UK, 60 Australia 30 88 and Mexico. 18 A fifth publication only used the patients' area of residence as part of their model. 95 All of the publications were on multiple cancer types and adult populations, although one included a paediatric population.…”

Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group

“…Many studies in various countries have reported the efficacy of a patient navigation system to overcome the transportation barrier [30][31][32]. The patient navigator assessed many factors that can impact on patient care such as financial burden, medical insurance, fear, and disability through a psychosocial interview, arranged for the appropriate mode of transportation, and monitoring the patient to ensure that they received the appropriated medical care.…”