The Effect of a Patient Navigator on Treatment Abandonment and Follow-up for High Grade Osteosarcoma Patients in the Philippine General Hospital

Abstract

Introduction: Treatment abandonment for osteosarcoma is a significant problem in developing countries with rates as high as 70%. This study aimed to determine the effect of a patient navigator on treatment abandonment and patient follow-up of osteosarcoma patients at a tertiary referral center. Materials and Methods: A retrospective review of osteosarcoma patients was performed investigating 2 cohorts based on the start of the patient navigator. Group 1 (Pre-Patient Navigator, n=46) were treated from January 2016 to December 2017 while Group 2 (Post-Patient Navigator, n=29) were treated from January 2018 to June 2019. The primary outcome investigated was treatment abandonment defined as missing 4 or more consecutive weeks of treatment. Semi-structured interviews were conducted to investigate the effect of the patient navigator on the cohorts. Results: Treatment abandonment rates for the Pre-Patient Navigator group was significantly higher compared to those with a patient navigator (50% vs 6%, p=0.0001). Abandonment for the pre-navigator group occurred at a mean of 2.9 months (0 -9 months, median 3 months). Fourteen of 23 patients who abandoned from Group 1 did not proceed to neoadjuvant chemotherapy while 3 patients abandoned after completing 1 cycle of neoadjuvant chemotherapy. In the patient navigator group, no patients abandoned prior to completing 3 cycles of chemotherapy. One patient abandoned after refusing a below knee amputation after 3 cycles of neoadjuvant chemotherapy and 1 patient did not complete further chemotherapy after having a hip disarticulation. Patient feedback on the patient navigator experience was favorable. Conclusions: Having a patient navigator from diagnosis throughout treatment reduced treatment abandonment rates in osteosarcoma patients and may serve as a model for other low to middle income countries.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

“…Across these studies, five reported using technology other than email or telephone calls. This included Google Hangouts and WhatsApp, 95 an online patient navigation tool, 96 social media and phone applications, 97 Zoom, 98 and web‐based tool and video conferencing 99 . Four implementation and feasibility studies were also included 95,100–102 .…”

“…There were significant improvements in follow‐up and treatment adherence rates as well as attendance at cancer peer support groups after the implementation of patient navigation programs 97,116,117 . The inclusion of patient navigation for organizing appointments, orientating patients to tailored resources, coordinating team care, and establishing communication using social media applications from the time of diagnosis through to treatment reduced abandonment rates 117,118 .…”

“…112,115 Cancer diagnosis and treatment There were significant improvements in follow-up and treatment adherence rates as well as attendance at cancer peer support groups after the implementation of patient navigation programs. 97,116,117 The inclusion of patient navigation for organizing appointments, orientating patients to tailored resources, coordinating team care, and establishing communication using social media applications from the time of diagnosis through to treatment reduced abandonment rates. 117,118 In addition, it has been demonstrated that navigation components focused on patients' knowledge of the health care system and available financial aids increase patient accrual, particularly in late-phase clinical trials.…”

Impact of delay of local control in nonmetastatic extremity primary osteosarcoma

“…Timing of local control (LC) is not well studied in osteosarcoma; most protocols call for LC after two to three cycles of neoadjuvant chemotherapy; however, this could be delayed from the schedule for many reasons. In countries with limited resources, delays in LC may be due to the cost of prostheses, hesitancy to go for LC when the only feasible LC is amputation because of fear of stigma, and long waiting lists in government hospitals 22–24 . The impact of the delay of LC on survival outcomes in osteosarcoma is not well reported.…”

“…In countries with limited resources, delays in LC may be due to the cost of prostheses, hesitancy to go for LC when the only feasible LC is amputation because of fear of stigma, and long waiting lists in government hospitals. [22][23][24] The impact of the delay of LC on survival outcomes in osteosarcoma is not well reported.…”