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Implementing a Multicomponent Navigation Program to Reduce Time Intervals to Treatment Initiation for Advanced Breast

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The RACAM navigation program significantly reduced time-to-treatment initiation for metastatic breast cancer patients in LMICs. This initiative offers a scalable solution to overcome healthcare access barriers.

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Area of Science:

  • Oncology
  • Healthcare Management
  • Public Health

Background:

  • Metastatic breast cancer presents complex challenges in low- and middle-income countries (LMICs) due to administrative burdens and diagnostic delays.
  • Patient navigation programs are known to improve treatment access and follow-up care across various diseases.

Purpose of the Study:

  • To evaluate the effectiveness of a multicomponent patient navigation program (RACAM) in accelerating treatment initiation for metastatic breast cancer patients in LMICs.
  • To assess the impact of the RACAM program on reducing delays in diagnostic assessments and treatment appointments.

Main Methods:

  • A hybrid-type III effectiveness-implementation design was employed to assess the RACAM program.
  • The RACAM program incorporated a referral network, patient advocates, educational materials, nurse navigator training, and a software for tracking delays.
  • Baseline time-to-treatment initiation (TTI) data were collected retrospectively (April 2021-2023), followed by prospective data collection post-RACAM implementation (December 2023-September 2024).

Main Results:

  • At baseline, only 29% of patients had a TTI <30 days, and 74% had a TTI <60 days.
  • Following RACAM implementation, the median TTI decreased to 17 days, with only 3.6% of patients exceeding 2 months for treatment initiation.
  • Key activities with reduced intervals post-implementation included bone scans, radiotherapy consults, and oncology visits. The program's acceptability rate was high at 96.3%.

Conclusions:

  • The RACAM program demonstrated a significant association with reduced time-to-treatment initiation for metastatic breast cancer.
  • Formalizing navigator programs in LMICs, such as Paraguay, presents a viable strategy to mitigate common healthcare access barriers.