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

Patient navigation programs have been associated with accelerated access to treatments and improved follow-up care in multiple diseases. Metastatic breast cancer reflects a complex scenario in low- and middle-income countries (LMICs) because of multiple barriers, including a challenging administrative burden associated with multiple diagnostic assessments.

We developed a multicomponent program (RACAM), where we established a referral network with the participation of patient advocates, as well as the creation of educational materials, the nurse navigator training, and the implementation of a software program to track delays in follow-up examinations and visits. A hybrid-type III effectiveness-implementation design was used to evaluate the program. Baseline intervals from time-to-treatment initiation were collected retrospectively between April 2021 and 2023.

Baseline measurements included 61 patients with complete pharmacy records. A total of 29% of the reviewed patients had a time-to-treatment initiation (TTI) of <30 days, and 74% had a TTI of <60 days. For RACAM, 55 patients were included between December 2023 and September 2024. The median TTI was 17 (95% CI, 12 to 19) days, with only 2 (3.6%) requiring more than 2 months to start the recommended treatment. After RACAM was implemented, the activities with longer intervals between scheduling and task completion were bone scans (25 days [range, 10-30]), radiotherapy consults (15 days [95% CI, 0 to 22 days]), and oncology visits (11 days [95% CI, 8 to 14 days]). The acceptability rate of the program was 96.3%.

The implementation of RACAM had an initial association with a time-to-treatment initiation interval. A progressive formalization of Navigator Programs in Paraguay represents an opportunity to overcome certain barriers normally reported in LMICs.