New Horizons for Breast Cancer Care: Patient Navigation in a Low- and Middle-Income Country

Abstract

Purpose We established a patient navigation program in a secondary hospital in Malaysia. Here, we report on its impact on diagnostic and treatment timeliness for patients in the first 2 years of its implementation (n = 135 in 2015 and n = 155 in 2016) and compare these patients’ timeliness outcomes with those of patients who were diagnosed in 2014 (n = 147). Methods A dedicated navigation team provided education, supportive care, and practical help in overcoming individual barriers. Demographic, clinical, and timeliness data were collected and analyzed using Kruskal-Wallis and Fisher’s exact tests. Results Navigated patients were more likely to meet national service targets for mammography (95% in 2015 and 96% in 2016 v 74% in 2014; P < .001), biopsy (92% in 2015 and 94% in 2016 v 77% in 2014; P < .001), and communication of news (80% in 2015 and 82% in 2016 v 58% in 2014; P < .001). There was a modest impact on primary surgery (58% in 2015 and 65% in 2016 v 52% in 2014; P = .077) and neoadjuvant chemotherapy (42% in 2015 and 54% in 2016 v 56% in 2014; P = .284). We observed improvements in surgery timeliness among patients with early-stage disease but not in late-stage patients’ surgery and neoadjuvant timeliness. Barriers typically associated with late-stage disease at presentation, such as health literacy, residential distance from the hospital, and financial barriers, were not associated with delayed treatment initiation. Of interest, patients who delayed treatment initiation were less likely to have dependents younger than age 17 years (29% v 63%; P = .033). Conclusion Our results demonstrate that a navigation program is feasible and sustainable in a state-run hospital in a low-resource community. Whereas the program improved overall diagnostic timeliness, opportunities to improve outcomes in patients with late-stage disease may lie in diversifying navigation solutions. This includes addressing challenges that are specific to late-stage presenters and harnessing efforts at the primary care and community level to downstage breast cancer burden in Malaysia. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Teo Soo Hwang Speakers’ Bureau: AstraZeneca Research Funding: AstraZeneca Patents, Royalties, Other Intellectual Property: Cancer Research Malaysia Travel, Accommodations, Expenses: AstraZeneca