Role of patient navigation in improving access to radiotherapy treatment in a limited resource setting.

Abstract

e19019 Background: Approximately 60% of cancer patients in low- and middle-income countries (LMICs) require radiotherapy (RT), with RT contributing 40% of curative treatment for cancers. Timely RT impacts prognosis. There are several difficulties in accessing RT in the Brazilian public health system: deficit of devices, obsolete machines, heterogeneous distribution of services, lack of investment in human resources and socioeconomic obstacles. Thus, it becomes necessary to optimize available resources. Although there are examples of successful patient navigation (PN) programs in vulnerable populations in high-income countries (HICs), data is scarce for LMICs. Considering the high incidence of cancer, complex difficulties in accessing treatment, and the positive results of PN in HICs, it was decided to evaluate this tool to improve RT access in the public system in Brazil. Methods: This pilot study was carried out in in a public school hospital in Belo Horizonte, Brazil, in partnership with the Global Cancer Institute, with a historical cohort as the control arm. The primary objective was to evaluate the changes in the time from definitive diagnosis to the start of treatment with the implementation of PN. Secondary objectives included: evaluating changes in the time between the beginning and end of RT, identification of the obstacles to access care, and quality of life data. Candidates for the program would be those considered for neoadjuvant or definitive RT, without previous cancer treatment. Results: 124 patients were included in the retrospective arm (12 excluded) and 73 in the navigation arm (1 excluded). Most had loco-regionally advanced disease, the most prevalent sites being esophagus, head, neck, and rectum. PN decreased the median time from biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN also decreased the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011); between the referral and the first consultation in the RT (25 to 13 days, p < 0.001) and between the referral and the end of the RT (98 to 78 days, p < 0.003). There was an increase in the proportion of patients who started RT within 60 days (maximum period established by law to start cancer treatment), from 20.5% in the retrospective arm to 38.5% in the prospective arm (p = 0.026). PN in this context showed no impeditive costs ( < $140 USD per patient) with a satisfaction rate greater than 90% from patients. Conclusions: In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely radiotherapy.