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Patient navigation (PN) support to timely access to radiotherapy in the Brazilian public health system

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Abstract

Purpose

Patient navigation (PN) is a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to integral care. Considering the complex difficulties in accessing treatment and the positive results of PN in high-income countries, our group decided to evaluate this tool to improve radiotherapy (RT) access in the public system in Brazil.

Patients and methods

This pilot study took place in a public school hospital, with a historical cohort as the control arm. The primary endpoint was the time from histologic diagnosis and RT initiation among cancer patients receiving RT with curative intent in a PN program. The secondary objectives were the following time frames: referral to the first consultation by the RT team; first consultation up to RT beginning; RT beginning to RT end; referral to the end of RT and identifying/describing obstacles to the treatment; and assessing patient satisfaction with PN program.

Results

A total of 124 patients were included in the retrospective arm and 73 in the navigation arm. Most had the loco-regionally advanced disease from the esophagus, head/neck, and rectum. PN decreased the median time from the biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN reduced 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 to the end of the RT (98 to 78 days, p < 0.003).

Conclusions

Proper identification of barriers, especially in a low-resource setting, is mandatory to guide PN programs in LMICs. In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely RT.

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Data availability

All the research results have been presented, and data has been filed in the university’s archives (Universidade Federal de Minas Gerais, Brazil).

Code availability

Not applicable.

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Acknowledgements

We thank the Global Cancer Institute for the financial and academic support, especially Dr. Paul E Goss, Founder & Chief Mission Officer of Global Cancer Institute, USA. This is the first time we have presented this study.

Funding

The project has had technical and scientific support from the Global Cancer Institute (GCI/MGH, Harvard), also responsible for financing due to his interest in PN studies in medium and low income. GCI is a non-profit research foundation based at Massachusetts General Hospital/Harvard University, USA, led by Dr. Paul Goss, a renowned clinical researcher from that university.

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Authors and Affiliations

  1. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130100, Brazil

    Carolina M. Vieira, Paulo H. C. Diniz & Angélica Nogueira-Rodrigues

  2. Global Cancer Institute, Gilroy, CA, USA

    Don S. Dizon

Authors
  1. Carolina M. Vieira
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  2. Paulo H. C. Diniz
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  3. Don S. Dizon
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  4. Angélica Nogueira-Rodrigues
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Contributions

Carolina M Vieira was responsible for conducting the project; collecting, analyzing, and interpreting the data; writing the first version of the manuscript; reviewing it; approving the version to be published; and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Paulo H C Diniz was responsible for analyzing and interpreting the data; reviewing the manuscript; approving the version to be published; and ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Don S Dizon was responsible for analyzing and interpreting the data; reviewing the manuscript; approving the version to be published; and ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Angélica N Rodrigues was responsible for mentoring the project; analyzing and interpreting the data; reviewing the manuscript; approving the version to be published; and ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Corresponding author

Correspondence to Carolina M. Vieira.

Ethics declarations

Ethics approval

Brazilian National Research Ethics Commission—Conep, following the attributions in Resolution No. 466 of 2012 and Operational Standard No. 001 of 2013, stated for the approval of the research project on March 31st, 2018, after analyzing all documents, including the patient’s consent form.

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All authors have freely accepted to participate in the project.

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The authors declare no competing interests.

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Vieira, C.M., Diniz, P.H.C., Dizon, D.S. et al. Patient navigation (PN) support to timely access to radiotherapy in the Brazilian public health system. Support Care Cancer 31, 182 (2023). https://doi.org/10.1007/s00520-023-07615-8

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  • DOI: https://doi.org/10.1007/s00520-023-07615-8

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