Impact of Patient Navigation on Time to Treatment Among Patients With GI Cancers at Rwanda Military Referral and Teaching Hospital.

Abstract

To evaluate the impact of a patient navigation program (PNP) on treatment delays among patients with GI cancers at the Rwanda Military Referral and Teaching Hospital (RMRTH). PNP is a personalized support model implemented at RMRTH on April 1, 2023, to guide patients with a cancer diagnosis through the health care system. We used a quasi-experimental study design and included all patients diagnosed and treated for esophageal, gastric, or colorectal cancer in pre- and postimplementation of PNP at RMRTH. The outcomes of interest were measured in days: treatment interval from pathology report to treatment initiation. Data were abstracted from patients' medical records and analyzed using STATA version 19. The Wilcoxon rank-sum test was performed. Treatment intervals were used in the time series analysis, and the Dickey-Fuller Test was used to test stationarity. A total of 151 patients, with 85 patients in the post-PNP group, were included. The mean age (years) at diagnosis was similar (59.4 ± 13.5 years in the pre-PNP and 59 ± 14.18 years in the post-PNP group). Most patients (80.0% pre-PNP group and 80.9% post-PNP group) presented with stage III/IV. Neoadjuvant chemotherapy was the most common initial treatment (48.5% pre-PNP and 54.1% post-PNP). The median treatment interval decreased from 53.5 days (IQR, 26-129) in the pre-PNP group to 32 days (IQR, 14-63) in the post-PNP group (<i>P</i> < .001). The reductions in treatment delays were significant over time following the implementation of the PNP (<i>P</i> = .004). PNP reduced treatment delays among patients with GI cancers at RMRTH. Despite the important findings, some limitations remain; hence, further studies are recommended to provide more comprehensive evidence. Integrating PNP into national cancer control strategies is essential to strengthen care coordination and ensure timely access to cancer treatment in low-resource settings like Rwanda.