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

Abstract

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.