Evaluating the Impact of a Patient Navigation Program on Treatment Timeliness, Continuity, and Follow-Up Outcomes for Patients With Digestive Tract Cancer at Kenyatta Hospital.

Abstract

GI cancers contribute substantially to cancer-related morbidity and mortality in Kenya, where patients often present with advanced disease and experience delayed treatment, interruptions, and loss to follow-up. To address barriers to care, Kenyatta National Hospital (KNH) implemented a Patient Navigation Program (PNP) in 2017, although its impact on clinical outcomes and equity had not been fully evaluated. To assess the effect of the KNH PNP on treatment timeliness, continuity of care, 1-year survival, and equity among adults with GI cancers. We conducted a retrospective cohort study of 360 adults with GI cancers treated at KNH between 2010 and 2025, comparing a prenavigation cohort (2010-2016; <i>n</i> = 180) with a navigation-era cohort (2017-2025; <i>n</i> = 180). Primary outcomes were time from diagnosis to treatment initiation and disease status at follow-up. Secondary outcomes included treatment initiation within 30 days, treatment completion, loss to follow-up by 1 year, and 1-year overall survival. Survival was analyzed using Kaplan-Meier methods and log-rank tests. Multivariable logistic regression assessed predictors of loss to follow-up and disease status, including equity by residence and insurance status. Median time to treatment initiation did not differ between cohorts (55 <i>v</i> 62 days; <i>P</i> = .14), and treatment completion remained low (41.1% <i>v</i> 46.1%; <i>P</i> = .96). Loss to follow-up declined from 20.0% to 6.7% (<i>P</i> < .001), and 1-year survival improved from approximately 70% to approximately 80% (log-rank <i>P</i> = .027). Benefits were consistent across residence and insurance subgroups. Patient navigation significantly improved continuity of care and 1-year survival without increasing disparities, supporting its role as an equity-promoting intervention in resource-limited settings.