Implementing a multicomponent navigation program to reduce time intervals to treatment initiation for advanced breast cancer in Paraguay.

Abstract

e13508 Background: Patient navigation programs have been associated to increase timely 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) as a result of multiple barriers, including costly therapies, presentation with impairing symptoms, and a challenging administrative burden associated with multiple diagnostic assessments. Methods: A multi-component program (RACAM), as part of a referral network with patient advocates, educational material, navigator training, and a software program to track delays in follow-up exams and visits was implemented in the National Cancer Institute in Paraguay in 2023. A hybrid-type III effectiveness-implementation design was conducted to evaluate the program. Out of an estimated minimum sample size of 42, 36 (85.7%) were required to evaluate the program as “acceptable”, and 30 (71%) had to start a physician’s planned treatment within 2 months of program entry to meet study objectives. Additionally, baseline intervals from time-to-treatment initiation were collected from a retrospective database of advanced breast cancer patients between 2022 and 2023. Results: Baseline measurements included 83 patients, 29% of the reviewed cases had a time-to-treatment initiation (TTI) of less than 30 days and 45% had TTI of 30-60 days. For RACAM, 55 patients were included between December 2023 and September 2024. The median TTI was 17 [IQR 8.5-21] days, with only 2 (3.7%) requiring more than one month to start cancer treatment. The most frequently scheduled tasks facilitated by the navigator were oncology visits (98.9%), lab analyses (72.7%) cardiological assessments (43.6%) and CT scans (40%). After RACAM was implemented, the activities with longer intervals between scheduling and competitions were bone scans (20 days [IQR 25-30]), radiotherapy consults (13 days [IQR 12-14 days]) and oncology visits (11 days [IQR 7-17 days]). The acceptability rate of the program was 100%. Conclusions: The implementation of RACAM has demonstrated an improvement in the quality of healthcare with relevant clinical impact. The application of implementation science principles to the continuum of care allows the evaluation of performance metrics, and the redefinition of budget necessities for the program sustainability. A progressive formalization of Navigator Programs in Paraguay represents an opportunity to overcome certain barriers normally reported in LMICs.