Impact of a pilot patient navigator program on pediatric cancer outcomes in a low resource setting.
Schroeder, K; Alvi, F; Johnston, H; Masalu, NA; Chao, NJA
Published in: Journal of Clinical Oncology
e18152 Background: Oncology patient navigation programs have been successfully implemented at hospitals throughout the U.S., enhancing the quality of canceer care. In low resource settings, the barriers to receiving cancer care are increased and a patient navigator in this setting has the potential to significantly impact outcomes. However, research on efficacy is limited. Methods: At Bugando Medical Centre (BMC) in Mwanza, Tanzania, semi-structured qualitative interviews of 15 key stakeholders in the oncology department and 15 families of patient with pediatric cancer diagnoses were completed to identify health system delivery and patient related barriers to timeliness of diagnosis, treatment initiation, and treatment completion. Based on identified barriers, a pilot patient navigation program was established to assist patients and their families with care coordination throughout the diagnosis and treatment process. A retrospective analysis of hospital records was conducted of all pediatric oncology patients seen at BMC from 2010-2016, separated by presentation date before or after establishment of navigation program. Collected data includes demographics, diagnosis, time from presentation to oncology evaluation and diagnosis, and treatment completion. Results: Identified patient related barriers included patient diagnosis and treatment knowledge, and complexity of care. Health system delivery barriers included limited provider capacity, and poor care coordination between the oncology providers, other health care services and patient families. A total of 238 patient files were reviewed, with 169 pre- and 69 post- program initiation. Patient groups did not differ by age or gender (p = 0.329 and 0.744), or diagnosis distribution. The average time to oncology evaluation decreased from 49.7 to 16.6 days (p = 0.015), and time to diagnosis decreased from 49.1 to 23.6 days (p = 0.07). Treatment abandonment decreased from 50% to 38% (p < 0.001). Conclusions: In pediatric oncology, early diagnosis is critical to the initiation of chemotherapy and improving outcomes. These data suggest that a patient navigation program is feasible in a LMIC and can impact both health system inefficiency and treatment abandonment, with the potential to improve pediatric cancer outcomes.
