Research has shown that low- and middle-income countries (LMICs) bear a greater cancer mortality burden, with a mortality-to-incidence ratio almost twice that seen in high-income countries (HICs). This global disparity can be mainly attributed to patients in LMICs presenting at more advanced stages of cancer and a lack of timely access to cancer care in LMICs. In order to address this disproportionate burden on LMICs, the Global Cancer Institute (GCI) is implementing a Patient Navigation Program, which is designed to help cancer patients navigate through complex and fragmented health systems in LMICs.
Patient navigation (PN) is an innovative tool that had been pioneered among underserved patient populations in the U.S., and it has been proven to reduce loss to follow-up rates and health disparities; improve screening rates, time to diagnostic resolution, and patient education; and lead to a higher proportion of patients receiving standard cancer care. PN programs use patient navigators, who are trained health care workers, to help patients overcome systemic barriers to care. Navigators may schedule diagnostic and follow-up appointments, facilitate health system referrals, provide language or translation services, coordinate communication between patients and health care providers, assist with insurance paperwork, link patients to hospital and community services, and provide health education resources. Throughout the U.S., patient navigation is being integrated into hospital systems as a cost-effective intervention, supported by doctors, hospital administrators, and patients alike.
Although PN programs have been shown to have significant benefit for underserved patient populations in the U.S., the implementation of these programs globally has been limited, despite great need in LMICs. GCI has thus taken the PN model used in the U.S. and customized it for use in LMICs, with the goal of proving the benefits of PN in diverse settings and promoting its integration into health policy. Thus far, GCI’s programs in Mexico and Uruguay have had enormous success. In Mexico City, patients are navigated from a secondary level hospital to a tertiary cancer center, in order to reduce referral times within Mexico’s highly fragmented health system. The patient navigator in Mexico has reduced median referral times from two months to only 10 days. In Uruguay, the program navigates all women who had an abnormal Pap test in the past two years and never returned to their community health center for follow-up. Here, navigators have successfully re-engaged nearly all of their patients thus far, helping them to receive appropriate follow-up care.
These preliminary successes in Mexico and Uruguay have informed GCI’s future PN Programs that are currently in planning for countries throughout Latin America and, later, globally. Patient navigation offers a unique opportunity to take a practical and proven initiative, customize it for use in diverse settings, and integrate it into national health systems. Rather than requiring new funding in settings where resources are limited, patient navigation calls instead for the reallocation funds from managing late-stage disease toward prevention and early treatment of cancer, making it part of a sustainable and cost-effective path to cancer control.
Patient Navigator training in Mexico