The impact of patient navigation (PN) on timely access to radiotherapy in the Brazilian public health system

Abstract Purpose: Considering the complex difficulties in accessing treatment, and the positive results of patient navigation (PN) in high income countries, it was decided to evaluate this tool to improve radiotherapy (RT) access in the public system in Brazil. Patients and methods: This pilot study was carried out in a public school hospital, with a historical cohort as the control arm.The primary endpoint was the time from histologic diagnosis and RT initiation among cancer patients receiving RT with curative intent in a PN program. The secondary objectives were the following time frames: referral to first consultation by RT team; first consultation up to RT beginning ; RT beginning to RT end; and identifying and describing the main obstacles to the treatment; and assessing patient satisfaction with PN program. Results: 124 patients were included in the retrospective arm and 73 in the navigation arm. Most had loco-regionally advanced disease from esophagus, head/ neck, and rectum. PN decreased the median time from biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN also decreased the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011); between the referral and the first consultation in the RT (25 to 13 days, p < 0.001) and between the referral and the end of the RT (98 to 78 days, p < 0.003).Conclusions: Proper identification of barriers involved in treatment, especially in a low resource setting is mandatory in order to guide PN programs in LMICs. In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely RT.