Background and Rationale
In early breast cancer, HER2-positivity demands timely anti-HER2 therapy to optimize outcomes. In low- and middle-income countries (LMICs), health-system constraints—ranging from fragmented care pathways to access barriers—often delay treatment initiation. This retrospective cohort study investigates whether a structured Patient Navigation Program can shorten the time from diagnosis to the start of anti-HER2 therapy and thereby improve overall care delivery in a resource-constrained setting.
Methods and Setting
The study analyzed medical records from a cohort of patients with HER2-positive, early-stage breast cancer treated at a tertiary care center in a LMIC. Data were extracted on diagnostic timelines, treatment initiation, and barriers encountered. The Patient Navigation Program involved trained navigators who coordinated appointments, facilitated referrals, addressed socioeconomic barriers, and provided patient education. We compared outcomes before and after program implementation and conducted subgroup analyses by age, comorbidity, and stage.
What the Patient Navigation Entailed
Key components included: (1) early patient contact after diagnosis, (2) streamlined scheduling for diagnostic tests and initial therapy, (3) assistance with transportation and social services, (4) reminders and follow-up calls, and (5) multidisciplinary communication to align medical, surgical, and medical oncologic teams. The goal was to reduce nonclinical delays (waiting for tests, referrals, or insurance approvals) and to ensure that eligible patients begin anti-HER2 therapy within clinically advisable windows.
Results: Timeliness of Therapy
Initial findings indicate that the Patient Navigation Program significantly reduced time-to-therapy metrics. Median days from diagnosis to anti-HER2 initiation improved notably after program rollout, with a meaningful decrease in missed appointments and a reduction in attrition at key care transitions. The most pronounced gains occurred in patients facing transportation barriers, lower health literacy, and longer diagnostic pathways prior to referral to systemic therapy.
Subgroup Insights
Older patients and those with multiple comorbidities benefited from tailored navigation strategies, including closer monitoring and flexible scheduling. Stage II and III disease patients saw the greatest relative improvement, suggesting navigation helps offset systemic delays most impactful for those with more complex treatment plans.
Impact on Outcomes and System Efficiency
While this retrospective study primarily focuses on timeliness, earlier initiation of anti-HER2 therapy is associated with improved disease control and potentially better survival. Beyond individual outcomes, the program demonstrated system-level benefits: better adherence to treatment schedules, enhanced communication between oncology subspecialties, and reduced hospital-level bottlenecks. Importantly, navigation helped align patients with affordable, locally available resources, a critical factor in LMIC settings where out-of-pocket costs and geographic barriers often impede care.
Discussion: Implications for LMIC Health Systems
These findings support the integration of patient navigation into standard breast cancer care models in LMICs. Key implications include the need for formal training programs for navigators, sustainable funding models, and data systems to monitor timeliness metrics. Moreover, navigation programs should be culturally appropriate and designed to address social determinants of health that most strongly influence access to anti-HER2 therapy.
Limitations and Future Directions
As a retrospective cohort analysis, causality cannot be definitively established, and unmeasured confounding factors may influence results. Prospective, multicenter studies are warranted to validate findings and to refine navigation strategies. Future research could explore integration with telemedicine, patient education tools, and community-based support networks to further reduce delays.
Conclusion
Structured patient navigation shows promise in streamlining care and accelerating initiation of anti-HER2 therapy for early HER2-positive breast cancer in LMICs. By mitigating nonclinical delays and facilitating multidisciplinary collaboration, navigation programs can contribute to more timely, equitable cancer care and potentially improve patient outcomes in resource-limited settings.
