Implementation and first evaluation of a nationwide oncology navigation program.
Authors: Baldotto Clarissa Serodio Da Rocha , Pereira Dos Santos Lucianno Henrique , Costa de Almeida Camila , Lopes Guimarães dos Santos Jaciara , Veiga Pereira Marcela , Trajano Rebeca , Paranhos Martins Romano Camila , Colli Aina 
Published: June 2022

e13532

Background: Navigation in oncology has demonstrated benefits for people at risk for or diagnosed with cancer. These include a shorter time to diagnosis and start of treatment, better adherence to recommended care, and improved quality of life. Implementing a nurse navigation program can be challenging in developing countries, especially when involving nationwide health care networks. This study describes the implementation of a pioneering oncology navigation program in Brazil. Methods: Rede D’Or São Luiz (RDSL) is Brazil's largest integrated private health care network, comprising 63 general tertiary hospitals and 50 oncology clinics in 13 states. In 2018 a comprehensive oncology navigation program was started. The first phase focused on identifying suspected or diagnosed cancer patients who attended general hospitals to improve their care coordination. A trained nurse was allocated to support each hospital, supervised by a regional nurse coordinator and physician. A web-based system was created, by the participants, to integrate data collected from all hospitals. Epidemiological, social, and clinical data were obtained, including time to establish a cancer diagnosis and start of treatment. A national virtual meeting is held every two weeks to present anonymous data, compare results, and create solutions to address national and local barriers. Results: From 2018 to 2022, a total of 25,862 potential patients were identified by the navigation program. Of these, 10,951 ended with a diagnosis of cancer. Currently 32 hospitals from 6 different cities are involved. In the beginning, most patients (38%) were identified at Inpatient Clinical Units, after a cancer diagnosis. Over time the number of patients identified at surgical and diagnostic centers increased from 365 to 589 and 282 to 542, respectively. Cancer epidemiology was comparable to Brazilian data. Most patients had breast cancer (13%), followed by prostate cancer (12%) and colon cancer (7%). These numbers were slightly different according to hospital location. The number of patients recruited at Emergency rooms is still low (9%) comparable to other facilities. A total of 2,391 patients required an inpatient treatment approach, supported by the oncology team. Conclusions: The goal of the navigation program is to reduce cancer morbidity and mortality by eliminating barriers to timely access to cancer care, which may be financial, social, logistical, or related to communication and equity of health care delivery. These results show that RDSL National Oncology Navigation Program is feasible. After this implementation phase, a comprehensive database was built to guide care coordination, and there was a shift to earlier identification of potential patients. In the future, we expect that data collected from this project may help individual patients and families but also address cancer care disparities over the country.