Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial
Authors: Soto-Perez-de-Celis Enrique , Chavarri-Guerra Yanin , Ramos-Lopez Wendy Alicia , Alcalde-Castro Jacqueline , Covarrubias-Gomez Alfredo , Navarro-Lara África , Quiroz-Friedman Paulina , Sánchez-Román Sofía , Alcocer-Castillejos Natasha , Aguilar-Velazco José Carlos , Bukowski Alexandra , Chávarri-Maldonado Juan Alberto , Contreras-Garduño Sergio , Krush Lindsay , Inoyo Itoro , Medina-Campos Andrea , Moreno-García María Luisa , Perez-Montessoro Viridiana , Bourlon María T. , de la Peña-Lopez Roberto , de la Mora-Molina Héctor , León-Rodriguez Eucario , Mohar Alejandro , Goss Paul E. 
Published: November 2020

Background

The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer.

Materials and Methods

This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life.

Results

One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34–0.62; p &lt; .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p &lt; .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07–0.38; p = .006), without differences in quality of life between arms.

Conclusion

Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings.

Implications for Practice

The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.