Abstract P5-13-15: The value of patient navigation in breast cancer being tested in Rio de Janeiro, Brazil
Authors: Gioia S , Torres C , Cavalcanti J , Brigagao L , Proencio T , Krush L , Goss P 
Published: May 2019

Abstract
OBJECTIVES: The main objective of this Patient Navigation Program in Rio de Janeiro (PNP Rio), Brazil, is to promote adherence to the "60 Day Law", which states that all patients with cancer within the public system should start treatment within 60 days after diagnosis of cancer. Thus, the objectives are: 1.) to establish feasibility of PNP in this setting; 2.) to identify barriers to compliance the Law of 60 days and 3.) to ensure that at least 70% of recruited breast cancer patients begin treatment within the mandated 60-day period. One report by FEMAMA states that only 30% of breast cancer patients in Rio de Janeiro to initiate treatment within the 60-day mandate.
METHODS: From August 2017 to May 2018, one hundred patients aged 33-81 years (mean age 59 years) were recruited for navigation at Rio Image - an advanced breast cancer diagnosis center administered by the state health secretary and located in the capital city of Rio de Janeiro, attending patients from the public system from all 92 municipalities in the state. Patient Navigator (PN), a trained social worker, starts navigation from diagnosis, administering questionnaires to collect: patient population data, dates and information of historical milestones, and patient satisfaction. Patients were followed up by phone, e-mail or text message to identify barriers to initiation of treatment.
RESULTS: Patients presented staging 0-I (17%), II-III (78%) and IV (5%). There were two deaths related to breast cancer in this group. All patients reported at least one barrier, ranging from 2 to 12 barriers (M=5). The barriers to compliance with the "Law of 60 days" were: Fear and fatalistic thoughts (99%), Financial problems (79%), Uncoordinated health care (76%), Health professionals ignore the Law of the 60 days (75%), Need to do staging exams again (52%), Concern about communicating with medical staff (52%), Transport (42%), Difficult in obtain surgical risk consultation (12%), Line of surgeries in hospitals (12%), Difficult of insertion in the regulation system in Primary Care(11%), Patient cannot express herself (5%), Social support(4%), Absent of the immunohistochemistry panel (4%), Cognitive problems (3%), Comorbidities (2%). The PNP had 100% patient satisfaction and in 60% of the cases it helped the patients to start treatment within the period established by law.
CONCLUSIONS: In summary, PNP Rio generated a positive experience for patients in the public health system because it is an intentional and proactive process of assisting the individual through the cancer system, accessing services and actively overcoming barriers to quality care. The PNP Rio did not achieve the success rate of 70% of compliance with the Law as intended (achieved 60%). However, the barriers that the PN can not overcome such as lack of human resources and medical supplies, were informed to health authorities and hospital administrators. This is an opportunity for discussion of reallocation of funds, focusing on the use of scarce resources in prevention and early treatment rather than late-stage disease. In the Brazilian context, PNP may represent an opportunity to implement existing legislation adequately, and as such, would have great potential for integration at the federal, state, and local health systems.
Citation Format: Gioia S, Torres C, Cavalcanti J, Brigagao L, Proencio T, Krush L, Goss P. The value of patient navigation in breast cancer being tested in Rio de Janeiro, Brazil [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-15.