Abstract C09: A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America
Authors: Guerra Yanin Chavarri , Celis Enrique Soto Perez de , Lopez Wendy A. Ramos , Bukowski Alexandra , Miguel Sandra San , Gutierrez Oscar Sanchez , Gonzalez Jesus A. Sanchez , Goss Paul E. 
Published: March 2017

Abstract
Background: Cancer mortality rates in developing countries such as Mexico are higher than in high-income countries, due in part to failure and delays in access to health care. The median delay from problem identification to start of treatment can be up to 7 months, which is largely related to shortcomings of a fragmented healthcare system. At least 7 public providers coexist within the Mexico City Metropolitan Area (MCMA). A cumbersome and inefficient system requires the referral of patients with suspicion or diagnosis of cancer between hospitals with different health coverage. A more coordinated delivery of cancer care or navigation of cancer patients is needed to achieve timely initiation of treatment. Here we report preliminary results of the first patient navigation (PN) program in Mexico City. We initiated this study with the objective of demonstrating that implementing a PN program at a second level hospital within the MCMA would be feasible and reduce time to initiation of tertiary cancer care treatment. Methods: Patients eligible for PN enrolment were aged &gt;18 with either suspicion or confirmed diagnosis of cancer who required referral to a cancer center for further care. Baseline demographic and psychosocial data were collected. Patients were navigated by a dedicated patient navigator, who assisted them with scheduling; paperwork; obtaining results in a timely manner; transportation; and appropriate oncological diagnosis and/or treatment. Our statistical assumption was a sample size of 40 patients needed to demonstrate it was feasible to successfully navigate at least 70% of the patients within 3 months of the start of navigation.
Results: Recruitment began in January 2016. Twenty-six patients have been accrued (median age 57 years [range 22 to 85]; 14 [53%] are male). Most common diagnoses are: genitourinary (35%, N= 9), hematologic (15%, N=4) and head and neck malignancies (15%, N4). Fourteen (53%) have &lt; middle-school education, 22 (85%) are unemployed, 23 (88%) have a monthly income of less than $410 USD and 21 (81%) have public insurance. The most frequently identified barriers to cancer care have been financial (73%, N=19), transportation (38%, N= 10), fear (38%, N=10) and poor communication with healthcare personnel (15%, N = 4); mean time to referral is 12 days (range 1-46, SD 10.1) and time to specialist appointment is 27 days (range 1-77, SD 8.9). To date 84% (N=21) of patients have been successfully referred to a cancer center, all of them within the pre-specified time period of less than 3 months.
Conclusion: Preliminary results indicate that a PN program aimed at improving referral between health systems and overcoming access barriers to cancer diagnosis and treatment in Mexico City is feasible, and that it decreases the time to referral to a cancer center. PN may be a solution to overcome barriers to healthcare access for underserved cancer patients and perhaps patients with other non-communicable diseases in developing countries.
Citation Format: Yanin Chavarri Guerra, Enrique Soto Perez de Celis, Wendy A. Ramos Lopez, Alexandra Bukowski, Sandra San Miguel, Oscar Sanchez Gutierrez, Jesus A. Sanchez Gonzalez, Paul E. Goss. A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C09.