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Closing the Gap: The Promise of Patient Navigation for Developing Countries

By Paul Goss, PhD, FRCP, MB BCH, <br>Director of Breast Center Research at Massachusetts General Hospital <br>and founder of Global Cancer Institute


February 2, 2018
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In honor of World Cancer Day, February 4th, ACCC asked guest blogger Dr. Paul Goss, founder of the Global Cancer Institute (GCI), to share how GCI's new patient navigation program is helping to accelerate care for breast cancer patients in Mexico.

At 77 years old, Juana was diagnosed with breast cancer. She lived in a remote village outside Mexico City, and was sent to a city hospital for treatment. Fortunately for Juana, that hospital had a new Patient Navigation program, organized by the Global Cancer Institute (GCI) and modeled after a U.S. protocol to help accelerate cancer patients’ path to treatment. Thanks to her Patient Navigator, Juana was seen by an oncologist within two weeks of referral – an impressive feat in Mexico City, where the median time to arrive to a tertiary care center after being referred is two full months. Juana was able to make this journey in a fraction of the time, and today, after treatment, she is back with her family, living cancer free.

Unfortunately, Juana is still the exception, not the rule, in developing countries.

Breast cancer is the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 (25 percent of all cancers). Breast cancer ranks as the fifth cause of death from cancer overall, globally.

But the mortality rate for breast cancer is twice as high in lower middle income countries than in developed countries: 24 vs. 48 percent, according to 2012 Globocan data.

In Mexico specifically, 90 percent of breast cancer patients initially came to the doctor with a self-detected mass. (By contrast, in the U.S., most women are initially diagnosed after a mammogram, before they or their doctor can feel anything.) In addition, 53 percent of breast cancer patients in Mexico are diagnosed with Stage III or Stage IV disease, which are more difficult to treat, with lower long-term survival rates. (In the U.S., 60 percent of patients are diagnosed in the early stages of the disease.)

All of this points to the need for earlier diagnosis and treatment. Initiatives like the GCI’s Patient Navigation program can help. In Mexico City, the program has helped reduce the median time from diagnosis to referral to a cancer center from two months to 11 days, improving patient care and boosting survival rates. The program proved so successful in Mexico City that GCI has expanded it to Rio de Janeiro, Brazil – another country with very high incidence rates of breast cancer. More cities will follow in 2018.

On World Cancer Day, let’s remember that a huge gap exists between lower middle income countries and the U.S. when it comes to cancer treatment practices and survival rates. Patient Navigation programs – common in U.S. hospitals, and easy to propagate elsewhere – are proving to be a low-cost, highly effective method for closing the gap. 
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Read about the Global Cancer Institute's Video-Based Online Global Tumor Boards in ACCC's journal, Oncology Issues (Nov-Dec, 2017).

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