Yeoh Zi-Yi, Jaganathan Maheswari, Rajaram Nadia, Rawat Sudha, Tajudeen Nurul Ain, Rahim Norlia, Zainal Nur Hidayati, Maniam Sakthi, Suvelayutnan Ushananthiny, Yaacob Rahani, Krishnapillai Vijayalakshmi, Kamal Meor Zamari Meor, Teo Soo-Hwang, Wahab Mohamed Yusof Abdul
Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
J Glob Oncol. 2018 Nov;4:1-13. doi: 10.1200/JGO.17.00229.
Late stage at presentation and poor adherence to treatment remain major contributors to poor survival in low- and middle-income countries (LMICs). Patient navigation (PN) programs in the United States have led to improvement in diagnostic or treatment timeliness, particularly for women in lower socioeconomic classes or minority groups. To date, studies of PN in Asia have been limited. We aimed to assess the feasibility of PN in a state-run hospital in an LMIC and to report the impact on diagnostic and treatment timeliness for patients in its first year of implementation.
We established PN in a dedicated breast clinic of a Malaysian state-run hospital. We compared diagnostic and treatment timeliness between navigated patients (n = 135) and patients diagnosed in the prior year (n = 148), and described factors associated with timeliness.
Women with PN received timely mammography compared with patients in the prior year (96.4% v 74.4%; P < .001), biopsy (92.5% v 76.1%; P = .003), and communication of news (80.0% v 58.5%; P < .001). PN reduced treatment default rates (4.4% v 11.5%; P = .048). Among navigated patients, late stage at presentation was independently associated with having emotional and language barriers ( P = .01). Finally, the main reason reported for delay, default, or refusal of treatment was the preference for alternative therapy.
PN is feasible for addressing barriers to cancer care when integrated with a state-run breast clinic of an LMIC. Its implementation resulted in improved diagnostic timeliness and reduced treatment default. Wider adoption of PN could be a key element of cancer control in LMICs.
就诊时处于晚期以及对治疗的依从性差仍是低收入和中等收入国家（LMICs）患者生存率低的主要原因。美国的患者导航（PN）项目已使诊断或治疗及时性得到改善，尤其是对社会经济地位较低阶层或少数群体的女性。迄今为止，亚洲关于PN的研究有限。我们旨在评估在一个LMIC的一家国立医院开展PN的可行性，并报告其实施第一年对患者诊断和治疗及时性的影响。
我们在马来西亚一家国立医院的专门乳腺诊所建立了PN。我们比较了接受导航的患者（n = 135）和上一年诊断的患者（n = 148）之间的诊断和治疗及时性，并描述了与及时性相关的因素。
与上一年的患者相比，接受PN的女性接受乳腺钼靶检查更及时（96.4%对74.4%；P <.001）、活检更及时（92.5%对76.1%；P =.003）以及消息传达更及时（80.0%对58.5%；P <.001）。PN降低了治疗失约率（4.4%对11.5%；P =.048）。在接受导航的患者中，就诊时处于晚期与存在情感和语言障碍独立相关（P =.01）。最后，报告的治疗延迟、失约或拒绝的主要原因是对替代疗法的偏好。
PN与LMIC的国立乳腺诊所相结合时，对于解决癌症治疗障碍是可行的。其实施提高了诊断及时性并降低了治疗失约率。更广泛地采用PN可能是LMICs癌症控制的关键要素。
