Implementing a Multicomponent Navigation Program to Reduce Time Intervals to Treatment Initiation for Advanced Breast Cancer in Paraguay

PURPOSE Patient navigation programs have been associated with accelerated access to treatments and improved follow-up care in multiple diseases. Metastatic breast cancer reflects a complex scenario in low- and middle-income countries (LMICs) because of multiple barriers, including a challenging administrative burden associated with multiple diagnostic assessments. METHODS We developed a multicomponent program (RACAM), where we established a referral network with the participation of patient advocates, as well as the creation of educational materials, the nurse navigator training, and the implementation of a software program to track delays in follow-up examinations and visits. A hybrid-type III effectiveness-implementation design was used to evaluate the program. Baseline intervals from time-to-treatment initiation were collected retrospectively between April 2021 and 2023. RESULTS Baseline measurements included 61 patients with complete pharmacy records. A total of 29% of the reviewed patients had a time-to-treatment initiation (TTI) of