Abstract 1724P
Background
In Botswana, 65% of breast cancers present at an advanced stage due to multifactorial delays. The WHO Global Breast Cancer Initiative recommends a maximum of 60 days of lead time in diagnostic workup and strongly advocates for the use of patient Navigation. A Patient Navigation Project was created to improve the timely diagnosis and treatment of breast cancer patients around Gaborone, the capital.
Methods
A 2-day theoretical and practical course was delivered in March 2022 to 15 clinical navigators (nurses from 6 district Hospitals and from the Referral Hospital) and 7 non-clinical navigators (advocacy groups). A navigation coordinator served as the point of contact, reported on program outcomes and provided smartphone airtime. Different virtual communication groups were created with navigators to accelerate patient flow and facilitate problem solving.
Results
Between April 2022 and July 2023, 75 patients were included in the navigation program: 21 were in early stages (stages I and II) (28%) and 53 in advanced stages (stages 3 and 4) (71%). From those patients, 46% received neoadjuvant chemotherapy, 17% adjuvant chemotherapy and 25% palliative therapy. Navigation enabled faster access to CT-scan staging, unveiling more stage IV disease (23%), thus avoiding inappropriate curative treatments.
Table: 1724P
Key navigation challenges and improvements
| Key persistent challenges | Key improvements |
| Delays in biopsy (needle shortages) | Biopsies and staging done locally, avoiding referral delays for diagnostic workup |
| Delays in obtaining biopsy and IHC results (pathology backlogs, loss of sample, reagent shortages) | Fast referral pathway for patients in need of urgent consultation |
| Patient transport issues | Closer tracking of patients and tests results |
| Treatment delays: Stock-outs of drugs (hormone therapy, chemotherapy) and radiation therapy delays | Facilitated access to counselling and transport services |
| Time constraints: Limited time allocated to navigation | Increased multidisciplinary collaboration |
Conclusions
The Botswana Breast Cancer Navigation project succeeded in implementing Cancer Navigation in accordance with international guidelines. It improved management of breast cancer patients through a smoother access to diagnosis and treatment, and it addressed barriers to care for specific situations. Many navigation sites referred patients with upfront biopsy diagnosis and minimal staging, and this reduced the time from first consultation in breast clinic to treatment (median delay 22 days). Dr Migeotte and Dr Soares de Pinho contributed equally to this work.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Botswana-Rutgers Partnership for Health.
Funding
UICC.
Disclosure
All authors have declared no conflicts of interest.
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