Patient navigation to improve access to breast cancer care in Brazil

Abstract

Noncommunicable diseases, such as cancer, are surpassing infectious diseases as the most pressing health care threat in low- and middle-income coun tries (LMICs).1 By 2025, 59% of new cancer cases and 68% of all cancer deaths will occur in LMICs,2 and health care systems in these countries are struggling to respond to this changing landscape.3 In Brazil, breast cancer is the most common cancer and the leading cause of cancer death among women, with 14,206 deaths in 20134 and 57,960 new cancerdiagnoses estimatedforthe year2016.5 Recognizing the need for cancer control strate gies, the Brazilian government issued Ministry of Health Law No. 12.732/12, also called the Law of 60 Days, in 2012. This law states that treatment of any cancer for patients in the public health system must start within 60 days of definitive diagnosis.6 Shortly after the Law of 60 Days was enacted, the Cancer Information System (or SISCAN, the Brazil ian acronym) was instituted to monitor the imple mentation of the law by tracking patient treatment times, appointments, diagnostic tests, and targets and indicators for future cancer control actions.7 However, even years after the institution of the law, a large proportion of patients still do not re ceive timely treatment, and SISCAN has not been effectively used. Innovative solutions are needed to ensure that the law is properly implemented. In this context, an intervention such as patient nav igation (PN) could potentially allow for appropriate implementation of the law.8 Although PN pro grams have shown demonstrable success among underserved populations in the United States, their global implementation has been limited. Here, we discuss the potential role of PN in alleviating health system barriers and supporting adherence to the Law of 60 Days in Brazil, which in turn could improvethe outcomes ofwomenwith breast cancer throughout the country.