Supporting metastatic breast cancer patients through improved patient navigation

Context

In Nigeria, the cancer with the highest mortality rate is breast cancer.[1] The greatest challenge with breast cancer management in Nigeria, as in most low - and middle - income countries, is advanced clinical stage at time of initial presentation. It is a common observation that after diagnosis of the disease and the initiation of treatment, many patients do not return for follow-up or further treatment because of financial reasons, religious influences and the belief that they are already cured after a single treatment. To address these issues, the University of Nigeria Teaching Hospital (UNTH) of Enugu has launched a project aimed at improving patients’ access to quality health care through patient navigation.

The University of Nigeria Teaching Hospital of Enugu was awarded a SPARC MBC Challenge grant in 2015 to develop a project aiming at providing customised support and palliative care for metastatic breast cancer patients (MBC) through patient navigation.

Project description

UNTH started to train patients navigators to help MBC patients navigate the health care system and help them assess their treatment options. They also established a palliative care protocol in support of MBC patients. With the establishment of a patient navigation unit in the UNTH oncology centre and the development of a navigation protocol for cancer patients, a step by step approach is proposed which includes: welcoming of patients, finding out what the patient already knows about the disease, registering the patient, offering psycho-education and psycho-support  and following-up of patients.

The navigation unit is positioned in the Oncology centre as the first point of contact for cancer patients seeking care in UNTH. This makes every patient accessible and enables the navigators to capture the patient’s data.  In order to reduce the loss to follow-up, a database of patients with all stages of breast cancer at UNTH was set-up and comprehensive information about each individual accessing the navigation programme (such as demographics, ER/PR/Her2 receptor status, treatment received, outcome and follow-up status) was gathered.

In addition to individualised patient navigation, UNTH established a breast cancer support group to improve patient’s access to care and information and that is meeting on a monthly basis. The support group meeting ensures that all cancer patients are carried along and that the newly diagnosed patients will find peer support. In these groups, patients are trained on how to handle emotional distress associated with cancer.

Finally, to promote early detection of breast cancer, UNTH developed patient education materials and a curriculum for community education on cancer. This contained information about breast health, cancer prevention strategies and accessible/affordable breast cancer screening/treatment services. 

Impact

At the end of the SPARC project implementation, a functional patient navigation unit was established in the oncology centre of the University of Nigeria Teaching Hospital of Enugu. A patient navigation protocol and a palliative care protocol were designed. Integrated within the hospital systems a database tracking 250 breast cancer patients was introduced.

In parallel to the supporting MBC patients, UNTH has conducted four outreach campaigns that reached over 2,000 women in Enugu to promote early detection of breast cancer.

In the future, UNTH of Enugu hopes to design an app for oncology patients to track their progress and send them reminders about upcoming appointments. They will also continue sustaining the database of breast cancer patients.

Finally, to promote early detection of breast cancer, UNTH developed patient education materials and a curriculum for community education on cancer. This contained information about breast health, cancer prevention strategies and accessible/affordable breast cancer screening/treatment services. The materials were developed based on the National Witness Project, an evidence-based, breast and cervical cancer screening programme.[2] The materials were translated and adapted for educational purposes and cultural sensitivity.

More

• Organisation’s website: The University of Nigeria Teaching Hospital of Enugu
• Project Document: "Patient Navigation Protocol in UNTH"
• Journal article: Improving Community Health Workers Knowledge of and Attitude Toward Breast Cancer in Rural Communities in Eastern NigeriaV. okwor, K. Nwankwo, N. Lasebikan, I. Martin, I. Okoye, C. Nwogu, A. Okereke C, C. Okwor, T. Onyeka, and A. Okorafor. Journal of Global Oncology 2018 4:Supplement 2, 237s-237s. DOI: 10.1200/jgo.18.95300 Journal of Global Oncology 4, no. Supplement 2
• UICC article: "SPARC grant awardees- Meet Vitalis from Nigeria", with Vitalis Okor, Consultant in Clinical and Radiation Oncology  and Coordinator Breast Cancer Support Group at UNTH

References

[1] GLOBOCAN 2018

[2] NCI. The witness project - community-based program designed to increase breast cancer screening and promote the practice of mammography among underserved African American women(1999). http://rtips.cancer.gov/rtips/programDetails.do?programId=270521. Updated 2015. Accessed 4/17, 2015.

(Information from the project description and context is compiled from the SPARC reports)