Summary

Health disparities hinder access to cancer care across the globe, especially in low- and middle-income countries.1 Patient navigation denotes an approach where people are provided with one-on-one support, guidance, advocacy and education to guide them through the care continuum.2 Recognising the importance of patient navigation and its capacity to help address health disparities, the American Cancer Society set up the Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) initiative.3 It is a global initiative that provides cancer centres and organisations in low- and middle-income countries with tools and resources to design and implement patient navigation programmes.4 Since an initial pilot roll-out across 8 centres in 2022, the initiative has had 137 users from 14 low- and middle-income countries. BEACON has also organised 20 virtual events to share real-world implementation insights; these have been attended by 141 users.5 The programme now aims to recruit more users, aiming to expand to 50 centres.6

Challenge

Health disparities are preventable differences in the burden of disease that are experienced by marginalised communities; these inequalities are present in cancer care across the globe.7 Although people living in low- and middle-income countries only make up 54% of the global population, 70% of people who die due to cancer live in these countries – and this proportion is expected to rise to 75% by 2030.1 8 Addressing the disparities experienced by populations in these countries is vital to improving access to cancer care and, ultimately, survival.

Health disparities are especially prevalent in low- and middle-income countries, where people with cancer often experience the following the barriers to accessing effective care:9

  • Limited public awareness of cancer and its symptoms – this is exacerbated by low literacy in certain populations
  • Inadequate healthcare funding and infrastructure – the people most effected by health disparities are often unable to pay for their own care, meaning they must rely on a severely under-resourced (or sometimes non-existent) public health system
  • Shortages in workforce, leading to increased waiting times to access care
  • Limited access to cancer screening programmes
  • Delays in diagnoses
  • Treatment abandonment due to low awareness of the risks and financial toxicity, and/or due to individuals needing to travel long distances to receive care
  • a lack of palliative care provision.

While these core challenges are shared across low- and middle-income countries, the unique cultural context and structure of many of these countries makes a one-size-fits-all approach ineffective to reducing health disparities.9 More complex and personalised solutions are needed.

Solution

Patient navigation is a community-based intervention that can help mitigate health disparities by eliminating barriers to accessing timely and high-quality cancer care.2 Patient navigators work one-on-one with individuals with cancer to guide and support them through the cancer continuum, providing services that address a wide range of needs – including physical, emotional, psychological, social and practical.2 10 Patient navigators can also act as an advocate and educator.10

Effective patient navigation can reduce care disparities and unequal access. For example, implementation of a patient navigation programme in Harlem for people with low socioeconomic status led to 37% increase in early-stage cancer diagnoses, and a 31% increase in five-year survival.2 Recognising this, the American Cancer Society set up the Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) initiative in 2022.3 BEACON is a global initiative that supports implementing cancer navigation programmes in low- and middle-income countries, with the aim of reducing health disparities in cancer care.3 Institutions that join the initiative gain free access to an online platform that is designed for learning and collaboration. The key resources available in English are:4

  • The Global Oncology Navigation Toolkit: a host of practical resources and templates that guide the user through the key processes and activities needed to design, launch and grow a patient navigation programme that befits the local context, resources and populations.
  • The virtual Community of Practice: access to online events that enable networking and discussions among patient navigation stakeholders to facilitate collaborative learning.

The initiative’s intended audience is health institutions providing cancer treatment services in low- and middle-income countries, cancer organisations partnered with these institutions and institutions focused on addressing health disparities in cancer care.11 The toolkit can be utilised at any stage of programme development, from conceptual programme design to refining existing programmes, or for restarting inactive programmes which may have lapsed due to lack of knowledge or effective management.11

What has been achieved?

The initiative was launched with a 15-month pilot phase in institutions in Armenia, Brazil, Egypt, Guatemala, Indonesia, Malaysia, Nigeria and South Africa.5 These studies demonstrated the positive impact that BEACON has had on reducing health disparities in cancer care. Pilot users reported feeling confident in setting up their own programmes after using the toolkit, and found the virtual platform an invaluable resource for real-world insights.5 The American Cancer Society has also since provided grants to some pilot locations to assist in their implementation activities.5

Between 2022 and 2023, 137 individuals from 14 low- and middle-income countries accessed the online platform to use the toolkit and participate in the Community of Practice. BEACON also hosted 20 virtual community events, which promoted co-learning and sharing of experiences on overcoming challenges in patient navigation implementation; 141 unique participants attended.5

Next steps

The initiative is being revised and expanded following user feedback from the pilot sites. The BEACON initiative aims to expand its reach to an additional 50 locations.6 The programme hopes to develop to address some of the current limitations of the toolkit by providing resources in more languages, focusing on patient navigation for specific cancer types, and expanding the remit to include policymakers and cancer control planners.5

There is a plan to conduct a full evaluation of the programme, its impact on patient navigation, and the effectiveness of patient navigation on reducing cancer care disparities.5

References:

  1. Brand NR, Qu LG, Chao A, et al. 2019. Delays and Barriers to Cancer Care in Low- and Middle-Income Countries: A Systematic Review. The oncologist 24(12): e1371-e80 [accessed: November 2024]
  2. Freeman HP, Rodriguez RL. 2011. History and principles of patient navigation. Cancer 117(15 Suppl): 3539-42 [accessed: November 2024]
  3. World Health Organization. 2024. American Cancer Society: BEACON Initiative. Available from: Available here: https://www.knowledge-action-portal.com/en/content/american-cancer-society-beacon-initiative [accessed: November 2024]
  4. American Cancer Society. 2024. American Cancer Society BEACON Initiative. Available from: Available here: https://beaconcommunity.cancer.org/s/about-acs-beacon-public [accessed: November 2024]
  5. McComb K. 2023. Importance of Navigating Patients in Health Systems, Clinics and Communities: ICCP ECHO April 2023 session. Atlana, GA Available here: https://www.citizensinformation.ie/en/health/health-services/cancer-services/cancer-services/ [accessed: November 2024]
  6. The White House. 2024. Fact Sheet: The Biden Cancer Moonshot Announces More Than $100 Million in New Actions to Decrease the Burden of Cancer in Africa. Available here: https://www.whitehouse.gov/ostp/news-updates/2024/07/15/fact-sheet-the-biden-cancer-moonshot-announces-over-100-million-in-new-actions-to-decrease-the-burden-of-cancer-in-africa/ [accessed: November 2024]
  7. Centers for Disease Control and Prevention. 2023. Health Disparities. Available from: Available here: https://www.cdc.gov/healthyyouth/disparities/index.html [accessed: December 2024]
  8. Tavallaii A, Meybodi KT, Nejat F, et al. 2023. Current Status of Research on Targeted Therapy Against Central Nervous System Tumors in Low- and Lower-Middle-Income Countries. World Neurosurgery 174: 74-80 [accessed: December 2024]
  9. Bamodu OA, Chung C-C. 2024. Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries. JCO Glob Oncol: 10.1200/go.23.00439 (10): e2300439 [accessed: December 2024]
  10. King G. 2016. Patient Navigators. Available here: https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2016/12/patient-navigators.pdf [accessed: December 2024]
  11. BEACON Initiative. 2022. Global Oncology Navigation Toolkit and Community Participation. Available from: Available here: https://beaconcommunity.cancer.org/s/recruitment [accessed: December 2024]