Enrique Soto Perez De Celis

Abstract C09: A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America

Background: Cancer mortality rates in developing countries such as Mexico are higher than in high-income countries, due in part to failure and delays in access to health care. The median delay from problem identification to start of treatment can be up to 7 months, which is largely related to shortcomings of a fragmented healthcare system. At least 7 public providers coexist within the Mexico City Metropolitan Area (MCMA). A cumbersome and inefficient system requires the referral of patients with suspicion or diagnosis of cancer between hospitals with different health coverage. A more coordinated delivery of cancer care or navigation of cancer patients is needed to achieve timely initiation of treatment. Here we report preliminary results of the first patient navigation (PN) program in Mexico City. We initiated this study with the objective of demonstrating that implementing a PN program at a second level hospital within the MCMA would be feasible and reduce time to initiation of tertiary cancer care treatment. Methods: Patients eligible for PN enrolment were aged >18 with either suspicion or confirmed diagnosis of cancer who required referral to a cancer center for further care. Baseline demographic and psychosocial data were collected. Patients were navigated by a dedicated patient navigator, who assisted them with scheduling; paperwork; obtaining results in a timely manner; transportation; and appropriate oncological diagnosis and/or treatment. Our statistical assumption was a sample size of 40 patients needed to demonstrate it was feasible to successfully navigate at least 70% of the patients within 3 months of the start of navigation. Results: Recruitment began in January 2016. Twenty-six patients have been accrued (median age 57 years [range 22 to 85]; 14 [53%] are male). Most common diagnoses are: genitourinary (35%, N= 9), hematologic (15%, N=4) and head and neck malignancies (15%, N4). Fourteen (53%) have Conclusion: Preliminary results indicate that a PN program aimed at improving referral between health systems and overcoming access barriers to cancer diagnosis and treatment in Mexico City is feasible, and that it decreases the time to referral to a cancer center. PN may be a solution to overcome barriers to healthcare access for underserved cancer patients and perhaps patients with other non-communicable diseases in developing countries. Citation Format: Yanin Chavarri Guerra, Enrique Soto Perez de Celis, Wendy A. Ramos Lopez, Alexandra Bukowski, Sandra San Miguel, Oscar Sanchez Gutierrez, Jesus A. Sanchez Gonzalez, Paul E. Goss. A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C09.

Health information seeking preferences of Mexican cancer survivors: Creating an evidence base for the design of high-quality communication programs.

190 Background: In order to improve the quality of the communication between the healthcare system and cancer survivors, it is fundamental to understand their preferred sources of health information. In low and middle-income countries (LMICs), little is known regarding which sources are used and trusted the most. This information is crucial to develop effective communication aimed at achieving high-quality equitable cancer care. Our objective was to explore the preferred sources of health information in Mexico, and to understand which factors influence these choices. METHODS We examined sources of health information among cancer survivors in Mexico City using questions from the Spanish Version of the Health Information National Trends Survey (HINTS). The characteristics of survivors who preferred the internet were compared with those who preferred other sources (doctors, printed materials, family members, organizations) using Fishers exact test. Logistic regression was used to assess the effects of patient characteristics on health information-seeking. RESULTS Of 148 participants, 82 (56%) had internet access. Of the 88 patients who had sought health information, 61 (69%) listed the internet as their preferred source. Those 65 and older were less likely to seek health information, regardless of the source (OR 0.17, p < 0.0001). Survivors who preferred the internet were more likely to be younger (p = 0.001), male (p = 0.003) and to have a higher educational level (p = 0.009). Comorbidities, stage, cancer type, and time from diagnosis had no effect on patient preferences. Doctors were the most trusted source of information (85%), followed by the internet (28%) and government agencies (23%). CONCLUSIONS Mexican patients who seek health information online are more likely to be young educated males. Doctors represent the most trusted source of information, particularly for patients from vulnerable populations (such as older women with low educational levels). High-quality healthcare information programs in LMICs should be designed taking these behaviors into account, and patients should continue to receive health information via their most trusted sources.

A prospective assessment of the quality of multidisciplinary tumor boards in Mexico and its relationship with decision making.

188 Background: Multidisciplinary Tumor Boards (MDTB) allow the review of cases and have been associated with improved decision making and outcomes. There is limited information regarding the performance of MDTBs in developing countries. The aim of this study was to assess the quality of MDTBs and its relationship with decision making at an academic hospital in Mexico City. METHODS We used a validated tool (MTB-MODe) to prospectively assess the quality of MDTBs at our institution. MTB-MODe assigns a score of 1-5 to various aspects of case presentations at a MDTB, including the quality of the information presented and the performance of team members, which are then averaged to obtain a mean score. The scores of MTDBs which reached a decision were compared against those who failed to do so using Mann-Whitney U-test. RESULTS 100 cases presented at MDTBs between April and June 2015 were analyzed. Median patient age was 57 years (19 - 87). The most common diagnoses were hepatic (23%), breast (20%) and prostate cancer (15%). 50% of cases (n = 50) were localized. Mean MTB-MODe score was 3.27 (range 1.75-4.75), and a decision was reached in 83% of cases (n = 83). Cases in which a multidisciplinary decision was reached had a better MTB-MODe score than those without a decision (n = 17) (3.4 vs 2.8, p = 0.01). The ability of the MDTB to reach a decision was associated with the quality of case presentation (4.1 vs 3.2, p = 0.01), the presentation of comorbidities (3.5 vs 2.6, p = 0.006), better leadership of the coordinator (3.5 vs 2.5, p = 0.002) and better participation of team members (4.2 vs 2.9, p < 0.001). The patients point of view was discussed in only 8% of cases (n = 8), while psychosocial issues were only considered in 10% of cases (n = 10). CONCLUSIONS We found that the quality of case presentations at MDTBs, and the performance of its members, are associated with the ability to reach multidisciplinary decisions. In contrast with reports from developed nations, we found that the patients point of view and psychosocial issues were not only largely ignored, but also irrelevant for decision making. The continuous evaluation and improvement of MDTBs is necessary for successful decision making in order to improve patient outcomes.