The Effect of a Patient Navigator on Treatment Abandonment and Follow-up for High Grade Osteosarcoma Patients in the Philippine General Hospital

Gaston, Czar Louie; Taleon, Kathleen; Barsales, Ken; Dimayuga, Cesar; Estanislao, Jochrys; Fajardo, Pamela; Quintos, Albert; Rubio, Donnel; Wang, Edward; Alcasabas, Ana Patricia

doi:10.31557/APJCP.2021.22.9.2873

The Effect of a Patient Navigator on Treatment Abandonment and Follow-up for High Grade Osteosarcoma Patients in the Philippine General Hospital

Document Type : Research Articles

Authors

¹ Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.

² Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.

10.31557/APJCP.2021.22.9.2873

Abstract

Introduction: Treatment abandonment for osteosarcoma is a significant problem in developing countries with rates as high as 70%. This study aimed to determine the effect of a patient navigator on treatment abandonment and patient follow-up of osteosarcoma patients at a tertiary referral center. Materials and Methods: A retrospective review of osteosarcoma patients was performed investigating 2 cohorts based on the start of the patient navigator. Group 1 (Pre-Patient Navigator, n=46) were treated from January 2016 to December 2017 while Group 2 (Post-Patient Navigator, n=29) were treated from January 2018 to June 2019. The primary outcome investigated was treatment abandonment defined as missing 4 or more consecutive weeks of treatment. Semi-structured interviews were conducted to investigate the effect of the patient navigator on the cohorts. Results: Treatment abandonment rates for the Pre-Patient Navigator group was significantly higher compared to those with a patient navigator (50% vs 6%, p=0.0001). Abandonment for the pre-navigator group occurred at a mean of 2.9 months (0 – 9 months, median 3 months). Fourteen of 23 patients who abandoned from Group 1 did not proceed to neoadjuvant chemotherapy while 3 patients abandoned after completing 1 cycle of neoadjuvant chemotherapy. In the patient navigator group, no patients abandoned prior to completing 3 cycles of chemotherapy. One patient abandoned after refusing a below knee amputation after 3 cycles of neoadjuvant chemotherapy and 1 patient did not complete further chemotherapy after having a hip disarticulation. Patient feedback on the patient navigator experience was favorable. Conclusions: Having a patient navigator from diagnosis throughout treatment reduced treatment abandonment rates in osteosarcoma patients and may serve as a model for other low to middle income countries.

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