# Streamlining care through patient navigation: a retrospective cohort study of timely anti-HER2 therapy in early breast cancer in a low-middle income country

## TL;DR

A patient navigation program in Egypt helped speed up anti-HER2 cancer treatment for patients, reducing delays in a low-middle income country.

## Contribution

Demonstrates that patient navigation can effectively reduce treatment delays in LMICs for early HER2-positive breast cancer patients.

## Key findings

- Navigation significantly reduced the time from MOH approval to treatment start (T4) in primary and sensitivity analyses.
- Overall time from registration to treatment initiation decreased across the full year with navigation, despite rising patient volumes.
- Pathological complete response rates remained comparable between groups with and without navigation.

## Abstract

Timely initiation of therapy is critical for patients with HER2-positive early breast cancer, especially in low- and middle-income countries (LMICs) where health-system constraints delay care. We evaluated whether a Patient Navigation Program could reduce time from registration to initiation of dual anti-HER2 therapy in Egypt.

Retrospective cohort study at the Breast Cancer Comprehensive Center (BCCC). Trained navigators tracked diagnostics, scheduled multidisciplinary tumor board (MDT), prepared/submitted Ministry of Health (MOH) approval files, monitored approval, and booked the earliest infusion slot. The primary endpoint was time from registration to therapy start; secondary endpoints were prespecified intervals—T1 (registration→MDT), T2 (MDT→MOH submission), T3 (MOH submission→MOH approval), and T4 (MOH approval→therapy start), time to surgery, and pathological complete response (pCR). The primary analysis compared symmetric six-month windows: July–December 2022 (without navigation) vs. January–June 2023 (with navigation). A sensitivity analysis included all eligible patients: May–December 2022 vs. January–December 2023. Two-sided p < 0.05 was significant.

In the primary analysis, navigation significantly shortened MOH approval → therapy start (T4) (p = 0.008), while T1–T3 and total time showed non-significant differences (total: p = 0.127). pCR was similar (78/115 [67.8%] vs. 81/117 [69.2%], p = 0.818). In the sensitivity analysis (N = 441), total time decreased from 146.2 ± 76.6 to 121.6 ± 50.4 days (–24.6 days, p < 0.001), driven by a large improvement in T4 (32.4→20.8 days; − 11.6 days, p < 0.001) while pCR remained comparable, although not statistically significant (64.1% vs. 69.9%, p = 0.76).

In an LMIC tertiary center, a Patient Navigation Program significantly accelerated the post-approval step to treatment and, across the full year, shortened the overall time from registration to initiation of dual anti-HER2 therapy despite rising volumes. These system-level gains, support navigation as a scalable, equity-promoting strategy aligned with World Health Organization (WHO)Global Breast Cancer Initiative priorities; prospective multicenter evaluations incorporating patient-reported outcomes and cost-effectiveness are warranted.

The online version contains supplementary material available at 10.1186/s12913-025-13606-8.