Aligning patient navigation activities with the early cancer care agenda in LMICs: a framework for implementation across the cancer continuum

Abstract

Delays in cancer care are a persistent challenge in low- and middle-income countries, often driven by social and systemic barriers. This challenge is particularly acute in LMICs where cancer mortality-to-incidence ratios remain disproportionately high and health system fragmentation undermines early diagnosis and timely treatment, threatening progress toward United Nations Sustainable Development Goal 3 (Good Health and Well-Being) and United Nations Sustainable Development Goal 10 (Reduced Inequalities). Patient navigation programmes (PNP) have emerged as a strategy to improve care coordination and reduce delays. However, heterogeneity in PNP design, implementation and the absence of standardized frameworks, hinder their evaluation in relation to early cancer care goals. To develop a conceptual framework that systematically maps PNP activities to key time intervals in the cancer care continuum to advance evidence-based implementation of patient navigation for early cancer care. This study employed a theory-informed, deductive qualitative approach using PNP literature to operationalize the emerging framework using sensitizing constructs from the “Model of Pathways to Cancer treatment” (MPT) (events, processes, and time intervals. Framework refinement was guided by observed evidence across cases. The resulting framework extends the MPT by incorporating two additional time intervals (post-treatment and survivorship) and identifies new patient navigation processes across these stages. PNP activities were consistently mapped to time intervals, revealing clear patterns of alignment with early cancer care objectives. Navigation activities were most densely concentrated within diagnostic and pre-treatment intervals, with variable longitudinal extension into post-treatment and survivorship stages. No contradictory evidence to the theoretical structure was identified. The framework enables the classification of PNP by timing and function, facilitating evaluation, replication, and scale-up. By providing a PNP classification, grounded in real-world LMIC implementation, this framework contributes to strengthening cancer control systems and advancing equitable progress toward universal health coverage.