Adaptation of an Evidence Based Patient Navigation Model to enhance treatment outcomes for patients with breast cancer at Butaro Cancer Center of Excellence (BCCoE) in Rwanda
Cancer remains a significant global health challenge, with the World Health Organization highlighting its substantial burden on healthcare systems and economies. Breast cancer is the most common cancer affecting women worldwide (Ferlay et al., 2024). Disparities are pronounced: low- and middle-income countries (LMICs), such as Rwanda, experience higher mortality rates due to limited access to early detection and effective treatments, whereas high-income countries (HICs) typically have higher prevalence but lower mortality owing to more advanced healthcare infrastructure (Bray & Parkin, 2022). Despite notable improvements in Rwanda’s cancer care infrastructure over the past two decades, disparities in breast cancer outcomes persist, driven by delayed detection, treatment challenges, and geographical barriers (Schleimer et al., 2019). Patient navigation (PN) provides tailored support that enhances access to care and treatment adherence (Chen et al., 2024). This formative research aims to identify barriers and facilitators to implementing WHO’s patient navigation guidelines , (WHO, 2024) at BCCoE, focusing on the diagnosis and
treatment stages to improve patient outcomes.
Students submitted photos and reflections as part of their thesis research. All the people in the photos gave permission for their photos to be taken and shared.
Directional sign at Butaro Cancer Center of Excellence (study site) indicating the infusion center, where breast cancer patients meet their clinical team for consultations and receive chemotherapy. Another sign directs patients to a support center that offers short accommodations for those staying overnight, either waiting for their next-day chemotherapy or receiving treatment on the same day, but are unable to travel long distances home afterward. These signs exemplify the biosocial approach essential for holistic breast cancer treatment in rural areas with limited accommodation and transport options. Photo Credit: Aimable Uwimana
Study Data Collection Team—Chantal Uwimana (left), Gasaro Sharon (left), both data collectors, and Vivens Nsabimana (right), research assistant—pause on the Butaro Level Two Teaching Hospital (BL2TH) sign during their lunch break amid data collection. The Butaro Cancer Center of Excellence (study site) is located within BL2TH. Photo Photo Credit: Aimable Uwimana
A 57-year-old breast cancer patient referred from the Western Province of Rwanda arrives at the Butaro Cancer Center of Excellence in Northern Rwanda seeking cancer care after an eight-hour journey on multiple connecting public buses. This photo highlights the geographical and logistical access barriers many women with breast cancer in rural Rwanda face, some of which have the potential to be addressed by patient navigation services.
A Focus Group Discussion (FGD) is underway with the Butaro Cancer Center Oncology Staff to examine barriers and facilitators to implementing a Breast Cancer Patient Navigation Model at the Butaro Cancer Center of Excellence. A trained study research assistant facilitates the FGD, while Kamanzi (the student study PI) follows online. This photo highlights opportunities for qualitative data collection methods when geopolitical travel restrictions limit the student PI’s ability to travel to the study site for in-person data collection.
In July 2024, the Butaro Cancer Center of Excellence (BCCoE) installed its first CT scan machine. CT scans are vital for diagnosing and staging breast cancer. Before getting the machine, patients had to travel over 60 miles to Kigali, the capital, for scans, which was time-consuming, costly, and caused delays in treatment. Since the CT scan became available, there has been a notable decrease in referrals for breast cancer diagnosis.