Barriers to Breast Cancer Care: Patient Navigation Pilot Results From Mwanza, Tanzania

PURPOSE Breast cancer incidence and mortality in Tanzania remain high due to late-stage diagnosis and limited access to timely care. We examined data from a needs assessment and patient navigation pilot program to identify breast cancer patient-reported barriers from diagnostic workup through treatment initiation and completion. METHODS This multiple methods study took place at Bugando Medical Center (BMC) in Mwanza, Tanzania. Breast cancer patients completed a cross-sectional survey assessing barriers to care. We also conducted a patient navigation pilot program for women who presented to BMC with breast concerns and were diagnosed with breast cancer. Navigators called to remind patients about appointments, assess barriers, and coach women on overcoming them to encourage attendance. We descriptively summarized survey responses and programmatic data on patients diagnosed with breast cancer. RESULTS In the survey, 98 patients were included. Median age was 52 years (IQR: 46-61), 56% had insurance, and 87% were married. Seventy patients (74%) initially presented to a district- or regional-level hospital before being referred to BMC. Costs associated with obtaining care were the most commonly reported barrier (58%), followed by fear of mastectomy (29%), fear of cancer diagnosis (21%), and transportation issues (16%). Although 83% were aware of breast cancer, the majority (90%) reported low knowledge. For the pilot, patient navigators connected with 31 patients diagnosed with breast cancer. Patients had a mean of 5 follow-up visits (range: 1-18). Median age was 49 years (IQR: 29-80) and 29% had insurance. During the pilot program, patients noted several challenges to attending appointments. Twenty-four (77%) patients noted financial challenges; 6 (19%) patients reported transportation/accommodation as a challenge, and 5 (16%) noted health concerns (weak, pain, pregnant). Additional challenges cancer patients faced included delays in diagnostic pathology results (n = 3), chemotherapy shortages (n = 1), and reliance on traditional medicine (n = 1). Navigators also assisted patients during hospital visits, sought financial exemptions for treatment, and connected patients with palliative care. CONCLUSION Our findings identified that finances were consistently problematic for breast cancer patients. Future navigation programs may benefit from incorporating need-based financial assistance, including transportation stipends, to improve timely diagnosis, treatment, and retention in care.