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Consider a woman at a rural district clinic in Tanzania who undergoes a fine needle aspiration for a suspicious breast mass. In many resource-constrained settings, this is where the care pathway breaks down. The specimen may sit for weeks awaiting transport to a central laboratory; once it arrives, a shortage of supplies like immunohistochemistry (IHC) reagents can delay the final report. Even if a diagnosis of malignancy is reached, the connection to care is often lost: the result may never reach the clinician, or the logistical and financial hurdles of transitioning to a distant oncology center may prove insurmountable for the patient. 

Across many low- and middle-income countries (LMICs), fragmentation in service delivery is a central challenge in cancer care. Patients encounter gaps at multiple points along the care continuum, including screening, diagnosis, and treatment initiation. These disruptions contribute to delays, loss to follow-up, and poor clinical outcomes. 

For pathologists and laboratory professionals, these systemic gaps are most visible at the diagnostic stage. Breakdowns in communication between laboratories and clinical teams, combined with limited access to molecular testing, often mean that even an accurate diagnosis fails to translate into timely treatment. 

Patient navigation has emerged as a critical strategy to bridge these divides. By providing structured support, navigation helps patients move through complex health systems, overcome logistical barriers, and complete their care in a timely manner. As cancer incidence rises globally, the need for coordinated, patient-centered systems has never been greater. The next phase of global oncology will require moving beyond isolated pilot programs toward coordinated, measurable, and sustainable navigation systems that can be implemented at scale. Navigation cannot succeed without treating diagnostics as a critical node in the system, and pathologists and laboratory professionals are the people best positioned to make that case. 

What is patient navigation? Global efforts to define the field  

Patient navigation encompasses a set of functions that support timely, coordinated movement through the cancer care continuum. These commonly include identifying individualized barriers to care, facilitating referrals, coordinating services, and supporting communication across providers and settings. In LMICs, navigation models are highly context-specific and may be delivered by nurses, non-clinical patient advocates, or digital systems. 

Recent efforts have focused on bringing greater clarity and consistency to the field. The Global Initiative to Advance Cancer Navigation for Better Outcomes (GINO), created by Flinders University and the Multinational Association of Supportive Care in Cancer (MASCC), has developed a global practice framework identifying eight core functions: barrier identification, care coordination, communication, education, psychosocial support, patient empowerment, clinical care support, and advocacy. The framework emphasizes that navigation is not a single role but a set of functions distributed across a care team.1 

The American Cancer Society (ACS), through its Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) initiative, has focused on implementation. BEACON supports health institutions and cancer organizations in LMICs and other low-resource settings in designing, implementing, and sustaining cancer patient navigation programs, including through a Global Oncology Navigation Toolkit and virtual community of practice. 

The Global Alliance for Cancer Patient Navigation, a collaborative effort spearheaded by ACS, brings together more than 50 organizations across more than 25 countries to advance patient navigation as a standard of care worldwide. Its mission is to develop a unified framework and shared principles for implementing sustainable, evidence-based navigation models across diverse health systems. By convening global stakeholders, the Alliance seeks to address challenges in navigation that no single organization can solve alone, including gaps in training, metrics, and implementation guidance. I represent ASCP on the Alliance’s Steering Committee, contributing a laboratory and diagnostics perspective to these efforts. Despite this growing momentum, patient navigation remains highly variable in how it is defined, delivered, and measured, particularly in LMIC settings, where health systems are often fragmented and coordination mechanisms are limited. 

The reality in LMICs: Why navigation matters 

In many LMIC settings, cancer care is delivered across multiple facilities, providers, and levels of the health system, often without strong coordination mechanisms. Patients may receive screenings in a mobile clinic, diagnostic services in secondary hospital, and treatment at a centralized cancer center hundreds of miles from their home. At each transition point, there is a risk of delay or loss to follow-up. 

Weak referral pathways and limited tracking systems make it difficult to ensure that patients complete each step in care. In some settings, there is no systematic way to confirm whether a patient with a suspicious lesion obtained a biopsy, whether pathology results were received, or whether treatment was initiated. These gaps are compounded by financial, geographic, and social barriers facing patients. 

Diagnostic services represent a critical point of vulnerability. Delays in specimen transport, limited access to pathology and biomarker testing, and inconsistent communication of results can slow or interrupt the care pathway. Even when diagnostic capacity exists, the absence of coordinated follow-up can prevent results from translating into timely clinical action.  

Lessons from PEPFAR: System-level approaches 

Efforts to improve cancer care delivery in LMICs can draw on lessons from large-scale global health programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). I spent a decade implementing PEPFAR-funded laboratory programs — first with a non-profit public health organization and later at the Centers for Disease Control and Prevention (CDC) field office in Vietnam — and three lessons travel directly into the cancer space: cascade thinking, task-shifted workforces, and routine data systems used in real time. 

A central feature of HIV programs is the care cascade, a framework that tracks patients across sequential steps in care, from diagnosis to treatment initiation and long-term follow-up. At each step, programs measure how many patients successfully move forward and identify where losses occur. This approach creates accountability and provides a clear structure for targeted interventions. A similar framework can be applied to cancer care, where patients must progress through screening, diagnosis, treatment planning, and treatment initiation. Mapping these steps makes it possible to identify where delays and losses occur and where navigation can have the greatest impact. 

PEPFAR-supported programs have also demonstrated the value of task-shifting and community-based workforces. Lay health workers, peer supporters, and adherence counselors play a critical role in supporting patients, particularly where clinical capacity is limited. Investments in data systems have enabled routine monitoring of patient outcomes and program performance, allowing programs to identify gaps and respond in real time. Differentiated service delivery models further support efficiency by tailoring the intensity of services based on patient needs. 

Cancer care presents distinct clinical and logistical challenges, but these experiences highlight transferable system-level approaches. Structured tracking across the care continuum, supported by appropriate workforce models and data systems, can improve coordination and continuity of care. These principles provide a useful foundation for strengthening cancer patient navigation in LMIC settings. 

Coming Soon: A continued discussion in The Diagnostic Bottleneck: Rethinking Patient Navigation in Global Oncology, Part II.