The Diagnostic Bottleneck: Rethinking Patient Navigation in Global Oncology, Part II

In Part I of this two-part article, I discussed patient navigation in low- and middle-income countries, and the impact that can have on patient care and outcomes. Patient navigation can be critical to the continuity of care, but it’s important to understand how it can be implemented and the gaps that remain. Part II will look at this as well as lessons learned. Part I of this article can be found here.   

Patient navigation in action  

To understand how patient navigation functions in practice across LMIC settings, it is useful to examine real-world implementation efforts. Through the Coalition for Implementation Research in Global Oncology (CIRGO), an initiative administered by ASCP with the financial support of Bristol Myers Squibb, a series of grants were awarded to support diverse navigation-related projects across multiple countries in Sub-Saharan Africa. These initiatives, typically funded at approximately $50,000, tested a range of approaches adapted to local health system needs and constraints. 

The projects illustrate the flexibility of navigation models. In Uganda, a navigation program integrated with Project ECHO connected frontline providers and navigators with oncology specialists, while also incorporating peer support to improve patient engagement and adherence to care. In Mozambique, a breast cancer database was paired with a navigation system to track patients from diagnosis through treatment, strengthening referral pathways and clinical decision-making. In Rwanda, a tablet-based electronic medical record enabled patient tracking and re-engagement, functioning as a digital navigation system even without that designation. Other models emphasized low-cost communication, as seen in Côte d’Ivoire, where clinical officers and patient advocates used WhatsApp to facilitate consultation and referral to oncologists. 

Insights from CIRGO  

Findings from a two-year follow-up survey we conducted of CIRGO grant recipients (initial findings presented in conference abstracts; manuscript in preparation) provide a practical view of how patient navigation is being implemented across LMIC settings, along with early signs of sustainability and system-level impact. Although the specific approaches differ, several consistent lessons emerge that are relevant for future program design and scale-up. 

Navigation functions appear most effective when embedded within existing clinical workflows rather than introduced as standalone roles. Across settings, programs often build on existing structures, such as patient databases, communication platforms, or clinical coordination processes, to improve follow-up and continuity of care. This approach allows navigation to strengthen systems without requiring new administrative layers.  

Across CIRGO projects, the most consistent impact is on follow-up and timeliness of care. Navigation approaches improve the ability to track patients across multiple steps, reduce delays between diagnosis and treatment, and support adherence to recommended care. As one project team noted, “Patient follow up continues and the interaction with the navigators continues even when patients return to the community.” These findings align with broader portfolio data that showed improvements in quality of care and patient access. The projects also highlight the role of digital tools as enablers of navigation. Electronic medical records, messaging platforms, and patient databases can strengthen tracking and communication, but their effectiveness depends on active follow-up by providers or navigators.   

The data also suggest that navigation programs can be sustained beyond initial seed funding. The majority of CIRGO-supported projects continued after the grant period ended, with some integrated into routine operations or incorporated into national guidelines and programs. Several have been replicated or expanded. These findings demonstrate that relatively small, locally led investments can contribute to longer-term improvements in care delivery. 

The remaining gaps: From pilots to systems 

The experiences from CIRGO and similar efforts demonstrate that patient navigation can improve coordination, timeliness, and patient engagement. They also highlight the next set of challenges. Patient navigation remains inconsistently defined. Programs vary in scope, workforce, and level of integration within health systems, making it difficult to compare models or build a shared evidence base. Measurement is similarly fragmented. Although indicator sets exist, they are not widely applied, limiting the ability to identify where patients are lost or which interventions are most effective.  

Another critical gap is the limited availability of cost and economic data. Many programs report improvements in efficiency and coordination, but few are able to quantify costs, savings, or return on investment. This lack of data makes it difficult for health systems and policymakers to justify sustained funding or to incorporate navigation into national cancer control strategies.  

Finally, most navigation efforts remain small in scale. Moving from pilot programs to routine practice will require clearer approaches to financing, workforce development, and integration into national cancer control strategies. These gaps highlight the need for coordinated multi-organizational approaches that extend beyond the scope of individual programs.  

The role of the Global Alliance for Cancer Patient Navigation 

The Global Alliance for Cancer Patient Navigation provides a platform for this coordination. By bringing together organizations across countries and disciplines, it supports the translation of locally successful models into more consistent approaches to implementation. As Anu Agrawal, Head of Global Health at the American Cancer Society and Co-Chair of the Alliance, explains:  

“We are at a tipping point in integrating patient navigation as a core component of patient-centered cancer care. The Global Alliance for Cancer Patient Navigation is building awareness and supporting the evidence base for patient navigation so that policymakers can move from identifying patient navigation as a useful tool to systematically and actionably incorporating it as a sustainable solution to help persons with cancer and their caregivers.” 

By connecting existing frameworks and implementation efforts, the Alliance can help clarify shared principles of patient navigation while still allowing for local adaptation.  The Alliance can also support the exchange of implementation experience across countries. As health systems consider how to incorporate navigation into routine care, they will require practical guidance, examples of sustainable models, and opportunities for shared learning. Through these functions, the Alliance can help move navigation from a collection of promising initiatives toward a more established component of cancer care delivery. 

Why diagnostics matter: A critical opportunity for ASCP 

Efforts to strengthen patient navigation must account for the central role of diagnostics in the cancer care continuum. In many LMIC settings, gaps at the diagnostic stage, including limited access to biomarker testing, frequent stock-outs, and communication breakdowns between laboratories and clinical teams, contribute directly to treatment delays and loss to follow-up. Strengthening specimen tracking, improving turnaround time, and ensuring that results are acted upon are areas where the application of navigation principles to the laboratory can directly improve continuity of care. 

An additional dimension of navigation that remains underdeveloped is patient understanding of diagnostic information. Cancer diagnoses and biomarker results increasingly guide treatment decisions, yet many patients have limited access to clear explanations of what their results mean. Emerging models like Pathology Clinics demonstrate the value of direct communication between pathologists and patients. In one small study, 78 percent of respondents strongly agreed that they felt more empowered after seeing their disease through the microscope.2  While these models may not be easily scalable in all settings, they underscore an important principle: supporting patients in understanding their diagnosis can improve engagement in care and adherence to treatment. 

Advancing patient navigation in global cancer care 

The evidence from CIRGO and other global health efforts suggests that patient navigation in LMICs has reached an inflection point. The focus now shifts from demonstrating feasibility to integrating navigation into routine care in ways that are practical and sustainable.  

For the pathology and laboratory medicine community, this transition represents an opportunity. Pathologists and laboratory professionals can help ensure that the diagnostic stage, often the most vulnerable point in the care pathway, is more effectively connected to treatment. This includes strengthening systems for specimen tracking, improving turnaround and communication of results, supporting appropriate use of biomarker testing, and ensuring that diagnostic information leads to timely clinical action.  

Improving cancer outcomes in LMICs will depend in part on the ability of health systems to ensure that patients complete each step in care and understand the decisions that follow. Strengthening patient navigation, including its integration with diagnostics, offers a practical path forward. The next phase of progress will depend not only on moving patients through the system, but on ensuring that they are informed participants in their care. 

The woman at the Tanzanian district clinic in Part One — with her suspicious mass and uncertain referral pathway — should never have been a vignette of failure. Whether her fine needle aspirate moves cleanly through transport, processing, reporting, and treatment is, in the end, a navigation question; and the laboratory is a central actor in answering it.