Navigation program: comparison of diagnosis-treatment times among breast cancer patients.

The study was observational, so patients were not randomly assigned to navigation, and people who entered the navigation program differed from those who did not. Navigated patients were more likely to be treated through the public system, to have non-white skin color, lower education, stage III or IV disease, and chemotherapy, so these differences may explain some time findings. Only age was matched and only insurance type was used to adjust comparisons, so other factors that affect treatment timing were not controlled. The surgery interval combined surgery performed before and after neoadjuvant treatment, and the database did not record which was which. Some records had negative diagnosis-to-treatment intervals because benign initial pathology was confirmed as cancer after surgery. The study reported time to treatment, not survival, quality of life, adherence, or clinical outcomes. It was done at one hospital in Brazil, with one nurse navigator for the breast cancer pathway, so results may not transfer to other services. The navigation program included several nurse activities, and the study cannot show which component produced any difference.

Do not conclude that nurse navigation caused faster care or shortened overall treatment time. In the whole group, times to any treatment and neoadjuvant treatment were not significantly different, and surgery timing was longer in navigated patients. The study was observational, groups differed, and navigation was a bundle of activities whose separate parts were not tested.