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Research Article Volume 17 Issue 3
Impact of a structured thoracic navigation pathway on diagnostic timeliness and survival in lung cancer: a prospective cohort study from Brazil
Cinthya Sternberg, Calabrich Aknar, Santana Iuri, Brandão Graziela
Clinica AMO, Salvador, BA, Brazil
Rede Mater Dei, Salvador, Brazil
PGPCT/Fiocruz-BA, Salvador, Brazil
Ética Pesquisa e Ensino, Brazil
Received: May 08, 2026 | Published: June 1, 2026
Citation: Aknar C, Iuri S, Graziela B, et al. Impact of a structured thoracic navigation pathway on diagnostic timeliness and survival in lung cancer: a prospective cohort study from Brazil. J Cancer Prev Curr Res. 2026;17(3):78‒83. DOI: 10.15406/jcpcr.2026.17.00611
Abstract
Lung cancer poses a significant public health challenge with high morbidity and mortality. In low- and middle-income countries (LMICs), access to novel oncological treatments is often delayed or restricted. However, process-based interventions such as patient navigation may improve clinical outcomes irrespective of the specific treatment used. This study evaluates whether a structured thoracic navigation pathway improves timeliness and survival in a Brazilian private outpatient clinic. Data collected in 2019 served as baseline pre-intervention measures; the navigation pathway was then implemented, and outcomes in 2020-2021 were measured during the COVID-19 pandemic as a natural stress test. This prospective cohort study included 226 consecutive lung cancer patients (2019-2021). Baseline data from 2019 (n=99) identified diagnostic delays, after which a dedicated thoracic oncology nurse navigator was implemented as part of an integrated care pathway. Post-intervention outcomes were measured in 2020 (n=56) and 2021 (n=71). Key metrics included time to diagnosis (TTD), time to treatment initiation (TTI), performance status (PS) decline, and 1-year overall survival (OS). At baseline, only 25% of patients were diagnosed within 21 days (median TTD 47 days). Following navigation implementation, results improved dramatically: median TTD decreased to 7.5 days (2020) and 18 days (2021), with 78% diagnosed within 21 days by 2021. Despite severe pandemic disruptions, including a 47% COVID-19 mortality rate among patients, the navigation pathway ensured continuity via teleconsultations and virtual tumor boards. While the pandemic delayed adjuvant chemotherapy, 1-year OS remained stable (78.6% at baseline vs. 76% post-intervention). PS decline remained below 16% across all periods. Main delays were biopsy waiting time and surgical scheduling, not treatment unavailability. A monitored care pathway with dedicated patient navigation improves diagnostic speed and survival independent of advances in systemic therapy. The model proved effective and resilient during the COVID-19 crisis, making it highly adaptable to resource-limited and public health settings where innovative drugs are not readily available. Policymakers in developing countries should prioritize navigation programs as a high-value, low-cost intervention.
Keywords: patient navigation; lung cancer; global health; care pathway; covid 19; resource limited settings
©2026 Aknar, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.