{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:47:04Z","timestamp":1783442824285,"version":"3.54.6"},"reference-count":23,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"4","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Patient navigation programs have been associated with accelerated access to treatments and improved follow-up care in multiple diseases. Metastatic breast cancer reflects a complex scenario in low- and middle-income countries (LMICs) because of multiple barriers, including a challenging administrative burden associated with multiple diagnostic assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We developed a multicomponent program (RACAM), where we established a referral network with the participation of patient advocates, as well as the creation of educational materials, the nurse navigator training, and the implementation of a software program to track delays in follow-up examinations and visits. A hybrid-type III effectiveness-implementation design was used to evaluate the program. Baseline intervals from time-to-treatment initiation were collected retrospectively between April 2021 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Baseline measurements included 61 patients with complete pharmacy records. A total of 29% of the reviewed patients had a time-to-treatment initiation (TTI) of &lt;30 days, and 74% had a TTI of &lt;60 days. For RACAM, 55 patients were included between December 2023 and September 2024. The median TTI was 17 (95% CI, 12 to 19) days, with only 2 (3.6%) requiring more than 2 months to start the recommended treatment. After RACAM was implemented, the activities with longer intervals between scheduling and task completion were bone scans (25 days [range, 10-30]), radiotherapy consults (15 days [95% CI, 0 to 22 days]), and oncology visits (11 days [95% CI, 8 to 14 days]). The acceptability rate of the program was 96.3%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The implementation of RACAM had an initial association with a time-to-treatment initiation interval. A progressive formalization of Navigator Programs in Paraguay represents an opportunity to overcome certain barriers normally reported in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00281","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T19:59:14Z","timestamp":1775246354000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Implementing a Multicomponent Navigation Program to Reduce Time Intervals to Treatment Initiation for Advanced Breast Cancer in Paraguay"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3075-472X","authenticated-orcid":true,"given":"Mar\u00eda Lucila","family":"Gonzalez Donna","sequence":"first","affiliation":[{"name":"INCAN\u2014Paraguayan National Cancer Institute, Capiat\u00e1, 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