Improving cancer outcomes requires more than getting patients through the door. It requires connecting the steps that follow.
Awareness Is Only the Beginning
Awareness is often where conversations about cancer begin. We encourage people to know the signs and symptoms, seek medical attention early and participate in screening where appropriate. These efforts matter. But another question deserves equal attention: what happens after a person decides to seek care?
A woman may recognise a concerning change, attend a health facility and receive a referral for further investigation. What happens if the next appointment is difficult to secure, the cost is unclear, transportation is difficult, the referral pathway is confusing, or she is unsure what to do after receiving a result?
Awareness may start the journey. It does not necessarily help the patient complete it.
What the Ghanaian Patient Journey Shows
Recent evidence from Ghana illustrates why this distinction matters. A prospective study followed 243 women presenting with breast symptoms across eight hospitals in the Oti and Volta regions. All 243 were referred for biopsy; 53 (21.1%) did not ultimately have one. The study covered the cost of the procedure when needed, yet missed biopsies resulted from both participant-related and health-system-related factors.
Among the 102 women whose biopsies confirmed malignancy, 65 (64%) initiated treatment. Thirty-seven did not: the study attributed 19 cases to participant-related factors and 12 to health-system-related factors, with the remaining cases not classified within those two categories. The median time from first presentation to receiving biopsy results was 14 days, compared with 76 days from first presentation to treatment initiation. Sixty-one per cent of those with malignancy were diagnosed at stage III or IV.
The lesson is not that every delay has one cause. It is that the pathway contains multiple points at which patients can become disconnected from care.
Patients Experience a Journey, Not a System
Healthcare systems are organised around services and institutions. Patients experience them as a journey—a series of decisions, appointments, referrals, costs, conversations and uncertainties.
A hospital may see a referral. A laboratory may see a specimen. A clinician may see an appointment. The patient experiences all of these as one continuous process.
If one connection breaks, the patient bears the consequences. That is why access cannot be defined only by whether a service exists. We also need to ask whether a patient can reach it, understand what is required, afford the associated costs and successfully move to the next stage.
The Barriers Are Not Always Medical
Some of the most important barriers to care sit outside the clinical encounter. Transportation, income, family responsibilities, work, geography, information and social support can all affect whether a patient remains connected to care.
In the Ghana study, fear of diagnostic and treatment costs was reported by 71% of women who identified factors making or delaying their visit to the study hospital, while 51% reported transportation cost. These are not clinical diagnoses, but they can determine whether the next clinical step happens.
This is why health-related social needs should be considered part of the care continuum. A patient may understand that she needs treatment and still be unable to get there. She may receive a referral but not know where to take it. She may miss an appointment and have no one checking whether she eventually returned.
Each barrier can appear small. Together, they can determine whether care is completed.
What Patient Navigation Adds
Patient navigation is, at its simplest, about helping people move through the healthcare system. A navigator can help a patient understand what happens next, connect with the appropriate service, coordinate appointments and referrals, identify barriers to continued care and follow up where necessary.
The navigator does not replace the physician, nurse, social worker or other healthcare professional. Navigation connects the different parts of the patient’s journey.
The World Health Organisation describes patient navigation as an evidence-based, personalised intervention that can help people overcome barriers within complex cancer care systems, particularly where services are limited or fragmented and socioeconomic barriers affect access. Its technical brief identifies benefits including improved screening, reduced delays to diagnosis, improved adherence to care and better patient experience.
Solutions Must Fit the System They Are Designed For
The answer is not simply to import a model that worked elsewhere. It is to understand why an intervention works and adapt it to the realities of the system in which it will operate.
Healthcare systems differ in their resources, referral structures, financing arrangements, workforce, geography and patient experiences. A navigation model therefore needs to be designed around how patients actually move through care.
The Ghana evidence is instructive. Of the 53 women who did not receive a biopsy, 22 cases were attributed to health-system-related barriers and 26 to participant-related barriers; the remaining five were not classified within those categories. This distinction matters. If part of the problem sits within the system, asking patients simply to seek care earlier cannot solve the entire problem.
The better question is: where does the pathway break, why does it break, and what practical intervention can connect the patient to the next step?
A Practical Way to Think About the Patient Journey
One practical way of thinking about cancer access is to look at five connected stages:
1. Awareness → Action: Does information lead people to seek appropriate care?
2. Action → Diagnosis: Once someone seeks care, can they reach the appropriate diagnostic service and complete the necessary steps?
3. Diagnosis → Treatment: Once a diagnosis is established, can the patient successfully enter the appropriate treatment pathway?
4. Treatment → Continuity: Can the patient remain connected to care through appointments, referrals and treatment requirements?
5. Continuity → Support: Are practical, financial, psychosocial and other needs affecting continued engagement identified and addressed where possible?
The value of this lens is in the connections between the stages. A patient who receives excellent information but cannot access diagnostic services has not fully gained access to care. A patient who receives a diagnosis but cannot navigate the referral process still faces a barrier. A patient who begins treatment but becomes disconnected from follow-up remains vulnerable to another break in the pathway.
From Awareness to Continuity
This is where the conversation around cancer awareness needs to evolve. Awareness remains essential, but it should be connected to what happens next.
The Ghana findings make this clear: the median time from first presentation to biopsy results was 14 days, while the median time to treatment initiation was 76 days. The study therefore found a substantial gap between diagnostic confirmation and treatment initiation even alongside relatively efficient pathology turnaround.
The goal should not simply be to create more entry points into the healthcare system. It should be to strengthen the connections between those entry points and the services that follow.
Designing Healthcare Around Patients
There is a broader lesson for health systems. Healthcare is often designed around institutions—the hospital, clinic, laboratory, pharmacy, specialist and payer. Patients experience healthcare as a journey.
Improving access therefore requires attention not only to whether a service exists, but whether a patient can realistically reach it, understand it, afford it and continue through it. It requires collaboration across healthcare institutions, patient advocacy organisations, community organisations and other stakeholders, as well as listening carefully to where patients encounter friction.
The most useful question may be less about whether another programme has been created and more about whether it has made it easier for a patient to move from one stage of care to the next.
The Next Step for Cancer Care
If we want earlier diagnosis, better treatment continuity and more equitable cancer outcomes, we have to think beyond awareness alone.
We need systems that connect awareness to action, action to diagnosis, diagnosis to treatment, treatment to continuity, and continuity to the practical support patients need to remain engaged.
Ultimately, access is not achieved simply because a service exists.
Access is achieved when a patient can successfully reach it, understand it, afford it, receive it and continue through it.
