Background
Cancer patients in low? and middle-income countries (LMICs) often have limited access to supportive and palliative care, despite high symptom burden and complex care pathways. In Egypt, supportive clinics are available in some public oncology centers but are underutilized, partially due to patient unawareness and lack of structured referral systems. Patient navigation models have improved continuity of cancer care in high-income settings, yet evidence from LMICs remains scarce.
Objectives
To describe and evaluate an evidence-based patient navigation initiative that uses a quality?of?life (QoL) questionnaire to systematically identify supportive care needs and direct cancer patients to existing supportive clinics in a public oncology center in Upper Egypt (Sohag).
Methods
A cross-sectional study was conducted at Sohag Oncology Center, a public facility serving a largely rural and socio?economically disadvantaged population in Upper Egypt. As part of the “Evidence-Based Patient Navigation” initiative (January–September 2024), navigation nurses administered the EORTC Core Quality of Life Questionnaire (EORTC QLQ?C30) to consecutive adult cancer patients attending outpatient clinics. Subsequently, they calculated domain-specific scores mapped to four available supportive clinics (psychiatry, physiotherapy, pain management, nutrition). Patients with a mean domain score greater than 2 (1–4 scale) were classified as needing the corresponding clinic. A nurse? and pharmacist-led navigation team explained identified needs, confirmed referrals with treating physicians, facilitated appointments, and documented follow-up plans. Routine physician assessments of need for each clinic were extracted from medical records. Agreement between patient-identified needs and physician decisions was assessed using accuracy and Cohen’s kappa (κ).
Results
A total of 4,423 patients (median age 54 years; 70% female) were included; most resided in Sohag governorate. Based on QLQ?C30 thresholds, 28% of patients were identified as needing pain management, 29% physiotherapy, 24% nutrition, and 22% psychiatric support, indicating substantial unmet or previously unrecognized supportive care needs. Treating physicians reported that 31%, 30%, 27%, and 25% of patients required physiotherapy, pain management, nutrition, and psychiatric clinics, respectively. Agreement between QoL-based navigation and physician assessments was high across all four clinics, with accuracy ranging from 94.1% to 95.6% and κ values between 0.86 and 0.90, indicating strong alignment. Follow-up plans revealed that the majority of patients did not need ongoing visits after their initial assessment, while a smaller group required continued care. This highlights the important role of navigation in connecting patients with the appropriate levels of supportive care.
Conclusions
In this LMIC public oncology setting, a nurse? and pharmacist-led navigation model using a standard QoL instrument was feasible and achieved high agreement with physician assessments while systematically exposing significant supportive care needs. The initiative demonstrates how existing but underutilized supportive clinics can be integrated into cancer care pathways without major new resources, offering a practical approach to strengthening cancer control and supportive care in similar low-resource environments. Further longitudinal and interventional studies are needed to assess the impact of this model on patient outcomes and health?system performance.