Title
Effectiveness of patient navigation programmes on cancer screening and follow-up in low and middle-income countries: a systematic review and meta-analysis
 
Background
Delays in cancer screening, diagnostic evaluation, and treatment initiation remain major contributors to advanced stage presentation and poor cancer outcomes in low and middle-income countries (LMICs). Fragmented referral systems, financial constraints, limited health literacy, and weak care coordination frequently result in loss to follow-up across the cancer care continuum. Patient navigation programmes (PNPs) have emerged as a promising health system intervention to address these multilevel barriers; however, evidence on their effectiveness in LMIC settings remains scattered and heterogeneous. 
 
Objective
To assess the effectiveness of patient navigation programmes on diagnostic related outcomes like cancer screening uptake, follow up after abnormal screening, diagnostic timeliness, and treatment initiation outcomes among cancer populations in low and middle income countries. Narrative synthesis was undertaken for outcomes not amenable to meta-analysis.
 
Methods
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Cochrane Library, Scopus, and Google Scholar were searched from inception until August 2025. Studies from low and middle-income countries assessing patient navigation programmes across the cancer care continuum were included. Two reviewers independently screened records and extracted data on study design, interventions, comparators, and outcomes using a standardized form. Risk of bias was assessed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool. Random-effects meta-analyses were performed using pooled risk ratios (RR) with 95% confidence intervals (CI) and heterogeneity was assessed using the I² statistic.
 
Results
A total of 579 records were identified through database searching. After removal of 193 duplicates, 386 records were screened by title and abstract. Twenty full-text articles were assessed for eligibility, of which 13 studies across Asia and Africa met inclusion criteria. Most studies were of fair methodological quality. Nine studies were included for meta -analysis. Navigation interventions significantly increased cancer screening uptake compared with usual care (pooled RR = 4.23; 95% CI: 1.50–11.96; p = 0.006; I² = 93.7%; six studies; n = 2,816). Follow-up after positive screening demonstrated a favourable but non-significant pooled effect (RR = 1.60; 95% CI: 0.93–2.76; p = 0.074; I² = 88.1%; five studies; n = 3,960). Narrative synthesis indicated consistent improvements in diagnostic completion, reduced time to diagnosis and treatment initiation, and improved treatment adherence across multiple cancer types, particularly breast and colorectal cancers.
 
Conclusion
Patient navigation programmes substantially improve cancer screening uptake in LMICs and show clinically meaningful benefits for post screening follow-up and diagnostic timeliness. High heterogeneity might be due to contextual variation in intervention design, health system capacity, and cancer pathways.

Implications
Strengthening standardized, context adapted navigation models could play a critical role in improving early cancer detection and reducing preventable cancer mortality in resource limited settings.