Original Article

Colour Coding Navigation: “Triage” Techniques to Improve Compliance in Breast Cancer Patients Requiring Primary Chemotherapy


  • Carol Ann Benn
  • Yastira Ramdas
  • Barend van den Bergh
  • Naa-Lamle Bannerman
  • Dominic van Loggerenberg
  • Tia van Loggerenberg
  • Vernon Shaw

Received Date: 13.05.2020 Accepted Date: 12.07.2020 Eur J Breast Health 2020;16(4):262-266


This is a pilot study to assess whether a file-colour-coded triage navigation system for patients on primary chemotherapy improves compliance and adherence and if it decreases defaulting.

Materials and Methods:

All breast cancer patients are discussed in a multidisciplinary meeting. All patients are triaged before starting on primary chemotherapy based on their specific challenges and beliefs and are consulted by the navigation team and contacted before the beginning of treatment and after each chemotherapy session by a navigator in the unit. File stratification for ease of navigation was instituted by a colour code dot into three groups. The three groups are:

Code Green: Compliant on treatment

Code Yellow: Side effects on treatment/ considering defaulting

Code Red: Non-compliant

The code red patients were further assessed in terms of reasons for non-adherence or non-compliance:

Fear of chemotherapy side effects

The belief that chemotherapy kills the patient

Interest in “alternative treatment regimens”

Other barriers to treatment as identified by the navigators


The system allows the navigation team to focus on which patients require specific navigation and inform the treating oncologists. Code green patients were courtesy called after each chemotherapy session. The code yellow patients had early involvement with the survivorship team to ensure appropriate management of any side effects. Access to the complimentary oncology navigator and complementary health website was instituted. The oncology navigator visited each patient at the oncology unit on the day the patient was due to have chemotherapy. For Code red 1 and 2, a “buddies'' network of patients who have been through similar treatment regimens was assigned by the navigation team. This was coordinated by patient navigators (trained counsellors who have had breast cancer treatment). Code red three was managed by a complementary health specialist who understood the value of chemotherapy. For Code red 4, the oncology navigator manages the concerns from finances services to family issues. For the 122 patients in total for primary chemotherapy, stratification was as follows:

Code Green=64.8%

Code Yellow=27.0%

Code Red=8.2%.


This system provides the Multidisciplinary team with the opportunity to improve patient adherence/compliance with primary chemotherapy. 80% of the code red patients eventually agreed to receive the recommended treatment. Navigation enhanced patient supervision, and the coding system improved patient primary chemotherapy adherence. Such a system would benefit larger oncological practices to improve primary chemotherapy adherence by empowering the navigation team to identify patients requiring more intensive navigation supervision.

Keywords: Breast cancer, navigation, neoadjuvant chemotherapy, patient compliance, patient adherence