Impact of patient navigation on timely cancer care

The patient navigation research program

Karen M. Freund, Tracy A. Battaglia, Elizabeth Calhoun, Julie S. Darnell, Donald J. Dudley, Kevin Fiscella, Martha L. Hare, Nancy Laverda, Ji Hyun Lee, Paul Levine, David M. Murray, Steven R. Patierno, Peter C. Raich, Richard G. Roetzheim, Melissa Simon, Frederick R. Snyder, Victoria Warren-Mears, Elizabeth M. Whitley, Paul Winters, Gregory S. Young & 1 others Electra D. Paskett

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Background Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. Methods The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center-and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. Results The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P <. 001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P <. 007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Conclusions Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

Original languageEnglish (US)
JournalJournal of the National Cancer Institute
Volume106
Issue number6
DOIs
StatePublished - Jun 11 2014
Externally publishedYes

Fingerprint

Patient Navigation
Research
Neoplasms
Meta-Analysis
Confidence Intervals
Minority Groups
Lost to Follow-Up
Ethnic Groups
Prostate
Breast
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Impact of patient navigation on timely cancer care : The patient navigation research program. / Freund, Karen M.; Battaglia, Tracy A.; Calhoun, Elizabeth; Darnell, Julie S.; Dudley, Donald J.; Fiscella, Kevin; Hare, Martha L.; Laverda, Nancy; Lee, Ji Hyun; Levine, Paul; Murray, David M.; Patierno, Steven R.; Raich, Peter C.; Roetzheim, Richard G.; Simon, Melissa; Snyder, Frederick R.; Warren-Mears, Victoria; Whitley, Elizabeth M.; Winters, Paul; Young, Gregory S.; Paskett, Electra D.

In: Journal of the National Cancer Institute, Vol. 106, No. 6, 11.06.2014.

Research output: Contribution to journalArticle

Freund, KM, Battaglia, TA, Calhoun, E, Darnell, JS, Dudley, DJ, Fiscella, K, Hare, ML, Laverda, N, Lee, JH, Levine, P, Murray, DM, Patierno, SR, Raich, PC, Roetzheim, RG, Simon, M, Snyder, FR, Warren-Mears, V, Whitley, EM, Winters, P, Young, GS & Paskett, ED 2014, 'Impact of patient navigation on timely cancer care: The patient navigation research program', Journal of the National Cancer Institute, vol. 106, no. 6. https://doi.org/10.1093/jnci/dju115
Freund, Karen M. ; Battaglia, Tracy A. ; Calhoun, Elizabeth ; Darnell, Julie S. ; Dudley, Donald J. ; Fiscella, Kevin ; Hare, Martha L. ; Laverda, Nancy ; Lee, Ji Hyun ; Levine, Paul ; Murray, David M. ; Patierno, Steven R. ; Raich, Peter C. ; Roetzheim, Richard G. ; Simon, Melissa ; Snyder, Frederick R. ; Warren-Mears, Victoria ; Whitley, Elizabeth M. ; Winters, Paul ; Young, Gregory S. ; Paskett, Electra D. / Impact of patient navigation on timely cancer care : The patient navigation research program. In: Journal of the National Cancer Institute. 2014 ; Vol. 106, No. 6.
@article{c3dba2d9d19848aaba50b4fd4eaf6528,
title = "Impact of patient navigation on timely cancer care: The patient navigation research program",
abstract = "Background Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. Methods The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center-and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. Results The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73{\%}) and publically insured (40{\%}) or uninsured (31{\%}). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95{\%} confidence interval [CI] = 1.23 to 1.84; P <. 001)) and treatment initiation (aHR = 1.43; 95{\%} CI = 1.10 to 1.86; P <. 007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Conclusions Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.",
author = "Freund, {Karen M.} and Battaglia, {Tracy A.} and Elizabeth Calhoun and Darnell, {Julie S.} and Dudley, {Donald J.} and Kevin Fiscella and Hare, {Martha L.} and Nancy Laverda and Lee, {Ji Hyun} and Paul Levine and Murray, {David M.} and Patierno, {Steven R.} and Raich, {Peter C.} and Roetzheim, {Richard G.} and Melissa Simon and Snyder, {Frederick R.} and Victoria Warren-Mears and Whitley, {Elizabeth M.} and Paul Winters and Young, {Gregory S.} and Paskett, {Electra D.}",
year = "2014",
month = "6",
day = "11",
doi = "10.1093/jnci/dju115",
language = "English (US)",
volume = "106",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Impact of patient navigation on timely cancer care

T2 - The patient navigation research program

AU - Freund, Karen M.

AU - Battaglia, Tracy A.

AU - Calhoun, Elizabeth

AU - Darnell, Julie S.

AU - Dudley, Donald J.

AU - Fiscella, Kevin

AU - Hare, Martha L.

AU - Laverda, Nancy

AU - Lee, Ji Hyun

AU - Levine, Paul

AU - Murray, David M.

AU - Patierno, Steven R.

AU - Raich, Peter C.

AU - Roetzheim, Richard G.

AU - Simon, Melissa

AU - Snyder, Frederick R.

AU - Warren-Mears, Victoria

AU - Whitley, Elizabeth M.

AU - Winters, Paul

AU - Young, Gregory S.

AU - Paskett, Electra D.

PY - 2014/6/11

Y1 - 2014/6/11

N2 - Background Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. Methods The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center-and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. Results The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P <. 001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P <. 007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Conclusions Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

AB - Background Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. Methods The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center-and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. Results The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P <. 001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P <. 007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Conclusions Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

UR - http://www.scopus.com/inward/record.url?scp=84903821497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903821497&partnerID=8YFLogxK

U2 - 10.1093/jnci/dju115

DO - 10.1093/jnci/dju115

M3 - Article

VL - 106

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 6

ER -