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. YoungElectra D. Paskett

Research output: Contribution to journalArticlepeer-review

116 Scopus citations

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Impact of patient navigation on timely cancer care: The patient navigation research program'. Together they form a unique fingerprint.

Cite this