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Impact of patient navigation on timely cancer care: the Patient Navigation Research Program
Karen M Freund1, Tracy A Battaglia1, Elizabeth Calhoun1
1Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
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.
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