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Patient Navigation Services for Breast and Cervical Cancer Screening and Follow-Up: A Meta-Analysis
Heidi D Nelson1, Amy G Cantor2, Miranda Pappas2
1Kaiser Permanente School of Medicine, Pasadena, California.
Importance:
Screening and follow-up rates for breast and cervical cancer vary across socioeconomic and demographic groups. While patient navigation services can help patients overcome barriers to health care, they are not commonly used in cancer screening.
Objective:
To determine the effectiveness and harms of patient navigation services to increase screening and follow-up rates for breast and cervical cancer.
Data Sources:
A search of the MEDLINE, Scopus, CENTRAL, and Cochrane Database of Systematic Reviews was conducted for English-language articles published between January 1, 2000, and September 19, 2024. A manual review of article references supplemented the search.
Study Selection:
Eligible articles were randomized clinical trials comparing the effectiveness of patient navigation services in participants eligible for breast or cervical cancer screening with usual care or control groups, as well as observational studies for harm. Investigators independently dual-reviewed abstracts and full-text articles to identify studies meeting prespecified eligibility criteria. Disagreements were resolved by consensus with a third reviewer. Of all abstracts and full-text articles reviewed, 2.9% were selected for analysis.
Data Extraction And Synthesis:
This report followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A single investigator extracted data from each study. A second investigator reviewed the data for accuracy. Investigators independently dual-rated individual study quality as good, fair, or poor. Discordant quality ratings were resolved with a third reviewer. Data were combined using a profile likelihood random-effects model.
Main Outcomes And Measures:
The main outcomes were breast and cervical cancer screening rates within 1 year of the intervention, follow-up rates within 2 years, and any harm.
Results:
A total of 42 randomized clinical trials with 39 111 participants assessing the effectiveness of patient navigation services to increase screening and follow-up rates for breast and cervical cancer were included in the meta-analysis; no studies described harms. For breast cancer, patient navigation resulted in higher rates of screening (risk ratio [RR], 1.50; 95% CI, 1.30-1.75; I2 = 88.0%; 30 trials; n = 34 744 participants) and follow-up (RR, 1.23; 95% CI, 1.15-1.41; I2 = 12.6%; 3 trials; n = 1008 participants) compared with comparison groups. For cervical cancer, patient navigation also resulted in higher rates of screening (RR, 1.62; 95% CI, 1.28-2.09; I2 = 89.6%; 20 trials; n = 11 820 participants) and follow-up (RR, 1.63; 95% CI, 0.86-2.65; I2 = 69.0%; 2 trials; n = 401 participants). Sensitivity analyses demonstrated higher screening rates with patient navigation vs comparison groups for general populations and populations based on race, ethnicity, low-income status, and other characteristics. Predicted 1-year absolute rates following patient navigation were 13.8% higher for breast cancer screening and 15.6% higher for cervical cancer screening than for comparison groups.
Conclusions And Relevance:
The results of this systematic review and meta-analysis suggest that patient navigation services can increase breast and cervical cancer screening and follow-up. Reducing barriers with patient navigation services could improve access and engage patients in more effective and equitable cancer preventive care.
