Patient Navigation Improves Time to Diagnosis Resolution and Treatment Initiation
In the Patient Navigation Research Program study reported in the Journal of the National Cancer Institute, Freund et al found that a patient navigation intervention improved diagnostic resolution and timely treatment initiation in a clinical population comprising predominantly racial/ethnic minorities and publicly insured or uninsured patients.
Study Details
The study compared patient navigation with usual care in 10,521 patients with abnormal breast, cervical, colorectal, or prostate screening tests and 2,105 with cancer or precancer diagnosis seen at nine centers between 2007 and 2010. The centers recruited patients from care sites that were predominantly community health centers.
Patient navigators developed individual strategies to address barriers to care and track patients through medical evaluation with a focus on timely diagnostic resolution and initiation of therapy. Navigation was started after a clinician informed the patient of the abnormal test result.
Overall, 73% of patients were from racial and ethnic minority groups, 40% were publicly insured, and 31% were uninsured. More than 85% were women, since most patients had abnormal breast or cervical cancer screening results or diagnoses.
A low enrollment in colorectal cancer (4%–5% of screening abnormality groups and 5% of cancer/precancer diagnosis groups) reflected a shift at most institutions to colonoscopy, in which concurrent diagnostic biopsy during screening eliminated the need for follow-up. Mean ages in the intervention and usual care groups were 44 to 47 years in the screening abnormality population and 52 to 54 years in the cancer/precancer diagnosis population.
Diagnosis Resolution
In the screening abnormality population, there was no difference between the intervention group and the usual care group in diagnostic resolution within the first 90 days after abnormal testing (adjusted hazard rate ratio [HR] = 1.14, P =.14) but a significant benefit for navigation from 91 to 365 days (adjusted HR = 1.51, P < .001). The effect of navigation was greatest at centers where the usual care group had the lowest rate of resolution, with differences of 20% at several centers being found. A ceiling effect was observed whereby there was little or no effect of navigation when usual care groups had ≥ 90% resolution by 1 year.
Navigation efforts were delayed for substantial periods after testing, including delays in receiving the test report, initial contact between clinician and patient, contacting patients for enrolment consent. Median times to the start of navigation were longer with cervical (24–64 days), colorectal (19–48 days), and prostate (33–34 days) screening results than with breast screening results (7–33 days).
Treatment Initiation
In the cancer/precancer diagnosis population, there was no benefit of navigation in initiation of treatment between 0 and 90 days (adjusted HR = 0.85, P = .07) but a significant benefit from 91 to 365 days (adjusted HR = 1.43, P < .007).
The investigators concluded, “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.”
Karen M. Freund, MD, MPH, of Tufts Medical Center/Tufts University School of Medicine, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by the National Cancer Institute, American Cancer Society, and Avon Foundation.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
