Patient Navigation Significantly Improves Receipt of Antiestrogen Therapy but Not Radiation Therapy After Lumpectomy in Breast Cancer Patients
An analysis in the population of the National Patient Navigation Research Program reported by Ko et al in the Journal of Clinical Oncology indicates that patient navigation significantly improves the likelihood of receiving antiestrogen treatment among hormone receptor–positive breast cancer patients eligible for such treatment. No significant improvement was seen with navigation in rates of receipt of radiation therapy following lumpectomy.
Study Details
This secondary analysis in newly diagnosed patients included 761 women in nine program research centers who were eligible to start antiestrogen therapy (380 randomly assigned to navigation vs 381 to control), 552 women eligible to receive postlumpectomy radiation therapy (255 vs 297), and 158 women aged < 70 years with triple-negative tumors > 1 cm eligible to start chemotherapy (86 vs 72). Data were collected between 2006 and 2011. Among the total of 1,004 patients in the analysis: mean age was 56 years; 38% were black, 22% Hispanic, and 36% white; 79% were English speakers; and 49% had private insurance, 38% public insurance, and 13% no insurance.
The patient navigation intervention focused on helping patients through care in a timely fashion. Navigators were trained to support patients through the course of care and empower them to become knowledgeable about their own health. Navigators were given basic education regarding breast cancer treatments but were specifically trained to not provide treatment advice.
Effect on Antiestrogen Therapy and Postlumpectomy Radiation Therapy
In multivariate analysis controlling for age, race/ethnicity, language, insurance, and study site, navigated patients eligible for antiestrogen therapy were significantly more likely vs non-navigated patients to receive such treatment (odds ratio [OR] = 1.73, P = .004). Although patients in the navigation group eligible for radiation therapy after lumpectomy were more likely to receive such treatment, the difference was not statistically significant (OR = 1.42, P = .22).
Receipt of Chemotherapy
Analysis of the effect of navigation on receipt of chemotherapy by women with triple-negative disease was hampered by small sample sizes and variation in receipt of chemotherapy among study sites. Overall, 69% of the navigation group and 89% of the control group received chemotherapy. An analysis restricted to four study sites suggested that navigated patients were less likely to receive chemotherapy (OR = 0.36, P = .0092).
The investigators noted, “[T]he value of the addition of a navigator is inconclusive from the data we have. These limited findings suggest that further targeted study of the likelihood of receiving clinically recommended chemotherapy care in a large sample of patients is warranted.”
They concluded, “We demonstrate that navigated participants were more likely than non-navigated participants to receive antiestrogen therapy. Future studies are required to determine the full impact patient navigation may have on ensuring that vulnerable populations receive quality care.”
Naomi Y. Ko, MD, MPH, AM, of Boston Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the National Institutes of Health, American Cancer Society, Avon Foundation, and Boston Medical Center Carter Disparities Fund. Steven R. Patierno, PhD, reported honoraria from Pfizer.
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®.
