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Impact of Nurse Navigation Program on Outcomes in Minority Patients With Aggressive Lymphoma


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In a single-institution study reported in the journal Cancer, Hu et al found that use of a dedicated nurse navigation program contributed to redressing the recognized inequities in care and outcomes between minority patients and White patients with aggressive large B-cell lymphoma (LBCL). 

Bei Hu, MD

Bei Hu, MD

As stated by the investigators: “Aggressive LBCLs are curable, but previous studies have shown inferior outcomes in [minority patients]. Nurse navigation programs can improve…outcomes by providing patient support. This study presents the outcomes of White and minority patients with aggressive LBCL at an institution with an active nurse navigation program.”

Study Details

The study involved prospectively collected data on 204 consecutive patients with LBCL, including 47 minority patients (including Black, Asian, Native American/Pacific Islander patients and those of Hispanic/Latinx ethnicity) and 157 White patients, treated at the Levine Cancer Institute central location between January 2016 and June 2019. Among the 204 patients, 186 had diffuse LBCL, 14 had primary mediastinal B-cell lymphoma, and 4 had high-grade B-cell lymphoma, with no significant differences in type between minority vs White patients.

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Nurse navigation encounters were characterized as low or high intensity. Low-intensity encounters were used for basic needs and initial guidance/education with either no further follow-up or follow-up as needed. High-intensity encounters were used for coordination of multimodality treatment to overcome major barriers and comply with treatment, including providing assistance to patients who were uninsured/underinsured, homeless, or undocumented or had poor health literacy.

Key Findings

For minority vs White patients, the median age at diagnosis was 56 vs 62 years (P = .03); men accounted for 45% vs 50% (P = .62); proportions with Medicaid or no insurance at diagnosis were 26% vs 4% (P < .001); and 62% vs 35% lived less than 20 miles from the treatment center. There were no differences between groups in prognostic scores (Revised International Prognostic Index score of 3–5 in 43% vs 47%, P = .50) or in proportions with relapsed or refractory disease (40% vs 38%, P = .74).

Nurse navigation was used by 81% vs 87% of patients (P = .35), with low-intensity navigation for 58% vs 79% and high-intensity navigation for 42% vs 21% (P = .01). The median duration of encounters was 135 vs 60 minutes (P < .001) for high- vs low-intensity encounters. More minority patients relied on nurse navigation for assistance with compliance concerns (18% vs 7%, P = .04), insurance questions (29% vs 8%, P = .002), financial concerns (37% vs 18%, P = .02), and transportation concerns (16% vs 2%, P = .004).

First-line treatment with rituximab/anthracycline chemotherapy was received by 98% vs 96% of patients (P = .68). Among patients with relapsed or refractory disease, 32% vs 29% (P > .99) underwent hematopoietic stem cell transplantation and 16% vs 19% (P > .99) received chimeric antigen receptor T-cell therapy. A total of 17% vs 14% (P = .64) of patients enrolled in clinical trials.  

At 2 years, overall survival was 81% vs 76% (P = .27), and progression-free survival was 62% vs 65% (P = .78).

The investigators concluded: “This study shows similar survival between Whites and minorities with aggressive LBCL, which was likely due to equal access to guideline-concordant therapy. Minorities received higher-intensity navigation encounters, which may have helped them to overcome socioeconomic disadvantages.”

Nilanjan Ghosh, MD, PhD, of the Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, is the corresponding author of the Cancer article.

Disclosure: The investigators reported no external funding for the study. For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.


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