183 Background: The Georgia Cancer Center for Excellence (GCCE) at Grady received a 5-year MERCK Patient Centered Grant in 2017 that focuses on improving care to vulnerable cancer patients (pts) through the introduction of nurse (RN) navigators, a dietician and a part time exercise coach. A review of the literature shows improved patient outcomes and satisfaction with decreased time to treatment for breast and lung cancer pts. [1-2] RN navigation has been shown to expedite care and one of our goals for the MERCK grant was to study the effect of introducing RN navigation in a safety net hospital for three cancer sites. Methods: Three RN navigators were hired for the Breast, GYN and Aerodigestive cancer programs since 2017. RN navigators meet all newly diagnosed cancer pts during clinic and track their progression of care, often intervening for timeliness of work up and treatment. Each RN navigator keeps a record of pts navigated. An audit of this prospectively collected data measuring time from diagnosis to treatment for breast, GYN and aerodigestive cancer pts took place for 2018 and 2019. Inclusion criteria: diagnosed and treated at Grady, navigated by RN, and not Stage IV disease. Results: The total numbers of cancer pts navigated over the past two years were 244 breast, 131 GYN, and 265 aerodigestive pts. Using the inclusion criteria described in the methods section, the time from diagnosis to treatment decreased for these three cancer sites (see Table). Conclusions: Implementation of RN navigators within the cancer program trended towards decreases in time from diagnosis to treatment for our breast, GYN, and aerodigestive cancer patients. These measurable improvements over three cancer sites are largely attributed to RN navigation and suggest that cancer outcomes will improve over time for our patients treated in our safety net hospital. We plan to study patients who were retained in the system or were adherent to care to better understand the importance of RN navigation in our system. References: (1)Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to Surgery and Breast Cancer Survival in the US. JAMA Oncol 2016;2(3):330–339. (2) Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer. Thorax 2009;64:749-756. [Table: see text]

Background/Objective Adherence to recommended care remains challenging for patients with breast cancer (BC), particularly those from disadvantaged groups. Although our Center has historically used lay BC navigators to meet with newly diagnosed patients, our team identified the need to improve care for vulnerable cancer patients (pts) through nurse (RN) navigators. This project aimed to investigate adherence to care over two-time intervals, pre and post RN navigators, and investigate the level of out migration (patients who leave our system) of BC patients during the same time. Methods An RN breast oncology navigator started navigating patients and collecting data on Jan 1st, 2018. The RN navigator meets with all newly diagnosed BC pts during clinic and tracks their progression of care, often expediting work up and treatment. A tumor registry audit of refusal of care as coded by “pt or pt guardian refused care” was conducted for two-time intervals: 2016-2017 (pre-RN navigation) and 2018-2019 (post-RN navigation). Out-migration of analytic BC patients was also measured during these time intervals. Results The tables below show total analytic cases and refusal of care rates. Refusal of care rates decreased from 17.8% pre- to 13.2% post-RN navigation. Out-migration was 3.6% for 2016-2017 and 3.6% for 2018-2019. Conclusions Implementation of an RN breast navigator in 2018 trended towards less refusal of care by our patients diagnosed or receiving at least one treatment in our safety net hospital. Refusing chemotherapy and hormonal therapy were treatments that were most impacted by RN breast navigation. RN navigation may enhance compliance through: offering personalized education, dispelling myths of therapy, proactively working with patients when side effects/complications occur, and supporting patients when questions or concerns arise. While there was no difference in “out-migration” to other cancer centers identified during this time interval, the number of patients leaving the system remains low. We plan to continue to track our BC navigated patients and collect patient satisfaction with navigation as a future initiative. This effort was supported by a grant from the Merck Foundation Alliance to Advance Patient-Centered Cancer Care. Table 1: Total BC pts and refusal of careBC Patients2016-2017(Pre RN navigation)2018-2019(Post RN navigation)P-valueTotal analytic325376Total Refusal of care58 (17.8%)50 (13.2%)0.128 Table 2: Refusal by type of recommended careTime IntervalChemoHormonalImmunotherapyRadiationSurgery2016-201729(62%)18(60%)0(0%)22 (48%)10(45%)2018-201918(38%)12 (40%)2 (100%)24(52%)12(55%) Citation Format: Christine Rehr, Susan Coples, Zhensheng Wang, Roland Matthews, Pooja Mishra, Jamil Facdol, Rosalyn Garrett, Kimberly Fritz, Sheryl Gabram. The impact of nurse navigation on adherence to care for patients treated for breast cancer in a safety net hospital [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-58.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

No abstract