Follow-Up and Timeliness After an Abnormal Cancer Screening Among Underserved, Urban Women in a Patient Navigation Program

Abstract

Background We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Methods Women with an abnormal breast (n=352) or cervical (n=545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Results Compared to controls, the breast navigation group had shorter time to diagnostic resolution (aHR=1.65, CI=1.20–2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR= 2.31, CI=1.75–3.06), with no difference before 30 days (aHR= 1.42, CI=0.83–2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Conclusions Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Impact Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women.

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening

“…The Chicago Cancer Navigation Project was conducted from 2005 to 2010 and utilized a quasiexperimental nonrandomized study design across five federally qualified health center sites and one safety net hospital. 18 Similar numbers of navigated and control participants were recruited using individual and nonrandom assignment. Navigated participants were drawn from these sites, while those receiving usual care were selected from 20 other clinic sites.…”

Can Patient Navigation Improve Receipt of Recommended Breast Cancer Care? Evidence From the National Patient Navigation Research Program

“…8 Traditionally, patient navigation targeted the cancer screening process, 8 but it has rapidly evolved within oncology practice so that navigators are expected members of oncology teams. 9 Recent studies suggest a benefit of patient navigation within time to diagnosis and follow-up from an abnormal screening, [10][11][12][13][14][15][16][17][18][19] but few studies have been performed to understand the impact of navigation after the diagnosis of breast cancer. 13,[20][21][22] …”

Patterns of task and network actions performed by navigators to facilitate cancer care

“…Health care organizations, especially those identified as ''safety net'' providers of care, have deployed patient navigators, assigning them the tasks of identifying patients at risk of poor access, mitigating the barriers they face, and facilitating provision of care, navigating them to needed cancer care. Recent reports from the national patient navigation research program (PNRP) provide evidence of the effectiveness of this strategy to improve timely care after abnormal cancer screening (Battaglia et al, 2012;Dudley et al, 2012;Fiscella et al, 2012;Hendren et al, 2012;Hoffman et al, 2012;Markossian, Darnell, & Calhoun, 2012;Paskett et al, 2012;Raich et al, 2012;Wells et al, 2012).…”