Predictors of resolution in navigated patients with abnormal cancer screening tests

Abstract

Background Patient navigation has been effective in improving cancer care, yet little is known about what predicts timely outcomes in navigated patients. Objective We identified predictors of resolution of abnormal cancer screening tests in patients who received navigation. Methods We examined data on patients with abnormal breast (n = 256) or cervical (n = 150) screening tests or symptoms who received navigation as part of the Ohio Patient Navigator Research Program during 2007–2010. We used multivariable Cox proportional hazards regression models to identify predictors of time to resolution (ie, when a patient’s clinical abnormality or abnormal screening test was determined to be a benign condition or a cancer diagnosis). Results The median time to resolution was 183 days for navigated patients with breast abnormalities and 172 days for navigated patients with cervical abnormalities. In patients with breast abnormalities, those who reported at least 1 barrier to care during navigation (HR, 0.66; 95% CI, 0.51–0.86) or higher perceived stress (HR, 0.90; 95% CI, 0.82–0.98) had slower resolution. Among patients with cervical abnormalities, those who reported at least 1 barrier to care during navigation had slower resolution (HR, 0.62; 95% CI, 0.42–0.91). Patients with cervical abnormalities had faster resolution if they had private health insurance, but this effect was present only in younger women (interaction P = .003). Limitations Unknown generalizability of results because patients were female and from clinics in central Ohio. Conclusions Several variables predicted whether patient navigation led to faster resolution, and predictors differed somewhat by disease site. Results will be useful in improving current patient navigation programs and designing future programs.

Lifestyle and Nutritional Risk in Women With Cervical Cancer: A Comparative Study

“…The comparison of the dimension of lifestyle and stress management indicated a significant relationship between the two groups. The mean score of stress management in patients was lower compared to healthy women, which is in agreement with the result of the study by Reiter et al (35). Similarly, Oran et al discovered changes in HPLP is possible by increasing the awareness about the periodic screening of cancer, but this is not applicable to all women in the community.…”

“…However, scientists have not yet been able to explain this relationship (34). Cigarettes might be a cofactor of women's cancers, which works through thickening the cervical mucus (35). Smoking further decreases the immune response in cervical cells and may affect the metabolism of female hormones.…”

Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis

“…36 A disproportionate burden of barriers among poor and minority women contributes to delays in follow-up care. 29,38,39 Furthermore, Tejeda et al 40 found that Hispanic women reported barriers: more often than black women. 29,38,39 Furthermore, Tejeda et al 40 found that Hispanic women reported barriers: more often than black women.…”

“…37 Women with barriers tend to have a longer time to diagnostic resolution of abnormal mammogram than women without barriers. 29,38,39 Furthermore, Tejeda and colleagues found that Hispanic women were more often than black women to report barriers. The authors suggest that this difference between black and Hispanic women may be associated with types of barriers, where Hispanic women compared with black women were more likely to report intrapersonal barriers such as financial problems, transportation, fear, and comorbility.…”