Reducing Cancer Screening Disparities in Medicare Beneficiaries Through Cancer Patient Navigation

Abstract

Significant racial disparities in cancer mortality are seen between Medicare beneficiaries. A randomized controlled trial tested the use of lay navigators (care managers) to increase cancer screening of Asian and Pacific Islander Medicare beneficiaries. The study setting was Moloka‘i General Hospital on the island of Moloka‘i, Hawai‘i, which was one of six sites participating in the Cancer Prevention and Treatment Demonstration sponsored by the Centers for Medicare and Medicaid Services. Between 2006 and 2009, 488 Medicare beneficiaries (45% Hawaiian, 35% Filipino, 11% Japanese, 8% other) were randomized to have a navigator help them access cancer screening services (experimental condition, n = 242) or cancer education (control condition, n = 246). Self-reported data on screening participation were collected at baseline and exit from the study, and differences were tested using chi-square. Groups were similar in demographic characteristics and baseline screening prevalence of breast, cervical, prostate, and colorectal cancers. At study exit, 57.0% of women in the experimental arm and 36.4% of controls had had a Papanicolaou test in the past 24 months (P = .001), 61.7% of women in the experimental arm and 42.4% of controls had had a mammogram in the past 12 months (P = .003), 54.4% of men in the experimental arm and 36.0% of controls had had a prostate-specific antigen test in the past 12 months (P = .008), and 43.0% of both sexes in the experimental arm and 27.2% of controls had had a flexible sigmoidoscopy or colonoscopy in the past 5 years (P < .001). Findings suggest that navigation services can increase cancer screening in Medicare beneficiaries in groups with significant disparities.

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

“…The majority of these studies tested the impact of PN on screening rates for colorectal (n = 32 [67%]), breast (n = 13 [27%]), or cervical cancer (n = 4 [8%]) . Thirty‐nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls . Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non–US‐born urban minority populations .…”

“…Thirty‐nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls . Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non–US‐born urban minority populations . Eight studies (17%) focused on low‐income, uninsured, medically underserved populations, patients from safety‐net health systems, or women residing in shelters .…”

Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

“…RCTs have shown that patient navigation is an effective intervention for implementing stool‐based and colonoscopy‐based screening programs. Navigation is particularly helpful in increasing CRC screening in vulnerable populations . Investigators have offered helpful guidance on key considerations when designing a successful navigation program .…”

Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial

“…31,[37][38][39][40] The current study focuses on the CPTD in Baltimore City, MD, one of the six sites in the national demonstration project.…”