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

Abstract

Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

Implementation of an integrated framework for a breast cancer screening and navigation program for women from underresourced communities

“…As such, limited historical data and a lack of a control group make it difficult to definitely and quantitatively assess the program's impact on breast cancer outcomes. However, this program clearly demonstrates the utility in implementing evidence‐based approaches that have been shown to increase breast cancer screening compliance and reduce barriers …”

“You can’t have a PrEP program without a PrEP Coordinator”: Implementation of a PrEP panel management intervention

“…We believe that the coordination of a patient's PrEP care would be more efficient, organized, and reduce cost when involving a panel management strategy such as PrEP-OI versus solely reliant on healthcare providers. Although we did not have a cost-effectiveness component for this study, studies of patient navigation-type services for other conditions have found them to be cost-effective [25].…”

Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors

“…Several trials have assessed the use of Patient Navigation in Latina BCS; it has successfully been used to reduce time to diagnosis and treatment, and increase informed decision‐making regarding clinical trial participation 29‐31 . However, studies have had conflicting results, and several studies have been hindered by methodological shortcomings like lack of robust evaluation strategies, control groups, adequate descriptions of promotoras , long‐term follow‐up assessments, or large, diverse samples 32,33 . In addition, few studies have focused on patient QoL or satisfaction with care 34‐36 .…”