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Randomized Controlled Trial
. 2012 Oct;21(10):1629-38.
doi: 10.1158/1055-9965.EPI-12-0513.

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population

Peter C Raich  1 , Elizabeth M Whitley, William Thorland, Patricia Valverde, Diane Fairclough; Denver Patient Navigation Research Program
Affiliations
Randomized Controlled Trial

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population

Peter C Raich et al. Cancer Epidemiol Biomarkers Prev. 2012 Oct.

Abstract

Background: Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population.

Methods: Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program. Of 993 eligible subjects with abnormal screening tests randomized to navigation and no-navigation (control) arms and analyzed, 628 had abnormal breast screens (66 abnormal clinical breast examinations, 304 BIRADS 0, 200 BIRADS 3, 58 BIRADS 4 or 5) whereas 235 had abnormal colorectal and 130 had abnormal prostate screens.

Results: Time to resolution was significantly shorter in the navigated group (stratified log rank test, P < 0.001). Patient navigation improved diagnostic resolution for patients presenting with mammographic BIRADS 3 (P = 0.0003) and BIRADS 0 (P = 0.09), but not BIRADS 4/5 or abnormal breast examinations. Navigation shortened the time for both colorectal (P = 0.0017) and prostate screening resolution (P = 0.06). Participant demographics included 72% minority, 49% with annual household income less than $10,000, and 36% uninsured.

Conclusions: Patient navigation positively impacts time to resolution of abnormal screening tests for breast, colorectal, and prostate cancers in a medically underserved population.

Impact: By shortening the time to and increasing the proportion of patients with diagnostic resolution patient navigation could reduce disparities in stage at diagnosis and improve cancer outcomes.

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Conflict of interest statement

Conflict of Interest Disclosure: The authors declare no conflicts of interest in this work. No significant relationship exists between the authors and the companies/organizations whose products or services may be referenced in this article.

Figures

Fig. 1
Fig. 1
CONSORT Flow Diagram of Screening Patients
Fig. 2
Fig. 2
Kaplan-Meier Estimates for Proportion of Subjects with Resolution by Days from Initial Screening: Breast Screening Subjects – BIRADS 0 and BIRADS 3
Fig. 3
Fig. 3
Kaplan-Meier Estimates for Proportion of Subjects with Resolution by Days from Initial Screening: Colorectal and Prostate Screening Subjects
See this image and copyright information in PMC

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