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Meta-Analysis
. 2014 Jun 17;106(6):dju115.
doi: 10.1093/jnci/dju115. Print 2014 Jun.

Impact of patient navigation on timely cancer care: the Patient Navigation Research Program

Karen M Freund  1 , Tracy A Battaglia  1 , Elizabeth Calhoun  1 , Julie S Darnell  1 , Donald J Dudley  1 , Kevin Fiscella  1 , Martha L Hare  1 , Nancy LaVerda  1 , Ji-Hyun Lee  1 , Paul Levine  1 , David M Murray  1 , Steven R Patierno  1 , Peter C Raich  1 , Richard G Roetzheim  1 , Melissa Simon  1 , Frederick R Snyder  1 , Victoria Warren-Mears  1 , Elizabeth M Whitley  1 , Paul Winters  1 , Gregory S Young  1 , Electra D Paskett  1 ; Writing Group of the Patient Navigation Research Program
Affiliations
Meta-Analysis

Impact of patient navigation on timely cancer care: the Patient Navigation Research Program

Karen M Freund et al. J Natl Cancer Inst. .

Abstract

Background: Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness.

Methods: The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided.

Results: The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care.

Conclusions: Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

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Figures

Figure 1.
Figure 1.
Unadjusted proportion of participants with abnormal cancer screening or symptoms who reach diagnostic resolution within 365 days in navigated and control arms by cancer screening type, study center: Patient Navigation Research Program.
Figure 2.
Figure 2.
Meta-analysis of impact of patient navigation on diagnostic resolution after cancer screening abnormality from 0 to 90 days: Patient Navigation Research Program. I 2 addresses the heterogeneity of the model and is not the overall effect of the intervention. The solid vertical line denotes 1, or no effect. The squares denote the adjusted hazard ratio for each center and cancer type, with the horizontal line indicating the 95% confidence interval. The dotted vertical line denotes the adjusted hazard ratio for the meta-analysis. The diamond indicates the 95% confidence interval of the adjusted hazard ratio. The letters (A–H) in the first column denote the study center. aHR = adjusted hazard ratio; CI = confidence interval.
Figure 3.
Figure 3.
Meta-analysis of impact of patient navigation on diagnostic resolution after cancer screening abnormality from 91 to 365 days: Patient Navigation Research Program. I 2 addresses the heterogeneity of the model and is not the overall effect of the intervention. The solid vertical line denotes 1, or no effect. The squares denote the adjusted hazard ratio for each center and cancer type, with the horizontal line indicating the 95% confidence interval. The dotted vertical line denotes the adjusted hazard ratio for the meta-analysis. The diamond indicates the 95% confidence interval of the adjusted hazard ratio. The letters (A–H) in the first column denote the study center.
See this image and copyright information in PMC

References

    1. Jean-Pierre P, Hendren S, Fiscella L, et al. Understanding the processes of patient navigation to reduce disparities in cancer care: perspectives of trained navigators from the field. J Cancer Educ. 2011;26(1):111–120 - PMC - PubMed
    1. American College of Surgeons. National Accrediation Program for Breast Centers Breast Center Components Chicago: American College of Surgeons; 2010. http://accreditedbreastcenters.org/standards/standards.html Accessed November 21, 2010
    1. National Comprehensive Cancer Network. The case manager or patient navigator: providing support for cancer patients during treatment and beyond National Comprehensive Cancer Network. http://www.nccn.com/living-with-cancer/understanding-treatment/152-case-... Accessed April 16, 2014
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    1. Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: a systematic review. Cancer Nurs. 2010;33(2):127–140 - PubMed

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