A randomized trial of patient navigation with symptom-monitoring in advanced lung cancer

Abstract

Aim: Patient navigators can help overcome barriers to cancer care. We evaluated the impact of patient navigation with symptom-monitoring in patients with advanced lung cancer.

Methods: In this randomized study, adult patients (>18 years) with advanced lung cancer planned for palliative systemic therapy were assigned 1:1 to an intervention or standard care arm. Patients in the intervention arm were paired with a navigator who coordinated investigations, scheduled appointments, facilitated access to services, and conducted regular telephone-based or in-person symptom monitoring. The primary endpoint was change in quality-of-life (QoL) from baseline to 12 weeks. Secondary endpoints included time-to-treatment initiation, performance status deterioration, unplanned/emergency visits, treatment compliance, symptom documentation, progression-free (PFS), and overall survival (OS).

Results: Between February and November 2022, we enrolled 150 patients: 75 per arm. Broad-panel molecular testing was performed more often in the intervention arm (44 % vs. 10 %; P < 0.001); overall molecular testing (any biomarker) in 86 % vs. 77 %. The mean time-to-treatment initiation was significantly shorter in the intervention group (19 vs. 28 days; P < 0.001). Emergency/unplanned visits were less frequent (67 % vs. 88 %; P = 0.002), and compliance was higher (85 % vs. 68 %; P = 0.012) in the intervention arm. Symptoms were documented in 93.2 % vs. 8.1 % (intervention vs. control). There were no significant differences in QoL change (mean 40.50 vs. 40.78; P = 0.906), performance status deterioration (2.79 vs. 2.27 months; P = 0.650), median PFS (6.47 vs. 7.49 months; P = 0.79) or median OS (11.93 vs. 13.86 months; P = 0.69).

Conclusion: Patient navigation with symptom monitoring improves care delivery by expediting treatment initiation, improving compliance, and reducing unplanned visits, without impacting QoL or survival.

Keywords: Developing countries; Health services accessibility; Lung neoplasms; Palliative care; Patient navigation; Quality of life; Symptom assessment.