Follow-Up and Timeliness After an Abnormal Cancer Screening Among Underserved, Urban Women in a Patient Navigation Program
ABSTRACT We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution.
Women with an abnormal breast (n = 352) or cervical (n = 545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site.
Compared with controls, the breast navigation group had shorter time to diagnostic resolution (aHR = 1.65, CI = 1.20-2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR = 2.31, CI = 1.75-3.06), with no difference before 30 days (aHR = 1.42, CI = 0.83-2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities.
Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Impact: Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women. Cancer Epidemiol Biomarkers Prev; 21(10); 1691-700. ©2012 AACR.
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ABSTRACT: Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.SpringerPlus 02/2013; 2(1):84. DOI:10.1186/2193-1801-2-84
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ABSTRACT: BACKGROUND: Breast cancer is the leading cause of cancer deaths in Latinas. Time from cancer diagnosis to treatment initiation is critical in optimizing cancer care. Patient navigation is a potentially effective means of promoting timely treatment of breast cancer, yet efficacy is insufficiently documented. Redes en Accion here evaluates a culturally sensitive patient navigation program to reduce time from cancer to diagnosis to treatment and increase proportions of women treated within 30 days of diagnosis. METHODS: We analyzed 109 Latinas diagnosed with breast cancer from July 2008-January 2011 (42 navigated, 67 controls). Women were navigated by locally trained navigators or non-navigated (data abstracted from charts). Kaplan-Meier, Cox proportional hazards, and logistic regression were used to determine group differences. RESULTS: Time from cancer diagnosis to 1st treatment was lower in the navigated group (MED 21 days, control 32 days, HR 1.6, p=0.02). 64.3% began treatment within 30 days of cancer diagnosis, compared to 47.8% of non-navigated Latinas (p=0.015) controlling for stage of cancer at diagnosis and numerous characteristics of clinics and participants. Effects were due to navigator activities compared to those who did not need or utilize them, including appointment reminders, transportation arrangements, accompaniment to appointments, and translation services. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast cancer diagnoses significantly reduces time from diagnosis to treatment, and increases the proportion of women who begin treatment within 30 days of diagnosis. Improvement appears to be associated with specific navigator activities.Cancer Research; 04/2013
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ABSTRACT: Prostate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen. Participants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated (n = 245) versus control (n = 245) participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score. Of 490 participants, 68% were African American, 47% were >= 65 years old, and 35% had cancer. Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to controls (median days of 97 versus 111; adj. HR 1.17, 95% CI, 0.96-1.43, p = 0.12). On analysis of the period beyond 80 days, navigated men reached resolution faster than controls (median of 151 days versus 190 days; adj. HR 1.41, 95% CI, 1.07-1.86, p = 0.01). Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to controls (median of 93 days versus 87 days; adj. HR 1.15, 95% CI, 0.82-1.62, p = 0.41). Our navigation program did not significantly impact the overall time to resolution or treatment for men with prostate cancer compared to controls. The utility of navigation programs may extend beyond targeted navigation times, however, and future studies focusing on other outcomes measures are therefore needed.BMC Health Services Research 08/2013; 13(1):314. DOI:10.1186/1472-6963-13-314 · 1.66 Impact Factor