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The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

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Abstract

Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36–3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities.

Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.

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Funding/support

Funding Sources Supported by NIH Grants U01 CA116892, U01 CA117281, U01CA116903, 01CA116937, U01CA116924, U01CA116885, U01CA116875, U01CA116925, American Cancer Society, including #SIRSG-05-253-01, the Avon Foundation and the Boston Medical Center Carter Disparities Fund.

Additional contributions

The authors greatfully acknowledge Richard Campbell for his statistical support and the contributions of the following members of the Patient Navigation Research Program.

Patient Navigation Research Program Investigators:

Clinical Centers Boston Medical Center and Boston University: Karen M Freund (principal investigator (PI)) and Tracy A Battaglia (co-PI); Denver Health and Hospital Authority: Peter Raich (PI) and Elizabeth Whitley (co-PI); George Washington University Cancer Institute: Steven R Patierno (PI), Lisa M Alexander, Paul H Levine, Heather A Young, Heather J Hoffman, and Nancy L LaVerda; H. Lee Moffitt Cancer Center and Research Institute: Richard G Roetzheim (PI), Cathy Meade, and Kristen J Wells; Northwest Portland Area Indian Health Board: Victoria Warren-Mears (PI); Northwestern University Robert H. Lurie Comprehensive Cancer Center: Steven Rosen (PI) and Melissa Simon; Ohio State University: Electra D. Paskett (PI); University of Illinois at Chicago and Access Community Health Center: Elizabeth Calhoun (PI) and Julie Darnell; University of Rochester: Kevin Fiscella (PI) and Samantha Hendren; University of Texas Health Science Center at San Antonio Cancer Therapy and Research Center: Donald Dudley (PI), Kevin Hall, Anand Karnard, and Amelie Ramirez. Program Office National Cancer Institute, Center to Reduce Cancer Health Disparities: Martha Hare, Mollie Howerton, Ken Chu, Emmanuel Taylor, and Mary Ann Van Dyun. Evaluation Contractor NOVA Research Company: Paul Young and Frederick Snyder.

Author information

Authors and Affiliations

  1. Women’s Health Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building 1st Floor, Boston, MA, 02118, USA

    Tracy A. Battaglia

  2. Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Bldg 115, Room 556, Maywood, IL, 60153, USA

    Julie S. Darnell

  3. Section of Hematology Oncology, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA

    Naomi Ko

  4. NOVA Research Company, 801 Roeder Road, Suite 700, Silver Spring, MD, 20910, USA

    Fred Snyder

  5. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, 1590 North High Street, Columbus, OH, 43201, USA

    Electra D. Paskett

  6. Department of Psychology, San Diego State University, 6363 Alvarado Ct., Ste. 103, San Diego, CA, 92120-4913, USA

    Kristen J. Wells

  7. Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO, 80246, USA

    Elizabeth M. Whitley

  8. University of Michigan School of Public Health, 2800 Plymouth Road, Building 16, 116 W, Ann Arbor, MI, 48109, USA

    Jennifer J. Griggs

  9. Division of Hematology-Oncology, Cancer Therapy & Research Center (CTRC), UT Health Science Center, 7979 Wurzbach Rd., San Antonio, TX, 78229, USA

    Anand Karnad

  10. George Washington University Cancer Institute, 950 New Hampshire Ave. NW 5th Floor, Washington, DC, 20052, USA

    Heather Young

  11. Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA

    Victoria Warren-Mears

  12. Northwestern University Feinberg School of Medicine, 633 N. St Clair, Suite 1800, Chicago, IL, 60611, USA

    Melissa A. Simon

  13. University of Arizona Health Sciences, 550 East Van Buren, Phoenix, AZ, 85004-2230, USA

    Elizabeth Calhoun

Authors
  1. Tracy A. Battaglia
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  2. Julie S. Darnell
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  3. Naomi Ko
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  4. Fred Snyder
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  5. Electra D. Paskett
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  6. Kristen J. Wells
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  7. Elizabeth M. Whitley
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  8. Jennifer J. Griggs
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  9. Anand Karnad
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  10. Heather Young
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  11. Victoria Warren-Mears
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  12. Melissa A. Simon
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  13. Elizabeth Calhoun
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Corresponding author

Correspondence to Tracy A. Battaglia.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

At all sites with with individual randomization, informed consent was obtained from all individual participants included in the study.

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Battaglia, T.A., Darnell, J.S., Ko, N. et al. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat 158, 523–534 (2016). https://doi.org/10.1007/s10549-016-3887-8

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  • DOI: https://doi.org/10.1007/s10549-016-3887-8

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