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The impact of nurse navigation on timeliness to treatment for benign high-risk breast pathology

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

High-risk breast pathology is a breast cancer risk factor for which timely treatment is crucial. Nurse navigation programs have been implemented to minimize delays in patient care. This study evaluated nurse navigation in terms of timeliness to surgery for patients with high-risk breast pathology.

Methods

This was a single-institution, retrospective review of patients with identified high-risk breast pathology undergoing lumpectomy between January 2017 and June 2019. Patients were stratified into cohorts based on periods with and without nurse navigation. Preoperative and postoperative time to care as well as demographic and tumor characteristics were compared using univariate and multivariate analysis.

Results

100 patients had assigned nurse navigators and 29 patients did not. Nurse navigation was associated with reduced time from referral to date of surgery (DOS) by 16.9 days (p = 0.003). Patients > 75 years had a shorter time to first appointment (p = 0.03), and patients with Medicare insurance had a reduced time from referral to DOS (p = 0.005). 20% of all patients were upstaged to cancer on final surgical pathology.

Conclusion

Nurse navigation was significantly associated with decreased time to care for patients with high-risk breast pathology undergoing lumpectomy. We recommend nurse navigation programs as part of a comprehensive approach for patients with high-risk breast pathology.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Cancer Stat Facts: Female Breast Cancer (2019) http://seer.cancer.gov/statfacts/html/breast.html. Accessed July 26, 2022

  2. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchió C, Reis-Filho JS (2010) Breast cancer precursors revisited: molecular features and progression pathways. Histopathology 57(2):171–192. https://doi.org/10.1111/j.1365-2559.2010.03568.x

    Article  PubMed  Google Scholar 

  3. American Cancer Society. Breast Cancer Facts & Figs. 2019–2020 Atlanta: American Cancer Society, Inc.

  4. Bleicher RJ, Ruth K, Sigurdson ER et al (2016) Time to surgery and breast Cancer survival in the United States. JAMA Oncol 2(3):330–339. https://doi.org/10.1001/jamaoncol.2015.4508

    Article  PubMed  PubMed Central  Google Scholar 

  5. Molina Y, Kim SJ, Berrios N et al (2018) Patient Navigation improves subsequent breast Cancer Screening after a noncancerous result: evidence from the patient Navigation in Medically Underserved Areas Study. J Womens Health (Larchmt) 27(3):317–323. https://doi.org/10.1089/jwh.2016.6120

    Article  PubMed  Google Scholar 

  6. McKevitt EC, Dingee CK, Leung SP et al (2017) Reduced time to breast Cancer diagnosis with coordination of Radiological and Clinical Care. Cureus 9(12):e1919. https://doi.org/10.7759/cureus.1919

    Article  PubMed  PubMed Central  Google Scholar 

  7. Garcia D, Siegel JB, Mahvi DA et al (2020) What is elective oncologic surgery in the time of COVID-19? A literature review of the Impact of Surgical Delays on Outcomes in patients with Cancer. Clin Oncol Res 3(6):1–11. https://doi.org/10.31487/j.COR.2020.06.05

    Article  PubMed  PubMed Central  Google Scholar 

  8. Basu M, Linebarger J, Gabram SG, Patterson SG, Amin M, Ward KC (2013) The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center. Cancer 119(14):2524–2531. https://doi.org/10.1002/cncr.28024

    Article  PubMed  Google Scholar 

  9. Role of the Oncology Nurse Navigator throughout the Cancer Trajectory. Oncol Nurs Forum. 45(3):283. https://doi.org/10.1188/18.Onf.283

  10. Case MA (2011) Oncology nurse navigator. Clin J Oncol Nurs 15(1):33–40. https://doi.org/10.1188/11.Cjon.33-40

    Article  PubMed  Google Scholar 

  11. Rosenberg K (2011) Patient navigators improve colorectal cancer screening rates. Am J Nurs 111(10):15. https://doi.org/10.1097/01.NAJ.0000406404.80894.5a

    Article  PubMed  Google Scholar 

  12. Enomoto LM, Fenstermaker J, Desnoyers RJ et al (2019) Oncology Navigation decreases time to treatment in patients with pancreatic malignancy. Ann Surg Oncol 26(5):1512–1518. https://doi.org/10.1245/s10434-019-07157-6

    Article  PubMed  Google Scholar 

  13. Luckett R, Pena N, Vitonis A, Bernstein MR, Feldman S (2015) Effect of patient navigator program on no-show rates at an academic referral colposcopy clinic. J Womens Health (Larchmt) 24(7):608–615. https://doi.org/10.1089/jwh.2014.5111

    Article  PubMed  Google Scholar 

  14. Bush ML, Kaufman MR, Shackleford T (2018) Adherence in the Cancer Care setting: a systematic review of Patient Navigation to Traverse Barriers. J Cancer Educ 33(6):1222–1229. https://doi.org/10.1007/s13187-017-1235-2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Baik SH, Gallo LC, Wells KJ (2016) Patient Navigation in breast Cancer Treatment and Survivorship: a systematic review. J Clin Oncol 34(30):3686–3696. https://doi.org/10.1200/jco.2016.67.5454

    Article  PubMed  PubMed Central  Google Scholar 

  16. McKevitt E, Dingee C, Warburton R et al (2018) Patient navigation reduces time to care for patients with breast symptoms and abnormal screening mammograms. Am J Surg 215(5):805–811. https://doi.org/10.1016/j.amjsurg.2017.12.016

    Article  PubMed  Google Scholar 

  17. Cantril C, Moore E, Yan X (2019) Diagnosis Disclosure: patient preferences and the role of the breast nurse Navigator. Clin J Oncol Nurs 23(6):619–626. https://doi.org/10.1188/19.Cjon.619-626

    Article  PubMed  Google Scholar 

  18. Motulsky H Intuitive Biostatistics: A Nonmathematical Guide to Statistical Thinking 4th ed. Published 4th

  19. Cen C, Chun J, Schnabel F (2020) Management of women at increased risk for breast cancer secondary to high-risk proliferative lesions and family history of the disease. Breast J 26(8):1543–1548. https://doi.org/10.1111/tbj.13964

    Article  PubMed  Google Scholar 

  20. Chen F, Mercado C, Yermilov I et al (2010) Improving breast cancer quality of care with the use of patient navigators. Am Surg 76(10):1043–1046 Published 2010/11/26

    Article  PubMed  Google Scholar 

  21. Ali-Faisal SF, Colella TJ, Medina-Jaudes N, Benz Scott L (2017) The effectiveness of patient navigation to improve healthcare utilization outcomes: a meta-analysis of randomized controlled trials. Patient Educ Couns 100(3):436–448. https://doi.org/10.1016/j.pec.2016.10.014

    Article  PubMed  Google Scholar 

  22. Chiarelli AM, Muradali D, Blackmore KM et al (2017) Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. Br J Cancer 116(10):1254–1263. https://doi.org/10.1038/bjc.2017.87

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ward WH, DeMora L, Handorf E et al (2020) Preoperative delays in the treatment of DCIS and the Associated incidence of invasive breast Cancer. Ann Surg Oncol 27(2):386–396. https://doi.org/10.1245/s10434-019-07844-4

    Article  PubMed  Google Scholar 

  24. Lewis JT, Hartmann LC, Vierkant RA et al (2006) An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 30(6):665–672. https://doi.org/10.1097/00000478-200606000-00001

    Article  PubMed  Google Scholar 

  25. Jacobs TW, Byrne C, Colditz G, Connolly JL, Schnitt SJ (1999) Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 340(6):430–436. https://doi.org/10.1056/nejm199902113400604

    Article  CAS  PubMed  Google Scholar 

  26. Said SM, Visscher DW, Nassar A et al (2015) Flat epithelial atypia and risk of breast cancer: a Mayo cohort study. Cancer 121(10):1548–1555. https://doi.org/10.1002/cncr.29243

    Article  PubMed  Google Scholar 

  27. Kraft E, Limberg JN, Dodelzon K et al (2021) Radial scars and complex sclerosing lesions of the breast: prevalence of malignancy and natural history under active surveillance. Ann Surg Oncol 28(9):5149–5155. https://doi.org/10.1245/s10434-021-09713-5

    Article  PubMed  Google Scholar 

  28. Limberg J, Kucher W, Fasano G, Hoda S, Michaels A, Marti JL (2021) Intraductal papilloma of the breast: prevalence of malignancy and natural history under active surveillance. Ann Surg Oncol 28(11):6032–6040. https://doi.org/10.1245/s10434-021-09870-7

    Article  PubMed  Google Scholar 

  29. Degnim AC, King TA (2013) Surgical management of high-risk breast lesions. Surg Clin North Am 93(2):329–340. https://doi.org/10.1016/j.suc.2012.12.005

    Article  PubMed  Google Scholar 

  30. Dudley DJ, Drake J, Quinlan J et al (2012) Beneficial effects of a combined navigator/promotora approach for hispanic women diagnosed with breast abnormalities. Cancer Epidemiol Biomarkers Prev 21(10):1639–1644. https://doi.org/10.1158/1055-9965.Epi-12-0538

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stahl KA, Dodge D, Olecki EJ et al (2022) Insurance Status and Travel Distance to single treatment facility Predictive of Mastectomy. J Surg Res 270:22–30. https://doi.org/10.1016/j.jss.2021.08.035

    Article  PubMed  Google Scholar 

  32. Sprague BL, Ahern TP, Herschorn SD, Sowden M, Weaver DL, Wood ME (2021) Identifying key barriers to effective breast cancer control in rural settings. Prev Med 152(Pt 2):106741. https://doi.org/10.1016/j.ypmed.2021.106741

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Medical University of South Carolina, Charleston, SC, USA

    Catherine S. Barker, Catherine W. Chung, Rupak Mukherjee, Julie B. Siegel, David J. Cole, Mark A. Lockett, Nancy Klauber-DeMore & Andrea M. Abbott

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  1. Catherine S. Barker
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  2. Catherine W. Chung
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  3. Rupak Mukherjee
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  4. Julie B. Siegel
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  7. Nancy Klauber-DeMore
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  8. Andrea M. Abbott
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Catherine Chung MD, Catherine Barker, Rupak Mukherjee PhD, Julie Siegel MD, and Andrea Abbott MD. The first draft of the manuscript was written by Catherine Chung and Catherine Barker and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Julie B. Siegel.

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The authors have no relevant conflicts of interest to disclose.

Ethical approval

This is an observational study. The IRB of the Medical University of South Carolina has confirmed that no ethical approval is required.

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Barker, C.S., Chung, C.W., Mukherjee, R. et al. The impact of nurse navigation on timeliness to treatment for benign high-risk breast pathology. Breast Cancer Res Treat 202, 129–137 (2023). https://doi.org/10.1007/s10549-023-07049-0

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