Can Patient Navigation Improve Receipt of Recommended Breast Cancer Care? Evidence From the National Patient Navigation Research Program

Abstract

Purpose Poor and underserved women face barriers in receiving timely and appropriate breast cancer care. Patient navigators help individuals overcome these barriers, but little is known about whether patient navigation improves quality of care. The purpose of this study is to examine whether navigated women with breast cancer are more likely to receive recommended standard breast cancer care. Patients and Methods Women with breast cancer who participated in the national Patient Navigation Research Program were examined to determine whether the care they received included the following: initiation of antiestrogen therapy in patients with hormone receptor–positive breast cancer; initiation of postlumpectomy radiation therapy; and initiation of chemotherapy in women younger than age 70 years with triple-negative tumors more than 1 cm. This is a secondary analysis of a multicenter quasi-experimental study funded by the National Cancer Institute to evaluate patient navigation. Multiple logistic regression was performed to compare differences in receipt of care between navigated and non-navigated participants. Results Among participants eligible for antiestrogen therapy, navigated participants (n = 380) had a statistically significant higher likelihood of receiving antiestrogen therapy compared with non-navigated controls (n = 381; odds ratio [OR], 1.73; P = .004) in a multivariable analysis. Among the participants eligible for radiation therapy after lumpectomy, navigated participants (n = 255) were no more likely to receive radiation (OR, 1.42; P = .22) than control participants (n = 297). Conclusion We demonstrate that navigated participants were more likely than non-navigated participants to receive antiestrogen therapy. Future studies are required to determine the full impact patient navigation may have on ensuring that vulnerable populations receive quality care.

Implementation of evidence-based patient navigation programs

“…The Patient Navigation Research Program, the largest study to date of patient navigation located at nine sites across the US showed benefits in cancer care, with a greater proportion of patients initiating cancer care in a timely fashion [20], with the benefits focused on those who had not initiated cancer care within 90 days of diagnosis. This study documented a greater adherence to guideline recommended care among the navigation arm of the study [21].…”

Second international consensus guidelines for breast cancer in young women (BCY2)

“…Navigators should ideally be breast nurses but lay-health professionals with strong communication skills and sufficient experience may also address complex care and mixed cultural settings 26 . Studies have shown that incorporating navigators in health clinics improves patients' sense of empowerment and increases the uptake of standard therapies [26][27][28] .…”

Outcomes research examining treatments, quality of life and costs in HER2 -negative and triple-negative metastatic breast cancer: a systematic literature review

“…Ko et al [47] examined whether patient navigation improved receipt of recommended breast cancer care. In this study, women with breast cancer who participated in the national Patient Navigation Research Program were examined to determine whether the care they received included: initiation of antiestrogen therapy in patients with HR-positive breast cancer; initiation of postlumpectomy radiation therapy; and initiation of chemotherapy in women less than 70-year-old with TN tumors greater than 1 cm.…”

“…Treatment appropriateness was addressed by one study, in terms of patient treatment navigation (Table 5) [47]. Ko et al [47] examined whether patient navigation improved receipt of recommended breast cancer care.…”