Cancer Care Delivery and Women’s Health: The Role of Patient Navigation

Abstract

BackgroundPatient navigation (PN) is a patient-centered health-care service delivery model that assists individuals, particularly the medically underserved, in overcoming barriers (e.g., personal, logistical, and system) to care across the cancer care continuum. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health-care facilities seeking CoC-accreditation must have PN processes in place starting January 1, 2015. The CoC mandate, in light of the recent findings from centers within the Patient Navigation Research Program and the influx of PN interventions, warrants the present literature review.MethodsPubMed and Medline were searched for studies published from January 2010 to October 2015, particularly those recent articles within the past 2 years, addressing PN for breast and gynecological cancers, and written in English. Search terms included patient navigation, navigation, navigator, cancer screening, clinical trials, cancer patient, cancer survivor, breast cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer, and vulvar cancer.ResultsConsistent with prior reviews, PN was shown to be effective in helping women who receive cancer screenings, receive more timely diagnostic resolution after a breast and cervical cancer screening abnormality, initiate treatment sooner, receive proper treatment, and improve quality of life after cancer diagnosis. However, several limitations were observed. The majority of PN interventions focused on cancer screening and diagnostic resolution for breast cancer. As observed in prior reviews, methodological rigor (e.g., randomized controlled trial design) was lacking.ConclusionFuture research opportunities include testing PN interventions in the post-treatment settings and among gynecological cancer patient populations, age-related barriers to effective PN, and collaborative efforts between community health workers and patient navigators as care goes across segments of the cancer control continuum. As PN programs continue to develop and become a standard of care, further research will be required to determine the effectiveness of cancer PN across the cancer care continuum, and in different patient populations.

Implementation of evidence-based patient navigation programs

“…Several review articles and large clinical trials have focused on the benefits of patient navigation for cancer screening and diagnostic evaluation following abnormal screening [7][8][9]. Most of these studies have found modest overall benefits of patient navigation in these areas.…”

“…The current literature on patient navigation in active management of patients with cancer has demonstrated mixed findings on improving timeliness or completion of care, with little data on either quality of care or patient experience with navigation [8,10]. Several studies have shown minimal benefit in the cancer care setting.…”

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

“…Few studies have focused on the last phase of life 5,8 . A number of qualitative 7 and intervention or disease cohort studies, including randomized trials 8 , have been carried out, but we found no population-based studies that identify the individuals who are and are not using navigation.…”

“…Few studies have focused on the last phase of life 5,8 . A number of qualitative 7 and intervention or disease cohort studies, including randomized trials 8 , have been carried out, but we found no population-based studies that identify the individuals who are and are not using navigation. Furthermore, the need for navigation might be changing, given the accelerating discovery of innovative cancer treatments, the fact that more people are living longer with cancer 9 , the current focus on narrowing the gap between oncology and primary care 10,11 , the aging of the population, and greater interest in advance care planning and a palliative approach to care [12][13][14] .…”

“…Although few studies of navigation in relation to palliative and end-of-life care have been reported 5,8 , the population-based study design for investigating care for people at the end of life has been well established in Nova Scotia and elsewhere [16][17][18][19][20][21][22][23] . Nova Scotia is therefore an ideal setting to investigate use of navigation by people with cancer who are in their last phase of life.…”