Randomized Controlled Trial of Patient Navigation for Newly Diagnosed Cancer Patients: Effects on Quality of Life

Abstract

Background Patient navigation (PN) is a promising intervention to ameliorate cancer health disparities. This study objective was to measure PN effects on cancer-specific quality of life (QOL) among newly diagnosed cancer patients. Methods A randomized, controlled trial of PN was conducted in Rochester, New York. Breast cancer and colorectal cancer patients were randomly assigned to receive a PN intervention or usual care. QOL was measured at baseline and four subsequent time points, using the validated Functional Assessment of Cancer Therapy (FACT-B, FACT-C) instruments. Results Among 319 randomized patients (165 PN, 154 control), median age was 57 years and 32.5% were from minority race/ethnicity groups. PN and control groups were comparable on baseline factors, except home ownership v. renting (more home ownership among controls, p=0.05) and race (more whites among controls, p=0.05). Total and subscale FACT scores did not differ between groups when analyzed as a change from baseline to 3 months, or at various time points. The emotional well-being subscale change from baseline approached significance (better change among PN group, p=0.05). Time trends of QOL measures did not differ significantly between groups. Adjustment for baseline patient factors did not reveal a benefit of PN on QOL. Conclusions In this randomized trial of PN, there was no statistically significant effect on disease-specific QOL. Impact These results suggest that PN may not affect QOL during cancer treatment, that social/medical support are adequate in this study’s setting, or that the trial failed to target patients likely to experience QOL benefit from PN.

Neighborhood Factors Associated with Time to Resolution Following an Abnormal Breast or Cervical Cancer Screening Test

“…Of the three existing studies examining the effects of any neighborhood deprivation metric on a cancer outcome among participants in a PN program (18, 22, 23), two reported insignificant associations (22, 23) and the other did not report the association (18). No other study has assessed the effects of CT-level measures of neighborhood deprivation, within a multilevel analytic framework or otherwise, among participants of a PN program.…”

“…Two studies reported statistically insignificant associations (22, 23), while the other did not report their findings (18). Neighborhood research suggests that: 1) census tract (CTs) approximate neighborhoods better than zip codes, and 2) measures of several neighborhood constructs (e.g., racial segregation, neighborhood socioeconomic deprivation) should be considered when investigating the effects of neighborhood factors on cancer outcomes (24, 25).…”

“…Previous PN studies explored the relationship between the postal service-based, zip code-level measure of median household income or percent below the federal poverty level (FPL) and various cancer outcomes (18, 22, 23). Two studies reported statistically insignificant associations (22, 23), while the other did not report their findings (18).…”

Effects of Delayed Surgical Resection on Short-Term and Long-Term Outcomes in Clinical Stage I Non-Small Cell Lung Cancer

“…[22] Two additional randomized clinical trials evaluating patient navigator programs also failed to improve time to treatment. [23,24]…”

Patterns of task and network actions performed by navigators to facilitate cancer care

“…Health care organizations, especially those identified as ''safety net'' providers of care, have deployed patient navigators, assigning them the tasks of identifying patients at risk of poor access, mitigating the barriers they face, and facilitating provision of care, navigating them to needed cancer care. Recent reports from the national patient navigation research program (PNRP) provide evidence of the effectiveness of this strategy to improve timely care after abnormal cancer screening (Battaglia et al, 2012;Dudley et al, 2012;Fiscella et al, 2012;Hendren et al, 2012;Hoffman et al, 2012;Markossian, Darnell, & Calhoun, 2012;Paskett et al, 2012;Raich et al, 2012;Wells et al, 2012).…”