Reducing time‐to‐treatment in underserved Latinas with breast cancer: The Six Cities Study

Abstract

BACKGROUND The interaction of clinical and patient‐level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less‐than optimal navigation results, specifically in Hispanic/Latino women. METHODS To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally‐funded Redes En Acción: The National Latino Cancer Research Network developed a culturally‐tailored patient navigation intervention model for Latinas with breast cancer. RESULTS Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants. CONCLUSIONS Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient‐family telephone support, Spanish‐English language translation, and assistance with insurance paperwork. Cancer 2014;120:752–760. © 2013 American Cancer Society.

Lay Navigator Model for Impacting Cancer Health Disparities

“…This, in part, can be attributed to the personal characteristics of the navigators (language spoken, commitment to community, knowledge of cultural values and beliefs, relationships with community and stakeholders) [13]. Overall, the role of the navigators as communication brokers is highly consistent with other navigation studies [12, 27–30,] that view them as valuable assets for helping patients access information, problem-solve, and sift through the myriad logistics of cancer care. Further, we ascribe that patient navigators often work within a number of functional area domains as cogently identified by Willis et al, 2013 (31): professional roles and responsibilities, community resources, patient empowerment, communication, barriers to care/health disparities, education/prevention and health promotion, ethics and professional conduct, cultural competency, outreach, care coordination, psychosocial support services/assessment, and advocacy.…”

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

“…Study methods are notable for several advantages, compared to existing navigation studies which are limited by single-site studies [20, 25, 37, 39–47]. First, we targeted a racial/ethnically diverse population of vulnerable patients seeking care in safety net settings across the country.…”

Implementation of evidence-based patient navigation programs

“…Other studies, however, have shown benefit. Ramirez and colleagues [17] in six city study and Lobb [18] in a multisite program in one state both found a benefit in time to initiation of treatment. Studies by both Castaldi and colleagues [19], and Raj and colleagues found a benefit in completion of guideline recommended treatment.…”