C. Jojola1, H. Cheng1, L. Wong1, K. Turaga1, T. C. Gamblin1, F. Johnston1 1Medical College Of Wisconsin,Surgical Oncology/ Surgery,Milwaukee, WI, USA
Introduction: Patient navigation (PN) is a process whereby patients with financial, social, and health-related barriers to care receive a personal escort to assist in overcoming obstacles to achieve timely treatment. The models of PN are diverse, and are often designed to prevent the marginalization of patients of low socioeconomic status and racial/ethnic minority groups. Herein we examine the literature assessing the efficacy of PN for patients with malignancies undergoing treatment.
Methods: The review was conducted according to the recommendations of the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) group with pre-specified inclusion and exclusion criteria. Data abstraction examined efficacy measurements, patient demographics, barriers to access, quality measures and models of patient navigation.
Results:A systematic review was performed by searching PubMed, CINAHL, The Cochrane Library and EMBASE. A total of 4029 citations were collected in Refworks, yielding 27 relevant articles, 19 published papers and 8 abstracts. Navigation was performed for patients with breast, gynecologic, lung, pancreatic, colorectal, and prostate cancer treatment. Four articles do not specify type of cancer treatment. When examining ethnicity, 27.9% Hispanics (SD +/- 15), 30.9% Blacks (SD +/-16), 46.4% Whites (SD +/- 23), 4.6% Asian (SD +/- 3), 9.5% Other (SD +/- 14) participated. Three articles had 100% Native American participation. On average, 60.3% of patients spoke English (SD+/- 22), 44.5% spoke Spanish (SD +/- 13) and 16% fell under the category of Other (SD +/- 13). The average mean age of patients was 58.4 years (SD +/- 6). Analysis of quality measures showed that PN alleviated financial barriers (10 articles), coordination of care (7 articles) and transportation barriers (7 articles). When averaged, the mean days from diagnosis to treatment was 38.54 +/- 16 with PN compared to 45.31 +/- 18 days for the control groups. The median days from diagnosis to treatment was 36 +/- 11 with PN compared to 44.75 +/- 11 days for the non-navigated group (Table 1). Palliative care was not examined in any studies.
Conclusion:: A majority of patients benefitting from PN were a member of a minority racial/ethnic group, and a large portion was non-English speaking. Most patients in PN programs held a breast cancer diagnosis, but colorectal, prostate, and lung cancers were common as well. Overall, patients receiving navigation initiated treatment sooner than did their non-navigated counterparts. The efficacy of PN warrants further study of its various models and exploration of how PN can be expanded to include both curative and palliative treatment for patients.
