Abstract PL06-02: Patient navigation and timeliness of diagnostic evaluation: Results from the Patient Navigation Research Program

Background: Patient navigation has been proposed as a means to reduce cancer health disparities, through the addition of a trained navigator to the health care team. Patient navigators help patients to identify barriers to receiving needed care, and to develop individually targeted plans to overcome these barriers. The Patient Navigation Research Program is a nine-site program to evaluate the benefit of patient navigation among underserved populations from diverse socioeconomic and geographic locations within the United States. Methods: Patients with breast, cervical, colorectal or prostate screening abnormalities were eligible for enrollment. The primary outcome was time to diagnostic resolution of the screening abnormality, assessed dichotomously as resolved or not within 365 days, and analyzed using survival curves and Cox proportional hazards models of time to resolution by 12 months. Due to the differing study designs at the 9 sites (RCT, Group randomized, and non randomized group allocation) we calculated an effect size for each cancer type for each site, and utilized a meta-analysis to assess an overall effect size. Models were adjusted for age, race, insurance and marital status. Results: There were 10,513 subjects (5,055 Navigated and 5,458 Non-navigated) recruited from the 9 sites, 64% with breast cancer screening abnormalities. The study population was diverse with 74% from minority groups (32% African American, 39% Latino, 4% other), and low income with 17% Medicaid insured, and 32% with no insurance. In the control population, 62% to 95% of the participants did not reach diagnostic resolution after their abnormal screening result within 12 months. Those in the navigation arm were more likely to reach resolution after an abnormal test in 13 of the 15 cancer sites, (89 to 99% resolved). Of the 15 hazard rate ratios, 11 showed a statistically significant positive effect of the navigation intervention, 3 others showed a non statistically significant benefit of navigation, and 1 showed a negative effect of navigation on time to diagnostic resolution, (effect sizes ranging from an adjusted HR of 0.38 to 3.94, with a higher HR favoring the navigation arm). Implications: Compared to non-navigated subjects, participants with an abnormal cancer screening test who were allocated to receive a patient navigation intervention were more likely to receive timely diagnostic resolution of their abnormal screening test. Patient navigation for vulnerable populations may be beneficial in reducing cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PL06-02.