Patient Navigation Aided Continued Care of Vulnerable Patients

Instituting a patient navigation program may help to aid in the continued cancer care of populations at a higher risk of being lost to follow-up, according to the results of a multicenter study published in the Journal of the National Cancer Institute.

“The study provides evidence that for vulnerable populations, patients, physicians, and practices benefit from the additional support of patient navigators to guide patients through the complicated care needed for abnormal cancer screening and after a cancer diagnosis,” study author Karen M. Freund, MD, MPH, of Tufts Medical Center told Cancer Network.

Patient navigation is support given to patients with abnormal cancer screening results in an attempt to help improve their overall access to and the timely coordination of care.

In recent years, patient navigation has started to become a standard of care. Now that several accrediting organizations are requiring patient navigation, it is critical to provide evidence of its effectiveness.

Freund and colleagues carried out the first multisite study of patient navigation, the Patient Navigation Research Program. This program compared patients who received patient navigation assistance with those who received usual care. The study included 10,521 patients with abnormal screening and 2,105 with cancer. All patients had breast, cervical, colorectal, or prostate screening abnormalities or cancers between 2007 and 2010.  

Of the participants, 73% were a racial or ethnic minority, 40% were publically insured and 31% had no insurance at the time of enrollment. The majority of participants were women.

During the first 90 days of care, the researchers identified no benefit to enrollment in a patient navigation program as compared with undergoing usual care. However, between day 91 and 365, a statistically significant difference in diagnostic resolution occurred (adjusted HR = 1.51; 95% CI, 1.23-1.84; P < .001). In addition, participants in patient navigation programs were also more likely to initiate treatment (adjusted HR = 1.43; 95% CI, 1.10-1.86; P < .007).

“The study confirmed that patient navigation benefits patients in settings that care for low income and minority patients,” Freund said. “Without patient navigators, there were some patients that never received recommended cancer care, even after 1 year of follow up.”

However, Freund said that the researchers were surprised by the lack of benefit in the first 90 days. 

“Even in low income, uninsured, and disadvantaged communities, many patients completed timely care without a navigator,” Freund said. “However, for those who have delays in care, navigators were able to support patients and ensure they received the care they need.”