Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia.

Published

Journal Article

BACKGROUND: Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis). METHODS: A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments. RESULTS: Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant. CONCLUSIONS: Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women. IMPACT: Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs.

Full Text

Duke Authors

Cited Authors

  • Hoffman, HJ; LaVerda, NL; Young, HA; Levine, PH; Alexander, LM; Brem, R; Caicedo, L; Eng-Wong, J; Frederick, W; Funderburk, W; Huerta, E; Swain, S; Patierno, SR

Published Date

  • October 2012

Published In

Volume / Issue

  • 21 / 10

Start / End Page

  • 1655 - 1663

PubMed ID

  • 23045540

Pubmed Central ID

  • 23045540

Electronic International Standard Serial Number (EISSN)

  • 1538-7755

Digital Object Identifier (DOI)

  • 10.1158/1055-9965.EPI-12-0479

Language

  • eng

Conference Location

  • United States