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Patient navigation reduced delays in breast cancer diagnosis
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Patient navigation services resulted in a fourfold reduction in the time it took to diagnosis a suspicious breast lump, according to results of a prospective study.
Patient navigation services — which include help setting up appointments and dealing with health insurance companies — often are offered to low-income women diagnosed with breast cancer who face barriers to timely treatment. Prior studies suggested navigation services helped those patients overcome obstacles that can cause potentially dangerous delays in diagnosis and treatment.
In 2005, the NCI created a patient navigation research program to measure the efficacy of patient navigation for several cancers. The George Washington Cancer Institute established its own patient navigation research program to determine how effectively patient navigation reduced breast cancer diagnostic time.
In the current study, researchers evaluated data on 2,601 women with breast cancer who were treated between 2006 and 2010 at nine hospitals and clinics in the Washington, D.C. area. Of those women, 1,047 received navigation services (median age, 49 years) and 1,554 did not (median age, 51 years).
The investigators controlled for race, ethnicity, type of insurance, age and study site.
Results showed the time it took to receive a diagnosis was significantly shorter for women who received navigation services (25.1 days; 95% CI, 21.7-29) compared with those who did not (42.1 days; 95% CI, 35.8-49.6).
Heather J. Hoffman
“The time savings really paid off for the women in this study,” Heather J. Hoffman, PhD, associate professor of epidemiology and biostatistics for the School of Public Policy and Health Services at George Washington University, said in a press release. “A quicker diagnosis of breast cancer often translates to faster treatment and might give women a better shot of survival.”
Hoffman and colleagues conducted a second analysis to determine whether navigation services reduced the time to diagnosis for patients who required a biopsy. That analysis included 1,760 women, 662 of whom received navigation services and 1,098 of whom did not.
Once again, after adjustments for several factors, the results showed the use of navigation services significantly reduced the time to diagnosis (26.6 days vs. 57.5 days; P<.0001).
The researchers identified 446 patients who ultimately were diagnosed with cancer. Of them, 416 (93%) underwent biopsy and 30 (7%) underwent fine-needle aspiration. Among those women, patients who received navigation services had a significantly shorter average time to diagnosis (9.8 days vs. 39.9 days; P<.0001), results showed.
“Navigation significantly reduced the odds of having diagnostic delays for both uninsured and privately insured women, with a similar non-significant trend seen from women with government insurance,” Hoffman and colleagues wrote. “Navigation was most effective in reducing diagnostic times within the first 60 days following abnormal screening.”
National health policymakers must evaluate the results of additional related studies before making determinations about the cost-effectiveness of navigation services, but patient navigation has the potential to become a standard part of cancer care, according to the researchers.
“This study clearly shows navigation is effective in decreasing time to diagnostic resolution, particularly among women who have a biopsy and have a diagnostic resolution to cancer,” they concluded.
Disclosure: Hoffman reports no relevant financial disclosures.
Perspective
Back to TopGina Villani, MD, MPH
More than a decade ago, the Institute of Medicine issued a report suggesting that many Americans were not receiving care known to be effective for their cancer. That significant disparities exist is no longer in question. Rather, the question is, how can these disparities be eliminated? Patient navigation, pioneered by Harold P. Freeman, MD, has been adopted by many institutions throughout the country. Hoffman and colleagues add to the body of evidence that patient navigation is effective by demonstrating that navigated patients reached diagnostic resolution sooner than non-navigated patients. This proved especially true for women whose resolution was a cancer diagnosis. Hoffman suggests that patient navigation should be a reimbursable expense.
Many questions still remain, however. Most importantly, does navigation ultimately relate to better clinical outcomes? Other issues to be resolved involve the navigators themselves. Who should a patient navigator be — a nurse, social worker, cancer survivor? Will patient navigation require certification, and what are the elements of such a certification? Should accrediting agencies require patient navigation programs, and will this be a burden or a blessing to institutions who struggle to care for the under and uninsured? Clearly reducing time to diagnosis is a valuable end point, and Hoffman and colleagues have performed a rigorous and comprehensive analysis of the impact of patient navigation. More work needs to be done such that patient navigation can become a key component in eliminating disparities and fulfilling Dr. Freeman’s vision.
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