Impact of patient navigation in eliminating economic disparities in cancer care Journal Article

Authors: Rodday, A. M.; Parsons, S. K.; Snyder, F.; Simon, M. A.; Llanos, A. A.; Warren-Mears, V.; Dudley, D.; Lee, J. H.; Patierno, S. R.; Markossian, T. W.; Sanders, M.; Whitley, E. M.; Freund, K. M.
Article Title: Impact of patient navigation in eliminating economic disparities in cancer care
Abstract: BACKGROUND: Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. METHODS: This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included. RESULTS: Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P = .02). Renters (HR, 0.81; P = .02) and those with other (ie, unstable) housing (HR, 0.60; P .001) had delays in comparison with homeowners. Never married (HR, 0.70; P .001) and previously married participants (HR, 0.85; P = .03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm. CONCLUSIONS: Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015. (c) 2015 American Cancer Society.
Keywords: Early Detection of Cancer; Colonic Neoplasms; Patient Navigation; Breast Neoplasms; Prostatic neoplasms; health care disparities; uterine cervical neoplasms
Journal Title: Cancer
ISSN: 1097-0142; 0008-543X
Publisher: American Cancer Society  
Date Published: 2015
Language: ENG
Notes: LR: 20150914; CI: (c) 2015; GR: U01 CA116892/CA/NCI NIH HHS/United States; GR: U01 CA116924/CA/NCI NIH HHS/United States; GR: U01 CA116925/CA/NCI NIH HHS/United States; GR: U01 CA116937/CA/NCI NIH HHS/United States; GR: U01 CA117281/CA/NCI NIH HHS/United States; JID: 0374236; OTO: NOTNLM; 2015/02/05 [received]; 2015/05/07 [revised]; 2015/05/13 [accepted]; aheadofprint