| Bickell16
|
RCT; participants randomly assigned to usual care (CON; written materials) or intervention (INT; PNP) Eight inner-city hospitals (New York, NY) |
PNP included an individualized action plan on the basis of needs assessment for patient assistance programs related to breast cancer and treatment. PNs were trained in identifying and addressing barriers to care and provided case management and informational, emotional, and practical support. |
|
Adjuvant treatment adherence rates for receipt of RT, CT, and HT |
No statistically significant differences in adherence rates to adjuvant treatments between INT and CON were found. Both groups had high rates of RT (87% v 91%; P = .39), CT (93% v 86%; P = .42), and HT (92% v 93%; P = .80) |
| Chen17
|
Retrospective cohort study; comparison of patients who received care before (CON) and after (INT) implementation of a breast cancer PNP Public hospital (Los Angeles County, CA) |
PNs were bilingual (English, Spanish) and bicultural; were trained in medical interpretation, cultural competency, case management, and patient navigation; and provided community outreach, health education, psychosocial support, care coordination, and access to transportation and financial resources. |
|
Treatment adherence rates for receipt of RT, CT, and HT Adherence to post-treatment surveillance mammography |
No statistically significant differences were found in treatment adherence rates between INT and CON. After implementation of PNP, adherence to surveillance mammography was significantly higher in INT than CON: 76% v 52% of INT v CON, respectively, received surveillance mammograms within 12 months (P < .05). |
| Dudley18
|
QE; prospective comparison of unmatched control participants (CON; usual care) and intervention participants (INT; usual care plus PNP) County safety net hospital, University Health System (San Antonio, TX) |
PNP included a PN paired with a promotora. PNs included a registered nurse, social worker, dental hygienist, and a person with an MBA who were trained in navigation and developed individualized care plans on the basis of patients’ individual and health system barriers. The PN focused on reducing medical-related barriers, whereas the promotora assisted with cultural or socioeconomic barriers. Navigation was through completion of initial therapy. |
|
|
Average time to treatment from diagnosis significantly differed by 17 days between CON (74 days) and INT (57 days; P = .042). This effect was more pronounced among Hispanic women (HR, 1.45; 95% CI, 1.09 to 1.67; P = .02) who received navigation compared with usual care (81 days [CON] v 56 days [INT]). No statistically significant difference was found in timeliness of treatment completion between INT and CON. |
| Ell19
|
Prospective comparison of participants who received PNP (INT) and participants who did not enroll or declined study participation (CON; usual care) Public and private urban screening, diagnostic, and treatment-referral centers (Los Angeles, CA; New York, NY) |
Patient navigation provided by PNs and social workers (MSWs). PNs were bilingual (English, Spanish) and bicultural peer counselors; had a minimum of a high school diploma and experience working in community health care programs; and provided telephone-based adherence risk/barrier assessment, health education, appointment reminders, individualized counseling, health care system navigation, and referrals to MSW for psychosocial counseling. |
N = 1,300 For INT (n = 605): Age: 40-64 years (73%) Race/ethnicity: Hispanic (71%) Black (18%) Other (11%) Health insurance: Insured (56%) Uninsured (44%) For CON (n = 695): Age: NR Race: NR Health insurance: NR |
Initiation of cancer treatment within 30 days of diagnosis |
No statistically significant difference was found in timeliness of treatment initiation between a subsample of INT (n = 64) and CON (n = 10) participants with breast cancer: 62% v 40% of INT v CON, respectively, initiated treatment within 30 days after diagnosis. |
| Ell20
|
RCT; participants randomly assigned to receive usual care (CON) or intervention (INT; PNP) Public medical center (Los Angeles, CA) |
PN was bilingual (English, Spanish) and provided telephone-based adherence risk assessment, health education, counseling, systems navigation, reminders, and referrals to community resources and MSW for psychosocial counseling. |
|
Initiation of cancer treatment within 30 days of diagnosis |
Among a subsample of participants with breast cancer (INT, n = 5; CON, n = 10), 80% of INT and 60% of CON initiated treatment within 30 days after diagnosis. Statistical analyses were not performed due to small sample size. |
| Ell21
|
RCT that compared two INTs; patients randomly assigned to enhanced usual care (CON; usual care plus written informational materials) or intervention (INT; written information plus PNP) Urban public safety net medical center (Los Angeles, CA) |
Culturally tailored PNP was designed to improve access and adherence to adjuvant treatment. PN was bilingual (English, Spanish) and bicultural; assessed adherence barriers and risk; and provided health education, decisional and emotional support, problem solving, self-management support, written resources, and referrals to MSW for brief counseling. Navigation services provided through telephone and/or in person. |
|
Adjuvant treatment adherence rates for completion of CT, RT, and HT |
No statistically significant differences were found between groups for overall adjuvant treatment adherence rates: 90% v 88% of CON v INT, respectively, completed CT; 90% of patients in both groups completed RT. Overall adherence to HT was 59%, with no significant difference in rates between groups. |
| Haideri22
|
Retrospective case series analysis of patients with breast cancer who received care before (CON) and after (INT) implementation of PNP Urban safety net hospital, Truman Medical Center (Kansas City, KS) |
PNs provided patients with cell phones for appointment reminders; assistance with scheduling appointments and services; communication with health care providers; educational information; one-on-one emotional support; and financial, insurance, transportation, and child care assistance. |
|
|
After implementation of PNP, the average time from symptom presentation to first treatment was shorter by a median of 9 days (42 v 33 days for CON v INT, respectively). No statistically significant difference was found in the average time from surgery to initiation of adjuvant therapy between groups (CON, 48 days [95% CI, 39 to 56 days]; INT, 43 days [95% CI, 38 to 48]; P = .62). |
| Ko23
|
Multicenter QE; comparison of patients who received care before (CON) and after (INT) implementation of patient navigation Academic research centers (Boston, MA; Chicago, IL; Denver, CO; Columbus, OH; Rochester, NY; San Antonio, TX; Tampa, FL; Washington, DC) |
PNPs varied across eight PNRP sites, but all focused on improving patient access to timely and quality cancer care. PNs received training and basic education about breast cancer treatment and provided informational and emotional support to patients through their course of care. Navigation was from diagnosis through the end of cancer treatment (surgery, CT, RT). |
N = 1,004 Mean age: 56.2 years (SD, 11.4 years) Race/ethnicity: Black (37.5%) White (36.3%) Hispanic (22.3%) Other (3.9%) Language: English (79.1%) Non-English (20.9%) Health insurance: Private (48.6%) Public (38%) Uninsured (13.4%) |
Treatment adherence rates for receipt of HT and RT |
INT was more likely to receive HT than CON (OR, 1.73; 95% CI, 1.19 to 2.53; P = .004; d = .43) when controlling for age, race/ethnicity, language, insurance, and site. No statistically significant difference was found between groups that received RT (OR, 1.42; 95% CI, 0.80 to 2.54; P = .22; d = .28). |
| Koh24
|
Prospective study of patients with breast cancer who received PNP (INT) compared with matched historical controls (CON) Breast center in a tertiary care facility (Denver, CO) |
PNP was provided to patients with newly diagnosed breast cancer by an oncology nurse who coordinated their care. Navigation was through diagnosis to end of cancer care (eg, patients transferred to cancer treatment center or other care provider) |
N = 110 Mean age: 56.5 years (SD, 12.28 years) Race/ethnicity: White (90%) Black (5.5%) Hispanic (3.6%) Asian (0.9%) Health insurance: Private (63.6%) Government (36.4%) |
Initiation of cancer treatment (time from diagnostic biopsy to initiation of cancer treatment) |
On average, INT initiated treatment in 26.2 days (SD, 9.15 days; 95% CI, 22.9 to 29.4 days), and CON initiated treatment in 30 days (SD, 11.79 days; 95% CI, 26.8 to 33.2 days). This shorter mean treatment interval from diagnostic biopsy was not statistically significant (t = 1.606; P = .112; d = .366). |
| Lobb25
|
Retrospective study that compared patients with breast cancer who received care before (CON) and after (INT) implementation of case management and free treatment policy (FTP) BCCEDP case management program, Massachusetts |
Case managers were required to have current licensure or a national certificate in case management and a bachelor’s degree in health and human services or registered nurse license in Massachusetts. They provided support, education, coordinated care and patient-physician communication, assistance with appointment scheduling, transportation vouchers, and interpreter services and reduced health system barriers. |
|
Initiation of cancer treatment (time from abnormal mammogram to initiation of cancer treatment) |
After the implementation of a case management program, time to treatment initiation from abnormal mammogram was reduced by 12 days, and an additional 3 days after the free treatment policy (57 v 45 v 42 days for CON v INT v FTP, respectively; P = .001). There was also a 39% reduction in the adjusted RR of treatment delay after implementing case management, but the decrease in risk was not statistically significant (RR, 0.61; 95% CI, 0.33 to 1.14). |
| Raj26
|
Retrospective, single-group study that compared patients with breast cancer who received PNP (INT) with previously published data for patients from NCCN centers Massachusetts General Hospital Avon Breast Care Program (Boston, MA) |
PNs were culturally diverse, trained layworkers who provided patient navigation services. |
N = 186 Median age: 58 years (range, 19-93 years) Race/ethnicity: White (32%) Hispanic (28%) Black (16%) Asian/Middle Eastern (4%) Not disclosed (20%) Language: English (57%) Spanish (30%) Health insurance: Private (31%) Medicare (24%) Medicaid (12%) Uninsured (6%) Unknown (23%) |
Treatment adherence rates for receipt of HT, CT, and RT |
INT had comparable treatment adherence rates with NCCN patients: 95% of INT and 89% of NCCN received HT, 88% of INT and 87% of NCCN received CT, and 92% of INT and 95% of NCCN received RT. No statistically significant differences were found between rates. |
| Ramirez27
|
QE; prospective comparison of patients with breast cancer who received usual care (CON) and patients who received PNP (INT) Six community-based health clinics (San Diego, CA; San Francisco, CA; Miami, FL; New York, NY; Houston, TX; San Antonio, TX) |
The PNP was culturally tailored for Latinas with breast cancer and implemented across multiple sites. PNs were bilingual community health workers with at least a high school diploma or a college degree trained to coordinate care and assist Latinas in using cancer care services. They emphasized adherence to diagnostic and treatment plans and overcoming barriers to care and provided health education; emotional support; communication with health care providers; translation services; accompaniment; appointment scheduling; and assistance with transportation, child care, and health insurance issues. Patients were contacted weekly or as needed by telephone and received navigation services at least once a month or as needed. |
N = 109 Age: ≥ 51 years (57.8%) Race/ethnicity: Hispanic (100%) Primary language: Spanish (60.2%) English (39.8%) Health insurance: Uninsured (41.7%) Local government (32.4%) Private (18.5%) Medicare (7.4%) |
Initiation of cancer treatment within 30 or 60 days of diagnosis |
INT was more likely to initiate treatment within 30 days (69% v 46.3% for INT v CON, respectively; P = .029) and 60 days (97.6% v 73.1% for INT v CON, respectively; P = .001) after cancer diagnosis than CON. The average time from cancer diagnosis to first treatment was 48.3 days in CON (95% CI, 35.56 to 61.04 days) and 22.22 days in INT (95% CI, 16.12 to 28.32 days). The overall time to treatment initiation was significantly shorter in INT (HR, 1.60; P < .001). |
| Weber28
|
Retrospective cohort study that compared patients with breast cancer who received treatment before (CON) and after (INT) implementation of a PNP East Carolina University Brody School of Medicine (Greenville, NC) |
PN was a registered nurse; assisted patients in overcoming individual barriers to accessing cancer care; and provided health education, emotional support, and resources for physical and psychosocial support. |
|
Treatment adherence rates for receipt of HT, CT, and RT Adherence to post-treatment surveillance mammography |
No statistically significant differences in treatment adherence rates were found between groups. After implementation of PNP, the percentage of patients who received surveillance mammography within 12 months significantly increased by 27% (53.5% v 80.5% for CON v INT, respectively; P < .001). |
