title: Cancer treatment adherence among low-income women with breast or gynecologic cancer: a randomized controlled trial of patient navigation.
abstract: BACKGROUND
  The authors implemented a controlled, randomized trial that compared 2 interventions: the provision of written resource navigation information (enhanced usual care [EUC]) versus written information plus patient navigation (TPN) aimed at improving adjuvant treatment adherence and follow-up among 487 low-income, predominantly Hispanic women with breast cancer or gynecologic cancer.
  
  
  METHODS
  Women were randomized to receive either TPN or EUC; and chemotherapy, radiation therapy, hormone therapy, and follow-up were assessed over 12 months. Patients with breast cancer were analyzed separately from patients with gynecologic cancer.
  
  
  RESULTS
  Overall adherence rates ranged from 87% to 94%, and there were no significant differences between the TPN group and the EUC group. Among women with breast cancer, 90% of the EUC group and 88% of the TPN group completed chemotherapy (14% of the EUC group and 26% of the TPN group delayed the completion of chemotherapy), 2% of the EUC group and 4% of the TPN group failed to complete chemotherapy, and 8% of the EUC group and 7% of the TPN group refused chemotherapy. Radiation treatment adherence was similar between the groups: Ninety percent of patients completed radiation (40% of the EUC group and 42% of the TPN group delayed the completion of radiation); in both groups, 2% failed to complete radiation, and 8% refused radiation. Among gynecologic patients, 87% of the EUC group and 94% of the TPN group completed chemotherapy (41% of the EUC group and 31% of the TPN group completed it with delays), 7% of the EUC group and 6% of the TPN group failed to complete chemotherapy, 6% of the EUC refused chemotherapy, 87% of the EUC group and 84% of the TPN group completed radiation (51% of the EUC group and 42% of the TPN with delays), 5% of the EUC group and 8% of the TPN group failed to complete radiation, and 8% of the EUC group and 5% of the TPN group refused radiation.
  
  
  CONCLUSIONS
  Treatment adherence across randomized groups was notably higher than reported in previous studies, suggesting that active telephone patient navigation or written resource informational materials may facilitate adherence among low-income, predominantly Hispanic women. Adherence also may have be facilitated by federal-state breast and cervical cancer treatment funding.
authors: School of Social Work, University of Southern California, Los Angeles, California, USA. ell@usc.edu
authors: Kathleen
authors: K
authors: Ell
authors: Betsy
authors: B
authors: Vourlekis
authors: Bin
authors: B
authors: Xie
authors: Frances R
authors: FR
authors: Nedjat-Haiem
authors: Pey-Jiuan
authors: PJ
authors: Lee
authors: Laila
authors: L
authors: Muderspach
authors: Christy
authors: C
authors: Russell
authors: Lawrence A
authors: LA
authors: Palinkas
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011203:Poverty; D011788:Quality of Life; D016019:Survival Analysis