title: Beneficial effects of a combined navigator/promotora approach for Hispanic women diagnosed with breast abnormalities.
abstract: BACKGROUND
  Patient navigation (PN) is an emerging strategy to overcome barriers to cancer care. We evaluated the efficacy of PN in improving time of key events in cancer care, including positive screening tests, definitive diagnosis, initiation of therapy, and completion of initial therapy.
  
  
  METHODS
  We evaluated PN in a prospective observational study of predominantly poor Hispanic women with an abnormal breast cancer screening or untreated biopsy proven breast cancer (control = 200, intervention = 260). Controls were contemporary record-based patients with positive screening. Analyses were conducted for the entire cohort and separately by ethnic strata. We used χ(2) tests to compare differences in proportions and Kaplan-Meier followed by Cox regression to compare time-to-event curves of the intervention and control groups.
  
  
  RESULTS
  The average days from definitive diagnosis to initiation of therapy was significantly reduced overall with PN (PN vs. control, 57 vs. 74 days, P = 0.04). This effect was more pronounced in the Hispanic strata (56 vs. 81 days, P = 0.02). More navigated Hispanic women were diagnosed within 60 days of abnormal screening (62.6% vs. 47.5%, P < 0.01) and more began treatment within 60 days of diagnosis (80% vs. 56.3%, P < 0.01). Navigated Hispanic and other ethnic minority women had a shorter time from positive screening test to definitive diagnosis (16 and 32 days, respectively).
  
  
  CONCLUSIONS
  Minority women may have benefited from navigation with shorter times from definitive diagnosis to initiation of therapy.
  
  
  CONCLUSIONS
  PN intervention may show promise in decreasing some delays that contribute to health disparities among minority women with breast cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA. dudleyd@uthscsa.edu
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Dudley
authors.forename: Joan
authors.initials: J
authors.lastname: Drake
authors.forename: Jennifer
authors.initials: J
authors.lastname: Quinlan
authors.forename: Alan
authors.initials: A
authors.lastname: Holden
authors.forename: Pam
authors.initials: P
authors.lastname: Saegert
authors.forename: Anand
authors.initials: A
authors.lastname: Karnad
authors.forename: Amelie
authors.initials: A
authors.lastname: Ramirez
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D062526:Patient Navigation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013997:Time Factors