Navigating veterans with an abnormal prostate cancer screening test: a quasi-experimental study.
BACKGROUND
Prostate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen.


METHODS
Participants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated (n = 245) versus control (n = 245) participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score.


RESULTS
Of 490 participants, 68% were African American, 47% were ≥ 65 years old, and 35% had cancer. Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to controls (median days of 97 versus 111; adj. HR 1.17, 95% CI, 0.96-1.43, p = 0.12). On analysis of the period beyond 80 days, navigated men reached resolution faster than controls (median of 151 days versus 190 days; adj. HR 1.41, 95% CI, 1.07-1.86, p = 0.01). Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to controls (median of 93 days versus 87 days; adj. HR 1.15, 95% CI, 0.82-1.62, p = 0.41).


CONCLUSIONS
Our navigation program did not significantly impact the overall time to resolution or treatment for men with prostate cancer compared to controls. The utility of navigation programs may extend beyond targeted navigation times, however, and future studies focusing on other outcomes measures are therefore needed.
Robert H, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA. m-simon2@northwestern.edu.
Melissa A
MA
Simon
Narissa J
NJ
Nonzee
June M
JM
McKoy
Dachao
D
Liu
Thanh Ha
TH
Luu
Peter
P
Byer
Elizabeth A
EA
Eklund
Elizabeth A
EA
Richey
Zhigang
Z
Wu
XinQi
X
Dong
Alfred W
AW
Rademaker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012947:Social Work / Q000379:methods; D013997:Time Factors; D014481:United States; D014728:Veterans
D017430:Prostate-Specific Antigen