title: Can patient navigation improve receipt of recommended breast cancer care? Evidence from the National Patient Navigation Research Program.
abstract: OBJECTIVE
  Poor and underserved women face barriers in receiving timely and appropriate breast cancer care. Patient navigators help individuals overcome these barriers, but little is known about whether patient navigation improves quality of care. The purpose of this study is to examine whether navigated women with breast cancer are more likely to receive recommended standard breast cancer care.
  
  
  METHODS
  Women with breast cancer who participated in the national Patient Navigation Research Program were examined to determine whether the care they received included the following: initiation of antiestrogen therapy in patients with hormone receptor-positive breast cancer; initiation of postlumpectomy radiation therapy; and initiation of chemotherapy in women younger than age 70 years with triple-negative tumors more than 1 cm. This is a secondary analysis of a multicenter quasi-experimental study funded by the National Cancer Institute to evaluate patient navigation. Multiple logistic regression was performed to compare differences in receipt of care between navigated and non-navigated participants.
  
  
  RESULTS
  Among participants eligible for antiestrogen therapy, navigated participants (n = 380) had a statistically significant higher likelihood of receiving antiestrogen therapy compared with non-navigated controls (n = 381; odds ratio [OR], 1.73; P = .004) in a multivariable analysis. Among the participants eligible for radiation therapy after lumpectomy, navigated participants (n = 255) were no more likely to receive radiation (OR, 1.42; P = .22) than control participants (n = 297).
  
  
  CONCLUSIONS
  We demonstrate that navigated participants were more likely than non-navigated participants to receive antiestrogen therapy. Future studies are required to determine the full impact patient navigation may have on ensuring that vulnerable populations receive quality care.
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO. naomi.ko@bmc.org.
authors: Naomi Y
authors: NY
authors: Ko
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Julie S
authors: JS
authors: Darnell
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Elizabeth
authors: E
authors: Calhoun
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Karen M
authors: KM
authors: Freund
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Kristin J
authors: KJ
authors: Wells
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Charles L
authors: CL
authors: Shapiro
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Donald J
authors: DJ
authors: Dudley
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Steven R
authors: SR
authors: Patierno
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Kevin
authors: K
authors: Fiscella
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Peter
authors: P
authors: Raich
authors: Naomi Y. Ko and Tracy A. Battaglia, Boston University School of Medicine; Karen M. Freund, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA; Julie S. Darnell and Elizabeth Calhoun, School of Public Health, University of Illinois at Chicago, Chicago, IL; Kristin J. Wells, San Diego State University and Moores Cancer Center, San Diego, CA; Charles L. Shapiro, Ohio State University Comprehensive Cancer Center and Wexner Medical Center, Columbus, OH; Donald J. Dudley, University of Texas Health Science Center, San Antonio, TX; Steven R. Patierno, The George Washington University Cancer Institute, Washington, DC; Steven R. Patierno, Duke Cancer Institute, Durham, NC; Kevin Fiscella, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and Peter Raich, Denver Health and University of Colorado Denver, Denver, CO.
authors: Tracy A
authors: TA
authors: Battaglia
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D011787:Quality of Health Care
chemical_list: D020847:Estrogen Receptor Modulators