Impact of patient navigation in eliminating economic disparities in cancer care.
BACKGROUND
Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays.


METHODS
This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included.


RESULTS
Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P = .02). Renters (HR, 0.81; P = .02) and those with other (ie, unstable) housing (HR, 0.60; P < .001) had delays in comparison with homeowners. Never married (HR, 0.70; P < .001) and previously married participants (HR, 0.85; P = .03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm.


CONCLUSIONS
Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
Angie Mae
AM
Rodday
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
Susan K
SK
Parsons
NOVA Research Company, Silver Spring, Maryland.
Frederick
F
Snyder
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
Melissa A
MA
Simon
Rutgers School of Public Health, Piscataway, New Jersey.|Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
Adana A M
AA
Llanos
Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, Oregon.
Victoria
V
Warren-Mears
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Donald
D
Dudley
Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.|University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.
Ji-Hyun
JH
Lee
George Washington University Cancer Institute, Washington, DC.|Duke Cancer Institute, Durham, North Carolina.
Steven R
SR
Patierno
Public Health Sciences, Loyola University Chicago, Chicago, Illinois.
Talar W
TW
Markossian
Department of Family Medicine, Department of Public Health Sciences, University of Rochester, Rochester, New York.
Mechelle
M
Sanders
Colorado Department of Public Health and Environment, Denver, Colorado.
Elizabeth M
EM
Whitley
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
Karen M
KM
Freund
D000328:Adult; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D062526:Patient Navigation; D016016:Proportional Hazards Models; D012923:Social Class
breast neoplasms; colonic neoplasms; early detection of cancer; health care disparities; patient navigation; prostatic neoplasms; uterine cervical neoplasms