title: Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening.
abstract: Whether patient navigation improves outcomes for patients with comorbidities is unknown. The aims of this study were to determine the effect of comorbidities on the time to diagnostic resolution after an abnormal cancer screening test and to examine whether patient navigation improves the timeliness and likelihood of diagnostic resolution for patients with comorbidities in comparison with no navigation.
  
  
  
  A secondary analysis of comorbidity data collected by Patient Navigation Research Program sites using the Charlson Comorbidity Index (CCI) was conducted. The participants were 6,349 patients with abnormal breast, cervical, colon, or prostate cancer screening tests between 2007 and 2011. The intervention was patient navigation or usual care. The CCI data were highly skewed across projects and cancer sites, and the CCI scores were categorized as 0 (CCI score of 0 or no comorbidities identified; 76% of cases); 1 (CCI score of 1; 16% of cases), or 2 (CCI score ≥ 2; 8% of cases). Separate adjusted hazard ratios for each site and cancer type were obtained, and then they were pooled with a meta-analysis random effects methodology.
  
  
  
  Patients with a CCI score ≥ 2 had delayed diagnostic resolution after an abnormal cancer screening test in comparison with those with no comorbidities. Patient navigation reduced delays in diagnostic resolution, with the greatest benefits seen for those with a CCI score ≥ 2.
  
  
  
  Persons with a CCI score ≥ 2 experienced significant delays in timely diagnostic care in comparison with patients without comorbidities. Patient navigation was effective in reducing delays in diagnostic resolution among those with CCI scores > 1. Cancer 2017;123:312-318. © 2016 American Cancer Society.
authors.affiliation: Prevention Services Division, Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Whitley
authors.affiliation: Denver Health, Denver, Colorado.|University of Colorado Denver, Aurora, Colorado.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Raich
authors.affiliation: Cancer Therapy and Research Center, University of Texas Health Science Center, San Antonio, Texas.|University of Virginia, Charlottesville, Virginia.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Dudley
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
authors.affiliation: Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University, Columbus, Ohio.|Division of Epidemiology, Ohio State University, Columbus, Ohio.|Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.
authors.forename: Electra D
authors.identifier: 0000-0002-8247-8299
authors.initials: ED
authors.lastname: Paskett
authors.affiliation: George Washington Cancer Institute, Washington, DC.|Duke Cancer Institute, Durham, North Carolina.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Patierno
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.|Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Melissa
authors.initials: M
authors.lastname: Simon
authors.affiliation: Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: Clinical Research Services, NOVA Research Company, Bethesda, Maryland.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Snyder
mesh_terms: D000328:Adult; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D062526:Patient Navigation / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D013997:Time Factors
keywords: cancer screening; comorbidity; patient navigation