Navigation programs aimed at breast and colorectal cancer patients could provide an enduring link to the healthcare system while boosting screening rates—but the added expenses of such a program mean clinicians will likely need to gear that care toward a select few, research published in the Journal of the American College of Radiology suggests.
Cancer screening and early detection has come a long way, but a hefty fraction of patients still present to the hospital with advanced disease, first author Chishanae D. Neal, BA, and colleagues said. Despite federal efforts to increase healthcare coverage and provide care to all Americans, those patients typically have a low income and little to no insurance. The highest-risk individuals tend to be racial and ethnic minorities and speak limited English—criteria that account for 25 million residents alone.
“Underrepresented minorities and individuals with lower socioeconomic status typically experience worse cancer outcomes relative to their white or more financially advantaged counterparts,” Neal and co-authors wrote. “The objective of patient navigation is to improve equity in care by improving access to, and the timeliness of, healthcare for patients in need.”
Neal et al. said the focus of patient navigation lies in overcoming personal, logistical and systematic barriers to care, with typical navigator duties of health education, appointment scheduling and reminders, transportation coordination and language interpretation.
“What sets navigation programs apart from other community-based outreach programs or interventions is that they are operationally centered within the healthcare system rather than within the community,” the authors said. “In this way, navigation programs act as a liaison between the patient and the healthcare system and offer a more durable solution to real-time barriers that present and evolve over the course of patient care.”
The team evaluated several patient navigation systems for their study, noting what was viable and what didn’t work. One of the first things that was apparent to them? The fact that patient navigation does work.
The first navigation program in the U.S., which was piloted in 1990, targeted low-income women in New York and resulted in a 31 percent increase in the five-year survival rate for black women diagnosed with cancer. The adjustments were simple, Neal and co-authors wrote, and included improving access to screening and decreasing delays in care.
Other trials have seen similar successes, the authors said, but few studies have analyzed the cost-effectiveness of navigation programs. And quantifying resource burden and implementing these programs can be pricey—especially since Neal and colleagues said it’s crucial to tailor the programs to specific geographical and socioeconomic areas.
“Not all navigation efforts have the same impact,” the authors said. “Certain forms work better for certain patient populations, so it is important to understand patients’ needs before instituting navigation services.”
Navigation might come with a higher price tag, they said, but if resources are targeted to specific groups in the most need—like minorities and patients without health coverage—the programs might be more cost-effective.
“In the future, in our opinion, greater sharing of the details of navigation programs’ implementation challenges, failures and cost-effectiveness, both within and outside of imaging and cancer screening communities, will be imperative for their success,” Neal and colleagues wrote.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.