Abstract
Cancer-patient navigators who are oncology nurses support and connect patients to resources throughout the cancer care trajectory, including end of life. Although qualitative and cohort studies of navigated patients have been reported, no population-based studies were found. The present population-based study compared demographic, disease, and outcome characteristics for decedents who had been diagnosed with cancer by whether they did or did not see a navigator. This retrospective study used patient-based administrative data in Nova Scotia (cancer registry, death certificates, navigation visits) to generate descriptive statistics. The study population included all adults diagnosed with cancer who died during 2011-2014 of a cancer or non-cancer cause of death. Of the 7694 study decedents, 74.9% had died of cancer. Of those individuals, 40% had seen a navigator at some point in their disease trajectory. The comparable percentage for those who did not die of cancer was 11.9%. Decedents at the oldest ages had the lowest navigation rates. Navigation rates, time from diagnosis to death, and time from last navigation visit to death varied by disease site. This population-based study of cancer-patient navigation enrolees compared with non-enrolees is the first of its kind. Most findings were consistent with expectations. However, we do not know whether the rates of navigation are consistent with the navigation needs of the population diagnosed with cancer. Because more people are living longer with cancer and because the population is aging, ongoing surveillance of who requires and who is using navigation services is warranted.
Highlights
This population-based study of cancer-patient navigation enrolees compared with non-enrolees is the first of its kind
Patient navigation was introduced by Freeman and Rodriguez in New York in 1990 when Freeman noticed that poverty was associated with diminished access to health care, leading to worse cancer outcomes
Most of the research into cancer-patient navigation over past decades has focused on screening and diagnosis[4,5], role clarity, improvement in quality of life, delivery of health and social services, and management of health needs[6,7]
Summary
Patient navigation was introduced by Freeman and Rodriguez in New York in 1990 when Freeman noticed that poverty was associated with diminished access to health care, leading to worse cancer outcomes. The scope of navigation expanded to include the entire cancer trajectory from “prevention, detection, diagnosis, treatment, and survivorship to the end of life”[1]. Cancer patients find it challenging to navigate through complex health care systems and are often lost at transitions[2]. A number of qualitative[7] and intervention or disease cohort studies, including randomized trials[8], have been carried out, but we found no population-based studies that identify the individuals who are and are not using navigation. Cancer-patient navigators who are oncology nurses support and connect patients to resources throughout the cancer care trajectory, including end of life. The present population-based study compared demographic, disease, and outcome characteristics for decedents who had been diagnosed with cancer by whether they did or did not see a navigator
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