The impact of patient navigation on receipt of quality breast cancer treatment in the national patient navigation research program.

Abstract

72 Background: The discrepancy in breast cancer outcomes for underserved populations has been linked to lack of receipt of quality treatment. Patient navigation programs are being rapidly adopted as a model to improve cancer outcomes for these vulnerable populations, yet the effect of navigation on their quality of cancer care is unknown. Methods: We conducted a secondary analysis of the National Patient Navigation Research Program (PNRP) data to assess the impact of navigation on receipt of quality care among women diagnosed with breast cancer. Data pooled from 7 PRNP sites were used to determine the proportion of newly diagnosed cancer patients whose care met National Comprehensive Cancer Network (NCCN) quality metrics: 1) hormonal therapy for HR+ patients 2) post-lumpectomy radiation therapy; and 3) chemotherapy for hormone negative, >1cm tumors, in patients <70 years of age. Chi-square tests were performed to compare probability of receiving recommended care among navigated and control patients. Results: A total of 1,006 breast cancer patients eligible for treatment were enrolled across all sites: 491 (49%) in the intervention arm, 515 (51%) in the control arm (mean age: 56 years; 38% African American, 23% Hispanic; 13% uninsured and 38% Medicaid). Among those eligible for hormone therapy, 283/357 (79%) navigated patients received hormonal therapy compared to 237/371 (64%) of controls (p < 0.001). Among those eligible for radiation therapy post lumpectomy, 235/277 (85%) of navigated patients received radiation compared to 270/324 (83%) of controls (p=0.62). Among those eligible for chemotherapy, 79/122 (65%) of navigated patients received chemotherapy compared to 81/100 (81%) of controls (p < 0.007). Logistic regression models to determine the odds of receiving recommended care for navigated and non-navigated patients, adjusting for patient demographics, will be conducted. Conclusions: Navigation had a positive effect for receipt of hormonal therapy, but not for radiation therapy and chemotherapy. Future studies are needed to assess the role navigation may play in ensuring quality care for the most vulnerable.