Cancer Patient Navigation Research Articles

A Cancer Patient Navigation Training Program for Limited-Resource Settings: Results from 5 Years of Training.

Limited research exists on the effectiveness of cancer patient navigation (CPN) in limited-resource countries which are challenging for patients to navigate. The aim of this study was to report on the workflow, resources developed, and outcomes of pilot CPN program developed by the Caribbean Cancer Research Institute (CCRI) in the limited-resource country of Trinidad and Tobago. Three part-time navigators and a part-time program manager were trained in CPN and hired by the CCRI. A network of local service providers, program policies, an electronic medical records system, and informational blog posts were developed to support the pilot. Patients were referred at monthly multi-disciplinary team meetings of the Sangre Grande Hospital. Navigators provided navigation services for a maximum of 10h. Changes in distress before and after navigation were measured using the National Comprehensive Cancer Network distress thermometer and evaluated using a paired t-test. Patient satisfaction with the navigator and the navigation service was evaluated in a post-navigation survey. One hundred and fifty-eight breast, prostate, pancreatic, and colon cancer patients were navigated. There was an average of 14 contacts between patient and navigator with an average of 30min per contact. There were 631 barriers identified of which physical (27%; n = 172), informational (26%; n = 164), and emotional or psychological (25%; n = 158) were the top three most frequently reported. Resolutions were offered for 62% (n = 391) of reported barriers. The CPN intervention resulted in a statistically significant reduction in patient distress overall (- 2.4 [2.07-2.79], < 0.001) and across most patient subgroups. Almost all patients reported high satisfaction with navigation. CPN significantly improved patient distress, and patients reported high satisfaction with navigation in the limited-resource setting of Trinidad and Tobago.

Abstract B066: Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs

Abstract Community-based organizations (CBOs) offer essential health information and support through programming directed toward women at-risk for and surviving with breast/ovarian cancer. This includes services delivered to women of color–who are more likely to have unmet medical and psychosocial needs, and high social determinants of health burdens. Yet, little is known about the effectiveness of CBO’s programs and services on these women’s levels of empowerment (e.g., their perceived control, self-efficacy, knowledge/skills, and coping with cancer risk, treatment, and survivorship) that could impact the outcomes of their cancer care. To study this, we conducted a secondary data analysis among N=124 breast/ovarian cancer survivors identifying as Black and/or Latine participating in CBO-led cancer control activities, and assessed their care satisfaction, quality of life, patient navigation, and empowerment. Patient empowerment was high: most women of color (M age=50, 54% Black, 48% Latine) felt more informed (75%) and confident (75%) in managing their care following program engagement. Care quality was also very high (87%), and perceived as: recommendable to others (94%), helpful (91%), informative (92%), timely (90%), reliable (91%), supportive (91%), and effective (91%). Regarding care satisfaction, these underrepresented women felt supported by abundant resources (93%) and programs (95%), understood (93%), and helped (91%) by the CBOs programs. Regarding quality of life, 69% were in fair/poor health and 24% endorsed frequent mental distress–with an average of 9.1 physically unhealthy days, 9.4 mentally unhealthy days, and 7.8 activity-limited days in the past month. Disparities in empowerment were observed as a function of survivors’ navigation experiences and physical/mental well-being, as empowerment was highest among those who benefited more from patient navigation (r=.58, p&amp;lt;.001), and had poorer quality of life (r=-.44, p&amp;lt;.001). In a multivariable model controlling for satisfaction with CBO-led cancer control, both patient navigation (B=.81, SE=.13, p&amp;lt;.001) and quality of life (B=-.18, SE=.07, p&amp;lt;.005) were associated with survivors’ experience of empowerment: those who rated their patient navigation experience more highly, and those who were more impaired, felt most empowered. Community cancer control empowers Black and Latine breast/ovarian cancer survivors: addressing disparities, through programs such as patient navigation, could enhance their effectiveness, and particularly for those with lower quality of life. Behavioral and Social Science: Socioeconomic Influences Citation Format: Marcelo Sleiman Jr, Dheeraj Oruganty, Adina Fleischmann, Mingqian Liu, Sahana Arumani, Kenneth Tercyak. Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B066.

Abstract B066: Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs

Abstract Community-based organizations (CBOs) offer essential health information and support through programming directed toward women at-risk for and surviving with breast/ovarian cancer. This includes services delivered to women of color–who are more likely to have unmet medical and psychosocial needs, and high social determinants of health burdens. Yet, little is known about the effectiveness of CBO’s programs and services on these women’s levels of empowerment (e.g., their perceived control, self-efficacy, knowledge/skills, and coping with cancer risk, treatment, and survivorship) that could impact the outcomes of their cancer care. To study this, we conducted a secondary data analysis among N=124 breast/ovarian cancer survivors identifying as Black and/or Latine participating in CBO-led cancer control activities, and assessed their care satisfaction, quality of life, patient navigation, and empowerment. Patient empowerment was high: most women of color (M age=50, 54% Black, 48% Latine) felt more informed (75%) and confident (75%) in managing their care following program engagement. Care quality was also very high (87%), and perceived as: recommendable to others (94%), helpful (91%), informative (92%), timely (90%), reliable (91%), supportive (91%), and effective (91%). Regarding care satisfaction, these underrepresented women felt supported by abundant resources (93%) and programs (95%), understood (93%), and helped (91%) by the CBOs programs. Regarding quality of life, 69% were in fair/poor health and 24% endorsed frequent mental distress–with an average of 9.1 physically unhealthy days, 9.4 mentally unhealthy days, and 7.8 activity-limited days in the past month. Disparities in empowerment were observed as a function of survivors’ navigation experiences and physical/mental well-being, as empowerment was highest among those who benefited more from patient navigation (r=.58, p&amp;lt;.001), and had poorer quality of life (r=-.44, p&amp;lt;.001). In a multivariable model controlling for satisfaction with CBO-led cancer control, both patient navigation (B=.81, SE=.13, p&amp;lt;.001) and quality of life (B=-.18, SE=.07, p&amp;lt;.005) were associated with survivors’ experience of empowerment: those who rated their patient navigation experience more highly, and those who were more impaired, felt most empowered. Community cancer control empowers Black and Latine breast/ovarian cancer survivors: addressing disparities, through programs such as patient navigation, could enhance their effectiveness, and particularly for those with lower quality of life. Behavioral and Social Science: Socioeconomic Influences Citation Format: Marcelo Sleiman Jr, Dheeraj Oruganty, Adina Fleischmann, Mingqian Liu, Sahana Arumani, Kenneth Tercyak. Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B066.

Abstract PO3-27-11: Exploring Associations among Breast Cancer Survivor Empowerment, Peer Support, and Patient Navigation: Implications for Community-Based Care Planning

Abstract Background: Women surviving with breast cancer (BC) may utilize peer support and patient navigation to augment their medical care–potentially leading to greater patient empowerment. However, the quality of support and navigation services vary widely among community-based organizations (CBOs) delivering such care, and often due to patients’ psychosocial status and program-specific determinants: outcome studies could inform care planning. Method: We analyzed secondary data from N=733 BC survivors participating in a CBO’s annual evaluation of its patient navigation program, assessing patients’ emotional distress, perceived navigation quality, care satisfaction, peer support, and empowerment. Bivariate associations explored program factors associated with these attributes; those significantly associated were retained in a multivariable model of patient empowerment. Results: Overall, patient empowerment was high as most BC survivors felt more informed (66.4%) and confident (71.2%) in managing their own care. Quality of navigation was also very high (91%) because it was: helpful (92.7%), informative (92.6%), timely (92.2%), effective (88.7%), supportive (91.3%), reliable (91.5%), and recommendable to others (93.9%). Regarding satisfaction, BC survivors felt helped (91.6%), understood (92.0%), and supported by abundant resources (92.8%) and programs (91.2%). Peer support, in particular, was offered to &amp;gt;25% of patients and 85.1% reportedly engaged with their assigned peer supporter. Regarding quality of life, 25.3% were in fair/poor health and 25.6% endorsed frequent mental distress–with an average of 8.3 physically unhealthy days, 8.16 mentally unhealthy days, and 6.71 activity-limited days. Interestingly, disparities in patient engagement were observed as a function of their quality of life: lowest among those with more frequent mental distress (t=-2.13, p&amp;lt; .05), mentally unhealthy days (r=-.083, p&amp;lt; .05), and activity-limited days (r=-.058, p&amp;lt; .05)). These burdens may have influenced survivors’ perceptions of their own empowerment–especially among those without peer support program engagement (t=3.77, p&amp;lt; .001), who downgraded the quality of the navigation services they received (t=.60, p&amp;lt; .01), and were least satisfied with their supportive care (t=.57, p&amp;lt; .01). In a multivariable model of empowerment controlling for frequent mental distress (B=-.318, SE=.144, p&amp;lt; .05), both care satisfaction (B=.194, SE=.019, p&amp;lt; .001) and speaking with a peer supporter (B=.610, SE=.151, p&amp;lt; .005) were positively associated with empowerment. Specifically, those who spoke with a peer and who rated their care satisfaction higher felt more empowered. Conclusion: The CBO’s patient navigation model among &amp;gt;700 respondents was strong and helped BCsurvivors feel more empowered to manage their health needs. The majority of BC survivors were better informed and in control of their futures. Where disparities existed were among those with the lowest CBO satisfaction and who had frequent mental distress. Outreach may strengthen navigation and the delivery of peer support for those with the poorest mental health in order to better empower their BC survivorship. Citation Format: Marcelo Sleiman Jr, Mary Rose Yockel, Adina Fleischmann, Mingqian Liu, Olivia Young, Sahana Arumani, Kenneth Tercyak. Exploring Associations among Breast Cancer Survivor Empowerment, Peer Support, and Patient Navigation: Implications for Community-Based Care Planning [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-11.

Disparities across the continuum of lung cancer care: a review of recent literature.

Lung cancer remains the leading cause of cancer mortality worldwide. Health disparities have long been noted in lung cancer incidence and survival and persist across the continuum of care. Understanding the gaps in care that arise from disparities in lung cancer risk, screening, treatment, and survivorship are essential to guiding efforts to achieve equitable care. Recent literature continues to show that Black people, women, and people who experience socioeconomic disadvantage or live in rural areas experience disparities throughout the spectrum of lung cancer care. Contributing factors include structural racism, lower education level and health literacy, insurance type, healthcare facility accessibility, inhaled carcinogen exposure, and unmet social needs. Promising strategies to improve lung cancer care equity include policy to reduce exposure to tobacco smoke and harmful pollutants, more inclusive lung cancer screening eligibility criteria, improved access and patient navigation in lung cancer screening, diagnosis and treatment, more deliberate offering of appropriate surgical and medical treatments, and improved availability of survivorship and palliative care. Given ongoing disparities in lung cancer care, research to determine best practices for narrowing these gaps and to guide policy change are an essential focus of future lung cancer research.

Expanding Outcomes in Cancer Screening Safety Net Programs: Promoting Sustainability and Policy Reform.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable.

Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.

Adapting, implementing and evaluating a navigation intervention for older people with cancer and their family caregivers in six countries in Europe: the Horizon Europe-funded EU NAVIGATE project.

Navigation interventions could support, educate and empower older people with cancer and/or their family caregivers by addressing barriers and ensuring timely access to needed services and resources throughout the continuum of supportive, palliative and end-of-life care. European Union (EU) NAVIGATE is an interdisciplinary and cross-country Horizon Europe-funded project (2022-2027) aiming to evaluate the effectiveness, cost-effectiveness and implementation of a navigation intervention for older people with cancer and their family caregivers in Europe. EU NAVIGATE aims to advance the evidence on cancer patient navigation in Europe. Adaptation, implementation and evaluation of a navigation intervention with an international pragmatic randomized controlled trial (RCT) and embedded mixed-method process evaluation at its core. A logic model guides dissemination and impact-generating strategies. EU NAVIGATE involves six experienced EU academic partners; one EU national cancer league with their affiliated academic partner; three EU dissemination partners; and a Canadian partner. We adapted the Canadian Navigation: Connecting, Advocating, Resourcing, and Engaging (Nav-CARE©) volunteer programme to healthcare contexts in Belgium, Ireland, Italy, the Netherlands, Poland and Portugal following the new ADAPT guidance. Nav-CARE was developed over the past 15 years and supports people with declining health and their families to improve their quality of life and well-being, foster empowerment and facilitate timely and equitable access to healthcare and social services. In EU NAVIGATE, the navigation intervention is being provided by trained and mentored social workers in Poland and by trained and mentored volunteers in the other five countries. Via a pragmatic RCT with process evaluation, we implement and evaluate the navigation intervention to study its impact on older people with cancer and their family caregivers. We also aim to understand its cost-effectiveness, how to optimally implement it in different countries, and its differential effects in patient subgroups. We will also map existing cancer navigation interventions in Europe, the United States and Canada to position EU NAVIGATE within the field of navigation interventions worldwide. EU NAVIGATE aims to deliver high-quality evidence on a navigation intervention for older people with cancer in Europe and to develop practice and policy recommendations for sustainable implementation of navigation interventions in Europe and beyond.

Adapting a Remotely Delivered Patient Navigation Program for Colorectal Cancer Screening in Primary Care: Important Considerations for Rural Contexts.

Colonoscopy is a critical component of colorectal cancer (CRC) screening and patient navigation (PN) improves colonoscopy completion. A lay navigator remotely providing navigation across rural primary care organizations (PCOs) could increase PN access. In preparation for the Colonoscopy Outreach for Rural Communities (CORC) study, we examined partners' perspectives on contextual factors that could influence CORC program implementation, and adaptations to mitigate potential barriers. We interviewed 29 individuals from 6 partner PCOs and the community-based organization (CBO) delivering the PN program. An analysis approach informed by Miles, Huberman, and Saldana identified critical themes. Results are reported using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). Potential barriers included that rural patients are hard to reach remotely and might mistrust the navigator, and the CBO is unfamiliar with the patient communities and does not have patient care experience or pre-existing communication pathways with the PCOs. Program content and navigator training was adapted to mitigate these challenges. Our study highlights contextual factors to account for before implementing a remote, centralized patient navigation program serving rural communities. Gathering partner perspectives led to intervention adaptations intended to address potential barriers while leaving the core components of the evidence-based intervention intact.

Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention

ObjectiveDespite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for...

Abstract A039: Translating research into practice: Results of a community-engaged, city-wide breast cancer patient navigation implementation study to reduce disparities

Abstract Introduction: Delays in accessing breast cancer care contribute to poor outcomes among women of color and those underinsured. Patient navigation is one of few proven interventions that overcome inequity in cancer care delivery, yet there is a need to address barriers to widespread implementation. Methods: Led by a city-wide coalition of multi-sector stakeholders, we conducted a Type 1 hybrid clinical effectiveness-implementation trial across five hospitals in Boston to test the impact of navigation on timely initiation of breast cancer treatment, while also exploring implementation outcomes including acceptability of and fidelity to an evidence-informed 11-step navigation protocol. A randomized cluster stepped wedge study design allowed for rolling out a multi-level navigation protocol iteratively in real life practices from 2019 through 2022. Hospital cancer registries sourced eligible cancer cases, while electronic medical record abstraction documented timely treatment, defined as within 60 or 90 days depending on the diagnosis. Odds ratios adjusted for time by calendar quarter and accounted for clustering by study site. Fidelity to protocol was measured using navigator documentation of interactions with patients and conducting social needs screenings. Key informant interviews and field observations were conducted to assess acceptability. Results: A total of 1,732 women with newly diagnosed breast cancer were included in the intent to treat analysis (553 historical control period, 1,179 intervention period). By study design, the majority of women were nonwhite (80%) and more than half were non-English speaking and on public health insurance. During the intervention period, 50% (n=587) had no documented evidence of receiving any contact from a navigator, 15% (n=181) had only one documented interaction with the navigator while 35% (n=407) were navigated and received social needs screens in accordance with study protocol. Compared with historical controls, navigated patients who received a social needs screen had twice the odds of receiving timely treatment (aOR 2.06, 95% CI 1.39, 3.06), those who had only one documented interaction with the navigator had 1.4 greater odds of timely treatment (aOR 1.44, 95% CI 1.08, 1.93) and those with no documented evidence of navigation were no more likely to receive timely treatment (aOR 1.42, 95% CI 0.81, 2.48. We found variability in how navigators identified patients, with significant disruption during the COVID pandemic. Navigators found navigation protocols and social needs screening acceptable, and patients reported feeling supported when asked about social needs. The study protocol formalized the navigation process within and across hospitals, yet tension for change in existing workflows and complexity in documentation served as barriers to adoption. Conclusions: Receipt of navigation is associated with more timely care among a diverse group of women at risk for poor outcomes. Despite stakeholder engagement, implementation of evidence-based breast cancer patient navigation remains suboptimal. Citation Format: Tracy A. Battaglia, Karen M. Freund, Jennifer S. Haas, Stephenie C. Lemon, Translating Research Into Practice (TRIP) Consortium. Translating research into practice: Results of a community-engaged, city-wide breast cancer patient navigation implementation study to reduce disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A039.

Abstract A022: Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans

Abstract The Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences (UAMS), Office of Community Outreach and Engagement has developed a Cancer Patient Navigation Program dedicated to improving cancer care for everyone in Arkansas. The team includes nurse navigators and community health workers that help bridge the gap between cancer patients, and financial resources in the community, and health care providers. The Cancer Patient Navigation Program emphasizes patient empowerment through prevention, screening, and treatment for rural and underserved populations across the state. The aim of the program is to help eliminate barriers to health care by providing resources for cancer treatment to rural and underserved populations across Arkansas. Navigators and community health works are located throughout every geographic region of Arkansas and are representative of the diversity in the communities they serve. Navigators and community health workers use the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE®) to identify cancer patients’ barriers to care. PRAPARE® is a standardized patient risk assessment tool consisting of a set of national core measures as well as a process for addressing the social drivers at both the patient and population levels. Since May 2022, the Cancer Patient Navigation program has assessed and addressed the needs of 350 cancer patients. The data collected by navigators and community health workers has improved care coordination services, increased collaborations with local community partners with similar goals, and provided a unique opportunity for UAMS to better understand challenges of cancer patients and provide more appropriate services and care that is needed on a community level. The PRAPRE data has allowed the Office of Community Outreach and Engagement to understand the number of social determinants risks as well as the most common social determinant risks in our patient population. The risk tally score established a baseline to determine who might be more “at risk” by both geographic location and cancer diagnosis. To date, the data collected has been analyzed to track referrals and interventions. The data will further be used to ensure community-engagement priorities and resources are integrated into all Winthrop P. Rockefeller Cancer Institute research cores and clinical enterprises. Addressing the adverse social drivers of health will ultimately allow UAMS to improve patient well-being, facilitate access to prevention, screening, and treatment. Citation Format: Valandra L. German. Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A022.

Stakeholder perspectives on six identified interpersonal communication components of patient navigation in breast cancer care.

Although identified as a key competency domain and a needed area of professional development, interpersonal communication in breast cancer care patient navigation is understudied. Moreover, the patient-navigator relationship may be influenced by the interpersonal communication skills and behaviors of the patient navigator. This paper reports on the interpretation step of a concept mapping study, where key stakeholders shared their perspectives on six identified interpersonal communication components of breast cancer care patient navigation. This study utilized concept mapping, a community-engaged mixed method approach. After conducting brainstorming, sorting, and concept mapping analysis, a six-cluster concept map of interpersonal communication in breast cancer care patient navigation was identified. Interpretation sessions with each participant group (patients, patient navigators, administrators) allowed both naming and more in-depth exploration of the six clusters. The sessions were led by a facilitator, the PI, and were audio recorded and transcribed. Six 2-h interpretation sessions were conducted with 21 participants, including patients with breast cancer, breast cancer patient navigators (lay or medically trained), and patient navigation administrators from Western Pennsylvania. Through a group consensus process, the six clusters were named. Participants identified that all six identified components were essential to patient navigation, but the ability to build patient-centered trust and relationships and maintain professional communication were the most impactful components of the patient-navigator relationship. These findings validate the importance of interpersonal skills and behaviors of patient navigators in breast cancer care. These findings can inform the patient navigation role description, competencies, and the development of curriculum for training and metrics for evaluation.

Optimization of Workup Pathways to Decrease Radiotherapy Wait Times and Improving Patient Experience: A Single Centre Study

Wait-times are challenging for certain radiotherapy (RT) centers, and benchmarking is challenging, given the different standards used. Beyond the standards of referral to consult and consult to treatment, certain centers have established a "ready-to-treat" (RTT) definition to address the reality of patients requiring further investigations from consult to enable a treatment plan. In this single RT center study, a Timely Access and Patient Support (TAPS) model of care has been implemented aiming to improve access to care and, ultimately, patient outcomes. Thiscomparative cohort study was conducted in a single mid-size RT center serving mainly rural communities as part of a larger multi-center academic institution. In collaboration with a Radiation Oncologist (RO), the TAPS clinic is run by a Nurse Practitioner who provides patient assessment and submits requisitions to ensure the patient has support services and is RTT by the time of RO consult. All newly suspected/diagnosed adult cancer patients referred to the center with a triage priority of ≥2 weeks were eligible. Non-metastatic breast and prostate cancers were excluded. Retrospective and prospective data were collected from patient medical records, and descriptive statistical analysis was performed. Pre- and post-TAPS clinic comparison was made for wait times and patient-reported outcomes (PROs) using the Edmonton Symptom Assessment System-revised. During the first 6 months of the study, 66 eligible patients were assessed in the TAPS clinic, prompting 177 orders including referrals (52%) (top 3: social worker 30%, dietitian 20%, and cancer patient navigator 11%), investigations (27%) (top 3: CT 21%, MRI 19%, and biopsy 25%), and interventions (21%). The most common cancers were thoracic (33%), GI (23%) and head and neck (14%). The mean wait time from referral to TAPS consult was 5 days compared to 15 days for pre-TAPS patients to be seen in RO consult. The mean wait time from referral to RTT was 33 days VS 40 days in the post- VS pre-TAPS setting.71% of post-TAPS patients were RTT at RO consult compared with 43% pre-TAPS. Post-TAPS patients reported less fatigue and anxiety and better overall well-being during CT simulation compared to pre-TAPS patients. Preliminary data of TAPS clinic implementation has shown the potential to positively impact RTT times and PROs for psychosocial distress by the time of RT planning. This data also sheds light on the topic of wait time definitions, the investigations required before RTT and the potential role of physician extenders within the health care team to facilitate accelerated workup of malignancies. While TAPS study data will help to inform local cancer care program operations, it is also considered relevant to the broader RT community and professional RT societies addressing standards related to RT access.

15 Development of a student-led cervical cancer patient education and navigation program

15 Development of a student-led cervical cancer patient education and navigation program

Role of verbal autopsy in cancer registration: A mixed-methods study from the population-based cancer registry of Northern India.

To describe utilisation of verbal autopsy as one of the data collection approaches in cancer registration in an Indian setting. We aimed to estimate the proportion and epidemiological characteristics of malignancies identified by the Varanasi population-based cancer registry (PBCR) using verbal autopsy between 2017 and 2019 and to develop a thematic network for implementing verbal autopsy. This was a cross-sectional mixed-methods study. Quantitative methods were applied to analyse information from PBCR proforma of the verbal autopsy-confirmed cancers; qualitative methods were applied to evaluate verbal autopsy conducted by field staff from key informants. In-depth interviews of field staff for the challenges and potential solutions during verbal autopsy were assessed. Of 6466 registered cancers, 1103 (17.1%) were verbal autopsy-confirmed cancers, which had no other source of information. The majority of verbal autopsy cases were from vulnerable populations who were aged >50 years (721, 65.4%), female (607, 55.1%), from rural backgrounds (853, 77.3%), illiterate or just able to read and write (636, 57.7%), and from lower and middle-income groups (823, 74.6%). Verbal autopsy helped provide information about symptoms and site of disease, diagnostic and treatment details, and disease status. Major challenges during verbal autopsy described by field staff were incomplete cancer treatment, destruction of medical records and non-cooperation by the community and lack of support from the local workforce as cancer is not notifiable. Verbal autopsy helped identify cancers that would have been missed during active case finding from available resources. The majority of verbal autopsy-confirmed patients belonged to vulnerable populations. Non-cooperation from community and local health systems was major challenge during verbal autopsy. Developing robust cancer awareness, patient navigation, and social support programmes will strengthen verbal autopsy. Integration of standardised and reproducible methods of verbal autopsy in cancer registry and digitalization of health information, especially in limited-resource settings with weak vital registration, will facilitate completeness in cancer registration.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature.

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.

Derivation of a Unique, Algorithm-Based Approach to Cancer Patient Navigator Workload Management.

Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs. We sought to develop an automated algorithm to fairly distribute new patients among CPNs specializing in the same cancer type(s) and assess its performance through simulation on a retrospective data set. Using a 3-year data set, a proxy for CPN work was identified and multiple models were developed to predict the upcoming week's workload for each patient. An XGBoost-based predictor was retained on the basis of its superior performance. A distribution model was developed to fairly distribute new patients among CPNs within a specialty on the basis of predicted work needed. The predicted work included the week's predicted workload from a CPN's existing patients plus that of newly distributed patients to the CPN. Resulting workload unfairness was compared between predictor-informed and random distribution. Predictor-informed distribution significantly outperformed random distribution for equalizing weekly workloads across CPNs within a specialty. This derivation work demonstrates the feasibility of an automated model to distribute new patients more fairly than random assignment (with unfairness assessed using a workload proxy). Improved workload management may help reduce CPN burnout and improve navigation assistance for patients with cancer.

COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer.

Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.

The Colocation Model in Community Cancer Care: A Description of Patient Clinical and Demographic Attributes and Referral Pathways.

Cancer disparities are well documented among Black, Indigenous, and People of Color, yet little is known about the characteristics of programs that serve these populations. Integrating specialized cancer care services within community settings is important for addressing the needs of historically marginalized populations. Our National Cancer Institute-Designated Cancer Center initiated a clinical outreach program incorporating cancer diagnostic services and patient navigation within a Federally Qualified Health Center (FQHC) to expedite evaluation and resolution of potential cancer diagnoses with the goal of collaboration between oncology specialists and primary care providers in a historically marginalized community in Boston, MA. Sociodemographic and clinical characteristics were analyzed from patients who were referred to the program for cancer-related care between January 2012 and July 2018. The majority of patients self-identified as Black (non-Hispanic) followed by Hispanic (Black and White). Twenty-two percent of patients had a cancer diagnosis. Treatment and surveillance plans were established for those with and without cancer at a median time to diagnostic resolution of 12 and 28 days, respectively. The majority of patients presented with comorbid health conditions. There was a high prevalence of self-reported financial distress among patients seeking care through this program. These findings highlight the wide spectrum of cancer care concerns in historically marginalized communities. This review of the program suggests that integrating cancer evaluation services within community-based primary health care settings offers promise for enhancing the coordination and delivery of cancer diagnostic services among historically marginalized populations and could be a method to address clinical access disparities.