Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays.
This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included.
Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0. 85; P = . 02). Renters (HR, 0. 81; P = . 02) and those with other (ie, unstable) housing (HR, 0. 60; P < . 001) had delays in comparison with homeowners. Never married (HR, 0. 70; P < . 001) and previously married participants (HR, 0. 85; P = . 03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm.
Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015. © 2015 American Cancer Society.
Cancer. 2015 Sep 08 [Epub ahead of print]
Angie Mae Rodday, Susan K Parsons, Frederick Snyder, Melissa A Simon, Adana A M Llanos, Victoria Warren-Mears, Donald Dudley, Ji-Hyun Lee, Steven R Patierno, Talar W Markossian, Mechelle Sanders, Elizabeth M Whitley, Karen M Freund
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. , Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. , NOVA Research Company, Silver Spring, Maryland. , Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. , Rutgers School of Public Health, Piscataway, New Jersey. , Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, Oregon. , Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. , Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico. , George Washington University Cancer Institute, Washington, DC. , Public Health Sciences, Loyola University Chicago, Chicago, Illinois. , Department of Family Medicine, Department of Public Health Sciences, University of Rochester, Rochester, New York. , Colorado Department of Public Health and Environment, Denver, Colorado. , Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.