From the Journals

Systematic review: Patient navigation programs improve outcomes, have financial benefits


 

FROM CANCER

Patient navigation programs improve outcomes across the cancer care continuum and have financial benefits, finds a systematic review.

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The study, which was published in Cancer (2019 Apr 29. doi: 10.1002/cncr.32147) also found methodologic limitations and gaps in the research regarding cancer sites and steps in care, highlighting areas needing more focus.

The patient navigation model, introduced in 1990 to address poverty-related disparities in cancer care (Cancer. 2011;117(15 Suppl):3539-42), is now widely used in chronic illness management and has support from legislation as well as public and private funding. However, a 2011 review of patient navigation programs used in cancer care identified only 33 articles assessing impact and yielded mixed results, suggesting improvement in some out-comes but not others (CA Cancer J Clin. 2011;61:237-49), and there has been scant research on their cost-effectiveness.

Investigators led by Brittany M. Bernardo, MPH, Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, searched PubMed and EMBASE databases for studies investigating the efficacy and cost-effectiveness of patient navigation across the cancer continuum, with aims of summarizing their results, assessing quality, determining gaps, and identifying avenues for future research.

Ultimately, the investigators included 113 articles published between August 1, 2010, and February 1, 2018. A total of 14 reported on the cost-effectiveness of patient navigation programs.

Results reported in Cancer showed that the largest share of the articles focused on the effectiveness of patient navigation in screening (50%) and diagnosis (27%), while few focused on treatment (15%), survivorship (9%), clinical trial enrollment (2 articles), and prevention (1 article). With respect to cancer site, the majority of programs pertained to breast cancer (52%) and colorectal cancer (51%).

Overall, studies reported patient navigation programs had positive outcomes. For example, they improved uptake of and adherence to cancer screenings, timely diagnostic resolution and follow-up, completion rates for cancer therapy, and rates of attending medical appointments.

The 14 studies focusing on cost-effectiveness suggested that patient navigation programs had financial benefits as well. Two found that the programs generated net revenue for clinics and hospitals. Programs additionally reduced medical treatment costs, improved life expectancy and quality-adjusted life-years, and decreased health care use.

When the quality of studies was assessed with the Quality Assessment Tool for Quantitative Studies, just 5% had strong methodology (having no weak components) and 30% had moderate methodology (having 1 weak component), while 65% had weak methodology (greater than or equal to 2 weak components).

“[Patient navigation] continues to be an effective method for overcoming barriers to care and should be integrated into more health care systems,” Ms. Bernardo and coinvestigators concluded. “With the encouraging results of this review and past reviews, it is hoped that new research will be conducted to fill in the remaining gaps and further elucidate the benefits of [patient navigation] in health care.”

One investigator disclosed having grant funding from the Merck Foundation and being a stockholder in Pfizer and a member of the American Cancer Society Patient Navigation Round Table; the other investigators made no disclosures. The study was supported by the Susan G. Komen Foundation and the Bradley Charles Cooper Foundation.

SOURCE: Bernardo BM et al. Cancer. 2019 Apr 29. doi: 10.1002/cncr.32147.

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