Patient Navigation After Diagnosis Reduces Treatment Interruptions

Patient navigation decreased treatment interruptions among Am - erican Indian patients receiving radiation treatment (RT) with curative intent in a recent study conducted at the Rapid City Regional Hospital Cancer Care Institute in South Dakota. The study also found a high rate of clinical trial participation among its patients. Similar patients who underwent treatment between 1991 and 2004 and did not receive navigation services acted as controls.

The importance of these findings are magnified when you take into account that treatment interruptions during curative RT have been shown to affect patient outcomes negatively (McCloskey SA, et al. Am J Clin Oncol. 2009;32:587-591). Known disparities in care for this population as well as high cancer mortality rates (Espey DK, et al. Cancer. 2007; 110:2119-2152) and low clinical trial enrollment rates (Murthy VH, et al. JAMA. 2004;291:2720-2726) among American Indians further amplify the significance of these results.

The Intervention

Building on knowledge from a previous review, the investigators designed a culturally tailored patient navigation program that followed American Indian patients from diagnosis through follow-up after cancer treatment completion. “There was an intense focus on trying to understand what the barriers were for people. The navigators were either members of the community or closely tied to the community,” lead investigator B. Ashleigh Guadagnolo tells the Academy of Oncology Nurse Navi gators. “They paid intensive attention to each patient’s treatment course, with an eye toward culturalspecific understanding of the healthcare experience for the patients they were serving.”

For this population the intervention focused on many aspects of a patient’s experience of cancer care including but not limited to logistical and financial barriers, and understanding the “social stigma around cancer diagnosis and treatment.” In addition, navigators focused on the socioeconomic barriers for this population that “is among one of the most economically disadvantaged in the country; and they live very far from this or any other cancer treatment center,” says Guadagnolo. Pine Ridge Reservation, home to most of the patients, is a 2-hour drive from the cancer institute, making transportation and housing main barriers to care. “The navigators sometimes gave gas money, sometimes meal money, and helped patients arrange lodging if they needed it, calling hotels or arranging other lodging,” she explains.

Patients were either recruited into the program by a community program staff member, by their treating physician or oncology nurse, or self-referred. Initially, most patients were referred for financial assistance or logistical support, as well as for cancer education or advocacy. After the first visit with the navigator, however, patients’ needs shifted. “The financial assistance needs to be pretty consistent because it was hard for people to come [for their treatment], but they needed less education about cancer as they progressed through their treatment course and advocacy and more psychosocial support,” says Guadagnolo.

The navigation efforts also led to higher rates of clinical trial participation. Guadagnolo attributes this to education. “This is a population that has very hardearned reasons to be wary of research, and the navigators were able to explain things very intensively and answer questions. And also each navigator was assigned to make sure that patients were offered a clinical trial, which often was as simple as making sure a doctor assess if they are eligible.”

This program, initially funded through a National Cancer Institute cancer disparities research grant, is now faced with finding hard funding for the future. “The challenge for us is to show that navigation is actually effective and, hopefully, to eventually get payers to reimburse for this service. That is not standard yet.”

The complete study is published in the June 15, 2011, issue of Cancer. In addition, details of the program’s development are available in Cancer Control (Petereit DG, et al. 2008; 15:254-259)