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Ver Hoeve ES, Calhoun E, Hernandez M, High E, Armin JS, Ali-Akbarian L, Frithsen M, Andrews W, Hamann HA. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res 2024; 24:550. [PMID: 38685006 PMCID: PMC11059763 DOI: 10.1186/s12913-024-10919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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Affiliation(s)
| | | | | | | | | | | | - Michael Frithsen
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Wendy Andrews
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
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2
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Barker CS, Chung CW, Mukherjee R, Siegel JB, Cole DJ, Lockett MA, Klauber-DeMore N, Abbott AM. The impact of nurse navigation on timeliness to treatment for benign high-risk breast pathology. Breast Cancer Res Treat 2023; 202:129-137. [PMID: 37584883 DOI: 10.1007/s10549-023-07049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/13/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE High-risk breast pathology is a breast cancer risk factor for which timely treatment is crucial. Nurse navigation programs have been implemented to minimize delays in patient care. This study evaluated nurse navigation in terms of timeliness to surgery for patients with high-risk breast pathology. METHODS This was a single-institution, retrospective review of patients with identified high-risk breast pathology undergoing lumpectomy between January 2017 and June 2019. Patients were stratified into cohorts based on periods with and without nurse navigation. Preoperative and postoperative time to care as well as demographic and tumor characteristics were compared using univariate and multivariate analysis. RESULTS 100 patients had assigned nurse navigators and 29 patients did not. Nurse navigation was associated with reduced time from referral to date of surgery (DOS) by 16.9 days (p = 0.003). Patients > 75 years had a shorter time to first appointment (p = 0.03), and patients with Medicare insurance had a reduced time from referral to DOS (p = 0.005). 20% of all patients were upstaged to cancer on final surgical pathology. CONCLUSION Nurse navigation was significantly associated with decreased time to care for patients with high-risk breast pathology undergoing lumpectomy. We recommend nurse navigation programs as part of a comprehensive approach for patients with high-risk breast pathology.
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Affiliation(s)
- Catherine S Barker
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine W Chung
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rupak Mukherjee
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - David J Cole
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mark A Lockett
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nancy Klauber-DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea M Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Rives TA, Pavlik H, Li N, Qasrawi L, Yan D, Pickarski J, Dietrich CS, Miller RW, Ueland FR, Kolesar JM. Implementation of Nurse Navigation Improves Rate of Molecular Tumor Testing for Ovarian Cancer in a Gynecologic Oncology Practice. Cancers (Basel) 2023; 15:3192. [PMID: 37370804 DOI: 10.3390/cancers15123192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the impact of implementing a Nurse Navigator (NN) to improve the rate and timeliness of molecular tumor testing. METHODS This is an evaluation of the impact of education sessions, consensus building, and NN implementation for molecular tumor testing in patients with epithelial ovarian cancer. The NNs' responsibilities included attending tumor boards and ensuring Next Generation Sequencing (NGS) is ordered, reviewed, and coordinated for appropriate patients. RESULTS NNs significantly improved NGS testing rates from 35.29% to 77.27%, p = 0.002. Ordering a targeted panel test (TPT) was the most common reason for not ordering NGS in the pre-NN cohort (13/22, 59%). The total turnaround time for testing was reduced after the introduction of NNs from 145.2 days to 42.8 days, p < 0.0001. The post-NN group had a significantly higher rate of actionable mutations identified for the recurrent setting [67.6% versus 20.8% (p = 0.0005)] and a trend towards a higher rate of actionable mutations identified in the frontline setting [41.2% versus 33.3% (p = 0.41)]. CONCLUSION NNs significantly improved somatic tumor testing rates and timeliness for patients with ovarian cancer. Discontinuing TPT in favor of NGS revealed a higher rate of actionable tumor mutations that would have been missed with TPT alone.
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Affiliation(s)
- Taylor A Rives
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Heather Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Ning Li
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Lien Qasrawi
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Donglin Yan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Justine Pickarski
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Charles S Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Jill M Kolesar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
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Salmi LR, Roberts T, Renaud T, Buffeteau S, Cueille S, Fourneyron E, Gaillard A, Abraham M, Arditi N, Castry M, Daniel F, N'gom NF, Guéry O, L'Horty Y, Pincemail S, Purgues S, Thiessard F, Ramel V, Langlois E, Saillour-Glénisson F, Sibé M, Wittwer J. An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design. J Health Serv Res Policy 2022; 27:122-132. [DOI: 10.1177/13558196211065704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Health information technology (HIT) can help coordinate health and social actors involved in patients’ pathways. We assess five regional HIT-based programmes (‘ Territoires de Soins Numériques’ or TSN) introduced in France, covering the period 2012–2018. Methods This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. Results TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. Conclusions If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.
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Affiliation(s)
- Louis-Rachid Salmi
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Tamara Roberts
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Thomas Renaud
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Sophie Buffeteau
- Fédération nationale des observatoires de la santé, Paris, France
| | | | - Emmanuelle Fourneyron
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Aurélie Gaillard
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Maelys Abraham
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Nora Arditi
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Mathieu Castry
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Fabien Daniel
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - N'deye Fatou N'gom
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Orlane Guéry
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Yannick L'Horty
- Fédération nationale des observatoires de la santé, Paris, France
| | - Stéphane Pincemail
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Sonia Purgues
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Franz Thiessard
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Viviane Ramel
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Emmanuel Langlois
- Univ. Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, Bordeaux, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Matthieu Sibé
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Jérôme Wittwer
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors Influencing the Implementation of Patient Navigation Programs for Adults with Complex Needs: A Scoping Review of the Literature. Health Serv Insights 2021; 14:11786329211033267. [PMID: 34349519 PMCID: PMC8287353 DOI: 10.1177/11786329211033267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Patient navigation is a model of care that aims to improve access to care by reducing the complexity of navigating health, education, and social services across the continuum of care and care settings. Little is known about the processes that facilitate or impede the implementation of patient navigation programs (PNPs). We conducted a scoping review to identify and summarize the current state of knowledge regarding the implementation and outcomes of existing implemented PNPs. We employed a 6-stage scoping review framework to identify and review eligible articles. Sixty-articles met the inclusion criteria (58 peer-reviewed and 2 grey literature). The Consolidated Framework for Implementation Research served as the theoretical framework during analysis to help extract factors relevant to implementation of navigator programs. Results of the scoping review are reported thematically. Influences on implementation were identified: (a) planning to ensure alignment with organizational need (b) funding (c) multidisciplinary engagement (d) establishing workflow (e) mechanisms for communication (f) stakeholders to encourage buy-in (g) appropriate caseload (h) in kind resources. PNPs improve the experiences of patients and families. The findings of this scoping review provides implementation considerations of PNPs across global care settings. Strategies for overcoming pragmatic and logistical issues must be developed for optimal implementation.
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Affiliation(s)
- Kristina M Kokorelias
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Jessica E Shiers-Hanley
- Hazel McCallion Academic Learning
Centre, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| | - Jorge Rios
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Amanda Knoepfli
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
- SPRINT Senior Care, Toronto, ON,
Canada
| | - Sander L Hitzig
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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7
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Sjövall A, Söderqvist L, Martling A, Buchli C. Improvement of the experience of colorectal cancer patients in Sweden with a regional cancer plan. Colorectal Dis 2020; 22:1965-1973. [PMID: 32737954 PMCID: PMC7818195 DOI: 10.1111/codi.15289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The Stockholm-Gotland Regional Cancer Plan was launched in 2012 to improve cancer care. A personal contact nurse (CN), an individual written care plan (IWCP) and a standardized care pathway (SCP) were introduced. The aim of the current study was to evaluate whether these efforts have resulted in an improved experience for patients treated for colorectal cancer. METHOD Patients treated with bowel resection for colorectal cancer in the Stockholm-Gotland region between 1 January 2013 and 31 December 2017 were identified through the Swedish Colorectal Cancer Registry. Six to eight months postoperatively, the patients received a patient-reported experience questionnaire. Patients were classified as 'satisfied' or 'not satisfied'. RESULTS The questionnaire was sent to 4465 patients, and 3154 (70.64%) responded. The proportion of patients assigned a CN increased over time (79.84%-88.44%) and so did the proportion of patients receiving an IWCP (39.36%-70.00%). The waiting times were significantly shortened during the study period. In multivariable analysis, access to a CN and an IWCP was independently associated with increased patient satisfaction (OR 3.03, 95% CI 2.28-4.02 and OR 1.64, 95% CI 1.38-1.94). Patients with a long waiting time were significantly less satisfied than patients with a short waiting time (OR 0.72, 95% CI 0.60-0.88). CONCLUSION Implementation of a CN, IWCP and SCP has been successful, measured by a higher proportion of patients gaining access to these assets and shortened waiting times. This has led to an improved patient experience in patients treated for colorectal cancer in the Stockholm-Gotland region.
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Affiliation(s)
- A. Sjövall
- Division of ColoproctologyDepartment of Pelvic CancerKarolinska University HospitalStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden,Regional Cancer Centre Stockholm‐GotlandStockholmSweden
| | | | - A. Martling
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - C. Buchli
- Division of ColoproctologyDepartment of Pelvic CancerKarolinska University HospitalStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
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8
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Angarita FA, Zhang Y, Elmi M, Look Hong NJ. Older women's experience with breast cancer treatment: A systematic review of qualitative literature. Breast 2020; 54:293-302. [PMID: 33242756 PMCID: PMC7695983 DOI: 10.1016/j.breast.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background The experience of older women during breast cancer treatment is insufficiently described by quantitative studies. This study aimed to systematically review qualitative data describing factors that influence older women’s (≥65 years old) experience with breast cancer treatment. Methods A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) principles. MEDLINE, CINAHL, PsycINFO, and EMBASE were searched (inception – 2020). Quality assessment of essential item reporting was performed using the Standards for Reporting Qualitative Research (SRQR) criteria. Common ideas were coded, thematically organized, and synthesized within a theoretical framework. Results Of 7,773 studies identified, twelve were included. The median SRQR score was 13.4 (range 11.3–15.9) (maximum score: 21). Data synthesis revealed that older women experienced breast cancer as a journey with challenges during each phase. During diagnosis, they delayed seeking medical help despite symptoms. Age and experience gave them perspective on the impact of their diagnosis. During decision-making, preconceptions and personal values determined choices. In the treatment phase, women experienced medical and social barriers to care. During the post-treatment phase, many experienced treatment adverse effects, but could move on or compartmentalize as coping mechanisms. Conclusion Older women with breast cancer have unique challenges specific to each phase of their treatment journey. Older women may benefit from proactive treatment discussions with health care providers to address their specific needs, individualize care, and assist with cancer care navigation. Older women have challenges specific to each phase of their treatment journey. Older women experience barriers to care and depended on their social network. Older women could conceptually move on or compartmentalize as coping mechanisms. Physicians should be aware of the unique features of each treatment phase.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - Yimeng Zhang
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Maryam Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada; Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada.
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9
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Español AJ, Salem A, Di Bari M, Cristofaro I, Sanchez Y, Tata AM, Sales ME. The metronomic combination of paclitaxel with cholinergic agonists inhibits triple negative breast tumor progression. Participation of M2 receptor subtype. PLoS One 2020; 15:e0226450. [PMID: 32911509 PMCID: PMC7482849 DOI: 10.1371/journal.pone.0226450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/18/2020] [Indexed: 12/15/2022] Open
Abstract
Triple negative tumors are more aggressive than other breast cancer subtypes and there is a lack of specific therapeutic targets on them. Since muscarinic receptors have been linked to tumor progression, we investigated the effect of metronomic therapy employing a traditional anti-cancer drug, paclitaxel plus muscarinic agonists at low doses on this type of tumor. We observed that MDA-MB231 tumor cells express muscarinic receptors, while they are absent in the non-tumorigenic MCF-10A cell line, which was used as control. The addition of carbachol or arecaidine propargyl ester, a non-selective or a selective subtype 2 muscarinic receptor agonist respectively, plus paclitaxel reduces cell viability involving a down-regulation in the expression of ATP “binding cassette” G2 drug transporter and epidermal growth factor receptor. We also detected an inhibition of tumor cell migration and anti-angiogenic effects produced by those drug combinations in vitro and in vivo (in NUDE mice) respectively. Our findings provide substantial evidence about subtype 2 muscarinic receptors as therapeutic targets for the treatment of triple negative tumors.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily G, Member 2/metabolism
- Administration, Metronomic
- Animals
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Arecoline/administration & dosage
- Arecoline/analogs & derivatives
- Carbachol/administration & dosage
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cholinergic Agonists/administration & dosage
- Down-Regulation/drug effects
- ErbB Receptors/metabolism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Mice
- Neoplasm Proteins/metabolism
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/pathology
- Paclitaxel/administration & dosage
- RNA, Small Interfering/metabolism
- Receptor, Muscarinic M2/agonists
- Receptor, Muscarinic M2/genetics
- Receptor, Muscarinic M2/metabolism
- Triple Negative Breast Neoplasms/blood supply
- Triple Negative Breast Neoplasms/drug therapy
- Triple Negative Breast Neoplasms/pathology
- Vascular Endothelial Growth Factor A/metabolism
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Alejandro J. Español
- Center of Pharmacological and Botanical Studies (CEFYBO), CONICET, Buenos Aires, Argentine
- Department of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentine
- Department of Biology and Biotechnologies Charles Darwin, Sapienza University of Rome, Rome, Italy
- * E-mail: (AJE); (AMT)
| | - Agustina Salem
- Center of Pharmacological and Botanical Studies (CEFYBO), CONICET, Buenos Aires, Argentine
- Department of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentine
| | - María Di Bari
- Department of Biology and Biotechnologies Charles Darwin, Sapienza University of Rome, Rome, Italy
| | - Ilaria Cristofaro
- Department of Biology and Biotechnologies Charles Darwin, Sapienza University of Rome, Rome, Italy
| | - Yamila Sanchez
- Center of Pharmacological and Botanical Studies (CEFYBO), CONICET, Buenos Aires, Argentine
- Department of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentine
| | - Ada M. Tata
- Department of Biology and Biotechnologies Charles Darwin, Sapienza University of Rome, Rome, Italy
- Center of Neurobiology Daniel Bovet, Sapienza University of Rome, Rome, Italy
- * E-mail: (AJE); (AMT)
| | - María E. Sales
- Center of Pharmacological and Botanical Studies (CEFYBO), CONICET, Buenos Aires, Argentine
- Department of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentine
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10
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Webber C, Whitehead M, Eisen A, Holloway CMB, Groome PA. Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study. Curr Oncol 2020; 27:e377-e385. [PMID: 32905256 PMCID: PMC7467790 DOI: 10.3747/co.27.6115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route. Methods This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007-2015 used linked administrative data. "Diagnostic interval" was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; "treatment interval" was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient's biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method. Results The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of -4.0 days [95% confidence interval (ci): -3.2 days to -4.9 days] for symptomatic patients and -5.4 days (95% ci: -4.7 days to -6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients. Conclusions Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals for patients who are bas-diagnosed remain a cause for concern.
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Affiliation(s)
- C Webber
- The Ottawa Hospital Research Institute and Bruyère Research Institute, Ottawa
| | | | - A Eisen
- Ontario Health (Cancer Care Ontario), Toronto
| | - C M B Holloway
- Ontario Health (Cancer Care Ontario), Toronto
- Department of Surgery, University of Toronto, Toronto
| | - P A Groome
- ices Queen's, Kingston
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON
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11
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Pollack LM, Ekwueme DU, Hung MC, Miller JW, Chang SH. Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA. Cancer Causes Control 2020; 31:691-702. [PMID: 32436037 PMCID: PMC7274897 DOI: 10.1007/s10552-020-01314-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. METHODS Data from Surveillance, Epidemiology, and End Results, NBCCEDP, and Medical Expenditure Panel Surveys were used. LYs saved and QALYs gained/100,000 women were estimated using modeling methods. They were used to predict additional health benefits gained if screening by the NBCCEDP increased from 6.5% up to 10-25% of the eligible women. RESULTS Overall, per 100,000 women screened by the NBCCEDP, 1,731 LYs were saved and 1,608 QALYs were gained. For white women, 1,926 LYs were saved and 1,780 QALYs were gained/100,000 women screened by the NBCCEDP. For black women, 1,506 LYs were saved and 1,300 QALYs were gained/100,000 women screened. If the proportion of eligible women screened by the NBCCEDP increased to 10-25%, the estimated health benefits would range from 6,626-34,896 LYs saved and 6,153-32,407 QALYs gained. CONCLUSIONS The reported estimates emphasize the value of cervical cancer screening program by extending LE in low-income women. Further, it demonstrates that screening a higher percentage of eligible women in the NBCCEDP may yield more health benefits.
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Affiliation(s)
- Lisa M Pollack
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, CDC, Atlanta, GA, 30341, USA
| | | | | | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.
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12
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Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer 2019; 125:2747-2761. [PMID: 31034604 DOI: 10.1002/cncr.32147] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost-effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost-effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow-up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost-effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost-effectiveness and more rigorous reporting of study designs and results in published articles.
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Affiliation(s)
- Brittany M Bernardo
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Rachel J Meadows
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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13
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Yeoh ZY, Jaganathan M, Rajaram N, Rawat S, Tajudeen NA, Rahim N, Zainal NH, Maniam S, Suvelayutnan U, Yaacob R, Krishnapillai V, Kamal MZM, Teo SH, Wahab MYA. Feasibility of Patient Navigation to Improve Breast Cancer Care in Malaysia. J Glob Oncol 2019; 4:1-13. [PMID: 30398950 PMCID: PMC7010457 DOI: 10.1200/jgo.17.00229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Late stage at presentation and poor adherence to treatment remain major contributors to poor survival in low- and middle-income countries (LMICs). Patient navigation (PN) programs in the United States have led to improvement in diagnostic or treatment timeliness, particularly for women in lower socioeconomic classes or minority groups. To date, studies of PN in Asia have been limited. We aimed to assess the feasibility of PN in a state-run hospital in an LMIC and to report the impact on diagnostic and treatment timeliness for patients in its first year of implementation. METHODS We established PN in a dedicated breast clinic of a Malaysian state-run hospital. We compared diagnostic and treatment timeliness between navigated patients (n = 135) and patients diagnosed in the prior year (n = 148), and described factors associated with timeliness. RESULTS Women with PN received timely mammography compared with patients in the prior year (96.4% v 74.4%; P < .001), biopsy (92.5% v 76.1%; P = .003), and communication of news (80.0% v 58.5%; P < .001). PN reduced treatment default rates (4.4% v 11.5%; P = .048). Among navigated patients, late stage at presentation was independently associated with having emotional and language barriers ( P = .01). Finally, the main reason reported for delay, default, or refusal of treatment was the preference for alternative therapy. CONCLUSION PN is feasible for addressing barriers to cancer care when integrated with a state-run breast clinic of an LMIC. Its implementation resulted in improved diagnostic timeliness and reduced treatment default. Wider adoption of PN could be a key element of cancer control in LMICs.
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Affiliation(s)
- Zi-Yi Yeoh
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Maheswari Jaganathan
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nadia Rajaram
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Sudha Rawat
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nurul Ain Tajudeen
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Norlia Rahim
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nur Hidayati Zainal
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Sakthi Maniam
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Ushananthiny Suvelayutnan
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Rahani Yaacob
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Vijayalakshmi Krishnapillai
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Meor Zamari Meor Kamal
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Soo-Hwang Teo
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Mohamed Yusof Abdul Wahab
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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14
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Enomoto LM, Fenstermaker J, Desnoyers RJ, Pasche BC, Blackstock AW, Howerton RM, Clark CJ, Levine EA, Shen P. Oncology Navigation Decreases Time to Treatment in Patients with Pancreatic Malignancy. Ann Surg Oncol 2019; 26:1512-1518. [PMID: 30652224 DOI: 10.1245/s10434-019-07157-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Care of pancreatic cancer patients has become increasingly complex, which has led to delays in the initiation of therapy. Nurse navigators have been added to care teams, in part, to ameliorate this delay. This study investigated the difference in time from first oncology visit to first treatment date in patients with any pancreatic malignancy before and after the addition of an Oncology Navigator. METHODS A single-institution database of patients with any pancreatic neoplasm evaluated by a provider in radiation, medical, or surgical oncology between 1 October 2015 and 30 September 2017 was analyzed. After 1 October 2016, an Oncology Navigator met patients at their initial visit and coordinated care throughout treatment. The cohort was divided into two groups: patients evaluated prior to the implementation of an Oncology Navigator and patients evaluated after implementation. Patient demographics and time from first visit to first intervention were compared. RESULTS Overall, 147 patients with a new diagnosis of pancreatic neoplasm were evaluated; 57 patients were seen prior to the start of the Oncology Navigator program and 79 were evaluated after the navigation program was implemented. On univariate analysis, time from first contact by any provider to intervention was 46 days prior to oncology navigation and 26 days after implementation of oncology navigation (p = 0.005). While controlling for other covariates, employment of the Oncology Navigator decreased the time from first contact by any provider to intervention by almost 16 days (p = 0.009). CONCLUSIONS Implementing an oncology navigation program significantly decreased time to treatment in patients with pancreatic malignancy.
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Affiliation(s)
- Laura M Enomoto
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Joyce Fenstermaker
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Rodwige J Desnoyers
- Department of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Boris C Pasche
- Department of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - A William Blackstock
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Russell M Howerton
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Clancy J Clark
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Perry Shen
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
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McKevitt E, Dingee C, Warburton R, Pao JS, Brown CJ, Wilson C, Kuusk U. Patient navigation reduces time to care for patients with breast symptoms and abnormal screening mammograms. Am J Surg 2018; 215:805-811. [DOI: 10.1016/j.amjsurg.2017.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/11/2022]
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16
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McKevitt EC, Dingee CK, Leung SP, Brown CJ, Van Laeken NY, Lee R, Kuusk U. Reduced Time to Breast Cancer Diagnosis with Coordination of Radiological and Clinical Care. Cureus 2017; 9:e1919. [PMID: 29464133 PMCID: PMC5807023 DOI: 10.7759/cureus.1919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Introduction Diagnostic delays for breast problems is a current concern in British Columbia and diagnostic pathways for breast cancer are currently under review. Breast centres have been introduced in Europe and reported to facilitate diagnosis and treatment. Guidelines for breast centers are outlined by the European Society for Mastology (EUSOMA). A Rapid Access Breast Clinic (RABC) was developed at our hospital applying the concept of triple evaluation for all patients and navigation between clinicians and radiologists. We hypothesize that the Rapid Access Breast Clinic will decrease wait times to diagnosis and minimize duplication of services compared to usual care. Methods A retrospective review was undertaken looking at diagnostic wait times and the number of diagnostic centres involved for consecutive patients seen by breast surgeons with diagnostic workups performed either in the traditional system (TS) or the RABC. Only patients presenting with a new breast problem were included in the study. Results Patients seen at the RABC had a decreased time to surgical consultation (33 vs 86 days, p<0.0001) for both malignant (36 vs 59 days, p=0.0007) and benign diagnoses (31 vs 95 days, p<0.0001). Furthermore, 13% of the patients referred to the surgeon in the TS without a diagnosis were eventually diagnosed with a malignancy and waited a mean of 84 days for initial surgical assessment. Of the patients seen at the RABC, 5% required investigation at more than one institution compared to 39% patients seen in the TS (p<0.0001). Cancer patients had a shorter time from presentation to surgery in the RABC (64 vs 92 days, p=0.009). Conclusion The establishment of the RABC has significantly reduced the time to surgical consultation, time to breast cancer surgery, and duplication of investigations for patients with benign and malignant breast complaints. It is feasible to introduce a EUSOMA-based breast clinic in the Canadian Health Care System and improvements in diagnostic wait times are seen. We recommend the expansion of coordinated care to other sites.
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Affiliation(s)
| | - Carol K Dingee
- Mt. St Joseph Hospital, University of British Columbia Vancouver
| | | | - Carl J Brown
- Surgery, University of British Columbia Vancouver
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17
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McKevitt E, Dingee C, Warburton R, Pao J, Brown C, Wilson C, Kuusk U. Coordination of radiologic and clinical care reduces the wait time to breast cancer diagnosis. Curr Oncol 2017; 24:e388-e393. [PMID: 29089809 PMCID: PMC5659163 DOI: 10.3747/co.24.3767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In 2009, a Rapid Access Breast Clinic (rabc) was opened at our urban hospital. Compared with the traditional system (ts), the navigated care through the clinic was associated with a significantly shorter time to surgical consultation. Since 2009, many radiology facilities have introduced facilitated-care pathways for patients with breast pathology. Our objective was to determine if that change in diagnostic imaging pathways had eliminated the advantage in time to care previously shown for the rabc. METHODS All patients seen in the rabc and the office-based ts in November-December 2012 were included in the analysis. A retrospective chart review tabulated demographic, surgeon, pathology, and radiologic data, including time intervals to care for all patients. The results were compared with data from 2009. RESULTS In 2012, time from presentation to surgical consultation was less for the rabc group than for the ts group (36 days vs. 73 days, p < 0.001) for both malignant (31 days vs. 55 days, p = 0.008) and benign diagnoses (43 days vs. 79 days, p < 0.001). Comparing the 2012 results with results from 2009, a decline in mean wait time was observed for the ts group (86 days vs. 73 days, p = 0.02). Compared with patients having investigations in the ts, rabc patients with cancer were more likely to undergo surgery within 60 days of presentation (33% vs. 15%, p = 0.04). CONCLUSIONS The coordination of radiology and clinical care reduces wait times for diagnosis and surgery in breast cancer. To achieve recommended targets, we recommend implementation of more systematic coordination of care for a breast cancer diagnosis and of navigation to surgeons for patients needing surgical care.
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Affiliation(s)
- E.C. McKevitt
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
| | - C.K. Dingee
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
| | - R. Warburton
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
| | - J.S. Pao
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
| | - C.J. Brown
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
| | - C. Wilson
- Department of Radiology, BC Cancer Agency; and
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - U. Kuusk
- Department of Surgery, Providence Health Care
- Department of Surgery, University of British Columbia
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18
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Gordils-Perez J, Schneider S, Gabel M, Trotter K. Oncology Nurse Navigation: Development and Implementation of a Program at a Comprehensive Cancer Center. Clin J Oncol Nurs 2017; 21:581-588. [DOI: 10.1188/17.cjon.581-588] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bridges J, Lucas G, Wiseman T, Griffiths P. Workforce characteristics and interventions associated with high-quality care and support to older people with cancer: a systematic review. BMJ Open 2017; 7:e016127. [PMID: 28760795 PMCID: PMC5642668 DOI: 10.1136/bmjopen-2017-016127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide an overview of the evidence base on the effectiveness of workforce interventions for improving the outcomes for older people with cancer, as well as analysing key features of the workforce associated with those improvements. DESIGN Systematic review. METHODS Relevant databases were searched for primary research, published in English, reporting on older people and cancer and the outcomes of interventions to improve workforce knowledge, attitudes or skills; involving a change in workforce composition and/or skill mix; and/or requiring significant workforce reconfiguration or new roles. Studies were also sought on associations between the composition and characteristics of the cancer care workforce and older people's outcomes. A narrative synthesis was conducted and supported by tabulation of key study data. RESULTS Studies (n=24) included 4555 patients aged 60+ from targeted cancer screening to end of life care. Interventions were diverse and two-thirds of the studies were assessed as low quality. Only two studies directly targeted workforce knowledge and skills and only two studies addressed the nature of workforce features related to improved outcomes. Interventions focused on discrete groups of older people with specific needs offering guidance or psychological support were more effective than those broadly targeting survival outcomes. Advanced Practice Nursing roles, voluntary support roles and the involvement of geriatric teams provided some evidence of effectiveness. CONCLUSIONS An array of workforce interventions focus on improving outcomes for older people with cancer but these are diverse and thinly spread across the cancer journey. Higher quality and larger scale research that focuses on workforce features is now needed to guide developments in this field, and review findings indicate that interventions targeted at specific subgroups of older people with complex needs, and that involve input from advanced practice nurses, geriatric teams and trained volunteers appear most promising.
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Affiliation(s)
- Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
| | - Grace Lucas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- The Royal Marsden NHS Foundation Trust
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
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DeSalvo JM, Young GS, Krok-Schoen JL, Paskett ED. Characterizing Time to Diagnostic Resolution After an Abnormal Cancer Screening Exam in Older Adult Participants in the Ohio Patient Navigation Research Program. J Aging Health 2017. [PMID: 28649914 DOI: 10.1177/0898264317715184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to test the effectiveness of a patient navigation (PN) intervention to reduce time to diagnostic resolution among older adults age ≥65 years versus those <65 years with abnormal breast, cervical, or colorectal cancer screening exams participating in the Ohio Patient Navigation Research Program (OPNRP). METHOD The OPNRP utilized a nested cohort group-randomized trial design to randomize 862 participants ( n = 67 for ≥65 years; n = 795 for <65 years) to PN or usual care conditions. A shared frailty Cox model tested the effect of PN on time to resolution. RESULTS Older adult participants randomized to PN achieved a 6-month resolution rate that was 127% higher than those randomized to usual care ( p = .001). This effect was not significantly different from participants <65 years. DISCUSSION PN significantly reduced time to diagnostic resolution among older adults beginning 6 months after an abnormal cancer screening exam. Health care systems should include this population in PN programs to reduce cancer disparities.
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van Ee I, Hagedoorn M, Slaets J, Smits C. Patient navigation and activation interventions for elderly patients with cancer: A systematic review. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- I.B. van Ee
- Research Group Innovating with Older Adults; Centre of Expertise in Health Care and Social Work; Windesheim University of Applied Sciences; Zwolle The Netherlands
| | - M. Hagedoorn
- Health Sciences/Health Psychology; University Medical Center Groningen; Groningen The Netherlands
| | - J.P.J. Slaets
- Leyden Academy on Vitality and Ageing, Leiden/Department of Geriatrics; University Medical Center Groningen; Groningen The Netherlands
| | - C.H.M. Smits
- Research Group Innovating with Older Adults; Centre of Expertise in Health Care and Social Work; Windesheim University of Applied Sciences; Zwolle The Netherlands
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Yatim F, Cristofalo P, Ferrua M, Girault A, Lacaze M, Di Palma M, Minvielle E. Analysis of nurse navigators' activities for hospital discharge coordination: a mixed method study for the case of cancer patients. Support Care Cancer 2016; 25:863-868. [PMID: 27830394 PMCID: PMC5266768 DOI: 10.1007/s00520-016-3474-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022]
Abstract
Background Modern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway. Purpose The purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination. Methods Patients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed. Results Qualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %). Conclusions The majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.
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Affiliation(s)
- Fatima Yatim
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France. .,EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France.
| | - Paula Cristofalo
- EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
| | - Marie Ferrua
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Anne Girault
- EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
| | - Marilene Lacaze
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Mario Di Palma
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Etienne Minvielle
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France.,EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
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Ayrault-Piault S, Grosclaude P, Daubisse-Marliac L, Pascal J, Leux C, Fournier E, Tagri AD, Métais M, Lombrail P, Woronoff AS, Molinié F. Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France). Int J Cancer 2016; 139:1983-93. [PMID: 27405647 DOI: 10.1002/ijc.30266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/30/2016] [Indexed: 01/27/2023]
Abstract
The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management.
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Affiliation(s)
| | - Pascale Grosclaude
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Laetitia Daubisse-Marliac
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Jean Pascal
- Département D'Information Médicale, Cellule d'Identito-Vigilance, CHU Toulouse, Toulouse, France
| | | | - Evelyne Fournier
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
| | | | - Magali Métais
- Registre Des Cancers De Loire-Atlantique-Vendée, Nantes, France
| | - Pierre Lombrail
- Laboratoire « Éducations Et Pratiques De Santé » EA3412, Université Paris 13-Sorbonne Paris Cité, Bobigny, France
| | - Anne-Sophie Woronoff
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
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Krok-Schoen JL, Oliveri JM, Paskett ED. Cancer Care Delivery and Women's Health: The Role of Patient Navigation. Front Oncol 2016; 6:2. [PMID: 26858934 PMCID: PMC4729879 DOI: 10.3389/fonc.2016.00002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/03/2016] [Indexed: 01/09/2023] Open
Abstract
Background Patient navigation (PN) is a patient-centered health-care service delivery model that assists individuals, particularly the medically underserved, in overcoming barriers (e.g., personal, logistical, and system) to care across the cancer care continuum. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health-care facilities seeking CoC-accreditation must have PN processes in place starting January 1, 2015. The CoC mandate, in light of the recent findings from centers within the Patient Navigation Research Program and the influx of PN interventions, warrants the present literature review. Methods PubMed and Medline were searched for studies published from January 2010 to October 2015, particularly those recent articles within the past 2 years, addressing PN for breast and gynecological cancers, and written in English. Search terms included patient navigation, navigation, navigator, cancer screening, clinical trials, cancer patient, cancer survivor, breast cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer, and vulvar cancer. Results Consistent with prior reviews, PN was shown to be effective in helping women who receive cancer screenings, receive more timely diagnostic resolution after a breast and cervical cancer screening abnormality, initiate treatment sooner, receive proper treatment, and improve quality of life after cancer diagnosis. However, several limitations were observed. The majority of PN interventions focused on cancer screening and diagnostic resolution for breast cancer. As observed in prior reviews, methodological rigor (e.g., randomized controlled trial design) was lacking. Conclusion Future research opportunities include testing PN interventions in the post-treatment settings and among gynecological cancer patient populations, age-related barriers to effective PN, and collaborative efforts between community health workers and patient navigators as care goes across segments of the cancer control continuum. As PN programs continue to develop and become a standard of care, further research will be required to determine the effectiveness of cancer PN across the cancer care continuum, and in different patient populations.
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Affiliation(s)
| | - Jill M Oliveri
- Comprehensive Cancer Center, The Ohio State University , Columbus, OH , USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Ustjanauskas AE, Bredice M, Nuhaily S, Kath L, Wells KJ. Training in Patient Navigation: A Review of the Research Literature. Health Promot Pract 2015; 17:373-81. [PMID: 26656600 DOI: 10.1177/1524839915616362] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the proliferation of patient navigation programs designed to increase timely receipt of health care, little is known about the content and delivery of patient navigation training, or best practices in this arena. The current study begins to address these gaps in understanding, as it is the first study to comprehensively review descriptions of patient navigation training in the peer-reviewed research literature. Seventy-five patient navigation efficacy studies published since 1995, identified through PubMed and by the authors, were included in this narrative review. Fifty-nine of the included studies (79%) mentioned patient navigation training, and 55 of these studies additionally provided a description of training. Most studies did not thoroughly document patient navigation training practices. Additionally, several topics integral to the role of patient navigators, as well as components of training central to successful adult learning, were not commonly described in the research literature. Descriptions of training also varied widely across studies in terms of duration, location, format, learning strategies employed, occupation of trainer, and content. These findings demonstrate the need for established standards of navigator training as well as for future research on the optimal delivery and content of patient navigation training.
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Affiliation(s)
- Amy E Ustjanauskas
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | | | - Lisa Kath
- San Diego State University, San Diego, CA, USA
| | - Kristen J Wells
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA San Diego State University, San Diego, CA, USA
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Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia. Cancer Causes Control 2015; 26:795-803. [PMID: 25814245 DOI: 10.1007/s10552-015-0560-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 03/11/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE The National Breast and Cervical Cancer Early Detection Program through each state's administration serves millions of low-income and uninsured women aged 40-64. Our purpose was to assess whether cases screened through Georgia's Breast and Cervical Cancer Program (BCCP) were diagnosed at an earlier stage of disease and whether those who used the state's program regularly continued to obtain age-appropriate screens as they aged out of BCCP into Medicare between 2000 and 2005. METHODS We used BCCP screening data to identify women with more than one screen and an interval of 18 months or less between screens as "regular" users of BCCP. Using the linked BCCP and Medicare enrollment/claims data, we tested whether women with any BCCP use (n = 3,134) or "regular" users (n = 1,590) were more likely than women not using BCCP (n = 10,086) to exhibit regular screening under Medicare. We used linked BCCP and Georgia Cancer Registry data to examine breast cancer incidence and stage at diagnosis of BCCP women compared to the Georgia population. RESULTS Under Medicare, almost 63 % of women with any BCCP use were re-screened versus 51 % of non-BCCP users. The probability of being screened within 18 months of Medicare enrollment was 3.5 % points higher for any BCCP user and 17.7 points higher for "regular" BCCP users, compared to nonusers. Among Black non-Hispanics, the difference for any BCCP user was 13.7 % points and for regular users, 22.4 % points. A larger percentage of BCCP users were diagnosed at in situ or localized disease stage than overall. CONCLUSIONS The majority of women aging out of the GA BCCP 2000-2005 had used the program to obtain regular mammography. Regular users of GA BCCP continued to be screened within appropriate intervals once enrolled in Medicare due perhaps to educational and support components of BCCP.
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Español AJ, Salem A, Rojo D, Sales ME. Participation of non-neuronal muscarinic receptors in the effect of carbachol with paclitaxel on human breast adenocarcinoma cells. Roles of nitric oxide synthase and arginase. Int Immunopharmacol 2015; 29:87-92. [PMID: 25812766 DOI: 10.1016/j.intimp.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/03/2015] [Accepted: 03/12/2015] [Indexed: 12/14/2022]
Abstract
Breast cancer is the most common type of cancer in women and represents a major issue in public health. The most frequent methods to treat these tumors are surgery and/or chemotherapy. The latter can exert not only beneficial effects by reducing tumor growth and metastasis, but also toxic actions on normal tissues. Metronomic therapy involves the use of low doses of cytotoxic drugs alone or in combination to improve efficacy and to reduce adverse effects. We have previously reported that breast tumors highly express functional muscarinic acetylcholine receptors (mAChRs) that regulate tumor progression. For this reason, mAChRs could be considered as therapeutic targets in breast cancer. In this paper, we investigated the ability of a combination of the cytotoxic drug paclitaxel plus carbachol, a cholinergic agonist, at low doses, to induce death in breast tumor MCF-7 cells, via mAChR activation, and the role of nitric oxide synthase (NOS) and arginase in this effect. We observed that the combination of carbachol plus paclitaxel at subthreshold doses significantly increased cytotoxicity in tumor cells without affecting MCF-10A cells, derived from human normal mammary gland. This effect was reduced in the presence of the muscarinic antagonist atropine. The combination also increased nitric oxide production by NOS1 and NOS3 via mAChR activation, concomitantly with an up-regulation of NOS3 expression. The latter effects were accompanied by a reduction in arginase II activity. In conclusion, our work demonstrates that mAChRs expressed in breast tumor cells could be considered as candidates to become targets for metronomic therapy in cancer treatment.
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Affiliation(s)
- Alejandro Javier Español
- Centro de Estudios Farmacológicos y Botánicos (CEFYBO)-(CONICET) 2° Cátedra de Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Agustina Salem
- Centro de Estudios Farmacológicos y Botánicos (CEFYBO)-(CONICET) 2° Cátedra de Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Daniela Rojo
- Centro de Estudios Farmacológicos y Botánicos (CEFYBO)-(CONICET) 2° Cátedra de Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - María Elena Sales
- Centro de Estudios Farmacológicos y Botánicos (CEFYBO)-(CONICET) 2° Cátedra de Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
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Rousseau SJ, Humiston SG, Yosha A, Winters PC, Loader S, Luong V, Schwartzbauer B, Fiscella K. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer 2014; 22:3143-51. [PMID: 24890503 PMCID: PMC4221546 DOI: 10.1007/s00520-014-2295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.
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Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center. Am J Surg 2014; 207:686-91; discussion 691-2. [DOI: 10.1016/j.amjsurg.2014.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/05/2014] [Accepted: 01/06/2014] [Indexed: 11/20/2022]
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