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Chen M, Wu VS, Falk D, Cheatham C, Cullen J, Hoehn R. Patient Navigation in Cancer Treatment: A Systematic Review. Curr Oncol Rep 2024; 26:504-537. [PMID: 38581470 PMCID: PMC11063100 DOI: 10.1007/s11912-024-01514-9] [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] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE OF REVIEW Patient navigation promotes access to timely treatment of chronic diseases by eliminating barriers to care. Patient navigation programs have been well-established in improving screening rates and diagnostic resolution. This systematic review aimed to characterize the multifaceted role of patient navigators within the realm of cancer treatment. RECENT FINDINGS A comprehensive electronic literature review of PubMed and Embase databases was conducted to identify relevant studies investigating the role of patient navigators in cancer treatment from August 1, 2009 to March 27, 2023. Fifty-nine articles were included in this review. Amongst studies focused on cancer treatment initiation, 70% found a significant improvement in treatment initiation amongst patients who were enrolled in patient navigation programs, 71% of studies focused on treatment adherence demonstrated significant improvements in treatment adherence, 87% of studies investigating patient satisfaction showed significant benefits, and 81% of studies reported a positive impact of patient navigators on quality care indicators. Three palliative care studies found beneficial effects of patient navigation. Thirty-seven studies investigated disadvantaged populations, with 76% of them concluded that patient navigators made a positive impact during treatment. This systematic review provides compelling evidence supporting the value of patient navigation programs in cancer treatment. The findings suggest that patient navigation plays a crucial role in improving access to care and optimizing treatment outcomes, especially for disadvantaged cancer patients. Incorporating patient navigation into standard oncology practice can reduce disparities and improve the overall quality of cancer care.
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Affiliation(s)
- Matthew Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Derek Falk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chesley Cheatham
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer Cullen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Richard Hoehn
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Ramírez-Galván YA, Cardona-Huerta S, Elizondo-Riojas G, Montemayor-Martínez A, Morales-Escajeda JI, Herrera-Peña CE. Value of a breast imaging unit in the detection of breast cancer in Mexico. Ecancermedicalscience 2021; 15:1272. [PMID: 34567257 PMCID: PMC8426018 DOI: 10.3332/ecancer.2021.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 11/06/2022] Open
Abstract
The screening breast cancer detection rate in Mexico is low. The main objective of this study was to determine the breast cancer detection rate in a Mexican population that attended a breast imaging unit, in which the same radiologist comprehensively evaluated and interpreted breast imaging studies. A total of 5,429 mammograms performed between 2015 and 2016 were evaluated. Rates for biopsy indication, biopsies performed and positive biopsies for cancer were determined. The malignancy detection rate, after a comprehensive imaging evaluation in a breast imaging unit, was 24.3 per 1,000 mammograms. In symptomatic women was 52.9 per 1,000 mammograms, and in screening women was 11.1 per 1,000 mammograms. Breast imaging units in which a comprehensive imaging approach is performed represent an opportunity for low- and middle-income countries without population-based screening programs to achieve a more efficient detection of breast cancer, without generating a higher cost.
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Affiliation(s)
- Yazmín A Ramírez-Galván
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Col. Mitras Centro, C.P. 64460, Monterrey, Nuevo León, México
| | - Servando Cardona-Huerta
- Hospital Zambrano Hellion, Breast Cancer Center, Batallón de San Patricio, San Pedro Garza García, C.P. 66278, México.,Unidad Médica de Alta Especialidad Nº25, Instituto Mexicano del Seguro Social, Av. Fidel Velázquez s/n, Monterrey, C.P. 64180, México
| | - Guillermo Elizondo-Riojas
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Col. Mitras Centro, C.P. 64460, Monterrey, Nuevo León, México
| | - Alberto Montemayor-Martínez
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Col. Mitras Centro, C.P. 64460, Monterrey, Nuevo León, México
| | - Jesús I Morales-Escajeda
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Madero y Gonzalitos, Monterrey, C.P. 64460, México
| | - Carlos E Herrera-Peña
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Madero y Gonzalitos, Monterrey, C.P. 64460, México
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Tamez-Salazar J, Mireles-Aguilar T, de la Garza-Ramos C, Garcia-Garcia M, Ferrigno AS, Platas A, Villarreal-Garza C. Prioritization of Patients with Abnormal Breast Findings in the Alerta Rosa Navigation Program to Reduce Diagnostic Delays. Oncologist 2021; 25:1047-1054. [PMID: 33400352 DOI: 10.1634/theoncologist.2020-0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/25/2020] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION In Mexico, there are considerable health system delays in the diagnosis and treatment initiation of women with breast cancer. Alerta Rosa is a navigation program in Nuevo Leon that aims to reduce barriers that impede the timely management of these patients. PATIENTS AND METHODS Since December 2017, women who registered to receive medical evaluations by Alerta Rosa were stratified based on their clinical characteristics into three priority groups ("Red," "Yellow," and "Green"). According to the category assigned, patients were scheduled imaging studies and medical appointments with breast specialists on a preferential basis. RESULTS Up until December 2019, 561 patients were scheduled for medical evaluations. Of them, 59% were classified as "Red," 25% "Yellow," and 16% "Green" priority. The median time from stratification to first medical evaluation was 4, 6, and 7 days, respectively (p = .003). Excluding those who had a prior breast cancer diagnosis, 21 patients were diagnosed by Alerta Rosa, with the initial "Red" priority classification demonstrating a sensitivity of 95% (95% confidence interval [CI], 75.1%-99.9%) and specificity of 42% (95% CI, 37.1%-47.1%) for breast cancer. The median time elapsed from initial patient contact to diagnosis and treatment initiation was 16 days and 39 days, respectively. The majority (72%) of patients were diagnosed at an early stage (0-II). CONCLUSION This patient prioritization system adequately identified women with different probabilities of having breast cancer. Efforts to replicate similar triage systems in resource-constrained settings where screening programs are ineffective could prove to be beneficial in reducing diagnostic intervals and achieving early-stage diagnoses. IMPLICATIONS FOR PRACTICE Low- and middle-income countries such as Mexico currently lack the infrastructure to achieve effective breast cancer screening and guarantee prompt access to health care when required. To reduce the disease burden in such settings, strategies targeting early detection are urgently needed. Patient navigation programs aid in the reduction of health system intervals and optimize the use of available resources. This article presents the introduction of a triage system based on initial patient concern. Appointment prioritization proved to be successful at reducing health system intervals and achieving early-stage diagnoses by overcoming barriers that impede early access to quality medical care.
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Affiliation(s)
- Jaime Tamez-Salazar
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Teresa Mireles-Aguilar
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Cynthia de la Garza-Ramos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Marisol Garcia-Garcia
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Alejandra Platas
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
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Dickerson JC, Ragavan MV, Parikh DA, Patel MI. Healthcare delivery interventions to reduce cancer disparities worldwide. World J Clin Oncol 2020; 11:705-722. [PMID: 33033693 PMCID: PMC7522545 DOI: 10.5306/wjco.v11.i9.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, cancer care delivery is marked by inequalities, where some economic, demographic, and sociocultural groups have worse outcomes than others. In this review, we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries. We found two broad categories of interventions that have been studied in the current literature: Patient navigation and telehealth. Navigation has the strongest evidence base for reducing disparities, primarily in cancer screening. Improved outcomes with navigation interventions have been seen in both high- and low-income countries. Telehealth interventions remain an active area of exploration, primarily in high income countries, with the best evidence being for the remote delivery of palliative care. Ongoing research is needed to identify the most efficacious, cost-effective, and scalable interventions to reduce barriers to the receipt of cancer care globally.
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Affiliation(s)
- James C Dickerson
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Meera V Ragavan
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Divya A Parikh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
- Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA 94305, United States
- VA Palo Alto Health Care System, Palo Alto, CA 94306, United States
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Reid AE, Doucet S, Luke A. Exploring the role of lay and professional patient navigators in Canada. J Health Serv Res Policy 2020; 25:229-237. [PMID: 32188293 DOI: 10.1177/1355819620911679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the roles of patient navigators in different settings and situations for various patient populations and to understand the rationale for implementing lay and professional models of patient navigation in a Canadian context. METHODS A qualitative descriptive design was applied, using interviews with 10 patient navigators from eight Canadian provinces, and Braun and Clarke's six phases of thematic analysis to guide the analysis of interview transcripts. RESULTS Findings indicate that a patient navigator's personality and experience (personal and work-related) may be more important than their specific designation (i.e. lay or professional). CONCLUSIONS Lay and professional navigators in Canada appear to be well suited to provide navigational services across populations. This study has the potential to inform future research, policy, and the delivery of navigation programmes in Canada.
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Affiliation(s)
- Amy E Reid
- Research Coordinator, Department of Nursing and Health Sciences, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, University of New Brunswick Saint John, Canada.,Director, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada.,Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick Saint John, Canada.,Co-Director, NaviCare/SoinsNavi, University of New Brunswick Saint John, Canada
| | - Alison Luke
- Research Associate, Department of Nursing and Health Sciences, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada
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Villarreal-Garza C, Lopez-Martinez EA, Muñoz-Lozano JF, Unger-Saldaña K. Locally advanced breast cancer in young women in Latin America. Ecancermedicalscience 2019; 13:894. [PMID: 30792811 PMCID: PMC6372300 DOI: 10.3332/ecancer.2019.894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this review is to organise, summarise and critically assess existing knowledge on locally advanced breast cancer (LABC) among young women in Latin America. We discuss the most relevant findings in six sections: 1) epidemiology of breast cancer in young women in Latin America; 2) being young as a factor for worse prognosis; 3) LABC in young women in the region; 4) aggressive tumour behaviour among young women; 5) delays in diagnosis and treatment and 6) burden of advanced disease. We point out the need to dedicate resources to enhance earlier diagnosis and prompt referrals of young women with breast cancer; promote research regarding prevalence, biologic characteristics, outcomes and reasons for diagnosis and treatment delays for this age group; and finally, implement supportive care programmes as a means of improving patients and their families’ well-being. The recognition of the current standpoint of breast cancer in young patients across the continent should shed some light on the importance of this pressing matter.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Research and Breast Cancer Department, Mexican National Cancer Institute, Mexico City 14080, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Edna A Lopez-Martinez
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Jose Felipe Muñoz-Lozano
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Karla Unger-Saldaña
- CONACYT fellow-Epidemiology Unit, Mexican National Cancer Institute, Mexico City 14080, Mexico
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