Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.

"A limited focus on cancer rehabilitation"-A qualitative study of the experiences from Norwegian Cancer Coordinators in Primary Health Care

OBJECTIVE

The facilitation of complex cancer rehabilitation interventions in primary health care has become of growing importance to meet the bio-psycho-social needs of cancer survivors. However, the delivery of cancer rehabilitation is debated and services are underutilised. Cancer coordinators (CCs) provide patients with coordinated services throughout the trajectory. Little is known about CCs' rehabilitation-focused tasks. This study's objective was to explore Norwegian CCs' experiences with cancer rehabilitation interventions in primary health care.

METHODS

Data were obtained via two focus group interviews with 12 participants, analysed using thematic analysis and discussed using Salutogenesis, a theory for health promotion.

RESULTS

The analysis revealed three themes: (a) "A missing link" to cancer rehabilitation in primary health care, (b) Aiming to put cancer rehabilitation "in the spotlight," (c) The need to build a system for rehabilitation service delivery.

CONCLUSION

CCs experience a lacking focus on and missing systems for cancer rehabilitation in primary health care. CCs aim to improve local practices by advocating patients' needs and educating professionals. CCs must be supported via education and training in system-level work, an increased policy focus and resources for cancer rehabilitation. More research is required into how CCs may facilitate cancer rehabilitation in primary health care.