Impact of patient navigation in eliminating economic disparities in cancer care

Angie Mae Rodday, Susan K. Parsons, Frederick Snyder, Melissa A. Simon, Adana Llanos Wilson, Victoria Warren-Mears, Donald Dudley, Ji Hyun Lee, Steven R. Patierno, Talar W. Markossian, Mechelle Sanders, Elizabeth M. Whitley, Karen M. Freund

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. METHODS This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included. RESULTS Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P =.02). Renters (HR, 0.81; P =.02) and those with other (ie, unstable) housing (HR, 0.60; P <.001) had delays in comparison with homeowners. Never married (HR, 0.70; P <.001) and previously married participants (HR, 0.85; P =.03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm. CONCLUSIONS Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015;121:4025-4034.

Original languageEnglish (US)
Pages (from-to)4025-4034
Number of pages10
JournalCancer
Volume121
Issue number22
DOIs
StatePublished - Nov 1 2015

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Patient Navigation
Economics
Social Class
Marital Status
Neoplasms
Early Detection of Cancer
National Cancer Institute (U.S.)
Hispanic Americans
Proportional Hazards Models
African Americans
Education
Research

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Keywords

  • breast neoplasms
  • colonic neoplasms
  • early detection of cancer
  • health care disparities
  • patient navigation
  • prostatic neoplasms
  • uterine cervical neoplasms

Cite this

Rodday, A. M., Parsons, S. K., Snyder, F., Simon, M. A., Llanos Wilson, A., Warren-Mears, V., ... Freund, K. M. (2015). Impact of patient navigation in eliminating economic disparities in cancer care. Cancer, 121(22), 4025-4034. https://doi.org/10.1002/cncr.29612
Rodday, Angie Mae ; Parsons, Susan K. ; Snyder, Frederick ; Simon, Melissa A. ; Llanos Wilson, Adana ; Warren-Mears, Victoria ; Dudley, Donald ; Lee, Ji Hyun ; Patierno, Steven R. ; Markossian, Talar W. ; Sanders, Mechelle ; Whitley, Elizabeth M. ; Freund, Karen M. / Impact of patient navigation in eliminating economic disparities in cancer care. In: Cancer. 2015 ; Vol. 121, No. 22. pp. 4025-4034.
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abstract = "BACKGROUND Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. METHODS This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included. RESULTS Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91{\%} were women, and the mean age was 44 years; 43{\%} were Hispanic, 28{\%} were white, and 27{\%} were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P =.02). Renters (HR, 0.81; P =.02) and those with other (ie, unstable) housing (HR, 0.60; P <.001) had delays in comparison with homeowners. Never married (HR, 0.70; P <.001) and previously married participants (HR, 0.85; P =.03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm. CONCLUSIONS Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015;121:4025-4034.",
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Rodday, AM, Parsons, SK, Snyder, F, Simon, MA, Llanos Wilson, A, Warren-Mears, V, Dudley, D, Lee, JH, Patierno, SR, Markossian, TW, Sanders, M, Whitley, EM & Freund, KM 2015, 'Impact of patient navigation in eliminating economic disparities in cancer care', Cancer, vol. 121, no. 22, pp. 4025-4034. https://doi.org/10.1002/cncr.29612

Impact of patient navigation in eliminating economic disparities in cancer care. / Rodday, Angie Mae; Parsons, Susan K.; Snyder, Frederick; Simon, Melissa A.; Llanos Wilson, Adana; Warren-Mears, Victoria; Dudley, Donald; Lee, Ji Hyun; Patierno, Steven R.; Markossian, Talar W.; Sanders, Mechelle; Whitley, Elizabeth M.; Freund, Karen M.

In: Cancer, Vol. 121, No. 22, 01.11.2015, p. 4025-4034.

Research output: Contribution to journalArticle

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AU - Rodday, Angie Mae

AU - Parsons, Susan K.

AU - Snyder, Frederick

AU - Simon, Melissa A.

AU - Llanos Wilson, Adana

AU - Warren-Mears, Victoria

AU - Dudley, Donald

AU - Lee, Ji Hyun

AU - Patierno, Steven R.

AU - Markossian, Talar W.

AU - Sanders, Mechelle

AU - Whitley, Elizabeth M.

AU - Freund, Karen M.

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N2 - BACKGROUND Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. METHODS This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included. RESULTS Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P =.02). Renters (HR, 0.81; P =.02) and those with other (ie, unstable) housing (HR, 0.60; P <.001) had delays in comparison with homeowners. Never married (HR, 0.70; P <.001) and previously married participants (HR, 0.85; P =.03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm. CONCLUSIONS Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015;121:4025-4034.

AB - BACKGROUND Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays. METHODS This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition. The primary outcome was the time to diagnostic resolution after a cancer screening abnormality. Separate adjusted Cox proportional hazard models were fit for each SES and household factor, and an interaction between that factor and the intervention status was included. RESULTS Among the 3777 participants (1968 in the control arm and 1809 in the navigation intervention arm), 91% were women, and the mean age was 44 years; 43% were Hispanic, 28% were white, and 27% were African American. Within the control arm, the unemployed experienced a longer time to resolution than those employed full-time (hazard ratio [HR], 0.85; P =.02). Renters (HR, 0.81; P =.02) and those with other (ie, unstable) housing (HR, 0.60; P <.001) had delays in comparison with homeowners. Never married (HR, 0.70; P <.001) and previously married participants (HR, 0.85; P =.03) had a longer time to care than married participants. There were no differences in the time to diagnostic resolution with any of these variables within the navigation intervention arm. CONCLUSIONS Delays in diagnostic resolution exist by employment, housing type, and marital status. Patient navigation eliminated these disparities in the study sample. These findings demonstrate the value of providing patient navigation to patients at high risk for delays in cancer care. Cancer 2015;121:4025-4034.

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KW - colonic neoplasms

KW - early detection of cancer

KW - health care disparities

KW - patient navigation

KW - prostatic neoplasms

KW - uterine cervical neoplasms

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Rodday AM, Parsons SK, Snyder F, Simon MA, Llanos Wilson A, Warren-Mears V et al. Impact of patient navigation in eliminating economic disparities in cancer care. Cancer. 2015 Nov 1;121(22):4025-4034. https://doi.org/10.1002/cncr.29612