Robert H, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
BMC Health Serv Res. 2013 Aug 15;13:314. doi: 10.1186/1472-6963-13-314.
Prostate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen.
Participants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated (n = 245) versus control (n = 245) participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score.
Of 490 participants, 68% were African American, 47% were ≥ 65 years old, and 35% had cancer. Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to controls (median days of 97 versus 111; adj. HR 1.17, 95% CI, 0.96-1.43, p = 0.12). On analysis of the period beyond 80 days, navigated men reached resolution faster than controls (median of 151 days versus 190 days; adj. HR 1.41, 95% CI, 1.07-1.86, p = 0.01). Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to controls (median of 93 days versus 87 days; adj. HR 1.15, 95% CI, 0.82-1.62, p = 0.41).
Our navigation program did not significantly impact the overall time to resolution or treatment for men with prostate cancer compared to controls. The utility of navigation programs may extend beyond targeted navigation times, however, and future studies focusing on other outcomes measures are therefore needed.
前列腺癌在低收入和少数族裔男性中发病率更高。本研究评估了患者导航干预对前列腺癌筛查异常的退伍军人诊断结果及时性和治疗启动的影响。
参与者于 2006 年至 2010 年期间入组。该干预措施涉及社工和非专业医疗工作者导航团队，以帮助患者克服医疗障碍。对于接受导航（n=245）与对照组（n=245）的参与者，我们评估了诊断结果和治疗的比例，并根据种族、年龄和 Gleason 评分进行了调整。
在 490 名参与者中，68%为非裔美国人，47%≥65 岁，35%患有癌症。在那些有异常筛查的人中，与对照组相比，导航对诊断结果的时间没有显著影响（中位数分别为 97 天和 111 天；调整后的 HR 为 1.17，95%CI，0.96-1.43，p=0.12）。在对超过 80 天的时间进行分析时，接受导航的男性比对照组更快地解决问题（中位数分别为 151 天和 190 天；调整后的 HR 为 1.41，95%CI，1.07-1.86，p=0.01）。在患有癌症的参与者中，与对照组相比，导航对治疗开始的时间没有显著影响（中位数分别为 93 天和 87 天；调整后的 HR 为 1.15，95%CI，0.82-1.62，p=0.41）。
与对照组相比，我们的导航方案并没有显著影响前列腺癌男性的整体诊断结果或治疗时间。然而，导航方案的效用可能超出了有针对性的导航时间，因此需要进行未来的研究来关注其他结果指标。
