Rodday Angie Mae, Parsons Susan K, Snyder Frederick, Simon Melissa A, Llanos Adana A M, Warren-Mears Victoria, Dudley Donald, Lee Ji-Hyun, Patierno Steven R, Markossian Talar W, Sanders Mechelle, Whitley Elizabeth M, Freund Karen M
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
NOVA Research Company, Silver Spring, Maryland.
Cancer. 2015 Nov 15;121(22):4025-34. doi: 10.1002/cncr.29612. Epub 2015 Sep 8.
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.
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.
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.
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.
患者导航可能会减少与社会经济地位（SES）和家庭因素相关的癌症差异。本研究调查了这些因素是否与癌症筛查异常患者的诊断解决延迟相关，以及患者导航是否改善了这些延迟。
本研究分析了美国国立癌症研究所患者导航研究项目10个中心中5个中心的数据，该项目收集了关于就业、收入、教育、住房、婚姻状况和家庭构成的社会经济地位和家庭数据。主要结局是癌症筛查异常后诊断解决的时间。针对每个社会经济地位和家庭因素拟合单独的校正Cox比例风险模型，并纳入该因素与干预状态之间的相互作用。
在3777名参与者中（1968名在对照组，1809名在导航干预组），91%为女性，平均年龄为44岁；43%为西班牙裔，28%为白人，27%为非裔美国人。在对照组中，失业者的诊断解决时间比全职工作者更长（风险比[HR]，0.85；P = 0.02）。与房主相比，租房者（HR，0.81；P = 0.02）和居住在其他（即不稳定）住房的人（HR，0.60；P < 0.001）存在延迟。从未结婚者（HR，0.70；P < 0.001）和以前结婚的参与者（HR，0.85；P = 0.03）的诊断时间比已婚参与者更长。在导航干预组中，这些变量中的任何一个在诊断解决时间上均无差异。
就业、住房类型和婚姻状况存在诊断解决延迟。患者导航消除了研究样本中的这些差异。这些发现证明了为癌症护理延迟高风险患者提供患者导航的价值。
