Ko Naomi Y, Snyder Frederick R, Raich Peter C, Paskett Electra D, Dudley Donald J, Lee Ji-Hyun, Levine Paul H, Freund Karen M
Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts.
NOVA Research Company, Silver Spring, Maryland.
Cancer. 2016 Sep 1;122(17):2715-22. doi: 10.1002/cncr.30109. Epub 2016 May 26.
Patient navigation was developed to address barriers to timely care and reduce cancer disparities. The current study explored navigation and racial and ethnic differences in time to the diagnostic resolution of a cancer screening abnormality.
The authors conducted an analysis of the multisite Patient Navigation Research Program. Participants with an abnormal cancer screening test were allocated to either navigation or control. The unadjusted median time to resolution was calculated for each racial and ethnic group by navigation and control. Multivariable Cox proportional hazards models were fit, adjusting for sex, age, cancer abnormality type, and health insurance and stratifying by center of care.
Among a sample of 7514 participants, 29% were non-Hispanic white, 43% were Hispanic, and 28% were black. In the control group, black individuals were found to have a longer median time to diagnostic resolution (108 days) compared with non-Hispanic white individuals (65 days) or Hispanic individuals (68 days) (P<.0001). In the navigated groups, black individuals had a reduction in the median time to diagnostic resolution (97 days) (P<.0001). In the multivariable models, among controls, black race was found to be associated with an increased delay to diagnostic resolution (hazard ratio, 0.77; 95% confidence interval, 0.69-0.84) compared with non-Hispanic white individuals, which was reduced in the navigated arm (hazard ratio, 0.85; 95% confidence interval, 0.77-0.94).
Patient navigation appears to have the greatest impact among black patients, who had the greatest delays in care. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2715-2722. © 2016 American Cancer Society.
患者导航旨在消除及时就医的障碍并减少癌症差异。本研究探讨了在癌症筛查异常诊断解决时间方面的导航及种族和民族差异。
作者对多中心患者导航研究项目进行了分析。癌症筛查检测异常的参与者被分配至导航组或对照组。按导航和对照情况计算每个种族和民族组未调整的诊断解决中位时间。拟合多变量Cox比例风险模型，对性别、年龄、癌症异常类型和医疗保险进行调整，并按护理中心分层。
在7514名参与者样本中，29%为非西班牙裔白人，43%为西班牙裔，28%为黑人。在对照组中，发现黑人个体诊断解决的中位时间（108天）比非西班牙裔白人个体（65天）或西班牙裔个体（68天）更长（P<0.0001）。在导航组中，黑人个体诊断解决的中位时间减少（97天）（P<0.0001）。在多变量模型中，在对照组中，与非西班牙裔白人个体相比，黑人种族与诊断解决延迟增加相关（风险比，0.77；95%置信区间，0.69 - 0.84），在导航组中这种相关性降低（风险比，0.85；95%置信区间，0.77 - 0.94）。
患者导航似乎对黑人患者影响最大，他们在就医方面延迟最为严重。《癌症》2016年。©2016美国癌症协会。《癌症》2016；122：2715 - 2722。©2016美国癌症协会。
