Nelson Heidi D, Cantor Amy G, Pappas Miranda, Blackie Keeley, Yu Yun, Fu Rongwei
Kaiser Permanente School of Medicine, Pasadena, California.
Oregon Health & Science University, Portland.
JAMA Intern Med. 2025 Jun 9. doi: 10.1001/jamainternmed.2025.1590.
Screening and follow-up rates for breast and cervical cancer vary across socioeconomic and demographic groups. While patient navigation services can help patients overcome barriers to health care, they are not commonly used in cancer screening.
To determine the effectiveness and harms of patient navigation services to increase screening and follow-up rates for breast and cervical cancer.
A search of the MEDLINE, Scopus, CENTRAL, and Cochrane Database of Systematic Reviews was conducted for English-language articles published between January 1, 2000, and September 19, 2024. A manual review of article references supplemented the search.
Eligible articles were randomized clinical trials comparing the effectiveness of patient navigation services in participants eligible for breast or cervical cancer screening with usual care or control groups, as well as observational studies for harm. Investigators independently dual-reviewed abstracts and full-text articles to identify studies meeting prespecified eligibility criteria. Disagreements were resolved by consensus with a third reviewer. Of all abstracts and full-text articles reviewed, 2.9% were selected for analysis.
This report followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A single investigator extracted data from each study. A second investigator reviewed the data for accuracy. Investigators independently dual-rated individual study quality as good, fair, or poor. Discordant quality ratings were resolved with a third reviewer. Data were combined using a profile likelihood random-effects model.
The main outcomes were breast and cervical cancer screening rates within 1 year of the intervention, follow-up rates within 2 years, and any harm.
A total of 42 randomized clinical trials with 39 111 participants assessing the effectiveness of patient navigation services to increase screening and follow-up rates for breast and cervical cancer were included in the meta-analysis; no studies described harms. For breast cancer, patient navigation resulted in higher rates of screening (risk ratio [RR], 1.50; 95% CI, 1.30-1.75; I2 = 88.0%; 30 trials; n = 34 744 participants) and follow-up (RR, 1.23; 95% CI, 1.15-1.41; I2 = 12.6%; 3 trials; n = 1008 participants) compared with comparison groups. For cervical cancer, patient navigation also resulted in higher rates of screening (RR, 1.62; 95% CI, 1.28-2.09; I2 = 89.6%; 20 trials; n = 11 820 participants) and follow-up (RR, 1.63; 95% CI, 0.86-2.65; I2 = 69.0%; 2 trials; n = 401 participants). Sensitivity analyses demonstrated higher screening rates with patient navigation vs comparison groups for general populations and populations based on race, ethnicity, low-income status, and other characteristics. Predicted 1-year absolute rates following patient navigation were 13.8% higher for breast cancer screening and 15.6% higher for cervical cancer screening than for comparison groups.
The results of this systematic review and meta-analysis suggest that patient navigation services can increase breast and cervical cancer screening and follow-up. Reducing barriers with patient navigation services could improve access and engage patients in more effective and equitable cancer preventive care.
乳腺癌和宫颈癌的筛查及随访率在不同社会经济和人口群体中存在差异。虽然患者导航服务可以帮助患者克服医疗保健障碍，但在癌症筛查中并不常用。
确定患者导航服务提高乳腺癌和宫颈癌筛查及随访率的有效性和危害。
检索MEDLINE、Scopus、CENTRAL和Cochrane系统评价数据库，查找2000年1月1日至2024年9月19日发表的英文文章。对文章参考文献进行人工检索以补充搜索。
符合条件的文章为随机临床试验，比较患者导航服务对符合乳腺癌或宫颈癌筛查条件的参与者与常规护理或对照组的有效性，以及危害的观察性研究。研究人员独立对摘要和全文进行双重审查，以确定符合预先设定的纳入标准的研究。分歧通过与第三位审查员达成共识来解决。在所有审查的摘要和全文文章中，2.9%被选中进行分析。
本报告遵循系统评价和Meta分析的首选报告项目（PRISMA）报告指南。由一名研究人员从每项研究中提取数据。另一名研究人员审查数据的准确性。研究人员独立对单个研究质量进行双重评级，分为好、中、差。质量评级不一致的情况由第三位审查员解决。使用轮廓似然随机效应模型合并数据。
主要结局为干预后1年内的乳腺癌和宫颈癌筛查率、2年内的随访率以及任何危害。
共有42项随机临床试验，39111名参与者评估了患者导航服务提高乳腺癌和宫颈癌筛查及随访率的有效性，纳入Meta分析；没有研究描述危害。对于乳腺癌，与对照组相比，患者导航导致更高的筛查率（风险比[RR]，1.50；95%CI，1.30 - 1.75；I² = 88.0%；30项试验；n = 34744名参与者）和随访率（RR，1.23；95%CI，1.15 - 1.41；I² = 12.6%；3项试验；n = 1008名参与者）。对于宫颈癌，患者导航也导致更高的筛查率（RR，1.62；95%CI，1.28 - 2.09；I² = 89.6%；20项试验；n = 11820名参与者）和随访率（RR，1.63；95%CI，0.86 - 2.65；I² = 69.0%；2项试验；n = 401名参与者）。敏感性分析表明，对于一般人群以及基于种族、民族、低收入状况和其他特征的人群，与对照组相比，患者导航的筛查率更高。患者导航后预测的1年绝对筛查率，乳腺癌比对照组高13.8%，宫颈癌比对照组高15.6%。
这项系统评价和Meta分析的结果表明，患者导航服务可以提高乳腺癌和宫颈癌的筛查及随访率。通过患者导航服务减少障碍可以改善医疗服务可及性，并使患者参与更有效和公平的癌症预防护理。
