Top

Published in:

01-10-2020 | Cervical Cancer | Review Paper

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

Authors: Heidi D. Nelson, MD, MPH, MACP, FRCP, Amy Cantor, MD, MPH, Jesse Wagner, MA, Rebecca Jungbauer, DrPH, MPH, MA, Rongwei Fu, PhD, Karli Kondo, PhD, MA, Lucy Stillman, BS, Ana Quiñones, PhD, MS

Published in: Journal of General Internal Medicine | Issue 10/2020

Abstract

Background

This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities.

Methods

Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models.

Results

Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I² = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I² = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I² = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I² = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality.

Conclusions

In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services.

Registration: PROSPERO: CRD42018109263

Available only for authorised users

Colorectal Cancer: Screening. 2016. Accessed at U.S. Preventive Services Task Force at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening on May 30, 2020.

Breast Cancer: Screening. 2016. Accessed at U.S. Preventive Services Task Force at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening on May 30, 2020.

Cervical Cancer: Screening. 2018. Accessed at U.S. Preventive Services Task Force at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening on May 30, 2020.

McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-45.PubMedCrossRef

Hou SI, Sealy DA, Kabiru CW. Closing the disparity gap: cancer screening interventions among Asians--a systematic literature review. Asian Pac J Cancer Prev. 2011;12(11):3133-9.PubMed

Jones TP, Katapodi MC, Lockhart JS. Factors influencing breast cancer screening and risk assessment among young African American women: An integrative review of the literature. J Am Assoc Nurse Pract. 2015;27(9):521-9.PubMedCrossRef

Joseph DA, Redwood D, DeGroff A, Butler EL. Use of evidence-based interventions to address disparities in colorectal cancer screening. MMWR Suppl. 2016;65(1):21-8.PubMedCrossRef

Martinez ME, Ward BW. Health care access and utilization among adults aged 18-64, by poverty level: United States, 2013-2015. NCHS Data Brief. 2016;(262):1-8.

Centers for Disease Control and Prevention 2015. Accessed at U.S. Department of Health and Human Services at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf on May 23, 2019.

10.

HD Pulse. 2017. Accessed at National Institute on Minority Health and Health Disparities at https://hdpulse.nimhd.nih.gov/ on May 30, 2020.

11.

Nelson HD, Cantor A, Wagner J, Jungbauer R, Quiñones A, Fu R, Stillman L, Kondo K. Achieving Health Equity in Preventive Services. Comparative Effectiveness Review No. 222. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 20-EHC022-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2019. Posted final reports are located on the Effective Health Care Program search page. https://doi.org/10.23970/AHRQEPCCER222.

12.

Pathways to Prevention: Achieving Health Equity in Preventive Services. 2019. Accessed at National Institutes of Health Office of Disease Prevention at https://prevention.nih.gov/research-priorities/research-needs-and-gaps/pathways-prevention/achieving-health-equity-preventive-services on May 30, 2020.

13.

Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 10(14)-EHC063-EF. Rockville, MD; 2014.

14.

U.S. Preventive Services Task Force Procedure Manual. 2018; Accessed at https://www.uspreventiveservicestaskforce.org/Page/Name/procedure-manual on May 30, 2020.

15.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.PubMedPubMedCentralCrossRef

16.

Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. Jama. 1998;280(19):1690-1.PubMedCrossRef

17.

Cole H, Thompson HS, White M, Browne R, Trinh-Shevrin C, Braithwaite S, et al. Community-based, preclinical patient navigation for colorectal cancer screening among older black men recruited from barbershops: The MISTER B Trial. Am J Public Health. 2017;107(9):1433-40.PubMedPubMedCentralCrossRef

18.

Hardy RJ, Thompson SG. A likelihood approach to meta-analysis with random effects. Stat Med. 1996;15(6):619-29.PubMedCrossRef

19.

Morton SC, Murad MH, O’Connor E, Lee CS, Booth M, Vandermeer BW, et al. Quantitative synthesis-an update. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. (Prepared by the Scientific Resource Center under Contract No. 290-2012-0004-C). AHRQ Publication No. 18-EHC007- EF. Rockville, MD: Agency for Healthcare Research and Quality; 2008.

20.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58.PubMedCrossRef

21.

Baker DW, Brown T, Buchanan DR, Weil J, Balsley K, Ranalli L, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1235-41.PubMedCrossRef

22.

Blumenthal DS, Smith SA, Majett CD, Alema-Mensah E. A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer. 2010;116(4):922-9.PubMedCrossRef

23.

Braun KL, Thomas WL, Jr., Domingo JL, Allison AL, Ponce A, Haunani Kamakana P, et al. Reducing cancer screening disparities in Medicare beneficiaries through cancer patient navigation. J Am Geriatr Soc. 2015;63(2):365-70.PubMedPubMedCentralCrossRef

24.

Christie J, Itzkowitz S, Lihau-Nkanza I, Castillo A, Redd W, Jandorf L. A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. J Natl Med Assoc. 2008;100(3):278-84.PubMed

25.

Davis T, Arnold C, Rademaker A, Bennett C, Bailey S, Platt D, et al. Improving colon cancer screening in community clinics. Cancer. 2013;119(21):3879-86.PubMedCrossRef

26.

DeGroff A, Schroy PC, 3rd, Morrissey KG, Slotman B, Rohan EA, Bethel J, et al. Patient navigation for colonoscopy completion: results of an RCT. Am J Prev Med. 2017;53(3):363-72.PubMedCrossRefPubMedCentral

27.

Dietrich AJ, Tobin JN, Cassells A, Robinson CM, Greene MA, Sox CH, et al. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006;144(8):563-71.PubMedPubMedCentralCrossRef

28.

Dietrich AJ, Tobin JN, Robinson CM, Cassells A, Greene MA, Dunn VH, et al. Telephone outreach to increase colon cancer screening in Medicaid managed care organizations: a randomized controlled trial. Ann Fam Med. 2013;11(4):335-43.PubMedPubMedCentralCrossRef

29.

Enard K, Nevarez L, Hernandez M, Hovick S, Moguel M, Hajek R, et al. Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial. Cancer Causes Control. 2015;26(9):1351-9.PubMedPubMedCentralCrossRef

30.

Fiscella K, Humiston S, Hendren S, Winters P, Idris A, Li SX, et al. A multimodal intervention to promote mammography and colorectal cancer screening in a safety-net practice. J Natl Med Assoc. 2011;103(8):762-8.PubMed

31.

Ford ME, Havstad S, Vernon SW, Davis SD, Kroll D, Lamerato L, et al. Enhancing adherence among older African American men enrolled in a longitudinal cancer screening trial. Gerontologist. 2006;46(4):545-50.PubMedCrossRef

32.

Fortuna RJ, Idris A, Winters P, Humiston SG, Scofield S, Hendren S, et al. Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. J Gen Intern Med. 2014;29(1):90-7.PubMedCrossRef

33.

Leone LA, Reuland DS, Lewis CL, Ingle M, Erman B, Summers TJ, et al. Reach, usage, and effectiveness of a Medicaid patient navigator intervention to increase colorectal cancer screening, Cape Fear, North Carolina, 2011. Prev Chronic Dis. 2013;10:E82.PubMedPubMedCentralCrossRef

34.

Myers RE, Stello B, Daskalakis C, Sifri R, Gonzalez ET, DiCarlo M, et al. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiol Biomark Prev. 2019;28(2):384-91.CrossRef

35.

Goldman SN, Liss DT, Brown T, Lee JY, Buchanan DR, Balsley K, et al. Comparative effectiveness of multifaceted outreach to initiate colorectal cancer screening in community health centers: a randomized controlled trial. J Gen Intern Med. 2015;30(8):1178-84.PubMedPubMedCentralCrossRef

36.

Guillaume E, Dejardin O, Bouvier V, De Mil R, Berchi C, Pornet C, et al. Patient navigation to reduce social inequalities in colorectal cancer screening participation: a cluster randomized controlled trial. Prev Med. 2017b;103:76-83.PubMedCrossRef

37.

Honeycutt S, Green R, Ballard D, Hermstad A, Brueder A, Haardorfer R, et al. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer. 2013;119(16):3059-66.PubMedCrossRef

38.

Horne HN, Phelan-Emrick DF, Pollack CE, Markakis D, Wenzel J, Ahmed S, et al. Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults. Cancer Causes Control. 2015;26(2):239-46.PubMedCrossRef

39.

Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J Urban Health. 2005;82(2):216-24.PubMedPubMedCentralCrossRef

40.

Lasser KE, Murillo J, Lisboa S, Casimir AN, Valley-Shah L, Emmons KM, et al. Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med. 2011;171(10):906-12.PubMedCrossRef

41.

Ma GX, Shive S, Tan Y, Gao W, Rhee J, Park M, et al. Community-based colorectal cancer intervention in underserved Korean Americans. Cancer Epidemiol. 2009;33(5):381-6.PubMedCrossRef

42.

Myers RE, Sifri R, Daskalakis C, DiCarlo M, Geethakumari PR, Cocroft J, et al. Increasing colon cancer screening in primary care among African Americans. J Natl Cancer Inst. 2014;106(12).

43.

Nash D, Azeez S, Vlahov D, Schori M. Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting.[Erratum appears in J Urban Health. 2007 May;84(3):459]. J Urban Health. 2006;83(2):231-43.PubMedPubMedCentralCrossRef

44.

Nguyen BH, Stewart SL, Nguyen TT, Bui-Tong N, McPhee SJ. Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. Am J Public Health. 2015;105(10):2083-9.PubMedPubMedCentralCrossRef

45.

Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009;24(2):211-7.PubMedCrossRef

46.

Percac-Lima S, Lopez L, Ashburner JM, Green AR, Atlas SJ. The longitudinal impact of patient navigation on equity in colorectal cancer screening in a large primary care network. Cancer. 2014;120(13):2025-31.PubMedCrossRef

47.

Reuland DS, Brenner AT, Hoffman R, McWilliams A, Rhyne RL, Getrich C, et al. Effect of combined patient decision aid and patient navigation vs usual care for colorectal cancer screening in a vulnerable patient population: a randomized clinical trial. JAMA Intern Med. 2017;177(7):967-74.PubMedPubMedCentralCrossRef

48.

Paskett E, Tatum C, Rushing J, Michielutte R, Bell R, Long Foley K, et al. Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. J Natl Cancer Inst. 2006;98(17):1226-37.PubMedCrossRef

49.

Russell KM, Champion VL, Monahan PO, Millon-Underwood S, Zhao Q, Spacey N, et al. Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women. Cancer Epidemiol Biomark Prev. 2010;19(1):201-10.CrossRef

50.

Marshall JK, Mbah OM, Ford JG, Phelan-Emrick D, Ahmed S, Bone L, et al. Effect of patient navigation on breast cancer screening among African American Medicare beneficiaries: a randomized controlled trial. J Gen Intern Med. 2016;31(1):68-76.PubMedCrossRef

51.

Percac-Lima S, Milosavljevic B, Oo SA, Marable D, Bond B. Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants. J Immigr Minor Health. 2012;14(4):727-30.PubMedCrossRef

52.

Phillips CE, Rothstein JD, Beaver K, Sherman BJ, Freund KM, Battaglia TA. Patient navigation to increase mammography screening among inner city women. J Gen Intern Med. 2011;26(2):123-9.PubMedCrossRef

53.

Powell ME, Carter V, Bonsi E, Johnson G, Williams L, Taylor-Smith L, et al. Increasing mammography screening among African American women in rural areas. J Health Care Poor Underserved. 2005;16(4 Suppl A):11-21.PubMedCrossRef

54.

Weber BE, Reilly BM. Enhancing mammography use in the inner city. A randomized trial of intensive case management. Arch Intern Med. 1997;157(20):2345-9.PubMedCrossRef

55.

Fang CY, Ma GX, Handorf EA, Feng Z, Tan Y, Rhee J, et al. Addressing multilevel barriers to cervical cancer screening in Korean American women: a randomized trial of a community-based intervention. Cancer. 2017;123(6):1018-26.PubMedCrossRef

56.

Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Women's Health. 2010;19(3):463-9.CrossRef

57.

Quiñones AR, O’Neil M, Saha S, Freeman M, Henry SR, Kansagara D. Interventions to Reduce Racial and Ethnic Disparities. VA-ESP Project #05-225; 2011.

58.

Carey TS, Bekemeier B, Campos-Outcalt D, Koch-Weser S, Millon-Underwood S, Teutsch S. National Institutes of Health Pathways to Prevention Workshop: achieving health equity in preventive services. Ann Intern Med. 2020;172:272-278.PubMedCrossRef

59.

Nelson HD, Cantor A, Wagner J, Jungbauer R, Quiñones A, Stillman L, Kondo K. Achieving health equity in preventive services: Systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2020;172:258-271.PubMedCrossRef

Title: Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis
Authors: Heidi D. Nelson, MD, MPH, MACP, FRCP
Amy Cantor, MD, MPH
Jesse Wagner, MA
Rebecca Jungbauer, DrPH, MPH, MA
Rongwei Fu, PhD
Karli Kondo, PhD, MA
Lucy Stillman, BS
Ana Quiñones, PhD, MS
Publication date: 01-10-2020
Publisher: Springer International Publishing
Keywords: Cervical Cancer
Cervical Cancer
Colorectal Cancer
Colorectal Cancer
Published in: Journal of General Internal Medicine / Issue 10/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-06020-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2020

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis

COVID-19 and Rhabdomyolysis

The Things They Carry: Veterans and the COVID-19 Pandemic

Steroid Knee Injections for Arthritis Are No Better than Placebo in a Randomized Controlled Trial

Trends in Ambulatory Electronic Consultations During the COVID-19 Pandemic

Racial and Ethnic Disparities in Population-Level Covid-19 Mortality

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page