1. DiGiulio, Sarah

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A patient navigator is someone who helps guide a patient through the health care system, according to the NCI's definition. In a new review article that looked at recent research on the effectiveness of patient navigation in terms of improving patient outcomes and cost savings, researchers noted this type of program works.

Electra D. Paskett, ... - Click to enlarge in new windowElectra D. Paskett, PhD. Electra D. Paskett, PhD

"Patients consistently love patient navigation, which also translates to greater satisfaction with care," said Electra D. Paskett, PhD, the Marion N. Rowley Professor of Cancer Research at The Ohio State University, as well as the Director of the Division of Cancer Prevention and Control in the College of Medicine and Professor in the Division of Epidemiology at the College of Public Health.


The new review published online ahead of print in the journal Cancer looked at studies on patient navigation published between Aug. 1, 2010, and Feb. 1, 2018. (2019; The data is an update on the researchers' previous work that had reviewed patient navigation research through 2010 (CA Cancer J Clin 2011;61:237-249).


"There are still many cancers that have not been studied with patient navigation," Paskett noted. "The quality of the studies is not uniformly strong. Not all points across the cancer continuum have been included in patient navigation studies. And more studies exploring the cost-effectiveness of patient navigation need to be conducted."


When patient navigation was gaining popularity in the early 2000s, it was less accepted than it was today, she explained. It is more established and accepted today, and patient navigation helps patients because there are still parts of the health care processes that patients have questions about and need answers to-costs, transportation and lodging for treatment, and newer treatments-for which patients may have more questions about.


Here's what Paskett told Oncology Times about what the data has-and has not-shown about patient navigation.


1 How did the findings from this review differ from your previous findings?

"In the other reviews, we didn't do an assessment of the quality of the research study. We also didn't look at cost of patient navigation. At that time, there wasn't a whole lot of verbalized interest in cost and there wasn't a lot of data on cost in terms of published literature. Those were the two new things, in addition to updating data through February of 2018.


"What we found was that, of the 113 articles [we looked at], 14 were on cost-effectiveness. The majority focused on cancer screening in terms of the component of the cancer continuum. And breast cancer was a predominant [cancer type looked at in the studies] followed by colon cancer.


"We found most of the studies found favorable patient navigation outcomes in terms of the increase uptake of screening, adherence to screening, timely diagnostic resolution and follow-up, higher rates of adherence of receiving cancer therapy, and higher rates of attending medical appointments.


"And then in the new category of the cost-effectiveness, studies showed that patient navigation programs did yield financial benefits.


"When we looked at the quality assessment of the studies-which is something new that we did in this review-75 of the 113 articles had two or more weak components. So, that led to our conclusion that there still are gaps in patient navigation in cancer research, specifically along the cancer control continuum and in different types of cancers, as well as cost-effectiveness.


"And all of the studies should be using more rigorous reporting...of study design. They don't necessarily need more rigorous study design, they might have had it-but we couldn't report it. We couldn't glean it from the articles."


2 Given these research findings, what will help further advance the benefit and use of patient navigation in oncology?

"I would like to see some more real-world evaluations of patient navigation. [For instance,] in places that have implemented patient navigation, keeping track of the costs, as well as the outcomes for the patient [and] the health care facility.


"It's so valuable to get real-world information, in addition to data from tightly controlled studies.


"When [you] do human subject research, you approach the patient, you inform them, and you get an informed consent. But sometimes people won't sign the consent form, you don't have time to enroll people, they won't be eligible for your study, etc.


"So the people who go on these studies sometimes are not representative of all people. So if you implement patient navigation as part of your routine regular care and you're able to capture data on an aggregate (not individual) level as part of a quality improvement program, you'll have a real-world version of what patient navigation can do and it won't be biased by a selection bias in terms of who enrolls in your study and other limitations."


3 What is the bottom-line message about these new review findings?

"Patient navigation works. It's a message that also needs to be heard by administrators, that we need to find a way to pay for patient navigation, because it's not a reimbursable cost right now.


"And, patient navigation is very effective in helping people who suffer from disparities.


"So, the investment is worth it. Investment in patient navigation is worth it in terms of outcomes for the patient, and for looking at the bottom line of the cost of running a health care enterprise."