Patient navigation programs can help to improve outcomes and reduce disparities; however, little is known about their effects on clinical outcomes, such as survival. In a retrospective, cohort study, a nurse-led patient navigation program was initiated to assess 12-month survival outcomes. The researchers presented the study at the ASCO Annual Meeting.  

The program was conducted at an academic, multisite, community-based cancer institute in January 2013. The patient navigation program included regular in-person and virtual interactions and coordination of diagnosis, management, and follow-up. Adult patients who were diagnosed with first primary cancer between January 2013 and December 2014 were included (N = 2,308), and the researchers compared outcomes of those receiving patient navigation (n = 477) versus standard care (n = 1831). 

Patients with the following eight cancers with poor relative survival rates, per the American Cancer Society’s statistics, were included. 

  • Acute myeloid leukemia 
  • Esophageal cancer 
  • Liver cancer 
  • Lung cancer 
  • Myeloma 
  • Ovarian cancer 
  • Pancreatic cancer 
  • Stomach cancer 

The researchers used electronic medical records and tumor registry data to assess outcomes at 12 months. Within 12 months of diagnosis, 229 (28%) patients died: 25% in the patient navigation cohort and 30% in the standard care group (p = 0.13). Patient navigation resulted in a median 12-month survival of 355 days compared with 329 days for standard care (p = 0.06). Standard care also resulted in greater odds of mortality at 12 months (hazard ratio = 1.34; 95% confidence interval = 1.01–1.78). 

The researchers concluded, “[Patients receiving patient navigation] had improved 12-month survival. Further research is needed to confirm long-term survival and value proposition benefit and explore subgroup differences.”

Comments

Posted by Theresa W. Gil… (not verified) 2 years ago

It's not clear why this study is being shared and the interpretation doesn't really match the findings. First, this was a non-randomized, retrospective study, with more than 3x as many patients in the standard group compared to the navigation group. There is no way to tell if these groups were in any way similar - it is possible that the standard group may have been sicker, more advanced disease, less access to care, etc so that may explain the differences reported. However, there were NO significant differences in mortality between the two groups (p=0.13), nor in median survival (p=0.06). Yes, it is correct that "navigation improved survival" but that needs to be in the context of likely unequal groups being compared and non-significant results. Based on the headlines, it looks like nurse navigation actually does improve survival. It would seem prudent and more accurate to be sure the context and study design are also reported and statistics are noted as well.

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