Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening.

Background: Whether patient navigation improves outcomes for patients with comorbidities is unknown. The aims of this study were to determine the effect of comorbidities on the time to diagnostic resolution after an abnormal cancer screening test and to examine whether patient navigation improves the timeliness and likelihood of diagnostic resolution for patients with comorbidities in comparison with no navigation.

Methods: A secondary analysis of comorbidity data collected by Patient Navigation Research Program sites using the Charlson Comorbidity Index (CCI) was conducted.

Racial and ethnic differences in patient navigation: Results from the Patient Navigation Research Program.

Background: 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.

Methods: The authors conducted an analysis of the multisite Patient Navigation Research Program.

Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience.

Objective: Cancer patients and survivors are assuming active roles in decision-making and digital patient support tools are widely used to facilitate patient engagement. As part of Cancer Information Service Research Consortium's randomized controlled trials focused on the efficacy of eHealth interventions to promote informed treatment decision-making for newly diagnosed prostate and breast cancer patients, and post-treatment breast cancer, we conducted a rigorous process evaluation to examine the actual use of and perceived benefits of two complementary communication channels -- print and eHealth interventions.

Methods: The three Virtual Cancer Information Service (V-CIS) interventions were developed through a rigorous developmental process, guided by self-regulatory theory, informed decision-making frameworks, and health communications best practices.

Can patient navigation improve receipt of recommended breast cancer care? Evidence from the National Patient Navigation Research Program.

Purpose: Poor and underserved women face barriers in receiving timely and appropriate breast cancer care. Patient navigators help individuals overcome these barriers, but little is known about whether patient navigation improves quality of care. The purpose of this study is to examine whether navigated women with breast cancer are more likely to receive recommended standard breast cancer care.

Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

Background: Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness.

Methods: The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care.

Psychometric evaluation of the patient satisfaction with logistical aspects of navigation (PSN-L) scale using item response theory.

Background: Patient navigation--the provision of logistical, educational, and emotional support needed to help patients "navigate around" barriers to high-quality cancer treatment offers promise. No patient-reported outcome measures currently exist that assess patient navigation from the patient's perspective. We use a partial independence item response theory model to report on the psychometric properties of the Patient Satisfaction with Navigation, Logistical measure developed for this purpose.

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.

Purpose: Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants.

Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the Patient Navigation Research Program.

Background: Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact.

Methods: The authors conducted a cost-consequence analysis of navigation versus usual care among 10,521 individuals with abnormal breast, cervical, colorectal, or prostate cancer screening results who enrolled in the Patient Navigation Research Program study from January 1, 2006 to March 31, 2010. Navigation costs included diagnostic evaluation, patient and staff time, materials, and overhead.

Responding to a significant recruitment challenge within three nationwide psychoeducational trials for cancer patients.

Purpose: When faced with a significant recruitment challenge for three nationwide psychoeducational trials targeting prostate and breast cancer patients, the Cancer Information Service Research Consortium initiated outreach efforts to increase accrual. Recruitment is reported by major outreach strategy to inform the use of similar campaigns, either as primary recruitment efforts or to supplement "in-reach" recruitment within oncology settings.

Methods: During a 33-month period, recruitment was tracked from the National Cancer Institute's Cancer Information Service (CIS), the American Cancer Society (ACS), Dr.

Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned.

The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist.

Patient navigation for breast and colorectal cancer treatment: a randomized trial.

Background: There is limited high-quality evidence about the impact of patient navigation (PN) on outcomes for patients with diagnosed cancer.

Methods: We pooled data from two sites from the national Patient Navigation Research Program. Patients (n = 438) with newly diagnosed breast (n = 353) or colorectal cancer (n = 85) were randomized to PN or usual care.

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population.

Background: Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population.

Methods: Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program.

Analysis of combined data from heterogeneous study designs: an applied example from the patient navigation research program.

Background: The Patient Navigation Research Program (PNRP) is a cooperative effort of nine research projects, with similar clinical criteria but with different study designs. To evaluate projects such as PNRP, it is desirable to perform a pooled analysis to increase power relative to the individual projects. There is no agreed-upon prospective methodology, however, for analyzing combined data arising from different study designs.

Metrics for evaluating patient navigation during cancer diagnosis and treatment: crafting a policy-relevant research agenda for patient navigation in cancer care.

Background: Racial and ethnic minorities as well as other vulnerable populations experience disparate cancer-related health outcomes. Patient navigation is an emerging health care delivery innovation that offers promise in improving quality of cancer care delivery to these patients who experience unique health-access barriers. Metrics are needed to evaluate whether patient navigation can improve quality of care delivery, health outcomes, and overall value in health care during diagnosis and treatment of cancer.

Conditional survival and the choice of conditioning set for patients with colon cancer: an analysis of NSABP trials C-03 through C-07.

Purpose: Colon cancer overall survival (OS) is usually computed from the time of diagnosis. Survival gives the initial prognosis but does not reflect how prognosis changes with changing hazard rates over time. Conditional survival (probability of surviving y additional years given they have survived x years [CS or OS|OS]) is an alternative measure that accounts for elapsed time since diagnosis, providing more relevant prognostic information.

National Cancer Institute Patient Navigation Research Program: methods, protocol, and measures.

Background: Patient, provider, and systems barriers contribute to delays in cancer care, a lower quality of care, and poorer outcomes in vulnerable populations, including low-income, underinsured, and racial/ethnic minority populations. Patient navigation is emerging as an intervention to address this problem, but navigation requires a clear definition and a rigorous testing of its effectiveness. Pilot programs have provided some evidence of benefit, but have been limited by evaluation of single-site interventions and varying definitions of navigation.

Patient navigation: state of the art or is it science?

First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost-effectiveness of patient navigation.

Decision making in cancer primary prevention and chemoprevention.

Background: We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention.

Purpose: The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research.

Methods: Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices.

Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer.

Background: Although several studies have established a link between obesity and colon cancer risk, little is known about the effect of obesity on outcomes after diagnosis. We investigated the association of body mass index (BMI) with outcomes after colon cancer in patients from cooperative group clinical trials.

Methods: The study cohort consisted of 4288 patients with Dukes B and C colon cancer who were accrued from July 1989 to February 1994 to National Surgical Adjuvant Breast and Bowel Project randomized trials.

Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer.

Background: Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in black women than in whites in North America. We evaluated obesity and race in relation to outcomes in women with ER-breast cancer.

Antidepressant prescribing in community cancer care.

Goals: To describe patterns of antidepressant (ADs) prescribing in community oncology practice.

Patients And Methods: Data were collected using an electronic medical record on all staged breast, colon, and lung cancer patients in three community-based oncology practices. The data were analyzed retrospectively, using descriptive and bivariate analyses and multivariate logistic regression modeling.

Randomized, controlled trial of an easy-to-read informed consent statement for clinical trial participation: a study of the Eastern Cooperative Oncology Group.

Purpose: Studies have documented that the majority of consent documents for medical diagnosis and treatment are written at a reading level above that of the majority of the U.S. population.

Literacy, comprehension, and informed consent in clinical research.

Institutional review boards (IRBs) and informed consent have recently come under increasing scrutiny. The provision of appropriate and understandable information and its comprehension are key elements of the informed consent process. This article examines how literacy and other factors might impact on comprehension of the information provided.