The case study for this discussion highlights the complexities of care coordination when patients arrive unprepared physically or mentally for the recommended medical treatments as determined by guidelines. It also [ Read More ]
May 2016 VOL 7, NO 4
A Feasibility Study of a Virtual Navigation Program for Low-Income Breast Cancer Patients
Kathy J. Helzlsouer; Susan E. Appling; Susan Scarvalone; Shannon Manocheh; Ryan MacDonald; Lisa Gallicchio; Dawn Henninger; Arti P. Varanasi
Background: Socioeconomic disparities negatively impact completion of adjuvant breast cancer treatment. Navigation programs may improve treatment completion but may not be accessible to all patients, especially in low-resource communities.
Objective: A randomized trial was conducted to determine the feasibility of a web-based navigation program to improve adjuvant breast cancer treatment completion among low-income patients.
Methods: Patients (N = 101) were recruited and randomized to either information access only (comparison arm) or to the web-based navigation program with nurse/social worker support (intervention arm), and were given a netbook computer, training, and Internet access. Adherence to recommended chemotherapy, radiation therapy, and/or initiation of hormone therapy was assessed by medical record review (available for 48 patients on each study arm). Baseline characteristics and results were compared by study arm using t test, chi-square, Fisher’s exact test, and Poisson regression analyses.
Results: The majority of participants were unemployed or on disability (68%) and were nonwhite (67%). Those randomized to the intervention had lower education levels and were slightly older than those on the comparison arm (P = .04). Two patients on the intervention arm refused part or all of recommended treatments, and 6 patients on the comparison arm refused some or all recommended treatments (Padj = .08).
Discussion: Treatment completion was improved with navigator interaction compared with information access alone, but the difference was not statistically significant. Absolute benefit compared with usual care should be evaluated in a randomized trial.
Conclusion: Centralized virtual navigation is feasible for low-income populations and has the potential to improve treatment completion.
Seasoned Navigator: A Case Study on Care Transitions in Genomic Testing and Timely Treatment Decision-Making
Along with the diagnosis of breast cancer comes many decisions regarding treatment options. Oncotype DX, a genomic/gene expression assay, provides quantitative assessment of chemotherapy benefit and risk of distant recurrence [ Read More ]