A systematic review of studies evaluating the effectiveness of oncology patient navigation programs revealed a number of weaknesses associated with a majority of the studies. These findings were published in Cancer.1
Patient navigation has been defined as a “community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to care.”2 These programs typically involve a relationship between a specific provider and a specific patient in which services facilitating access to low-cost or free cancer screening, transportation to cancer-related care facilities, and individualized patient education are provided. In addition, patient navigators are often involved in helping patients find physicians and scheduling appointments, as well as serving as a patient advocate in discussions with their healthcare providers, insurers, and even family members.
The potential benefits of patient navigation programs in the setting of cancer have been widely recognized in the last 2 decades, and organizations such as the National Cancer Institute and the American Cancer Society have provided support for research evaluating the impact of these programs on clinical outcomes and cancer expenditures. Although several systematic reviews of studies evaluating the effectiveness of patient navigation programs have been conducted, most of these studies were focused on specific subgroups of patients with cancer, such as those with breast cancer, or were limited to only one portion of the cancer continuum, such as diagnosis.
This systematic review included studies published between August 1, 2010, and February 1, 2018 that investigated the effectiveness of patient navigation programs, regardless of cancer type or point in the cancer continuum, and also included studies involving cancer survivorship and cost-effectiveness.
Of the 2311 articles identified, 2198 did not meet eligibility for inclusion in this systematic review for reasons including lack of relevancy, fewer than 50 participants, lack of a cancer outcome, or lack of inclusion of patient navigation as an exposure.
Among the 113 studies included in this review, 50% focused on screening, 27% on diagnosis/follow-up, 15% on treatment, and 9% on survivorship. In addition, nearly three-quarters of the studies focused on a single cancer site, most commonly breast or colorectal cancer. Cost effectiveness of patient navigation in the setting of cancer was assessed in only 12% of these studies.
“As cancer survival rates continue to improve, increased effort in the survivorship domain will be essential for increasing the efficiency of cancer care and treatment and improving quality of life among survivors,” the investigators noted.
The studies were classified as strong (5%), moderate (30%), or weak (defined as 2 or more weak components; 65%) with the Quality Assessment Tool for Quantitative Studies, which rated them according to selection bias, study design, confounders, blinding, data collection, and missing components.
Many studies did not provide information on the reliability and validity of data collection, did not adequately document patients who withdrew from the study, and/or were considered to have potential selection bias due to lack of random patient assignment. Even in the randomized, controlled trials involving blinding of research staff to research outcomes, most studies did not report whether the patient was also blinded to the research questions. Specifically focusing on those studies involving an assessment of cost-effectiveness, 78% were rated as weak.
Despite these limitations, however, this systematic review revealed a number of promising results compared with a previous systematic review conducted in 2011.3 In particular, a substantial increase in the number of randomized clinical trials was noted, as well as 2 additional trials evaluating the impact of patient navigation on clinical trial enrollment, and encouraging results regarding the cost-effectiveness of patient navigation.
Furthermore, the investigators concluded that the results of this and the previous systematic review show that patient navigation is proven effective in the screening and diagnostic areas of the continuum of cancer care.
Future studies on the efficacy of patient navigation should evaluate navigation regarding other cancer sites and assess its effects on long-term outcomes such as morbidity and mortality. “Patient navigation continues to be an effective method for overcoming barriers to care and should be integrated into more health care systems,” the investigators concluded.1
1. Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: a systematic review [published online April 29, 2019]. Cancer. doi: 10.1002/cncr.32147
3. Paskett ED, Harrop JP, Wells KJ. Patient navigation: an update on the state of the science. CA Cancer J Clin. 2011;61(4):237-249.