Faster Diagnosis Possible

Photo: Mammographic screening

The study shows that patient
navigation services reduces the
mean for breast cancer patients
to get help; © panthermedia.net/
MonkeybusinessImages

Patient navigation is a service that helps patients overcome barriers to getting health care, including setting up appointments, dealing with health insurance, and helping with fears about cancer. It led to a nearly four-fold reduction in the time it took to diagnose a suspicious breast lump, the new study found. Previous research had already suggested that navigation services can help women, especially low-income women, overcome obstacles that might result in long lags in diagnosis and treatment of breast cancer.

"The time savings really paid off for the women in this study," says lead author Doctor Heather J. Hoffman. "A quicker diagnosis of breast cancer often translates to faster treatment and might give women a better shot at survival."

Hoffman and his team wondered if patient navigation might help address the high breast cancer death rates in the District of Columbia. To find out, the team studied 2,601 women who were evaluated at nine hospitals or clinics in the capital. All of the women had a breast lump, which raised the worry of cancer, and about half received navigation services. The remainder of the women got the standard advice to follow up on the lump but did not get the extra help that a patient navigator often provides, Hoffman said.

The researchers discovered that patient navigation services shaved days off the time it took to get a diagnosis. For example, women in the navigated group had a mean diagnosis time for breast cancer of just 25 days. In contrast, women in the control group waited an average of 42 days to receive a diagnosis, a delay that slows down the next step — initiation of treatment: surgery, chemotherapy, radiation therapy or other treatments that can prevent the cancer from spreading.

Navigation services offered to women who needed a test known as a biopsy had even more of a time advantage: Women in this study who needed a biopsy got a diagnosis in just 27 days if they received navigation. Similarly, women who did not get extra help in navigating the system found that it took a lot longer — an average of 58 days — to get a diagnosis of cancer.

"Navigators follow up with women and encourage them to go on for additional tests until they get an answer either one way or the other," Hoffman said, adding that many women feel overwhelmed or paralyzed by fear when they find a breast lump or get a mammogram with an abnormal result. "With help, many women are able to move forward to get the care they need," she said.

But this study also suggests that navigation services can also overcome other obstacles to care — such as the lack of health insurance. In fact, the team found that women without insurance who had the help of a navigator were significantly more likely to get a timely diagnosis compared to uninsured women who did not get navigation. Hoffman says uninsured women often have trouble finding health care providers who will treat them and they also face other barriers to care, including a lack of transportation to the clinic or childcare.

MEDICA.de; Source: School of Public Health and Health Services