ASBrS: Patient Navigator Program Increases Quality of Breast Cancer Care

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(ChemotherapyAdvisor) – Implementing a patient navigator program improved compliance with all 10 Breast Cancer Care Quality Indicators (BCCQI) examined in a retrospective cohort of patients with stage 1 to 3 breast cancer, with the greatest impact on patient preferences and inclusion in decision-making domain, according to a study presented at the 13th Annual Meeting of the American Society of Breast Surgeons (ASBrS), held May 2–6 in Phoenix, Arizona.

“Patient navigation programs were initiated to help guide patients through barriers in a complex cancer-care system,” noted Joseph Weber, MD, of East Carolina University, Brody School of Medicine, Greenville, NC, and colleagues. They analyzed impact of their patient navigator program on adherence to 10 of 36 BCCQIs associated with surgery, systemic adjuvant therapy, and respect of patient preferences and inclusion in decision-making domains of the National Initiative for Cancer Care Quality.

“Quality indicators deemed appropriate for analysis were those associated with overcoming barriers to treatment and those associated with providing health education and improving patient decision making,” he noted. Having a mammogram in the past 12 months was also examined.

A total of 134 consecutive patients treated between January 1, 2006, and December 31, 2006 — the year prior to initiation of the navigation program — were compared with 234 consecutive patients treated between January 1, 2008, and December 31, 2009; all were evaluated for BCCQI compliance. Non-invasive cancer was diagnosed in 65 patients in both groups.

Patients in the pre- and post-navigation groups had a similar age distribution, 59.7 years vs. 57.6 years, respectively (P=0.12), as well as a similar race distribution, 53% and 54% white, respectively (P=0.85).

“In all 10 BCCQIs evaluated, there was improvement in the percentage of patients in compliance with the quality indicator,” the investigators found. These indicators included:

  • Axillary node sampling performed
  • Completion of axillary node dissection in SN+ patients
  • Initiation of endocrine therapy in ER+ or PR+ disease
  • Receipt of chemotherapy in patients younger than 50 years of age with T2 and/or N+ disease
  • Initiation of chemotherapy in patients younger than 50 years of age with T2 and/or N+ disease within 8 weeks of last therapeutic surgery
  • Receipt of radiation therapy with breast conservation surgery (BCS)
  • Receipt of radiation therapy with mastectomy with +margin or T3 or N2
  • Patients with stage 1 to 3 disease informed about BCS if undergoing mastectomy
  • Patients with stage 1 to 2 informed of breast reconstruction option prior to mastectomy
  • Mammogram within previous 12 months

“Indicators associated with informed decision making and patient preference achieved statistical significance, while only completion axillary node dissection in sentinel node positive biopsies in the process of treatment achieved statistical significance.”

In a subset of patients, significantly more patients in the post-navigation group, 80.5%, had a mammogram within the past 12 months, compared with 53.5% of patients in the pre-navigation group (P=0.0001).

“The impact, if any, on relapse free and overall survival remains to be determined,” the investigators concluded.

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