Patient ‘Navigators’ Boost Cancer Screening in Hard-to-Reach Groups

In study, program staffers successfully contacted and guided patients who’d previously faced roadblocks to testing

Cancer screening can save lives, but not everyone can easily avail themselves of mammograms, colonoscopies and other tests.

Now, a new study finds that in particularly tough-to-reach populations, trained “patient navigators” can remind individuals about the importance of screening – and get more of them to needed tests.

The study was led by Dr. Sanja Percac-Lima, physician leader for cancer outreach at the Massachusetts General Hospital’s Center for Community Health Improvement in Boston.

Her team found that patient navigator programs nearly doubled the number of “at-risk” individuals who received cancer screening, compared to usual care.

“Patient navigators provide a critical bridge between patients and caregivers that enhances and improves care,” Percac-Lima said in an MGH news release. “By employing these types of tactics, we can address critical health disparities for at-risk communities.”

Reporting recently in JAMA Internal Medicine, the Boston team described patient navigators as well trained staff that, “assist patients in accessing care and guide them through the health care system, helping them overcome identified individual barriers.”

The new research focused on people who in the past had faced barriers to obtaining screens for breast, colon and cervical cancers.

For example, patients had prior histories of missed care appointments or overdue tests, or barriers around language. 

Using a special computer algorithm, Percac-Lima’s team identified a group of more than 1,600 people, averaging 57 years of age, who’d already encountered obstacles such as these. The patients came from 18 primary care clinics throughout the MGH network.

About half were randomly assigned to a patient navigator who would speak their language and provide “intense” outreach and guidance. This included one-on-one interviews with patients, reminder phone calls, help with transportation to screening appointments, assistance with screening prep, and accompanying a patient to screening if needed. 

The other half received usual care, consisting of reminder letters.

The result: Among patients guided by a patient navigator, nearly a third (32 percent) got at least one overdue cancer screening, compared to just 18 percent in the “control” group.

In each screening category – breast, colon and cervical cancers – more of these hard-to-reach patients underwent screening compared to those in usual care.

However, the Boston researchers stressed that a typical patient navigator program doesn’t come cheap, with an average annual cost of $100,000 for an intervention such as the one they employed. That’s why it’s important that navigator programs focus on patients who face barriers that would otherwise block their access to screening, the investigators said.

Dr. Richard Wender is Chief Cancer Control Officer at the American Cancer Society. In a commentary accompanying the study, he agreed that cost will be an issue in implementing patient navigator programs, but the new study “moves us closer to a final conclusion that [these programs are] efficacious.”

More study is needed, in more varied populations, Wender added. However, he believes that, “until we have a more cost-effective approach, patient navigators are necessary to increase screening rates in individuals at high risk for nonadherence.”