Patient Navigation in Breast Cancer: A Systematic Review

Stephanie Robinson-White, MD; Brenna Conroy, BS; Kathleen H. Slavish, BA; Margaret Rosenzweig, PhD, APN-BC, AOCNP

Disclosures

Cancer Nurs. 2010;33(2):127-140. 

In This Article

Implications for Nursing

Disparities in healthcare access extend beyond race/ethnicity and sex and include age, socioeconomic status, disability, geographic location, and sexual orientation. One important consideration for nursing is the coordination of navigation services with ongoing care. A lay community member involved in counseling and coordination of services may add complexity to an already complex breast caner care plan. Nursing needs input into navigation training, evaluation, and development of care protocols to ensure that patients are provided accurate, streamlined, evidence-based care.

Future Issues

There are important considerations in the evaluation of patient navigation in breast cancer care. First, it appears that navigation is an effective encouragement for women to advance through breast cancer screening into further diagnostic evaluation and even into breast cancer treatment. More scientific rigor in navigation evaluation is necessary. Additional retrospective research quantifying the risk of diagnostic and treatment delay to specific breast cancer outcomes including survival is needed across the breast cancer treatment trajectory. These findings will likely validate the justification for the navigation role. The important question of breast cancer navigation efficacy in encouraging adherence to breast cancer treatment is unanswered.

In addition, although the results of patient navigation in cancer care are generally positive, the results need to be demarcated according to race, income, disease stage, and other important demographic characteristics so that the efficacy of patient navigation in breast cancer can be delineated according to specific population groups. Ongoing and future research will detail the roles of navigation throughout the breast cancer continuum and continue to strengthen research design for optimal evaluation and utilization of patient navigation programs.

Lastly, it is very important to note that the addition of the role of patient navigation in breast cancer does not adequately address the larger issues of cancer care disparity, complexity, and fragmentation of cancer care. Navigation is a "Band-Aid" rather than a solution to the larger healthcare issues, particularly lack of equal access in cancer care. In a 2001 report to the president, "Voices of a Broken System: Real People, Real Problems," Freeman and Reuben[44] acknowledged the value of the navigator role in cancer care by advocating for community-based programs, including patient navigator programs, that help people obtain cancer information, screening, treatment, and supportive services.[42] It appears that navigation is effective in encouraging appropriate breast cancer care in many diverse settings and for many populations. Further research should be encouraged.

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