Abstract PR12: Considering unintended effects of a colorectal cancer navigation program in a Federally Qualified Health Center in Chicago on mammography uptake
Authors: Miguel Yazmin San , Watson Karriem S. , Hobbs Keia , Winn Robert , Molina Yamile 
Published: February 2019

Introduction: Health care facilities often have competing public health priorities they must address, including different types of cancer. The burden of addressing these conditions is particularly great in Federally Qualified Health Centers, wherein marginalized populations suffer simultaneously from late-stage detection for various cancers. Patient navigation is an approach that has been documented to be effective across many of these cancers, including breast and colorectal (CRC). What is less known is if and how navigation for one site may influence patients' behaviors with regard to other cancer sites. Such information may be helpful for evaluating the benefits of different programs, and deciding which optimize patients' health maximally.

Methods: During January 2015 through December 2015, a patient navigation intervention was implemented for cancer screening in three of the health clinics: Main site, Englewood, and Back of the Yards site (BOTY). Starting in January 2016, a 1,453-patient chart review was completed using electronic health records. The criteria for the review are as follows: 1) age 50-5 years old and 2) scheduled for a provider visit at one of the three participating sites during the 12-month study period. Neighborhood characteristics were added to the dataset by combining it with the American Community Survey at the zip code level. The sample size for this analysis was n = 863. The independent variable was CRC navigation, with the following categories: none (REFERENT), mailed reminders, provider education, lay patient navigator (LPN), and combined interventions (including 2+ of the intervention types). The outcome variable was mammogram status with the following categories: adherent (receipt of screening within 2 years), nonadherent with a lifetime history of mammography, and nonadherent without a lifetime history of mammography. The analysis conducted was a polychotomous logistic regression model. The association was adjusted by age, race/ethnicity, percent poverty, and percent non-Latino White.

Results: The patient population had a mean age of 60.3. There was an average of 31.3% poverty in each zip code. 60% of the population were non-Latino Black. Latino represented 29% of the study population. Non-Latino White and other category consisted of 11% of the sample. The distribution of the insurance in the study population was as follows: private insurance made up 23% percent of the sample, public insurance represented 69% of the sample, and self-pay made up 8% of the population. Mammography status was associated with neighborhood poverty, %NLW residents, clinic site, and insurance status (all P &lt;.05). In terms of our main question, women receiving LPN (OR = 0.25, 95%CI: 0.08, 0.77) and women receiving mailed reminders (2.16, 95%CI: 1.02, 4.58) were associated with odds of being nonadherent with a lifetime history of mammography.

Conclusion: The results show certain colorectal interventions were associated with mammogram status. The navigation arm showed a protective effect against past-due mammograms if the patient was navigated by LPN. However, it was a risk factor for past-due mammogram for those in the mailed reminders arm. These results implicate that lay patient navigators may improve overall cancer-screening completion rates. This could be due to lay patient navigators' focus on overall patient health, and therefore emphasize the importance of all cancer screenings, whereas mailed reminders solely focus on colorectal cancer and thus do not affect other cancer-screening completion rates.

Citation Format: Yazmin San Miguel, Karriem S. Watson, Keia Hobbs, Robert Winn, Yamile Molina. Considering unintended effects of a colorectal cancer navigation program in a Federally Qualified Health Center in Chicago on mammography uptake [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr PR12.