Abstract P1-09-20: Patient navigation significantly improves vulnerability score after breast cancer. A pilot experience in an underprivileged community
Authors: Zelek L , Festa A , Morin N , Bodere C , Morere J-F , Boubaya M , Levy V 
Published: August 2014

BACKGROUND: We decided to evaluate the effect of patient navigation in an area (Seine-Saint-Denis, SSD) with an estimated population of 1.4 billion, which is among the poorest in France. Median household income is 68% lower than in Paris (+68%), a gap growing with time. In SSD, cancer is the leading cause of premature mortality. Whereas it is widely admitted in France that 25% of patients are faced with financial difficulties after breast cancer, this proportion reaches 40% in SSD.

PATIENTS AND METHODS: Oncologie 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring precarity, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score &gt;30 and considered as severe when &gt;40. In SSD two thirds of the population are affected by vulnerability. Patients included in the navigation program were scored after cancer diagnosis (E1) and 1 year after the beginning of cancer therapy (E2). Psychosocial comorbidities, demographic data, and treatments received were also recorded.

RESULTS: Over a 1-year period 74 breast cancer patients were included and had E1 and E2 scores, detail of therapy was available for 64 pts. The score significantly improved for the whole population (p = 0.04) but worsened in 23 pts (31%). Among all the variables studied, undergoing surgery was the only one to be significantly correlated with outcome. However, surprisingly, patients who did not undergo surgery had a significantly better evolution of the score than those who did (p = 0.04). E1 score was lower in patients eligible for surgery.

Evolution of median vulnerability score before (E1) and after (E2) breast cancer therapy, first and third quartiles (Q1-Q3) and minimal-maximal values. n =E1Q1-Q3min-maxE2Q1-Q3min-maxwhole population7439.615.8-63.53.17-92.232.87.1-45.81.6-92.1no surgery2447.925.8-57.83.17-75.115.13.6-40.22.7-78.7surgery403714.5-63.93.17-92.233.48-47.31.6-92.9

CONCLUSION: We showed that patient navigation significantly improves vulnerability score during cancer therapy. It emphasizes the importance of evaluating deprivation with standardized tools in cancer patients in order to propose appropriate interventions. The only factor correlated with the evolution of the score is surgery. Patients that were not eligible for surgery had higher E1 score but significantly better evolution during the following year. We hypothesize that deprivation leads to more advanced tumors or is associated with comorbidities contraindicating breast surgery. For unclear reasons, the magnitude of the benefit seems greater in this population. About one third of patients experience worsening of the vulnerability after breast cancer therapy and the underlying mechanisms remain to be determined.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-20.