Abstract A122: Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability
Authors: Tergas Ana , Mercurio Annette , Cai Lauren , Gaytan Lorena , Razavi Marianne , Lefkowitz Deborah , Kim Chrissy , Hernandez Terry , Morales Steven , Dale William , Nonzee Narissa 
Published: December 2023

Background:   The rapidly growing population of older adults and racial/ethnic minorities with cancer necessitates innovative patient navigation strategies to address their unique needs. Our Enhanced Vulnerable Elders Navigation (EVEN) Program aims to increase the capacity to deliver high-quality, evidence-based oncology patient navigation services at a comprehensive cancer center, with the goal of improving equity in cancer care delivery.  Methods: Based on a comprehensive needs assessment, the EVEN Program comprises three main domains: health information technology infrastructure enhancements, navigation workflow standardization, and stakeholder engagement. The primary outcome measure is time to treatment initiation. A quasi-experimental design compares outcomes of older adults with cancer who receive enhanced navigation during the implementation period to outcomes of historical controls (matched by age, race, and ethnicity) who received standard navigation during the lead-in "pre-implementation" period. We hypothesize that the EVEN Program will improve the timeliness of cancer treatment initiation among vulnerable older adults. Univariate and multivariable analyses using cox regression models will adjust for patient and health system factors. Logistic regression will assess the likelihood of treatment delay between the standard navigation and EVEN groups. Process metrics across multiple domains will be analyzed at 6-month intervals over 2 years. Qualitative interviews with program stakeholders will provide nearly real-time feedback on program implementation.  Baseline Data Approximately half of newly diagnosed cancer patients (N&gt;3000) seen at our institution's main campus in 2021 received navigation services, and at least half of those patients are estimated to be 65+. Patient navigators addressed language/communication barriers (17% of navigated patients) and social determinants of health (15%); they facilitated communication and emotional support (45%) and routinely made referrals to clinical care team members (39%) and for resource coordination (37%), such as interpreters, social work, financial counseling, and external resources. Most navigator contacts were in person (61%), followed by phone calls (34%). We found wide variation in time to initial cancer treatment across cancers, suggesting opportunities for improvement in care coordination. Conclusion: Our multi-component enhanced patient navigation program is conceptually grounded, innovative, with the potential to reduce cancer disparities among older adults from vulnerable populations. Our multidisciplinary project team includes expertise in geriatric oncology, implementation of patient navigator programs, health equity, community partnerships, and patient navigators with over 30 years of experience in compassionate coordination of cancer care. If proven feasible and effective, the EVEN Program has the potential to scale to our entire enterprise, other health delivery systems nationally, and long-term, to improve equitable cancer care for underserved older adults with cancer.

Citation Format: Ana Tergas, Annette Mercurio, Lauren Cai, Lorena Gaytan, Marianne Razavi, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, William Dale, Narissa Nonzee. Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A122.