Abstract PR13: Availability of Patient Navigation Services at NCI Community Oncology Research Program (NCORP) Community Sites
Authors: Weaver Kathryn E. , Gansauer Lucy , Pajewski Nicholas M. , Castro Kathleen , Carlos Ruth , Das Irene Prabhu , Ford Marvella E. , Geiger Ann M. 
Published: March 2017

Purpose: Patient navigation, support and guidance provided by trained culturally sensitive health care workers, has been promoted as a strategy to improve care quality and reduce cancer health disparities. Yet, the availability and extent of navigation in community oncology practices is unclear. The purpose of this analysis was to assess: 1) availability of navigation services across diverse community oncology practices and 2) characteristics of oncology practices that do and do not offer navigation.

Methods: Community oncology practices were surveyed regarding availability of cancer navigation services, cancer types served, and presence of lay and nurse navigators, as part of a larger survey of cancer care delivery research (CCDR) capacity of NCI Community Oncology Research Program (NCORP) sites. CCDR leads at practices reported navigation data, along with other information about the site.

Results: We collected data from 350 of 401 CCDR-designated NCORP oncology sites, representing 201 adult practices. The majority of the practices included a hospital-based outpatient clinic (73.6%) and were multi-specialty (76.6%). 15.9% were designated by NCORP as minority and underserved community sites and 14.4% self-identified as a safety net hospital. Navigation services were not available to cancer patients at 20.0% of practices; 45.2% of practices provided navigation to all patients and 34.8% provided it to some oncology patients. Larger practices were more likely to provide navigation to some or all patients (vs none); ORs for 5-9, 10-17, and 18+ providers (vs 1-4 providers), respectively, were 6.1, 8.9, and 3.3 (all p&lt;. 05). Other significant predictors included multidisciplinary vs single discipline practice (OR=7.7, 95% CI 3.5-16.8), and having a hospital-based outpatient clinic (OR=4.1, 95% CI 2.0-8.6). Minority and underserved community sites were not significantly more likely to offer navigation to oncology patients (OR= 0.83, 95%CI 0.3-2.1), but if they did, they were more likely to offer it to all (vs some) patients (OR=2.9, 95%CI 1.1-7.6). Practices that were part of large regional/multisite networks with (OR= 0.4, 95% CI 0.2-0.9) or without (OR= 0.3, 95% CI 0.1-0.9) a health care plan tended to be less likely than smaller single or small regional practices to offer navigation to all patients. Nurse navigators were available at 82.6% of practices and lay navigators were available at 24.3% of sites. Navigation was most commonly provided to breast cancer patients (78.5%), followed by lung cancer (68.9%); other cancer types ranged from 53.5-63.6% of sites. Navigation was less likely to be provided prior to screening and after completion of treatment, than from screening to diagnostic resolution and during treatment.

Conclusions: Navigation is available in some capacity in a majority of community oncology practices, but variation exists in cancer types covered and integration in the care continuum. Details regarding what specific navigation activities were provided and impact on cancer disparities are not known. Practices designated as serving a larger proportion of minority and underserved patients were more likely to provide navigation to all patients, if they offered it. The widespread availability of navigation in NCORP community sites provides opportunities for observational and intervention studies to assess the impact of navigation on cancer outcomes.

Citation Format: Kathryn E. Weaver, Lucy Gansauer, Nicholas M. Pajewski, Kathleen Castro, Ruth Carlos, Irene Prabhu Das, Marvella E. Ford, Ann M. Geiger. Availability of Patient Navigation Services at NCI Community Oncology Research Program (NCORP) Community Sites. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR13.