Abstract PO-077: Impact of COVID-19 on patient navigation for cancer treatment
Authors: Percac-Lima Sanja , Warner Erica T. , Whited Emma C. , Irwin Kelly E. , Navarrete Aileen , Benjamin Carmen , Pichardo Ausubel R. , Friese Christopher R. , Ford Colleen , Wheeler Amy E. , Morrill James , Moy Beverly 
Published: December 2020

Abstract
Patient navigation has been shown to improve cancer care in underserved populations. Since November 2017, we have enrolled newly diagnosed cancer patients from three community health centers into a patient navigation study. Most of our patients receive primary care in Chelsea, a city that had the highest rate of COVID-19 infection in Massachusetts. The goal of this analysis was to explore the impact of COVID-19 on patient navigation and care utilization during active cancer treatment. Methods: Our analysis examined two time periods: prior to the COVID-19 pandemic in Massachusetts (November 2017 – February 2020) and during the pandemic (March – June 2020). We used bivariate Poisson regression to examine whether the number of patients per month recruited to our study, or the number of patient navigators’ interventions per month differed between these periods. We used chi-square tests to compare the proportion of cancer treatment appointments completed, missed (no shows), or cancelled prior to and during the COVID-19 pandemic. Attended appointment rate was defined as completed appointments of scheduled (including cancelled) appointments. Results: Of 201 patients enrolled, 47% were women, 27% self-identified as Hispanic or Latino, 7% as Black or African American, 3% as Asian, 20% as other and 30% did not speak English. Prior to COVID- 19, 178 patients (6.36/per month) enrolled in patient navigation compared to 23 (5.75/per month) during COVID-19 (p=0.65). Prior to COVID-19, 3425 of 4040 (84.8%) total appointments were attended compared to 391 of 511 (76.5%) during COVID-19 (p&lt;0.0001). Prior to COVID-19, there were 115 missed appointments (2.9%) compared to 15 missed appointments (2.9%) during COVID-19 (p=0.91). Prior to COVID-19, 500 appointments were cancelled (12.4%) compared to 105 appointments (20.6%) during COVID-19 (p&lt;0.0001). Total number of navigators’ interventions prior to COVID-19 was 1846 (65.9/per month) compared to 650 (162.5/per month) during COVID-19 (p&lt;0.0001). Conclusion: Underserved cancer patients successfully enrolled into a patient navigation program during the COVID-19 pandemic at rates similar to prior to COVID-19. During COVID-19, the proportion of attended appointments dropped, due to more cancelled appointments (likely both institution and patient driven). Although navigators could not provide in-person navigation during COVID- 19, they performed substantially more interventions per month. There was no change in rate of missed appointments with only 2.9% of cancer appointments missed during COVID-19 suggesting that navigation during COVID-19 was effective in reducing missed appointments in a patient population including underserved communities at the epicenter of the COVID-19 pandemic. Patient navigation may be a promising strategy to ensure cancer care for underserved patients during public health crises such as COVID-19.
Citation Format: Sanja Percac-Lima, Erica T. Warner, Emma C. Whited, Kelly E. Irwin, Aileen Navarrete, Carmen Benjamin, Ausubel R. Pichardo, Christopher R. Friese, Colleen Ford, Amy E. Wheeler, James Morrill, Beverly Moy. Impact of COVID-19 on patient navigation for cancer treatment [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-077.