Abstract IA05: A GPS for cancer care: How patient navigation engages Latinos in preventing and reducing health disparities
Authors: Ramirez Amelie G. 
Published: May 2016

Abstract
Purpose: U.S. Latinos have higher rates of liver, cervical, and other cancers, have lower cancer screening rates, and are diagnosed at more advanced, less treatable cancer stages than non-Latinos. Community-based participatory research (CBPR) and patient navigation (PN) are emerging ways to tackle these grave disparities. Patient navigation is a means for providing access to recommended cancer screening services, follow-up, diagnosis, and treatment in medically underserved populations.
Methods: Over several years, several CBPR-based PN programs and interventions have been implemented and evaluated among Latino cancer patients by the Institute for Health Promotion Research (IHPR) at the UT Health Science Center at San Antonio. Each of these IHPR projects starts with a community advisory group that identifies and assesses cancer health issues and needs. Based on that input, navigators from the community are selected and trained to help navigate underserved people through the complex care system and other barriers to care (finances, transit, child care, language, culture, etc.). The goal is to help reduce missed appointments, reduce delays in seeking care, increase follow-up care, and cover the entire ecological framework. The IHPR's main PN program is the Redes En Acción Six Cities Study, which was funded by the National Cancer Institute. The Six Cities Study formed a community advisory group, conducted a needs assessment, developed a PN program for minorities, and tested it in the Six Cities quasi-experimental study to evaluate the impact of patient navigation on Latinas' time from an abnormal mammogram to confirmatory breast cancer diagnosis and to initiation of treatment (within 30 and 60 days). The study recruited 425 women (208 navigated, 217 non-navigated controls).
Results: The Redes En Acción Six Cities Study recruited 425 women (208 navigated; 217 non-navigated controls). Overall, navigated women achieved timely diagnosis significantly faster than non-navigated women. We also found that navigated women were much more likely (nearly 1.5x more likely) to initiate treatment tan non-navigated women. The PN activities most associated with treatment initiation were: accompaniment, transportation, telephone support, language, and system intervention.
Conclusions: We suspect, based on evidence from other large studies of the rate of breast cancer growth and spread, that our CBPR-based PN intervention saved lives. Based on this success, the IHPR and Redes team has gone on to test PN in other studies: one hypothesizing that Latino breast, prostate, and colorectal cancer survivors who get an innovative navigation intervention (vs. usual care) will show greater compliance in following prescribed treatments and improved general and cancer-specific quality of life; one to teach breast cancer survivors how certain foods may reduce the risk of breast cancer recurrence as well as the risk of developing other cancers; and the creation of the Patient Navigator Manual: Developing and Implementing a Patient Navigator Program manual to outline the necessary steps and provides tools to incorporate navigation for Latinos at any organization.
Citation Format: Amelie G. Ramirez. A GPS for cancer care: How patient navigation engages Latinos in preventing and reducing health disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA05.