Impact of neighborhoods and navigation on survivorship
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Title: Impact of neighborhoods and navigation on survivorship. Background: Due to advances in breast cancer screening and care, the number of survivors in the United States is increasing. However, survivorship outcomes (e.g., survival, quality of life) continue to be lower among women of color and low-socioeconomic status. Researchers are just beginning to study how neighborhood factors, such as how walkable and connected the streets are or the racial/ethnic mix of neighbors, might partly explain why these survivorship differences persist for certain communities. As early findings show that neighborhood factors shape cancer outcomes, providers are encouraged to take into account these factors when developing treatment and survivorship plans with their patients. While patient navigation (PN) is widely accepted as an effective intervention to help women overcome barriers as they go from screening to diagnosis, including those they face within their neighborhoods, we know very little about how PN influences survivorship, if at all. We also do not know how navigators attend to neighborhood factors when working with women who live in or frequent areas with features associated with poor cancer survivorship outcomes. This collaboration between the Cancer Prevention Institute of California (CPIC) and Shanti�s Margot Murphy Women�s Cancer Program (Shanti) seeks to fill these gaps in knowledge and recommend actions. Research Questions: 1) Are survivorship outcomes different for breast cancer patients who have received navigation services compared to patients who have not? 2) Do neighborhood factors influence how care navigation is delivered (i.e., does number of contacts or duration of navigation vary by neighborhood characteristics)? And 3) Can navigation help address neighborhood factors that influence survivorship outcomes? Aims: 1) Link distinct sources of data about survivors, including information about their neighborhoods, treatments, survival and quality of life that will enable us to examine how navigation impacts survivorship. 2) Examine associations between neighborhood and quality of life to inform the development of neighborhood assessment tools to help care navigators better tailor their services. 3) Strengthen the partnership between CPIC and Shanti, as well as the internal capacity of each partner to conduct research with and for vulnerable communities through this and future studies. Methods: This pilot study will link 3 existing resources to build a unique dataset that helps us understand the impact of neighborhood factors and navigation on survivorship outcomes: 1) community data of over 1200 breast cancer clients receiving care navigation services at Shanti, 2) patient-level clinical data from Greater Bay Area Cancer Registry, and 3) data from the California Neighborhoods Data System. Together, this data will be used to identify neighborhood factors associated with quality of life among Shanti clients and conduct focus groups with navigators and clients to better understand their experience of these factors and recommend strategies to address barriers. We will also review existing tools that address neighborhood barriers impacting care and survivorship, culminating in the development of a new assessment tool to improve navigation and survivorship. Innovative elements: Researchers and providers are constantly collecting new personal and clinical data from patients, however much of that data remains inaccessible to the community because of how it is gathered and stored, or it remains incomplete because it has not been validated by the community. Our project is innovative in how we build upon what we already know: how we will mine, link and validate community, surveillance, and neighborhood data, and use that to develop tools and techniques to strengthen existing navigation programs in light of the growing body of research that links neighborhood factors to survivorship. Community involvement: Shanti care navigators and their clients regularly attend breast cancer conferences. Upon learning that the environment can profoundly affect a woman�s experience with cancer, Shanti staff reached out to CPIC researchers for help in understanding how these findings were reflected in Shanti clients� experiences and to sharpen care navigation services. For this pilot, Shanti�s Client Advisory Board and other clients will participate as consultants, community liaisons, and focus group participants. Their experiences will inform the iterative design of the project, on-going data analysis, the development of neighborhood assessment tools, dissemination of our findings and future plans. Future Plans: The success of this pilot project will form the foundation for future studies to deepen our understanding of the impact of navigation on breast cancer survivorship, and to develop intervention strategies and tools to address neighborhood factors in breast cancer treatment and survivorship planning.