Improving treatment adherence of breast cancer multimodal patients through patient navigation

Introduction: African American compared to white women in the U.S. are diagnosed with later stage breast cancer (BC), experience longer treatment delays, are less likely to receive/complete treatment according to recommended guidelines and have a 36% higher mortality rate. A Patient Navigation (PN) program can help patients overcome barriers to treatment adherence. As a Continuous Quality Improvement study at a large inner city cancer center hospital, this study documents the PN program's influence on compliance with two National Quality Forum (NQF) breast indicators: 1) chemotherapy discussed/administered for patients <70 years old (yo) with >1cm triple negative BC and 2) radiation therapy for patients <70 yo with Stage I-III BC treated with lumpectomy. Method: This cohort study consisted of 34 multimodal BC patients who were predominately low-income, African American, and referred to the PN program. PN services included phone support, home visits, appointment attendance, support groups and incentives. Data collection included demographics, preexisting health conditions, health risk behaviors, barriers to care and treatment recommendations. Patients were followed until treatment completion or failed compliance. Results: The standard of treatment (radiation and chemotherapy) compliance in 2006 was 74.4%, 75% respectively and the 2008 multimodal patients were 100%, 93% compliant, which was also higher than the 2008 overall BC patient adherence 95.8%, 93.7%. Conclusions: Higher rates of treatment adherence were obtained with the assistance of a PN program in at-risk, multimodal patients. These findings demonstrate the importance of PN program in eliminating barriers and disparities in the treatment of African American, multimodal BC patients.