Randomized controlled trial of patient navigation for colorectal cancer screening and cancer-related risk, worry in Latino Medicare beneficiaries

Patient navigation (PN) guides individuals through and around barriers that impede access to appropriate prevention, early detection, diagnosis, treatment, survivorship and end-of-life care. However, more evidence is needed to understand the effectiveness of PN in addressing disparities in cancer outcomes. This study, conducted as part of CMS' multicenter Cancer Prevention and Treatment Demonstration project, aimed to measure the effect of individualized PN, compared to standard printed colorectal cancer (CRC) education materials, on CRC screening behaviors and cancer-related risk and worry among Latino Medicare fee-for-service beneficiaries in Houston, Texas. We recruited/randomly assigned participants who had no cancer diagnosis within 5+ years of the study to PN (n=1,044) or control group (n=1,040) groups. Screening behaviors (FOBT within 2 years; colonoscopy/sigmoidoscopy within 5 years) and cancer-related risk and worry were measured at baseline (T1) and upon completion of the study (T2). The majority of participants were Latino (99.4%); born outside of the U.S. (45.1%); primarily Spanish-speaking (50.0%); female (59.3%); educated at less than a high school level (60.0%); and living in households with incomes of less than $20,000 annually (57.0%). At T1 and T2, no differences in CRC screening were found between groups, controlling for relevant patient characteristics. Participants receiving PN had lower mean cancer-related risk and worry at baseline, but no differences were found at T2. Among a sample of Latino Medicare beneficiaries, PN had no differential effect on CRC screening behaviors. Secondary analyses, however, suggest that PN may help to address cancer-related risk and worry in this population.