Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

Abstract

Background: This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities.

Methods: Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models.

Results: Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I² = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I² = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I² = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I² = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality.

Conclusions: In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.

Keywords: cancer screening; health disparity; health equity; patient navigation; prevention.

Fig. 1

Meta-analysis of randomized controlled trials of the effect of patient navigation on colorectal cancer screening rates. AA, African American; AAM, African-American men; Fil, Filipino American; Haw, Native Hawaiian; His, Hispanic/Latino; LI, low income; LIHis, Hispanic/Latino low income; LIR, low-income racial/ethnic minority; LIW, low-income women; Viet, Vietnamese American; Colo, colonoscopy; Endo, endoscopy (colonoscopy and flexible sigmoidoscopy); FIT, fecal immunohistochemistry test; FOBT, fecal occult blood test.

Fig. 2

Meta-analysis of randomized controlled trials of the effect of patient navigation on breast cancer screening rates. AA, African American; AALI, African American low income; Fil, Filipino American; Haw, Native Hawaiian; LI, low income; LIRE, low-income racial/ethnic minority; RAA, rural African American.