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Navigators can help guide breast cancer patients through care

By Ronnie Cohen

NEW YORK (Reuters Health) - Patient navigators may be able to help steer women with breast cancer through what can be a daunting treatment process, a new study suggests.

Breast cancer kills a disproportionate share of low-income and African-American women, researchers note, and employing patient navigators is thought to be a potential way to assist underserved patients.

“There are a lot of barriers for patients who are poor and have a low health literacy. We’re really hoping that patient navigation is the solution,” said Dr. Naomi Ko, who led the study at Boston University School of Medicine.

Navigators can provide comfort, accompany patients to medical meetings, translate, map transit routes and repeat and explain complex medical recommendations.

“We really need to figure out why it helps and where it helps. And if we can do that right, we have the potential to help a lot of needy, vulnerable, low-income minority patients get the right and timely care,” Ko told Reuters Health.

She and her team examined the records of 1,288 racially diverse women diagnosed with breast cancer at eight centers across the U.S. Roughly half of the women were assigned navigators and the rest were not.

The researchers sought to determine whether women with navigators might be more likely to get guideline-recommended treatment. Based on women’s age and the type and size of their breast tumors, that treatment included anti-estrogen therapy, radiation or chemotherapy.

Participants eligible for anti-estrogen therapy had a 73 percent greater chance of getting that treatment when they had a navigator. That was after taking into account other potential differences between women, such as their age, ethnicity, language, insurance and treatment site.

The finding was particularly promising because poor, minority women can have low levels of use of anti-estrogen therapy, the authors write in the Journal of Clinical Oncology. The medication treats hormone-receptor-positive breast cancer by lowering estrogen levels and blocking estrogen’s ability to act on breast cancer cells.

Navigators, however, did not seem to influence whether women received radiation after breast-conserving surgery. And at the four sites where the authors could estimate the effect of navigators on chemotherapy, patients with navigators were less likely to get recommended chemo.

“We think patient navigation helps, but we don’t know where it helps and how it helps,” Ko said. “There are still a lot of questions.”

“Is (patient navigation) effective?” said biostatistician Donald Berry, from the MD Anderson Cancer Center in Houston, Texas. “If you just had to look at this study, you’d say, ‘I don’t know.’”

“But it can’t be bad,” added Berry. He was not involved in the new research.

Patient navigators in this study were funded by grants, Ko noted. Typically either grants or hospitals themselves cover the cost of navigators.

Dr. Michael Alvarado told Reuters Health he sees navigators help his low-income breast cancer patients at San Francisco’s county hospital.

“The navigators we have at San Francisco General are invaluable, an amazing resource for the patients,” he said. “They’re an objective bystander to help give information, to relay information, to get them to their next appointment. The patients love them.”

Alvarado is a surgeon at the University of California, San Francisco Medical Center and was not involved in the current study.

The number of options facing breast cancer patients and the amount of time and money needed to get appropriate care can be overwhelming, Alvarado said.

“Having options is such a wonderful thing. But at the same time, patients are pulling their hair out. It’s totally an information overload. They’re searching for people to give them an answer, and it’s complicated,” he said.

“In some of these situations, it can be daunting for patients to be in a clinic with doctors in white coats. To have a navigator as their friend, I think it gives them a lot of comfort. It makes a huge difference,” Alvarado said.

Some breast cancer treatments, such as radiation, require patients to make frequent visits to the hospital. The treatment exacts an especially heavy toll on mothers who must work to support their families, Ko said.

"For some women, they feel very anxious about losing their job," she said. Navigators can help by informing patients about their employment rights and about disability payments, for example.

Every day, five African-American women die of breast cancer because of a disparity in care, Ko noted.

“With the right support and encouragement and the right team,” she said, “I think we can do a lot for these patients.”

SOURCE: http://bit.ly/WN2SDs Journal of Clinical Oncology, online July 28, 2014.

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