SAN FRANCISCO — Implementing effective patient navigation programs is key to mitigating radiation therapy treatment disparities — both racial and socioeconomic — according to presentations delivered September 28 at the American Society for Radiation Oncology (ASTRO) meeting.
“Patients are lost and need to be navigated,” said presenter and radiation oncologist Christina Chapman, MD, of Baylor College of Medicine in Houston. “We’ve built a [cancer treatment] road with no signs — or we hung signs, but then passed anti-literacy laws. Patient navigation is necessary, owed, and [a form of reparation].”
Chapman outlined reasons for discrepancies in breast cancer care for Black women, noting that these women have higher mortality rates from the disease.
“Because Black women are more likely to die of breast cancer, there’s a larger [stage shift] benefit to earlier screening,” she said. “So if you start screening black women at 40, the benefit to harm ratio is the same as that for screening white women at 50.”
Christina Chapman, MD
She also noted that studies have shown that Black, Asian, and Hispanic women are less likely to return to screening after receiving a false positive — the incidence of which can increase if screening starts earlier — making patient navigation even more important.
And successful patient navigation benefits everyone, Chapman noted.
“Doing things for excluded populations doesn’t need to benefit everyone, but when you do [establish programs] for excluded [groups] it often does,” she said.
Trained navigators needed
In another presentation, Matthew Manning, MD, of Cone Health in Greensboro, NC, outlined results from the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) trial, explaining that the research was conducted over the course of five years and included nurse navigators “trained in race-specific barriers with special training regarding trust [and] culturally appropriate communication.” The ACCURE study found that patient navigation improved five-year breast cancer survival rates among both Black and white women:
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ACCURE study results on the effects of patient navigation on five-year breast cancer survival rate |
|||
|
Population |
Years |
5-year observed survival rate |
P-value |
| Black women |
2007 to 2011 |
79.8% |
— |
|
2013 to 2015 |
88.4% |
0.04 |
|
| White women |
2007 to 2011 |
87.3% |
— |
|
2013 to 2015 |
89.4% |
0.02 |
|
Manning also underscored that improving cancer outcomes benefits everyone.
“This study shows that the implementation of systems change can eliminate racial disparities in treatment completion and cancer survival while improving survival for all,” he concluded.
Matthew Manning, MD
Short RT plus navigation improves outcomes
Finally, Shearwood McClelland, MD, of the University of Oklahoma in Oklahoma City, discussed how RT is “a mainstay of cancer care, significantly improving outcomes across multiple disease sites.”
“Failure of timely receipt of RT not only results in substandard care, but may harm survival,” he said. “Unfortunately, disparities in equitable RT access continue to persist.”
McClelland noted that hypofractionation protocols can help patients complete treatment. He described a patient navigator model that he created with colleagues called Navigator-Assisted Hypofractionation (NAVAH). Under the auspices of the program, McClelland and colleagues have conducted a number of studies with cohorts of Black women with breast cancer that, in early results, show improvement in completion of treatment and patient satisfaction with the navigation process.
“The natural progression of this work is to expand this model to include additional breast cancer populations most vulnerable to suffering suboptimal RT access,” he said. “Further progression involves formal clinical trial investigation towards actively addressing barriers in receipt of RT.”