Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations

Although there is a growing number of people living with advanced or metastatic cancer, primarily because of more effective treatment regimens, there are limited estimates of the actual number of people living with advanced or metastatic cancer. Many people will have treatable but not curable cancers, may have survival measured in years, and may have periods on and off therapy. People with advanced or metastatic disease, as well as their families and caregivers, may experience significant unmet needs, overlapping yet distinct to those with potentially curable cancer. Recently, the Multinational Association of Supportive Care in Cancer and ASCO developed standards and practice recommendations relevant to the delivery of quality survivorship care for people living with advanced or metastatic cancer. The recommendations included seven domains: (1) person-centered care; (2) coordinated and integrated care; (3) evidence-based and comprehensive care; (4) evaluated and communicated care; (5) accessible and equitable care; (6) sustainable and resourced care; and (7) research and data-driven care. Immediate priorities to improve clinical care include focusing on (1) discussions regarding prognosis and goals of care; (2) routinely assessing physical, psychological, and social unmet needs with referral to appropriate supportive care services; and (3) creating blended models of care, incorporating elements of palliative care and survivorship services. Additional areas for focus include (1) advocacy and policy; (2) system design and health care delivery; (3) defining, measuring, and managing quality; (4) addressing inequity; and (5) research specifically focused on these cancer populations.

Characteristics of interventions aimed at reducing inequalities along the cancer continuum: A scoping review

Cancer inequalities are wide and enduring, within countries between socio-demographic groups and between countries. These are generated and sustained throughout the key phases of the cancer pathway, from investigation, clinical assessment, decision and access to treatment, and follow-up care. We aimed to describe the characteristics of implemented interventions, evaluated in published controlled experiments in the medical literature, specifically designed to target reductions in inequalities along the cancer pathway. We searched the Ovid Medline and Embase databases from January 2005 to April 2024 for controlled experiments reporting on interventions tackling inequalities. We extracted information on the publication, the aim and type of intervention, its setting, the characteristics of the sample and of the interventions, and summarised their results and limitations. We identified 56 articles reporting on 57 interventions. Of these, 51 (89.5%) focused on access to screening; 56 (98.2%) focused on colorectal, breast, and cervical cancers; 37 (64.9%) concentrated on ethnic inequalities and 48 (84.2%) were based in the USA. In addition, the majority of interventions sought to change individual knowledge, beliefs, and behaviour rather than issues at the system-level. The importance of addressing how healthcare is delivered equitably to all individuals is widely recognised, and there is evidence that individual factors account for only a small part of cancer pathway inequalities. Yet, this scoping review reports a lack of diversity in the implementation of interventions addressing cancer inequalities, and a minority of them target health system issues.

Enhancing Cancer Patient Navigation: Lessons from an Evaluation of Navigation Services in Alberta, Canada

Cancer patient navigation has emerged as a patient-centric intervention enabling equitable cancer care, by mitigating barriers patients encounter throughout their cancer journey. Cancer Care Alberta (CCA) implemented a professional navigation model over a decade ago and commissioned a program evaluation in response to evolving operational demands. The objectives were (1) to better understand the current state of CCA's cancer patient navigation program; (2) to explore the need for other specialized streams; and (3) to provide key recommendations to strengthen and grow the program. A mixed methods approach, including a survey, administrative data, and semi-structured interviews, captured patient-, staff-, and system-level insights. Findings revealed difficulties in identifying complex patients needing navigation, along with inconsistencies regarding intake practices, program awareness, referral pathways, standardized workflows, and a lack of programmatic supports, which contributed to variability in service delivery. A need for enhanced palliative navigation support also emerged. Approximately 25% of surveyed patients reported being unable to access perceived needed support before their first oncology consultation. These findings underscore the importance of early, targeted navigation for equity-deserving populations. Recommendations include harmonizing program structure, refining navigator roles, expanding navigation streams, standardizing processes, and enhancing equity-focused competencies. These findings offer a roadmap with which to improve person-centered cancer care.

Diagnosis of cancer in the South and North of Nigeria: duration and causes of delay

INTRODUCTION

Nigeria has a growing cancer burden, with late presentation and delayed diagnosis contributing to poor outcomes. We explored the durations and causes of the delay in the diagnosis of four common and treatable cancer types (breast, colorectum, head and neck, and uterine cervix) in Nigeria.

METHODS

Retrospective study based on interviews with cancer patients following the Aarhus framework for designing and reporting such studies. The study focused on the first two of WHO's three main designated stages of cancer diagnosis: duration from symptom to presentation and presentation to histological diagnosis. Our hospital-based study involved 264 patients recruited from tertiary care facilities in the Northwestern (Kano) and Southwestern (Ibadan) regions of Nigeria. We obtained quantitative data to measure the duration of delay by stage, while interview data were collected to explore the causes of delay. We analysed the data by computing the median duration for the two stages of delay, and framework analysis was used to identify themes on the causes of delay.

RESULTS

The median time to receive a cancer diagnosis after noticing the first symptoms was 12 months (interquartile range 5 to 27 months), with head and neck cancer patients reporting the most prolonged (15-month) delay. Patients waited a median of 3 months (interquartile range 12 months) before presenting their first cancer symptom to a healthcare professional. The median time for patients to receive a cancer diagnosis after the first presentation of symptoms to a formal healthcare professional was 5 months (interquartile range 12 months). There was wide variance for all time intervals. Patients reported visiting a median of 3 health facilities before diagnosis in a formal hospital setting. Qualitative findings identified two main reasons patients reported delays in cancer pathway to care: patient-related factors and health system issues.

CONCLUSION

Long delays were observed, and more than half the delay followed presentation to the local health sector.

Challenges oncologists face when caring for hispanics living in puerto rico with colorectal cancer and multiple chronic conditions

BACKGROUND

Colorectal cancer (CRC) is the leading cause of cancer-related death in Puerto Rico, posing significant challenges for patients with multiple chronic conditions (MCC). This qualitative study aimed to explore oncologists' perspectives regarding the care of patients with CRC and MCC in Puerto Rico.

METHODS

We conducted semi-structured interviews in Spanish with nine oncologists providing care for patients with CRC in Puerto Rico. We reached data saturation. We performed thematic analysis to identify key patterns and themes within the interview data. The coding scheme evolved through team discussions, with discrepancies addressed for consistency. Quotes were translated from Spanish to English.

RESULTS

Five key themes were: (1) social determinants of health, (2) diagnosis pathways, (3) factors influencing treatment decisions, (4) survivorship and end-of-life care, and (5) care coordination and communication. Oncologists treating patients with CRC and MCC identified the lack of a social support network as a notable care coordination challenge. The health insurance system's pre-authorization requirements for procedures and treatments further complicated care delivery, particularly for older adults, who faced challenges navigating these administrative processes without sufficient support. A lack of transportation and local specialized care services was a noted barrier to comprehensive patient care. Communication between patients, physician and caregivers proved challenging when multiple physicians and procedures were involved with patient's care, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication primarily relied on phone calls or notes sent with the patient.

CONCLUSIONS

Oncologists caring for Hispanic older adults with CRC and MCC encounter complex challenges influenced by unmet social needs and the presence of comorbidities. Tailored approaches, culturally sensitive care, and improved coordination among physicians are vital to enhance the quality of care for this patient population.

Effectiveness of transitional care interventions in patients with serious illness and their caregivers: a systematic review and metanalysis of randomized controlled trial

BACKGROUND

Patients with serious illnesses require continuous care from professionals in multiple settings. The care transition interventions aim to promote the safe and timely transfer of patient care across settings through several components including discharge planning, post-discharge communication, and patient/caregiver education on self-management. Despite the reported evidence on transitional care interventions, little is known about their effectiveness for seriously ill patients and their caregivers and for those receiving or needing palliative care.

OBJECTIVE

Assess the effectiveness of transitional care interventions for outcomes related to seriously ill patients and their caregivers.

METHODS

A systematic review was conducted following the PRISMA and JBI guidelines. The search was conducted on MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials up to February 2024. Primary outcomes included mortality and/or survival, symptoms, functional status, caregiver burden, and health-related quality of life. Critical appraisal was performed using the JBI checklist. Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

We included 16 studies with 3781 participants. The pooled results of mortality and functional status did not show differences between transitional care and standard of care. Meta-analyses on quality of life (SMD = 0.20, 95% CI 0.08 to 0.33; I2 = 42%; p = 0.09, low certainty of evidence) and symptoms (SMD = -0.39, 95% CI -0.74 to -0.04; I2 = 77.5%; p < 0.01, very low certainty of evidence) suggest a small to moderate improvement for patients receiving transitional care interventions. Concerning caregiver burden, studies showed no difference between transitional care within a palliative care approach versus standard of care (SMD = -0.48, 95% CI -1.03 to 0.07; I2 = 60%; p = 0.11, low certainty of evidence).

CONCLUSIONS

Transitional care interventions can improve quality of life and symptoms, although based on low or very low certainty of evidence. Subgroup analysis suggests that transitional care intervention for those receiving palliative care improves quality of life and symptoms. Further research should increase the robustness of evidence on the effectiveness of transitional care interventions in seriously ill patients.

REGISTRATION NUMBER

PROSPERO CRD42022319848.

Barriers to and Facilitators of a Novel Preprofessional Patient Navigation Program in Surgery

INTRODUCTION

Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.

METHODS

A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.

RESULTS

Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.

CONCLUSIONS

Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations.

Enhancing emergency obstetric care navigation through a 'Welcome Person' model: insights from a health system strengthening initiative in Bangladesh

Background

Maternal mortality remains critical in Bangladesh, driven by delays in accessing timely care at health care facilities. Globally, a woman dies every two minutes from pregnancy or childbirth, often due to systemic inefficiencies in health care. In Bangladesh, high maternal mortality rates are worsened by overcrowded facilities, limited resources, and complex procedures. The 'three delays' model identifies barriers to care, with the third delay - receiving timely treatment - being a major contributor to maternal deaths. This study aims to generate evidence on how the 'Welcome Person' can improve maternity care at the facility level in Bangladesh.

Methods

We conducted a cross-sectional study from April to December 2022 among pregnant women at three selected health care facilities in Gaibandha District, Bangladesh. We deployed 20 'Welcome Persons' to navigate and assist pregnant women, enhancing maternal health care. The Welcome Persons provided round-the-clock support, guiding mothers from the moment they entered the hospital through their admission, treatment, and any necessary referrals. The Welcome Persons maintained detailed time-stamped records, tracking patient movements and service timelines.

Results

In this study of 5260 mothers, 47% presented with complications, with 52% arriving after office hours. The median time from entry to treatment was 15 minutes, with those without complications taking 14 minutes and those with complications 15 minutes. Entry-to-admission took a median of nine minutes, varying by age, with younger patients completing faster. Admission-to-treatment had a median time of six minutes, with severely complicated patients experiencing shorter times. Only 1% completed within five minutes, while 63% finished within 15 minutes. Upazila Health Complexes (UHCs) showed better performance in completing procedures within median times compared to the District Hospital (DH). Future study plans should include measuring maternal and neonatal outcomes as well.

Conclusions

This study demonstrates that timely maternal care is achievable by deploying a support person. Using the 'Welcome Person' model to address admission bottlenecks, health care facilities can enhance patient experiences and outcomes. Despite a few limitations, evidence generated from this study can be utilised for scaling up decisions and can contribute to the health policy.

Global trends and research hotspots in autophagy and tumor drug resistance: a bibliometric analysis

Autophagy plays a crucial role in tumor drug resistance by enabling cancer cells to survive under stress conditions, including chemotherapy. It helps tumor cells maintain homeostasis, resist cell death, and contribute to therapy failure. This study analyzed the literature related to autophagy and tumor drug resistance based on the Web of Science Core Collection (WoSCC) database. The results revealed that there are 9284 relevant articles published to date, covering 103 countries and regions, with contributions from 5964 institutions and 37,240 researchers. The annual number of publications has steadily increased since 2004, especially after 2019, indicating the growing importance of autophagy in tumor drug resistance research. China leads globally in terms of publication output, accounting for nearly 50% of the total publications. Additionally, international collaboration and cross-country research have become increasingly prominent, particularly collaborations between China and countries like South Korea and Japan. Journal analysis showed that the International Journal of Molecular Sciences and Oncotarget are the most productive journals, while Autophagy stands out with a higher impact factor. Author, citation, and keyword analyses revealed research hotspots and future trends in the field of autophagy and tumor drug resistance, including chemotherapy resistance, cell death mechanisms, and immunotherapy. This study provides a systematic academic perspective for future research in the field of autophagy and tumor drug resistance and emphasizes the importance of strengthening international cooperation.

Cancer Screening 3 Years After the Onset of the COVID-19 Pandemic

This study examines post–COVID-19 pandemic cancer screening rates in 2023 relative to previously documented declines through 2021.

Leveraging Artificial Intelligence for Digital Symptom Management in Oncology: The Development of CRCWeb

UNSTRUCTURED

Digital health interventions offer promise for scalable and accessible healthcare, but access is still limited by some participatory challenges, especially for disadvantaged families facing limited health literacy, language barriers, low income, or living in marginalized areas. These issues are particularly pronounced for colorectal cancer (CRC) patients, who often experience distressing symptoms and struggle with educational materials due to complex jargon, fatigue, or reading level mismatches. To address these issues, we developed and assessed the feasibility of a digital health platform, CRCWeb, to improve the accessibility of educational resources on symptom management for disadvantaged CRC patients and their caregivers facing limited health literacy or low income. CRCWeb was developed through a stakeholder-centered participatory design approach. Two-phase semi-structured interviews with patients, caregivers, and oncology experts informed the iterative design process. From the interviews, we developed the following five key design principles: user-friendly navigation, multimedia integration, concise and clear content, enhanced accessibility for individuals with vision and reading disabilities, and scalability for future content expansion. Initial feedback from iterative stakeholder engagements confirmed high user satisfaction, with participants rating CRCWeb an average of 3.98 out of 5 on the post-intervention survey. Additionally, using GenAI tools, including large language models (LLMs) like ChatGPT and multimedia generation tools such as Pictory, complex healthcare guidelines were transformed into concise, easily comprehensible multimedia content, and made accessible through CRCWeb. User engagement was notably higher among disadvantaged participants with limited health literacy or low income, who logged into the platform 2.52 times more frequently than non-disadvantaged participants. The structured development approach of CRCWeb demonstrates that GenAI-powered multimedia interventions can effectively address healthcare accessibility barriers faced by disadvantaged CRC patients and caregivers with limited health literacy or low income. This structured approach highlights how digital innovations can enhance healthcare.

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/48499.

Quality cancer survivorship care: a modified Delphi study to define nurse capabilities

PURPOSE

To establish capabilities required by nurses to deliver quality cancer survivorship care in Australia.

METHODS

A two-round online modified Delphi involving Australian cancer nurses. Initial domains and capability statements were based on the Quality of Cancer Survivorship Care Framework and supplemented by national and international nursing frameworks. In Round 1 (R1), experts categorised the applicability of 53 capabilities for cancer nurses, across eight domains, in relation to Australian National Professional Development Framework for Cancer Nursing (EdCaN) groups: 'All', 'Many', 'Some', and 'Few' nurses, or not relevant. In Round 2 (R2), experts rated agreement with capabilities allocated to the nurse groups. A priori consensus was set at ≥ 80%.

RESULTS

Surveys were distributed to 51 experts, with a response rate of 92% (47/51) for R1 and 75% (38/51) for R2. Following R1, ten capabilities were added, resulting in 63 capabilities for R2 to establish consensus allocation to EdCaN groupings. Fifty-seven capabilities reached consensus; four capabilities were moved from 'many' to 'some' nurses; one capability was moved from 'some' to 'few' nurses; and one capability was retained in 'all' nurses following Delphi feedback and research team discussion.

CONCLUSIONS

Sixty-three capabilities across eight cancer survivorship care domains were identified and allocated to different nursing groupings. This study provides important foundational work by identifying the capabilities of cancer nurses to deliver quality cancer survivorship care in Australia.

IMPLICATIONS FOR CANCER SURVIVORS

The identification of clearly defined capabilities may improve the quality of cancer survivorship care through the enrichment and standardisation of educational curricula and continuing professional education, and through improved workforce planning.

Emergency Department Navigator Interventions and Outcome Measures: A Scoping Review

INTRODUCTION

Emergency department (ED) patient navigators are increasingly used, but a lack of understanding of how ED navigator interventions are designed, described, and evaluated creates gaps in our ability to understand, monitor and improve care. The purpose of this scoping review is to identify how the literature describes and evaluates ED patient navigator interventions for older people transitioning to a primary care setting.

METHODS

A scoping review was conducted following the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews. We searched three databases: MEDLINE, EMBASE and CINAHL. We included English language articles without any restrictions on study designs that two reviewers screened. All articles focused on distinct ED navigator roles to facilitate transitions for older people from the ED to primary care were included. Data extraction was completed by the primary reviewer and validated by two secondary reviewers. We report study characteristics in a table. Descriptive content analysis was used to analyse the main findings.

RESULTS

A total of 10 studies were included out of 2102 articles identified. All studies used quantitative designs except one, which used a qualitative research design. Four studies were conducted in the United States, two in Australia and the UK and one in Canada and Belgium. Twenty unique outcome measures were identified, with hospital admission rate, frequency of ED presentations and ED/hospital length of stay being the most common. We identified six intervention components: assessment, consultation, liaison, development of care plan, referral and follow-up. Interventions using 4 or more components more commonly reported positive outcomes. Outcome measures used to evaluate interventions were often not tracked across care settings, potentially obscuring the impact of ED navigator interventions across the care continuum.

CONCLUSION

Future research should examine which patients benefit from ED navigation and which outcome measures might help contextualise intervention effectiveness across care settings.

Clinical Profile of Pediatric Solid Tumors: Experience From a Tertiary Care Center in Ethiopia

BACKGROUND

Pediatric solid tumors are a significant health challenge worldwide, especially in low- and middle-income countries such as Ethiopia, where healthcare infrastructure is limited and treatment modalities are scarce.

AIMS

This study aims to understand the epidemiological characteristics of these tumors and short-term treatment outcomes.

METHODS AND RESULTS

A retrospective study spanning a period of 2 years and 8 months was conducted among all children below age 15 years admitted to St. Paul's Hospital Millennium Medical College hemato-oncology unit with a pediatric solid tumor. Data from patient charts was extrapolated and analyzed using SPSS version 29. A total of 173 pediatric solid tumor patients were identified over the study period. 22.6% of patients were treated in the first year, 34.6% of patients were treated in the second year, and 42.8% of patients were treated in the last 8 months of the study period. 56.1% of them were males. Most patients came from the Oromia region. The most frequent solid tumors were retinoblastoma, Wilms tumor, and rhabdomyosarcoma. Eighty-six patients are still on treatment, 23 patients achieved complete remission, 4 relapsed, 2 were defaulters, 5 patients were lost to follow-up, 21 died, 5 were referred to other hospitals, and 10 opted against treatment.

CONCLUSION

The study reveals a rising trend in childhood solid tumor cases over the years. A significant proportion of patients achieved remission, whereas most remain under treatment or follow-up care. A relatively small percentage experienced relapses, with some cases of defaulters, loss to follow-up, and a few instances of mortality. Implementing early detection strategies and community-based awareness programs could improve outcomes by encouraging timely diagnosis and intervention.

Economic Impact of the Apoyo con Cariño Intervention: Improving Palliative Care for Hispanics with Serious Illness

Context: Specialty palliative care has been associated with cost savings at the end of life, while patient navigators have been independently associated with cost savings due to screening and treatment early in the course of disease. Evidence is limited regarding patient navigators and cost savings at the end of life. Objectives: To determine the cost-effectiveness of a lay patient navigator intervention in improving palliative care outcomes for Hispanic persons with serious noncancer illness. Methods: Total health care expenditures in the last 30, 90, and 180 days of life were compared for a randomized sample of 56 Hispanic persons. Expenditures included all inpatient, outpatient, and pharmaceutical claims. Results: Overall spending in the final 180, 90, and 30 days of life was $76,008, $34,731, and $16,613. Spending was lower (p = 0.05) in the last 30 days of life for individuals who died in hospice ($9,403) than those who did not ($19,032), and persons in the intervention had a significantly (p = 0.03) higher probability of dying in hospice (63%) versus those in the control group (37%). Conclusion: Study results support the use of a culturally tailored lay patient navigator intervention to improve palliative care outcomes. The results suggest a potential return on investment for culturally appropriate lay patient navigator interventions of 4:1.

Utilization outcomes of a cancer rehabilitation (CRNav) program: getting to the quadruple aim in cancer care

BACKGROUND

A cancer rehabilitation navigation (CRNav) program is an evidence-based care delivery model that uses a rehabilitation professional in the navigation role to support oncology care delivery, provide functional screening for early identification of impairment, and coordinate care delivery services to optimize early rehabilitation. There is limited research showing how a CRNav impacts healthcare utilization. The objective of this study was to assess utilization data for a CRNav Program and demonstrate how the program influences the effectiveness of cancer care delivery and patient and provider satisfaction.

METHODS

Data was collected from the electronic health record of the Brooks Rehabilitation/Halifax systems at a community cancer center to assess program and service utilization over 3.2 years using a retrospective design.

RESULTS

Over 3.2 years, the CRNav program received 1585 referrals and screened 1447 (91.3%) patients. Of the 1447 screenings performed, 73.6% were recommended to receive outpatient rehabilitation (n = 1065). Among patients screened, breast cancer was the most common cancer diagnosis (47%) followed by head and neck cancers (14%). There were 638 total rehabilitation visits identified for patients who were seen for services within the health system, with physical therapy encounters accounting for the greatest number (n = 462). The most common reasons for receiving physical therapy services included lymphedema (27%), pain (25%), and limited range of motion (12%). Patients reported high satisfaction (≥ 95.4%) in the areas of how well rehabilitation met expectations and overall satisfaction with the rehabilitation experience.

CONCLUSIONS

Using a CRNav in a community cancer center resulted in efficient care of patients with cancer, improved patient satisfaction and patient outcomes, and an enhanced clinician experience. This program provides a value-based approach to care supporting the quadruple aim and improving the identification and management of cancer-related functional morbidity.

Impact of a Patient Navigation Program on Cancer Treatment in Kenya

PURPOSE

Patient navigation (PN) is a critical intervention in the United States to overcome barriers to cancer care, including logistical, financial, and informational barriers, ensuring patients receive timely and coordinated care. However, there are few studies assessing effectiveness of PN in low- and middle-income countries (LMICs). Here, we aim to begin to fill this gap by assessing the effectiveness of the Kenyatta National Hospital (KNH) patient navigation program (PNP) in improving patient-reported outcomes (PROs).

MATERIALS AND METHODS

We used repeated cross-sectional survey design by collecting data from randomly selected 1,126 adults with cancer in three surveys conducted in 2018, 2019, and 2022. The study also drew on qualitative data collected from patients with cancer, caregivers, and program team members as part of an external outcome evaluation.

RESULTS

Logistic regression showed that a higher number of navigation encounters was associated with increased likelihood of improving patients' understanding of their diagnosis, duration of treatment, and satisfaction with information received about needed clinical services. Compared with the 2018 survey, participants of the 2019 (odds ratio [OR], 12.00, 8.00-17.99) and 2022 (OR, 17.18, 10.88-27.14) surveys had markedly higher odds of receiving help finding their way around the facility. Moreover, compared with the 2018 survey, participants of the 2019 survey had lower odds of delaying the start or continuation of their treatment (OR, 0.50, 0.32-0.78).

CONCLUSION

This study contributes to a limited pool of studies to assess PROs of PNPs specifically for cancer treatment in LMICs, making an important contribution to the existing body of knowledge in global cancer patient support. This study provides evidence that PNPs can function effectively and complementarily in LMICs.

Family Navigation Programs for Children With Autism Spectrum Disorder: A Scoping Review

OBJECTIVES

Family navigation (FN) programs are an integrated care delivery model for children with chronic conditions. However, there is a lack of synthesized evidence of FN programs for children with autism spectrum disorder (ASD). This scoping review aimed to map the current evidence to describe the characteristics and synthesize the effectiveness of FN programs for children with ASD.

METHODS

We searched the PubMed, Web of Science, Embase, CINAHL, PsycINFO, and ProQuest databases for studies published between 2011 and 2023. After duplicate records were removed, 2 researchers read the titles and abstracts and screened the full texts. Disagreements were resolved by a third researcher. Two researchers independently extracted the data and performed data synthesis in both tabular and narrative formats.

RESULTS

Twenty-seven studies were included. The navigation activities included family assessment, service coordination, psychosocial support, health education, service advocacy, and logistic assistance. Navigators could be professionals or nonprofessionals with bilingual and bicultural backgrounds. FN programs accelerated service access from positive screening to definite diagnosis and to intervention initiation for children with ASD. Positive effects were also detected for the health outcomes of caregivers.

CONCLUSIONS

The results were narratively synthesized because of the heterogeneity of the included studies. This study provides guidance for the development and implementation of future FN programs. The findings indicate that the inclusion of solid theoretical frameworks, consistent reporting of intervention components, and conduction of effectiveness-implementation mixed studies may facilitate the generalizability of FN programs in wider contexts.

"I Became the Messenger Between the Hospitals": A Study on the Journeys of People With Cancer Using the Critical Incident Technique

INTRODUCTION

Patients with serious conditions face complex, long-lasting patient journeys involving multiple healthcare providers. Research shows that these journeys are frequently perceived as fragmented, with significant challenges in communication and information flow. However, there is limited knowledge about the organisational and informational aspects linked to good and poor experiences. This study investigated critical factors in cancer journeys, focusing on communication and the informational and organisational elements shaping patient experiences.

METHODS

The critical incident technique was used to identify positive and negative factors in cancer patient journeys. People with cancer and their next-of-kin were recruited through Norway's national cancer organisation. Patient episodes were collected from 41 participants via digital workshops combined with questionnaires and supplemented by in-depth interviews. Critical incidents were extracted using specific analytical criteria.

RESULTS

A total of 187 critical incidents were identified, including 81 positive and 106 negative. Content analysis revealed 12 categories of incidents. Positive incidents were linked to effective communication, timely information, and well-coordinated care, particularly through cancer pathways. Negative incidents often involved communication delays, insensitive information delivery, and poor coordination among healthcare providers. Notably, around 40% of the negative incidents stemmed from fragmented health services or a lack of progress, often forcing patients to act as messengers.

CONCLUSION

By examining critical experiences, this study highlights key areas for improving cancer care. Timely information and clinical empathy when delivering sensitive diagnoses are essential. Healthcare providers must coordinate services more effectively to prevent patients from intervening to ensure care progress.

PATIENT OR PUBLIC CONTRIBUTION

Patients' stories formed the core data. The public contributed to recruitment, while patient feedback informed the workshop design.

Core elements and principles of nutrition models of care for people with cancer: A scoping review

BACKGROUND AND AIMS

The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.

METHODS

MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003-8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.

RESULTS

The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).

CONCLUSIONS

Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.

Connecting patients with clinical trials using patient navigation: a scoping review protocol

INTRODUCTION

Interventions are needed to increase participation in clinical trials through optimised trial design and enrolment workflows. Patient navigation is a promising intervention for increasing participation in clinical trials by optimising enrolment workflows. Patient navigation is defined as a personalised intervention aimed at overcoming barriers and ensuring timely access to healthcare services, diagnosis, treatment and care. This scoping review aims to fill a gap in current literature by summarising what is known about patient navigation, aiming to increase clinical trial participation.

METHODS AND ANALYSIS

A search was conducted for peer-reviewed literature published in English from inception through 21 December 2023, and the search was updated on 5 March 2025. Sources of literature included Cochrane CENTRAL (Ovid), MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index of Nursing and Allied Health (CINAHL; on EBSCOhost; EBSCO Industries, Inc), Epistemonikos and PROSPERO databases. Searches were also conducted through the Turning Research into Practice and International Clinical Trials Registry Platform (WHO) databases, Google Scholar and the Agency for Health Research and Quality platform to ensure the retrieval of all relevant articles. Reference lists of eligible studies were also examined. The Google Scholar search was limited to the first 10 pages of results. The search strategy focused on the following key concepts: navigation (eg, navigator, care coordination, case management) and clinical trials. Searches were reviewed using the PRESS Peer Review of Electronic Search Strategies 2015. This review was guided based on the JBI methodology for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarise and report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

ETHICS AND DISSEMINATION

This scoping review identifies and analyses existing research; therefore, ethics approval is not required. Findings will be disseminated through conference presentations and a publication in a scientific journal.

What services are available for culturally and linguistically diverse (CALD) patients in the cancer survivorship setting? An Australian study

PURPOSE

People of Culturally and Linguistically Diverse (CALD) backgrounds face disparities in cancer care. This study aimed to explore CALD-specific Cancer Survivorship (CS) resources and supports in Australian oncology centres.

METHODS

This was an interview-based, qualitative study. Oncology professionals were interviewed using a questionnaire exploring demographics, available resources and referral patterns, and factors influencing CALD CS care. Purposive sampling was used to ensure representation across states and remoteness areas. Contextual survey data were analysed with descriptive statistics, and interviews were recorded and transcribed for thematic analysis.

RESULTS

Twenty-two interviews from 15 institutions across 6 Australian states were conducted from May to August 2023. Six (40%) centres reported seeing > 25% CALD patients. Six (40%) centres reported having dedicated CS services dichotomised into clinic-based or needs-based services. Ten (67%) centres reported having CALD-specific resources/supports for oncology patients, and three (20%) had CS-specific services. Four themes were identified: patient-clinician interface; in-language resources with a focus on cultural relevance; structural and logistical considerations, particularly interpreter services, workflow management and models of care; and education and collaboration between healthcare professionals and survivors, carers and community leaders.

CONCLUSIONS

Cancer survivors from CALD backgrounds face unique challenges in receiving optimal care, with limited availability of CALD-specific resources in Australian cancer centres. Future work should utilise a tailored and collaborative approach to optimise cultural relevance and service engagement.

Young-onset metastatic colorectal cancer: an opportunity and a vision for progress in cancer

Metastatic young-onset colorectal cancer (yo-CRC) is a distinct and aggressive disease subtype that is becoming increasingly prevalent worldwide with Australia leading the world in this trend. This article provides an evidence-based perspective, through the prism of authors' personal experience, to craft an effective pathway not only to deliver improved outcomes for the patients but also to reduce disparities and foster collaboration amongst the cancer-treating community and indeed patients. It highlights an opportunity to re-define, re-design, and create a model that is rewarding to patients and cancer-treating community. Although our focus is on the high unmet needs group of yo-CRC, this model has the potential to expand to other cancer types and care models. We analyse the unique epidemiological trends, challenges, and burdens, emphasising the need for tailored treatment approaches for younger patients with colorectal cancer especially in the metastatic setting. We identify current gaps in clinical practice and research. To improve real-world outcomes, we propose a conceptual framework to enhance clinician-patient communication and treatment planning. Central to our approach is the integration of a Registry of Incidence, Intervention, and Outcomes (RIIO), which enables real-time data collection and analysis, improving treatment personalisation and efficacy. This registry could revolutionise patient care and drive research innovation through enhanced data sharing and collaboration. We advocate for a patient-centric integrated care model that utilises all available therapies to maximise survival and quality of life. Our perspective underscores the urgent need for a paradigm shift in how yo-CRC is viewed, researched and managed, proposing a pathway to significantly enhanced outcomes. Whilst it is feasible to expand the concepts discussed here for all colorectal cancer and indeed all cancer types, we believe this approach is most relevant and acutely needed in yo-CRC setting for reasons detailed in the manuscript.

Disparities in the cancer continuum experienced by transgender and gender-diverse patients: A rapid review

Transgender and gender-diverse (TGD) populations experience health disparities across all areas of health care due to issues of bias, discrimination, and structural barriers to care. Existing literature on cancer screening in TGD populations demonstrates significant gaps in care; for example, transgender men receive Pap smears at lower rates than cisgender women. Because of known disparities in cancer screening, and gaps in our understanding in terms of diagnosis, treatment, and survivorship, the authors conducted a rapid review of the literature to examine cancer care continuum (screening, treatment, and survivorship) disparities among TGD persons. The results reported disparities across the cancer care continuum. Although there is currently limited research on cancer diagnosis, treatment, and survivorship, the available evidence indicates TGD patients are diagnosed with cancer at later stages than cisgender patients. TGD patients were also less likely than cisgender patients to receive treatment for some types of cancer. The results of this rapid review demonstrate the need for more research across the cancer care continuum for TGD patients with significant gaps in knowledge for cancer treatment and survivorship.

Impact of the clinically oriented roles of a general practice receptionist: a systematic review with narrative synthesis

BACKGROUND

Modern general practice is characterised by increased demand and growing multidisciplinarity, including ring-fenced funding for additional non-clinical roles. For practice receptionists, however, training has remained unchanged for decades despite primary care being under greater pressure than ever, with receptionists becoming a growing focal point for abuse and unprecedented numbers leaving the role.

AIM

To present the evidence of the range of tasks that receptionists continue to perform, describing their impact on primary care delivery and how the role might be better supported.

DESIGN AND SETTING

Systematic review of research conducted in the UK.

METHOD

A systematic review of evidence contained in the major medical databases (MEDLINE/PubMed, CINAHL, ASSIA, Cochrane Library, and Embase) from January 2000 to March 2024 was conducted, including hand searches of the bibliographies of included studies.

RESULTS

In total, 29 studies were identified that grouped into three themes: service delivery, patient attitudes, and receptionist experience. The theme 'service delivery' confirms the continuing role of receptionists in providing administrative support alongside the clinical tasks of prioritising patients for consultations, facilitating repeat prescriptions, and communicating blood test results. The theme 'patient attitudes' describes how patients lacked trust in receptionists, who were viewed as unqualified and unnecessarily obstructive. Finally, in considering receptionist experience, the contrast between their confidence in performing administrative roles and the anxiety induced from the clinically related tasks was described, particularly the mounting pressure from patients to meet their preferences for clinician appointments.

CONCLUSION

Although confident performing administrative tasks, receptionists described uncertainty and anxiety when providing clinically oriented support or managing patients when their requests for appointments could not be met. More appropriate training or professionalisation might improve staff retainment.

Impact of Social Determinants of Health on Melanoma Nodal Surveillance in a Multi-institutional Cohort

BACKGROUND

Nodal surveillance (NS) has overtaken completion lymphadenectomy as the preferred management for sentinel node-positive (SLN+) melanoma, but requires frequent exams and nodal ultrasound (US). Social determinants of health (SDoH) may affect US adherence in real-world populations, and evaluation of these potential impacts is needed.

METHODS

Adults with SLN+ melanoma diagnosed from July 2017 to December 2019 who received NS at nine cancer centers were identified retrospectively. Exposures included insurance status, travel distance, and Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), a validated measure of area-level SDoH, indicated as 0 (low) to 1 (high) vulnerability. The primary outcome was US adherence (≥ 1 study per 6-month follow-up interval). The secondary outcomes were combined-modality adherence [US, computed tomography (CT), or positron emission tomography (PET)] and loss to follow-up (LTFU). Bivariate analyses and mixed-effects multivariable logistic regression were performed.

RESULTS

Most of the 519 patients were male (57%), non-Hispanic white (94.4%), and insured privately (45.3%) or by Medicare (43.5%). The median travel distance was 63.3 miles (interquartile range [IQR], 31.2-111.0 miles), and the median SVI was 0.426 (IQR, 0.253-0.610). The surveillance adherence rates were 41.6% for US and 75.1% for combined modalities. No significant differences in US adherence were observed based on sociodemographic covariates in regression analysis. Medicaid (odds ratio [OR], 3.12; p = 0.02) and uninsured (OR 4.48; p = 0.01) patients had increased likelihood of LTFU.

CONCLUSIONS

Less than half of the patients in this multicenter cohort achieved US adherence, although the rates improved with combined modalities. Medicaid or non-insurance were social risk factors for LTFU. Optimizing surveillance practices for socially vulnerable groups will be crucial for the ongoing real-world implementation of NS.

Enhancing supportive medication patient education for oncology nurses

ABSTRACT

This article discusses a quality improvement project that developed and implemented supportive care medication cards to enhance patient education in outpatient oncology settings. Recognizing the challenges oncology nurses face in delivering effective education amidst the complexities of cancer treatment, the project evaluates the impact of these cards on patient understanding and adherence to prescribed therapies. Results from a trial period indicate significant improvements in both nurse workflow and patient comprehension, ultimately contributing to safer and more effective oncology care.

Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes

BACKGROUND

Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes.

METHOD

We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health.

RESULTS

Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants.

DISCUSSION

The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.

Feasibility of a Comprehensive eCoach to Support Patients Undergoing Colorectal Surgery: Longitudinal Observational Study

BACKGROUND

The mainstay of colorectal cancer care is surgical resection, which carries a significant risk of complications. Efforts to improve outcomes have recently focused on intensive multimodal prehabilitation programs to better prepare patients for surgery, which make the perioperative process even more complex and demanding for patients. Digital applications (eCoaches) seem promising tools to guide patients during their care journey. We developed a comprehensive eCoach to support, guide, and monitor patients undergoing elective colorectal surgery through the perioperative phase of the care pathway.

OBJECTIVE

The primary aim of this study was to determine its feasibility, in terms of recruitment rate, retention rate, and compliance. Also, usability and patient experience were examined.

METHODS

A single-center cohort study was conducted from April to September 2023 in a tertiary teaching hospital in the Netherlands. All elective colorectal surgery patients were offered an eCoach that provided preoperative coaching of the prehabilitation protocol, guidance by giving timely information, and remote monitoring of postoperative recovery and complications. Recruitment and retention rate, as well as compliance for each part of the care pathway, were determined. Secondary, patient-reported usability measured by the Usefulness, Satisfaction, and Ease of Use questionnaire and patient experiences were reported.

RESULTS

The recruitment rate for the eCoach was 74% (49/66). Main reasons for exclusion were digital illiteracy (n=10), not owning a smartphone (n=3), and the expected burden of use being too high (n=2). The retention rate was 80% (37/46). Median preoperative compliance with required actions in the app was 92% (IQR 87-95), and postoperative compliance was 100% (IQR 100-100). Patient-reported usability was good and patient experiences were mostly positive, although several suggestions for improvement were reported.

CONCLUSIONS

Our results demonstrate the feasibility of a comprehensive eCoach for guiding and monitoring patients undergoing colorectal surgery encompassing the entire perioperative pathway, including prehabilitation and postdischarge monitoring. Compliance was excellent for all phases of the care pathway and recruitment and retention rates were comparable with rates reported in the literature. The study findings provide valuable insights for the further development of the eCoach and highlight the potential of digital health applications in perioperative support.

Navigation as a system approach: A qualitative descriptive study to inform a statewide cancer navigation approach in Australia

PURPOSE

This study aimed to identify challenges and facilitators in accessing cancer care in South Australia, from the perspectives of cancer survivors and caregivers, to inform responsive cancer navigation approaches.

METHODS

A qualitative descriptive study was conducted using an online qualitative survey (n = 75) and video, phone, and in-person semi-structured interviews (n = 22) with cancer survivors and caregivers (herein cancer consumers). Data analysis was performed in two phases: content analysis categorised consumer challenges and facilitators, while a subjective-inductive approach guided by the supportive care framework was used to develop a statewide navigation approach.

RESULTS

Key challenges reported by consumers included perceived invalidation of medical concerns, delayed diagnoses, poor communication, inadequate information provision, fragmented care, and limited logistical, cultural, and psychological support. Inductive analysis identified four key themes: 1) cancer consumers have dynamic care needs that can evolve throughout a patient's cancer experience, 2) cancer consumers require a foundational level of information to support navigation, 3) some cancer consumers express a preference for community-based navigation services to help them manage their care, and 4) individuals with more complex care needs may require more intensive professional navigation services. A conceptual needs-based navigation approach (the Flinders Needs-Based Approach to Cancer Navigation) was developed based on these insights. This approach consists of three levels of navigation interventions: level 1 involves providing information-based navigation to all individuals affected by cancer, level 2 involves community-based navigation support offered to those requiring or wanting additional supported assistance, and level 3 offers professional navigation for individuals with complex needs.

CONCLUSION

Our study highlights the importance of tailoring cancer navigation services to meet the evolving needs of patients, emphasising the role of both community and professional support, particularly for individuals with complex care requirements. Findings will inform further co-design discussions involving consumers, health professionals, and policymakers to implement cancer navigation services across South Australia.

Cancer Survivorship and the Significance of an Integrated Diachronic Life Course Perspective

Standardised health care is primarily focused on remediation and delivered episodically through costly and fragmented health-care systems. Such an approach is untenable, given the diversity and complexity of peoples' health-care needs, increasing prevalence of chronic disease and existing heath inequities. A life course perspective fundamentally challenges our current understanding of health care and has great potential to promote innovation in health-care practice, systems and policy. However, the way that health develops and manifests across the life course is a highly complex process underpinned by a plethora of causal antecedents, consequences and interdependencies that have yet to be adequately captured and articulated in current life course frameworks. The field of cancer survivorship and its recent rise to prominence provides a highly relevant and compelling case example to inform development and refinement of existing life course frameworks. Cancer survivorship exemplifies what can be described as an integrated diachronic life course perspective, which serves as a conceptual framework to enhance our understanding of health development across the life course and guide health-care practice, systems and policy to meet the increasingly complex health-care needs of current and future generations.

Enhancing Patient Outcomes Through Integrated Education and Navigation Programs at the Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University

Breast cancer remains a significant global health challenge, particularly in low- and middle-income countries where disparities in healthcare exacerbate the disease burden. The Breast Cancer Comprehensive Center at the National Cancer Institute, Cairo University, has implemented integrated patient navigation and education programs aimed at enhancing patient outcomes and healthcare quality. This study evaluated the effectiveness of these programs involving 2202 participants over 12 months. The methodology included systematic data collection, material preparation, and the application of tailored educational strategies to facilitate the patient's journey from diagnosis to treatment. The study utilized three-phased patient navigation assistance to provide comprehensive support. The programs significantly improved patient satisfaction, with over 90% of participants reporting high levels of contentment with the services received. Key improvements included enhanced understanding of breast cancer (including risk factors, symptoms, importance of seeking early care, and treatment options), reduction in patient anxiety, improved treatment adherence, and streamlined diagnostic and treatment processes. Notably, the use of audio-visual educational tools effectively bridged the literacy gap among patients. The integration of patient navigation and education systems at BCCC-NCI has proven to be a highly effective model for improving breast cancer care. This model not only enhances patient understanding and treatment compliance but also facilitates a more efficient healthcare process. The study underscores the potential for replicating this approach in similar healthcare settings globally, suggesting that such integrations can significantly improve cancer care outcomes.

Interventions for subjective and objective social isolation among people living with HIV: A scoping review

Subjective and objective social isolation has been a globally significant public health issue for people living with HIV, yet little is known about the characteristics, effectiveness, and acceptability of available interventions. The purpose of this scoping review was to systematically identify and map the available evidence on interventions for subjective and objective social isolation among people living with HIV. We searched PubMed, Cochrane Library, Embase, Scopus, Social Sciences Citation Index, PsycArticles, CINAHL, ProQuest Dissertation & Theses Global, OpenGrey, Google Scholar, international trial registers, and websites for eligible studies from their inception to June 1, 2024. We included any studies that identified subjective or objective social isolation as a primary goal or outcome of an intervention for people living with HIV (≥18 years old). Two researchers independently conducted study selection, data extraction, and data analysis. A 'basic qualitative content analysis' approach was used to analyze the findings of the included studies. Of the 12762 records identified, 19 full-text studies involving 961 participants were included in this scoping review. Overall, we identified seven interventions for subjective and objective social isolation among people living with HIV, as well as their characteristics, including psychological therapy, support group intervention, online support community, peer mentorship, navigation-type intervention, activity intervention, and knowledge/skills development intervention. However, there was limited, mixed evidence on the effectiveness and acceptability of different interventions for subjective and objective social isolation among people living with HIV. More rigorously designed and large-scale randomized control trials are needed to support and enrich existing evidence further.

Loss of Follow-up for Thyroid Nodules in Patients Living in Poverty

INTRODUCTION

Inadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection.

METHODS

We performed a retrospective analysis of patients who underwent fine needle aspiration for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% CIs.

RESULTS

Of 2446 patients included, the majority were White (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs 45.9%, P < .001) or clinic visits (53.7% vs 61.2%, P = .001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64-0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24-0.81).

CONCLUSION

There is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.

Childhood Cancer-Connect: Identifying solutions to elevating the cancer experience for adolescents and young adults with cancer

Adolescents and young adults with cancer (aged 15-39 years) experience unique challenges because of their developmental life stage, and many have limited access to support and resources. Childhood Cancer (CC)-Connect, the patient assistance component of the White House Cancer Moonshot Childhood Cancer-Data Integration for Research, Education, Care, and Clinical Trials initiative that aims to help childhood cancer families find the best care for their child, undertook a multipronged effort to identify key strategies for addressing the unique needs of adolescents and young adults with cancer. This article describes the 4 strategies that emerged to form a comprehensive framework for addressing the unmet needs of adolescents and young adults with cancer, which can improve outcomes and enhance the cancer care experience for this vulnerable population.

Development of a Health Insurance Navigation Program for Long-Term Childhood Cancer Survivors

Adapting interventions to new contexts requires consideration of the needs, norms, and delivery structures of the new setting. We describe how we followed the ORBIT model of intervention development to create Health Insurance Navigation Tools (HINT), a health insurance patient navigation intervention for childhood cancer survivors. By engaging stakeholders and leveraging institutional resources, we identified and preemptively addressed real-world barriers, which may improve the feasibility and efficacy of the intervention. Using evidence-based implementation science models to adapt and refine interventions enhances rigor and reproducibility, implements checks and balances, and surmounts challenges of intervention rollout to accelerate the delivery of health insurance education to childhood cancer survivors.

How Do People Living With Cancer Navigate Health Systems?: A Multi-Grounded Theory

BACKGROUND

Cancer and its physiological and psychological effects are well defined, but how these factors impact health system navigation for people living with cancer (PLWC) is lacking.

OBJECTIVE

To develop a theory explaining how PLWC navigate health systems to meet their health and well-being needs.

METHODS

This study used multi-grounded theory to explain how PLWC navigate health systems to meet their needs. Individuals more than 6 months postdiagnosis participated in semistructured interviews. The theory was grounded with the Health Beliefs Model and Socioecological Model to generate a candidate theory.

RESULTS

Eighteen participants were interviewed (n = 12 female); the most prominent cancer type was breast (50%). The theory comprised 5 components describing how PLWC navigate health services: (1) "being on the journey" referenced a core care team and differing utilization over time; (2) "adjusting to a new identity" addressed feeling lost and isolated and a desire to be around people who have experienced cancer; (3) "assimilating knowledge" included knowledge about cancer, timing, and source of information; (4) "navigating the health system" found health-seeking attitudes and behaviors dictated whether services were accessed; and (5) "policy environment" acknowledged how policy set the context within which all theory components exist.

CONCLUSIONS

The candidate theory depicts core factors influencing how PWLC navigate health and well-being services over their cancer journey and into survivorship.

IMPLICATIONS FOR PRACTICE

The theory identifies factors that influence access to healthcare, including trust and knowledge, which can form the basis of navigational initiatives and programs.

Doing 'detective work' to find a cancer: how are non-specific symptom pathways for cancer investigation organised, and what are the implications for safety and quality of care? A multisite qualitative approach

BACKGROUND

Over the past two decades, the UK has actively developed policies to enhance early cancer diagnosis, particularly for individuals with non-specific cancer symptoms. Non-specific symptom (NSS) pathways were piloted and then implemented in 2015 to address delays in referral and diagnosis. The aim of this study was to outline the functions that enable NSS teams to investigate cancer and other diagnoses for patients with NSSs.

METHODS

The analysis was derived from a multisite ethnographic study conducted between 2020 and 2023 across four major National Health Service (NHS) trusts. Data collection encompassed observations, patient shadowing, interviews with clinicians and patients (n=54) and gathered documents. We used principles of the functional resonance analysis method to identify the functions of the NSS pathway and analyse their relevance to patient safety.

RESULTS

Our analysis produced 29 distinct functions within NSS pathways, organised into two clusters: pretesting assessment and information gathering, and post-testing interpretation and management. Safety-critical functions encompassed assessing the reason for referral, deciding on a plan of investigation and estimating the remaining cancer risk. We also identified ways that teams build and maintain safety across all functions, for example, by cultivating generalist-specialist expertise within the team and creating continuity through patient navigation. Variation in practice across sites revealed targets for an NSS pathway blueprint that would foster local development and quality improvement.

CONCLUSIONS

Our findings suggest that national and local improvement plans could differentiate specific policies to reduce unwarranted variation and support adaptive variation that facilitates the delivery of safe care within the local context. Enhancing multidisciplinary teams with additional consultants and deploying patient navigators with clinical backgrounds could improve safety within NSS pathways. Future research should investigate different models of generalist-specialist team composition.

Evaluating the implementation and impact of a volunteer navigation oncology support programme: study protocol for a pragmatic, real-world hybrid type 2 study

INTRODUCTION

Patient navigation is recommended by accrediting bodies such as the Commission on Cancer and is a key element in payment reform demonstration projects, due to the established benefits in reducing barriers to healthcare, improving care coordination and reducing healthcare utilisation. However, oncology practices are often resource constrained and lack the capacity to extend navigation services at the desired intensity for their patient population. The American Cancer Society (ACS) developed the ACS Community Access to Resources, Education, and Support (CARES) programme to expand navigation capacity through the training of students from local universities as volunteers to serve as non-clinical navigators to support cancer patients. Although this approach has great potential for scalability, the best approach to early implementation and impact of volunteer navigation remains unclear.

METHODS AND ANALYSIS

This pragmatic single-arm pre-post study evaluates the implementation and effectiveness of volunteer navigation for patients participating in the 2023-2024 pilot. This study will use data collected during routine care for quantitative implementation and patient outcomes. The Updated Consolidated Framework for Implementation Research will guide evaluation of early programme implementation with three initial pilot sites. This pragmatic evaluation of real-world implementation of volunteer navigation in the oncology setting will support future efforts to scale-up this intervention across US health systems.

ETHICS AND DISSEMINATION

This study was approved by University of Morehouse School of Medicine Social and Behavioral (IRB), which served as the IRB for record for this project (IRB-2025819-2). No consent required for this study protocol. ACS CARES plans to disseminate this model and include additional sites as participants in future years.

Identifying Complex Scheduling Patterns Among Patients With Cancer With Transportation and Housing Needs: Feasibility Pilot Study

Background

Patients with cancer frequently encounter complex treatment pathways, often characterized by challenges with coordinating and scheduling appointments at various specialty services and locations. Identifying patients who might benefit from scheduling and social support from community health workers or patient navigators is largely determined on a case-by-case basis and is resource intensive.

Objective

This study aims to propose a novel algorithm to use scheduling data to identify complex scheduling patterns among patients with transportation and housing needs.

Methods

We present a novel algorithm to calculate scheduling complexity from patient scheduling data. We define patient scheduling complexity as an aggregation of sequence, resolution, and facility components. Schedule sequence complexity is the degree to which appointments are scheduled and arrived to in a nonchronological order. Resolution complexity is the degree of no shows or canceled appointments. Location complexity reflects the proportion of appointment dates at 2 or more different locations. Schedule complexity captures deviations from chronological order, unresolved appointments, and coordination across multiple locations. We apply the scheduling complexity algorithm to scheduling data from 38 patients with breast cancer enrolled in a 6-month comorbidity management intervention at an urban hospital in the Washington, DC area that serves low-income patients. We compare the scheduling complexity metric with count-based metrics: arrived ratio, rescheduled ratio, canceled ratio, and no-show ratio. We defined an aggregate count-based adjustment metric as the harmonic mean of rescheduled ratio, canceled ratio, and no-show ratio. A low count-based adjustment metric would indicate that a patient has fewer disruptions or changes in their appointment scheduling.

Results

The patients had a median of 88 unique appointments (IQR 60.3), 62 arrived appointments (IQR 47.8), 13 rescheduled appointments (IQR 13.5), 9 canceled appointments (IQR 10), and 1.5 missed appointments (IQR 5). There was no statistically significant difference in count-based adjustments and scheduling complexity bins (χ24=6.296, P=.18). In total, 5 patients exhibited high scheduling complexity with low count-based adjustments. A total of 2 patients exhibited high count-based adjustments with low scheduling complexity. Out of the 15 patients that indicated transportation or housing insecurity issues in conversations with community health workers, 86.7% (13/15) patients were identified as medium or high scheduling complexity while 60% (9/15) were identified as medium or high count-based adjustments.

Conclusions

Scheduling complexity identifies patients with complex but nonchronological scheduling behaviors who would be missed by traditional count-based metrics. This study shows a potential link between transportation and housing needs with schedule complexity. Scheduling complexity can complement count-based metrics when identifying patients who might need additional care coordination support especially as it relates to transportation and housing needs.

A Mail-Based HPV Self-Collection Program to Increase Cervical Cancer Screening in Appalachia: Results of a Group Randomized Trial

BACKGROUND

Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia.

METHODS

We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups.

RESULTS

Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90-5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached.

CONCLUSIONS

HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services.

IMPACT

Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

Developing a city-wide, community-engaged cancer disparities research agenda

INTRODUCTION

In response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clinical cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered.

METHODS

Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship, and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3's Stakeholder Advisory Committee.

RESULTS

Stakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: communication between patients, providers, and caregivers; education that reaches patients and community members with tailored and targeted information; navigation that assists people in finding and accessing the right cancer screening or treatment option for them; and representation that diversifies the workforce in clinics, cancer centers, and research offices.

CONCLUSION

A community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians.

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting

BACKGROUND

The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial.

AIM

To explore how patients and families navigate palliative care and the problems they experience.

DESIGN

An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis.

SETTING/PARTICIPANTS

Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia.

THE ANALYSIS

Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices.

CONCLUSIONS

Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

Addressing Colorectal Cancer Disparities in Unhoused Populations: A Call for Equitable Access and Compassionate Care

Housing is essential for health. Unhoused individuals have markedly worse health status than the general population culminating in higher rates of premature mortality. Cancer is a leading cause of death in older unhoused adults. Caring for unhoused patients at risk for or with colorectal cancer poses challenges at every stage of oncologic care: prevention, screening, diagnosis, treatment, and follow-up. These challenges result in later stages at diagnosis and worse overall survival. Health systems can work to advance health equity in colorectal cancer in unhoused patients by improving access to care, transitions of care, health care quality, and focusing on socioeconomic/environmental impact.

Cultural and Linguistic Adaptation of an Evidence-Based Tailored Navigation Intervention to Increase Cancer Screening Uptake Among Southeast Asian Women

BackgroundSoutheast Asian immigrant women in the U.S. have high rates of breast and cervical cancer, yet they are the least likely of all racial/ethnic groups to get screened. To address this disparity, we adapted the evidence-based Tailored Intervention Messaging System© (TIMS©), which uses tailored messages and navigation by culturally and linguistically matched community health advisors to overcome barriers to cancer screening.ObjectivesThis study describes the cultural and linguistic adaptation of TIMS© to improve breast and cervical cancer screening among Southeast Asian immigrant women in the U.S.MethodsGuided by Stirman et al.'s adaptation framework, we conducted focus groups and in-depth interviews to identify key constructs related to cancer screening (knowledge, perceived barriers, perceived risk, benefits, self-efficacy). Using the TIMS© and the thematic content from qualitative data, we modified messages for content and context. Messages were divided into three categories: 1) existing messages identified in thematic analyses, 2) existing messages not identified in thematic analyses, and 3) new messages that emerged from thematic analyses.ResultsContextual and content modifications were made to the TIMS© message library. Messages were translated into Lao, Khmer, and Vietnamese. Through an iterative process, the investigator, community health advisors, and cultural community advisory board members reviewed and revised the messages for translation accuracy, relevance, and clarity.ConclusionUsing relatable language and context is critical to engaging women from Southeast Asian communities in improving breast and cervical cancer screening uptake. This adaptation approach can be applied to tailor interventions for other languages, cultures, and underrepresented groups.

Cost and activity analysis for a citywide patient navigation intervention to engage underserved patients in breast cancer treatment: Findings from the Translating Research Into Practice study

BACKGROUND

Patient navigation is an evidence-based intervention for reducing delays in cancer care for underserved populations. There are limited economic evaluations of patient navigation in the US health care system and few have considered costs at various phases along the implementation spectrum. Having economic data, including costs and cost savings, can support sustainability of patient navigation programs. This study presents findings from a cost and activity analysis of a citywide hospital-based patient navigation program to engage women in timely breast cancer treatment post-diagnosis.

METHODS

This study was conducted as part of Translating Research Into Practice (TRIP), a citywide patient navigation hybrid effectiveness-implementation research study conducted at five cancer care hospitals in Boston, Massachusetts. The authors surveyed participating patient navigators and supervisors about their tasks and level of effort over consecutive 10-day periods from 2019 to 2021. Patient navigators documented the time spent on activities in accordance with an 11-step protocol across five sites. Cost data were collected from annual fiscal year end expenditure hospital administrative databases at concurrent time frames. Descriptive analyses were used to calculate average time on tasks, cost per activity and cost per outcome. Cost savings were estimated by calculating the additional persons engaged in timely entry to treatment compared to a matched control group with respect to hospitalization and emergency room costs averted.

RESULTS

Average time spent per day on TRIP-specific navigation activities was approximately 3 hours (range, 0-8 hours) and the average time per patient per day was 25 minutes (n = 7 navigators). Total costs for clinical site interventions were $218,394 for startup and $392,407 for maintenance costs over the study period. A total of 223 patients were served during the intervention period with an average cost per patient of $979 for startup and $1759 for maintenance. Potential costs savings with the TRIP navigation program from averted hospitalization and emergency room visits for 63 additional patients who received timely treatment is estimated at $21,798-$30,429 and $2536-$5692 per patient, respectively, compared to treatment as usual.

CONCLUSIONS

The economic evaluation in this study provides insight into startup and implementation costs for uptake and scalability of navigation programs across a citywide system. The information may be useful for payors in reimbursing navigation activities and health systems in planning for high quality navigation programs to ensure patient-centered and timely treatment for women diagnosed with breast cancer.