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©The Author(s) 2020.
World J Clin Oncol. Sep 24, 2020; 11(9): 705-722
Published online Sep 24, 2020. doi: 10.5306/wjco.v11.i9.705
Published online Sep 24, 2020. doi: 10.5306/wjco.v11.i9.705
Table 1 Randomized trials from the United States focusing on navigation interventions to improve outcomes in cancer care for historically marginalized populations
| Ref. | Population | Cancer type | Navigator type | Time point | Outcome | Result (intervention vs control) | Location | |
| Screening | Jandorf et al[91] (2005)a | Hispanic (82% of n = 78) | CRC | Lay navigator vs usual care | 6 mo | Screening rate | Endoscopy: 16% vs 5% (P = 0.019) | FOBT: 42% vs 25% (P = 0.086) | New York, NY (urban) |
| Tu et al[92] (2006)a | Chinese Americans (n = 210) | CRC | Education + FOBT card vs usual care | 6 mo | FOBT rate | 70% vs 28% (P < 0.05) | Seattle, WA (urban) | |
| Christie et al[93] (2008)a | Hispanic (71% of n = 25) | CRC | Lay navigator vs usual care | 3 mo | Colonoscopy rate | 54% vs 13% (P = 0.058) | New York, NY (urban) | |
| Percac-Lima et al[27] (2009)a | Low income (n = 1223) | CRC | Lay navigator vs usual care | 9 mo | Screening rate | 27% vs 12% (P < 0.001) | Boston, MA (urban) | |
| Ma et al[94] (2009)b | Korean Americans (n = 167) | CRC | Lay navigator vs usual care | 12 mo | Screening rate | 77% vs 11% (P < 0.001) | NR | |
| Phillips et al[95] (2011)b | African American (47% of n = 3895) | Breast | Lay navigator vs usual care | 9 mo | Mammography rate | 87% vs 76% (P < 0.001) | Boston, MA (urban) | |
| Lasser et al[96] (2011)a | Low income (n = 465) | CRC | Lay navigator vs usual care | 12 mo | Screening rate | 34% vs 20% (P < 0.001) | Boston, MA (urban) | |
| Myers et al[97] (2014)a | African American (n = 764) | CRC | Mailed FOBT and reminder +/- lay navigation | 12 mo | Screening rate | 44% vs 32% (P = 0.001) | Philadelphia, PA (urban) | |
| Braschi et al[98] (2014)a | Hispanic (n = 392) | CRC | Culturally tailored lay navigation vs standard navigation | NR | Colonoscopy rate | 82% vs 79% (P > 0.05) | New York, NY (urban) | |
| Enard et al[99] (2015)a | Hispanic (n = 303) | CRC | Lay navigator vs mailed information | 16 mo (average, not pre-specified) | Screening rate | 44% vs 32% (P = 0.04) | Houston, TX (urban) | |
| Braun et al[100] (2015)a | Hawaiian and Filipino (90% of n = 488) | Multiplec | Lay navigator vs usual care | NR | Screening rate | Pap: 57% vs 36% (P = 0.001) | Mammogram: 62% vs 42% (P = 0.003) | Prostate: (54% vs 36% (P = 0.008) | CRC: 43% vs 27% (P < 0.001) | Hawai‘i (rural and urban) | |
| Marshall et al[28] (2016)a | African American (n = 1905) | Breast | Lay navigator vs pamphlet | 18 mo (average, not pre-specified) | Screening rate | 93% vs 88% (P < 0.001) | Baltimore, MD (urban) | |
| Percac-Lima et al[101] (2016)a | Non-adherent patients (n = 1612) | Multiplec | Lay navigator vs usual care | 8 mo | Percentage of patients up to date on all screens | 10% vs 7% (P < 0.001) | Boston, MA (urban) | |
| Degroff et al[102] (2017)a | Low income (n = 843) | CRC | Lay navigator vs usual care | 6 mo | Screening rate | 61% vs 53% (P = 0.021) | Boston, MA (urban) | |
| Thompson et al[103] (2017)a | Hispanic (n = 443) | Cervical | Video + lay navigation vs usual care | 7 mo | Screening rate | 53% vs 34% (P < 0.001) | Washington and Oregon (rural) | |
| Ma et al[104] (2019)b | Korean Americans (n = 925) | CRC | Lay navigator + group teaching + FIT card vs usual care | 12 mo | Screening rate | 69% vs 16% (P < 0.001) | NR | |
| Diagnostic resolution | Ell et al[105] (2007)a | Hispanic (n = 204) | Breast | Social worker navigation vs usual care | 2 mo | Completion of follow-up testing | 90% vs 66% (P < 0.001) | Los Angeles, CA (urban) |
| Ferrante et al[106] (2008)a | African American and Hispanic (87% of n = 105) | Breast | Lay navigator vs usual care | N/A | Mean time to diagnosis (days) | 25 vs 43 (P = 0.001) | Newark, NJ (urban) | |
| Raich et al[107] (2012)a | 72% non-white (n = 993) | Multipled | Lay navigator vs usual care | 12 mo | Completion of follow-up testing | 88% vs 70% (P < 0.001) | Denver, CA (urban) | |
| Lee et al[108] (2013)b | Hispanic (60% of n = 1039) | Breast | Lay navigator vs usual care | N/A | Time to diagnosis | 2.0 mo vs 1.7 mo (P > 0.05) | Tampa, FL (urban) | |
| Treatment | Ell et al[40] (2009)a | Low income (n = 487) | Breast and Gynecological | Lay navigator + social worker vs usual care | 12 mo | Chemotherapy completed as scheduled | Breast: 62% vs 75% (P = 0.47) | Gyn: 63% vs 46% (P = 0.13) | Los Angeles, CA (urban) |
| Palliation | Fischer et al[49] (2018)a | Hispanic (n = 223) | All | Lay navigator doing at least 5 home visits + educational packet vs usual care | Enrollment till end of life | Advance care planning, pain scores, hospice use | Documentation: 65% vs 36% (P < 0.001) | Pain reduction ND (P = 0.88) | Hospice use ND (P = 0.58) | Colorado (urban and rural) |
| Patel et al[50] (2018)a | Rural veterans (n = 213) | All | Lay navigator discussing advanced care planning vs usual care | 6 mo | Advanced care planning documentation | Documentation: 92% vs 18% (P < 0.001) | Palo Alto, CA (urban and rural) |
Table 2 Patient-facing studies from low- and middle-income countries involving either a navigation or technology-based component of the intervention
| Ref. | Study design | Country | Cancer type | Intervention type | Time point | Outcome | Result (intervention vs control) | Location | |
| Screening | Thomas et al[35] (2002) | Cluster randomized trial | China (n = 266064) | Breast | Classes teaching self-breast exam with supervised exams every 6 mo vs none | 10 yr | Deaths attributable to breast cancer | 0.1% vs 0.1% (P = 0.67) | Factory workers in Shanghai (urban) |
| Mittra et al[34] (2010) | Cluster randomized trial | India (n = 151538) | Breast | Lay health care workers doing clinical breast examination vs social worker delivered education | 3 rounds of screening at 2-yr intervals | Downstaging at diagnosis | 1st round: ND (P = 1.00) | 2nd round: ND (P = 0.47) | 3rd round lower stage at diagnosis (P = 0.004) | Slums in Mumbai (urban) | |
| Sankaranarayanan et al[32] (2011) | Cluster randomized trial | India (n = 115652) | Breast | Lay worker clinical breast exam vs education only | 3 yr | Stage at diagnosis | Early-stage diagnosis: 44% vs 25% (P = 0.023) | Advanced-stage diagnoses: 45% vs 68 (P = 0.005) | Thiruvananthapuram, Kerala (suburban) | |
| Ma et al[109] (2012) | Cluster randomized trial | China (n = 453) | Breast | Education + lay navigation vs printed materials | 6 mo | Screening rate | 73% vs 5% (P < 0.001) | Employees in Nanjing (urban) | |
| Shastri et al[110] (2014) | Cluster Randomized Trial | India (n = 151538) | Cervical | Lay health care workers doing cervical examination vs social worker delivered education | 12 yr | Cervical cancer mortality (rate per 100000 person years of observation) | 11% vs 16% (P = 0.003) | Slums in Mumbai (urban) | |
| Abiodun et al[111] (2014) | Cohort trial with control from neighboring area (quasi-experimental design) | Nigeria (n = 700) | Cervical | Patient education by medical students vs none | 3.25 mo | Cervical cancer screening rate | 8% vs 4% (P = 0.038) | Ogun state (rural) | |
| Rosser et al[112] (2015) | Randomized controlled trial | Kenya (n = 251) | Cervical | Lay health worker 30-minute educational talk vs none | 3 mo | Screening rate | 59% vs 61% (P = 0.60) | Homa Bay County (rural) | |
| Lima et al[113] (2017) | Randomized cohort trial | Brasil (n = 524) | Cervical | Behavioral telephone interview vs educational telephone call | NR | Screening rate | 67% vs 58% (NR) | Women without up-to-date screens in Fortaleza (urban) | |
| Diagnostic resolution | Pisani et al[33] (2006) | Single arm description of a cluster randomized trial | Philippines (n = 151168) | Breast | Lay health worker clinical breast exam | 2 yr | Follow-up for abnormal screening exam | 35% follow-up rate | Manila (urban) |
| Ginsburg et al[36] (2014) | Cluster randomized trial | Bangladesh (n = 22337) | Breast | CHW with smartphone +/- additional CHW training to navigate | NR | Follow up care if abnormal CBE | 63% vs 43% (no navigation) (P < 0.0001) | Khulna Division (rural) | |
| Mishra et al[114] (2017) | Retrospective descriptive study | India (n = 2610432) | Head and Neck | CHWs doing physical exams, counseling patients to stop smoking, and referring patients to an ENT practice if a positive exam | 3 yr | Referral to tertiary care center | 2610432 screened | 10522 (1.1%) quit smoking | 3309 (0.13%) referred to tertiary care center of which 1890 (57%) were positive for cancer | 1712 (91%) diagnosed were able to start treatment | Gujarat (rural) | |
| Riogi et al[38] (2017) | Cohort study with retrospective control group | Kenya (n = 75) | Breast | Cohort of patients cared for by nurses trained to navigate vs historic cohort | 1 mo | Completion of follow-up testing | 58% vs 24% (P = 0.0026) | Nairobi (urban) | |
| Vasconcelos et al[39] (2017) | Randomized cohort trial | Brasil (n = 775) | Cervical | Tying ribbon with appointment date on hand vs education session vs card reminder | 2 mo | Return for pap test results | 66% vs 82% (education) vs 77% (control) (P < 0.05) | Fortaleza (urban) | |
| Chavarri-Guerra et al[115] (2019) | Retrospective descriptive study | Mexico (n = 70) | All | Lay navigator | 3 mo | Obtain appointment at cancer center | 91% had appointment at 3-mo censor | Mexico City (urban) | |
| Mireles-Aguilar et al[116] (2018) | Retrospective descriptive study | Mexico (n = 656) | Breast | Media campaigns for navigation program followed by navigation by a nurse if alert activated | NR | Follow-up for self-reported symptomatic breast lesions | 69% attendance to appointment | Median time from alert activation to treatment (n = 22): 33 days | Nuevo Leon state (urban and rural) | |
| Treatment | Li et al[117] (2016) | Randomized controlled trial | China (n = 66) | Bladder | "Enhanced" nursing care including phone follow-ups vs usual nursing care | NR | Follow-up after tumor resection | 86% vs 63% (P = 0.032) | Laiwu, Shandong province (NR) |
| Alvarez et al[45] (2017) | Retrospective descriptive study | Guatemalan children (n = 1,789) | All | Multifaceted intervention including transportation, food, shelter, and education/guidance on the importance of completing treatment | N/A | Treatment abandonment (year 2001 vs 2008) | 27% vs 7% (NR) | Guatemala City (urban and rural) | |
| Yeoh et al[46] (2018) | Cohort study with retrospective control group | Malaysia (n = 283) | Breast | Nurses who received additional education in patient navigation vs retrospective cohort | N/A | Treatment abandonment | 4% vs 12% (P = 0.048) | Klang (suburban) | |
| Palliative | Sajjad et al[118] (2016) | Parallel cohort trail | Pakistan (n = 50) | Breast | Nurse delivered education series + nurse delivered support during chemotherapy sessions + nurse phone follow-ups vs none | 1.5 mo | Change in global quality of life score | Improvement for the intervention group (P = 0.020) | No change for historic cohort (P = 0.111) | Karachi (urban) |
| Nejad et al[119] (2016) | Parallel cohort trail | Iranian caregivers of cancer patients (n = 60) | Breast | Nurse delivering 2 in-person education / training sessions + 4 telephone follow-up sessions vs none | NR | Change in caregiver strain index scores | Improved scores for the intervention group (P = 0.001) | Tabriz (urban) |
Table 3 Randomized trails from the United States examining technology interventions to improve outcomes in cancer care for historically marginalized populations
| Ref. | Population | Cancer type | Technology | Time point | Outcome | Result (intervention vs control) | Location | |
| Screening | Miller et al[120] (2005)a | African American (70% of n = 194) | CRC | Educational multimedia computer program vs nurse instruction on using FOBT card | 1 mo | Completed FOBT kit | 62% vs 63% (P = 0.89) | Winston Salem, NC (urban) |
| Dignan et al[121] (2005)a | Native American (n = 157) | Breast | Lay navigator on phone vs lay navigator in person | 12 mo | Screening rate | 42% vs 45% (P = 0.83) | Denver, CA (urban) | |
| Champion et al[62] (2006)a | African Americans (n = 344) | Breast | Interactive educational computer program vs video vs pamphlet | 6 mo | Mammography rate | 40% vs 25% (video) vs 32% (pamphlet) (P = 0.037) | Indianapolis, IN (urban) | |
| Russell et al[63] (2010)a | African American (n = 181) | Breast | Interactive educational computer program + monthly lay navigation vs pamphlet | 6 mo | Mammography rate | 51% vs 18% (P < 0.001) | Indianapolis, IN (urban) | |
| Miller et al[122] (2011)a | African American (75% of n = 264) | CRC | Web-based decision aid vs usual care | 6 mo | Completion of CRC screening | 19% vs 14% (P = 0.25) | Winston Salem, NC (urban) | |
| Greiner et al[64] (2014)a | Low income (n = 470) | CRC | Computer-delivered information on screening +/- implementation intentions theory-based behavior modification tool | 6.5 mo | Completion of CRC screening | 54% vs 42%, (P < 0.01) | Kansas City, KS (urban) | |
| Fernandez et al[123] (2015)b | Hispanic (n = 665) | CRC | Interactive educational multimedia on a tablet vs video vs none | 6 mo | Completion of CRC screening | 10% vs 14% (video) vs 11% (none) (P = 0.46) | Lower Rio Grande Valley in Texas (rural) | |
| Valdez et al[124] (2019)a | Hispanic (n = 943) | Cervical | Kiosk delivered education versus pamphlet | 6 mo | Pap rate | 51% vs. 48% (P = 0.35) | Los Angeles, San Jose, and Fresno, CA (urban) | |
| Treatment | Helzlsouer et al[65] (2018)a | African American (n = 101) | Breast | Web-based navigation program versus list of websites | 12 mo | Adjuvant treatment completion | 94% vs 86% (P = 0.24) | Baltimore, MD (urban) |
| Percac-Lima et al[66] (2015)a | Likely to no show (n = 4425) | All | Lay navigator vs usual care | 5 mo | No show rate | 10% vs 18% (P < 0.001) | Boston, MA (urban) | |
| Palliation | Bakitas et al[77] (2009)a | Rural patients (n = 322) | All | Psycho-educational classes followed by monthly tele-health check-ins with advanced nurse practitioner vs usual care | Death or study completion (5 yr) | Quality of life | Intervention > control for quality of life (P = 0.02) and mood scores (P = 0.03) | ND in symptom intensity (P = 0.24) | Vermont (rural) |
| Kroenke et al [75] (2010)a | Low income (n = 405) | All | Telecare management with automated home-based symptom monitoring by interactive voice recording or internet vs usual care | 12 mo | Improvement in pain and depression scales | Intervention > control for pain and depression (P < 0.0001 for both) | Indiana (rural and urban) | |
| Yanez et al[76] (2015)a | African American (40% of n = 74) | Prostate | Cognitive-behavioral stress management delivered via web/tablet vs generic health information via web/tablet | 6 mo | Depression scale change | ND (P = 0.06) | Chicago, IL (urban) | |
| Anderson et al[125] (2015)a | African American and Hispanic (n = 60) | Breast | Twice weekly automated telephone calls with patient rating of pain. If pain was elevated, e-mail sent to clinician vs usual care | 2-2.5 mo | Reduction in pain severity from baseline | Intervention > control (P = 0.015) | Houston, TX (urban) | |
| Ramirez et al[78] (2020)a | Hispanic (n = 288) | Breast, CRC, and Prostate | Intensified telephone and internet-based patient navigation vs “standard” navigation | 15 mo | Change in health-related quality of life score | Intervention > control (P < 0.05) for female CRC patients | Intervention = control (P > 0.05) for breast cancer, male CRC, and prostate | Chicago, IL and San Antonio, TX (urban) |
- Citation: Dickerson JC, Ragavan MV, Parikh DA, Patel MI. Healthcare delivery interventions to reduce cancer disparities worldwide. World J Clin Oncol 2020; 11(9): 705-722
- URL: https://www.wjgnet.com/2218-4333/full/v11/i9/705.htm
- DOI: https://dx.doi.org/10.5306/wjco.v11.i9.705