District of Columbia City-wide Patient Navigation Research Program (DC-PNRP) Free

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Introduction: Minority breast cancer mortality rates in Washington, DC are among the Nation’s highest with a significant differential compared to whites. Evidence suggests the cause of this disparity is late stage at diagnosis and/or delayed initiation of treatment. Purpose: DC-PNRP is one of nine U.S. sites included in a joint National Cancer Institute - American Cancer Society (NCI/ACS) national research program evaluating whether or not using patient navigators (trained health workers assisting patients in reducing barriers to obtaining health care while addressing cultural/psychological factors) can reduce the breast cancer disparity in DC. Study Procedures: Our hypotheses include: Patient navigation will be more effective than “usual care” in decreasing time from suspicious breast finding to diagnostic resolution and time from diagnosis to breast cancer treatment initiation. We expect to enroll approximately 1400 women at the point of abnormal breast finding with minorities targeted at all seven participating DC sites. The comparison groups include historical controls selected from medical records at the recruitment sites for the time period prior to initiation of navigation at those sites, and concurrent controls selected from DC Department of Health records. The study is on a five-year timeline with data collection beginning February 2007 and extending to 2010. Local area training was conducted to supplement National introductory and follow-up training seminars. Summary of Results To-Date: A complex infrastructure was established with site-specific Standard Operating Procedures providing for common data collection and communication links to assure protocol adherence. An intricate national committee system was developed to assure agreement on data elements and procedures across sites. Participation rates for navigated patients across the DC sites are highly variable ranging from 5% to 100% with an overall rate of 34%. The racial/ethnic distribution of enrolled navigated patients includes approximately 57% Black, 9% White, and 35% Hispanic. Conclusion: A city-wide patient navigation program can be established among non-affiliated care centers to assure the underserved receive timely, high-quality care. Existence of the well-established DC Cancer Consortium, plus the commitment of DC’s major medical centers to reducing cancer disparities, suggests DC-PNRP will continue to be sustainable and successful after conclusion of the research study.