The Effect of Patient Navigation on Time to Diagnosis, Anxiety, and Satisfaction in Urban Minority Women with Abnormal Mammograms: A Randomized Controlled Trial

Delay in follow-up after an abnormal mammogram is associated with advanced disease stage, poorer survival, and increased anxiety. Despite the implementation of many patient navigator programs across the country, there are few published, peer-reviewed studies documenting its effectiveness. We tested the effectiveness of a patient navigator in improving timeliness to diagnosis, decreasing anxiety, and increasing satisfaction in urban minority women after an abnormal mammogram. Women with suspicious mammograms were randomly assigned to usual care (N = 50) or usual care plus intervention with a patient navigator (N = 55). There were no demographic differences between the two groups. Women in the intervention group had shorter times to diagnostic resolution (mean 25.0 vs. 42.7 days; p = .001), with 22% of women in the control group without a final diagnosis at 60 days vs. 6% in the intervention group. The intervention group also had lower mean anxiety scores (decrease of 8.0 in intervention vs. increase of 5.8 in control; p < .001), and higher mean satisfaction scores (4.3 vs. 2.9; p < .001). Patient navigation is an effective strategy to improve timely diagnostic resolution, significantly decrease anxiety, and increase patient satisfaction among urban minority women with abnormal mammograms

Prostate cancer disparities in Hispanics by country of origin: a nationwide population-based analysis

BACKGROUND: We sought to evaluate prostate cancer (PCa) characteristics and outcomes of Hispanics living in the United States by country of origin in the Surveillance, Epidemiology and End Results (SEER) program. METHODS: Retrospective analysis of 72,134 adult Hispanics with PCa between 1995-2014. Origin was Mexican (N=16,995; 24%), South/Central American (N=6,949; 10%), Puerto Rican (N=3,582; 5%), Cuban (N=2,587; 4%), Dominican (N=725; 1%), Hispanic not specified (NOS, N=41,296; 57%), as coded by SEER. Patient and PCa characteristics were analyzed with chi-square and Kruskal-Wallis tests. Overall and PCa survival were analyzed with Kaplan-Meier and Cox models adjusting for baseline variables. RESULTS: At diagnosis, Mexicans had more advanced stage, higher prostate-specific antigen and higher Gleason score while Cubans and Dominicans had more favorable PCa at diagnosis (all P<0.05). After a median follow up of 69 months, 20,317 men died, including 6,223 PCa deaths. Compared to Mexicans, Cubans (HR=1.22, 95%CI=[1.14-1.30]) and Puerto Ricans (HR=1.15 [1.08-1.22]) had worse overall survival while Dominicans (HR=0.76 [0.64-0.91]), South/Central Americans (HR=0.68, [0.65-0.72]) and NOS (HR=0.81 [0.78-0.84]) had better overall survival. Compared to Mexicans, Cubans (HR=1.08, [0.96-1.22]) and Puerto Ricans (HR=1.03, [0.92-1.15]) had similar PCa survival while Dominicans (HR=0.72, [0.53-0.98]), South/Central Americans (HR=0.67 [0.60-0.74]) and NOS (HR=0.68 [0.64-0.73]) had significantly better PCa survival. CONCLUSIONS: Among Hispanics in the United States, disparities in PCa characteristics and survival by country of origin exist, with Dominicans, South/Central Americans and Hispanic NOS having better PCa survival compared to Mexicans, Cubans and Puerto Ricans