"Navigators" help improve colon cancer screening

Trained guides known as patient navigators can help encourage people to get screened for colorectal cancer, the results of a new pilot study shows.

People belonging to racial or ethnic minorities, who are foreign born, or who lack health insurance are less likely to undergo colorectal cancer screening, Dr. Karen E. Lasser of Boston Medical Center and her colleagues note in their report, while being of low socioeconomic status or being covered by Medicaid also reduce the likelihood of getting screened.

Patient navigators have been shown to help improve colorectal cancer screening rates among urban minorities in New York City, the researchers add. They sought to investigate whether this approach could work in Boston, and among Haitian Creole and Portuguese-speaking patients from Brazil, Portugal, the Azores, and Haiti.

Lasser and her team identified 55 patients 52 to 80 years old served by one of Cambridge Health Alliance's community health centers. All were informed by mail that they were overdue for screening, and that they would be getting a call from a patient navigator.

The three patient navigators received 2-day training and all were experienced community health workers. They called patients and spoke to them about why screening was important and the relative advantages of screening with colonoscopy or fecal occult blood testing. The patient navigator also helped patients arrange for and follow through with the test.

The control group, all of whom were eligible for colorectal cancer screening, received usual care, meaning they were offered colonoscopy or fecal occult blood testing during primary care visits.

Within 6 months, 31 percent of the patients in the intervention group had undergone colorectal cancer screening. Sixteen completed fecal occult blood tests, all of which were negative. Among the 13 who had colonoscopies, three had high-risk abnormalities.

For the control group, 9 percent, or eight people, had been screened within six months. Seven completed the fecal occult blood test, and three had a positive test result, but just one of these patients had undergone a follow-up colonoscopy within 6 months. In the single patient who had a colonoscopy in this group, no abnormalities were found.

The navigators were unable to contact 25 percent of the patients in the intervention group, which may be because many traveled frequently to and from their country of origin, Lasser and her team note.

They conclude: "Our study adds to an emerging literature supporting the use of patient navigators to increase colorectal cancer screening in diverse populations served by urban health centers."

SOURCE: BMC Family Practice, online May 29, 2009.