Minorities suffer disproportionately worse outcomes in malignancies of the head and neck; Here we seek to determine the potential for patient navigation to improve the timeliness of head and neck cancer care in an underserved population.
Retrospective chart review of 100 consecutive patients presenting from each of two tertiary referral centers in inner city New Orleans, Louisiana located in the same zip code serving the local community, with a new diagnosis of squamous cell carcinoma of the head and neck between 2011 and 2014.The data from 187 patients were analyzed for delay at presentation and subsequent provider delay. Statistical analysis was performed to evaluate the effect of race, insurance status, and patient navigation on patient and provider delay using.
The mean patient delay to presentation was 161 days while the mean provider delay was 27 days. Analysis revealed three groups with significant provider delay: African Americans (37 vs. 23 days, P = 0.0003), uninsured (33 vs. 21 days, P = 0.002), and absence of navigation (36 vs. 19 days, P = 0.0001). Accounting for race and insurance status, adjusted subset analysis revealed that the absence of patient navigation was associated with an increased risk of provider delay. An adjusted risk ratio (RRmh) was found to be 1.55 (1.10, 2.2 P = 0.006).
Patient navigation has the potential to diminish temporal disparities for the underserved and at risk populations afflicted with HNC; This finding has great implications in the shaping of future health policy. Further studies are needed to define the benefit of patient navigation in this at risk population.