Patient navigation and cancer screening

A Health Education and Patient Navigation Program Increased Breast and Cervical Cancer Screening for Rural and Border Texas Residents

Derek Falk, Catherine Cubbin, Barbara Jones

Introduction

In the United States, women who live in rural counties with high poverty rates screen for breast cancer at much lower rates than their urban counterparts. Screening gaps are even larger between rural women of color and urban White residents. Lower screening rates among rural women compared with urban residents may, in turn, contribute to later stage diagnoses and higher mortality rates for breast and cervical cancer for the rural residents.

These general research findings also hold true for women who live in lower socioeconomic status areas in the Texas-Mexico border region: they have lower breast and cervical cancer screening and higher cancer-related mortality rates compared to their counterparts who live in higher socioeconomic status areas. Moreover, Latina and Black women in these areas fare worse on cancer screening and mortality, on average, than White women. Studies have also reported several barriers to cancer screening in Texas border counties, including limited clinical capacity, cost, lack of government funding sources, low health literacy, work-related issues, and transportation challenges.

Patient navigation – or programs that provide support to help people overcome barriers to get the health care they need – has been shown to increase breast and cervical cancer screening rates among different populations. However, few studies have focused on patient navigation to increase breast and cervical cancer screening among rural and border populations.

This brief reports on a recent study [1] in which the authors addressed this gap in knowledge. Specifically, they examined the impact of patient navigation services on clinical screening for breast and cervical cancer among women who attended an educational program. They also identified variation in breast and cervical cancer screening rates among rural and border counties in Texas.

Participants in the study included women in rural and border Texas counties who attended a bilingual, culturally sensitive “pink party” – an evidence-based education program that informed participants about the need for timely mammograms to screen for breast cancer and Pap tests to screen for cervical cancer. At the end of the event, women were offered patient navigation services to help them get screened. Patient navigators would help participants to overcome obstacles that might prevent them from screening, such as costs, transportation, and child care. Participants filled out pre- and post-test surveys and follow-up surveys. County-level poverty data was obtained from the 2014 American Community Survey.

Key Findings

• Patient navigation services increased breast and cervical cancer screening for patients with barriers to care. Women with barriers to care (such as those who worried about the cost of screening or had transportation issues) who received patient navigation services had significantly higher rates of receiving a mammogram and/or a Pap screening than those without patient navigation. That is, more women screened for breast and cervical cancer when supportive staff identified barriers to care and addressed them with instrumental support (e.g., paid for screenings, provided transportation).
• Overall, there was a higher prevalence of both mammogram and Pap screening in counties with the highest poverty levels.
  • However, in statistical models in which women were linked to their home county, women living in counties with the highest rates of adults living in poverty had the lowest probabilities of Pap screening compared with those living in the counties with the lowest poverty rates. This finding highlights the need to prioritize counties with high rates of poverty, many of which are located on the Texas-Mexico border and suffer from the highest incidence of and mortality rates from cervical cancer in the US.

This figure shows that more women who wanted help and had barriers to care screened for breast and cervical cancer when supportive staff identified those barriers and addressed them with instrumental support; for example, paid for screenings, provided transportation.

Policy Implications

Despite extensive evidence that shows the positive impact of patient navigation to improve cancer and other health outcomes, patient navigation services are underfunded and only cover a small percentage of the U.S. population. Though a bill was proposed in the 2019-2020 Congress to address this gap in Medicaid funding, it did not become law. Instead, these services are primarily supported through grant-funded research studies or other funding sources rather than covered in public or private health care systems as a reimbursable expense. As a result, many health care systems do not employ navigators or other supportive staff, including community health workers or social workers. These supportive staff could help to identify and address patients’ social factors (for example, language barriers, lack of transportation, challenges with costs) before these barriers negatively impact people’s health and health care access.

Ignoring these social factors increases health care costs because people with barriers to care often seek care only as a last resort. When addressing cancer and other conditions, later detection and treatment is vastly more expensive compared to early detection and treatment. Investing in supportive care services represents a minimal expenditure that has the potential to reduce health care costs. It also has the benefit of improving outcomes for underserved populations in the United States.

Reference

[1] Falk, D., Cubbin, C. & Jones. B. (2022). County-level poverty and barriers to breast and cervical cancer screening in a health education and patient navigation program for rural and border Texas residents. Journal of Cancer Education 37:421–429. DOI: https://doi.org/10.1007/s13187-020-01832-z.

Suggested Citation

Falk, D., Cubbin, C. & Jones. B. (2022). A health education and patient navigation program increased breast and cervical cancer screening for rural and border Texas residents. PRC Research Brief 7(6). http://dx.doi.org/10.26153/tsw/41679.

About the Authors

Derek Falk, derek.falk@case.edu, is an assistant professor in the Department of Population and Quantitative Health Sciences at the Case Western Reserve University School of Medicine and a research associate in the Institute for Collaborative Health Research and Practice at the University of Texas at Austin; Catherine Cubbin is the Clara Pope Willoughby Centennial Professor in Community Safety and Associate Dean for Research in the Steve Hicks School of Social Work, and a faculty scholar at the Population Research Center, The University of Texas at Austin. Barbara Jones is the Josleen and Frances Lockhart Memorial Professor for Direct Practice in Social Work, University Distinguished Professor, Associate Dean for Health Affairs, and co-director of the Institute for Collaborative Health Research and Practice at the Steve Hicks School of Social Work.

Acknowledgements

This work was supported by grant, T32CA122061, Training Grant in Cancer Prevention and Control from the National Cancer Institute and the Doctoral Training Grant in Oncology Social Work (125672-DSW-14-115-01-SW, awarded to Dr. Falk) from the American Cancer Society; and by grant, P2CHD042849, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Evidence-Based Prevention Programs and Services grants, PP120099 and PP150089, from the Cancer Prevention Research Institute of Texas provided the funding for the program and its evaluation.