Despite life-saving benefits of anti-hormonal medications, surveillance mammography, and physical exams, many breast cancer survivors do not adhere to these recommendations and experience decreased physical quality of life due to the adverse effects of cancer and its treatment. Research also indicates that some racial and ethnic minority women and women of low socioeconomic status (hereafter described as underserved), are less likely to get optimal health care following treatment for breast cancer than Caucasian women and women of higher socioeconomic status. Patient navigation, a barrier-focused intervention designed to reduce health care disparities, has demonstrated some degree of efficacy in improving adherence to breast cancer screening and diagnostic services. No known research has focused on development and evaluation of patient navigation interventions during the cancer survivorship period. Therefore, the objectives of the proposed project are to develop and pilot test a culturally relevant patient navigation program focused on underserved breast cancer survivors prescribed anti-hormonal medications. It is expected that a nurse patient navigation intervention can improve access and adherence to breast cancer survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors who have completed surgery, chemotherapy, and radiation. The proposed project will be conducted in two phases. In Phase I, a patient navigation intervention will be developed using the structure of two existing patient navigation programs combined with information obtained from qualitative data collected through in-depth interviews. In Phase II, the patient navigation intervention will be pilot-tested to evaluate its feasibility and potential in improving adherence to survivorship care recommendations and quality of life for underserved breast cancer survivors by comparing it to receipt of usual medical care plus the National Cancer Institute's booklet entitled Facing Forward: Life After Cancer Treatment. Hormone receptor positive breast cancer survivors randomized to patient navigation will receive the services of a patient navigator for 8 months. Adherence and quality of life outcomes will be evaluated at 4 and 8 month follow ups.
The specific aims of the study are to (1) evaluate underserved breast cancer survivors'facilitating factors (resources) and barriers related to obtaining survivorship care;and (2) develop a patient navigation intervention, infused with the results of qualitative research, designed to improve adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors;and (3) conduct a pilot test of the patient navigation intervention by evaluating its effect on adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors. The implementation of the proposed project is consistent with the long-term objective of this line of research: to develop, evaluate, and disseminate culturally, literacy, and linguistically relevant interventions to improve quality of life and adherence to recommended health care in underserved breast cancer survivors.

Public Health Relevance

Research has shown that adherence to life saving recommendations for breast cancer survivorship, including anti-hormonal medications, surveillance mammography, and physical exams, is low among some breast cancer survivors. The proposed study is the first to develop and pilot test a patient navigator program that focuses specifically on underserved breast cancer survivors who are prescribed anti-hormonal medicines. An intervention that increases adherence to recommendations for breast cancer survivorship care meets national priorities for providing quality care to cancer survivors and has the potential to reduce breast cancer mortality.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Rowland, Julia
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University of South Florida
Other Clinical Sciences
Schools of Medicine
United States
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Wells, Kristen J; Campbell, Kevin; Kumar, Ambuj et al. (2018) Effects of patient navigation on satisfaction with cancer care: a systematic review and meta-analysis. Support Care Cancer 26:1369-1382
Boukhechba, Mehdi; Baee, Sonia; Nobles, Alicia L et al. (2018) A Social Cognitive Theory-based Framework for Monitoring Medication Adherence Applied to Endocrine Therapy in Breast Cancer Survivors. IEEE EMBS Int Conf Biomed Health Inform 2018:275-278
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