April 2016: The role of patient navigators
Electra Paskett, PhD, MSPH, keynote speaker at Dana-Farber's 2016 Cancer Disparities Research Symposium
Since Dana-Farber began its patient navigator program in 2005, these important members of the health care team have been helping individuals facing
language barriers, financial hardships, racial/cultural biases, and other challenges as they access cancer care. Now there is evidence that navigators not only enable underserved patients to better understand and fight their disease, but they can
also have a profound impact on a region's cancer disparity and mortality rates.
As keynote speaker at the fourth annual Cancer Disparities Research Symposium, held at Dana-Farber on April 5, 2016, Electra Paskett, PhD, MSPH, director of the Division of Cancer Prevention and Control at The Ohio State University, gave a powerful example
of the value of patient navigators. Under the Delaware Cancer Consortium, she explained, that state offered 5,000 free colorectal screenings and colonoscopies from 2002-2011 to underserved individuals at risk for the disease – mostly African-Americans.
All those diagnosed with colorectal cancer were then given free access to patient
navigators during their treatment.
The results were dramatic. Screening rates increased and incidence rates decreased for all groups during the 10-year intervention, and racial disparities disappeared. In 2002, for instance, African-Americans age 50 or older in Delaware were 10 percent
less likely to have a colonoscopy than their Caucasian counterparts; within 10 years, the gap was gone.
"Delaware eliminated the disparity in how early and often African-Americans were screened, eliminated the incidence disparity between blacks and whites, and almost eliminated a huge mortality disparity – with mortality decreasing by 20 percent overall
in 10 years," said Paskett. "The program cost $7 million annually, but with the increased screenings, there were fewer incidences of cancer and cancers caught at earlier stages – which saved Delaware $8.5 million a year. That's a net cost savings
of $1.5 million annually for the state."
Symposium co-hosts Christopher Lathan, MD, MS, MPH (left), and Karen Burns White, MS (right), with keynote speaker Electra Paskett, PhD, MSPH
The symposium was held during National Minority Cancer Awareness Week, and is part of an ongoing effort by Dana-Farber's Cancer Care Equity Program and the Initiative to Eliminate Cancer Disparities (IECD) at Dana-Farber/Harvard Cancer Center to raise awareness of these issues. Other sponsors included the Harvard Catalyst Health Disparities Research Program, the Harvard Medical School office for Diversity Inclusion and Community Partnership,
and the Harvard T.H. Chan School of Public Health Lung Cancer Disparities Center.
"Cancer has, and continues to have, a disproportionately severe impact on minorities and the economically disadvantaged," Karen Burns White, MS,
IECD deputy associate director and co-host of the symposium, said in her opening remarks. "It is without question that although we are making strides at Dana-Farber, and across the broader cancer center, there continue to be opportunities to enhance
our role and to create the necessary and deliberate outcomes that are needed to reduce unequal burden."
One suggestion, posed by Paskett, is a national program similar to the Delaware Consortium Plan. If such a program were enacted, she said, there would be 4,200 fewer African- Americans diagnosed with colorectal cancer each year – and 2,700 fewer deaths.
Citing the $14 billion annual cost of colorectal cancer incidence and mortality across the United States, Paskett asked the crowd to "imagine if we can save billions in costs and reduce pain and suffering. It is possible."
Group breakout sessions after Paskett's talk centered on three key areas within disparities research:
- Risk and prevention, led by Marcela Del Carmen, MD, medical director of the Massachusetts General Physicians Organization
- Outcomes, with Jennifer Tseng, MD, MPH, chief of the Division of Surgical Oncology and clinical co-director of the Cancer Center at Beth Israel/Deaconess Medical Center
- Interventions and navigation, led by Karen Winkfield, MD, PhD, director of Hematologic Radiation Oncology at Massachusetts General Hospital
"Dr. Paskett's work is an excellent example of utilizing the research process not just to describe disparities but also to take action to alleviate the disparities," says Christopher Lathan, MD, MS, MPH,
faculty director of Cancer Care Equity and co-host with Burns White. "We have the opportunity here to make an incredible impact on equity in cancer care, right in own proverbial back yard. We were honored to be able have her share her passion and