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Patient Navigation Can Improve Breast Cancer Outcomes among African American Women in Chicago: Insights from a Modeling Study

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Abstract

African American (AA) women experience much greater mortality due to breast cancer (BC) than non-Latino Whites (NLW). Clinical patient navigation is an evidence-based strategy used by healthcare institutions to improve AA women’s breast cancer outcomes. While empirical research has demonstrated the potential effect of navigation interventions for individuals, the population-level impact of navigation on screening, diagnostic completion, and stage at diagnosis has not been assessed. An agent-based model (ABM), representing 50–74-year-old AA women and parameterized with locally sourced data from Chicago, is developed to simulate screening mammography, diagnostic resolution, and stage at diagnosis of cancer. The ABM simulated three counterfactual scenarios: (1) a control setting without any navigation that represents the “standard of care”; (2) a clinical navigation scenario, where agents receive navigation from hospital-affiliated staff; and (3) a setting with network navigation, where agents receive clinical navigation and/or social network navigation (i.e., receiving support from clinically navigated agents for breast cancer care). In the control setting, the mean population-level screening mammography rate was 46.3% (95% CI: 46.2%, 46.4%), the diagnostic completion rate was 80.2% (95% CI: 79.9%, 80.5%), and the mean early cancer diagnosis rate was 65.9% (95% CI: 65.1%, 66.7%). Simulation results suggest that network navigation may lead up to a 13% increase in screening completion rate, 7.8% increase in diagnostic resolution rate, and a 4.9% increase in early-stage diagnoses at the population-level. Results suggest that systems science methods can be useful in the adoption of clinical and network navigation policies to reduce breast cancer disparities.

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Acknowledgements

This work is supported by R21 CA 215252 (MPI Molina, Khanna, Watson). Additionally, A.S.K. was supported by P20 GM 130414 and P30 AI 042853. This work was completed in part with resources provided by the University of Chicago’s Research Computing Center and the Center for Computation and Visualization, Brown University. S.S. was supported by the Cancer Education and Career Development Program (T32 CA 057699). J.R.S. funded in part by RAD-AID, International grant, unrelated to current study. J.E.H. was supported by T34 GM105549.

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Authors and Affiliations

  1. Brown University, Providence, RI, 02912, USA

    Aditya S. Khanna

  2. University of Chicago, Chicago, IL, 60637, USA

    Bryan Brickman

  3. Boston University School of Medicine, Boston, MA, 02118, USA

    Michael Cronin

  4. Univeristy of Illinois Chicago, Chicago, IL, 60607, USA

    Nyahne Q. Bergeron & Yamilé Molina

  5. University of Washington, Seattle, WA, 98195, USA

    John R. Scheel

  6. Northeastern Illinois University, Chicago, IL, 60625, USA

    Joseph Hibdon

  7. University of Kansas, Lawrence, KS, 66045, USA

    Elizabeth A. Calhoun

  8. National Institutes of Health, Bethesda, MD, 20814, USA

    Karriem S. Watson

  9. University of North Carolina Wilmington, Wilmington, NC, 28403, USA

    Shaila M. Strayhorn

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Khanna, A.S., Brickman, B., Cronin, M. et al. Patient Navigation Can Improve Breast Cancer Outcomes among African American Women in Chicago: Insights from a Modeling Study. J Urban Health 99, 813–828 (2022). https://doi.org/10.1007/s11524-022-00669-9

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