Saturday, July 4, 2015

Guides can be useful, especially for underserved

Studies differ on whether trendy 'patient navigators' are truly beneficial in cancer cases 

Are navigators — those nurses or lay aides who guide cancer patients through the bureaucratic mazes that must be negotiated again and again in the medical system — really valuable?

Well, research findings are contradictory, according to a July 3, 2015 Washington Post article by Lenny Bernstein.

The Post piece cites, for example, a recent study conducted at the University of Alabama at Birmingham that looked at 6,743 cancer patients (aided by 42 lay navigators) covered by Medicare in five southeastern states. 

Researchers found, according to the Post, "that the number of hospitalizations, emergency room visits and admissions to intensive care declined more sharply among people assisted by navigators, as did costs."

Dr. Scott Ramsey
Systems are proliferating around the country in which such guides sometimes serve as patient helpers, sometimes patient advocates.

Navigators, in effect, have become trendy. 

But the Post also referred to an earlier study. That one, it said, showed only moderate benefits at best, and only after 90 days — except in cases involving what the lead researcher labeled "underserved patients who typically 'fell through the cracks' of the medical system."

In conjunction with those findings, the Post said "the debate over effectiveness and costs [centered on] the National Cancer Institute's $30.3 million, nine-site study of patient navigation. With smaller studies showing promise, the agency [had] hired and trained navigators to help 10,521 people with signs of breast, cervical, colorectal or prostate cancer…Most were minorities, had no insurance or were covered by government programs."

Navigators— sometimes nurses, sometimes not — purportedly added $275 per patient in costs.

But the Post also quoted a Seattle cancer center researcher, Dr. Scott Ramsey, who'd examined the cost-effectiveness question and who said navigators exist because "the cancer community has done a very poor job of helping patients through the system."

The fact "that navigation exists," he added, "is kind of an indictment of the cancer-care system." 

Looking at studies whose findings contradict each other is something I, Woody Weingarten, have done in "Rollercoaster: How a man can survive his partner's breast cancer," a book aimed at male caregivers. 

I believe it's worth checking out.

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