The oncologist | |
Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial | |
article | |
Enrique Soto-Perez-de-Celis1  José Carlos Aguilar-Velazco1  Alexandra Bukowski2  Juan Alberto Chávarri-Maldonado3  Sergio Contreras-Garduño1  Lindsay Krush2  Itoro Inoyo2  Andrea Medina-Campos4  María Luisa Moreno-García1  Viridiana Perez-Montessoro1  María T. Bourlon5  Yanin Chavarri-Guerra5  Roberto de la Peña-Lopez5  Héctor de la Mora-Molina5  Eucario León-Rodriguez5  Alejandro Mohar6  Paul E. Goss7  Wendy Alicia Ramos-Lopez1  Jacqueline Alcalde-Castro5  Alfredo Covarrubias-Gomez8  África Navarro-Lara4  Paulina Quiroz-Friedman9  Sofía Sánchez-Román9  Natasha Alcocer-Castillejos9  | |
[1] Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Global Cancer Institute;Universidad Autónoma de Ciudad Juárez;Physical Therapy Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Instituto Nacional de Cancerología Universidad Nacional Autónoma de México;Massachusetts General Hospital, Harvard Medical School;Department of Pain and Palliative Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán;Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán | |
关键词: Palliative care; Patient navigation; Advance directives; Symptom assessment; Health resources; Developing countries; | |
DOI : 10.1002/onco.13599 | |
学科分类:地质学 | |
来源: AlphaMed Press Incorporated | |
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【 摘 要 】
Background The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. Materials and Methods This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. Results One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34–0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care ( p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07–0.38; p = .006), without differences in quality of life between arms. Conclusion Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. Implications for Practice The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.
【 授权许可】
CC BY|CC BY-NC
【 预 览 】
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