Background: Genesis Healthcare Partners (GHP), in San Diego, CA, has been proactively seeking effective solutions to improve prostate cancer (PCa) advancement detection rates. According to the National Cancer Institute, the 5-year survival rate of de novo metastatic castration-sensitive prostate cancer (mCSPC) is 30%, compared with 100% for clinically localized prostate cancer.1 In addition, we have seen a 76% increase in de novo mCSPC diagnosis since 2010.2 Knowing this, the focus was to discover how GHP could close this PCa detection gap utilizing a new workflow and software solution for patient navigators to help detect PCa recurrence and progression.
Objectives: To empower navigators, GHP will utilize a systematic workflow and navigation software program to perform chart reviews, detect when patients are out of compliance with standardized PCa protocols, and assist in protocol compliance. In addition, navigators would assess treatment tolerance, identify barriers to care, and improve quality of life via structured needs assessment questionnaires.
Methods: Patient navigators proactively reviewed charts and initiated interventions to ensure compliance with treatment plans. This included identifying and reconciling missing lab tests, imaging scans, and medical referrals, as well as intervening on unfilled prescriptions and unscheduled follow-up appointments. A hybrid of quantitative and qualitative research methods was used to determine the impact on patient care. Patient outcomes were selected by navigators when documenting care for patients in the patient navigation software. Navigators were given predetermined patient outcome options to choose from, such as cancer progression detected, missing lab or scan discovered, new treatments identified/initiated, symptoms improved, side effects reduced or removed, and patient satisfaction score increased. The primary outcome measure was the number of patients with cancer progression detected. One limitation of the method is that qualitative interviews with patient navigators revealed patient outcomes may have been underreported since they relied on patient navigators asking patients for their reported outcomes. This could vary based on patient and navigator education, recollection, and perspective.
Results: Data at 9 months showed 62 of 229 PCa patients were detected to have cancer progression through the newly structured patient navigation system. Forty- five of those 62 patients were identified and started on new advanced PCa treatments, including multiple oral oncolytics (29), relugolix oral androgen deprivation therapy (7), and docetaxel immunotherapy (9). Twenty-two patients had missing labs or scans discovered, 113 patients reported symptom improvement, 83 reported side effect(s) were reduced or removed, and 176 patients reported an increased satisfaction score.
Conclusion: Using a systematic workflow and navigation software, GHP navigators detected 20% of their PCa population had progressed in their disease in 9 months. Success of this program underscores the need to utilize technology-guided navigators to help patients adhere to standardized clinical protocols. Further studies are needed to understand the generalizability of the intervention across urology practices. Structured navigation is one potential solution to layer in the execution of quality metric measures, such as improving patient satisfaction scores.
- National Cancer Institute. SEER Cancer Statistics Review, 1975-2017. https://seer.cancer.gov/csr/1975_2017/results_merged/sect_23_prostate.pdf.
- Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER Research Data, 18 Registries, Nov 2019 Sub (2000-2017)–Linked to County Attributes–Time Dependent (1990-2017) Income/Rurality, 1969-2017 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, release April 2020, based on the November 2019 submission.