Social Workers as Patient Navigators: A Review of the Literature

abstract

In recent decades, patient navigation has emerged as a promising strategy to address health disparities. This literature review assesses the involvement of social work in the field of patient navigation and identifies gaps in the literature that future social work research can address. Eighteen publications met authors’ inclusion criteria, of which 13 were research studies that used social workers as patient navigators and five were studies that used social workers solely in the training, support, or supervision of patient navigators. Only one of the 18 articles was published in a social work journal, and 69% of the research studies were authored by one group of authors. Although implementation of the 2010 Patient Protection and Affordable Care Act provides enhanced opportunities for patient navigation, the paucity of research involving social workers suggests that social work scholars and professionals are not yet well positioned to take advantage of these new opportunities. The limited evidence showing social work’s impact on patient outcomes is encouraging, but social workers need to increase their contributions in this area and more convincingly demonstrate their effectiveness as patient navigators.

TP53 mutations, tetraploidy and homologous recombination repair defects in early stage high-grade serous ovarian cancer

open access (somewhat technical - worth reading)

Conclusions 

.....Despite heterogeneity in somatic sequence variations, CNAs and structural variations, none of these somatic genotypes appears to be associated with clinical outcome. Only stage appears to be strongly linked to patient survival, as six of eight patients with stage I HGS ovarian carcinomas are still alive (median follow-up 101 months), whereas only two of eight with stage 2 disease are still alive (median follow-up 79 months). Collectively, these observations provide new insight into the biology and likely pathogenesis of early stage HGS ovarian cancer.

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead

open access
 About the Journal
Carcinogenesis: Integrative Cancer Research is a multi-disciplinary journal that brings together all the varied aspects of research that will ultimately lead to the prevention of cancer in man.....

Introduction

Cancer is a burden on humanity and among the leading causes of morbidity and mortality worldwide, with ~14 million new cases and 8.2 million cancer-related deaths in 2012 (1). In general, both genetic and environmental factors play a role in an individual’s cancer susceptibility (2,3), so there has been a long-standing emphasis on avoidable ‘lifestyle’ factors (i.e. those that can be modified to reduce the incidence of the disease) and a parallel focus on exogenous chemical exposures (e.g. agricultural, occupational and so on) (4). But advances in our understanding of the complexity of cancer biology have resulted in serious critiques of current risk assessment practices related to exogenous exposures (5) along with calls for an expanded focus on research that will allow us to evaluate the (potentially carcinogenic) effects of in-utero exposures and low-level exposures to combinations of chemicals that occur throughout our lifetime (6,7).....

Knowledge and attitudes regarding medical research studies among patients with breast cancer/gynecological diseases

open access

The present study investigated the general level of knowledge on the topic of “clinical studies” in a group of patients being treated at a university gynecology department. In addition, the way in which they perceived the design and conduct of studies and their attitudes to them were also noted.

eg.: selected key items
 Table 1. Characteristics of the patients

Table 2. Summary of statements to assess patients’ level of knowledge about the design and conduct of studies (questions on the rating scale are marked in bold type)

Fig. 1. Analysis of patients’ knowledge about clinical studies (relative frequencies of numbers of correct answers)

Patients who presented in the department due to pregnancy or birth had an average of 2.3 answers right; patients with gynecological diseases had 1.79; patients with breast cancer had 1.97; patients attending for fertility treatment had 2.11; patients with endometriosis had 1.9; and patients with benign gynecological diseases had 2.04 (P < 0.001) (Fig. 2).

 The amount of information desired by patients is also important in the context of autonomy when participating in a study. The majority of patients in the present group (95.9 %) wanted to receive all of the available information during the consultation process. A similar picture has also been described in other studies [5], [15]. Patients who do not believe that they have fully understood the implications of a study may ultimately feel regret about their decision to participate [19].

 Altruistic motivations generally play an important role in study participation, as has often been shown in other studies [20], [21].

 Conclusions

This study shows that women with gynecological diseases have only moderate knowledge about clinical studies.

Oral Contraceptive Use and Reproductive Characteristics Affect Survival in Patients With Epithelial Ovarian Cancer: A Cohort Study

abstract

OBJECTIVES:

Prognostic risk factors influencing survival in patients with epithelial ovarian cancer (EOC) include tumor stage, grade, histologic subtype, debulking, and platinum status. Little is known about the impact of hormonal milieu and reproductive factors before cancer diagnosis on clinical outcome. We sought to evaluate whether oral contraceptive (OC) use carries any prognostic significance on overall survival (OS) in patients with EOC.

METHODS:

Newly diagnosed patients with EOC, fallopian tube, and primary peritoneal cancers between 1982 and 1998 were prospectively evaluated with a comprehensive epidemiologic questionnaire. A retrospective chart review was performed to abstract clinicopathologic data, including OS. A Kaplan-Meier analysis was performed to compare survival across various exposures. A Cox regression model was used to compute adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS:

We identified 387 newly diagnosed cancers with evaluable information in this cohort. Decreased risk of death was observed in women who reported prior use of OC, previous pregnancy, or a live birth after adjusting for age at diagnosis, stage, and histologic subtype. Oral contraceptive use was associated with a crude reduced risk of death, with reported median OS of 81 months in OC users versus 46 months in nonusers. Patients who reported a single live birth experienced the largest potential survival advantage. Oral contraceptive use and prior pregnancy were associated with improved survival across all strata.

CONCLUSIONS:

Oral contraceptive use may have lasting effects on epithelial ovarian tumor characteristics conferring favorable prognosis. Putative mechanisms that affect tumor biology include complex interactions between ovarian cells, host immune cells, and hormonal microenvironment during carcinogenesis. Future efforts should be directed to determine the role of reproductive factors in antitumor immunity.

Integrated multidisciplinary screening for patients with Lynch syndrome at 33 US-based cancer centers

abstract

 Integrated multidisciplinary screening for patients with Lynch syndrome at 33 US-based cancer centers designated by the National Cancer Institute

Objective

To assess the availability and capacity of US-based integrated centers for the management of Lynch syndrome.

Methods

A cross-sectional survey of practice patterns in the care of patients with Lynch syndrome was conducted at 33 National Cancer Institute-designated cancer centers in the USA from March 1 to June 1, 2013. Each cancer center was contacted by telephone and the caller used a uniform scripted greeting and survey format.

Results

All centers routinely recommended colonoscopy. Other recommended screening modalities were hysterectomy and bilateral salpingo-oophorectomy (29/33; 88%), endoscopy (27/33; 82%), urinalysis (23/33; 70%), endometrial sampling (21/33; 64%), dermatologic examination (19/32; 59%), pelvic ultrasonography (18/33; 55%), serum CA125 level (14/33; 42%), urine cytology (14/33, 42%), computed tomography (1/33; 3%), and magnetic resonance imaging (1/33; 3%). Each center had a multidisciplinary team but the composition õvaried. A designated team leader was present at 21 centers (64%). Having a team leader was associated with an increased likelihood of recommending endoscopy (P = 0.04) and dermatologic surveillance (P = 0.01). Only 23 centers (70%) had a system in place for communicating follow-up with patients.

Conclusion

The lack of consensus in practice patterns recorded among participating centers probably reflected the limited existing evidence on the usefulness of most screening modalities.

Bevacizumab in ovarian cancer: Focus on clinical data and future perspectives

open access - pdf file

Conclusions: ..... As treatment options expand, the outlook for women with ovarian cancer is at last slowly but steadily improving.

 (blogger's note: questions still that need to be answered )eg. Nevertheless, there are no data available to answer the important question of whether bevacizumab can be used in combination with chemotherapy in both the front-line and recurrent setting in the same patient.

 Critical Reviews in Oncology/Hematology