Nurse Navigation in Safety Net Hospital Resulted in Less Frequent Care Refusal for Patients with Breast Cancer

A poster presented at the 2020 San Antonio Breast Cancer Symposium found a trend towards less frequent care refusal when a safety net hospital introduced nurse breast navigators.

The implementation of nurse breast navigators resulted in trends towards less frequent refusal of care by patients diagnosed or receiving treatment, according to a poster published at the 2020 San Antonio Breast Cancer Symposium (SABCS).

Researchers found that lower refusal rates of chemotherapy and hormonal therapy were the areas of treatment most effected by the implementation of nurse breast navigation.

The team of researchers compiled a tumor registry comprised of patients diagnosed or treated at a minimum of 1 time at the Grady Cancer Center for Excellence. Then, they conducted a tumor registry audit of refusal of care as coded by “patient or patient guardian refused care” for 2-time intervals of pre- (2016-2017) and post-nurse navigation (2018-2019).

Patients who were diagnosed at the Grady Cancer Center for Excellence but were treated elsewhere (out-migration of breast cancer patients) was also an audited group for the same time intervals.

In the pre-nurse navigation period, a total of 325 patients with breast cancer were analyzed with 58 (17.8%) refusing care. During the post-nurse navigation period, 376 patients were seen with 50 (13.2%) refusing care (P = 0.128).

The overall refusal of care rates decreased from 17.8% during the pre-nurse navigation period to 13.2% during the post-nurse navigation period. The out-migration rates of patients with breast cancer during both time periods was 3.6%.

“While there was no difference in 'out-migration' to other cancer centers identified during this time interval, the number of patients leaving the system remains low,” wrote the researchers in their study’s presentation poster for SABCS 2020.

During the pre-nurse navigation period, when breaking down the data according to treatment refusal by the type of recommended care, 29 patients refused chemotherapy, 18 refused hormonal therapy, 0 refused immunotherapy, 22 refused radiation therapy, and 10 refused surgery.

For the post-nurse navigation period, 18 patients refused chemotherapy, 12 refused hormonal therapy, 2 refused immunotherapy, 24 refused radiation therapy, and 12 refused surgery. It’s noted in the poster that the rates of refusal for different treatment types varied between the 2 different time periods analyzed.

The researchers used Grady Memorial Hospital in Atlanta, Georgia as their safety net hospital, and the Georgia Cancer Center for Excellence at Grady received a Merck Foundation grant in which it introduced a nurse navigator to the breast cancer program on January 1, 2018.

Grady Memorial Hospital treats a diverse and medically underserved population, with a reported 28% of patients who are uninsured. The grant was awarded to “improving care for vulnerable cancer patients.”

The nurse navigators meet with all of the newly diagnosed breast cancer patients during clinic. More, they track the progression of care for these patients, occasionally intervening for timeliness of work-up and for treatment.

“We plan to continue to track our navigated patients and collect patient satisfaction information with navigation as a future initiative,” wrote the researchers.


Rehr C, Coples S, Wang Z, et al. The Impact of Nurse Navigation on Adherence to Care for Patients Treated for Breast Cancer in a Safety Net Hospital. Presented at: 2020 San Antonio Breast Cancer Symposium; December 8-11, 2020; Virtual. Poster PS7-58.

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