Study Finds Social Barriers Impact Cancer Follow-Up Care.

Women who face social barriers to healthcare, such as problems with housing and income, experience delays in cancer screening follow-up, compared to those with fewer or no social barriers, according to a new study by researchers at the BU schools of public health and medicine and Tufts Medical Center.

The study, which appears online in the Journal of General Internal Medicine, was led by Sarah Primeau, research assistant in the department of general internal medicine at BUSM. BUSPH researchers include Timothy Heeren, professor of biostatistics, and Clara Chen, assistant director of operations for the Data Coordinating Center.

Previous studies on healthcare barriers have shown that training individuals from the community as “patient navigators,” to provide emotional and logistical support to patients, is an effective way to care for patients in a culturally sensitive way. However, those studies have not addressed whether patient navigators also are effective in addressing social service barriers such as financial problems, employment issues, housing constraints, and adult and child-care.

“Social barriers are more complex than other obstacles to healthcare such as transportation or language, and will likely require interventions that healthcare providers and patient navigators aren’t traditionally trained to provide,” said Primeau.

The study looked at 1,493 subjects enrolled in the Boston Patient Navigation Research Program (PNRP), a study performed at BMC from 2007-2010 that used patient navigators to help women with breast and cervical cancer screening abnormalities. The researchers used the data to separate the women into groups based on how many social barriers the navigator was able to identify. They then examined the data to see how long it took for each patient to reach a final diagnosis from the time of the initial abnormal screening test.

The researchers found that it took longer to achieve a final diagnosis in patients facing multiple barriers, and that having one or more social barrier further increased the follow-up time. The results of the study indicate that there is a continued need to better understand and overcome complex social obstacles to patient care, the authors said.

“The findings suggest that not all women benefit equally from patient navigation,” said senior author Dr. Tracy A. Battaglia, director of the Women’s Health Unit at Boston Medical Center and associate professor of medicine and epidemiology at BUSM.