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Can a patient navigator increase quality of life in colorectal cancer patients? The WeGuide trial
Background
An estimated one-third of patients with cancer will experience clinically significant distress, manifesting as anxiety or depression that is associated with their diagnosis and treatment. This has been shown to negatively impact health outcomes and quality of life (QOL). Intrahospital processes are complex, involving a significant amount of paperwork and several stakeholders, creating overwhelming circuits which can add up to generating more anxiety. Patient navigators (PN) can help to overcome these barriers by helping in several dimensions: information management and mediation (organize clinical information, prepare appointments, engaging in patient-healthcare professional communication), healthcare education and self-care (clarifying doubts about the therapeutic process, encouraging adherence to therapy) and on emotional and spiritual support (mobilizing social and family support, self-help groups). On this basis, the investigators designed the WeGuide trial, with the primary objective of assessing the impact of a PN in the QOL of patients with colorectal (CRC) cancer and also the utility of a PN from the patient’s point of view.
Methods
Participants were recruited from Hospital de Santa Maria and were randomized 1:1 to receive a PN or not. Three questionnaires (EORTC QLQ-C30, Utility Likert Scale and Satisfaction Scale) were applied in four moments: at diagnosis, three months, six months (end of therapy) and nine months (first follow-up). Value Based Health Care (VBHC) concepts were also applied to assess the impact of a PN on patient’s well-being and on the cost-effectiveness of CRC treatment in the health care system.
Results
We present the results of a preliminary analysis of 30 patients (of 160 needed). The PN group had a better Global Health Status with the average score increasing in 12.37% (p=0.05) when comparing the baseline to the last evaluation. Several other dimensions also improved in the same time period: physical functioning (6.40%; p=0.09), role functioning (10.18%; p=0.09), emotional functioning (8.49%; p=0.06) and cognitive functioning (10.16%; p =0.03). Symptom scales registered an absolute decrease in average, albeit not statistically significant in the current analysis. Regarding VBHC, medical appointments were considered to be more effective, patient visits to the emergency department were reduced and there was also a reduction in the number of trips to the hospital by optimizing the scheduling of procedures to the same day when possible. Patient safety could also be improved, with PN reporting to the responsible physician when alarm thresholds/symptoms had been noticed.
Conclusions
PN were useful to patients in this setting, promoting their QOL and their emotional well-being in spite of few observations. Looking at these indicators, the result of the positive impact on the patient's functional capacity comes from an improvement in the emotional component and, above all, in the cognitive capacity. We still have few observations to establish a concrete VBHC.
Legal entity responsible for the study
The authors.
Funding
Terra dos Sonhos is responsible for raising the necessary funds to implement this study. To achieve this objective, this non-profit organization has applied to several grants and has been awarded the BPI Capacitar Grant and, more recently, the Caixa Social Grant. In addition, WeGuide is also financed by some organizations sharing the same belief about this project. These include Saúde Prime, Fundação D. Pedro V, among others.
Disclosures
All authors have declared no conflicts of interest.
