Healthcare delivery interventions to reduce cancer disparities worldwide

Table 1 Randomized trials from the United States focusing on navigation interventions to improve outcomes in cancer care for historically marginalized populations

	Ref.	Population	Cancer type	Navigator type	Time point	Outcome	Result (intervention vs control)	Location
Screening	Jandorf et al[91] (2005)a	Hispanic (82% of n = 78)	CRC	Lay navigator vs usual care	6 mo	Screening rate	Endoscopy: 16% vs 5% (P = 0.019) | FOBT: 42% vs 25% (P = 0.086)	New York, NY (urban)
	Tu et al[92] (2006)a	Chinese Americans (n = 210)	CRC	Education + FOBT card vs usual care	6 mo	FOBT rate	70% vs 28% (P < 0.05)	Seattle, WA (urban)
	Christie et al[93] (2008)a	Hispanic (71% of n = 25)	CRC	Lay navigator vs usual care	3 mo	Colonoscopy rate	54% vs 13% (P = 0.058)	New York, NY (urban)
	Percac-Lima et al[27] (2009)a	Low income (n = 1223)	CRC	Lay navigator vs usual care	9 mo	Screening rate	27% vs 12% (P < 0.001)	Boston, MA (urban)
	Ma et al[94] (2009)b	Korean Americans (n = 167)	CRC	Lay navigator vs usual care	12 mo	Screening rate	77% vs 11% (P < 0.001)	NR
	Phillips et al[95] (2011)b	African American (47% of n = 3895)	Breast	Lay navigator vs usual care	9 mo	Mammography rate	87% vs 76% (P < 0.001)	Boston, MA (urban)
	Lasser et al[96] (2011)a	Low income (n = 465)	CRC	Lay navigator vs usual care	12 mo	Screening rate	34% vs 20% (P < 0.001)	Boston, MA (urban)
	Myers et al[97] (2014)a	African American (n = 764)	CRC	Mailed FOBT and reminder +/- lay navigation	12 mo	Screening rate	44% vs 32% (P = 0.001)	Philadelphia, PA (urban)
	Braschi et al[98] (2014)a	Hispanic (n = 392)	CRC	Culturally tailored lay navigation vs standard navigation	NR	Colonoscopy rate	82% vs 79% (P > 0.05)	New York, NY (urban)
	Enard et al[99] (2015)a	Hispanic (n = 303)	CRC	Lay navigator vs mailed information	16 mo (average, not pre-specified)	Screening rate	44% vs 32% (P = 0.04)	Houston, TX (urban)
	Braun et al[100] (2015)a	Hawaiian and Filipino (90% of n = 488)	Multiplec	Lay navigator vs usual care	NR	Screening rate	Pap: 57% vs 36% (P = 0.001) | Mammogram: 62% vs 42% (P = 0.003) | Prostate: (54% vs 36% (P = 0.008) | CRC: 43% vs 27% (P < 0.001)	Hawai‘i (rural and urban)
	Marshall et al[28] (2016)a	African American (n = 1905)	Breast	Lay navigator vs pamphlet	18 mo (average, not pre-specified)	Screening rate	93% vs 88% (P < 0.001)	Baltimore, MD (urban)
	Percac-Lima et al[101] (2016)a	Non-adherent patients (n = 1612)	Multiplec	Lay navigator vs usual care	8 mo	Percentage of patients up to date on all screens	10% vs 7% (P < 0.001)	Boston, MA (urban)
	Degroff et al[102] (2017)a	Low income (n = 843)	CRC	Lay navigator vs usual care	6 mo	Screening rate	61% vs 53% (P = 0.021)	Boston, MA (urban)
	Thompson et al[103] (2017)a	Hispanic (n = 443)	Cervical	Video + lay navigation vs usual care	7 mo	Screening rate	53% vs 34% (P < 0.001)	Washington and Oregon (rural)
	Ma et al[104] (2019)b	Korean Americans (n = 925)	CRC	Lay navigator + group teaching + FIT card vs usual care	12 mo	Screening rate	69% vs 16% (P < 0.001)	NR
Diagnostic resolution	Ell et al[105] (2007)a	Hispanic (n = 204)	Breast	Social worker navigation vs usual care	2 mo	Completion of follow-up testing	90% vs 66% (P < 0.001)	Los Angeles, CA (urban)
	Ferrante et al[106] (2008)a	African American and Hispanic (87% of n = 105)	Breast	Lay navigator vs usual care	N/A	Mean time to diagnosis (days)	25 vs 43 (P = 0.001)	Newark, NJ (urban)
	Raich et al[107] (2012)a	72% non-white (n = 993)	Multipled	Lay navigator vs usual care	12 mo	Completion of follow-up testing	88% vs 70% (P < 0.001)	Denver, CA (urban)
	Lee et al[108] (2013)b	Hispanic (60% of n = 1039)	Breast	Lay navigator vs usual care	N/A	Time to diagnosis	2.0 mo vs 1.7 mo (P > 0.05)	Tampa, FL (urban)
Treatment	Ell et al[40] (2009)a	Low income (n = 487)	Breast and Gynecological	Lay navigator + social worker vs usual care	12 mo	Chemotherapy completed as scheduled	Breast: 62% vs 75% (P = 0.47) | Gyn: 63% vs 46% (P = 0.13)	Los Angeles, CA (urban)
Palliation	Fischer et al[49] (2018)a	Hispanic (n = 223)	All	Lay navigator doing at least 5 home visits + educational packet vs usual care	Enrollment till end of life	Advance care planning, pain scores, hospice use	Documentation: 65% vs 36% (P < 0.001) | Pain reduction ND (P = 0.88) | Hospice use ND (P = 0.58)	Colorado (urban and rural)
	Patel et al[50] (2018)a	Rural veterans (n = 213)	All	Lay navigator discussing advanced care planning vs usual care	6 mo	Advanced care planning documentation	Documentation: 92% vs 18% (P < 0.001)	Palo Alto, CA (urban and rural)

If a study had comparisons at multiple points (i.e., three months and six months) only the final time point in each study is reported.

^aRandomized Controlled Trial.

^bCluster Randomized Trial.

^cBreast, Prostate, Colorectal, and Cervical.

^dBreast, Prostate, and Colorectal. FOBT: Fecal occult blood test; CRC: Colorectal cancer; NR: Not reported.