Patient Navigation in Gynecologic Oncology: Improving Care among Rural Endometrial Cancer Patients

Rural women with endometrial cancer (EC), the most prevalent gynecologic cancer in the US, have 8-17% higher odds of mortality than their urban counterparts. As the number of new EC cases is expected to increase 50% by 2030, this urban-rural disparity is expected to continue widening. Contributing to this disparity is the reduced receipt of guideline-concordant treatment; in particular, rural women with EC are less likely to receive comprehensive surgical care, the cornerstone of regional stage EC treatment. The overall objective of this project is to identify and target multilevel determinants to receiving guideline-concordant treatment among rural EC patients by developing and piloting a patient navigation intervention. Patient navigation interventions can address a multitude of determinants of care faced by patients with low access to care and have been shown to shorten time to initiating treatment, increase receipt of and adherence to treatment, and improve patient satisfaction. However, because of the substantial variation in the design and delivery of patient navigation interventions, developing effective and cost-effective interventions for new contexts and populations has become a major challenge; among treatment-related patient navigation interventions, most have focused on patients with breast and colorectal cancers. Unlike these cancer patients, EC patients have different needs, such as requiring treatment to be directed by a gynecologic oncologist, who often are only located near urban areas or at academic medical centers. Only 10% of gynecologic oncologists practice in rural areas, and as a result, rural EC patients often travel far distances for care. In the proposed study, I will identify multilevel determinants to receiving guideline-concordant treatment among rural women with EC (Aim 1), use intervention mapping to design a patient navigation intervention (Aim 2), and pilot a patient navigation intervention (Aim 3). Using intervention mapping to design an EC navigation intervention will not only precisely target the multilevel determinants to treatment but also will optimize the fit and implementation of the navigation program within the gynecologic oncology setting. This approach is novel in that it integrates the identification of appropriate implementation strategies into the program’s design. This project will provide preliminary data for an R01 application to test the developed patient navigation intervention in a Type 1, hybrid effectiveness-implementation trial. The expected outcomes of this study will contribute to the National Institute on Minority Health and Health Disparities’ mission of using interventions to eliminate health disparities. Additionally, I will receive training in (1) community-engaged research methods to understand the multi-level determinants of cancer care, (2) designing interventions to fit specific populations and context, and (3) conducting intervention studies. This project will contribute to my long-term goal of becoming an independent investigator who develops and evaluates interventions to reduce disparities in cancer care and outcomes among rural communities.