UMass Chan Medical School Faculty Publications


Assessment of patient navigation programs for breast cancer patients across the city of Boston

UMMS Affiliation

Department of Population and Quantitative Health Sciences, Division of Preventive And Behavioral Medicine; UMass Worcester Prevention Research Center

Publication Date


Document Type



Health Services Administration | Health Services Research | Neoplasms | Oncology


PURPOSE: Healthcare systems contribute to disparities in breast cancer outcomes. Patient navigation is a widely cited system-based approach to improve outcomes among populations at risk for delays in care. Patient navigation programs exist in all major Boston hospitals, yet disparities in outcomes persist. The objective of this study was to conduct a baseline assessment of navigation processes at six Boston hospitals that provide breast cancer care in preparation for an implementation trial of standardized navigation across the city.

METHODS: We conducted a mixed methods study in six hospitals that provide treatment to breast cancer patients in Boston. We administered a web-based survey to clinical champions (n = 7) across six sites to collect information about the structure of navigation programs. We then conducted in-person workflow assessments at each site using a semi-structured interview guide to understand site-specific implementation processes for patient navigation programs. The target population included administrators, supervisors, and patient navigators who provided breast cancer treatment-focused care.

RESULTS: All sites offered patient navigation services to their patients undergoing treatment for breast cancer. We identified wide heterogeneity in terms of how programs were funded/resourced, which patients were targeted for navigation, the type of services provided, and the continuity of those services relative to the patient's cancer treatment.

CONCLUSIONS: The operationalization of patient navigation varies widely across hospitals especially in relation to three core principles in patient navigation: providing patient support across the care continuum, targeting services to those patients most likely to experience delays in care, and systematically screening for and addressing patients' health-related social needs. Gaps in navigation across the care continuum present opportunities for intervention.

TRIAL REGISTRATION: Clinical Trial Registration Number NCT03514433, 5/2/2018.


Breast cancer, Health disparities, Implementation science, Patient navigation

DOI of Published Version



LeClair AM, Battaglia TA, Casanova NL, Haas JS, Freund KM, Moy B, Parsons SK, Ko NY, Ross J, Ohrenberger E, Mullikin KR, Lemon SC. Assessment of patient navigation programs for breast cancer patients across the city of Boston. Support Care Cancer. 2022 Mar;30(3):2435-2443. doi: 10.1007/s00520-021-06675-y. Epub 2021 Nov 12. PMID: 34767089. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

PubMed ID