Impact of neighborhoods and navigation on survivorship

Institution: Shanti Project, Inc.
Investigator(s): Alyssa Nickell, Ph.D. - Salma Shariff-Marco, Ph.D. -
Award Cycle: 2017 (Cycle 23) Grant #: 23AB-1500 Award: $86,250
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 23AB-1501 -

Initial Award Abstract (2017)

Background: Due to advances in breast cancer screening and care, the number of survivors in the United States is increasing. However, survivorship outcomes [e.g., receipt of guideline-recommended treatment, quality of life (QoL), mortality] continue to be lower among women of color and low-socioeconomic status. While patient navigation is widely accepted as an effective intervention to help women overcome barriers as they go from screening to diagnosis, we know very little about how navigation influences survivorship, if at all. Researchers are just beginning to study how neighborhood factors, such as the racial/ethnic mix of neighbors (social environment factors) or access to transportation or food (built environment factors), might partly explain why these survivorship differences persist for certain communities. As early findings show that neighborhood factors indeed shape cancer outcomes, researchers have recommended that providers consider these factors when developing treatment and survivorship plans with their patients. However, few studies focus on how both neighborhood social and built environment factors affect survivorship of breast cancer patients in particular, and no studies have looked at how navigators attend to neighborhood factors when working with women who live in disadvantaged neighborhoods.

Research Questions: 1) Are survivorship outcomes different for breast cancer patients who have received care navigation services compared to patients who have not? 2) Do neighborhood factors influence how navigation is delivered (i.e., does number of contacts or duration of navigation vary by neighborhood characteristics)? And 3) Can navigation help address neighborhood factors that negatively influence survivorship outcomes?

Aims: 1) Link distinct sources of data about breast cancer survivors, including information about their neighborhoods, treatments, survival and quality of life that will enable us to examine how navigation impacts survivorship. 2) Examine associations between neighborhood and QoL to inform the development of neighborhood assessment tools to help care navigators better tailor their services. 3) Strengthen the partnership between Shanti and CPIC and the internal capacity of each partner to conduct research with and for vulnerable communities through this and future studies.

Methods: This pilot study will link 3 existing resources to build a unique dataset that helps us understand the impact of neighborhood factors and navigation on breast cancer survivorship outcomes: 1) community data of over 1200 breast cancer clients receiving care navigation services at Shanti, 2) patient-level clinical data from Greater Bay Area Cancer Registry, and 3) data from the California Neighborhoods Data System. Together, this data will be used to identify neighborhood factors associated with quality of life among Shanti clients and conduct focus groups with navigators and clients to better understand their experience of these factors and recommend strategies to address barriers. We will also review existing tools that address neighborhood barriers impacting care and survivorship. All of these activities will inform the development of a new assessment tool to improve navigation and survivorship.

Innovative elements: Researchers and providers are constantly collecting personal and clinical data from patients, however much of that data remains inaccessible to the community because of how it is gathered and stored, or it remains incomplete because it has not been validated by the community. Our project is innovative in how we build upon what we already know: how we will mine, link and validate community, public health, and neighborhood data, and use that to develop tools and techniques to strengthen existing navigation programs in light of the growing body of research that links neighborhood factors to survivorship.

Community involvement: Shanti care navigators and their clients regularly attend breast cancer conferences. Upon learning that the environment can profoundly affect a woman’s experience with cancer, Shanti staff reached out to CPIC researchers for help in understanding how these findings were reflected in Shanti clients’ experiences and to sharpen care navigation services. For this pilot, Shanti’s Client Advisory Board and other clients will participate as consultants, focus group participants, and presenters of study findings. Their experiences will inform the iterative design of the project, on-going data analysis, the development of neighborhood assessment tools, dissemination of our findings and future plans.

Future Plans: The success of this pilot project will form the foundation for future studies to deepen our understanding of the impact of navigation on breast cancer survivorship, and to develop intervention strategies and tools to address neighborhood factors in breast cancer treatment and survivorship planning.