Application of patient navigation programs across the entire continuum of breast cancer care: a GRADE-assessed systematic review with meta-analysis.

backgroundPatient navigation programs (PNPs) have been increasingly applied in breast cancer (BC) care of underserved clients, as they can significantly assist them with coordinating services across the care continuum. However, existing evidence has produced inconclusive findings regarding the empirical adequacy of BC-related caring interventions developed from PNPs. Hence, the aim of the present systematic review and meta-analysis was to clarify the benefits of PNPs across all phases of the BC care continuum. Primary outcomes comprised care-continuum indicators extracted predominantly from medical records, while secondary outcomes included client-reported healthcare measures.

methodsFive electronic data sources were searched for randomized controlled trials (RCTs) that investigated the effectiveness of PNPs across the BC care continuum from 1995 to January 10, 2025, with no restrictions on clients' sociodemographic characteristics. A random-effects model, using both the DerSimonian-Laird (DL) method and the Hartung-Knapp (HK) adjustment, was applied to estimate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, with 95% confidence intervals (CIs).

resultsThirty-seven RCTs met the inclusion criteria, including four cluster RCTs and 33 individual RCTs. Quantitative synthesis was not feasible for time-to-resolution, adherence to adjuvant or post-treatment follow-up care, timely treatment initiation, treatment completion, satisfaction with care, or psychological distress; therefore, the effectiveness of PNPs for these outcomes remains uncertain. Meta-analyses of individual RCTs, all conducted using a DL random-effects model, indicated that PNPs significantly improved diagnostic follow-up compliance (OR, 2.42; 95% CI, 1.64, 3.59; P < 0.001); screening mammogram adherence (OR, 2.18; 95% CI, 1.71, 2.77; P < 0.001); and timely diagnostic resolution (OR, 2.51; 95% CI, 1.21, 5.24; P = 0.014). Using the same DL model, PNPs also improved quality of life (SMD, 0.44; 95% CI, 0.09, 0.79; P = 0.014) and reduced anxiety (SMD, -0.94; 95% CI, -1.66, -0.22; P = 0.010). However, no statistically significant effects were observed under the DL model for depression (SMD, -0.34; 95% CI, -0.71, 0.04; P = 0.076) or BC knowledge (SMD, 0.27; 95% CI, -0.19, 0.73; P = 0.247). Substantial heterogeneity was observed across most pooled outcomes (I

conclusionAlthough initial analyses suggested that PNPs may improve several BC-related outcomes, these observed benefits were reduced in magnitude and, in some cases, no longer statistically significant after applying more conservative adjustment methods. Moreover, substantial heterogeneity across studies and the overall low methodological quality limit the certainty of the evidence. Therefore, the current findings should be interpreted cautiously, and further high-quality RCTs are needed to draw more definitive conclusions about the effectiveness of PNPs across the BC care continuum. PROSPERO REGISTRATION: CRD42023487495.