Harlem Education and Demonstration Project

Program Support

Best Practices

Harlem Education and Demonstration Project1,2

In 1990 the Harlem Cancer Education and Demonstration Project (HCEDP) piloted a patient navigation program and expanded community outreach and access to screening services with culturally sensitive educational programs. Harlem Hospital Center serves a predominantly poor, urban, African American population.

A study compared 5-year survival rates of treated patients with breast cancer before (1964-1986) and after (1995-2000) the introduction of improved access to cancer screening and a patient navigation program. This study showed improvements in stage at diagnosis and 5-year survival rates in navigated patients. From 1964 through 1986, nearly half of patients were incurable at diagnosis (stages III and IV), and only 6% had early breast cancer (stage I). The 5-year survival rate of these patients was only 39%. In comparison, between 1995 and 2000, 41% of patients were diagnosed at stages 0 and I, and only 21% were diagnosed at stages III and IV. The 5-year survival rate of navigated patients was 70%. It should be noted that while multiple factors likely affected these changes, including advances in diagnostic and therapeutic modalities, it is likely that patient navigation was a contributing factor.1

Part of the HCEDP was the development and piloting of a patient navigation program to help address the barriers poor people have in trying to obtain clinical follow-up services for suspicious findings. Of those patients who had suspicious results of breast examinations or mammograms and who were navigated, 85.7% completed the recommended breast biopsies vs 56.6% of nonnavigated patients. Biopsies were also completed in a more timely manner (within 4 weeks) for those who were navigated: 71.4% of navigated patients vs 38.5% of nonnavigated patients. The majority of patients who had been navigated (90.9%) were highly satisfied with the assistance they received.2

1Freeman HP. A model patient navigation program. Oncol Issues. September/October 2004:44-46.
2Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3:19-30.