Patient Navigation Improves Colorectal Cancer Screening in Washington, DC Safety Net

Key Takeaways: 

• A 2023 evaluation of a patient navigation (PN) program at MedStar in Washington, DC, found that 43.5% of navigated patients completed colorectal cancer (CRC) screening or follow-up procedures.
• The program navigated 1287 patients, with 77.5% successfully reached and 20.9% still in progress at year’s end.
• The average cost was $209.83 per person navigated and $482.23 per patient completing screening or follow-up.

A quantitative evaluation of a patient navigation program at MedStar Health, a nonprofit hospital system in the Washington, DC area, found that navigation services improved colorectal cancer screening uptake in a safety net setting. The study assessed screening outcomes, barriers to care, and program costs during the 2023 calendar year, focusing on stool-based testing and colonoscopy completion.

Study Findings

Investigators analyzed sociodemographic data, screening completion rates, reported barriers, and both labor and non-labor costs associated with the patient navigation (PN) program. The primary outcomes included the number of patients navigated, overall screening uptake, and completion of follow-up procedures.

In 2023, the PN program navigated 1287 patients referred for colorectal cancer screening or follow-up colonoscopy. Of these, 77.5% were successfully reached by navigators. Overall, 43.5% completed screening or follow-up procedures during the study period. An additional 20.9% remained in progress, such as awaiting scheduled colonoscopy appointments.

The most commonly reported barriers to screening were bowel preparation challenges (25.3%) and comorbid conditions (13.7%). These barriers highlight the logistical and medical complexities faced by patients in safety net populations.

Cost analysis demonstrated that the average cost per person navigated was $209.83. The average cost per patient who completed screening or follow-up procedures was $482.23, reflecting both outreach efforts and procedural facilitation.

Clinical Implications

For clinicians working in safety net settings, the findings underscore the potential of patient navigation to improve colorectal cancer screening rates and adherence to follow-up care. CRC remains a preventable cause of cancer mortality when detected early, yet screening disparities persist, particularly among underserved populations.

Patient navigation can help address structural and patient-level barriers, including bowel preparation difficulties and management of comorbidities. By facilitating communication, appointment coordination, and education, PN programs may reduce delays in diagnostic colonoscopy and improve continuity of care.

Importantly, the reported costs suggest that navigation can be delivered at a moderate per-patient investment, which may be justified given the downstream benefits of earlier CRC detection and treatment. Health systems serving vulnerable populations may consider PN as part of comprehensive screening strategies.

Conclusion

The study authors concluded that “PN is effective in increasing CRC screening and follow-up and this improvement can be achieved at a reasonable cost in safety net settings.” They emphasized the need for future research to identify strategies to reach all referred patients and to optimize approaches for overcoming common screening barriers.

Reference

Tangka FKL, Hoover S, Krudy M, et al. Outcomes and cost of patient navigation in increasing colorectal cancer screening in a safety net hospital-based health center. Cancer Causes Control. 2026;37(39). doi:10.1007/s10552-026-02135-2