Patient navigation improves outcomes and addresses health equity across the cancer continuum

Research shows that cancer patients who receive navigation have improved survival, access to advanced care like clinical trials, and services like genetic testing and palliative care. Navigation often results in increased screening and patients receiving treatment sooner, resulting in improved quality of life and more cancer-free days.

Patient navigation drives sustainable solutions

For more than 30 years, the American Cancer Society has been a leader in establishing patient navigation as a path to ensuring access to quality care.

In the cancer care setting, patient navigation refers to individualized assistance offered to patients, families, and caregivers to help traverse the complex healthcare system and address logistical, financial, and other barriers.

Such a personalized, high-touch approach facilitates timely access to quality health and psychosocial care from pre-diagnosis through all phases of the cancer experience.¹ This impact crosses all geographies where care is provided.

For example, in the inpatient setting, research has shown that navigation programs decrease hospitalizations and intensive care unit admissions and improve timely diagnostic follow-up. In the outpatient setting, patient navigation increases scheduled appointment arrivals, adherence to recommended cancer screening, and the likelihood that treatment is initiated within 30 to 60 days from diagnosis. This impact is realized across all populations, as navigation is proven to help eliminate health disparities and improve health equity in cancer care.²

To underscore the American Cancer Society’s commitment to ensuring everyone has a fair and just opportunity to prevent, find, treat and survive cancer, last week, we awarded $4.2 million in multi-year grants for patient navigation programs to the following 14 health systems:

• HIMA San Pablo Oncologico-Caguas, Caguas, Puerto Rico
• University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
• VCU Massey Cancer Center, Richmond, Virginia
• The University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
• The University of Alabama Birmingham, Birmingham, Alabama
• Harris Health System, Houston, Texas
• Boston Medical Center, Boston, Massachusetts 
• Montefiore Einstein Cancer Center, Bronx, New York
• Fred Hutchinson Cancer Center, Seattle, Washington
• City of Hope, Los Angeles, California
• The University of Chicago, Chicago, Illinois
• Rush University Medical Center, Chicago, Illinois
• Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
• The University of Colorado Denver, Aurora, Colorado

Each health system selected will receive $300,000 to invest in the creation or enhancement of oncology patient navigation services with a particular focus on sustainability of efforts beyond the funded period and equitable access to care for cancer patients and their families. 

Patient navigation reduces health inequities

Barriers to equitable access to prevention and treatment and challenges in delivering appropriate care coordination stand in the way of achieving equity in cancer care and delivering high-quality care to all people with cancer. Notable advances in cancer prevention, cancer screening, and the development of effective cancer treatments have contributed to improved outcomes for many populations of patients with cancer.³

However, the benefits of these advances are not shared equally, and significant disparities persist in cancer outcomes by race/ethnicity, socioeconomic status, sexual orientation, gender identity and geography.^4,5 

The main drivers of differences in cancer survival are not related to biology; instead, they derive from structural barriers to accessing care and overt documented differences in the delivery of evidence-based care.^6,7,8 

Patient navigation can facilitate improved health care access and quality for underserved populations through advocacy and care coordination. It can also help to address deep-rooted issues related to distrust in providers and the health system that often leads to avoidance of health problems and noncompliance with treatment recommendations. 

By addressing many of the disparities associated with language and cultural differences and barriers and connecting people with similar lived experiences, patient navigators can foster trust and empowerment within the communities they serve. We are committed to supporting hospitals and health systems in advancing high-quality cancer care to treat underrepresented populations.

Patient navigation can facilitate improved health care access and quality for underserved populations through advocacy and care coordination.

We are grateful to the funders of this initiative—Janssen Pharmaceutical Companies of Johnson & Johnson, Bristol Myers Squibb and Daiichi Sankyo. They share our commitment to sustainable models of oncology patient navigation.

Last month the American Cancer Society’s National Navigation Roundtable (NNRT) published a new supplement on the role navigation plays in improving patient outcomes. Launched in 2017, the NNRT is a coalition of over 100 member organizations and individuals dedicated to achieving health equity and access to quality care across the cancer continuum through effective patient navigation. 

Collectively, the roundtable disseminates best practices and works on key issues that enhance the navigation field. The free supplement can be accessed here and learn more about the NNRT here. 

References:

1. Oncology Nursing Society (ONS), Association of Oncology Social Work (AOSW), & National Association of Social Workers (NASW). (March 2010). Joint Position on the Role of Oncology Nursing and Oncology Social Work in Patient Navigation.
2. Dwyer Cancer Paper: Dwyer AJ, Wender RC, Weltzien ES, Dean MS, Sharpe K, Fleisher L, Burhansstipanov L, Johnson W, Martinez L, Wiatrek DE, Calhoun E, Battaglia TA; National Navigation Roundtable. Collective pursuit for equity in cancer care: The National Navigation Roundtable. Cancer. 2022 Jul 1;128 Suppl 13:2561-2567. doi: 10.1002/cncr.34162. PMID: 35699616.
3. Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117:3539-3542.
4. Siegel DA, O’Neil ME, Richards TB, et al. Prostate cancer incidence and survival, by stage and race/ethnicity: United States, 2001-2017. MMWR Morb Mortal Wkly Rep. 2020;69:1473-1480.
5. Mark E Bensink et al., “Costs and Outcomes Evaluation of Patient Navigation after Abnormal Cancer Screening: Evidence from the Patient Navigation Research Program.,” Cancer 120, no. 4 (February 15, 2014): 570–78, https://doi.org/10.1002/cncr.28438.
6. Farrow NE, An SJ, Speicher PJ, et al. Disparities in guideline-concordant treatment for node-positive, non–small cell lung cancer following surgery. J Thorac Cardiovasc Surg. 2020;160:261- 271.e1.
7. Blom EF, Ten Haaf K, Arenberg DA, et al. Disparities in receiving guideline-concordant treatment for lung cancer in the United States. Ann Am Thorac Soc. 2020;17:186-194.
8. Visser BC, Ma Y, Zak Y, et al. Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. HPB (Oxford). 2012;14:539-547.