Background

Health policymakers have determined that a major disconnect or gap exists between cancer research discovery and the delivery of those research findings in the form of improved patient care. Unrecognized barriers can prevent many Americans from receiving the best quality care and health disparities arise when the delivery system does not provide access to timely, standard care to everyone in the nation. The National Cancer Institute (NCI) has established the goal of eliminating suffering and death due to cancer by 2015. To meet this goal requires immediate action to address the gap between development and delivery, particularly among underserved populations.

NCI is addressing these unequal patterns of access to standard care by conducting a NCI-sponsored Patient Navigation Research Program (PNRP) at multiple sites. The NCI's Center to Reduce Cancer Health Disparities is already conducting several pilot patient navigator projects (http://crchd.cancer.gov/attachments/equal_access_volume1_issue4.pdf).

The purpose of the PNRP is to develop interventions to reduce the time of delivery of standard cancer services, cancer diagnosis, and treatment after identifying an abnormal finding from a cancer detection procedure.

Patient navigator interventions, by identifying innovative methods for overcoming access barriers for people in underserved communities, should have a substantial impact on reducing cancer health disparities and the burden of cancer within the next decade.

NCI will assess the impact of patient navigators on providing timely quality standard care and encouraging research collaborations and partnerships across cancer care delivery systems and organizations (e.g., primary care facilities, community health centers, hospitals, and academic centers).

1. What exactly is a patient navigator?

   "Patient navigation" in cancer care refers to the assistance offered to healthcare consumers (patients, survivors, families, and caregivers) to help them access and then chart a course through the healthcare system and overcome any barriers to quality care. A patient navigator can be a registered nurse or a social worker who functions as a "guide." Navigators help their patients move through the complexities of the healthcare system - getting them more timely treatment, more information about treatment options and preventive behaviors. For example, in one community, a navigator's job may be to coordinate transportation to medical care for patients since some residents may have to travel more than 100 miles to receive cancer treatment. The program is designed for the navigator to serve as a reliable ally to lean on for advice, support and direction. A navigator is someone who understands the patient's fears and hopes, and who removes barriers to effective care by coordinating services, increasing a cancer patient's chances for survival and quality of life.

   The patient navigator will assist patients and their families through the cancer care continuum. Examples of navigation services may include: arranging various forms of financial support; arranging for transportation to and childcare during scheduled diagnosis and treatment appointments; identifying and scheduling appointments with culturally sensitive caregivers; coordinating care among providers (such as screening clinics, diagnosis centers, and treatment facilities); arranging for translation/interpretation services; ensuring coordination of services among medical personnel; ensuring that medical records are available at each scheduled appointment; and coordinating other services to overcome access barriers encountered during the cancer care process. The Patient Navigator will link patients and families with appropriate follow-up services.

2. When does patient navigation begin?

   Navigation spans the period from an abnormal finding via a cancer detection procedure, through necessary cancer diagnostic tests, to completion of cancer treatment.

3. What are the benefits of the Patient Navigator Program?

   Evidence shows that in addition to unequal access to health care, racial/ethnic minorities and underserved populations do not always receive timely, appropriate advice and care when confronted with a cancer diagnosis. Patient navigators can make the difference between someone from an underserved population becoming a cancer survivor or a cancer death. If navigators get involved early enough after a person has received a cancer diagnosis, they can help steer patients and their families to appropriate care and treatment that could dramatically improve patients' chances of getting the best care and have an opportunity to live with cancer as a manageable disease. By navigating patients around barriers to quality care, patient navigators actually help ensure that cancer patients are not shortchanged in their options and their care.

4. What are some of the barriers faced by cancer patients from underserved communities that the Patient Navigator Program can address?

   A cancer patient from an underserved population is likely to face a variety of barriers to quality care and treatment. For example, there are financial challenges (especially for the uninsured and underinsured); communication and information problems including language barriers; problems with an inferior healthcare system within their communities; travel and distance challenges that can lead to missed doctor appointments; and emotional barriers where irrational fears lead to cancellation or delay of medical services.

   The patient navigator offers disadvantaged cancer patients someone with whom they can feel comfortable; someone who has the knowledge base and confidence the patient might not possess.

5. Is the patient navigator concept in existence in communities across the country?

   The patient navigator concept has been utilized in several communities with different variations and is being implemented in some form or fashion across the country. The Patient Navigator Program is part of a much larger framework of NCI initiatives focused on overcoming cancer health disparities.

   NCI supports three Patient Navigator pilot programs for Native American communities at three sites of the Indian Health Service in the Portland, Ore., area. NCI also awarded funding to two hospitals to establish and monitor Patient Navigator Programs as a component of its Cancer Disparities Research Partnerships - at the Rapid City, S.D., Regional Hospital that serves 100,000 Native Americans from surrounding communities and reservations, and the Laredo, Texas, Medical Center, which serves 50 "colonias" communities. The "colonias" areas historically have been home to an extremely poor segment of the Hispanic population, whose unclean living conditions generally rival that of Third World nations.

6. Where can one obtain additional information about the Patient Navigator Program?

   Information is available at the NCI Center to Reduce Cancer Health Disparities Web site, at http://crchd.cancer.gov/, or by calling 301-496-8589.

   Equal Access, the newsletter of the NCI Center to Reduce Cancer Health Disparities:
   http://crchd.cancer.gov/attachments/equal_access_volume1_issue4.pdf
   http://crchd.cancer.gov/attachments/equal_access_volume1_issue2.pdf

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   For more information about cancer, visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

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