A cancer diagnosis has the power to produce a myriad of overwhelming emotional responses, including shock, denial, anxiety, fear, grief, and depression. A cancer patient’s footpath through the health care system involves dealing with this host of feelings while juggling a multitude of medical tests and consultations to determine a definitive diagnosis and course of treatment.
In addition, many patients do not fully appreciate the need for prompt access to care, which further confounds their situation. This pathway, to say the least, can be a confusing labyrinth.1
Cancer care is often complex, with many patients facing complicated treatment regimens, individualized therapies, and rapidly changing evidential recommendations for existing therapies. Patient navigators take some of this burden from the patient. They guide patients with cancer through complex treatments during a formidable time. Patient navigators are an important bridge between the doctor, adjunct services, and the patient.
A HEALTH CARE ROLE EMERGES
The concept of a cancer patient navigator was originally developed by Harold Freeman, MD, in 1990.1-8 Freeman’s model was in response to seeing a disproportionate number of African American women presenting with late-stage breast cancer, which he attributed in part to their inability to access an array of cancer care services.3,4 Freeman partnered with the American Cancer Society (ACS) to create the first patient navigation program at Harlem Hospital in New York, New York.3-6
The first patient navigators were laypersons who worked directly with patients through each phase of care. Their responsibilities included providing patient education, removing barriers to care, and ensuring tests and appointments were completed in a timely manner.6 Freeman’s model emphasized community outreach and encouraged people to undergo appropriate cancer screenings. After the navigator program was implemented, the percentage of patients presenting with late-stage disease at diagnosis was significantly reduced and 5-year survival rates increased considerably. Due to the initial success and promising results, development of patient navigation programs increased impressively across the United States for other diseases as well as cancer.3,5
The Harlem Hospital program focused on the specific needs of its local community. The program was designed to help people overcome barriers of access to care and screening.2,5,6 The Harlem Hospital program served as a springboard for other patient navigation models across the country that address varied health system needs based on their different settings, diseases, and divergences in care.6 In 2010, the American College of Surgeons’ Commission on Cancer exemplified the notability of navigation services by adding a criterion for patient navigation services to its standards for cancer program accreditation; the new criterion will be phased in by 2015.8,9
Patient navigator services follow several models. Successful models are developed to meet the specific needs of individual cancer programs and patient populations. The clinically oriented model pairs patients with navigators based on tumor site. A point-of-entry model is driven by logistical methodology based on the patient’s varying needs due to tumor site, diagnosis and stage, chosen treatment regimen, and existing support systems. The most common approach, high-volume/low-acuity model, allows for a higher patient load per navigator, and is often used to manage breast cancer cases.