Patient Navigators Can Help When Life Disrupts Cancer Care

Many people drop almost everything when they get a cancer diagnosis. The rest of life might stop while they get the treatment they need. They might miss work, make arrangements for someone else to take care of their kids, and defer other responsibilities in order to get the next available doctor’s appointment, earliest surgery, or needed treatment.

“But, for some patients,” said Karen Freund, MD,  from Tufts University School of Medicine in Boston, “cancer is not the most pressing issue in their life.”

For patients who face housing insecurity, who lack childcare or eldercare, or who could lose their job if they miss work for cancer care, among numerous other issues, life responsibilities can get in the way of completing treatment.

Freund, an ACS clinical research professor, wants to help make sure that doesn’t happen. “There’s a whole group of patients who are dying early and dying needlessly because they aren’t getting the treatments that we know work,” she said, “and this is such a fixable problem.”

Patient navigators help address cancer disparities one person at a time

Patient navigators are trained laypeople who can help make sure that cancer care isn’t pushed aside for patients juggling these challenging circumstances. They can help guide patients through the often-complicated health care system with the resources they need to get care. “They help us address cancer disparities one person at a time,” Freund said.

Freund’s prior research with the National Cancer Institute Patient Navigation Research Program tested patient navigation as a way to help patients overcome these social barriers to care.

But carrying out a large trial and creating the accompanying database, as Freund did through this program, is just the tip of the iceberg. The database contains information on patients who received patient navigation and whether the service helped them.

“There are always opportunities to ask questions of these databases, but oftentimes the funding runs out or everybody moves on to their next project, when there was so much more research you could do,” said Freund. “I think some of the papers with the greatest impact that we’ve published from that trial were the ones I was able to shepherd through because of the American Cancer Society professorship.”

More research is needed to customize navigation for various patient needs and cancer types 

As an ACS clinical research professor,* Freund explored which patients benefit most from navigation services. “In one paper, we showed that for patients of color, with low income, and with housing insecurity, having a patient navigator basically eliminated the disparities in cancer care,” said Freund. Navigators helped shorten the time from abnormal screening to diagnosis. “Those patients no longer had the delays in treatment. Their time to treatment and completion of treatment looked the same as any other patient.”

In a later paper, Freund and her colleagues identified 11 steps that patient navigators must take to provide the most benefit to patients. Those steps include:

• An in-person meeting with the patient at the first oncology visit
• Establishing the frequency of ongoing contact
• Identifying the barriers to getting care
• Connecting the patient with resources that address those barriers
• Frequent, consistent follow-up

But the impact of her ACS professorship doesn’t stop with her own publications. For patient navigation to become standard of care, Freund says, more research is needed. It needs to focus on questions like how to integrate navigation into various types of health systems; how to structure insurance coverage of the service; and how to customize it for various patient needs and cancer types.

“The ACS grant is allowing me to support the research for the next generation of health disparities’ researchers,” said Freund.

The professorship will also allow Freund to implement a program to address breast cancer disparities across the City of Boston and to continue collaborating with the Cancer Disparities Research Network.

“The ACS professorship has been such an opportunity,” Freund said, “because, unlike grants that fund a specific project, this one gives me a decade to go and find the best work and do it.” 

* The American Cancer Society (ACS) Research Professor and Clinical Research Professor Awards are the most prestigious research grants made by our national program. Researchers are selected for ACS professorships based on their history of pioneering, influential work that’s continuing to change the direction of cancer research and on their track record of mentoring people who have become successful in cancer research.