American Cancer Society: Patient Navigation Improves Cancer Care Outcomes
As part of our ongoing coverage of non-profit organizations with programs and initiatives aligned with the White House Cancer Moonshot, Real World Health Care turns our spotlight to the American Cancer Society (ACS) and two of their initiatives focused on improving patient navigation. For more than 30 years, ACS has been a leader in establishing patient navigation as a path to ensuring access to quality care across the cancer continuum.
Patient navigation is one of the only evidence-based interventions to eliminate health disparities and improve health equity in cancer care.1 Patient navigators help guide patients through the often-complicated health care systems with the resources they need to get care. Navigation is a crucial component of cancer care, from prevention through treatment and survivorship. By providing individualized assistance to patients, families, and caregivers, navigation ensures high-quality health and psychosocial care, creating positive health outcomes for patients.
Dr. Arif Kamal
“ACS is committed to advancing high-quality cancer care through capacity building and support for innovative, sustainable models of oncology patient navigation,” said Dr. Arif Kamal, chief patient officer at ACS. “Patient navigation is one of the few interventions in oncology that improves outcomes for the patient, caregiver, and health system, as well as reduces the overall cost of care. It is a crucial component of our commitment to ensuring everyone has a fair and just opportunity to prevent, find, treat, and survive cancer.”
Patient Navigation: A Continuum of Services Built for Patient Experiences
Dr. Kamal noted that patient navigation is not a one-size-fits-all concept. Instead, it’s a continuum of services designed to meet individual patient needs – like the continuum of available services people may use to pay their annual income taxes. Some people file with the minimal assistance of an online portal or software program. Others need one-time help from a tax preparation service, while still others need the support of a full-time accountant.
In the case of cancer navigation, services can span the continuum from a peer navigator – someone who has similar lived experiences to the patient and can therefore generate trust – to clinical navigation services provided by a nurse or social worker. These professional navigators can help the patient navigate the logistical challenges of cancer treatment such as how to get to treatment appointments and obtain financial assistance for treatment costs, as well as medical components such as managing symptoms and side effects.
According to Dr. Kamal, ACS thinks about cancer navigation in four ways:
- Information navigation. ACS offers a 24/7 free help line at 800-227-2345 and an online chat line staffed by trained specialists who can connect patients, caregivers, and family members with essential services and resources at every step of their cancer journey. Nearly 50 million people access these resources every year.
- Peer navigation. In June 2023, ACS launched ACS CARES™ (Community Access to Resources, Education, and Support). ACS CARES™ includes a free app that provides personalized information and resources that update as patients age, their situation changes, or new information becomes available. The program also includes 24/7 access to phone support from trained ACS staff, virtual support from trained ACS community volunteers, and in-person support from clinic volunteers. The program works like a dating app, matching patients with volunteers who have similar lived experiences and/or who live in the same area.
- Community navigation. ACS created its Leadership in Oncology Navigation program in response to Cancer Moonshot requests for a program to train and credential non-clinical support staff working as patient navigators in health systems or community health departments. See more information below.
- Clinical navigation. While ACS does not provide direct clinical navigators, it funds existing navigation programs to build evidence for best practices that impact patient outcomes. See more information below.
ACS Cancer Moonshot Highlight #1: Patient Navigation Grant Awards
To address barriers to timely, equitable cancer care across diverse geographies and demographics, in 2022 ACS and partners awarded nearly $6 million in multi-year grants for patient navigation programs to 20 health systems:
- Boston Medical Center, Boston, Massachusetts
- City of Hope, Los Angeles, California
- Fred Hutchinson Cancer Center, Seattle, Washington
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, Texas
- Harris Health System, Houston, Texas
- HIMA San Pablo Oncologico-Caguas, Caguas, Puerto Rico
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Markey Cancer Center-University of Kentucky, Lexington, Kentucky
- Montefiore Einstein Cancer Center, Bronx, New York
- Rush University Medical Center, Chicago, Illinois
- Standford Cancer Institute, Palo Alto, California
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma
- The University of Chicago Medicine, Chicago, Illinois
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
- University Of Alabama Birmingham, Birmingham, Alabama
- University of Colorado Denver, Aurora, Colorado
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- University of Southern California, Los Angeles, California
- University of Texas Health, San Antonio, Texas
- Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
Each grant supports an established navigation program for 30 months, with the goal to enhance institutional oncology patient navigation processes, policies and systems and address barriers, gaps and challenges for patients, especially those from populations traditionally excluded. Grantees participate in a bi-monthly learning community to share and hear about the experiences, expertise and lessons of successful patient navigation programs and help improve patient navigation as a practice.
“We are currently at the mid-point of the grant period and are learning that the navigation needs of individual health system populations are unique,” Dr. Kamal said. “The early data generated indicates that additional clarification is needed around how clinical navigation codes can be used and by whom.”
ACS Cancer Moonshot Highlight #2: Oncology Professional Navigator Curricula and Certification Program
In January, ACS, with input from key partners, launched Leadership in Oncology Navigation (ACS LION™), a standardized national curricula and certification program for professional, non-clinical navigators to support people with cancer. The program is designed to align evaluation and adherence to best practices with improved outcomes and professional oncology navigation (PONT) standards, as well as to support new reimbursement for navigation services for Medicare enrollees.
“The ACS and other groups have long promoted the idea of creating a reimbursement mechanism to help overcome barriers associated with starting or scaling community navigation,” Dr. Kamal said. “Historically, these initiatives have been funded through charitable and philanthropic support, meaning they often are short-lived.”
The ACS LION™ program benefits navigators by providing them with:
- Greater credibility with the formal endorsement of their patient navigator expertise.
- Improved knowledge and skills of the complex cancer care system.
- Enhanced understanding of how to tailor support by patient needs.
- Preparation for greater responsibility and professional development.
The program includes a series of asynchronous online learning modules and a proctored exam reflecting the rigor of real-world patient navigation scenarios. In just the first three months since the program’s inception, several hundred people have enrolled.
Dr. Kamal noted that those interested in pursuing ACS LION™ credentialing do not need a background in the medical field. In fact, including those without a health care background will help to create a more diverse patient navigation workforce.
About the American Cancer Society
The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 100 years, ACS has been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. ACS is committed to ensuring that everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more about ACS, visit cancer.org or call the ACS 24/7 helpline at 1-800-227-2345. Connect with ACS on Facebook, Twitter, and Instagram.
Reference
1 -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.