Diagram Credit: Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care, Wagner et al. J Alternative and Complementary Medicine 2005
Cancer Patient Navigation
Patient navigation is a barrier-focused, personal intervention intended to improve cancer-related care, especially care among vulnerable populations who have limited access to medical and preventive care. The term “patient navigation” was coined by Dr. Harold Freeman, who, in partnership with the American Cancer Society, developed the first patient navigation program which was associated with a reduction in late-stage breast cancer among low-income women in Harlem, New York.1 Building from that initial program, a 2011 review of 33 studies found patient navigation to be efficacious at increasing cancer screening rates.2 More recently, patient navigation has become Standard 3.1 for the accreditation of cancer centers by the American College of Surgeons.
Residents of Appalachia, including those who reside in one of the 52 Appalachian counties in Pennsylvania, experience excess cancer burden,3 due in part to patient barriers, such as transportation and financial barriers, as well as health system barriers, such as limited availability of certified cancer screening facilities and fewer oncologists and primary care providers. Consequently, the prevalence of cancer screening in the 27-county catchment area of the Penn State Cancer Institute (Cancer Institute), including 18 Appalachian counties, does not meet Healthy People 2020 goals.
To address this cancer health disparity, the PSCI Community Sciences and Health Outcomes (CSHO) Shared Resource, began in 2016 an initiative to increase the capacity of the local workforce for cancer patient navigation. In collaboration with the Markey Cancer Center of the University of Kentucky, the CSHO Shared Resource conducted two series of trainings on patient navigation in Appalachia. The first series was three sessions held on May 17, 18, and 19 in Jackson Center (PA), Hornell (NY) and Hershey (PA), respectively. In all, 32 individuals attended one of the three sessions. Attendees represented organizations that provided breast, cervical and colorectal cancer outreach, screening and treatment. The primary purpose was to review curriculum and training programs, and to select and tailor navigation materials appropriate for residents of Appalachia. The second series was held on August 15 (Jackson Center, PA), August 17 (Hornell, NY) and August 19 (Hershey, PA). In all, 75 persons attended one of the second series of trainings. The primary purpose of the second series was to actually train participants in patient navigation. Participants represented small, large and academic hospitals/health care systems, cancer centers, federally-qualified health centers, health departments, community-based screening programs and organizations; all were motivated to improve cancer-related care and outcomes in their local community. The CSHO Shared Resource, along with its community cancer research networks in Pennsylvania such as the Northern Appalachia Cancer Network, provides ongoing consultation and guidance to patient navigators in hospitals, clinics, and community-based organizations. Currently, the CSHO Shared Resource is developing curriculum and training material for the management, operation and evaluation of a patient navigation program within a hospital or clinic.
The patient navigation initiative was supported in part with funding from the Pennsylvania Department of Health (SAP 4100073089), the Appalachia Community Cancer Network (U01 CA114622) and the Penn State Cancer Institute. The CSHO Shared Resource is grateful to the Northern Appalachia Cancer Network and its community and clinical partners who participated in the 2016 trainings. For more information, contact:
Eugene J. Lengerich, VMD, MS
Faculty Director, Community Sciences and Health Outcomes (CSHO) Shared Resource
Associate Director, Health Disparities and Engagement
Penn State Cancer Institute
717-531-7178; elengeri@phs.psu.edu
- Oluwole SF, Ali AO, Adu A, et al. Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. Journal of the American College of Surgeons;196:180-8.
- Paskett ED, Harrop JP, Wells KJ. Patient navigation: An update on the state of the science. CA Cancer J Clin 2011;61:237-49.
- Lengerich EJ, Tucker T, Powell RK, et al. Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia. J Rural Health 2005;21:39-47.