The National Cancer Institute (NCI) recently awarded Boston Medical Center (BMC) more than $3 million to develop a patient navigator research program. The five-year study will evaluate the effectiveness of a multisite patient navigator intervention. BMC was one of eight institutions across the country selected to study the navigator model. The grants will focus on cancer patients from minority groups with low socioeconomic status, and patients from medically underserved areas.
Patient navigators are advocates who help patients and their families manage cancer diagnoses and overcome common barriers to obtaining timely and appropriate cancer care and treatment. They help coordinate services among medical personnel, schedule appointments with caregivers, develop treatment calendars, arrange translation or interpretation services, facilitate transportation to and from medical visits, call or visit patients who have skipped appointments, arrange child care services during diagnosis and treatment appointments, and offer support and encouragement. Navigators from primary care or community health settings provide support and guidance, linking patients to existing health care services.
Patient navigators function much like case managers, who have for years been coordinating care for disadvantaged or low-income patients with chronic medical conditions such as diabetes. At BMC, navigators include nurses, paraprofessionals and medical assistants who guide cancer patients through complex diagnostic and treatment plans.
“Logistic, cultural, educational, and other barriers can impede the delivery of high-quality cancer care to underserved patients,” says Tracy Battaglia, codirector of the Avon Breast Health Initiative at BMC and an assistant professor of medicine at the School of Medicine. “Patient navigators act as the liaison between the patient, the treatment team, and the multitude of people and services with whom the patient interacts at BMC.”
The research program will test and evaluate interventions designed to improve access to timely and appropriate cancer care and treatment following a cancer diagnosis. It will focus on four cancers for which screening tests are available: breast, cervical, prostate, and colorectal.
Dedicated patient navigators started working in the Breast Health Center at BMC’s Women’s Health Group in 2001 through grants from various organizations and an anonymous donor. Additionally, because of their success in bringing women into care in a more timely manner, navigators have since expanded to provide services in BMC’s breast health and breast imaging programs, the Hematology/Oncology Clinic, and at the Whittier Street Health Center, a Boston HealthNet community health center in Roxbury. Plans are also under way to hire patient navigators to assist in BMC’s department of otolaryngologyâ€“head and neck surgery and urology department.
The navigator role is one of many steps taken by BMC to address disparities in cancer care access and outcomes that are reflected in public health data for Boston and the nation, according to Battaglia. “We are ensuring that people have a definitive diagnosis and complete their treatment,” she says, and that “they have improved chances for better long-term outcomes and survivorship.”
“We expect that our most disadvantaged patients who receive the navigator intervention will ultimately have timelier treatment following cancer diagnosis and that is cost-effective as well,” says Karen Freund, director of the Women’s Health Unit at BMC, a professor of medicine at MED, and principal investigator of the NCI grant. “They will receive the quality care they need.”