Cancer Services Navigator Programs Literature Review

Cancer Services Navigator Programs Literature Review (E Portfolio 3 Literature Review)

Dahab Keflom
Health Communication and Advocacy
HLTH 634 B02 LUO
June 3, 2016

Cancer Services Navigator Programs Literature Review

Introduction
Cancer is one of the most complex human diseases found throughout history. Roughly
44% of Americans will be diagnosed with this condition during their lifetime.2 There is a
misconception that Cancer is one disease when in fact it consists of more than 200 diseases all
exhibiting unique characteristics and innovative treatments.18 Often times, a treatment that is
successful for one individual is not necessarily acceptable for the next person and unfortunately
some treatments may collectively stop working. Nationally, a high volume of deaths and
disabilities are attributed to chronic diseases. The top three killers are Heart Disease, Cancer, and
Stroke accounting for more than 50% of deaths annually. More than 75% of all health care
spending nationally assists people with chronic conditions.11 As public health scholars we
understand that chronic diseases are the most common, deadliest, and most preventable
conditions in the United States. Given the abundance of Cancer information available, effective
health communication is important in disseminating appropriate information to the public so that
program planners can gain credibility, achieve clarity, and maintain cohesiveness when
presenting health topics.2,5,11,12
This literature review identifies the health communication efforts and benefits provided
by Cancer services navigator programs. With Cancer and Stroke deaths rising Cancer navigation
programs are valuable in addressing unmet health needs and providing support to Cancer
patients.
Given the complexity of a Cancer diagnosis; an interdisciplinary approach to care is
valuable. An important aspect of the complete Cancer care continuum is the incorporation of a
Cancer Navigation program and a thorough understanding of the history and support provided by
Cancer Navigators. The value of health literacy is widely known in the delivery of excellent

Cancer Services Navigator Programs Literature Review

Cancer care, with significant implications for patient provider communication and care
coordination. It is a vital factor impacting the continuum of Cancer care, from prevention and
screening, to explanation of diagnosis and treatment.9 Although major advances in Cancer
research, screening, and treatment have be established, there was a 14% decrease in Cancer
related deaths over the years of 1991-2004 and racial and ethnic minorities continue to die
disproportionately from Cancer in comparison with other groups. This fact and Cancer disparities
exist due to disconnect between discoveries in Cancer care and inadequacy of healthcare delivery
for all Americans. Furthermore, answers to improve the equity of Cancer care delivery are
urgently needed. Patient navigation programs have been established as a potential solution for
improving Cancer care delivery. These programs streamline access to quality medical care by
identifying barriers to care and by bridging gaps in services through culturally sensitive
coordination. Patient navigators serve as health mentors for patients and providers and assist with
all phases of access, including primary Cancer prevention, screening and follow-up care, Cancer
treatment, and survivorship care. Researchers continue to examine the usefulness of navigation
programs in improving the relevance and acceptance of Cancer screening and diagnostic care
after an abnormal screening test.4,8,14
The American Cancer Society is the premier organization for Cancer education. This
organization has an extensive history of cultivating the growth and development of Cancer
navigation evident by providing funding for Dr. Freemans pilot program, to establishing a
Cancer program that includes training, policy development, and research. This organization
strives to provide sustainable leadership to improve patient navigation so patients have better
access to care and smooth transition through the health care system while providing patient
focused care and eliminating health disparities. The ACS navigation model allows Cancer

Cancer Services Navigator Programs Literature Review

navigators to undergo extensive training so they are equipped to meet with patients, identify
barriers, and work with institutional health care teams so that patients are supported and staff
members are assisted with aspects of care that can be managed by non-medical personnel.
Additionally, the Swedish Cancer Institute in partnership with the American Cancer Society
provides a creative patient assistance program called the American Cancer Society Patient
Navigator. Collectively these two organizations and countless others diligently make policy
makers and funders aware of the needs of Cancer research .1,3,10
Body of Evidence
To further validate the importance of Cancer navigator programs it is important to focus
our attention on the growing research detailing the importance and need for such programs and
the many people they serve. Many times, Cancer patients are unprepared for a Cancer diagnosis
and might find treatment intimidating, bewildering and their mounting distress might impair their
thinking, coping mechanisms, and may induce complications. Many barriers exist that negatively
affect a persons Cancer outcome. Patients become crippled by psychosocial, logistical, and
healthcare system barriers. These barriers can greatly obstruct access to adequate Cancer care.16
Cancer patients require an interdisciplinary approach to their care by utilizing various health care
professionals along with the guidance of a Cancer Navigator. This concepts is ideal because all
involved work to educate, support, and guide patients through challenging situations. In the past,
this responsibility has fallen on family doctors excluding them from the day to day needs of the
patient while undergoing Cancer treatments. As a result, they lacked the circumstantial
information required to deal with the complex issues facing Cancer survivors after completing
grueling treatments. The downfalls of these experiences results in strengthening Cancer patient
navigation programs and establishing a more holistic and patient centered care during the Cancer

Cancer Services Navigator Programs Literature Review

treatment process. Cancer navigation programs have seen their share of challenges such as
limiting program objectives and varying degrees of success. Fortunately, some have adopted a
comprehensive approach in addressing the entire spectrum of challenges faced by patients during
treatment and into survivorship.7,11,15
It is unfortunate that patients have to deal with the disparities and barriers that exist when
seeking care. Although Cancer can exist at any age, greater than 75% of Cancer diagnoses occur
in those aged 55 and older. Although Medicare financially supports Cancer screening and
treatment for its enrollees; racial and ethnic disparities in Cancer mortality and screening
prevalence still exist in our society. For example, among in Hawaiis four leading ethnic groups,
Cancer mortality is found to be higher for Native Hawaiians and Filipinos than for Caucasians
and Japanese. Furthermore, Native Hawaiians and Filipinos are more hesitant to report timely
Cancer screening or be diagnosed with early-stage Cancer than other ethnic groups. Cancer
navigation programs are designed to help individuals overcome the many hurdles evident in
completing recommended Cancer screenings and treatments in a well-timed manner. Some
persistent barriers include lack of disease knowledge and the influence of screening to detect
Cancer in the early stages of the condition, incapability of negotiating the healthcare system, and
poor access to services and inability to pay for services. Cancer navigators are amazing because
they link Cancer patients with diagnostic tests and if Cancer is found, they help patients find
insurance and transportation for appointments. They also teach patients to be healthcare
advocates for themselves. In America, Cancer Navigation programs are found in many clinics,
hospitals and community organizations and Navigators come from various academic
backgrounds and disciplines. Navigators may be required to go through 12 to 400 hours of
navigation specific training. Although many navigators come from varying backgrounds,

Cancer Services Navigator Programs Literature Review

empirical research suggests that individuals who receive such services are more likely than those
who do not to receive timely, age and sex-appropriate cancer screening. Furthermore navigation
programs have contributed to the rise in Cancer screenings among minorities including Native
Americans, Alaska Natives, Asian Americans, Micronesians, Hispanics, and African Americans.
Despite the promise of navigation programs in increasing screening rates in minority
populations, more research is needed in examining the use of navigators to increase cancer
screenings in the Medicare population.2,17
A firm understanding of cultural competency and compassion is vital to the success of a
Cancer navigation program and disparities in care delivery impact patient outcomes.6 Despite the
mounting reduction in breast Cancer deaths because of early detection and treatment, many
patients still exhibit advanced disease without prior screening. Immigrants, people with limited
English proficiency, and low income patients are most vulnerable to these issues and they have
been found to not routinely practice preventative cancer care. The 2000 National Health
Interview Survey revealed that women who settled to the America within the last decade were
less likely to have had a mammogram within the last 2 years than non-immigrants. This finding
is not surprising because many immigrants lack the necessary knowledge to make informed
health decisions and they may not seek treatment because of procedure fears, and racial
discrimination. Interestingly, Arab women are more likely to avoid Cancer screenings due to
embarrassment and fear of the unknown. Crippled by their fears, they have lower mammography
rates than other ethnic groups.13 The disparities found in numerous ethnic minority groups in
America exist because of increased breast Cancer risks and people bringing awareness to their
condition when it is too late to intervene. Disparities are also evident because of increased
mortality and morbidity following diagnosis.2

Cancer Services Navigator Programs Literature Review

Summary & Conclusion

Cancer Navigators and the inception of Cancer Navigator Programs have a commendable
rich history. The term patient navigation began with lay people in the 1900s functioning as
community outreach workers. Their role was to promote mammography screenings among
undeserved women with an overall goal of reducing mortality through early detection.18 Their
historical impact was not in vain. Over the past decade, the federal government has provided
significant funding to support patient navigation research and programs. Recent studies have
identified a number of patient, provider, and policy-level factors that have significantly
influenced timely follow-up after the detection of an abnormality.6,8,19 Cancer care has taken a
more proactive approach allowing patients to continue their busy lives while experiencing
minimized side effects attributed to their condition. Today many hospitals and Cancer centers
have established navigation programs. The American Cancer Society Cancer Resource Network
provides Cancer patients and families with personalized Cancer information, helps patients make
informed decisions, and enhances Cancer patients quality of life by ensuring services are
utilized appropriately. The network includes an online website, phone hotline, and office based
and hospital based services. Cancer Resource Navigators are there to support a persons Cancer
journey.11 Currently, the American Cancer Society program has patient navigators at 125
hospitals, treatment centers, and other health care settings throughout the country.1,3 Patient
Navigators play an important role in the survivorship of Cancer patients because they act as
sideline cheerleaders for the patients they serve. With respect to the advancements of breast
Cancer research, more researchers are taking pride in showcasing the growing survival curve and
letting the public know that more women are surviving their diagnosis and treatment of Cancer.18
The benefits of Cancer navigation programs are endless. Furthermore, the services they provide

Cancer Services Navigator Programs Literature Review

to patients, families, and communities are valuable because Cancer continues to be a major
public health epidemic.

Cancer Services Navigator Programs Literature Review

References
1. American Cancer Society Patient Navigator. Swedish.
http://www.swedish.org/services/cancer-institute/patient-support-resources/american-cancersociety-cancer-patient-navigator. Accessed June 3, 2016.
2. Braun K, Thomas W, Tsark J, et al. Reducing Cancer Screening Disparities in Medicare
Beneficiaries Through Cancer Patient Navigation. Journal of The American Geriatrics Society
[serial online]. February 2015;63(2):365-370 6p. Available from: CINAHL Plus with Full Text,
Ipswich, MA. Accessed June 3, 2016.
3. Breast Cancer Programs. American Cancer Society.
http://makingstrides.acsevents.org/site/PageServer?
pagename=MSABC_CY13_BreastCancer_Programs. Accessed June 3, 2016
4. Freund K, Battaglia T, Young G, et al. Impact of Patient Navigation on Timely Cancer Care:
The Patient Navigation Research Program. JNCI: Journal of The National Cancer Institute
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Accessed June 3, 2016.
5. Grizzi F, Chiriva-Internati M. Cancer: looking for simplicity and finding complexity.
http://cancerci.biomedcentral.com/articles/10.1186/1475-2867-6-4. Accessed June 3, 2016.
6. Gunn C, Clark J, Battaglia T, Freund K, Parker V. An assessment of patient navigator
activities in breast cancer patient navigation programs using a nine-principle framework. Health
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7.
Hryniuk W, Simpson R, McGowan A, Carter P. Patient perceptions of a comprehensive
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8. Jean-Pierre P, Winters P, Fiscella K, et al. Do better-rated navigators improve patient
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COMMUNICATION
9. Martinez-Donate A, Halverson J, Wang X, et al. Identifying health literacy and health
system navigation needs among rural cancer patients: findings from the Rural Oncology Literacy
Enhancement Study (ROLES). Journal of Cancer Education: The Official Journal of The
American Association for Cancer Education [serial online]. September 2013;28(3):573-581.
Available from: MEDLINE with Full Text, Ipswich, MA. Accessed June 3, 2016.
10. Matthews B, Baldwin LM., Hannon P, Jeffrey Harris. The American Cancer Societys
Cancer Resource Navigator Program: Perspectives on the Navigator Role and Program
Operations from Cancer Center Navigators, Staff, and Administration.
https://depts.washington.edu/hprc/docs/acsnav3.pdf. Accessed June 3, 2016.

Cancer Services Navigator Programs Literature Review

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11. McKenzie JF, Neiger BL, Rosemary T. Planning, Implementing, & Evaluating Health
Promotion Programs: A Primer. 6th ed. Upper Saddle, NJ: Pearson Publishers; 2012.
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Communication. Burlington, MA: Jones & Bartlett Learning; 2011.
13. Percac-Lima S, Ashburner J, Bond B, Oo S, Atlas S. Decreasing disparities in breast
cancer screening in refugee women using culturally tailored patient navigation. Journal of
General Internal Medicine [serial online]. November 2013;28(11):1463-1468. Available from:
MEDLINE with Full Text, Ipswich, MA. Accessed June 3, 2016.
14. Raj A, Ko N, Battaglia T, Chabner B, Moy B. Patient navigation for underserved patients
diagnosed with breast cancer. The Oncologist [serial online]. 2012;17(8):1027-1031. Available
from: MEDLINE with Full Text, Ipswich, MA. Accessed June 3, 2016.
15. Ramachandran A, Freund K, Bak S, Heeren T, Chen C, Battaglia T. Multiple Barriers
Delay Care Among Women with Abnormal Cancer Screening Despite Patient Navigation.
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from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 3, 2016.
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Text, Ipswich, MA. Accessed June 3, 2016.
17. Warren-Mears V, Dankovchik J, Patil M, Fu R. Impact of patient navigation on cancer
diagnostic resolution among Northwest Tribal communities. Journal of Cancer Education: The
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18. Why Worldwide Research Is So Important. Worldwide Cancer Research. 2016.
http://www.worldwidecancerresearch.org/research/philosophy. Accessed June 3, 2016.