In our first panel, a group of experts discussed how patient navigation services can improve access to quality cancer care and explored the challenges associated with delivering these services.
Sharon Rivera Sanchez, a cancer survivor and member of NCCS’s Cancer Policy and Advocacy Team, leveraged her position as the founder of Saving Pennies 4 a Cure and Trials of Color to survey cancer survivors in her network about their personal experiences with patient navigation. During her treatment, Ms. Rivera Sanchez received limited assistance from a patient navigator who helped her schedule a few appointments. Of the cancer survivors she surveyed, many had never heard of patient navigators or had been referred to navigation services but had never been contacted. Others had to seek out navigators whose services were fortunately covered by their insurance. However, they all thought patient navigation services were or would have been helpful during their treatment.
The panelists discussed significant needs cancer patients have, including understanding treatment options and the different specialists involved, accessing support for psychosocial and financial needs, and finding resources to help with food insecurity, transportation, and housing. Dr. Kashyap Patel, CEO of Carolina Blood and Cancer Care and immediate past President of the Community Oncology Alliance, raised concerns about the fragmentation of the health system and the isolation patients experience when they are lost in the system. He adopted Mahatma Gandhi’s principle to become the “voice for the voiceless,” which he tries to do through navigation. He described No One Left Alone, the nonprofit organization he founded to help provide his patients with housing, employment, and health insurance assistance. Because of our fragmented system, he says providers often do not know about the availability of community resources for patients. He said helping patients access these resources “is not rocket science. The countries that have invested heavily in the social safety network – which is almost like the navigation system – they have about five to seven years more life expectancy compared to the US…social determinants of health actually dictate outcome.” Members of the panel stressed the need for a multi-level, or team, approach to address barriers to care at multiple levels. Dr. Bonny Morris, Senior Director of Patient Navigation at the American Cancer Society and a former oncology nurse navigator, reflected on her own challenges caring for her father who was diagnosed with metastatic cancer while living in a rural community. She said, despite her knowledge, connections, and resources, she needed support from a team of navigators, including a rural and financial navigator, to effectively address her father’s needs.
Additionally, the panelists collectively stressed the importance of building trust in communities. Ms. Rivera Sanchez called for providers to partner with survivors to help bridge the gap between health systems and communities. She said survivors are in a better position to reach and build trust with the community while also bringing hope to other cancer patients. Dr. Robert Winn, the Director and Lipman Chair in Oncology at VCU Massey Cancer Center, suggested establishing stronger connections and increasing community involvement by developing activation programs within communities. Health systems can provide jobs to trusted members in the community who others could call to “activate” the patient navigation process. He said, “the investment of building trustworthiness is going to take big, bold actions and will at the end of the day save us more than it will cost… even if you have the miracle drug, they may not take it from you because they don’t trust you, but they may take it from someone else.”
Finally, members of the panel discussed various models of navigation to address these needs, as well as how to pay for navigation and make it sustainable. Reimbursement, they said, will be a key issue. Dr. Patel, whose community practice does not receive federal funding, discussed his use of the Chronic Care Management code, a reimbursable code that helps his practice address his patients’ health-related social needs through local community resources.