“There are no constraints on the human mind, no walls around the human spirit, no barriers to our progress except those we ourselves erect.”—Ronald Reagan
Welcome back to Navigation Refresh, a recurring, informative feature for novice and seasoned patient navigators alike. In this issue, we cover the role of resource management in patient navigation, specifically in a US context, although insights can be extrapolated for other geopolitical areas.
At its core, cancer patient navigation is an evidence-based intervention to address barriers to care faced by people affected by cancer through individualized assistance. Barriers can be physical, informational, emotional, psychosocial, spiritual and/or practical.1
Several tools exist to assess patient barriers. A widely used tool is the NCCN Distress Thermometer.2 Electronic health records may have programmed questions to ask patients about social determinants of health, such as food and transportation access. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences Tool assesses multiple domains that affect patient access to resources and is available in numerous languages.3
These tools provide a systematic way to identify multiple barriers that could impact a patient’s access to, continuation of, and adherence to cancer care. But how do we know which barriers need to be addressed and how to address them? First, we can break down problems into smaller parts. If the patient cannot get to their appointment, is it because of transportation access, no time off from work, or financial limitations? Based on the root cause of the problem, what can the patient address through their personal skills and social networks? For example, could a neighbor drive them to the appointment? Could they ask for flex time at work? This helps you support patient empowerment to solve problems where it is possible, so you can focus on barriers where they truly need your help.
While not every barrier can always be addressed, create some kind of plan of action for each challenge or barrier. For example, perhaps a patient needs daily radiation treatment, but they cannot ask their neighbor to bring them to the cancer center every day. Can you put together a schedule of transportation assistance that leverages assets the patient has (willing neighbors to help drive them), assets from their insurance (managed care transportation program), and philanthropy programs (transportation assistance from the cancer center)?
Rarely do patients have only 1 challenge to accessing optimal healthcare and outcomes. Navigators are continuously assessing, prioritizing, sequencing, and problem-solving. If the patient also has food insecurity, what combination of resources makes sense to ensure food stability? Are there family or neighbors who could contribute a delivered meal once a week? Is the patient eligible for food bank resources? Do you have a meal delivery program, like Meals on Wheels, in your area? Does food insecurity take priority over transportation assistance in terms of urgency?
We are limited in our ability to address patient barriers by the resources available. One cannot navigate a patient to something that does not exist or for which a patient is not eligible. This leads to the next 2 principles.
A challenge voiced more frequently by navigators on my team in 2025 has been resource limitations. Once a resource is gone, it is gone. If you have a city utility assistance program with a certain budget for the fiscal year, as soon as the funds are gone, you must wait until the next fiscal year. Likewise, there are patient financial assistance programs from nonprofits that may have capped funds. For this reason, stewarding resources—or protecting them—for those who need them most, is an important navigator skill.
Many times, a patient may qualify for a resource but be put on a waitlist due to resource unavailability. Providing referrals to multiple and complementary resources may expedite patient access to needed resources. Helping patients navigate slow responses, waitlists, other delays, and simply a lack of resources to address a barrier to care can be emotionally taxing on navigators and patients alike. Managing patient and family expectations while maintaining trust is a delicate, challenging, and critical part of the navigator–patient relationship.
Holding a patient and/or family’s feelings is a skill that takes practice. Emerging from parenting literature and referenced in therapeutic literature, “emotional containment” can be challenging for navigators and transforming for patients. Active listening, clear boundaries, and empathy from the navigator can model emotional regulation and create safety that may ease the patient experience.1 The weight of holding these emotions and modeling emotional regulation requires exceptional self-care and a supportive environment for navigators to avoid burnout. Given rapidly changing federal resources and regulations, the number and degree of strong emotions felt by patients—particularly immigrants and uninsured individuals—may be extremely high. The impact of emotional containment on the navigation team may be similarly high. Navigation supervisors can help build resilience by acknowledging the current weight on patient navigators, advocating for resources, and supporting navigators when they need a break.
Resources are available at the individual, interpersonal, community, and system levels (Table).
Recently, many system resources that we have relied on for patients have been defunded in the United States, making the job of navigators exponentially harder. Under the Trump administration, there has been a $10 million reduction to the Affordable Care Act navigator program that helped people sign up for insurance,4 an $11.4 billion cut for behavioral health programs and addiction recovery programs,5 withholding of Supplemental Nutrition Assistance Program food assistance for low-income families,6 and zeroing out with proposed elimination of the Low Income Home Energy Assistance Program that helps patients with utility bills.7 The Trump administration has also called for massive reductions to Medicaid and the Children’s Health Insurance Program,8 has canceled at least 383 clinical trials that stopped 74,000 research participants from completing critical and potentially lifesaving studies,9 and has deregulated carcinogenic pollution.10
A core competency and professional standard for navigators is advocacy.11-13 As individual citizens, institutions, and professional organizations, it is critical to advocate for the programs that you know patients need in order to access and complete cancer treatment.11 Policymakers may think they are doing the right thing by cutting expenses for taxpayers; sharing the benefits of lifesaving resources and the challenges when those resources disappear for patients could make a difference in the availability of that resource in the future. Advocacy can also look like maintaining strong relationships with key personnel at community-based organizations. Advocacy can take many different forms; what is important is using our power where we have it for the good of our patients.
Resources will always be limited. However, it is incumbent upon those of us who know that resources can save lives to advocate for, steward, and maximize those resources to ensure the greatest benefit for those most impacted by cancer disparities.
This edition of Navigation Refresh aligns with standards 5 (Interdisciplinary and Interorganizational Collaboration), 11 (Prevention, Screening, and Assessment), 12 (Treatment, Care Planning, and Intervention), 13 (Psychosocial Assessment and Intervention), 14 (Survivorship), 15 (End of Life), and 16 (Advocacy) of the Professional Oncology Navigation Task Force (PONT)12 and Core Competencies Domain 1: Patient Care (Identify appropriate and credible resources responsive to patient needs [practical, social, physical, emotional, spiritual], taking into consideration reading level, health literacy, culture, language, and amount of information desired).13
Thank you to Claudia Campos, Ozioma Scott, Jennifer Cook, and Kelly Angell for comments on a prior draft. Their feedback made this piece stronger and more pragmatic.
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