In the more than 50 years since the signing of the National Cancer Act in 1971 by President Richard Nixon, the nation has made extraordinary progress toward a more in-depth understanding of the molecular, cellular, and genetic changes resulting in cancer. We have also seen significant declines in overall and site-specific cancer mortality.
This decline in mortality has been attributed to improved cancer prevention, advanced screening and detection measures, as well as application of more effective treatments.
However, some Americans, in particular the poor and the uninsured, have not fully benefited from this progress, as measured by their higher cancer mortality and lower cancer survival. Poor and uninsured Americans meet significant barriers to obtaining timely diagnosis and treatment of cancer and other life-threatening diseases.
These findings suggest that there is a disconnect between the nation’s discovery and delivery enterprises; a disconnect between what we know and what we do. Poor and uninsured Americans are more likely to be diagnosed with late-stage cancer and are more likely to die of the disease. The discovery/delivery disconnect can be diminished or even eliminated by patient navigation.
In my role as president of the American Cancer Society (ACS) in 1989, I had the privilege of conducting the ACS National Hearings on Cancer in the Poor.
A principal finding of the hearings was that poor people meet significant barriers in seeking and obtaining timely diagnosis and treatment of cancer and face financial, communication, and medical system barriers.
I soon became personally aware that the barriers faced by the individuals who testified from all 50 states at the ACS hearings were similar to the barriers faced by the cancer patients in Harlem I had been treating for many years. In other words, these are the universal experiences of poor people with cancer who were attempting to navigate the American healthcare system.
With this background of information and knowledge, in 1990 I pioneered the concept and original model of patient navigation across the healthcare continuum at Harlem Hospital. The elements of the healthcare continuum include the entire journey individuals take, beginning in the community in which they live, to a medical setting where an examination/test is performed, followed, if indicated, by diagnosis, treatment, and posttreatment survivorship support.
Navigation is a patient-centered intervention, the core function of which is to eliminate barriers to timely care across all phases of the healthcare continuum. The determination of who should navigate should be based on the level of skills required in a given phase of navigation.
To promote healthcare equity there is a need to harness, combine, and apply the power of nonclinical and clinical patient navigators with the goal of guiding the movement of individual patients from the communities where they live through detection, diagnosis, and treatment at clinical care sites.
Key to this achievement is the development of patient navigation and cancer care delivery teams.
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