Hayley Freedman, MPH1; Shahid Umar, PhD2; Andriy Chybisov, MPH2; Anurag K. Agrawal, MD2; Erica Krisel, MPH2; Kristie McComb, MPH2
1Public Health Ethics, Advocacy and Leadership Program, Willamette University, Portland, OR, and, during development of this manuscript, with American Cancer Society; 2American Cancer Society
Background: While the field of patient navigation (PN) has expanded and matured in the United States over the past 30+ years to meet the needs and challenges of patients and families facing cancer, PN is a relatively limited intervention in many parts of the world,1 particularly in low- and middle-income countries (LMICs), which are estimated to shoulder 75% of the world’s cancer deaths.2 Recognizing the vital role of PN in decreasing inequities and supporting the achievement of positive health outcomes for individuals with cancer, we, the American Cancer Society (ACS), created the Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) Initiative to support LMIC health institutions, cancer organizations, and other civil society organizations focused on addressing disparities in cancer care through the design and implementation of sustainable PN programs.
Objective: To describe the components of the initiative and key findings from its pilot, conducted with 10 organizations from 8 countries from February 2022 to May 2023.
Findings: The BEACON Initiative’s offerings were found to successfully aid organizations in achieving milestones in program development and implementation. Progress was enhanced by individualized support, modest planning grants to cover program development costs, and virtual events.
Conclusion: As part of the mission of ACS to end cancer as we know it, for everyone, we continue to share BEACON resources freely as we cultivate a thriving community of global PN practitioners, which has grown to a membership of 49 organizations from 34 countries.
Cancer incidence will increase by 75%, from 20 million new cases in 2022 to an estimated 35 million new cases by 2050.3 This rise in cases will pose significant challenges to health systems worldwide, particularly those less equipped to respond.4 LMICs will shoulder a disproportionate burden of cancer deaths; up to 4 times higher for some LMICs than high-income countries (HICs).5
Numerous factors contribute to excess cancer mortality in LMICs, including late presentation, insufficient diagnostic services and cancer treatments, an understaffed oncology workforce, poverty, and sociocultural barriers like fear, stigma, and misconceptions.6 Many of these barriers are the same as those faced in HICs, but they are often experienced in greater magnitude.7
While the field of patient navigation (PN) has expanded and matured in the United States over the past 30+ years to meet the needs and challenges of patients and families facing cancer, PN is a relatively new and limited intervention in low- and middle-income countries (LMICs).6
Proof of concept to allow for more extensive dissemination and implementation in diverse LMIC settings has been lacking due to poor infrastructure, limited funding, and a lack of appropriate program design and training content. There are significant gaps in how to evaluate the effectiveness of PN, foster in-country buy-in, and develop a structured approach to design, implement, and sustain responsive and effective PN programs in LMIC settings.
While resources on and evaluation of navigator competencies, roles, and skills exist in the United States,7 the appropriate adaptation of these resources and the subsequent evaluation of their use in LMIC settings has been lacking. In fact, representatives of LMIC institutions with whom we spoke during initial scoping for our global PN initiative reported using resources inappropriate for their settings and challenges with knowing where to turn for guidance, despite interest. Coupled with the lack of infrastructure and funding support, PN capacity development in LMICs has been limited.
We, the American Cancer Society (ACS), recognize the vital role of PN in decreasing inequities and supporting the achievement of positive health outcomes for individuals with cancer in the United States and elsewhere.8 Since 2015, we have steadily increased our investments in the capacity development of LMIC health institutions and civil society organizations, with the goal of providing high-quality, patient-centered cancer care to close the gap in cancer outcomes between high-income countries (HICs) and LMICs.
With generous support from the Merck Foundation, we created the Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) Initiative to support LMIC health institutions, cancer organizations, and other civil society organizations focused on addressing disparities in cancer care through the design and implementation of sustainable PN programs. The initiative also promotes and supports the integration of PN into national cancer control planning and cancer care delivery (Box).
The BEACON Initiative includes the following resources for all Community Participating Organizations:
The Global Oncology Navigation Toolkit focuses primarily, but not exclusively, on the cancer treatment phase, and specifically on the universal ‘how-tos’ of PN program design, implementation, and sustainability (Figure 1). Recognizing that PN can enhance the ability of healthcare systems to adapt to emerging patient needs and challenges, the Toolkit uses a health systems’ strengthening approach9 to support sustainably embedding navigation into broader cancer care delivery systems, accounting for referral pathways to other levels of care and leveraging community-based resources for patient and caregiver support. It provides practical, adaptable, self-service resources coupled with a self-paced approach for maximum flexibility. It also features an adaptable navigator training curriculum.
Given the immense need and potential benefit of PN in LMICs, we aimed to first test our approach supporting LMIC institutions and cancer organizations with designing, implementing, improving, and sustaining PN services in their unique settings.
We piloted the Global Oncology Navigation Toolkit and other offerings with 10 Community Participating Organizations (CPOs) from 8 countries from February 2022 to May 2023. Pilot CPOs varied by location, institution type, and in their prior experience with PN (Table).
CPO representatives included working professionals in cancer care (eg, physicians, nurses, hospital administrators) and cancer patient support (eg, cancer organization staff, volunteers, and cancer survivors).
CPOs were granted access to the BEACON Community platform, Toolkit, and individualized support and received $2500 planning grants to facilitate using Toolkit resources.
We gathered feedback from the CPOs on the Toolkit as well as information on their engagement in virtual events (VEs), their uptake of individualized support, and their achievements during the pilot period through voluntary feedback channels within the Toolkit and platform, post-VE participant surveys, and an external developmental evaluation that used surveys and in-depth interviews.
Pilot CPOs found BEACON’s offerings helpful in supporting their aims and objectives to initiate or improve PN services. They achieved key milestones in program design and implementation, including formalizing PN processes and procedures, gaining buy-in and securing program approvals, training navigators, and integrating program data capture into hospital data systems (Table).
“We [were] expecting to have guidance for creating a cancer patient navigation program. ACS provided it for us. It has exceeded our expectations. It’s a very systematic way to show how you can do this; show[ing] you the main points…to focus [on].”—Pilot Participant
While envisioned to be self-service, targeted individualized support and VEs facilitated Toolkit use by helping to break down complex concepts and guide the application of best practices and key learnings. As one pilot participant noted:
“We have no doubt that the Toolkit, as well as the [VEs], have been and continue to be a very important resource for our decisions and implementation. The ‘Ask an Expert’ webinars were particularly helpful in planning our program. The Toolkit is a true road map for the implementation and [the] future improvement of our patient navigation program.”
Respondents also expressed appreciation for coming together to learn from their peers through the BEACON Community platform and VEs, with one saying, “It really helps to see what our neighbors [have done]. We feel we can do this because they are successfully doing this.”
Even with dedicated staff and extensive BEACON offerings, some CPOs were challenged with acquiring the financial resources and institutional backing to successfully integrate navigation into cancer care delivery systems during the pilot period. Some CPOs reported spending planning grant funds on program implementation, indicating the importance of catalyzing financial support to launch and run programs.
Many faced competing demands of direct patient care and other duties, devoting less time to BEACON offerings than they would have preferred. Yet, they remained committed to the process and made demonstrable progress over time.
As part of ACS’ mission to end cancer as we know it, for everyone, we continue to share our BEACON resources freely as we cultivate a thriving community of global PN practitioners (Figure 2). Post-pilot, we invited interested institutions to apply to join the BEACON Community.
Given steady demand, we now welcome new members on a rolling application basis. The application process assesses applicant alignment with initiative goals and ensures agreement with ACS’ terms of use and participation and privacy policies.
As of September 2023, we welcomed 39 additional organizations. Including our pilot CPOs, the initiative has reached 57 health institutions and cancer organizations from 36 countries across Africa, Asia, Europe, Latin America and the Caribbean, Northern America, and Oceania.
To learn more about the ACS BEACON Initiative, please visit https://beaconcommunity.cancer.org/s/about-acs-beacon-public. To learn more about ACS’s global cancer work, go to http://cancer.org/global. Have a question or want to get in touch with us? You can reach ACS’s Global Patient Support team at This email address is being protected from spambots. You need JavaScript enabled to view it..
Despite the anticipated challenges in LMICs due to lack of infrastructure and funding, the BEACON Initiative’s offerings successfully aided CPOs in advancing their PN programs. Progress was enhanced by individualized support, financial assistance, and VEs.
Seven of the original 10 pilot CPOs navigated 6125 patients in 2023, while the remaining 3 made key advancements in program design and preparations for launch. We provided a competitive granting opportunity to our pilot CPOs to support early implementation objectives beginning in 2024 and to create additional localized evidence for PN uptake in LMICs.
We awarded grants to 5 pilot CPOs, ranging from $40,000 to $60,000 each, over 24 months. We aim to secure and offer additional funding to more CPOs in the future as we continue to push for an increase in the number, reach, and quality of PN programs in LMICs. However, the variability of funding to make grants does not limit our ability to successfully build PN capacity. We see time-limited catalyst grant funding as an enhancement to our suite of BEACON resources.
Resources permitting, we aim to expand Toolkit content to cover PN program design and implementation beyond the treatment phase with the addition of cancer site–specific navigation resources and in-service training modules. We also aim to mitigate language barriers through Toolkit translation.
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