Patient navigation is a well-established intervention that improves patient access, timeliness of care, communication, and health outcomes. Increasingly, health systems are using individuals without a clinical license (patient navigators, peer navigators, community health workers) to expand navigation capacity, recognizing that addressing health-related social needs improves time to treatment, participation in clinical trials, documentation of advance care planning, quality of life, healthcare utilization, and care cost. Despite these benefits, nonclinical navigation programs are not universal due to unreliable funding sources and limited workforce capacity. To address this gap, the American Cancer Society (ACS) developed ACS Community Access to Resources, Education, and Support (ACS CARES), the first nationwide navigation program for people with cancer and caregivers that provides direct, individualized, nonclinical assistance through a digital app, telephonic, and in-person support.
ACS CARES leverages a multichannel approach providing personalized support through an app with virtual peer support volunteers, telephonic support by ACS staff, and in-person support by undergraduate and graduate student volunteers. The tiered program structure provides multiple access points for patients with varying levels of digital literacy and access. Since 2023, the in-person component has been implemented in 23 cancer centers nationwide (Figures 1 and 2). ACS CARES sites are selected through a competitive application process that evaluates key stakeholder buy-in, current patient navigation structure, and population served.
Using a modified version of the NCCN distress thermometer and problem list, the ACS CARES program identifies patient or caregiver concerns and provides tailored information and support. Student volunteers integrate with existing navigation workflows at partner sites, extending the reach of the professional services provided. Depending on the gaps identified during implementation planning, volunteers either administer needs assessments or receive referrals of patients screened by health system professionals. Using an ACS database of national and local organizations and ACS articles, volunteers connect patients and caregivers to tailored resources and education. They provide longitudinal support, following up in-person or telephonically at a cadence determined by the patient’s acuity level. Since 2023, ACS has trained 340 undergraduate and graduate student volunteers across the country to deliver this tailored support. Students are primarily studying health sciences and express interest in pursuing medical school, physician assistant (PA) school, social work, nursing, a master’s degree in healthcare administration, public health, and more.
To ensure success of the in-person program implementation, the ACS navigation team conducts preimplementation planning and workflow mapping at each selected site. ACS staff and sites begin the planning process 6 to 8 months prior to implementation. Planning includes monthly meetings with key stakeholders, including administrators, providers, navigators, social workers, and representatives from volunteer services. Members of the ACS CARES navigation team also conduct an in-person site visit to evaluate current screening and support workflows and suggest optimal modifications to fill any gaps. We conduct key informant interviews and use inductive coding and thematic analysis to identify site-specific contextual barriers and facilitators to program implementation. Iterative codesign sessions develop and refine implementation models, leading to the development of site-specific process maps. These maps serve as communication tools to inform all members of the multidisciplinary team of the final workflow ahead of implementation and are also used during volunteer training sessions (Figure 3).
Following the site visit, the ACS navigation team iteratively refines workflows throughout the course of the implementation year, adjusting to site needs and feedback from ACS CARES volunteers and the healthcare team. Site partners are surveyed at the end of each semester to assess the barriers and facilitators to successful integration of the ACS CARES volunteers in their clinics. Their responses are used to alter the workflows, set site-specific goals, and refine the implementation planning approach. Responses from the most recent survey were categorized by theme in the Table and described in the following sections.
Across sites, the preimplementation phase was widely cited as a critical step for program success. Stakeholders described the workflow mapping process as particularly valuable for clarifying roles, defining referral pathways, establishing escalation protocols, and ensuring alignment between ACS CARES activities and existing organizational workflows. They noted that engaging both clinical and administrative staff early in the process increased organizational buy-in and resulted in a smoother program launch.
An administrative champion in navigation leadership at University of California San Diego (UCSD) noted, “This collaborative approach improved communication, clarified team roles, and created efficient processes to identify and address patient barriers to care.”
As a result of the thoughtful implementation planning, many sites identified that volunteers complemented rather than competed with existing navigation services. While staff trust was often identified as a potential barrier to successful uptake during implementation planning sessions, surveys following implementation revealed that the tailored workflows codesigned during implementation planning created a defined scope that increase staff trust in volunteer support.
Student involvement increased capacity for patient outreach and follow-up while preserving clinical staff time for higher-complexity psychosocial and medical concerns. An administrative champion at Texas Oncology summarized this impact by noting that “their participation expanded support capacity and enhanced the patient experience without replacing the essential role of professional social workers or clinical staff.”
Similarly, clinical leaders at UCLA Health reported that “the volunteers have become trusted members of our care team and have enhanced our ability to deliver holistic, family-centered care.”
As a result of their defined scope, structured health-related social needs (HRSN) assessment, rapport with patients, and collaboration with existing navigation workflows, volunteers have been able to successfully deliver navigation support. They provide additional warm touchpoints, leading to the discovery of patient concerns that may have otherwise gone unidentified, even in systems with robust navigation workflows.
A social worker at Mount Sinai Medical Center described this phenomenon as “having another set of trained individuals available to engage patients often allowed us to identify concerns that may have otherwise gone unnoticed.”
Similarly, a patient navigator at UCSD reported that volunteer interactions frequently revealed “practical, emotional, or informational needs that may not have surfaced during routine clinical encounters.”
Effective training has enabled volunteer support to extend beyond the identification of patient needs to the provision of tailored support resources. During the preimplementation planning process, ACS identified a lack of resource documentation as a gap in the navigation processes of several sites. Thus, volunteers dedicated time to developing or refining community resource databases that could be leveraged by the professional team.
A social worker from Mount Sinai noted that volunteers “independently researched community organizations, contacted agencies to verify information, and created updated resource guides that continue to be used in our clinic today.”
An administrator at West Michigan Cancer Center noted that this process transformed a potential implementation challenge into an actionable path to success, resulting in “a comprehensive resource database that strengthened both volunteer preparedness and the clinic's long-term navigation infrastructure.”
The cohesion awarded by increased personal touchpoints and robust resource databases resulted in tangible resolution of HRSNs before they became barriers to accessing care. Across 2522 assessments conducted in person, students identified 5175 concerns, with transportation, lodging, finances, and food insecurity emerging as the most frequently endorsed practical concerns. Volunteers connected patients to 1961 support resources to address patient concerns.
This impact was tangibly summarized by the story of a patient who, following treatment for head and neck cancer, was found to be living in a household without access to safe drinking water after a filtration system malfunctioned. Through ACS CARES resource coordination and locally available financial assistance, the family obtained bottled water and repaired the filtration system.
Site leadership at Orlando Health noted that the intervention enabled the patient “to focus on healing instead of access to basic needs.”
Another example from UCLA involved an adolescent oncology patient whose family faced transportation, lodging, and employment-related challenges while traveling a significant distance to access treatment. ACS CARES volunteers made referrals to multiple support resources, helping reduce financial strain and encourage treatment adherence.
“During a subsequent clinic visit, the patient’s caregiver shared that having someone ask about these practical concerns and then help connect them with meaningful resources made them feel supported not only as a family navigating cancer but as people whose overall well-being mattered to the healthcare team,” their oncologist reported.
The combination of collaboration with diverse members of the clinical team and successful patient support made the ACS CARES volunteer experience valuable for workforce development. Several supervisors reported that students progressed from observational roles to increasingly independent navigation responsibilities over the course of the program. This growth was attributed to structured ACS training, ongoing mentorship provided by both ACS and site staff, and direct patient engagement.
A clinical supervisor at Mount Sinai noted, “Watching the students develop meaningful relationships with patients and grow into more independent patient navigators was one of the most rewarding parts of my experience.”
Similarly, a volunteer at West Michigan Cancer Center reflected, “ACS CARES has not only strengthened my communication and problem-solving skills but also deepened my commitment to advocating for accessible, patient-centered support.”
Following participation in the program, many volunteers request letters of recommendation to pursue graduate-level education. Alumna of the program are currently in medical school, PA school, nursing school, pursuing master’s degrees, or working as nurses, physical therapists, and more.
Experiences across the 23 ACS CARES sites demonstrate that the program can be successfully integrated through multidisciplinary collaboration and structured implementation planning. As a result of the implementation planning process, participating health systems consistently reported increased capacity to identify and address HRSNs, improved connections to community resources, and enhanced patient support without substantial disruption to existing workflows. As healthcare systems continue to emphasize equitable, whole-person care, ACS CARES offers a sustainable framework for expanding the navigation workforce without imposing a cost burden. ACS CARES will continue to examine the scalability of the program at individual sites and across the country. Additional sites will be encouraged to apply in the summer of 2027 for implementation in the fall of 2028.
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Patel MI, Ramirez D, Agajanian R, et al. Association of a lay health worker Intervention with symptom burden, survival, health care use, and total costs among Medicare enrollees with cancer. JAMA Netw Open. 2020;3:e201023.
Patel MI, Ramirez D, Agajanian R, et al. Lay health worker-led cancer symptom screening intervention and the effect on patient-reported satisfaction, health status, health care use, and total costs: results from a tri-part collaboration. JCO Oncol Pract. 2020;16:e19-e28.
Patel MI, Sundaram V, Desai M, et al. Effect of a lay health worker intervention on goals-of-care documentation and on health care use, costs, and satisfaction among patients with cancer: a randomized clinical trial. JAMA Oncol. 2018;4:1359-1366.
Charlotte Waugh, BS, is Program Manager of Patient Navigation at ACS, where she supports implementation and growth of the ACS CARES navigation program. Charlotte brings a unique perspective to her role as a former student volunteer in the program that served as the foundation for ACS CARES.
Bonny Morris, PhD, MSPH, RN, is a behavioral scientist with a clinical background as an oncology nurse navigator. She is Vice President of Navigation at ACS, where she leads the strategy, development, and implementation of navigation programs, including ACS CARES, and ACS ACTS (Access to Clinical Trials & Support).
Nicole Robertson, MPH, is Director of Navigation Operations at ACS, where she leads the development, implementation, and expansion of the ACS CARES navigation program. In addition, she contributes to the strategic direction of ACS’s comprehensive navigation portfolio.
Shanthi Sivendran MD, MSCR, MBA, is Senior Vice President of Cancer Care Support at ACS, where she provides strategic direction and subject matter expertise across a variety of initiatives that improve cancer care delivery and support to patients and caregivers.
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