Patient Navigation: Reducing Disparities in Cancer Care
By Omasan Richardson, Government Relations Coordinator, Association of American Cancer Institutes (AACI)
Patient navigation has become an essential piece of the health care puzzle, particularly in the United States, where it plays a pivotal role in bridging the gaps in health care accessibility and affordability.
To understand the current state of patient navigation, it is important to appreciate its history. The concept was first introduced by Dr. Harold P. Freeman, a surgical oncologist, at Harlem Hospital in 1990. Dr. Freeman noted the intersectionality of health disparities in the poor, primarily Black communities, where poverty, social injustice, and cultural factors often overlap.
In a 2022 interview published by The Cancer Letter’s Cancer History Project, Dr. Freeman described patient navigation as encompassing a patient’s entire health care journey–from community engagement to post-treatment support. This comprehensive approach informed the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005, which allocated $25 million to support the establishment of community-based navigation programs and led to the creation of the Center to Reduce Cancer Health Disparities at the National Institutes of Health.
Patient navigators work collaboratively with patients and their families to optimize care and help eliminate barriers that contribute to health disparities, significantly improving patient outcomes. For example, a study by the Boston Patient Navigation Research Program on patient outcomes for breast and cervical cancer, primarily from underrepresented racial or ethnic backgrounds, revealed that patients with navigators were significantly more likely to achieve diagnostic resolution within one year. Notably, cervical cancer patients with navigators benefited the most, with an approximately eight percent increase in the number of patients reaching a diagnostic resolution.
Moreover, studies have shown that patient navigation can lead to a reduction in health care costs by reducing hospitalizations, emergency department visits, and intensive care admissions. However, the U.S. health care system still faces systemic inequities, including barriers like insurance coverage gaps, communication challenges arising from language or cultural differences, misalignment of provider and patient values, and financial burdens associated with health care. Additionally, it remains unclear who ultimately bears fiscal responsibility for supporting patient navigation programs. Currently, 82.4 percent of accredited patient navigation programs primarily rely on operational sources for funding, while community-based and non-accredited programs use a combination of operational and grant funding, with only 25.8 percent relying solely on grants.
Recent developments in sustaining patient navigation programs include the establishment of medical billing codes by private insurance companies and Medicare, alongside guidance from the American Medical Association on billing for patient navigation services. While CMS reimbursement represents a crucial step forward for patient navigation services, required co-pays may still be a barrier for some patients. Health care advocates must leverage recent progress to raise awareness of continued reimbursement concerns with Congress.
Additional challenges are posed by a lack of standardized training for navigators. A survey conducted by NCI-Designated Comprehensive Cancer Centers revealed that nearly half of patient navigation programs were relatively new, with inconsistent training across the board. While the Patient Navigation Research Program from the Harold P. Freeman Patient Navigation Institute and the Colorado Patient Navigator Program both offer specialized curricula, other initiatives, including the American Cancer Society’s Leadership in Oncology Navigation (LION) program, are still new. Efforts are underway to standardize the patient navigator role, with the Professional Oncology Navigation Task Force establishing Oncology Navigation Standards of Professional Practice to enhance the quality of navigation services.
Though it is important to develop consistent training standards, navigation services should not take a “one-size-fits-all” approach. To truly mitigate disparities in cancer health outcomes, navigators must provide individualized services to meet patients’ needs, from diagnosis through survivorship. While patient navigation has led to significant cost savings within the health care system and new medical billing codes for navigation services are expected to further alleviate financial burdens, stable, predictable funding increases remain essential to advancing research and care at our nation’s cancer centers. We urge Congress to support increased funding for the National Institutes of Health (NIH) and National Cancer Institute (NCI). AACI is among the leading cancer advocacy organizations requesting $51.303 billion for the NIH and $7.934 billion for the NCI in Fiscal Year 2025.
By investing in broader access to patient navigation throughout the U.S., cancer centers are well positioned to make a significant impact on health equity. Through targeted advocacy efforts, AACI is enhancing the work of academic cancer centers to improve outcomes for all patients with cancer.
The Association of American Cancer Institutes (AACI) represents more than 100 premier academic and freestanding cancer centers in the United States and Canada. AACI is accelerating progress against cancer by enhancing the impact of academic cancer centers and promoting cancer health equity. Learn more at https://aaci-cancer.org.