Delivering Care to Cancer Survivors Coordinating Care The multifaced approach to treating cancer necessitates providing survivors with appropriate care to address their many needs including transitioning from active treatment, coordinating followup appointments, addressing financial needs, and gaining access to other survivorship resources. While these resources are often available, understanding how or where to gain access to them can be challenging. Coordination of care is critically important to help patients identify and gain access to such resources. Coordinating cancer care is most effective when a designated individual or a team of people helps a cancer patient or survivor to gain access to the resources they need. A systemic review of over 30 years of studies found that coordination approaches led to improvements among 81 percent of survivors across multiple facets of cancer care, including screening, patient experience, and quality of end-of-life care (642). Patient navigators and clinical care coordinators are individuals who help cancer patients and survivors access resources more effectively (see Sidebar 47, p. 141). Furthermore, patient advocates, who are often cancer survivors themselves, are uniquely positioned to bridge critical gaps between patients, survivors, and the health care system. Financial navigators can help reduce financial toxicity among survivors and their caregivers. These navigators can screen patients to determine if they are at an increased risk of financial toxicity and can provide assistance and resources. One study that implemented Patient Navigation The first patient navigation program in the United States was designed specifically to address racial disparities in breast cancer screening and follow-up for Black women. Implementation of this program led to a 70 percent increase in 5-year survival in this group (644). While patient navigation is being increasingly recognized as a potent resource for helping cancer survivors, challenges in implementation remain. BENEFITS Patient navigation bridges a variety of gaps and addresses diverse needs across the cancer care continuum: • Patient navigation improves access to screening, patient care coordination, symptom management, and follow-up care (642,645,646). • Patient navigation reduces the cost of health care by reducing emergency room visits and missed appointments (643,647,648). WHAT HAS BEEN DONE? Recognizing the benefit of patient navigators, legislative efforts have been made to increase access to patient navigation, including: • The Patient Navigation Outreach and Chronic Disease Prevention Act in 2005 which provided $25 million over 5 years to develop patient navigator programs and determine if they help reduce barriers to access to care and improve health care outcomes in underserved patient populations. This act was the first of its kind in the United States • The Patient Protection and Affordable Care Act in 2010 which helped increase access to patient navigation programs for cancer patients and survivors. Additionally, the American College of Surgeons’ Commission on Cancer requires all accredited organizations to have a patient navigation program. The Community Preventive Services Task Force (CPSTF) also recommends the use of patient navigation services to increase cancer screenings among historically disadvantaged racial and ethnic populations and people with lower incomes. CHALLENGES Despite the benefits of patient navigators, challenges remain: • There is often high variability in the organization and training of patient navigators in the United States. Lack of standardization can lead to different experiences for survivors. • There is often confusion about coverage and financial benefits of patient navigator services through Medicare, Medicaid, and private/commercial insurers. SIDEBAR 47 Supporting Cancer Patients and Survivors AACR Cancer Progress Report 2023 141
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