As someone who has worked in oncology for over 15 years, I’ve seen firsthand how innovation in new drug development and therapeutics has drastically changed the way the six letter word, C-A-N-C-E-R truly impacts people. Due to these advances, millions of people with cancer are now living longer, better lives. And yet, I also know that not every cancer patient has benefited equally from that progress, because of personal and social barriers to health and societal gaps in health equity
Adverse social determinants of health (SDOH) can increase people’s susceptibility to illness and challenge rates of screening, which can lead to a delayed diagnosis. Once diagnosed, economic and social vulnerability can lead to poor healthcare outcomes and ultimately increased mortality.
Cancer care navigation, which offers individualized assistance to help a patient navigate their cancer journey, is a powerful tool for overcoming personal barriers to care that are often rooted in health disparities. But addressing those disparities and barriers at scale is a challenge for the current healthcare system, which is so burdened with navigating the daily requirements of large patient loads and the administrative burden of running a successful business. Physician practices and health systems must grow staffing in tandem with the size of their patient population to manage navigation, creating an expense that is often prohibitive. However, when independent navigation programs exist as an extension of the clinic and are supported with data, analytics and an easily accessible network of social service organizations, it becomes possible to make a real difference on both cancer care outcomes and health equity at scale.
Increased Awareness Of Social Disparities In Cancer Care
The underlying causes of disparities in cancer care are complex, and involve various social, economic, environmental and cultural factors. These conditions can present challenges around housing, nutrition, transportation and other barriers that make it more difficult for patients to access care and adhere to treatment. For example, in certain communities, fresh groceries may be hard to procure, chronic disease may be more rampant, and quality healthcare may be scarce. If they are stricken with cancer, people, for no fault of their own, may face delays with screening and difficulties accessing quality care in a timely and consistent way. Moreover, they may lack sufficient insurance and resources to cover co-pays and drug costs, or lack a network of support needed to manage treatment. Demographic factors, like race, ethnicity, language, age, gender, and sexual orientation, can exacerbate those barriers. Cumulatively, these social determinants of health can lead to diminished outcomes, poor quality of life, and low rates of survivorship.
We know what those disparities are, and the powerful impact they exert on health. The question is what can be done to bridge the gaps that large cross-sections of people with cancer face?
Leveraging Cancer Care Navigation To Reduce Health Disparities
Cancer care navigation has a storied history in addressing health equity gaps. In the early 1990s, Dr. Harold Freeman launched an innovative program at Harlem Hospital Center in New York City to improve breast cancer treatment among African American women in the local community. Freeman’s program used care navigators, who were non-medical personnel living in the same communities as their patients, to help eliminate barriers to timely care access and improve care coordination by taking into account the economic, social, personal and cultural circumstances of each patient. The approach was remarkably successful, increasing the 5-year survival rate from 39% to 70%.
Those achievements highlight a truism about cancer care. Cancer patients respond best when they receive the kind of whole-person care that takes comprehensive needs into account, including physical, socio-economic, familial, emotional, mental, and even spiritual. Cancer care navigation is one of the most effective tools for supporting those psycho-social needs and overcoming other barriers to care. For example, arranging for transportation to an appointment or connecting a food-insecure patient to a food bank can be as important to health outcomes as access to medication.
In the years since Freeman’s work, various programs have been launched to further test the utility of cancer navigation in advancing health equity. For example, a study by the Accountability for Cancer through Undoing Racism and Equity (ACCURE) program proved the efficacy of using real-time alerts and nurse navigators trained to address race-specific barriers to improve survival rates among African Americans with curable lung or breast cancer. In July of 2023, CMMI will launch the Enhanced Oncology Model (EOM) a value-based payment model for oncologists which, among other things, takes particular aim at addressing health disparities among cancer patients. Oncologists participating in the EOM will be required to conduct a social needs screening for their patients and to offer 24/7 care navigation services.
By expanding traditional navigation programs to include robust technology and data, nurses and lay health workers alike are able to manage the needs of a larger cross-section of patients. With access to tech-enabled navigation tools, care teams can systematically collect and analyze information about a patient’s health-related social needs, stratifying them by level of acuity to ensure they are reaching out to the right people at the right time. Once certain needs are identified, these tools can intelligently surface the right resources to address the patient’s needs, including information on community based resources or grant assistance programs. Finally, these tools enable care teams to leverage electronic patient-reported outcomes to continually check in on patients ensuring they feel supported over the course of their care journey.
In this way, we’re able to use care navigators paired with technology to address challenges related to health equity in an automated, intelligent, and scalable way, making it available to even more patients who need it
Bridging The Health Equity Divide
Like any practice of medicine, cancer care tends to focus on the disease or condition first, and put less emphasis on the person and their unique personal circumstances. But an individual’s psycho-social needs can be just as influential on health outcomes, survivorship, and quality of life as the treatment itself.
Paired with the right technology, care navigation programs can help identify and manage the barriers that cancer patients face due to health disparities, lifting the administrative and care coordination burden from oncologists and supporting them in delivering high-quality cancer care to their patients.
Cancer care navigation may not be able to solve the root problems of health equity, but it can ensure those gaps are bridged so that all cancer patients benefit equally from the remarkable advances that have been made in cancer care.