First Annual NCONN Conference: Patient Navigation an Important Component of Healthcare Reform

At the First Annual National Coalition of Oncology Nurse Navigators (NCONN) Conference, held in Baltimore, Maryland, on October 10, Harold P. Freeman, MD, (pictured left) President and Founder, Ralph Lauren Center for Cancer Care and Prevention, Senior Advisor to the Director, National Cancer Institute, New York City, outlined the crucial role that oncology nurse navigators play in improving outcomes in patients with cancer. Dr Freeman had pioneered the “patient navigation program” in 1990 in a small Harlem community after noticing how many poor black women were presenting to Harlem Hospital Center with advanced breast cancer (45% with stage II, 39% with stage III disease, and 10% with stage IV). He implemented a Breast Cancer Screening Program to ensure all women could have mammograms, regardless of their socioeconomic status, and that any abnormalities were followed up on. The program produced dramatic results, and between 1995 and 2000, the percentage of women presenting with late-stage disease at Harlem Hospital Center was significantly decreased (38% with stage II, 14% with stage III, and 7% with stage IV). Not only were patients presenting earlier, but their outcomes were also considerably improved, with a 5-year overall survival of 70% compared with the 39% observed before the Breast Cancer Screening program was implemented.

Dr Freeman noted that patient navigation is a critical component of healthcare reform, indicating that universal healthcare coverage is not enough to effect change, as patients on Medicaid, for example, do not have better outcomes than those without insurance. The healthcare system is fragmented and even when patients have coverage and are highly educated, they may not know how to navigate their care. “There is a critical window of opportunity to save lives from cancer between the point of an initial suspicious finding and the resolution of the finding by further diagnosis and treatment,” said Dr Freeman. He noted that nurse navigators are critical because they have the clinical knowledge to guide patients and keep their care on track and timely, while also helping with cancer prevention through outreach programs.

Dr Freeman concluded that three major factors are needed to improve results in patients with cancer: (1) all patients need to have access to screening regardless of their ability to pay; (2) widespread patient navigation programs; and (3) an increase in outreach and public education. In 2005, President Bush signed the “Patient Navigator Outreach and Chronic Prevention Act of 2005,” and there are currently 23 government sites and 1000 other sites that offer some form of patient navigation assistance. While this is a step in the right direction, Dr Freeman noted that all patients should have access to nurse navigators.

Those interested in bringing nurse navigation to their institutions can receive training through the Harold P. Freeman Patient Navigation Institute, which has already trained almost 300 individuals throughout the United States and several from institutions overseas, including Romania and the United Kingdom.