The Role of the Navigator
Any discussion of timely access to care should consider the
work of Harold Freeman, former president of the ACS, and his
vision of the role of navigation in addressing healthcare disparities
in access to cancer care (Freeman & Rodriguez, 2011). The
founding principle of the program of patient navigation is offering
individualized assistance to patients, families, and caregivers
to help overcome barriers in the healthcare system and facilitate
timely access to quality care (C-Change, 2005). That role can be
filled by a trained layperson or healthcare professional.
In an article evaluating the cost effectiveness of navigation
programs for patients with cancer, Ramsey et al. (2009) found
that few prospective, controlled trials have evaluated the efficacy
of navigator programs and their impact on cancer-related
morbidity and survival. Because of those findings, the cost effectiveness
of navigation programs is not known. Survival data
are not functional outcome measurements for studying breast
cancer. A comprehensive analysis of the healthcare system and
the needs of patients should be performed to identify barriers
to care. The decision to implement a navigation program should
be driven by data and measureable patient outcomes, but those
data are not available.