A major gap exists in the cancer discovery-development-delivery continuum for many Americans. Discovery and development research typically results in beneficial procedures for cancer prevention, early detection, diagnosis, and treatment that are intended for all Americans. Health disparities arise when the delivery system does not provide access to timely, standard cancer care to everyone who needs it. This is particularly evident among racial/ethnic minorities, people of low socioeconomic status, residents of rural areas, and members of other underserved populations.

NCI is working to close this gap between development and delivery among underserved populations. A central issue is that patients face a variety of barriers to standard cancer prevention information, screening, diagnosis, treatment, and follow-up care that inhibit timely access to health services. These barriers include fragmentation of health care services; lack of health insurance or underinsurance; provider- and patient-related education barriers; communication barriers, particularly for patients whose first language is not English; inadequate transportation to medical appointments; and missed appointments due to travel, child care, or employment barriers.

A Patient Navigator is a credible and reliable guide who assists patients and their families in "navigating" their way through the complexities of the cancer care process. The basic goal of patient navigation is to facilitate timely access to quality, standard cancer care in a culturally sensitive manner for all patients. Examples of navigation services include: facilitating communication and information exchange for patients with a limited understanding of the English language; coordinating care among medical service providers; and arranging for financial support, transportation, or child care services. Navigators may be community lay persons or professional health care providers. Patient navigation for cancer care spans the period from cancer detection procedures through cancer diagnostic tests to completion of cancer treatment. The cost-effectiveness of patient navigation is also an important consideration.

In September 2002, through an interagency agreement with the Indian Health Service, the Center to Reduce Cancer Health Disparities (CRCHD) implemented a pilot project to develop long-term strategic plans for establishing a Patient Navigator Research Program in the Portland area. The agreement was intended to plan, develop, and pilot a cancer patient navigator program at three sites: Yakama, Wash.; Tacoma, Wash.; and Portland, Ore.

Additionally, as part of the Cooperative Planning Grant for Cancer Disparities Research Partnership Program, issued by the Radiation Research Program, the CRCHD provided funding for a Patient Navigator Program to be implemented at six sites: Inglewood, Calif.; Laredo, Tex.; Rapid City, S. D.; Pascagoula, Miss.; Pittsburgh, Pa.; and Wilmington, N.C.

For the recently released Patient Navigation Research Program: Eliminating Barriers to Timely Delivery of Cancer Diagnosis and Treatment Services (RFA-CA-05-019), NCI is inviting applications for funding to conduct research into the efficacy and cost-effectiveness of various patient navigator interventions and techniques. The CRCHD will fund up to six grants over a 5-year project period.

As the Patient Navigator Program continues to operate at its current sites and is expanded at the sites to be funded, we will gain information that will enable us to tailor the program to meet the needs of the diverse populations served and continue to reduce cancer health disparities. For more information, see http://crchd.nci.nih.gov/initiatives/#Navigator.

Dr. Harold P. Freeman, Director
Center to Reduce Cancer Health Disparities,
and
Dr. Mark Clanton, Deputy Director,
Office of the Director,
Cancer Care Delivery Systems