Cancer survivors could play a key role in helping new patients navigate treatment — and the system

6 Feb 2023

Cancer survivors could become patient navigators by using the knowledge gained from their lived experience to guide newly diagnosed patients through the cancer care pathway — a pathway that can be daunting and may span several clinics and hospitals.

Cancer is one of the biggest non-communicable disease threats facing mankind. The International Agency for Research on Cancer estimates that each year there are nearly 20 million new cancer cases and approximately 10 million cancer-related deaths reported around the world.

In South Africa, rapid urbanisation and adoption of Western lifestyles since the mid-1990s has contributed towards the emergence of cancer as a public health problem in the general population, and cancers now rank among the most important causes of death in the country.

Furthermore, a large proportion of South African cancer patients are diagnosed late, already have extensive disease, and require a combination of surgery, chemotherapy or radiation therapy to improve the probability of cure.

Established by the Union for International Cancer Control, World Cancer Day is observed annually on 4 February. The theme for 2023 is “Close the Care Gap”. This year’s campaign seeks to mobilise action against inequities and barriers to cancer care, while considering the perspectives and lived experiences of cancer survivors.

The growing public health significance of cancer has not gone unnoticed, and the South African government has developed the National Cancer Strategic Framework to combat the ever-increasing burden of disease. This policy document is underpinned by the need to facilitate access to cancer care for those who require it.

Nevertheless, newly diagnosed South African cancer patients continue to experience challenges in accessing care within the public healthcare sector. Cancer care is not offered through a “one-stop shop” clinic and patients are required to navigate a complex referral pathway, which may span several clinics and hospitals, in order for them to receive their recommended cancer treatment.

This task can be even more daunting when patients are not well-informed about the process of accessing cancer care. Inevitably, a proportion of newly diagnosed cancer patients will become frustrated and abandon their efforts to seek care.

Since a combination of cancer treatments is often required to maximise the probability of cure, non-receipt of one or multiple treatments has downstream implications for cancer control, the most significant of which is a decrease in five-year survival rates.

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Patient navigators

Herein exists a potential role for cancer survivors as patient navigators. Cancer survivors are individuals who have already undertaken the cancer care journey and have subsequently been cured of cancer.

Cancer survivors can become patient navigators by using the knowledge gained from their lived experience to guide newly diagnosed cancer patients through the cancer care pathway.

Data, predominantly from the United States, suggests that cancer survivors who serve as patient navigators make positive contributions toward cancer control efforts in the context of underserved communities where there are low levels of health literacy, high levels of medical mistrust, or language and cultural barriers which hinder the effective communication of care processes between healthcare providers and patients.

Additional responsibilities that patient navigators might have when guiding newly diagnosed cancer patients through the care pathway include reminding patients about their clinic appointments, motivating patients to keep a positive mindset during their cancer journey, and encouraging adherence to any cancer treatment plans.

Patient navigators (peers) have been successfully used in the South African public healthcare sector to improve linkage to care and treatment adherence for HIV. Therefore, it is reasonable to assume that cancer survivors will have a positive impact if they are to be used as patient navigators in our public healthcare sector.

However, there are two key questions which must be answered before a decision can be made by public health specialists and policymakers on the use of cancer patient navigators in the public healthcare sector.

Firstly, how will they be trained? Secondly, will this approach be financially sustainable given the prevailing resource constraints in the public healthcare sector?

The answer to the first question is relatively simple — adopt a similar training approach to that used for HIV patient navigators.

The answer to the second question is less straightforward — although training and employing cancer patient navigators is likely to be a costly undertaking in the short term (and raise the eyebrows of public health specialists and policymakers in a resource-constrained setting), there are long-term benefits in that cancer patients who are efficiently linked to care and encouraged to be adherent to their treatment plans would suffer lower rates of costly complications.

Most cancer survivors are open to sharing their experiences of cancer care with newly diagnosed patients and are keen to assist them along the way.

What better way to involve them as ongoing stakeholders in local cancer control efforts than as role models and advocates for those who are just beginning their cancer journey? DM

Dr Yoshan Moodley is a public health researcher and senior lecturer at the African Cancer Institute in the Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University.

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Patient navigators