During cancer treatment, a structured support system is necessary. It forms a bridge between patients and access to care.
To achieve this, creating a special workforce is essential. They are patient navigators. Navigators are not oncologists, but their overall contribution to cancer care is immense.
Visiting a cancer centre for treatment can be intimidating in itself. Logistic and emotional help is necessary. Cancer survivors can also be excellent patient navigators, but need to be adequately trained.
Oncologists can provide evidence-based treatment, but patient overload keeps them busy. It becomes difficult for them to communicate for long to solve patients’ problems. They may not be able to address the emotional, social, economic or logistic issues.
Five to 55 per cent of patients cannot complete the entire treatment, which may extend beyond six months. This is unfortunate.
Cancer patients need hand-holding and compassionate care.
Tata Memorial Hospital, Mumbai, a grant-in-aid institution of the department of atomic energy, has made an immense contribution in this field. It has started a MSc course in patient navigation. This is the first degree course in this subject globally. It is a two-year course with a one-year compulsory internship. This postgraduate course has generated interest in patient navigation across the country.
American physician Harold Freeman’s groundbreaking patient navigation study in 1995 has steadily achieved its goal over the past few decades. He especially addressed the economically weak and uninsured patients.
In 2012, the cancer burden of new cases was around 1 million in India. It is expected to be 1.7 million in 2035. TMH, Mumbai, gets 40 per cent its patients from Maharashtra and 60 per cent from other states, including Bengal.
The requirement of helpful and compassionate patient navigators is vital in providing quality care. There are issues that the cancer patients cannot confide in the doctor. In difficult times, many patients fight the battle alone.
Acquaintances are inquisitive, but they seldom help. Most patients have to stop working during treatment. The requirement of proper information and emotional support becomes paramount.
The patient navigators are trained for this purpose. They can guide patients through the healthcare system, thereby ensuring timely, effective and efficient care.
Dignity and confidentiality must be maintained. However, their opinion should always be unbiased and only in the interest of the patient.
A one-year diploma course in patient navigation named Kevat was launched in 2018 at the Tata Institute of Social Sciences (TISS) under the guidance of TMH, Mumbai.
The idea was to create a robust workforce of patient navigators. In all these courses, theoretical knowledge and hands-on training were imparted by the leaders in the field.
Evidence-based information is provided regarding cancer screening, diagnosis, treatment, survivorship, and end-of-life care. The navigators engage as friends and motivators but maintain professional boundaries.
They are placed at the reception, outdoors and palliative care departments. A patient navigator can assist around 20 to 25 patients daily. Usually, 4 or 5 of them need hand-holding.
Any graduate of science, doctors, nurses, hospital administrators or technology students can enrol for this course. A patient navigator is empowered to:
Build an adequate knowledge base in the subject
Overcome administrative and medical barriers to care
Improve healthcare delivery
Help to provide socioeconomic support with limited resources
Get feedback on services provided and arrange follow-up
With experience, patient navigators can perform well in administrative positions and take up leadership roles. Great placement opportunities are available all over the country.
There have been various studies on the benefits of patient navigation. In a landmark review, around 59 research papers were assessed. The findings were interesting:
70 per cent of the studies found improvement in treatment initiation
71 per cent demonstrated improvement in treatment adherence
87 per cent showed improvement in patient satisfaction
81 per cent demonstrated a positive impact on quality care indicators
Delays and disparities in treatment were addressed.
Although a new discipline, patient navigation has already helped a large number of cancer families in the country. They have assisted in the non-negotiable goal of patient care.
Cured patients can volunteer to guide other patients.
Presently, there are no degree or diploma courses on patient navigation in Bengal. If started, such courses can generate job opportunities for many graduates. Recruitment of patient navigators in government and corporate hospitals is necessary to improve services.
Recently, an organisation in Calcutta has been recruiting breast cancer survivors to navigate diagnosed patients throughout the treatment. Basic training is being provided to the survivors.
This initiative has been named Jiboner Sathi. It is indeed a laudable effort and can be the beginning of patient navigation in Bengal.
Gautam Mukhopadhyay is a surgical oncologist trained at Tata Memorial Hospital, Mumbai. At present, he is the clinical lead, department of surgical oncology, Narayana Health Cancer Institute