Shepherd of the Sick
Poor people with cancer, says Harold Freeman, need a guiding hand
It's a busy summer afternoon at the Ralph Lauren Center for Cancer Care and Prevention in Harlem. The breast clinic is in full swing as a surgeon and a medical assistant go back and forth between exam rooms, performing biopsies, delivering test results, and checking in on patients after treatment. Maud Colas is hot on their heels. "You need to go back to Washington Heights and get your original films," Colas says to one patient. "Can you do that this week?" To another, awaiting the results of a breast biopsy in three days, Colas says: "You call me if there's any worrying, OK?" One woman has just finished her eighth go-round of chemotherapy, and Colas, she says, helped her apply for Medicaid and financial assistance to cover transportation expenses to the clinic. The two also prayed together. "I come right to you and let you deal with my problems," she says to Colas. Both laugh.
Colas is a patient navigator. Her job at the center-which sees all kinds of cancer patients but particularly those facing a diagnosis of breast, cervical, prostate, or colon cancer-is to help patients get treatment. Traversing the thickets of healthcare, especially when dealing with a serious illness like cancer, is difficult for everyone. It's even more so for the poor and nonwhite, says surgeon Harold Freeman, president and medical director of the center, who pioneered the patient navigator program at nearby Harlem Hospital more than 15 years ago. The navigators aren't medical professionals but people who speak the same language and are familiar with the patients' communities and cultures. They come from backgrounds ranging from insurance to social work and teaching, and step in when a screening test reveals a suspicious finding. Their main role: knocking down barriers to follow-up tests and treatment. "You have to make sure that whatever the doctor recommends at that point, the patient gets," says Freeman. That includes helping the patient with child care, prescription drug coverage, and getting to appointments-not to mention providing a shoulder to cry on.
A 2003 study in the Journal of the American College of Surgeons found that the navigator program at Harlem Hospital boosted the number of women who were diagnosed when their breast cancer was in its early, treatable stage from 6 percent to 41 percent, and the five-year survival rate from 39 percent to 70 percent. Last year, Congress approved funding to implement similar pilot projects, while the Centers for Medicare & Medicaid Services is currently supporting navigators at six facilities across the country. The National Cancer Institute is passing out $25 million in grants to eight healthcare institutions for navigators, targeting underserved groups such as low-income patients in Chicago and American Indians in Portland, Ore. "We can help coordinate care, so that if the patient has to take a day off from work, we can get as many appointments as possible in that day," says Karen Freund, who is overseeing one of the grant recipient programs, at Boston University Medical Center.