Navigator program helps fight cancer

Photo by Casey Dixon

Photo by Casey Dixon

ALBANY, Ga. -- Five years ago, a movement began to ensure those uninsured or underinsured in Southwest Georgia were getting regular cancer screenings.

So far, the returns on this have been promising.

The Southwest Georgia Cancer Coalition's health navigator program, consisting of three full-time employees, go into six community health centers in the region to identify the uninsured or underinsured that are due for screenings and walk them through the process of getting the screenings performed from start to finish.

"They identify patients that are eligible, put a prompt in their record to alert their doctors and the doctors provide the medical clearance (for the screenings)," explained Denise Ballard, vice president of cancer prevention and control for the Cancer Coalition.

The navigators maintain contact with the patients, prompting them to follow proper preparatory procedures. From the first phone call until the time the screening is complete, the patient has talked to their navigator eight times.

"The navigators get the patients into lab services or hospital services (as needed) and help them with financial services," Ballard said.

"We prevent them from running into roadblocks."

The program was piloted in Baker County in 2006 and eventually expanded to the influence it has now. The health navigator system was fully up and running by 2008.

In that time, a total of 800 colonoscopies have been done through the program with six cancers found.

Navigators conduct one-on-one patient education and preparatory procedures, assist patients with the proper paperwork, arrange transportation as needed, arrange initial surgical treatment if its necessary, collect and report data, ensure timely medical record transfer among providers and provide performance feedback to referring physicians.

"We walk them through every step of the process," Ballard said.

"It's a constant communication."

Rhonda Green, program manager for the coalition's community cancer screening program, said that patients are generally tracked for two months if not longer.

"We have to stay connected to these patients," she said.

They remain on the program's radar indefinitely.

"As long as the patient is with the community health center, they stay in our system," Ballard said. "Right now, we have patients coming back for their five-year screenings."

The Cancer Coalition covers the cost of the colonoscopies, which it is able to do in part from a grant from the Georgia Cancer Coalition.

The end result of the process is that a relationship forms between the navigator and the patient.

"They tend to rely on us," Ballard said. "They come back to us if they need to be connected with the right services."

Charles Greene, one of the navigators, said that education is perhaps the most important thing that he does while citing a study from the Nancy C. and J.C. Lewis Cancer & Research Pavilion, which found that eliminating the education barrier can reduce cancer deaths among African-American males by 50 percent.

"Education is the largest thing we do," Greene said. "People don't know when to get screened our where to go."

Education may mean explaining to a patient what a colonoscopy is.

"We get them, educate them and they share their experiences with other people," Green said.

Perhaps the second most important thing is making sure the patients keep their appointments.

"These slots are rare, so we have to make sure we keep the patient on our minds," Greene said.

Greene starts his tracking process by finding out who is coming into the clinic that week and what screenings they need. Once that's been determined, the patient's name is submitted on the referral the doctor approves.

"The referral is the bread and butter," the navigator said.

Greene has been associated with the Cancer Coalition for three years, serving the last two as a health navigator. The first year, he was involved with a prostate cancer project which tracked a group of 60 men to determine their risk of developing the disease.

"I was going out and recruiting people," Greene said of the project. "I would contact individuals and set up appointments.

"Since I had a lot of experience, they saw I was a good fit (as a health navigator), and I was given a clinic."

Greene is based at South Albany Medical Center, but also tracks patients at Lee Medical Arts Center and East Albany Medical Center. At one time, he is keeping up with 20 to 30 people.

This program is needed here, especially in the environment where the navigators are based.

"Eighty-five to 90 percent of those diagnosed with cancer are treated in community centers," Greene said. "It's important to have navigators where people are being treated."

Once the referral process is complete, Greene speaks to the patient about everything -- including what might be standing in the way of getting the screening done. He then schedules the screenings, gives the patient the preparatory kit and teaches him or her how to use it.

"We make sure they understand in clear language," he said. "It is a lot of back and forth.

"And we encourage them to call us anytime."

Aside from addressing the education disparities, Greene said the best part about the job is knowing cancers are being caught early, and that patients are telling their loved ones about the program.

"It really does pay off," Greene said.

Probably the worst part about the job is knowing there are some patients you just can't convince to get screened.

"You can't reach everybody," Greene said. "We are making a difference, but it's a slow process to change cultures.

"It takes one person at a time."

The system has been helpful in the region, officials say, especially with what it is faced with in terms of maintaining good health.

"In Southwest Georgia, in most counties, there are higher incidents and death rates from many preventable cancers," Ballard said. "We focus on prevention.

"We also focus on early detection. Prevention is the best thing, but early detection is the second best thing."

Specifically, the barriers faced locally include high rates of uninsured or low-income patients -- which in turn can prevent regular screenings.

Unfortunately, that's only one piece of the puzzle -- which is why navigators have so many responsibilities.

"These individuals face all kinds of barriers, so we work with local health providers to eliminate these barriers," Ballard said.

"We can eliminate the financial barriers, but that's not enough. Anything we see as a problem, we help them overcome those issues."

The overall idea is to prevent potential cancer patients from ending up in the emergency room.

"Cancer centers see a lot of patients that show up in the emergency room when they have severe symptoms, and they absorb that cost," Ballard said. "With one patient diagnosed, the (health navigator) program pays for itself."

The program also helps physician offices in that there is not always time to track every patient this closely.

"On average, doctors have only 10 minutes with a patient," Ballard said. "The doctors here (due to physician shortages) may have less time, and patients have more severe symptoms."

During the fiscal year that ended on June 31, there were 540 patients served through the program. In that timeframe, there were four colon cancers and one prostate cancer found -- all in stage 1.

Of the screenings performed for colon, prostate, cervical and breast cancers, colon screenings have made for the most activity. Out of the 320 colon screenings done, 244 came back abnormal.

Almost 130 of those screenings revealed adenomatous polyps -- which can turn into cancer over time.

"Even though it is worrisome that all these people are walking around with polyps and not knowing it, we have able to prevent a number of cancers," Ballard said.

Currently, the program serves 18 counties. In the next two weeks, health navigators will soon be adding Tift County to their influence.

"We are slowing getting to our goal of reaching all 31 counties (within the Cancer Coalition's influence)," Ballard said.

That's a goal the coalition wishes to reach in another three years, Ballard said.

The addition of Tift County will likely mean another navigator position.

"We are going to need more, but we will make do with the staff we have," Ballard said.

"As we grow, we will need more resources."

Officials are in the process of conducting an evaluation of the program, which is expected to be complete by next spring.