What is a Patient Navigator, and Should We Have Them in Major Cancer Centers?

Author: Harold J. Burstein MD, PhD
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An October op-ed piece in The New York Times (http://www.nytimes.com/2009/10/10/opinion/10DeVries.html?_r=1&scp=1&sq=mammologist&st=cse) introduced a new term into the medical lexicon: Mammologist. This title refers to a multidisciplinary breast cancer specialist who would serve as a facilitator specifically for patients with newly diagnosed breast cancer. The concept proposed was timely, with October marking Breast Cancer Awareness Month, although the goal of a mammologist—to ease patients through the steps of cancer care by being involved in every step of their treatment—is very similar to that of patient navigators.The idea of a patient navigator is gaining currency at cancer centers around the country. Its rationale is based on recognition of the complicated layers cancer patients must negotiate from diagnosis through treatment and follow-up. Consider a “typical” woman with newly diagnosed breast cancer. She may already be under the care of a primary care physician and a gynecologist. She is sent for routine screening mammography and is told by the radiologist that she needs a biopsy based on the findings. Based on the biopsy results, she is referred to a breast surgeon and may also need to see a plastic surgeon, radiation oncologist, and medical oncologist. That's 7 doctors before even she gets to a second opinion!Anyone who has tried to negotiate the current health care system knows how vexing it can be. Care at a comprehensive center—where radiology, surgery, and oncology specialists all reside under one roof and may even work through one scheduling office—can minimize some of the hurdles. But many patients...

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Harold J. Burstein, MD, PhD, editor-in-chief of JNCCN, is an Associate Professor of Medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute and Brigham & Women's Hospital. He is a clinician and clinical investigator specializing in breast cancer.

Dr. Burstein attended Harvard College and earned his MD at Harvard Medical School, where he also earned a PhD in immunology. He trained in internal medicine at Massachusetts General Hospital and was a fellow in medical oncology at Dana-Farber before joining the staff.

Dr. Burstein's clinical research interests include novel treatments for early- and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast cancer. He has written widely on breast cancer in both traditional medical journals and on the web, including New England Journal of Medicine and Journal of Clinical Oncology. International committees focusing on cancer treatments that he has or continues to participate in include the NCCN Clinical Practice Guidelines Breast Cancer Panel, St. Gallen Breast Cancer Panel, CALGB Breast Cancer Committee, ASCO Health Services Research and Clinical Research Committees, the National Quality Forum Breast Cancer Technical Panel, and other ASCO expert panels.

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