BY Jane Hall-Alston
The cost of health care has exploded in the last 40 years. In 1950, five cents of every dollar earned went to health care; in 2010 health care consumed 17 percent of the gross domestic product (GDP). If this rate continues, in 70 years health care will consume 40 percent of the GDP.
Getting to the core of health care disparities and implementing a navigator system is necessary. Patient navigators can connect the dots by addressing insurance, financial and logistic issues such as transportation, child care and elder care. They provide understandable health education to lessen fears of disease and treatment. What makes the program unique is that the navigator is a flexible problem solver to overcome barriers to care. A social worker navigator gains a trusting relationship with the patient, ensuring what the next step is, as well as providing transportation to their appointments and arranging child or elder care if needed, allowing the patient to leave the house without worry. A nurse navigator can provide education to the patient about the disease and the importance for follow up and treatments in a non-threatening and understandable manner. They assist patients with cancer and those who are at risk by advocating for them, getting through the complicated health care system and decreasing costs to taxpayers and the health care system overall through early detection, proper education, follow up and treatments that can optimize care and maximize positive outcomes.
As an advanced practice registered nurse (APRN) with over 20 years of experience in oncology care and currently working in a New York City breast cancer center, I believe disparities amongst different races in breast cancer come from barriers that can be altered. African American women who have breast cancer continue to die at higher rates than do white women. This disparity in death from breast cancer stems from the biology of tumor types, as well as socio-economic status.
According to CA: A Cancer Journal for Clinicians (2011), the incidence and death rate among females vary by race and ethnicity for breast cancer. The average annual female breast cancer death rate from 2003 to 2007 was highest in African American women, with 32.4 deaths per 100,000 females compared to 24 per 100,000 deaths in non-Hispanic white women. This alarming disparity exists despite the fact that African American women have a lower incidence than non-Hispanic whites and is due in part to being diagnosed at a later stage. Research suggests that cancer death disparities are driven by socioeconomic status differences. The differences by race and ethnicity suggest the stage at diagnosis, tumor biology and access to high quality treatments all account for the disparity.
We need health policies that address the core of these disparities by breaking down barriers. Such barriers include not having transportation, child care or elder care; mistrust of the health care profession; and fear of treatment. Using an interdisciplinary patient navigator system to advocate for these women ensures they receive quality and equitable care.
We need to implement patient navigator programs. By having a patient navigator system, patients will be less apt to get lost in follow-up care. Writing to our congressmembers for funding for these programs is essential. Insurance companies and hospitals agree that navigation programs can improve access to care, but argue whether the programs are cost effective. As it is now, late stage diagnosing is ultimately causing early deaths in African American women and sucking the system dry from services that are costing the health care system an astronomical amount of money without improving patient outcomes. Implementing patient navigator programs is needed NOW.
Jane Hall-Alston, APRN, BC, ANP Clinical Specialty Coordinator at The Dubin Breast Center, Mount Sinai Medical Center in New York, NY 10029