BACKGROUNDThe evidence continues to build in support of implementing patient navigation to reduce barriers and increase access to care. However, health disparities remain in cancer outcomes. The goal of the National Navigation Roundtable (NNRT) is to serve as a convener to help support the field of navigation to address equity.METHODSTo examine the progress and opportunities for navigation, the NNRT submitted a collection of articles based on the results from 2 dedicated surveys and contributions from member organizations. The intent was to help inform what we know about patient navigation since the last dedicated examination in this journal 10 years ago.RESULTSThe online survey of >700 people described navigators and examined sustainability and policy issues and the longevity, specific role and function, and impact of clinical and nonclinical navigators in addition to the role of training and supervision. In addition, a full examination of coronavirus disease 2019 and contributions from member organizations helped further define progress and future opportunities to meet the needs of patients through patient navigation.CONCLUSIONSTo achieve equity in cancer care will demand the sustained action of virtually every component of the cancer care system. It is the hope and intent of the NNRT that the information presented in this supplement will be a catalyst for action in this collective action approach.

Over the past 30 years, the American Cancer Society (ACS) has played a key role in shaping the field of patient navigation as a means to address cancer disparities. Through collaborations with organizations like the National Navigation Roundtable and the ACS Cancer Action Network, the ACS is uniquely positioned to help develop sustainable navigation models that directly address disparities in access to quality cancer care. As health systems continue to adapt and change in response to various factors, including an aging population and rapid advances in screening and treatment, it is important to evaluate existing navigation-delivery models and promote those that are sustainable while maximizing reach and impact and providing the greatest return on investment (ROI). In this report, the term ROI is used to describe the potential financial gain resulting from the navigation service (ROI = net gains/total program cost). Calculating net gains requires assigning a monetary value to key outcomes and subtracting this amount from the total program cost. ROI is a measure often used by health care executives to show the savings or financial benefit from a program or service. Other measures of financial impact exist that may be of greater or lesser value to program leadership, including cost effectiveness (if financial information for outcomes is not available) and cost-benefit analysis. Here, the current and future commitment of the ACS to advancing the field of patient navigation is outlined as an organizational priority and a key building block in their health equity strategy. By working with partners like the National Navigation Roundtable, the ACS can help guide efforts to evaluate these approaches, with the goal of identifying the most effective and potentially sustainable models of delivery while also increasing equitable access to care.

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack-year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology-designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January-June 2016) followed by 2 years of implementation (July 2016-June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

Abstract Introduction: The American Cancer Society Patient Navigator Program assists high-need, vulnerable patients in overcoming nonmedical barriers to cancer care with the goal of improving treatment adherence, completion, and patient quality of life. Methods: In the last year, the American Cancer Society has been implementing a pilot program aimed at increasing the activation and quality of life of patients at 6 navigation program sites nationwide. The sites were selected based on patient need, geographic location, and cancer center type. Navigators completed a 7-part training series focusing on coaching and communication skills and slight modifications were made to the current lay navigation protocol, including addition of the Insignia Health Patient Activation Measure® (PAM®) Survey, a patient satisfaction survey, formal action planning with the patient, and follow-up on the action plan over a period of at least 3 visits. Results are measured by ability of the patient to achieve the set actions in the plan, ability of the patient to overcome or successfully manage nonmedical barriers to care, and change in the patient's activation score. The following results are from the 3 sites in phase 2 of implementation. Results: After 6 months of implementation, 419 patients have been enrolled in phase 2 of the program. Patients represent 6 different races with African American/Black (40%) and Hispanic/Latino (36%) being most common. Medicaid is the most common form of insurance (42%) and 79% of patients are either insured by Medicaid, Medicare + Medicaid (10%), or uninsured (27%). Patient diagnoses span 32 different cancer types. Early results show positive uptake of the program among navigators and patients with all navigators reporting utilization of new coaching-based training skills, and 95% of patients reporting creating an action plan with their navigator. After their first meeting with the navigator, patients rated their confidence the action plan would work at an average of 8.7/10. Initial patient reactions also indicate a high level of satisfaction with a 4.4/5 average score when asked how much they agreed with the statement: “The navigator made me feel better about my ability to manage my diagnosis and treatment.” 182 patients have completed at least one follow-up visit with the navigator in the first 6 months. These patients set 634 actions with navigators and progress has been made or achieved on 76% of these actions by the first formal follow-up visit. 29 patients have completed the full program with 78% of barriers overcome or successfully managed. 100% of patients completing the program also completed treatment, and the average PAM® score increased by +4.15 points. The project is still ongoing. Final results of the pilot are expected in late 2019. Conclusion: Navigation with coaching and action planning tailored to the patient's activation level is a successful method to assist vulnerable populations with overcoming nonmedical barriers to cancer care and increasing patient activation. Citation Format: Shelby S. Roberts, Dawn Wiatrek, Nicole Erb, Katherine Sharpe. The effects of coaching and action planning on patient activation and quality of life in vulnerable cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B038.

The National Colorectal Cancer Roundtable (NCCRT) is an organization of organizations with staffing, funding and leadership provided by the American Cancer Society (ACS) and guidance and funding by the Centers for Disease Control and Prevention (CDC). In 2014, ACS, CDC, and the NCCRT launched the 80% by 2018 campaign. This highly successful initiative activated hundreds of organizations to prioritize colorectal cancer screening, disseminated smart, evidence-based interventions, and ultimately led to 9.3 million more Americans being up to date with screening compared with the precampaign rate. It's new campaign, 80% in Every Community, is designed to address persistent screening disparities.

The American Cancer Society (ACS) is committed to addressing the needs of cancer caregivers. Many caregivers are unexpectedly thrust into their role as a caregiver with little or no preparation. A wide range of support services and caregiver resources is needed to help cancer caregivers. Consistent with the ACS’s mission and goals to measurably improve the quality of life of all cancer survivors and their caregivers from the time of diagnosis through the balance of life, the ACS has developed a program of work to meet the specific needs of family members and friends providing care for those diagnosed. This chapter describes the ACS Caregiver Support Program, including specific initiatives aimed at optimally supporting cancer caregivers across the care trajectory.

Background: Low-dose CT (LDCT) lung cancer screening is associated with improved outcomes in high-risk adults, but uptake remains low and such medical advances are often not available in low-resource areas. The American Cancer Society (ACS) launched a pilot program focused on establishing effective processes to refer and screen patients for lung cancer in under-resourced areas in West Virginia and Tennessee. ACS partnered with two Federally Qualified Health Centers (FQHCs) and accredited screening facilities to refer and screen patients, and to identify critical facilitators, barriers, and lessons learned in implementing LDCT and moving patients through the screening continuum. Methods: Annual site visits in 2017 and 2018 captured data on implementation, progress, and lessons learned. ACS evaluators conducted 47 key informant interviews with staff from both study sites, including navigators, clinical staff, and administrators. Interviews were recorded and transcribed verbatim. Evaluators used transcripts and project notes to conduct a thematic analysis to assess factors associated with effective implementation and improved outcomes. Results: Participants shared a wealth of insight on program implementation, including lessons learned about forming successful partnerships, personnel and resource requirements, determining screening eligibility, and conducting shared decision-making. One key area where site teams had to overcome implementation challenges was in determining appropriate follow-up testing for patients with suspicious or borderline suspicious findings (L-RADS 3 or 4). Some referring primary care providers were confused by existing clinical guidelines, unsure of when to order LDCT versus chest-CT, and felt ill-equipped to determine the optimal follow-up tests. There was confusion about the difference between billing follow-up exams as “screening” versus “diagnostic.” Program leaders investigated these and other matters and came to consensus on the most practical, logical solutions. One study site also initiated a lung nodule team to discuss suspicious findings in-depth. This practice allowed the team to review clinical history and gain consensus around appropriate diagnostic testing for individual patients, and its implementation went well enough for the team to recommend it to ACS as a potential best practice for future programs. Conclusions: By identifying challenges in conducting follow-up testing after LDCT and successful means of overcoming these challenges, this pilot study can inform practitioners in means of overcoming challenges that may enable underserved populations to move successfully through the lung cancer screening continuum. In so doing, this study may promote further reduction in cancer health disparities. Citation Format: Lesley Watson, Megan M. Cotter, Robert A. Smith, Katherine Sharpe. Appropriate follow-up for patients with suspicious lung cancer screening findings: Lessons learned from Federally Qualified Health Centers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3312.

e18844 Background: Evidence suggests that there is a mortality reduction benefit from low-dose CT (LDCT) scans for patients at high-risk for lung cancer, yet screening rates remain low. The American Cancer Society has implemented a pilot program to improve access to lung cancer screening in vulnerable populations with high lung cancer mortality rates in Memphis, Tennessee and Charleston, West Virginia through partnerships with Community Health Centers (CHCs) that serve limited resource patients. The program focuses on developing systems within CHCs for identifying screening-eligible patients, patient education, shared decision-making referral and navigation to screening, and appropriate follow-up. The program also helped CHCs stimulate collaboration among local partners and develop long-term structures and relationships needed to improve the links of care in the community to deliver lung cancer screening. This presentation focuses on evaluation results related to the 3 core components of the program–provider education, navigation, and the development of tools and resources. Methods: Participating CHCs submitted quarterly monitoring reports tracking the number of patients they assessed for program eligibility, shared decision-making visits, screenings, screening results, and cancer diagnoses. Evaluators also conducted key informant interviews to determine processes used by CHCs when implementing the program, as well as program facilitators and barriers. Results: To date, the program has screened 193 patients. Of those, 45 received an abnormal result that required follow-up and there have been two cancer diagnoses. Qualitative results indicate that CHCs face challenges with identifying eligible patients due to EHR barriers and difficulties with pack-year calculations. Conclusions: This project adds to the growing knowledge base of effective lung cancer screening practices, specifically for patient populations with access barriers. The project also identifies challenges to implementation that can be used to help CHCs looking to initiate similar lung cancer screening programs.

Existential distress among caregivers of patients with all sites and stages of cancer is common and may serve as a driving mechanism of caregiver burden. Concurrently, the caregiving experience is an opportunity for meaning-making and growth. To date, no empirically supported treatments specifically target meaning-making and existential distress among cancer caregivers. To address this critical gap in the literature, meaning-centered psychotherapy has been adapted for delivery to cancer caregivers (meaning-centered psychotherapy for cancer caregivers (MCP-C)). This chapter presents the rationale and overview of MCP-C, and it highlight key elements of the intervention that uniquely target the specific existential needs of cancer caregivers. A case example of an MCP-C group member is presented to illustrate key MCP-C therapeutic techniques. It also discusses challenges of delivery of MCP-C to this vulnerable population and current MCP-C trials that address these barriers to delivery and utilization.

Many cancer survivors feel unprepared for the physical and psychosocial challenges that accompany the post-treatment care transition (i.e., re-entry phase), including management of cancer-related symptoms. Few studies have investigated personal and contextual factors associated with the extent of preparedness for re-entry or how they are related to cancer-related symptom management. Data from the American Cancer Society's Cancer Survivor Transition Study examined (1) characteristics of breast, prostate, and colorectal cancer survivors (n = 1188) within the first year of completing treatment who are most and least prepared for re-entry; and (2) how preparedness level and other characteristics are related to cancer-related symptom management. Stanton and colleagues' [1] conceptual model of survivorship guided the selection of interpersonal/environmental, individual, and disease/treatment-related characteristics as potential contributors to levels of preparedness and cancer-related symptom management using regression tree and multivariate linear regression analyses. Survivors, on average, felt moderately prepared for the transition to post-treatment care. Lowest levels of preparedness were found among survivors with relatively high depressive symptoms, low perceived quality of oncology-provided survivorship care, and limited discussion about potential side effects with a health professional. Poorer symptom management was associated with younger age, having more comorbid conditions, and lower preparedness, social support, and spirituality. Survivors who feel unprepared for the transition to post-treatment care report poorer cancer-related symptom management. Identification of factors associated with low perceived preparedness and poor cancer-related symptom management will assist in risk stratification and development of tailored interventions to meet the needs of cancer survivors during re-entry.

Breast cancer survivors face a number of unique psychosocial challenges following completion of treatment. In particular, having confronted their own mortality, the desire to live meaningful lives is often intensely heightened. However, a significant subset of survivors feel “stuck,” disconnected, and a decreased sense of meaning, identity, and purpose. Although breast cancer survivors have expressed that their greatest unmet need is support for existential issues, there is an absence of empirically supported interventions that focus on enhancing meaning. Meaning-centered group psychotherapy for breast cancer survivors (MCGP-BCS), which has been adapted from meaning-centered group psychotherapy for advanced cancer patients, addresses this need. This chapter describes the rationale for developing MCGP-BCS; presents a description of the intervention adaptation process; and provides an overview of the intervention, including presentation of excerpts from a sample group.

The American Cancer Society (ACS) has been a leading voice for healthcare reform and an informed advocate for effective health insurance reforms. Since the implementation of the Affordable Care Act (ACA), the ACS has observed a shift in inquiries to its Health Insurance Assistance Service (HIAS) from individuals seeking coverage, to a growing problem of individuals presenting issues from being underinsured. Underinsured patients with cancer face serious financial challenges due to large co-pays and coinsurance costs. HIAS was created to help these patients identify potential options for insurance coverage while tracking patient trends. The types of calls received by HIAS have been captured as part of an internal database that allows for the analysis of trends and emerging issues. By evaluating several case studies that illustrate common issues faced by underinsured individuals, we identified solutions ranging from exploring financial assistance programs, such as co-pay relief and providing appeal information, to searching for more adequate or affordable insurance options. Additionally, the ACS has worked to find strong partnerships with other nonprofit organizations to aid in cost relief. Although the ACA has made plans available to many patients and their families, the maximum for an individual's in-network out-of-pocket costs are still too high for many individuals. New approaches are needed to improve the cost protection of health plans. By documenting access problems faced by patients with cancer, the ACS is better positioned to tell policy makers about the concerns of real patients and work toward policy solutions.

The American Cancer Society (ACS) has embraced the achievement of equity in cancer-related health outcomes as a foundational principle. Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities related to certain risk factors for cancer and in certain cancer outcomes. Accordingly, the ACS is defining a new program of work in partnership with the LGBT community to help understand and reduce disparities in cancer risk factors and outcomes. This article describes the cancer control program of the ACS including specific public health and research programs targeted at reducing cancer related health disparities for the LGBT population.

Answer questions and earn CME/CNEColorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two‐thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short‐term and long‐term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long‐term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk‐based health care for CRC survivors who have completed active therapy.CA Cancer J Clin 2015;65:427–455. ©2015 American Cancer Society.