This article is the first in a 10-part series highlighting the work of the Alliance for Equity in Cancer Care, a national initiative focused on expanding access to high-quality cancer care for underserved communities.
Each installment will spotlight a different Alliance grantee site, exploring how health care teams are partnering with community organizations to break down barriers to care and reimagine what navigation looks like on the ground.
Through these stories, we’ll see how tailored, community-informed solutions are making cancer care more accessible.
In the past 30 years, we have made significant strides in the fight against cancer; 34% fewer people are dying of cancer in the United States today. But despite these milestones, the journey to cancer care and survivorship hinges on something even more fundamental: access.
The Alliance for Equity in Cancer Care is a 5-year, 8-site initiative supported by a $20-million commitment from the Merck Foundation to improve timely access to high-quality cancer care for patients from underserved populations.1,2 Spanning a range of healthcare organizations—from community hospitals to academic medical centers—the Alliance brings together a diverse group of grantees, including Conquer Cancer, ASCO Foundation; Boston Medical Center; Case Comprehensive Cancer Center (Case Western Reserve University); Mary Bird Perkins Cancer Center; Memorial Sloan Kettering Cancer Center; National Comprehensive Cancer Network; RWJBarnabas Health and Rutgers Cancer Institute of New Jersey; and University of Kentucky Markey Cancer Center, all committed to reducing cancer care disparities through community‑rooted solutions. The locations of Alliance Grantees are illustrated in Figure 1.
This article is the first in a 10-part series highlighting the work of the Alliance for Equity in Cancer Care, a national initiative focused on expanding access to high-quality cancer care for underserved communities.
Each installment will spotlight a different Alliance grantee site, exploring how health care teams are partnering with community organizations to break down barriers to care and reimagine what navigation looks like on the ground.
Through these stories, we’ll see how tailored, community-informed solutions are making cancer care more accessible.
While patient navigation—care coordination service that guides individuals through the inherently complex healthcare system—has been in place for decades,3 the Alliance distinguishes itself through its deep emphasis on community partnerships. Members of the Alliance collaborate with trusted local organizations to engage populations disproportionately impacted by cancer, cocreating solutions that are informed by the lived experiences and specific needs of each community. In the Alliance’s approach, navigation extends beyond hospital walls into churches, barbershops, libraries, and neighborhood centers, spaces that are woven into the fabric of community life. Although each site has its own tailored strategies and focuses on distinct patient populations, they are united by a shared goal: to ensure that everyone—regardless of background, income, or zip code—has access to lifesaving cancer treatment.
Already, the impact is clear. In the 3 years since its inception, the Alliance has grown to include nearly 200 cancer navigators coordinating care for more than 2000 patients and their families across the nation (Figure 2). This momentum demonstrates the power of collaboration between healthcare organizations and the community—and positions the Alliance as a national model for scaling navigation programs to reach even more patients.
“The Alliance isn’t just about delivering care; it’s about dismantling the barriers that make care inaccessible in the first place.”
—Robert A. Winn, MD, director, Alliance for Equity in Cancer Care
The Link Between Navigation, Social Drivers of Health, and Patient Outcomes
Since the concept of patient navigation was introduced by Harold P. Freeman, MD, more than 30 years ago, our understanding of cancer care, and the factors that influence outcomes, has evolved significantly. We now recognize that social determinants of health (SDOH), such as housing instability, food insecurity, language barriers, transportation challenges, and lack of insurance, influence whether a patient accesses timely, effective cancer care—or any care at all. These external circumstances can inform everything from when a patient first seeks help to whether they complete treatment. While the cancer itself may be biologically similar across populations, the path to survival looks vastly different and is often unattainable without systemic support.
Evidence continues to show that patients supported by navigation services experience improved outcomes. One study published in Cancer Epidemiology, Biomarkers & Prevention showed patients who were navigated had a significantly shorter diagnostic time: 25.1 days compared with 42.1 days for those without navigation.4 That’s weeks of a patient’s life that could mean the difference between beating cancer instead of becoming another statistic. Navigation is one of the most powerful tools we have to dismantle structural obstacles and connect patients to care. Just as precision medicine has revolutionized cancer treatment by tailoring therapies to the unique biology of each patient, navigation revolutionizes care delivery by addressing the real-life circumstances that influence a patient’s ability to heal. It’s personalized care in its fullest form—focused on people, families, and communities.
“The Alliance is showing us what’s possible when we stop asking communities to navigate cancer care alone—and start building systems that walk with them, every step of the way.”
—Marcie S. Wright, PhD, deputy director, Alliance for Equity in Cancer Care
A Shared Framework
As advancements are made in screening and treatment technologies, navigation strategies must evolve in tandem. Navigation is no longer just about guiding individuals through clinical systems; it’s about meeting people where they are and addressing the full scope of their needs.
Through the Alliance’s multilevel framework, each site has designed and is implementing its own distinct program tailored to local needs, patient populations, and systems, grounded in the following goals:
- Improve cancer care coordination from diagnosis through survivorship for underserved patients
- Strengthen patient–provider communication and patient engagement in treatment decisions
- Build sustainable community partnerships to address barriers to cancer care related to SDOH
- Disseminate findings and program results to improve the delivery of equitable cancer care
This framework serves as a compass and connector, guiding the work at each site while enabling shared learning and collective evaluation. To ensure consistency in measuring progress, grantees are supported by the Alliance National Program Office (NPO), led by the Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center, in partnership with the VCU Center on Health Advancement. The NPO serves as the coordinating hub for program partners, fostering communication and peer-to-peer learning, and overseeing the Alliance’s standardized data collection tool that aligns outcomes with these core goals.
Navigation as a Process, Not Just a Person
A pivotal shift the Alliance advocates for is the redefinition of patient navigation. Rather than a role performed by an individual, navigation can be reframed as a structured, system-level process embedded throughout the care continuum. Although navigators are essential building blocks for systemic change, relying exclusively on individuals can lead to inconsistent training and burnout, which disrupt the continuity of care. Even the most skilled and dedicated navigators who serve as trusted guides for patients can be limited by lack of institutional support. That’s why the Alliance emphasizes investing in navigation as an evidence-informed process—one that is standardized, scalable, and sustainable.
By immersing navigation into clinic workflows, electronic health records, and cross-sector partnerships, we create durable structures that transcend individual roles. These systems help ensure that patients consistently receive coordinated, personalized support, regardless of who is on staff. Standard protocols, shared data tools, and defined touchpoints all contribute to making navigation a reliable part of the patient experience.
This system-based approach also strengthens our ability to integrate community-based organizations into care delivery. Whether it’s ensuring patients are screened for social needs, referred to support services, or guided through complex treatment decisions, process-driven navigation enables stronger partnerships and more seamless care across specialties and fields. Ultimately, it turns navigation from a combination of individual efforts into a resilient infrastructure that can grow, adapt, and endure to meet the needs of patients for years to come.
Overcoming Challenges by Cocreating Solutions
The first 2 years of the Alliance initiative focused on laying the groundwork: building trust within institutions, cultivating relationships with community partners, and establishing a shared vision. This foundational work was critical for launching navigation programs and ensuring they were rooted in the real needs and priorities of the communities they serve.
As programs have taken shape, common challenges have surfaced across sites: staff turnover, limited training pipelines for navigators, difficulty with patient outreach and engagement, and the complexity of meeting the needs of populations that have historically been overlooked by the healthcare system. These are the growing pains of creating a program from the ground up; while significant, these obstacles have become catalysts for innovation.
Rather than applying one-size-fits-all solutions, Alliance grantees and their community partners are meeting these challenges head-on by cocreating responses that are locally grounded and community-informed. They’re redesigning workflows, investing in navigator development, adapting outreach methods, and forging deeper relationships with community organizations. Each solution is tailored, reflecting the strengths, cultures, and realities of the populations served.
These stories of adaptation and resilience offer critical lessons for others looking to partner with the community to inform how to provide effective care.
A Lasting Impact
The Alliance marks the beginning of a movement toward community-driven solutions that prioritize individualized care. Patient navigation is a frontline strategy for eliminating gaps in cancer care and making sure every patient feels empowered to fight cancer.
Transforming cancer care at scale requires providers to forge strong, reciprocal relationships with community partners who bring knowledge, trust, and reach. It means designing care systems that meet patients where they are—not where the system expects them to be. And most importantly, it means listening—and learning from—the communities we serve.
We are building an infrastructure of equity that can be sustained, replicated, and scaled. As we continue this journey, we carry with us the stories, data, and insights from cancer centers across the country. They serve as proof that when communities and health systems come together as true partners, we can revolutionize how we treat cancer patients and their families, and ultimately, save more lives.
References
- Alliance for Equity in Cancer Care. Improving access to cancer care for all. www.equityincancercare.org/
- Merck. Philanthropy. www.merck.com/company-overview/sustainability/philanthropy/
- Freeman HP, Rodriguez RL. The history and principles of patient navigation. Cancer. 2011;117:3539-3542.
- Hoffman HJ, LaVerda NL, Young HA, et al. Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia. Cancer Epidemiol Biomarkers Prev. 2012;21:1655-1663.