Navigator Program is there for cancer patients at San Francisco General Hospital

The American Cancer Society launched its Patient Navigator Program at San Francisco General Hospital and Trauma Center (SFGH), this past April.

This is the 36th Patient Navigator Program site, and the second in California as part of a strategic nationwide effort to significantly extend the reach of this innovative program and assist individual cancer patients in negotiating the health care system.

BCCS program coordinator Barbara Cicerelli pointed out that the Breast and Cervical Cancer Services Program patient navigator program has been in existence in one form or another for 14 years. With the help of California State Assembly woman Carol Migden, then member of the San Francisco Board of Supervisors, a patient navigator program for San Francisco was initiated in 1997.

Since 1997 a patient navigator program of the San Francisco Dept. of Public Health Breast and Cervical Cancer Services (BCCS) for the SF General Hospital has become a public health intervention outreach designed to expand services to undeserved populations of women.

"We reach out to everyone as San Francisco General Hospital is the safety net for the City," said Cicerelli. We work with the uninsured; many women who do not have access to adequate health care," she said. "Cancer is a scary diagnosis and many women are too afraid to follow up," she said.

Yet as Cicerelli points out, "there has been lots of raising of awareness of breast cancer, for testing, screening but follow up has been sparse," she said. This is why follow up through the Patient Navigator Program is so important.

BCCS at SF General Hospital works to coordinate breast and cervical cancer screening services within the San Francisco Public Health system; and to collaborate with othercommunity partners, such as Lifelines, Breast Cancer Emergency Fund, Charlotte Maxwell Complementary Clinic and American Cancer Society to provide practical and emotional support to women diagnosed with breast cancer.

BCCS assists women with breast and cervical cancer screening, diagnostic and treatment services, follow-up appointments, education, outreach and referrals. All navigation services are available in Cantonese, Mandarin and Spanish. Cicerelli hopes more funding can provide for more interpreters in more languages; especially Asian languages like Tagalog and Vietnamese.

"Just recently we had a patient who speaks Erdu," she said. San Francisco is an international city and so having access to many language interpreters is crucial. "A lot of important medical information can literally get lost in the translation, that is why we need professional translators," said Cicerelli.

The American Cancer Society launched a new navigation program in the oncology department of SFGH funded by a pharmaceutical company, AstraZeneca. Yet with budget cuts due to the current economic recession more funding is needed. "We are short-staffed at times, especially when we need to really walk a patient through the process of various treatments, such as chemotherapy, etc.," said Cicerelli.

"We have over 350 patients in our program," said Cicerelli. "And our patients may encounter 15-20 different health providers throughout their course of treatment. The patient navigator is the sigle point of contact ensuring continuum of care"We have gotten really good at knowing who to call to help," said Cicerelli.

Yet the level of commitment from the staff in the face of some of the most trying aspects of cancer can be very intimate. With treatments lasting anywhere from three months to over a year, contact with patients can vary. "We provide intensive case management to our patints," said Cicerelli.

"Some patients we contact and visit weekly, others wevisit monthly or every six weeks and in some cases we see a patient two or three times a week - providing support each step of the way," said Cicerelli. "It all depends upon where that patient is in the process," she said. "Wemeet each patient where they are at not just with the diagnosis or stage of the disease but emotionally," she said.

"And, yes, it is not easy when a patient dies," said Cicerelli.

According to the nonprofit group Breastcancer.org, cancer is the leading cause of death in economically developed countries, such as the United States.

Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. The data the nonprofit collected indicates that more than one in every four diagnosis of cancer in women are breast cancer cases. That averages to be about 28 percent.

"I lost my mother to breast cancer," said Cicerelli. At that time, Cicerelli was working as a caterer in the restaurant business. "I never thought I would be doing this kind of work," she said. It was while catering an event that she heard of a rearch program at Norther California Cancer Center and became involved in a breast cancer screening outreach program

She eventually joined the staff at BCCS. "I went back to school and so on, this has become my vocation," said Cicerelli.

Cicerelli sees the work she does as a bridge or a life-line for the most vulnerable. "Getting this kind of diagnosis is overwhelming for many women, especially those who are already burdened," she said.

As reported in the NY Times, since 2009 the number of women in today's workforce is more than 50 percent. And in many instances, especially for low-income families, the working mom is both primary caregiver and breadwinner. Cicerelli wants to get the word out that even with no insurance, she and her staff will do all they can to get the expenses covered.

The primary focus of the Patient Navigator Program is to support patients and help with getting the barriers to access care and treatment minimized. Treatment is complicaticated and grueling. Patient navigators become the single point of contact in a confusing maze of health services and appointments.

"To have a diagnosis of cancer along with that responsibility of being primary salary earner and provider can be devastating," said Cicerelli. "Some women think that since it is just a small lump, it might just go away." Or sadly as in some cases, the lack of access to healthcare, has situations were the cancer has become an enlarged tumor.

"Despite all the advances made in the last 15 years or more, cancer is still a very life-altering situation," said Cicerelli.

What Cicerelli and the staff at BCCS strive to maintain is a high level of compassion and dedication. There are cases where drug and alcohol abuse make dealing with cancer more complicated.

Still Cicerelli and her staff are committed to reaching out. "Compassion comes from the heart and BCCS believes that no one should have to go through the cancer journey alone. training we receive," she said. BCCS and the Patient Navigators receive monthly training sessions to ensure all aspects of the painful journey of someone with cancer is understood.