Advocates and Navigators

People who can guide you through cancer treatment and beyond come with various levels of training and experience and have titles such as medical advocate, navigator, or patient advocate.

Cancer Advocates and navigators at a glance

Guides in unfamiliar territory

The cancer experience is intricate, complex, nuanced, and varied. It can feel like a whole new world, complete with an unfamiliar language, to someone who is newly diagnosed. 

CancerChoices co-founder Michael Lerner believes that “the experience of a person who is given a cancer diagnosis is similar to that of a soldier who is given orders by his officers to parachute into a jungle war zone without a map, a compass, or training of any kind.”1Lerner M. Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer. MIT Press. 1994. p xix. Having physicians and other professionals say, “Let me know if you have any questions” may not be enough, for you may not know enough to know what questions to ask.

Having guides who have the cancer equivalents of a map, a compass, and knowledge of the territory—plus compassion—can be very helpful. Even well after a diagnosis, guides can continue to provide much needed information and support.

Such guides come with various levels of training and experience and have titles such as medical advocate, navigator, or patient advocate.

Also see our guide for making skillful decisions.

Medical advocates

Also called clinical advocates, medical advocates are trained healthcare professionals, primarily physicians, who specialize in working with patients and families who are facing complex medical situations.

They work to “leave no stone unturned” in learning about and pursuing all possible diagnostic and treatment options.

Read more ›

Patient advocates

A patient advocate can fill various roles and positions. In a hospital, a patient advocate may guide you through institutional processes or paperwork, or an advocate may intervene to represent people who think their healthcare rights are being violated.

Some of these guides are cancer survivors themselves, bringing a valuable perspective to their service. Sometimes these survivor guides are called peer navigators or peer advocates.

Read more ›

Navigators

Navigators can be either licensed health care professionals such as nurses or social workers (professional navigators) or trained lay people or patients/survivors (peer navigators). They help reduce any barriers to accessing cancer care and completing treatment that you may have.

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Integrative oncology navigators focus on assuring that you have access to both conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy treatment and complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies useful in meeting your physical, psychosocial, and spiritual needs.

Read more ›

A family or friend caregiver often acts as a patient advocate or navigator. For caregivers who are not trained or experienced in this role, having additional support from someone who is trained and experienced can be very helpful.

See suggestions and links below for Finding a navigator or advocate ›

Medical or clinical advocates

Medical advocates, sometimes called clinical advocates, are trained healthcare professionals, primarily physicians, who specialize in working with patients and families who are facing complex medical situations.

A medical advocate works as a personal consultant, researcher, and advocate to help you get the information and authority you need to be in charge of your health care. They navigate and guide you in implementing individualized medical plans and strategies, while working collaboratively with your medical team.

“Rarely does this advocacy lead to confrontation [with the person’s medical team] . . . it’s about enhancing, expanding, and building bridges between people.”2Renneker M. No Stone Unturned: Medical Advocacy Techniques for People with Cancer and Other Serious Conditions. Healing Circles workshop presentation, Commonweal. June 5, 2015.

Medical advocates do not provide care, but instead work to “leave no stone unturned” in learning about and pursuing all possible diagnostic and treatment options. They may include experimental, conventional, and complementary medical strategies.

These advocates typically work by phone, consulting with patients from across the country and around the world.

The field of medical or clinical advocacy was founded by Mark Renneker, MD. Commonweal, the parent organization of CancerChoices, has worked closely with him for many years. He describes medical advocates as doing for a patient what any physician would do if a serious illness hit close to home. His philosophy and approach is described in his seminal article, No Stone Unturned: Medical Advocacy Techniques for People with Cancer and Other Serious Conditions.

Integrative navigator and CancerChoices advisor Mark Renneker, MD, describes the services a medical advocate provides for a patient.

Dr. Robert Nagourney, creator of a personal cancer testing technique called functional profiling, points out that medical advocates can also help a person sort through and assess published research results. In a blog post, Nagourney cautions that sometimes problems compromise the objectivity and accuracy of study reports published in peer-reviewed articles. He goes on to suggest that patients consider seeking “the assistance and input of one of a growing number of medical advocates.”3Nagourney RA. Cancer patients want to win, but is the playing field level? Updated October 25, 2021. Viewed January 28, 2022.

Medical advocacy is not a medical specialty, and no certification or licensing exists for medical advocates.

Patient advocates

Patient advocates provide several types of support:4With gratitude to Betsy Glosik, chair of the patient advocates special interest group of the Society for Integrative Oncology 

  • Patient navigation throughout treatment and beyond within the conventional medical system, as well as outside the system for integrative and complementary care
  • Financial and legal navigation, particularly for end-of-life matters for people with cancer 
  • Educating people with cancer and caregivers on research and decision making. Research can involve everything from gaining an understanding about treatments and side effects to learning about other possible treatment options, clinical trials, and therapies that may improve quality of life and outcomes.

A patient advocate may also intervene if requested to represent people who think their healthcare rights are being violated. Their advocacy may be specific to a disease and/or function, such as palliative care with cancer or insurance/financial issues related to cancer. 

Oncology patient advocates are often cancer survivors. They are not necessarily trained in a healthcare profession, although they may have professional training as a health advocate. Advocates who are cancer survivors may bring a unique and valuable perspective and understanding to their services.

Integrative oncologist and CancerChoices advisor Dwight McKee, MD, speaks on “the tremendous value of patient advocates that have been down the cancer road.”

Patient advocate certification and licensing

Patient Advocate Certification Board

Patient advocates can be certified. No state board licensing of advocates is available, and neither federal nor state governments require licensure or certification to practice advocacy.

Access the PACB website

Navigators

Oncology navigation

Oncology navigation was originally created by surgeon Dr. Harold Freeman who founded The Harold P. Freeman Patient Navigation Institute to reduce disparities in access to diagnosis and treatment of cancer, particularly among poor and uninsured people.5The Harold P. Freeman Patient Navigation Institute. About Us. Viewed February 1, 2022 His work showed that the availability and use of both community health workers and patient navigators improved breast, cervical, and colorectal cancer screening completion and timeliness and/or referral for diagnostic resolution at federally qualified health centers.6Roland KB, Milliken EL et al. Use of community health workers and patient navigators to improve cancer outcomes among patients served by federally qualified health centers: a systematic literature review. Health Equity. 2017 May 1;1(1):61-76.

As a result of this work, The American College of Surgeons Commission on Cancer now requires its certified cancer centers to provide navigation services. Someone providing navigation services may or may not formally be called a navigator, though the title of navigator is becoming more common in cancer centers. To access these services, we recommend you ask for a nurse, social worker, or other person who can help coordinate your care and help you deal with barriers to receiving and completing your care.

Oncology navigators serve several roles.7Academy of Oncology Nurse & Patient Navigators. Helpful Definitions. Viewed January 28, 2022.

  1. Navigators help patients overcome healthcare system barriers, such as a lack of clarity about treatment options, a lack of transportation or social support, insurance or financial issues and problems communicating with healthcare professionals. 
  2. Navigators provide timely access to quality medical and psychosocial care. Services can start before cancer diagnosis and continue through all phases of cancer.

They play an important role in reducing healthcare disparities.

Navigators may come from various backgrounds and experience with cancer:

  • Oncology nurses
  • Oncology social workers
  • Patient (peer) navigators who are not clinically licensed

Navigators can be employed by community groups, hospitals, or insurance companies. They may also be volunteers, or independent consultants hired by people with cancer or their families.8Patient Navigators Can Help When Life Disrupts Cancer Care. American Cancer Society. April 19, 2021. Viewed January 28, 2022.

Why use an oncology navigator?

Oncology navigation “provides strong support to the patients when experiencing disruption from cancer diagnosis and treatment.”9Tan CH, Wilson S, McConigley R. Experiences of cancer patients in a patient navigation program: a qualitative systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2015 Mar 12;13(2):136-68. Benefits to patients:10Tan CH, Wilson S, McConigley R. Experiences of cancer patients in a patient navigation program: a qualitative systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2015 Mar 12;13(2):136-68; Tho PC, Ang E. The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2016 Feb;14(2):295-321; Wagner EH, Ludman EJ et al. Nurse navigators in early cancer care: a randomized, controlled trial. Journal of Clinical Oncology.] 2014 Jan 1;32(1):12-8.

  • Increased accessibility to care
  • Emotional support
  • Increased knowledge and empowerment regarding treatment goals and plans
  • Increased patient satisfaction
  • Practical assistance to ensure continuity of care

We perceive that, as health care becomes more patient-centered, cancer survivors who are more involved in their care and decision-making have a better experience and satisfaction with care.

Integrative oncology navigation

Integrative oncology navigation is a patient-centered, whole-person healthcare delivery model that expands upon the original patient navigation model.

Distinct from more conventional patient navigators, integrative navigators focus on assuring that you have access to both conventional treatment and complementary therapies useful in addressing your physical, psychosocial, and spiritual needs.

Trained integrative navigators are well versed in the array of complementary therapies and approaches most commonly used in cancer care and skilled in assisting you in researching, responsibly selecting, and using these therapies. They emphasize the importance of communication and coordination with your medical team.

Integrative oncology navigators serve as educators, advocates, and compassionate guides with these goals:

  • Reduce barriers to accessing cancer care and completing treatment
  • Guide you to select appropriate, evidence-informed complementary approaches to use alongside conventional medical treatment
  • Facilitate access to complementary therapies by directly teaching you about them and/or connecting you with resources that support emotional, spiritual, and physical healing
  • Maintain a consistent presence by coordinating care and providing seamless support throughout the entire cancer experience
  • Offer a refuge by providing compassionate, sensitive support to you and your loved ones

Other professionals such as integrative health coaches, cancer guides and patient advocates perform similar roles but may not have the specific focus or specialized training of integrative navigators.

Why use an integrative navigator?

Integrative navigation services have been found to support people with cancer to reduce their cancer-related concerns and stress levels and increase knowledge and confidence. These outcomes led to making better, more informed choices. People felt heard and supported, resulting in improved levels of patient satisfaction. People also had higher commitment to self care and practiced it and used supportive therapies more. They reported improvements in symptoms and concerns, leading to better outcomes overall.11Institute for Integrative Oncology Navigation. Survey of Integrative Oncology Navigation Training Alumni, 2009-2012. Smith Center for Healing and the Arts. May 2013; Chatman MC, Green RD. Addressing the unique psychosocial barriers to breast cancer treatment experienced by African-American women through integrative navigation. Journal of the National Black Nurses’ Association. 2011 Dec;22(2):20-8.

Types of navigators

Nurse navigators, patient or non-clinically licensed navigators, oncology social workers, and lay navigators each have different backgrounds and training. Some are licensed.

Nurse navigator

A nurse navigator has a clinical background and is a critical member of the multidisciplinary cancer team. They identify and address your barriers to timely and appropriate cancer treatment. They guide you through cancer care from diagnosis through survivorship.

Patient navigator, or non-clinically licensed navigator

A patient navigator does not have or use clinical training to provide individualized assistance to patients and families affected by cancer. The patient navigator is a primary point of contact for the person with cancer and works with other members of the care team to coordinate care.

Oncology social worker

The role of the oncology social worker is to help people with cancer, and their families and caregivers, deal with the experience of facing cancer.

Lay navigators

Lay navigators come to the profession without a medical background and are trained by organizations such as Susan G. Komen and Livestrong.

Navigator certification and licensing

The Academy of Oncology Nurse and Patient Navigators (AONN) offers certification in traditional oncology navigation. Certification indicates that a nurse or patient navigator has the basic knowledge to carry out their roles and responsibilities as navigators.

No state board licensing of navigators is yet available, and neither licensure nor certification is required for practicing advocacy or navigation. Nurse and social worker navigators and physician medical advocates are typically licensed in their professions. The field of integrative oncology navigation is relatively new, and no certification or licensure is available for integrative oncology navigators.

Finding a navigator or advocate

When searching for a navigator or advocate, we encourage you to ask about costs for services and whether your insurance will cover charges.

Suggestions for finding a navigator or advocate:

  • Ask your doctor if his/her practice has a navigator, advocate, and/or social worker.
  • Ask if your cancer center has a navigator, advocate, social worker, and/or ombudsman.
  • Search the options below.

Finding a navigator

Academy of Oncology Nurse & Patient Navigators® (AONN)

Local navigation networks are available in the US and internationally.

Existing Local Navigator Networks

Susan G. Komen Patient Care Center

1-877 GO KOMEN (Mon to Fri 9am – 10pm Eastern Time, English and Spanish)

HELPLINE@KOMEN.ORG

Finding an integrative navigator

Institute for Integrative Oncology Navigation (IION)

Request navigation services with the link below or call Smith Center at 202-483-8600 during business hours (US Eastern Time zone)

Individual Cancer Patient Navigation

Health Navigators

Offering holistic cancer health coaching to all disciplines of cancer, including education, coaching and opportunities to build community for social support with like-minded individuals.

Access the website

Finding an advocate

Resources

Become a navigator

Susan G. Komen

Komen’s free, online Navigation Nation Training Community features courses, tools, resources, informative events and panel discussions. The training develops and/or enhances the professional skills, peer network, and emotional support patient navigators need to best address the needs of people experiencing disparities in breast cancer outcomes.

Navigation Nation Training

Are you a health professional?

Navigator training

The Institute for Integrative Oncology Navigation (IION), within Smith Center for Healing and the Arts, currently offers the only national professional training for integrative oncology navigators. To date IION has trained more than 130 navigators from around the US. Graduates include oncology nurses, social workers, physicians, integrative practitioners, and cancer survivors. An online version of this training has been created with Maryland University for Integrative Health (MUIH) and is slated to be released in 2022.

Institute for Integrative Oncology Navigation

Sign up to have your name added to the list to be notified when training goes live.

202-483-8600

Our Training

Author

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Reviewer

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Last update: July 28, 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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