Implementing a System-Wide Comprehensive Cancer Navigation Program in a Rapidly Expanding Health System

Cancer care involves a host of multidisciplinary teams that can often result in fragmented care, creating delays and increasing patient stress. Navigation programs have demonstrated benefits in screening adherence, timely follow-up, and patient satisfaction, but most remain confined to single or only few specialties. We describe the design, implementation, and early outcomes of a comprehensive, system-wide nurse navigation program spanning multiple oncology service lines.

Northwell Health, a 26-hospital system serving approximately 13 million people, launched its first navigation pilot in 2022. Nurse navigators were paired with patients at diagnosis and coordinated all subsequent care steps including specialty referrals, appointments, ancillary services, and psychosocial support. Referrals occurred through electronic pathology alerts, provider or self-referrals, and imaging or emergency department findings. Outcomes included time to initial oncology appointment (TTA) and patient-reported satisfaction.

From 2023 to 2024, 7,010 patients entered navigation, including 5,329 with confirmed malignancy. In breast oncology, TTA decreased from 22.8 days prenavigation (2022) to 6.8 days postimplementation. Gynecologic, colorectal, and hepatobiliary/GI services saw similar reductions (7-8 days v 12-14 days prior). High satisfaction was generally observed during the postdiagnosis period, with potential areas of improvement including ease of communication (median, 4.5; IQR, 2) and program explanation (median, 4; IQR, 2). Patient satisfaction remained high throughout care, with median scores of 5 (IQR, 1) across both peritreatment and post-treatment surveys. Greater variability in satisfaction was observed during the immediate postdiagnosis period, particularly regarding communication and program explanation.

Implementation of a centralized, system-wide cancer navigation program was feasible and associated with improved access to oncology care and consistently high patient satisfaction across multiple cancer service lines. These findings support comprehensive navigation infrastructure as a scalable strategy to enhance care delivery in large health systems.