Massachusetts General Hospital Cancer Center: Patient Navigation as the Cornerstone of Cancer Care

Intervention Area: Northeastern Massachusetts

BOSTON – Most cancer diagnoses begin with a primary care physician (PCP), with PCPs remaining involved throughout the continuum of cancer care. According to a recent study, more than 50% of PCPs had a role in shaping treatment preferences for individual patients. After receiving an initial diagnosis from primary care, patients are usually transferred to oncology for further testing and treatment. If this transition is not properly coordinated, it is possible for vital information to be overlooked, or for patients to miss crucial treatment stages. This is especially true for underserved and vulnerable patient populations, who face significant socio-economic barriers to getting the care they need. The Massachusetts General Hospital Cancer Center’s intervention aims to improve care for newly diagnosed patients on multiple fronts: the TopCare registry can help detect patients in need of additional support, and Patient Navigators are empowered to step in and act as a conduit between primary care and oncology services.

The TopCare Patient Registry collects patient data from a number of different sources into one, user-friendly platform. It was developed to screen the patient population of all MGH Community Health Centers and their community partners, helping to identify patients who are eligible to receive navigation services. The system updates every day, extracting information from electronic medical records and billings. It can track patients as they make their way through the MGH system, accurately recording their entire cancer care roadmap.  Based on TopCare data and referrals from community health centers and community partners, patients can be referred to a Patient Navigator, who assists in creating a plan to overcome any barriers to appropriate and timely care.

Patient Navigators can support patients in securing transportation to and from appointments, guide the patient through treatment decisions and subsequent treatment options, and can help manage financial concerns. Patient Navigators can also provide interpreter services and accompany patients to their medical appointments. In addition to these in-person services, patients at the MGH Cancer Center can receive phone navigation, including phone calls reminding them about upcoming appointments and screening for barriers to care. Over the Merck Foundation grant period, over 400 vulnerable patients diagnosed with cancer are projected to receive navigation services.

The Massachusetts General Hospital Cancer Center’s intervention specifically targets underserved communities to ensure that low-income and minority patients receive patient-centered care throughout the cancer continuum, with the ultimate goal of achieving equity in cancer care in northeastern Massachusetts.

Facts and Figures

The main communities that are part of the Massachusetts General Hospital Cancer Center intervention are Chelsea, Revere, and Charlestown:

  • Residents of Charlestown, Chelsea and Revere struggle with the risk and health factors associated with poverty, such as violence and substance use, educational attainment, and obesity.
  • Every year, the MGH community health centers in Revere and Charlestown, where mortality of colorectal and lung cancer are the highest in the state, refer approximately 200 newly diagnosed patients to the MGH Cancer Center.

About the Massachusetts General Hospital Cancer Center

The Massachusetts General Hospital Cancer Center is among the leading cancer care providers in the United States. Known for providing customized, innovative treatments and compassionate care to both adults and children, the Cancer Center comprises more than 37 treatment programs within 29 fully integrated, multidisciplinary disease centers and a vast array of support and educational services. Its network of affiliations extends throughout New England and the southeastern U.S.

Part of one of the largest hospital-based research programs in the nation, the Cancer Center is committed to eradicating cancer. Through a powerful synergy between laboratory scientists and bedside physicians, the Mass General Cancer Center fosters innovation in all phases of cancer research. Physician investigators conduct nearly 400 clinical trials annually.

The Massachusetts General Hospital Cancer Center is proud to be a founding member of a Harvard Medical School consortium designated by the National Cancer Institute as a comprehensive cancer center. This prestigious seven-member center forms the largest cancer research collaboration in the country. The promising new treatments developed through this partnership are revolutionizing the future of cancer medicine.

About the Alliance to Advance Patient-Centered Cancer Care

The Alliance to Advance Patient-Centered Cancer Care, a multi-site initiative funded by the Merck Foundation, works to increase timely access to patient-centered care and reduce health disparities among under-served populations in the United States. The Alliance includes the following organizations: Georgia Cancer Center for Excellence at Grady Health System, Johns Hopkins University School of Medicine, Massachusetts General Hospital (MGH) Cancer Center, Northwestern University Feinberg School of Medicine, The Ohio State University Comprehensive Cancer Center, The University of Arizona Cancer Center, and University of Michigan School of Nursing, which serves as the National Program Office (NPO). For more information, visit the Alliance to Advance Patient-Centered Cancer Care’s website at

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