Cancer care navigators in primary care: an opportunity for Wales

Why this matters

Patients frequently describe this period as stressful and confusing. At the same time, primary and secondary care services face increasing pressure to ensure patients move through diagnostic pathways quickly, safely and equitably.

These delays can arise from complex referral pathways, difficulties accessing investigations, poor communication between services, missed appointments, patient anxiety, and uncertainty about what happens next.

What is the evidence?

There is a substantial international evidence base supporting cancer patient navigation. An umbrella review of 61 systematic reviews concluded that patient navigation improves access to care, reduces time from screening to diagnosis and from diagnosis to treatment, improves patient satisfaction and may be cost-effective. 

Although most evidence comes from North America and hospital-based settings, findings are consistent across healthcare systems.

More recent systematic reviews have demonstrated that navigation programmes improve treatment initiation, treatment adherence, quality-of-care indicators and patient experience, particularly for individuals facing barriers to accessing healthcare.

The question for Wales is therefore not whether navigation works, but where it should be located to achieve the greatest impact.

Why primary care?

The period between GP referral and diagnosis is often where patients face the greatest uncertainty and risk of delay. Cancer Care Navigators based in primary care are uniquely positioned to support patients through this stage by:

• Acting as a single point of contact for patients and families.
• Supporting attendance at investigations and appointments.
• Identifying and addressing practical barriers that may delay diagnosis.
• Monitoring progress through diagnostic pathways and escalating concerns where necessary.
• Reducing the risk of patients becoming lost between services.
• Improving communication between primary and secondary care.

By helping patients navigate complex diagnostic pathways, these roles could contribute to faster, safer and more equitable cancer diagnosis across Wales.

Importantly, Cancer Research Wales-funded research has identified several challenges that navigators could help address, including lack of continuity of care, transport and distance barriers, fear of investigations or diagnoses, delays in help-seeking behaviour, loneliness and insufficient support during the diagnostic process, unfamiliarity with healthcare systems, and language barriers experienced by some migrant communities.

As a result, Cancer Care Navigators have the potential not only to improve diagnostic timeliness but also to reduce inequalities in access and experience across diverse patient groups.

The Welsh opportunity

Elements of navigator-type roles already exist within parts of NHS Wales, demonstrating local feasibility and acceptability. However, provision remains inconsistent and largely dependent on geography.

The development of a national Cancer Care Navigator programme embedded within primary care would provide a more equitable and standardised approach across Wales. 

Such a model would complement existing efforts to improve cancer pathways while building on foundations established through the ThinkCancer! programme funded by Cancer Research Wales.

Embedding navigation support at the primary-secondary care interface also aligns with wider ambitions to improve patient-centred care, reduce unwarranted variation, and support earlier diagnosis.

Policy recommendation

As part of the new Cancer Strategy for Wales, the Welsh Government should support the phased development, implementation and evaluation of Cancer Care Navigator roles within primary care. 

Initially linked to existing cancer diagnostic pathways, this approach would enable Wales to adapt and evaluate an intervention with a strong international evidence base within the NHS Wales context.

By providing practical support during the critical period between referral and diagnosis, Cancer Care Navigators could help reduce delays, improve patient experience, address inequalities in access, and strengthen the effectiveness of cancer diagnostic pathways across Wales.