Original Research Patient Navigation Based Care-delivery to Reduce Inequities in Cancer Care Among Immigrants and Refugees: A Commentary on the Successes and the Unmet Needs. Sailaja Kamaraju, MD, MS 1 , Janette Merrill, MS 2 , James Wu, MD 1 , Sanford Jeames, DHA 3 , Meghan Conroy, BS 4 , Heun Min, BS 5 , Miracle Powell, BS 1 , Aasim Padela, MD, MSc 6 1 Medicine, Medical College of Wisconsin, 2 Health Equity, American Society of Clinical Oncology, 3 Social and Behavioral Sciences, Huston-Tillotson University; Health Equity, American Society of Clinical Oncology, 4 School of Medicine-Medical Student, Medical College of Wisconsin, 5 School of Medicine- Medical Student, 6 Department of Emergency Medicine, Medical College of Wisconsin Keywords: Cancer Care Delivery, Health Inequities, Immigrants' and Refugee health, Social Determinants of Health, Patient navigation https://doi.org/10.53876/001c.33154 International Journal of Cancer Care and Delivery As immigrant and refugee populations continue to enter American shores, multiple factors such as lack of health and healthcare knowledge, cultural and linguistic barriers, and obstacles related to the social determinants of health (SDOH) limit the timely uptake of healthcare screenings, particularly cancer screening. Although acculturation experiences are unique to immigrants and refugees, similar to several other minority communities, these groups also face fnancial and other access-related challenges to cancer screening and treatment. Furthermore, the ongoing COVID-19 pandemic has likely exacerbated these issues. Therefore, exploring novel methods to reduce cancer related inequities among these populations is critical. Accordingly, in this article, we describe the importance of culturally tailored educational tools and patient navigation to reduce cancer-related disparities. Specifcally, this article examines historical aspects of patient navigation, highlights experiences and studies using patient navigation to promote cancer screening and treatment within immigrant and refugee populations and discusses the unmet needs and future directions for patient navigator models along the cancer care continuum. INTRODUCTION As of 2019, a total of 44.9 million documented immigrants and refugees (IRPs) reside in the US. 1 Although annual refugee resettlement and ceiling policies have led to smaller numbers and slower rates of refugees arriving in the US in recent decades, from 250,000 in 1980 to fewer than 12,000 in 2020, 2 there have been periodic upshifts due to political circumstances. For example, after the recent political change in Afghanistan in August 2021, a total of 150,000 Afghan refugees arrived in the US. 1 The constant and di- verse stream of IRPs poses many healthcare challenges in- cluding healthcare access and routine health maintenance given their new and unfamiliar context. At the same time, healthcare systems do not have adequate familiarity, fscal and human resources, or trusted connectors to these com- munities to forge bridges to healthcare quickly. 3 The ongoing infux of IRPs within the United States has generated heterogeneity among this group in terms of spo- ken language, culturally-based health behaviors, and health literacy rates. 4 Moreover, IRPs are faced with their own unique physical and psychological health challenges that, in some cases compel their emigration here. Indeed, given the diversity of racial, ethnic, and religious beliefs, IRP pop- ulations will have different sociocultural norms that infu- ence healthcare decisions. 5–8 As such, diverse approaches to addressing their unmet health needs and specifc health challenges are necessary. At the same time, IRPs share some commonalities with historically underserved communities in the U.S., including the lack of healthcare access and lim- ited health literacy. IRP’s therefore similarly struggle to navigate the complex healthcare systems, which leads to suboptimal use of primary care visits and preventive health- care, including cancer screening. 9 Furthermore, most pa- tient education materials are developed at high school level standards in the US, and resources for those with low Eng- lish profciency and health literacy are lacking. 10,11 This gap poses additional challenges to cancer screening and control within the IRPs. Given the infux of IRPs, patient navigators (PNs) to help them navigate through the US healthcare system and to assist with coordination of health- care screenings, follow up medical appointments would be invaluable. While immigrants and refugees vary in literacy rates, employment rates, and fnancial securities, some chal- lenges may overlap. 12,13 For example, among the refugee populations, suboptimal use of cancer screening may be related to limited access to resources and barriers related to social determinants of health (SDOH) such as food and housing insecurities, barriers to language, technology, transportation, and neighborhood factors. 14,15 However, among the immigrant populations, low cancer screening rates may not be directly related to the barriers associated with the SDOH, but other overlapping factors such as lack of trust in preventive healthcare and healthcare systems and/ Kamaraju S, Merrill J, Wu J, et al. Patient Navigation Based Care-delivery to Reduce Inequities in Cancer Care Among Immigrants and Refugees: A Commentary on the Successes and the Unmet Needs. IJCCD. Published online March 10, 2022.