Patient Navigation for Older Adults with Cancer Remains Scarce in Europe, Major Review Finds

Older adults with cancer face a perfect storm of medical complexity: multimorbidity, frailty, polypharmacy, functional decline and treatment side effects, all layered on top of emotional distress and social isolation. A new scoping review published in European Geriatric Medicine suggests that the healthcare system’s answer to this complexity — patient navigation — has largely bypassed the very people who need it most. Drawing on more than two decades of research, the review finds that navigation programs specifically designed for older people with cancer are strikingly rare in Europe, and rare worldwide.

Patient navigation, a concept that originated in the United States in the 1990s, aims to reduce barriers to care by guiding patients through screening, diagnosis, treatment, rehabilitation, survivorship and end-of-life care. Navigators may be nurses, social workers or trained lay people, and their work spans education, barrier assessment, care coordination, psychosocial support and referrals. Yet while navigation has become a fixture of American cancer care, the European evidence base remains fragmented, inconsistently evaluated and rarely tailored to the ageing patient.

The review, conducted as part of the EU-funded EU-NAVIGATE project (2022–2027), followed PRISMA-ScR guidelines and searched PubMed, CINAHL and Web of Science for studies published between 1993 and 2025, supplemented by grey literature and manual reference screening. Of 4,249 records identified, 215 studies met the inclusion criteria. Only 28 of these reported patient navigation interventions conducted in Europe, spanning 11 countries, with Denmark contributing the most studies (six), followed by France (five) and the United Kingdom (four). The United States accounted for 153 studies, reflecting its far longer tradition of navigation research and implementation.

The numbers for older adults are stark. Across the 28 European studies, only one exclusively targeted adults aged 65 and over, and just one focused on adults aged 75 and over — the latter being the EU-NAVIGATE project itself, which is testing a navigation intervention for older people with cancer and their family caregivers across six European countries. Six further studies targeted pre-elderly populations aged 50 and above, while the remaining 20 involved general adult populations that included older participants. Only eight studies worldwide specifically investigated navigation programs for adults aged 65 and over.

The content of European programs varied with the age group served. Among interventions for adults aged 50 and over, education and barrier assessment dominated, with six of the eight programs operating at the cancer screening stage, one in treatment and one in supportive, palliative and end-of-life care. In contrast, programs for broader adult populations most often operated during treatment and placed greater emphasis on education, emotional support, barrier assessment and care coordination, with additional activities including skills building, symptom management, appointment assistance and referrals.

Navigator profiles differed sharply by age group. In European studies involving adults aged 50 and over, lay navigators (50 percent) and social workers (38 percent) predominated, with nurses accounting for just 13 percent. The pattern reversed in studies of general adult populations, where nurses delivered navigation in 16 of the studies and lay navigators were almost absent. In the United States, lay navigators were also the most frequently reported group among programs for people 50 and over, whereas nurses dominated in studies from other regions. The authors suggest that lay and social-work navigators may be particularly suited to addressing the social, practical and community needs of older patients, while professional navigators contribute clinical expertise and familiarity with treatment pathways.

Training practices revealed both promise and inconsistency. Nearly all European studies targeting adults 50 and over reported navigator training, typically lasting from two hours to one week, and European studies in this age group more frequently documented training in psychosocial skills, medical knowledge and the navigation process than did studies from the United States or elsewhere. Training content ranged from communication skills, motivational interviewing and coaching to healthcare system knowledge, nutrition, exercise and disease-specific topics. By contrast, in studies of broader adult populations, training was reported in only half of cases, and competencies were usually inferred from professional qualifications rather than defined by explicit frameworks.

Perhaps the most troubling finding concerns evaluation. Fewer than half of the European studies — 12 of 28 — described any form of evaluation, and only a handful used structured methodological approaches. Where assessment occurred, it often relied on participants’ subjective satisfaction rather than objective outcomes. Systematic evaluation was reported in 38 percent of European studies involving adults 50 and over, compared with just 2 percent in the United States and none elsewhere. Only two European studies assessed cost-effectiveness, and standardized outcome measures, such as quality-of-life instruments and the Work Ability Score, appeared only rarely.

The authors argue that the scarcity of age-tailored navigation may amount to a form of elder neglect in cancer care research, echoing broader concerns about ageism and the underrepresentation of older adults in clinical studies. Older people account for the majority of cancer diagnoses, yet recent ASCO guidelines recommending routine geriatric assessment for patients aged 65 and over have rarely been reflected in the design of navigation programs. Navigation during palliative and end-of-life care — where coordination needs are most acute — was almost entirely absent from the literature, with only one identified program specifically serving adults aged 70 and over.

The review concludes that patient navigation holds genuine promise across the cancer care continuum but must be adapted to the complex, individual needs of older patients, including frailty, cognitive and functional impairment and caregiver burden. The authors call for age-sensitive navigation models with clearly defined competencies, standardized evaluation using outcomes such as quality of life, functioning and independence, and well-structured training for lay navigators as a promising route to expanding navigation within European cancer care systems. Until such models are built and rigorously tested, they warn, Europe’s fastest-growing group of cancer patients will continue to navigate a fragmented system largely on their own.

Subject of Research: Patient navigation interventions for older adults with cancer in Europe

Article Title: Scoping review on navigation interventions for older adults with cancer in Europe and beyond

Article References: Stodolska, A., Wójcik, G., Reigada, C., Ashford, K., Miranda, R., Van den Block, L., Malmur, E., Drapała, N., & Szczerbińska, K. (2026). Scoping review on navigation interventions for older adults with cancer in Europe and beyond. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01609-5

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01609-5

Keywords: patient navigation, older adults, cancer care, geriatric oncology, care coordination, navigator training, psychosocial support, scoping review, Europe, frailty, Scoping, review