Harold P. Freeman Explained

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Harold P. Freeman (born March 2, 1933) is an authority on race, poverty and cancer. In his work in Harlem, Freeman identified the impact of poverty and cultural barriers on rates of cancer incidence and cancer-related death, in economically disadvantaged and under-served communities. He also pioneered patient navigation (or nurse navigation) in the field of breast cancer. In navigation programs, trained personnel work with patients to identify and overcome barriers to their obtaining timely treatment as they move through the medical system.[1]

Freeman is a Fellow of the American College of Surgeons and a member of the National Academy of Science's Institute of Medicine. He served as President of the American Cancer Society from 1988-1989, leading the society's initiative on Cancer in the Poor.[2] Freeman has argued for the involvement of scientists in policy formation. His work has led to the passage of the Patient Navigator Outreach and Chronic Disease Prevention Act (H.R. 1812) of 2005, and to the creation of billing codes for patient navigation services in Medicare and Medicaid Services as of 2024.

Early life and education

Harold Paul Freeman[3] was born on March 2, 1933, in Washington, D.C.[4] to Clyde and Lucille Thomas Freeman.[5] The family name "Freeman" was chosen by his great-great-grandfather who bought himself free from slavery on a North Carolina plantation. The Freeman family has a history of educational achievement in medical fields. Harold Freeman's great-granduncle, Robert Tanner Freeman, was the first African-American dentist in the United States, graduating from Harvard in 1869.[6] His grandfather, Henry W. Freeman, graduated from Howard University Medical School in 1898 and became doctor in Washington, D.C.[7]

Harold's father, Clyde Freeman, took night classes to put himself through law school. His mother Lucille was a teacher. Clyde died of testicular cancer when Harold was only 13 years of age.[8] [9] Despite this, Harold completed his high school education at Dunbar High School, then an academically elite but segregated institution in Washington, D.C.

Freedman' parents had met on a tennis court. Coached by their mother Lucille, Harold and his older brothers Thomas and Clyde all became national boys tennis champions. Harold was boys' champion in 1948, at age 15.[10] Harold and Clyde won the national tennis doubles championship on the adult African American tennis circuit in 1955.[11] Harold also played in the U.S. Open in subsequent years.[12]

Freeman won an academic scholarship to Catholic University of America where "Hal" Freeman is listed as playing both tennis and basketball.[13] He was chosen as team captain of both in his senior year. Freeman graduated from Catholic University in the class of 1954, with the Harris Award for Outstanding Scholar, Gentleman, and Athlete.[13] In 1978, he was received a Distinguished Alumni Achievement Award from Catholic University.[14] In 1992, he was inducted into the university's Athletes Hall of Fame.[15]

He went on to study medicine at Howard University Medical School in Washington, D.C., also a historically Black school. There Freeman studied with Burke Syphax and was inspired by LaSalle D. Leffall Jr. and Jack E. White. Freeman received his medical degree in 1958, completing both his internship and residency at Howard. The school awarded him the Daniel Hale Williams Award for Outstanding Achievements as Chief Resident.[16]

In 1964, Freeman accepted an advanced residency position at Memorial Sloan Kettering Cancer Center (MSK) where he worked with Arthur Holleb.[17] From 1966 to 1968, he was Senior Resident in Cancer Surgery at MSK.

Career

In 1967, Freeman joined Harlem Hospital Center. The patients he saw there were overwhelmingly poor and black, and most of his cancer patients had advanced stage cancers. He began to investigate the incidence and treatment of cancer in African Americans.[18] By 1974, he had opened a free clinic, held on Saturdays, to improve accessibility for patients. This later officially become part of the hospital system. Freeman served as professor of clinical surgery at Harlem Hospital from 1974 to 1999.[19]

In 1977, at hearings convened by New York City governor Hugh Carey, Freeman criticized the American Cancer Society for their lack of involvement in areas like Harlem. The board of directors of the American Cancer Society responded by inviting Freeman to become a director at large in 1978.[20] He succeeded LaSalle D. Leffall as chairman of the ACS committee dealing with Cancer in Minorities.

In 1979, the American Cancer Society (ACS) gave Freeman a grant to establish screening centers for breast and cervical cancer in Harlem. He established the Breast Examination Center of Harlem, becoming its Medical Director. His publication Cancer in the Economically Disadvantaged (1989) is considered a "landmark report", connecting poverty and mortality.[4] [21] In Excess Mortality in Harlem (1990), Freeman and Colin McCord documented the lower lifespan of African American males in Harlem, which was less than that of males in Bangladesh.[22] Mortality rates for men and women in some age categories were up to six times those of white men and women of similar age nationally.[23]

As President of the American Cancer Society (1988-1989), Freeman held nation-wide hearings that examined economic, educational and socio-cultural factors and their effects on access to care, explaining the higher incidence and mortality of cancer to be found in under-served populations in terms of interlinking conditions of poverty, social injustice, and culture. In 1990, the ACS established the Harold P. Freeman Service Award to recognize those working with underserved communities at risk for cancer.[5]

Freeman pioneered the concept of patient navigation (also known as nurse navigation), in which trained individuals work consistently with patients and their families throughout their experience of the medical system. Patient navigators work to identify and overcome barriers to timely treatment, to ensure that patients are able to get the full continuum of care that is needed. Barriers include financial issues, lack of insurance, difficulty in getting time off from work, access to transportation and child-care, difficulties in language and communication, fear, distress, and the complex and often disconnected nature of the healthcare system itself.[24] [25] In 1990, the ACS funded Freeman's pilot program for patient navigation in Harlem Hospital.[26]

Freeman became a professor of clinical surgery at Columbia University College for Physicians and Surgeons as of 1989. He was President and CEO of New York's North General Hospital from 1999 to 2001.

Freeman served as chairman of the United States President's Cancer Panel from 1991 to 2000.[27] [28] He was first appointed by President George H. W. Bush and reappointed three times by President Bill Clinton.[29] [30] President George W. Bush signed the Patient Navigator Outreach and Chronic Disease Prevention Act (H.R. 1812) into law on June 29, 2005. The initiative was based on Freeman's success with the patient navigator program in Harlem.[31] [32]

Freeman served as an Associate Director of the National Cancer Institute (NCI). From 2000 to 2005, Freeman served as the founding Director of the Center for Reducing Cancer Health Disparities,[33] which replaced the NCI Office of Special Populations Research. Freeman emphasized the need to advocate for policy changes based on research, in addition to the organization's work in education and communication.[34]

As of 2003, Freeman became founding president and medical director of the Ralph Lauren Center for Cancer Care and Prevention in Harlem.[35] He continues to be chairman emeritus of the organization.[36]

As of June 2007, with funding from the Amgen Foundation, the Harold P. Freeman Patient Navigation Institute was established in New York City.[37] Freeman was its founder, president, and CEO. The Harold P. Freeman Patient Navigation Institute runs training programs in patient navigation for nurses and others. In addition to cancer, the program has been applied to the management of infectious diseases and chronic conditions like diabetes, heart disease, and mental health. Patient navigation has been included in the accreditation standards of the American College of Surgeons for hospital cancer programs.

As of 2024, the Centers for Medicare and Medicaid Services created billing codes to enable health care providers to fill for “patient navigation” services, under President Joe Biden’s Cancer Moonshot initiative.[38]

Awards and honors

Selected publications

Notes and References

  1. Web site: Shockney . Lillie . 2018 . Breast Cancer Awareness Month: Honoring Navigation . 18 May 2024 . Journal of Oncology Navigation & Survivorship . 8.
  2. Web site: Genes & Justice: Biographies . WE ACT for Environmental Justice.
  3. Web site: Distinguished Alumni Achievement Awardees Catholic University Advancement . 2024-05-20 . engage.catholic.edu.
  4. Web site: Dr. Harold Freeman . The History Makers . 20 May 2024.
  5. Web site: Piana . Ronald . June 3, 2022 . From the Segregated Tennis Courts of Washington, DC, to a Leadership Role in Surgical Oncology . 2024-05-20 . ascopost.com . en.
  6. Web site: Portrait of Dr. Freeman Honors HSDM's First African American Graduate . 2024-05-20 . hsdm.harvard.edu . en.
  7. Web site: Freeman, Harold P. 1933– Encyclopedia.com . www.encyclopedia.com.
  8. Web site: Harold Freeman, father of patient navigation, on cutting the cancer out of Harlem . 2024-05-20 . Cancer History Project . en-US.
  9. News: Wadler . Joyce . 1999-07-01 . PUBLIC LIVES; A Cancer Fighter Keeps Fighting Injustice . 2024-05-21 . The New York Times . en-US . 0362-4331.
  10. Web site: Breaking Barriers : The Freeman Family of Washington, D.C., ca. 1955 . International Tennis Hall of Fame.
  11. Web site: Walker . Rhiannon . 2017-08-04 . Althea Gibson, Arthur Ashe highlight a century of ATA champions . 2024-05-21 . Andscape . en-US.
  12. Web site: Tennis Abstract: Harold Freeman Match Results, Splits, and Analysis . 2024-05-21 . www.tennisabstract.com.
  13. Web site: Inventory of The Catholic University of America Photograph Collection . The Catholic University of America . en.
  14. Web site: Distinguished Alumni Achievement Awardees Catholic University Advancement . 2024-05-20 . engage.catholic.edu.
  15. Web site: Hall of fame . 2024-05-20 . Catholic University of America . en.
  16. Web site: 2010-03-13 . 2010 Honorees . 2024-05-20 . The Hope Funds for Cancer Research . en-US.
  17. Web site: Finding Aid to The HistoryMakers ® Video Oral History with Dr. Harold Freeman . The HistoryMakers.
  18. Web site: Our History . Vagelos College of Physicians and Surgeons . 21 May 2024 . en . 16 October 2023.
  19. Web site: Giving . Mass General . 2011-01-01 . The one hundred honoree: Harold P. Freeman, MD . 2024-05-20 . Massachusetts General Hospital Giving . en.
  20. Book: Fleming . Irvin D. . Eyre . Harmon J. . Pogue . Jan . The American Cancer Society: a history of saving lives . 2010 . American Cancer Society . Atlanta, Ga . 9780944235911 . 68–70 . en.
  21. Book: Kiernan . Stephen P. . Authentic Patriotism Restoring America's Founding Ideals Through Selfless Action . 2010 . St. Martin's Press (Macmillan US Trade) . 9781882926909 . en.
  22. News: 2024-03-02 . Harlem men die at rate above Bangladesh's . 2024-05-20 . Washington Post . en-US . 0190-8286.
  23. Geronimus . AT . Bound . J . Colen . CG . Excess black mortality in the United States and in selected black and white high-poverty areas, 1980-2000. . American Journal of Public Health . April 2011 . 101 . 4 . 720–9 . 10.2105/AJPH.2010.195537 . 21389293 . 3052342 .
  24. Goodman . Alice . The Birth of Patient Navigation . Journal of Oncology Navigation & Survivorship . 2015 . 6 . 3 .
  25. News: Gilinsky . Rhoda M. . 1987-10-25 . CANCER'S TOLL ON POOR STRESSED . 2024-05-21 . The New York Times . en-US . 0362-4331.
  26. Knudsen . Karen E. . Wiatrek . Dawn E. . Greenwald . Jennifer . McComb . Kristie . Sharpe . Katherine . 2022 . The American Cancer Society and patient navigation: Past and future perspectives . Cancer . en . 128 . S13 . 2673–2677 . 10.1002/cncr.34206 . 0008-543X.
  27. Web site: Health Disparities in Cancer Part 1: The meaning of "Race" in Science - President's Cancer Panel . President's Cancer Panel.
  28. Book: President's Cancer Panel Meeting . July 19, 1999 . Boston, Massachusetts .
  29. Web site: Dr. Harold Freeman and Dr. Lovell Jones on Living Your Best Life with Genma Holmes Genma Speaks . Genma Speaks . 14 July 2012.
  30. Web site: Appointment for the President's Cancer Panel The American Presidency Project . The American Presidency Project . 20 May 2024.
  31. Bennett . Charles L. . Calhoun . Elizabeth A. . 2007-04-01 . $25 Million Patient Navigation Program Aims to Reduce Cancer Health Disparities in Targeted Communities . Oncology NEWS International . en . 16 . 4.
  32. Lindsey . Heather . 2005-11-25 . New National Patient Navigation Program Aims to Improve Outcomes . Oncology Times . en-US . 27 . 22 . 12–15 . 10.1097/01.COT.0000291156.92885.87 . 0276-2234.
  33. News: Harold Freeman To Direct NCI Center To Reduce Cancer Health Disparities . The Cancer Letter . 33 . 26 . September 15, 2000.
  34. News: NCI Health Disparities Center Will Attempt To Influence Policy, Harold Freeman Says. . Cancer History Project . November 3, 2000.
  35. Web site: 2023-09-26 . The MSK Ralph Lauren Center Celebrates 20 Years MSK Giving . 2024-05-20 . giving.mskcc.org . en.
  36. Web site: 2022-05-11 . Ralph Lauren Corporate Foundation Announces $25 Million Commitment to Five Cancer Centers Across America With Goal of Reducing Disparities in Cancer Care in Underserved Communities . 2024-05-20 . Lombardi Comprehensive Cancer Center . en-US.
  37. Web site: Harold P. Freeman Patient Navigation Institute Completes First Trainings and Certifications . Apr 24, 2008 . Fierce Healthcare.
  38. Web site: 2024-01-05 . CMS starts paying for patient navigation; ACS offers navigation credentialing program . 2024-05-20 . The Cancer Letter . en-US.
  39. Web site: For Immediate Release December 17, 1997 . clintonwhitehouse6.archives.gov.
  40. Web site: Hofschneider . Mark . Addressing social determinants of diseases . 2024-05-20 . Lasker Foundation . en-US.
  41. Web site: 2016-02-05 . Lasker Awards . 2024-05-21 . National Institutes of Health (NIH) . EN.
  42. 2001-01-03 . Awards, Appointments, Announcements . JNCI Journal of the National Cancer Institute . en . 93 . 1 . 15 . 10.1093/jnci/93.1.15 . 0027-8874.
  43. Web site: All Award Recipients . 2024-05-20 . ASCO . en.
  44. Web site: GNYHA Foundation: 2004 Winner: Harold P. Freeman, M.D. . Greater New York Hospital Association Foundation.
  45. 2004-07-01 . American Journal of Health Promotion presents the recipient of the 2004 Robert F. Allen Symbol of H.O.P.E. Award. Harold P. Freeman, MD . American Journal of Health Promotion . 18 . 6 . v . 10.4278/0890-1171-18.6.V . 15293925.
  46. News: This Giant of Cancer Care Made Bridging the Fairness Gap His Lifelong Quest . 20 May 2024 . Oncology Live . 7. 17 . 3 April 2016 . en.
  47. Berberabe . Tony . 2015-05-29 . 3rd Annual Giants of Cancer Care Class Brings Together Diverse Honorees . Oncology Live . 2015 . en . 16 . 6.
  48. Web site: Stabile . Nicholas C. . 2017-10-05 . Dr. Harold P. Freeman to Receive Cura Personalis Award . 2024-05-20 . Georgetown University Medical Center . en-US.

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