Nurse Navigators Help Guide Patients Through Treatment for Better Outcomes

Three words can change your life.

When those three words are, "You have cancer,” life can feel like it comes to a screeching halt, making it difficult to move forward with the steps needed to beat the disease.

According to the American Cancer Society, over 1.6 million new cancer cases will be diagnosed and almost 600,000 will die from cancer in the U.S. in 2015, which means these people are wayfinding, sometimes blindly, through chemotherapy, surgery, radiation, clinical trials, nutrition counseling and other treatment modalities.

To prevent this, the Commission on Cancer is requiring that all accredited institutions have a navigation system in place as part of a larger survivorship program by 2018.

The UC Cancer Institute is making strides to meet these requirements and to provide the best possible outcomes for patients by hiring nurse navigators in the head and neck, breast and lung cancer centers.

Candi Brown, who will be working with the lung center, came on board in late September. 

"I was already serving as a patient navigator to some degree at the small community hospital I worked for in Indiana,” she says, adding that she is an oncology certified nurse. "Everyone knows that the earlier one can detect cancer, the better the outcomes, and in the case of the lung center, we have a multidisciplinary Lung Cancer Screening Program. However, many patients don’t follow up on their care because of financial barriers or problems with transportation. There are so many people who don’t know about the numerous resources available to them. That’s where I come in.”

A nurse navigator by definition provides personal guidance to patients as they move through a health care system. Other patient navigators may include those with legal, financial or administrative experience.

Marilyn Kugler has been with the head and neck cancer center as a nurse since 2012 but just officially stepped into the role as a nurse navigator in August.

"I meet with patients at the first appointment, usually with the physician, and then I meet with them each time they begin a new arm of their treatment plan,” she says. The other navigators say they follow these guidelines as well and that a phone call is typically made to the patient before that first visit just to make sure he or she knows where to go and what to expect.

"Sometimes patients will come in on that first visit and expect chemo, so it’s great to give them some information before they arrive,” Kugler adds. "I check in with the patients regularly, and they all have my contact information and can get in touch with me any time they have a question. I follow up with them if I haven’t heard from or seen them. We want to reduce their stress and anxiety as much as possible and let them concentrate on getting better. 

"I’m there to connect the dots and make sure they have everything they need to do that.”

Anndee Meyer, the nurse navigator for the breast center, has been in her position for over a year, and says it has been great to meet with Kugler and Brown to share ideas to find the best way to meet patients’ needs.

"We’ve started meeting weekly to see if we can develop some guidelines,” she says. "Of course, our patients have different needs, so something that works for me might not work for the others, but I’m so excited to have other navigators on board.”

A fourth dedicated navigator, Tracy Thompson-Lang, will also be joining as a radiology navigator this fall. 

Meyer has created both an introductory letter for the patient explaining navigation with her contact information and a flow chart so that patients know what to expect from each branch of treatment. 

"We don’t want to see anyone get lost, and we want to make sure they have everything they need to get through the system effectively,” she says. "This system is very large and it involves many physicians and specialties with many different processes and places. It can be nerve wracking. Each step can take months to years, and I’m here to make sure that the patients have what they need to complete each step and that the physicians are taking the steps they need to move the patient along in his or her treatment plan.”

Besides being that advocate for the patient—which all three navigators state is their number one priority—they also hope to be the conduit for introducing clinical trials and other therapeutic services.

Kugler says early introduction to palliative care in order to relieve symptoms is a major goal for her.

"Traditionally, patients are put into hospice, but palliative care is so much more than that—hospice is just a tiny piece of the pie,” she says. "We can truly relieve symptoms and help patients achieve a broader spectrum of end-of-life goals.”