Multisite Tumor Navigators

Jay Swanson, RN, BSN, OCNSaint Elizabeth Cancer Institute

Shanna Gillming, RN, BSNGood Samaritan Hospital Cancer Center

Objectives

• Discuss concerns with navigation• Identify potential best practices• Review case study highlighting the strengths

and difficulties of multisite navigation

Why Navigate Multiple Sites?

• Small amount of cancer for service area• Program can only support 1 navigator• Referral systems not in place• “Don’t want to leave anyone out”

Brainstorming Time

• Take 5 minutes to think about…– Why are you/do you have a multisite navigator?– What are the benefits?– What are the concerns?– Would you want to be or wish you were

specialized?– Do you have a preferred disease site to navigate?

J.M.

• 75-year-old woman with stage IV lung cancer• Navigated at time of diagnosis through

treatment– Including 2 different cycles of chemotherapy– WB XRT– Cyberknife to left rib cage

• Now on PO TKI for therapy

Thoughts

• What are some thoughts about… – How often to follow up with this patient?– What are the main areas of focus for her care?

Next Patient

• E.L., 28-year-old woman with gastric cancer– Navigated for financial assistance through

treatment and beyond– Patient had minimal side effects to chemotherapy– Always acted like it was not a big deal to be on

treatment– Always had 12-year-old daughter in room– Admitted over weekend for anxiety and nausea

Thoughts

• What are your thoughts about…– Her care, and what concerns should be addressed

with her?– How does she differ from the patient you saw

before her?– How often should we follow up with her?

Then…

• J.C., plasmacytoma - spine– 44-year-old man, lives with significant other– Uninsured, has worked as a truck driver– Unable to work as a result of tumor– Undergoing radiation– Tolerated radiation treatment fairly well– Has applied for public assistance

Thoughts

• What are your thoughts…– Regarding his care?– How does he differ from everyone else today?

GYN Patient

• J.N., 56-year-old patient with advanced cervical cancer– Waitress, uninsured– Was symptomatic for 2 years with spotting, pain,

and weight loss. Waited to see an MD• Has a sister from California here to care for her• Borrowing a car from patient’s ex-husband to get back

and forth to treatment• Hospitalized for several weeks with side effects from

concurrent chemo/XRT

Thoughts

• What are your thoughts…– What are the barriers here?– How can a navigator assist this patient?

H&N Patient

• S.S., 56-year-old life-long smoker/drinker– Receiving radiation for 6 weeks– Using American Cancer Society for rides– Wife calls daily about concerns• Pain meds• Swallowing• Eating

– Patient never has any concerns; rates distress level 0 on numerous occasions

Thoughts on This Case…

• What can we do for this gentleman?– Is his score concerning?– What can we do for his wife?– How is this different from other cancer

navigation?

Final Thoughts on Case Study

• The purpose of specialization is to be able to provide a more focused knowledge base for care

• How to specialize the following morning?– Stage IV lung– Gastric– Plasmacytoma– GYN– H&N

Resources Utilized by Navigators

• American Cancer Society• Med companies• Local resources (food, lodging)• National resources – Healthwell, Chronic

Disease Fund, Cancer Care, Patient Advocate Foundation, LLS

• Cleaning for a Reason• Centers for Medicare & Medicaid Services

Next Steps

• Within AONN we have a network– We have an ability to provide a safe place for

multisite navigators– Certification for Navigation is happening on some

level and will only become more prevalent in the coming year

Next Steps

• What are your thoughts about…– Building a place on the AONN site for multisite

navigation• What would we include on the site?• Any tools that we use that would be helpful?• Contact information?• Resources?

– Networking throughout the year to help address concerns, maybe as a teleconference or webinar?