Along the continuum of cancer care for many patient populations, navigators play an essential role in community outreach and prevention. To be effective, navigators must have core knowledge of the early signs of cancer, and the current screening guidelines, as well as the available community and state resources for screening and diagnostics. Navigators must also be able to develop collaborative relationships with community partners, and provide education to the community on the importance of cancer prevention and early detection for improving survival.
In this case study, an oncology nurse navigator in a university-based medical center is contacted by a member of the community, “BB,” regarding the institution’s lung cancer screening program. BB is a woman aged 66 years with a smoking history of 40 pack-years. She quit smoking 8 years ago and is asymptomatic, but concerned about developing lung cancer.
The institution provides low-dose helical computed tomography (CT) lung cancer screenings based on the results of the National Lung Screening Trial, a lung cancer screening study that demonstrated a reduction in lung cancer mortality with the detection of earlystage tumors. It was shown that high-risk patients—those with a strong smoking history—who received a low-dose spiral CT screening had a 15% to 20% lower mortality from lung cancer compared with patients screened with a chest x-ray.1 Based on these data, the US Preventive Services Task Force and the American Lung Association recommend screening for current and former smokers based on specific guidelines.1
After obtaining the high-risk medical history of BB, the oncology nurse navigator educated BB on the lung screening guidelines recommended for current (>30 pack-year smoker) and former (<15 years since quitting) smokers who are apparently healthy and between the ages of 55 and 74 years, including an annual screening with low-dose CT. BB wished to pursue the low-dose CT screening.
Across all aspects of the cancer care continuum (screening, treatment, follow-up), nurse navigators provide instrumental and emotional support, address barriers to patient care, coordinate referrals, and strengthen patient–provider relationships. The nurse navigator assisted BB in the scheduling and completion of the lowdose helical CT screening.
BB’s CT scan results indicated a 5-mm lung nodule. Based on the institution and the Fleischner Society guidelines for recommended follow-up, BB should have an initial follow-up CT at 6 to 12 months, then at 18 to 24 months if there is no change.2 When lung nodules do not require immediate diagnostics, the surveillance program of the institution is implemented. The abnormality is communicated to the patient’s primary care physician, and the follow-up surveillance guidelines are coordinated by the nurse navigator and primary care physician.
- Business performance and return on investment metrics:
- Referrals to revenue-generating services and downstream revenue
- Number of patients referred to rehabilitation programs
- Decrease outmigration and increase patient retention rates
- Immediate referrals of self-paying patients for financial assessment.
- Clinical outcome and patient experience metrics:
- Patient pathway and guideline compliance
- Interventions for barriers to screening
- Timeliness of care
- Smoking cessation education and reducing barriers to participating in cessation programs
- Patient experience survey
- Physician experience survey
- Quality-of-life survey.
Tools and Resources
- Journal of Oncology Navigation & Survivorship articles:
- Brown G. Assuring lung nodule surveillance: a navigation model. J Onc Nav Surviv. 2013;4:8-12.
- Gerber DE, Gillam AO, Hamann HA. Lung cancer screening in the real world and the role of nurse navigators. J Onc Nav Surviv. 2013;4:21-23.
- American Lung Association, www.lung.org
- Fleischner Guidelines, www.fleischner.org
- Middlesex Hospital Cancer Center Lung Cancer Screening Program, http://middlesexhospital.org/our-services/hospital-services/cancer-center/cancer-programs-and-services/total-lung-care-center/lung-cancer-screening-program.
- National Cancer Institute. National lung screening trial: questions and answers. www.cancer.gov/types/lung/research/nlst-qa. Updated November 12, 2014. Accessed December 18, 2015.
- Fleischner Society. Fleischner Society recommendations for follow-up of small lung nodules detected incidentally on CT (patients ≥35 years of age). http://snmmi.files.cms-plus.com/docs/PET_COE/off_the_wall/Fleis.pdf. Accessed December 18, 2015.