Does Virtual Navigation Improve Continuation of Care and Compliance for Early-Stage Colon Cancer Patients?

November 2018 Vol 9, NO 11
Jeremy Ortega, LVN
Sarah Cannon Cancer Center
Nashville, TN
Dayna Crawford, LPN
Sarah Cannon Cancer Center
Nashville, TN

Background: Colon cancer is the third most common cancer subtype for both men and women, with an occurrence rate of 4.49% for men and 4.15% for women. In 2018, there are expected to be 50,630 deaths related to colon cancer in the United States.1 Early detection is on the rise, with approximately 45% of colon cancers being diagnosed as stage I/II.2 Treatment for early-stage colon cancer generally involves surgery followed by surveillance. Complex or on-site navigators perform their duties based on patient need and barriers to care. Stage III/IV colon cancer patients require more assistance and face more barriers, leaving early-stage colon cancer patients without an advocate or educator in many situations. This disparity can lead to lower rates of follow-up care and interventions for early-stage patients. Sarah Cannon created a program for virtual colon navigation (VCN) to determine if early-stage colon cancer patients can benefit from a virtual navigator who follows and assists these patients throughout their disease process via telephone.

Objectives: The goal is to increase the knowledge of patients with early-stage colon cancer about their disease as well as to convey the importance of compliance with follow-up care, such as repeat colonoscopy as recommended by the physician and NCCN guidelines.

Methods: Sarah Cannon created an automated process to identify colon cancer patients by developing software that utilizes artificial intelligence, which technology identifies patients at time of diagnosis, then routes positive pathology reports to a VCN who contacts the early-stage colon cancer patients by telephone to ensure appropriate care and assist in routing the patient to the appropriate interventions, such as surgical consult. The VCN helps patients understand their diagnosis, provides patient education materials, connects the patient to relevant resources, provides emotional support, and offers follow-up surveillance for office visits and colonoscopies based on NCCN and physician guidelines. The VCN also ensures all late-stage patients are connected with a complex GI navigator in their region for more hands-on follow-up.

Results: In 2017, Sarah Cannon navigated 656 colon cancers—334 early-stage I/II and 322 stage III/V. With our increased capacity, Sarah Cannon/HCA was able to maintain a 97% rate of follow-up for surgical or oncologic care with new diagnoses of all stages of colon cancer.

Conclusions: By creating a VCN program, Sarah Cannon/HCA has been able to improve continuation of care and compliance for early-stage colon cancer patients based on NCCN guidelines. By providing this resource to early-stage patients, we have greatly improved access to education and ensured compliance to physician-recommended follow-up care over 5 regions and 31 facilities.


  1. American Cancer Society. Key Statistics for Colorectal Cancer. Updated February 21, 2018.
  2. Sarah Cannon. Sarah Cannon Cancer Registry. 2015.
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Last modified: November 9, 2018

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