According to the American Cancer Society, lung cancer is the leading cause of death for both men and women in the United States. The average age for people diagnosed with lung cancer is 70 years, with most patients diagnosed at 65 years or older.1 Various methods are used to detect and stage lung cancer, such as a clinical evaluation, laboratory test, sample of tissue or fluid, chest x-ray, chest CT with contrast, PET scan, transthoracic needle aspiration and transbronchial needle aspiration during a bronchoscopy, surgical mediastinoscopy, or endobronchial ultrasound.2
Lung cancer is staged by identifying the size of the tumor and evaluating if the cancer has spread to nearby lymph nodes or distant parts of the body. A strong correlation exists between the length of survival and the stage of lung cancer at diagnosis. Treatment for lung cancer often involves multiple members of the healthcare team, which creates challenges to manage care. Surgical resection, chemotherapy, radiation, molecularly targeted therapies, and immunotherapeutics are treatment options available depending on the type and stage of lung cancer.2
The Role of the Lung Cancer Nurse Navigator
Navigation is initiated at the time of a positive lung cancer diagnosis and ends when the patient has completed active treatment. The lung cancer nurse navigator (LCNN) cares for cancer patients by ensuring they adhere to the treatment plan through the removal of barriers to care. Common barriers include but are not limited to the following: difficulty coordinating care, poor health insurance coverage, lack of health insurance, financial toxicities, transportation concerns, lack of caregiver support, and language barriers. The treatment plan for a patient with lung cancer is complex, thus demanding frequent patient communications from the LCNN. Using a multidisciplinary approach, the LCNN establishes trust with the healthcare providers and patients to coordinate care.
It is important to educate patients about their cancer to enable them to make informed decisions about their care. The navigator not only provides emotional support to the patient but also to the patient’s family and caregiver. The LCNN enhances patient outcomes and the experience by improving access to and utilization of customized resources to meet their needs. Patient satisfaction is assessed through the use of a survey consisting of 6 questions that evaluate the experience with the navigator (Table 1).
The LCNN partners with physicians to achieve the best outcomes for patients living with cancer. Physicians are notified by the LCNN when the patient is at risk of not adhering to the treatment plan, or if barriers to care have the potential to negatively impact the treatment plan. Monthly reports on timeliness to treatment from first diagnosis, number of new and active patients navigated, and missed opportunities are shared with physicians. The LCNN attends and participates in bimonthly tumor conferences by providing patient updates to the multidisciplinary team.
Nurse Navigator Perspective
Monica Tapia, RN, an LCNN at Methodist Healthcare, a part of Sarah Cannon, offered insights on her past experiences in the oncology field. When a nurse is asked why he/she chose their profession, a typical response is, “I have a desire to help people.” It was that underlying desire to help others that led Monica to the field of oncology. Monica’s passion is to provide care and support for patients facing a cancer diagnosis.
After working in oncology for 15 years, Monica now finds herself in an LCNN role. When she tells people she is a nurse navigator, more often than not, the response is, “I have never heard of that, what is a navigator?” Monica understands that by definition, a nurse navigator is a clinically trained individual responsible for identifying and addressing barriers to timely and appropriate cancer treatment and guiding the patient through the cancer care continuum.3 By definition, a nurse navigator guides the patient, but Monica recognizes that the role of navigation extends itself to a much broader spectrum.
Monica stated “oncology patients often encounter many challenges and find themselves overwhelmed while attempting to navigate the healthcare system.” She provides support to patients and caregivers, while also serving as a central point of contact for the multidisciplinary team. Monica believes this is especially helpful in lung cancer patients because their team can involve multiple specialists, including a pulmonologist, cardiothoracic surgeon, medical oncologist, and radiation oncologist. She also directly facilitates care and bridges gaps between members of the healthcare team to improve the patient’s cancer journey.
Patient and Caregiver Perspectives
Several patients and caregivers were interviewed by the LCNN using open-ended questions to evaluate their perspectives on navigation services and the impact of navigation on lung cancer patients (Table 2).
Most patients had never heard of a nurse navigator and did not have a clear expectation of the role. After patients were informed of the navigator role, they recognized the navigator would be a good resource they could turn to for answers during their cancer journey. One patient stated, “I didn’t even know this kind of nursing role existed, but I sure am glad I ended up with a navigator. I quickly came to realize how valuable this service was. I had so many questions and didn’t know what to expect or what the next steps were.”
All patients and caregivers felt the LCNN positively affected their care. Patients felt the LCNN was available when needed to help answer questions to better understand the care plan. One patient commented, “My navigator has been there for me every step of the way from the time I was diagnosed and continues to check up on me now that I’m on a maintenance schedule. She attended several appointments with my wife and me and was able to hear my doctors’ recommendations and could explain or elaborate if we had questions. She took notes for us and was able to help us remember things we forgot or missed altogether. My navigator made me feel like I was never alone.”
Another patient describes how the LCNN had established relationships with the team and was able to coordinate care effectively. “Any time I had a problem I called my navigator, because she had direct contact with my team. When I was having trouble getting my cancer medication from the pharmacy, my navigator was able to expedite delivery and coordinate for me to get a starter pack so that I could begin my treatment. When I had side effects from my treatment, she explained what was expected and unexpected, so my wife and I knew what to monitor. When she thought I might be developing pneumonitis, she was able to contact my oncologist and help coordinate for an immediate referral to a pulmonologist. I was able to receive treatment right away and did not have to permanently discontinue my cancer medication.”
A patient’s son was appreciative of navigation services because it allowed him to focus more on his dad. “Words cannot describe how our navigator’s care, knowledge, and experience helped. She lifted so many burdens from us so we could concentrate on my dad. She made appointments, tracked down results, called, and followed up on a frequent basis.”
Another caregiver, the patient’s sister, was pleased the LCNN provided assistance with transportation and financial needs. “My sister and I live on a fixed income and have very limited transportation. When we were told my sister would need radiation every day for 4 weeks, we were beside ourselves. I thought I was going to have to stop working just to be able to take my sister to her appointments. Our navigator was able to coordinate with the American Cancer Society for transportation to and from her radiation appointments. She was also able to help us get gas cards and copay assistance through a foundation to help with some of our costs. She spoke with the financial counselors at our oncologist’s office and did her best to ease the financial burden so we could focus on getting better to fight the cancer.”
All patients and caregivers would definitely encourage other patients with lung cancer to seek out a navigator. One patient had already done so for a dear friend who was recently diagnosed with lung cancer. Another patient expressed the need for anyone with cancer to seek a navigator to better their cancer journey. “My navigator is an educator, a patient advocate, an encourager, and a medical professional. My wife and I believe my navigator is an integral part of my team. Although I have advanced lung cancer, my navigator has encouraged me every step of the way and has managed to make my cancer journey a positive experience.”
Patients and caregivers were open about sharing their experience with the LCNN. Overall, the individuals interviewed had a positive view on navigation services and provided specific examples of how the LNCC removed barriers to care.
Lung cancer is the leading cause of death in the United States. The treatment and management of lung cancer is complex and may present challenges for patients to remain adherent to the treatment plan. It is important for the LCNN to remove barriers to care to ensure the patient adheres to the treatment plan. Although the role of navigation is not widely known, the effects of navigation are tremendously valuable to patients and caregivers.
- American Cancer Society. Key Statistics for Lung Cancer. www.cancer.org/cancer/lung-cancer/about/key-statistics.html. 2019.
- Detterbeck FC, Massone PJ, Naidich DP, Bach PB. Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e78S-e92S.
- Academy of Oncology Nurse & Patient Navigators. Helpful Definitions. https://aonnonline.org/education/helpful-definitions.