Objective: The early phases of cancer care have received relatively little research attention. The period of time surrounding the diagnosis and shortly thereafter involves information-seeking, momentous decision-making, and navigation among multiple providers at a time of intense emotional stress. The purpose of this 5-year proposal is to develop and test the efficacy in a randomized, controlled clinical trial of an oncology nurse navigator (ONN) program to support cancer patients early in their course. Our primary goal is to assess the impact on quality of life, quality of care, and other outcomes of an ONN program for newly diagnosed breast, colorectal, and lung cancer patients.
Methods: We enrolled 108 eligible primary care providers from 11 group health (GH) clinics. These providers were randomized, and their newly diagnosed lung, breast, and colorectal cancer patients either receive enhanced usual care or the ONN program. First, potential participants were ascertained rapidly from newly diagnosed lung, breast, and colorectal cancers using automated pathology data. Invitation letters were mailed to each of these patients. Second, the enrolled patients in the intervention group were assigned an ONN, who works with them for approximately 16 weeks. Both groups are mailed a packet of cancer care information specific to the patient’s type of cancer. To study the outcomes, we administered questionnaires to all study patients and their respective clinicians at baseline, at 4 months, and at 12 months.
Results: Our project team has developed an early cancer notification system based on automated data that can identify new breast, colorectal, and lung cancer diagnoses within 3 days of biopsy. We have successfully implemented an ONN program that addresses patient questions, symptoms, psychosocial needs, and facilitates timely, coordinated care. The recruitment phase of the study has just been completed, and we currently have baseline data on all 250 enrollees and preliminary follow-up data on most participants.
Conclusions: The ONN program has been well-received in the GH delivery system. The process of continuing improvement to the intervention has helped to make the ONN program a very effective support tool for cancer patients. We currently are working with the GH leadership to translate the results of this study into an ONN program that is a standard part of cancer care at GH.