Care Transitions: When Lung Nodules Become Cancer

December 2020 Vol 11, No 12

Categories:

Lung Cancer
Monica Tapia, RN, OCN
Methodist Healthcare – San Antonio, TX
Veronica Campos, DNP, MSN, RN, NE-BC, OCN
Division Director of Navigation – San Antonio
Sarah Cannon, The Cancer Institute of HCA Healthcare

Lung cancer is the deadliest form of cancer among men and women in the United States. If discovered at an early stage, lung cancer is more likely to be treated successfully. The 5-year survival rates are 61% for those diagnosed with localized non–small-cell lung cancer (NSCLC) and 27% for those diagnosed with small-cell lung cancer (SCLC). However, if an individual is found to have metastatic disease at the time of diagnosis, the 5-year survival decreases significantly to 6% for NSCLC and 3% for SCLC. Unfortunately, symptoms of lung cancer are often not detected or reported until the disease is at an advanced stage. Thus, lung cancer screening for high-risk individuals and incidental lung nodule programs have been developed to aid in early detection and intervention.1

Early Detection

The purpose of a lung nodule program is to increase early-stage detection and curative treatment through lung cancer screening and follow-up of suspicious and/or incidental lung nodules. Our current program uses artificial intelligence technology to identify lung nodules in patients undergoing a CT scan in our emergency department. Once a lung nodule is identified, it is sent to the thoracic program navigator. The thoracic program navigator and thoracic cancer nurse navigator are integral in the continuum of care for a patient who is identified to have a lung nodule that evolves into lung cancer. The goal is to diagnose and initiate treatment during the early stages of disease when survival rates are the highest.

Care Coordination and Transition

Care coordination by the thoracic program navigator begins at the time of an incidental/suspicious finding of a lung nodule. The thoracic program navigator works closely with the physician to ensure the patient has a clinic visit with a pulmonologist, additional imaging, and all diagnostic procedures applicable to obtaining a biopsy and confirming the diagnosis. The thoracic program navigator is a patient advocate who assists patients in understanding the next steps of their treatment plan and ends navigation services at the time of a positive lung cancer diagnosis and transitions care to the thoracic cancer nurse navigator. The thoracic program navigator contacts the thoracic cancer nurse navigator via phone and sends a secure e-mail with the patient name, facility name, positive pathology findings, and any relevant information on the patient. The patient is introduced to the thoracic cancer nurse navigator, and the role of the navigator is discussed. The thoracic cancer nurse navigator provides patients, families, and caregivers with individualized education and support beginning at the time of diagnosis. Diagnosis, staging process, and potential treatment options to enable informed decision-making is discussed with the patient and their family. Barriers to care are addressed at the time of introduction, and the navigator serves as an advocate to remove barriers, including but not limited to insurance/financial concerns, transportation issues, health literacy, psychosocial support, and poor communication with healthcare providers.

The thoracic cancer nurse navigator also serves as a liaison between the patient and the multidisciplinary team to ensure a complete staging workup occurs expeditiously. The navigator works closely with the healthcare team to coordinate care and assists with scheduling appointments with the thoracic surgeon, medical oncologist, and radiation oncologist, if needed. The patient’s case may be presented at a multidisciplinary meeting to review and discuss treatment recommendations. Once the final plan of care is established, the navigator continues to provide services throughout the following touchpoints of care: neoadjuvant and adjuvant, preoperative/postoperative, radiation oncology, and medical oncology. The thoracic cancer nurse navigator ends navigation at the time of active treatment completion, survivorship, or transfer to hospice.

Considerations for Evaluation

The healthcare facility can evaluate the number of CT scans performed in the emergency department during a specific period to identify the percentage of nodules present. It is also important to assess the number of patients with nodules who have developed lung cancer. Furthermore, an assessment of the stage and type of lung cancer for those who have a positive lung cancer diagnosis should be completed. Monitoring the time from the date of diagnosis of lung cancer to first date of treatment could help identify opportunities to improve care.

Conclusion

Lung cancer survival rates are significantly lower when metastases are found at diagnosis. Lung cancer screening and incidental lung nodule programs aid in early detection, thereby improving patient outcomes. The thoracic program navigator and thoracic cancer nurse navigator are instrumental in care coordination starting with the identification of a lung nodule, continuing through care transitions, and ending once active treatment is complete. They collaborate to remove barriers to care, improve timeliness to care, and increase patient satisfaction.

Reference

  1. American Cancer Society. Lung Cancer: About Lung Cancer. www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html. 2020.
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Last modified: February 5, 2021

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