LBA Category VI: Research, Quality, Performance Improvement

October 2022 Vol 13, No 10 —November 8, 2022

D1 Benefits of the Cancer Navigation Program in a Private Oncology Institution

Anna Carolina Riul Messias, André Paranzini Faria, Daniel do Espirito Santo, Alexandre Andrade dos Anjos Jácome

São Paulo, Brazil

Background: Cancer navigation programs (CNPs) contribute to decrease the interval time to start cancer treatment and to improve patient adherence to treatment, factors that influence survival and quality of life of cancer patients. CNPs have been managed and performed by the nurse navigator (NN) and implemented in oncology outpatient units in Brazil. However, the measurement of the impact of CNPs needs to be better investigated in our country.

Objective: To demonstrate the benefits for patients who have been followed up by the CNPs, such as the impact on interval time to start cancer treatment and the effectiveness of clinical management (ECM) after starting cancer therapy.

Methods: A retrospective study based on data analysis from 2 outpatient oncology units with CNPs for patients undergoing venous cytotoxic chemotherapy and immunotherapy from January to June 2022. The CNPs consist of linking the patient to a reference NN, who is present during the continuum of care from the first appointment, supporting with follow-up appointments and exams, in addition to contacting the patient 3 days after the start of the treatment and during the chemotherapy nadir period to monitor adverse events. Two indicators will be evaluated: ECM, defined as the percentage of contacts with the patients that resulted in improvement of their symptoms, and the mean time (in days) between the definition of drug treatment and its initiation (MTI). These indicators will be compared with conventional data (without CNP) recorded from January to December 2021.

Results: The MTI was analyzed in 310 patients, of whom 217 (70%) were women, and 201 (65%) were ≥50 years old. Patients with breast, pancreatic, and colorectal cancers were the most frequent, accounting for 46.8%, 5.8%, and 5.5%, respectively. The MTI was 10 days (range, 4-17), compared with 30 days in 2021. To analyze the ECM, 745 patients were analyzed, generating a total of 1293 contacts. An effectiveness of 93% was obtained.

Conclusion: The CNP showed a high ECM and decreased the MTI, which contributes favorably to the prognosis of the cancer patients. The present study reinforces the literature data that the CNP positively impacts on the continuum of care of cancer patients. Strategies to expand the program in private and public institutions should be discussed so a progressively larger portion of patients could have access to these improvements.

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D2 Improving Patient Understanding of Testing in Precision Medicine with Consistent, Plain Language Testing Terms

Kristi M. Griffith, MSN, RN, CHPN, OON-CG1; Angela James, MBA, LMSW, MEd, OSW-C, OPN-CG1; Christine Verini, RPh2; Nikki Martin1

1LUNGevity Foundation; 2CancerCare

Background: Patients rely on oncology navigators to simplify complex medical content by eliminating professional jargon, making clinical information more understandable. In this age of precision medicine, navigators must be able to confidently explain testing and how results may impact treatment. The evolving testing landscape, new actionable and emerging biomarkers, and various platforms and scope of testing pose an ongoing challenge. When navigators successfully provide education that patients understand, patients gain a better appreciation for why biomarker testing is critical.

Objectives: A working group of 23 patient advocacy groups, 5 professional societies, and 19 pharmaceutical and diagnostics companies identified patient confusion and inconsistent terminology as a possible barrier to uptake in biomarker and germline testing for cancer patients. This partnership aimed to identify and recommend consistent plain language terms for somatic and germline testing across cancer types. Consistent terminology should improve awareness and applicable understanding of types of testing for enhanced communication between navigators and patients.

Methods: Following a stakeholder roundtable regarding precision medicine barriers, working group members explored how consistent terms could improve patient understanding. We conducted a framework analysis for testing by cancer type, purpose of test, biospecimen source, terms used in patient education, and preferred plain language term. The preferred germline testing term was selected using survey results from working group members and 1700 patients within their constituencies.

Results: Thirty-three different terms were noted across all cancers in patient education related to biomarker and genetic and genomic testing. Based on survey results and discussions, we agreed to create separate umbrella terms that distinguish between somatic and germline testing with additional context provided for each specific cancer community. “Biomarker testing” was selected for testing for somatic mutations and other biomarkers. “Genetic testing for an inherited mutation” and “genetic testing for inherited cancer risk” were selected for germline testing. A white paper is available at

Conclusions: Consistent, plain language testing terms should reduce patient confusion, and improve communication and shared decision-making. The unique relationship between navigator and patient allows for personalized education regarding testing, treatment decisions, and additional implications such as genetic counseling and clinical trials. Oncology navigators can improve best practices in patient education and communication by influencing multidisciplinary team members to adopt the recommended terms for patient education and by partnering with patient advocacy organizations for patient education on testing/precision medicine.

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D3 What’s Your Take? We Don’t Know If We Don’t Ask!

Stephanie Bonfilio, MSN, RN, OCN, ONN-CG; Stacey Ritter, BSN, RN, OCN; Karen Burke, BSN, RN, OCN; Jennifer Mulholland, BSN, RN, OCN; Katie Barrett, BSN, RN, OCN

St. Elizabeth Healthcare, Edgewood, KY

Background: Oncology nurse navigators (ONNs) must advocate and demonstrate their value to the cancer patient and the hospital system. Building a robust oncology patient navigation program (OPNP) must include buy-in from key stakeholders, including cancer program and referring providers, as their support is critical for ensuring patients receive referrals early in the care continuum. When providers understand the importance of navigation for their patients with the increased level of support and resources, the value of the OPNP is discernible.

Objectives: To gain provider knowledge and understanding of the OPNP to target areas for improvement and program growth.

Methods: An electronic Microsoft Forms survey was e-mailed to all providers (MDs, APRNs, PAs) in the following areas: medical, radiation, and surgical oncology; thoracic surgery; pulmonology; ear, nose, and throat; and GI surgery. This survey used a Likert scale to assess 8 areas of understanding with the option to answer “Yes,” “No,” “N/A,” or “Unsure.” The questions assessed the respondents’ level of understanding of the role of the ONN; the level of perceived inclusion in decision-making about the OPNP; knowledge of how to refer, identify appropriate patients, and identify their navigator; provider perceptions of patient feedback; and the impact on clinical outcomes.

Results: The survey was sent to 65 providers, with a response rate of 49.2% (n = 32). The data revealed the ONNs are positively impacting both patients and the cancer care team as evidenced by these responses: 78% feel the ONN has a positive impact on patient experience, 72% feel they have a positive impact on clinical outcomes, 85% were likely to refer their patients to the program, and 88% knew how to do this. The OPNP is less than 3 years old, so it was important to assess understanding of the ONN role and how the program is growing. The survey demonstrated the following as areas for the program to target: 59% felt the ONN role was clearly defined, 53% felt included in decisions made about the program, and 66% knew how to determine if an ONN was following their patient.

Conclusion: The survey results will guide future growth of the oncology patient navigation program and the ONN role. Having an almost 50% response rate indicates many providers are interested in ensuring the program supports patients in the most comprehensive way possible. The role of the ONN is always to support and advocate for the patient. This survey also demonstrates the need to ensure the ONN role is clearly defined, and that providers are aware of their impact on patients. To gain additional feedback, a patient survey is being created to obtain qualitative data regarding patient experience, but additional work must be done to utilize navigation metrics to show the impact the ONN has on clinical outcomes to build on these results. And lastly, to standardize practices and continue to build a sustainable program ensuring provider education is essential, including new provider orientation to the ONN role and program and regular navigation updates to providers.


Gordils-Perez J, Schneider S, Gabel M, Trotter K. Oncology nurse navigation: development and implementation of a program at a comprehensive cancer center. Clin J Oncol Nurs. 2017;21:581-588.

Strusowski T. St. Elizabeth Healthcare: Oncology Patient Navigation and Best Practices [PowerPoint Presentation]. Edgewood, KY. 2018.

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Last modified: August 10, 2023

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