Lay Navigation Program Improves Health Care, Health System Use, Costs for Older Cancer Survivors

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The number of older cancer survivors in the United States is estimated to increase to 26.1 million people by 2040.
The number of older cancer survivors in the United States is estimated to increase to 26.1 million people by 2040.
The following article features coverage from the 2017 ONA Navigation Summit in Austin, Texas. Click here to read more of Oncology Nurse Advisor's conference coverage. 

AUSTIN, Tx — Use of a navigation system targeted to older cancer survivors can reduce numbers of hospitalizations, emergency department (ED) visits, and intensive care unit (ICU) admissions and lower health care costs, according to a presentation at the 2017 ONA Navigation Summit.

The number of older adult cancer survivors in the United States is estimated at 15.5 million people in 2016; in 1975, that number was 3.6 million, and it is estimated to increase to 26.1 million people by 2040. Severity of disease and of treatment are increased in this population, further exacerbating the physiologic effects of aging and leading to greater frailty, increased polypharmacy, and increases in ED visits, hospitalizations, and ICU admissions.

 

Due to the higher prevalence of pre-existing conditions and greater likelihood of new-onset morbidity after completing cancer treatment, cancer centers are challenged by a need for survivorship care plans that can meet the unique needs of the older cancer survivor.

To address this need, a team at the University of Alabama Birmingham (UAB) Health System Cancer Community Network led by Edward Partridge, MD, primary investigator, developed the Patient Care Connect Program (PCCP). The program was supported by an Innovation Challenge Grant from the Centers for Medicare & Medicaid Services (1C1CMS-331023). The goals for this program were to improve the health, to improve the health care delivery, and to lower costs of survivorship care for older cancer survivors, Karen Meneses, PhD, RN, FAAN, told Summit attendees. 

PCCP is a lay navigation program integrated into the care system that serves adults aged 65 years and older who are undergoing cancer treatment or follow-up care. The program operates in 12 cancer centers in 5 states in southeastern United States (Tennessee, Mississippi, Alabama, Georgia, and Florida). It is staffed with 12 nurse site managers and approximately 40 lay (nonclinical) navigators.

The PCCP care plan is based on a distress assessment using the National Comprehensive Cancer Network (NCCN) Distress Thermometer. The care plan is initiated with the PCCP navigator administering the distress assessment to the survivor.

If the survivor's score is less than 4, the navigator evaluates the cause of distress and offers the appropriate resource to assist with the distress item. The distress assessment is repeated in 5 to 7 days.

If the survivor's score is 4 or higher, the navigator refers the survivor to the site manager or to the physician, who address the distress item, and the navigator follows up with the survivor after the intervention. As with those survivors whose distress scores are lower, the distress assessment is repeated in 5 to 7 days.

Enrollment in the program began in March 2013. Survivors were not randomized to the PCCP program, rather it was offered to them. The survivors could also request assistance with distress regardless of their distress assessment score. Assistance requests were closed only if the survivor stated no need for further assistance.

Requests for assistance were resolved to survivor satisfaction in 90.7% of cases. A survey of 360 navigated patients and a random group of Medicare beneficiaries who were potential PCCP users indicated 82% were very satisfied or satisfied with their care and 88.3% would recommend PCCP navigation to other patients.

Over 8 quarters from the beginning of enrollment, Medicare costs were reduced by an estimated $9000, the number of hospitalizations were reduced by approximately 75%, and significant reductions were seen in ED visits and ICU admission.

The number of older cancer survivors is expected to increase to an estimated 26.1 million in the next 20 to 30 years. Lay navigation programs can be expanded as health systems transition to values-based health care to meet the needs of this growing population. “Use of PCCP, a navigation system targeted to older cancer survivors, health care costs and health care use declined for navigated patients compared with matched group of comparison patients,” concluded Dr Meneses.

Read more of Oncology Nurse Advisor's coverage of the 2017 ONA Navigation Summit by visiting the conference page.

Reference

1. Meneses K. Innovative navigation strategies. Oral presentation at: 2017 ONA Navigation Summit; June 15-17, 2017; Austin, TX.

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