Thoracic oncology navigation involves directing patients to resources, providing education about the disease and its treatments, coordinating patient care, providing information on benefits and assisting with insurance authorizations, and bridging the communication gap between patients and the health care team. The role of the thoracic oncology nurse navigator and how it fits into the multidisciplinary lung cancer (MDLC) team at UMass Memorial Medical Center in Worcester, Massachusetts, was presented by Debra Maddox, RN, BSN, OCN, at the NCONN Conference in Atlanta, Georgia.

“You have cancer.” These dreaded words are a call to action—by the thoracic nurse navigator. At UMass Memorial Medical Center, the thoracic nurse navigator will set up an appointment for the patient with a new lung cancer diagnosis to meet with the MDLC team within 5 business days.

The MDLC team members may include an oncology nurse navigator, a medical oncologist, a radiation oncologist, a thoracic surgeon, a clinical health psychologist, a nurse practitioner, an oncology research nurse or clinical research coordinator, the palliative care team, an American Cancer Society patient navigator, a clinical oncology social worker, a financial counselor, and a smoking cessation counselor. Additional team members may be added to provide other support services such as nutrition, physical therapy, occupational therapy, and cultural/spiritual needs.

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The team meets weekly to discuss patient cases. A new patient case is discussed prior to the team visit. At UMass Memorial Medical Center, the patient stays in one examination room, and the appropriate care team members come to the patient and family/caregivers. By the end of the visit, a personalized treatment plan has been designed for that patient. Patients are advised that this initial visit may last for 2.5 to 4 hours, Maddox explained. But she said patients feel better knowing they will meet the whole team and have a care plan in place at the end of the visit.

Most cases of lung cancer are distant (metastatic), which has the lowest 5-year relative survival rate. Localized lung cancer that is confined to the primary site has the highest 5-year relative survival rate. Patients with lung cancer and their families go through Kubler-Ross’ stages of grief—denial, anger, bargaining, depression, and acceptance. Anticipatory grieving is also experienced, and a feeling of loss of control. A hope line is available to patients to help them cope. The call center is staffed by experienced oncology certified nurses and oncology patient access schedules; oncology managers answer the calls after hours. UMass recently added an online appointment feature, which are addressed that day or the next business day.

A significant role for the oncology nurse navigator is to help patients manage their distress. Feelings of guilt can be very strong, for example, because the patient may have quit smoking but after having smoked for many years, lung cancer developed.

Traditional strategies for coping with lung-cancer related distress are getting adequate rest and nutrition, walking or exercise as tolerated; complementary strategies are music, aromatherapy, guided imagery, and the healing arts; and alternative strategies are shopping, going to the movies (or some other activity the patient enjoys), gardening, or hobbies. Keeping a journal can be a very effective coping strategy for some patients.

An oncology nurse navigator is key to providing comprehensive patient-centered care, and a multidisciplinary lung cancer team is ideal, concluded Maddox. Oncology nurse navigators should be creative and responsive to individual patients, no two patients are alike so cancer care is not one-size-fits-all. Maddox believes thoracic nurse navigators should expand their resources and recommends working with at least one national group such as NCI, ACS, LCA, etc, and she also recommends participating in at least one lung cancer awareness campaign per year.

Speaker:  Debra J. Maddox, RN, BSN, OCN, UMass Memorial Medical Center, Cancer Center of Excellence.