Without the benefit of a standing multi-disciplinary clinic to service patients with head and neck cancer, an ear, nose, and throat (ENT) a team at Center for Cancer Care and CORE ENT Physicians in Exeter, New Hampshire, proposed a virtual navigation that would allow these patients to follow the same pathway as clinic patients but without the formal clinic setting. The results of their program was presented in a poster by primary author Cheryl A. Bougie, RN, OCN, an oncology nurse navigator at the Center for Cancer Care, at the NCONN Conference in Atlanta, Georgia.

The primary goal of patient navigation is to identify and assist patients with barriers to cancer care.  As the role developed, navigators gradually become an integral part of the patient’s care team. They assist with identifying the appropriate treatment pathway as well as coordinate the timeliness to care. The services of patient/nurse navigators primarily focus on the higher-volume disease sites, such as breast, lung, and prostate cancers. However, as oncology providers and patients experience the benefits of navigation, the demand for this service has grown, Bougie’s team recognized a need to explore navigation for lower-volume disease sites. 

First, they identified the primary pretreatment services that these patients need, then developed a process for pretreatment referrals and timely consults for developing an appropriate plan of care.  The flow ensures the patient receives the appropriate care at the right time.

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The next step was to test the method. Three new patients with a diagnosis of head and neck cancer served as the trial patients. The result was the patients received early, streamlined access to supportive care services, and in all cases, timely referrals for oncologic treatment. Early education regarding the treatment plan and expected effects of treatment improved the patients’ experience by eliminating some of the fears and anxiety of what to expect. In addition, having a navigator as a direct contact person to assist the patient with communication among all members of the care team reduced the patient’s anxiety about managing multiple phone numbers and appointments for so many providers and support staff.

A primary communication method, a navigation summary, was developed for new consults. The navigation summary reduces delays to treatment and provides the care team with a current status of the patient’s pathway to care.  

The head and neck cancer virtual navigation trial period had been going for approximately 1 month at the time of presentation; however, early feedback from both the providers and the patients indicates that the program will continue to develop into a standard of care for all patients with head and neck cancer who are referred into our cancer center. 

The current staff includes only one full-time nurse navigator, and next steps include an assessment of Exeter Hospital’s need for additional staff to support these patients.  Staffing needs will continue to be assessed and monitored, and as more data are collected, a method for accurately measuring patient outcomes of the patients who are navigated from diagnosis through completion of treatment will be developed. 

First author: Cheryl A. Bougie, RN, OCN – Oncology Nurse Navigator, Center for Cancer Care, Exeter, NH.

Co-authors: Dr. Taraneh Azar, MD; Dr. Eric Anderson, MD; Dr. Gregory Danielson, MD, ENT Core Physicians, Exeter, NH; and Dr. Gary Proulx, MD – Medical Director, Radiation Oncology, Center for Cancer Care, Exeter, NH.