The following article features coverage from the 2018 Oncology Nurse Advisor Navigation Summit. Click here to read more news highlights and expert perspective from the Summit on Oncology Nurse Advisor. 

A diagnosis of head and neck cancer can be devastating to a patient and their family members. Unlike other cancers, the effects of head and neck cancer can be difficult to hide and for many the diagnosis is written quite literally all over their face. Acute and long-term effects and toxicities of surgery, radiation therapy, chemotherapy, and the cancer itself can rob patients of so much. The ability to eat and drink normally, speak, and even kiss those we love can have profound influence on a person’s daily activities. The ability to work, maintain family relationships, and engage in society can be adversely impacted.

The head and neck oncology nurse navigator (ONN) is a unique and critical position to help patients, their families, and their caregivers as they face their diagnosis and undergo treatment. The core competencies delineated by the Oncology Nursing Society provide a foundation for helping patients throughout the continuum of care. Coordination of care, open and productive communication, and educational strategies guide the professional behaviors of the ONN. Identification and attention to the individual’s barriers to care, education, referrals, and patient-centered care are all important aspects of the interactions of the ONN with their patients.

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Identification of the risk factors for the various sites of disease in head and neck cancer can help the ONN make appropriate referrals such as tobacco cessation or substance abuse programs.

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Many nurses working in the ambulatory setting are unfamiliar with the complex surgical management that patients have had before receiving adjuvant therapy. It is my strong belief that oncology navigators should understand where the patient has been and what they have gone through before coming to the infusion suite. 

Radiation therapy, chemotherapy, and other systemic treatments have many side effects and associated toxicities and it is important to understand the various arms of treatment, the benefits and side effects of the treatment, and the role of the nurse navigator through the continuum of care from diagnosis to survivorship.  The ONS Core Competencies and interventions can be nicely intertwined with the needs of this challenging population.

Racial disparities, health literacy, insurance status, financial considerations, family dynamics, and transportation are barriers that should be assessed from the beginning with interventions geared to the special needs of each patient as well as the cancer diagnosis, treatment plan and coordination of care.

A well-functioning organized and communicative multidisciplinary team is vital to the multidimensional care of patients with head and neck cancer. The ONN is in the position to make appropriate referrals to members of the team at the right time, such as a registered dietician (whose role is to monitor weight loss, nutritional status and makes recommendations to gain or stabilize weight) and a speech therapist (who assesses for dysphagia, aspiration, and maintenance of swallowing function and is a key member of the team for most head and neck cancer patients. In addition the speech therapist may work with patients with dysphonia or the total loss of speech due to surgery or the effects of the cancer.)

The effects of radiation on the oral mucosa and teeth can be long-lasting and permanent.  Referral to a skilled and knowledgeable dental team is very important for this population and will remain so for the remainder of their lives. Unfortunately; this care is frequently out of the reach of many patients due to cost. Because this care is not covered by health insurance patients are frequently left to live with broken, loose, and painful teeth. Obtaining this important care can be one of the most challenging aspects for patients with head and neck cancer and is an important opportunity for assistance from the oncology nurse navigator.