The following article features coverage from the 2020 ONA Virtual Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage. In addition, the original presentation is available for on-demand viewing and CNE credit until September 2021, click here to access.

 

Breast cancer is the most common cancer in women except for skin cancer. One in 8 women will develop breast cancer in their lifetime. Breast cancer will be diagnosed in an estimated 276,480 women in the United States in 2020, and 42,170 will succumb to their disease.

The rate of breast cancer deaths has decreased by 40% since the 1980s due to early detection and improvements in treatment. However, disparities in care exist, resulting in poor outcomes. The disease is less likely to be diagnosed in African American, Hispanic, American Indian, and Alaskan women at an early stage. African American women are more likely to develop breast cancer at a younger age, have a higher risk of developing triple-negative breast cancer, and are more likely to succumb to their disease.

The role of breast cancer navigation is to overcome barriers to care throughout the care continuum. Breast cancer navigation promotes access to care, timely treatment, and adherence to therapy resulting in better outcomes. Breast cancer navigator must possess the knowledge and skills required to earn a trusting relationship and rapport with their patients. Navigators should assess each patient to identify their potential barriers to care. Some common barriers to care are financial issues, transportation, fear, depression, addiction, mental health disorders, and poor social support. Lack of medical literacy and knowledge of their disease and treatment are additional barriers.

Breast cancer screening is important to identify breast cancers at an early stage. However, there is a lack of consensus in the recommended screening guidelines between the United States Preventive Services Task Force (USPSTF), the American Cancer Society, and a consortium of physician groups such as the American College of Radiology, the American College of Obstetrician and Gynecologists, and the American Academy of Physicians. Primary care provider recommendation is a strong predictor of whether breast cancer screening occurs.


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A mechanism to remind patients about their breast cancer screening should be in place, and underserved women proactively linked to the National Breast and Cervical Cancer Early Detection Program or alternate free screening program. Navigator involvement in the screening process and follow up of suspicious findings is important to ensure timely access to appropriate care.

Patient understanding of medical information is a prerequisite to treatment adherence. Assessment of patient understanding of the diagnosis and treatment recommendations is critical. Navigators can simplify complex information for the patient and promote increased understanding, enabling a more informed treatment decision.

The work of nonclinical navigators improves the overall quality of care simultaneously decreasing healthcare delivery costs. Nonclinical navigators are an important link, providing focus to a variety of patient social services: social workers, financial counselors, food banks, transportation services, support groups, and wellness programs. Nonclinical navigators provide invaluable 1-on-1 emotional support that helps patients cope with their disease.

At Vidant Cancer Center, we learned through experience that nonclinical breast navigators enabled our breast nurse navigator to focus on clinical barriers, while they addressed nonclinical barriers. By implementing nonclinical breast navigator services into our breast cancer program, we were able to increase the number of new patient encounters by 29% and return patient encounters by 27%.

Ensuring the successful outcome of breast cancer survivorship requires patient access to early breast cancer screening and patient support from a breast cancer navigator.