ORLANDO, FL—Gastrointestinal oncology nurse navigation improved the timeliness and quality of care for patients with GI malignancies, according to research presented at the ONS 40th Annual Congress.
Data collected over 3 years demonstrated improved patient outcomes and increased adherence, both to National Comprehensive Cancer Network (NCCN) guidelines and national benchmark recommendations, said Teresa Labovich, RN, MSN, OCN®, of Penrose Cancer Center in Colorado Springs, Colorado.
“Although breast cancer navigation has been around since 1998, the gastrointestinal oncology nurse navigator is a relatively new and unique position that can remove barriers to care, and facilitate timely, comprehensive, and evidence-based care for patients,” said Labovich in explaining why the program was instituted.
In developing her program, Labovich mapped out the various steps and providers patients must go through from initial test results, diagnosis, and on to treatment.
She also created quality indicators for her navigation program that included overall importance, evidence, measurability, demonstrated value, intentional interventions, and standards accreditation.
NCCN guidelines recommend initiating adjuvant chemotherapy in patients with colorectal cancer within 30 days of surgery.
For each 30-day delay, overall survival is decreased by 14%. Labovich reported that 90% of patients met the goal of diagnosis to chemotherapy. “I would have wanted 100%,” she said. But factors out of her control, such as complications, would make that an unrealistic goal.
Although national benchmark recommendations for patients with rectal cancer are to initiate treatment within 4 to 6 months of diagnoses, “extrapolating from the colon data, the team felt more comfortable initiating neoadjuvant chemoradiotherapy within 30 days of diagnosis,” she reported. Successful navigation resulted in 90% of patients initiating treatment within the 30 days.
In addition, the NCCN guidelines recommend screening all patients younger than 50 years for Lynch syndrome, but after careful scrutiny of the literature, as well as our performance in screening patients younger than 50 years, we implemented universal screening on 100% of our patients with colorectal cancer, regardless of age, to include monitoring and facilitation of proper follow-up diagnostic tests, and referrals to the genetic counselor.
The process was successfully implemented through targeted navigator interventions that included provider and staff education, tracking and monitoring pathology results, and the gastrointestinal oncology nurse navigator facilitating patient flow through multiple disciplines.