Navigating Patients With Gastrointestinal Cancer

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Colorectal cancer can present numerous complexities for the nurse navigator.
Colorectal cancer can present numerous complexities for the nurse navigator.
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. 

Nurse Navigators play a crucial role in the continuum of care for patients with cancer. This role spans from diagnosis to cancer survivorship and through the provision of individualized care based on identified patient needs and diagnosis. Patient navigation includes education around the disease state, tests such as colonoscopies and CT scans, and facilitating the scheduling of appointments.

Nurse navigators play a critical role in ensuring compliance and also act as patient advocate to help overcome barriers that could hinder timely cancer care. However, this role does not come without barriers. Patient factors such as financial and economic difficulties, poor health literacy, language barriers, and personal beliefs about the health care system could potentially prevent timely cancer care. Nurse navigators spend a substantial amount of time identifying high-risk patients and assisting with their individual needs. This is often ineffective when nurses are understaffed or have heavy workloads and have poor interdisciplinary team support. The complexities of the health care system and health insurance also play a role in preventing effective patient navigation.

Some patient barriers can be addressed from the first contact with a patient. A proper introduction and explanation of the role of the nurse navigator can help the patient understand that the navigator is a key contact for any needs throughout the continuum of care. A structured approach in identifying patient barriers to cancer care involving distinct and appropriate questions or carefully standardized questionnaires are useful. Nurse navigators should learn to anticipate, address, and support the most commonly seen barriers to timely cancer care and have resources or refer the patient to those resources. Transportation is one of those most common patient barriers to treatment adherence. A family support system and involvement should be encouraged when appropriate.

Colorectal cancer is a complex disease to navigate. Treatment can range from surgery for an early stage tumor to radiation, especially in rectal cancer, for neoadjuvant and adjuvant treatment and typically in combination with chemotherapy to decrease risk of local recurrence. Chemotherapy plays a major role in metastatic disease treatment and radiation can also be used in the palliative setting. 

In pancreatic cancer, Whipple surgery or distal pancreatectomy in early stage non-metastatic disease is an option. Radiation can be used in combination with chemotherapy in neoadjuvant, adjuvant stages of treatment and locally advanced or borderline disease. Chemotherapy is the preferred treatment for metastatic disease.

As patient educators, nurse navigators are responsible for reinforcing goals of care and setting realistic expectations for the patient. Key components in this phase should include an assessment of the patient's readiness to learn prior to any teaching; provision of teaching aides during education on treatments, expected side effects, appropriate interventions, and discussions about when to contact a health care provider. With common colorectal and pancreatic cancer treatment side effects, such as nausea, vomiting, neutropenia, fatigue, diarrhea, anorexia, and hair loss, patient education cannot be overemphasized to promote compliance and prevent complications.

Cancer survivorship is a crucial part of the cancer continuum of care. Survivorship should be guided by the acknowledged risk of recurrence which will guide follow up visits and routine tests. Nurse navigators have a role in creating a survivorship care plan, ensuring that patients understand the plan and assisting in scheduling appointments to ensure compliance.

Patient navigation in the cancer continuum can be complex and fragmented. However, a skilled nurse navigator helps to identify barriers to care, assists in providing/identifying appropriate resources, and creates fluid and timely cancer care for patients.

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