Navigating Patients with Hematologic Malignancies

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An ONN can work with the inpatient/outpatient teams to address barriers to outpatient care.
An ONN can work with the inpatient/outpatient teams to address barriers to outpatient care.
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. 

Hematologic malignancy is a broad category of blood cancers that arise from stem cells in the bone marrow or lymphoid tissues. Blood cancers include acute and chronic leukemia, Hodgkin and non-Hodgkin lymphoma, multiple myeloma, myelodysplastic syndrome, and the myeloproliferative neoplasms (MPNs) polycythemia vera, essential thrombocythemia, and myelofibrosis.

New cases of blood cancers according to the American Cancer Society Cancer Facts and Figures 2017 are estimated to be 172,910 total cases; this includes lymphoma (47%; 80,500 cases), leukemia (36%; 62,130 cases), and myeloma (18%; 30,280 cases). Five-year relative survival rates have improved dramatically over time and are approaching 89% for Hodgkin lymphoma, 73% for lymphoma, 63% for leukemia, and 50% for myeloma.

Hematologic malignancies can present with patients who are ill enough to require acute hospitalization to stabilize their medical condition and initiate treatment for the underlying cancer. Patients who come through an emergency room for acute symptoms have not established an outpatient oncology home. For example, a patient may require inpatient stays for up to 4 to 6 weeks for a diagnosis of acute myelogenous leukemia (AML) and will need ongoing outpatient management. Some patients with AML move eventually to hematopoietic stem cell transplant (HSCT). The costs of management for AML are linked to significant economic burden, especially where HSCT is utilized, because of repeated hospitalizations, expensive treatments and medications, and the need for labor-intensive supportive care infusion services in the ambulatory setting.   

Oncology nurse navigators (ONN) coordinate the cancer plan and transition in care to ensure safe and timely access to the ambulatory team. At University of California, Davis Medical Center, the ONN is based in the Cancer Center Clinic and is uniquely positioned to proactively anticipate supportive care services that improve quality of life. As such, the ONN is present from diagnosis through trajectory of illness and becomes an integral point of contact for the patient, family, and members of the care team. 

The ONN develops strong patient and family relationships and provides education and support during repeated hospitalizations and in the outpatient setting. By vetting and removing barriers to outpatient care, the ONN facilitates a safe and early discharge from acute hospital admissions. The ONN works with the inpatient/outpatient teams to address barriers to outpatient care that can impact ongoing management. Timely access to outpatient and infusion services at discharge is important to decrease readmission rates. 

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