Category Archives: Oncology

Access to Oncofertility Options for Rural Cancer Patients

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Cancer Navigators working in smaller rural cancer centers often face a challenge in arranging a timely fertility consult for a newly diagnosed cancer patient. Time constraints due to the need to begin cancer therapy, along with the distance required for the patient to travel for the consult, frequently cause patients to forgo the fertility preservation options discussion before treatment. Following cancer treatment, many patients want to investigate their fertility options.

Cancer Navigators not working in a facility with a fertility specialist, now have access to an online  Fertility Patient Navigator, providing the opportunity to better educate young patients about fertility options.  The new website, hosted by the Department of Obstetrics and Gynecology at Northwestern, has been designed to assist young patients in learning about their reproductive options in the midst of a cancer diagnosis or after treatment for cancer. The website, Patient Navigator for Fertility Preservation, provided by the Oncofertility Consortium of Northwestern University, has a Fertility Patient Navigator, Kristin Smith, available to answer questions about reproduction options surrounding a cancer diagnosis. She is experienced in talking to patients and providers about the best reproductive options for cancer survivors at all stages of treatment.

The web site has an interactive tool to provide information for patients before or after puberty, and before or after cancer treatment.  At his/her convenience, the patient can watch tutorial videos explaining how fertility is impacted by chemotherapy, radiation therapy or surgery.  Personal stories from others who have selected different types of fertility preservation are also available for viewing. This new website should be an excellent resource to help Cancer Navigators educate their patients about fertility options.

Have any of you working in rural areas dealt with this issue? How have you managed it?

Breast Health Navigator Challenge: Overseeing Patient’s Surgical Arm Range of Motion Restoration

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One of the major roles of a Breast Health Navigator is to see that each post-operative patient, after undergoing a lumpectomy or mastectomy, has her physical range of motion restored to her surgical arm.  Most often, the patient is given written instructions and instructed to perform a set of recommended range of motion exercises at home until their physical range of motion is restored.  She is then expected to perform the recommended exercises at home under her own initiative.

Some women accept the challenge and perform the exercises as instructed, while some find it difficult to read the instructions and perform the exercises.  Having a coach, either a support partner or a healthcare professional, increases the likelihood the patient will be consistent and achieve full range of motion before they discontinue the program either from boredom or frustration.

Failure to perform the exercises and restore range of motion can result in future limited use of the arm.  This can cause difficulties with everyday tasks, such as zipping a back zipper or combing hair using the surgical arm. Occasionally, failure to exercise can result in a frozen shoulder which extremely limits normal movement and causes stiffness and pain.  Frozen shoulder occurs from scarring, thickening and shrinkage of the capsule that surrounds the normal shoulder joint.

Treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injections into the shoulder and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. Physical therapy is often essential for recovery and can include ultrasound, electric stimulation, range of motion exercise maneuvers, stretching, ice packs and eventually strengthening exercises. Physical therapy can take weeks to months for full recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is essential that patients are encouraged to comply with the stretching and range of motion exercises to avoid either limited movement or having a frozen shoulder.

Some large breast centers address the problem of compliance by referring patients to a Physical Therapist or to a post-surgical group exercise program for patients.  Patient compliance increases with increased encouragement from the personal interaction when attending a group or from the personal coaching provided by the Physical Therapist.  But what about the woman who has time and travel constraints and this is not a viable option?  For these women, achieving maximum rehabilitation can be a challenge.

A good solution is a new DVD, the Breast Cancer Survivor’s Guide to Physical Restoration, written and directed by a Dr. Suzanne Martin a Physical Therapist.  It is now available for breast cancer patients for at-home coaching. Dr. Martin’s video provides instruction for a complete physical rehabilitation program through a 30-minute daily workout program. The DVD includes nutritional guidelines along with a daily Pilates workout to increase core stability and strength. The video is designed for post-op rehab from breast cancer related surgeries including lumpectomy, mastectomy and reconstruction. Dr. Martin includes a self-test to measure surgical arm range of motion, a chest wall lymphatic massage demonstration and the foundation for restoring core strength and posture. The video is 108 minutes in length.  The cost is $19.95, making it affordable for most patients.

For Breast Health Navigators, this is an excellent answer to the challenge of surgical arm physical rehab and an excellent tool to recommend to patients. For women who cannot afford to purchase the video, it could be purchased by the facility and loaned out to patients during their arm rehab period after surgery and then returned to the facility. The DVD can be ordered here. Or, you may contact Balanced Body by phone at 1-800-745-2837.

Have any of you used this video yourself or with your patients. What are your thoughts on it?

 

Commission on Cancer Distress Assessment Recommendation Impact on Navigators

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The Commission on Cancer (CoC) has recommended regular on-site psychosocial distress screening for all cancer patients outlined in Cancer Program Standards 2012: Ensuring Patient-Centered Care. The CoC emphasizes the importance of screening patients as a critical first step to providing high quality healthcare. According to Institute of Medicine, distress is any psychological, behavioral or social problems of a patient that interferes with their ability to participate fully in their health care and manage their illness and its consequences.

“Distress should be recognized, monitored, documented and treated promptly at all stages of disease,” recommends the CoC. The goal is to identify patients with distress or barriers to care and provide them with resources or referral to healthcare providers prepared to modify their identified problems.

The CoC recommendation is a huge advancement in keeping with up the great strides in medical treatment over the past decade. Now cancer patients can be ensured that their psychosocial needs will also be addressed.

Like any new mandate, the question arises, “Who will be responsible for implementing the standard?”  It seems fairly obvious that the responsibility will fall mainly to nurse navigators because of their continuous relationship with the patient across the continuum of cancer care. Other appropriate caregivers for patient assessment include oncology social worker, clinical psychologist or other mental health professional.

The Nurse Navigator’s role has traditionally included reducing patient barriers and relieving psychosocial stress through education. The major difference with the new recommendations for most Navigators will be that these assessments now have recommended criteria on time of administration, documentation of referral and follow-up.

Implementing Process Requirements:

A distress assessment should be made soon after a patient enters into care to remove any barriers that could prevent them from receiving adequate medical treatment for their disease.

Timing:

  • Recommended distress screening times are at major transitions in care: diagnosis, presurgical and postsurgical visits, first visit with medical oncologist, first visit with radiation oncologist, post chemotherapy or radiation therapy treatments, and any major transitions during and after treatment.
  • The results of the assessment should to be documented and referral to an on-site or outside care facility should be made to address problem.
  • A report on findings and referrals should be made to the cancer committee annually.

Method:

  • The assessment can be a written patient questionnaire or a clinician-administered questionnaire.

Distress Assessment Tool:

  • The distress assessment tool should be a standardized, validated instrument with established clinical cutoffs. Each facility can determine the cutoff score used to identify distressed patients.

Distress Referral:

  • Patients identified with distress (barriers) should be addressed with appropriate interventions by the Navigator or referred to resources either on-site or to community resources.

Documentation of Distress:

  • Screening, referral or provision of care and follow-up should be documented in the patient medical record to facilitate integrated high-quality care.

Facility Guidelines for Meeting Compliance:

  • Cancer committee develops and implements a process to provide assessment and monitor on-site psychosocial distress screening.
  • Conduct a community needs assessment at least once every 3 years.

 

Facility Decisions:

  • Select distress tool*
  • National Comprehensive Cancer Network has a distress assessment tool available free by contacting them and asking for permission to use tool.
  • Determine clinician to administer
  • Determine major care transitions of care to conduct assessments
  • Cancer committee referral for provision of psychosocial care and follow-up
  • Review all barriers to care and establish referral methods
    • Social Work
    • Psychosocial services
      • On-site
  • Outside facility

Documentation:

  • Screening assessment, referral or provision of identified barriers to care and outcomes of referral should be documented in patient record.

 

Facility Decisions:

  • Documentation:
    • Pen/paper/chart
    • Navigation software program

The new CoC accreditation standard for regular distress assessment is a major advancement in providing patient-centered care.  You can download it here. Nurse Navigators will play a major role in facilitation of this new standard. How do you see it impacting your role in caring for your patients?

 

Dr. Ruth O’Regan: Featured Speaker at Educare Training this September

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For those of you visiting our Blog for the first time, we want to let you know that we have an exclusive, annual Breast Health Navigator Training at Emory University Conference Center in Atlanta. This year’s training takes place September 17- 20.  EduCare has been training Navigators for 18 years and over 2,200 nurses have attended the training.

This year’s training promises to be our best yet.  We say this because we are very excited to have, Dr. Ruth O’Regan, practicing Oncologist at the prestigious Emory Breast Center, who will teach the oncology treatment modules. Dr. O’Regan currently serves as an Associate Professor of Hematology and Oncology at the Emory Winship Cancer Institute and is the Director of Winship’s Translational Breast Cancer Research Program.

One of the most challenging roles of a Breast Health Navigator is understanding and discussing cancer treatments with a patient after surgery.  Drugs for chemotherapy are constantly changing, as is the delivery of radiation therapy.  New gene testing and targeted drugs are now a mainstay of oncology treatment.  The body of breast cancer treatment information is large, often complicated, and changes rapidly.  For nurses without an oncology background, cancer treatment navigation may be intimidating. Determining what is important to understand among the vast array of options is essential for effective patient navigation.  Because patients look to their Nurse Navigator to help interpret a physician’s treatment decision, a Navigator needs to feel competent to answer basic patient questions about chemotherapy, hormonal therapy, radiation therapy and the management of their side effects.

Dr. O’Regan brings her front-line, hands-on experience, to prepare Breast Health Nurse Navigators for the role of educating, supporting and navigating breast cancer patients through treatment.  She will condense the vast body of breast cancer information into the basic essentials that you, as a Navigator, must know to educate and empower your patients.

Starting with how treatment decisions are determined for a patient, Dr. O’Regan will:

  • Explain the most recent guidelines and treatment essentials a Navigator needs to understand to support a patient throughout chemotherapy, hormonal, and radiation therapy treatment.
  • Discuss the emotionally charged issues of fertility preservation for young women and treating a woman who is pregnant.
  • Teach Navigators the signs and symptoms of recurrence and the latest practice standards for the treatment of recurrent breast cancer.

We know you will benefit greatly from Dr. O’Regan’s expertise on these topics, and we can’t wait to have you join us in Atlanta. You can register for our conference here. We’ll also be glad to answer your questions in our comment section, or if you prefer, call us at (843) 760-6064 or reach out to us online here.