Navigating Cancer Survivorship Tricia L. Cox, ANP-BC, AONCP Thomas - - PowerPoint PPT Presentation

Navigating Cancer Survivorship

Tricia L. Cox, ANP-BC, AONCP Thomas Johns Cancer Hospital Richmond, Virginia

Overview of Survivorship Navigation

► 2 nursing approaches to survivorship care

§ Navigate through to CS care § Enroll after active treatment complete

► Multiple institutional approaches!

§ Dependent on type and size of facility and community § Varies from one end of the spectrum to the

• ther (marketing to MD, etc)

What Patients want: Multidisciplinary Team

Social Services Radiologist Oncology Nurses Navigator Plastic Surgeon Supportive Services Radiation Oncology Medical Oncology Radiologist Pathologist Genetic Counselor Surgeon PCP/GYN

PATIENT

What Administration Wants Return on Investment

Referrals From Patients Referrals for Supportive care Additional Radiographic Imaging Medical Oncology/ Chemo Radiation Therapy Surgery Surgical Consult Percutaneous biopsy Ultrasound Diagnostic mammogram Screening mammogram

Cancer Trajectory

Dx Treatment Year 1 Year 2 Year 3

Discharge 3 months 6 months 9 months 12 months Create Care Plan Oncologist Follow Up Oncologist Follow Up Oncologist Follow Up Oncologist Follow Up Pelvic Exam Bilateral Mammogram

… Survivorship

Navigation Opportunities

Outreach/Screening Diagnosis Treatment Survivorship

Freeman, H. (2009). Patient navigation across the healthcare continuum. Retrieved March 20, 2010 from http://www.hpfreemanpni.org/patient- navigation/

Retrieved from http://www.hpfreemanpni.org/our-model/ on 7/26/2012

Navigation and Survivorship

What is Navigation?

► Advocacy for patients ► Education on disease &

treatment

► Communication between

family, healthcare providers and patient

► Referrals to resources

and into survivorship

► Assistance with

appointments What is Survivorship?

► Advocacy for patients ► Education on side effects,

late effects, monitoring and healthy living

► Communication between

family, healthcare providers and patient

► Referrals to resources ► Assistance with

appointments (follow-up)

Our Plan for Buy-in

► Pre-implementation ► Increase awareness of gaps ► Tell a story or two! ► Develop relationship(s) with key players ► Develop model for care delivery

Data from Livestrong

2006 The Advisory Board Company, Washington, DC

Most Common Survivorship Model

Surgeon Medical Oncologist

Patient

Radiation Oncologist

Primary Care Provider

Surgeon Medical Oncologist Radiation Oncologist

Primary Care Provider

Survivorship Clinic

Common Academic Medical Center Model

Patient

Surgeon

Our Community based Model

Medical Oncologist Radiation Oncologist

Patient

Navigator Primary Care Provider

Survivorship Navigation

► Nurse Practitioner Clinic ► Shared Space ► ARIA Scheduler ► Patients registered and Billable service

Our Process

► Radiation Therapy patients are referred

into survivorship within the last week of treatment

► Lung and Head and neck are referred in

by our Navigator

► Medical oncology and surgical oncology

slowly referring patients

How it works

► Radiation therapy patients are referred into

survivorship clinic after two weeks

► Lung and head and neck are referred in by

the Navigator depending on their treatment and performance status

Implementation

Start Small Breast Cancer Prostate Cancer Build on Successes Add Colorectal, Lung & Brain Work on Processes! Registration One hour appointment Written Care Plan provided at visit

Product Description

► Multiple products available, we chose this

• ne…
• Internet based
• Nightly back up of data
• Easy to use tabs or hypertext
• “Nurse-friendly”

Four Domains of Survivorship Care

► Physical Well Being ► Social Well Being ► Psychosocial Well Being ► Spiritual Well Being

What was the greatest need identified in our survey of survivor’s needs at the end of treatment?

• 1. Psychosocial support
• 2. Financial assistance
• 3. Physical symptom management
• 4. Diet and exercise program

Assessment and Affecting Lifestyle Changes

► Assessment of survivors’ needs post-

treatment

► Diet and Exercise classes started

§ Utilize dietitian § Athletic trainers

► Chemo-Brain classes

Lessons Learned

► Start slow ► Allow time between each intervention ► Re-visit process ► Engage your physicians every step along

the way

► From a mentor, “Don’t let the perfect get

in the way of the good.”

Final Thoughts

► A breast cancer survivor brought her

mother in for the CS visit, and tearfully said, “I wish this had been available when I finished treatment. I have learned things today, and I am 7 years out.”

► “I found the session very

• informative. I feel in control of my

future care.”

Case Study

► 49 y.o. Caucasian female s/p ER/PR

positive, HER-2/Neu negative breast cancer

► Stage II (T1, N1a, M0) chemotherapy ► Taxotere and cytoxan ► Radiation therapy ► Moved to this community 2 months prior to

diagnosis and has no support system here

► Tearful and nervous during CS visit

What do you think?

► I like to approach with the 4 domains

§ Physical – What might we expect? § Psychological § Emotional § Spiritual

Questions?