The Effect of Early Detection and Treatment of Early-Stage Lung Cancer on the Thoracic Navigator Role

November 2019 Vol 10, No 11
Maritza Chicas, RN, BSN, OCN
Lehigh Valley Cancer Institute
Allentown, PA
Raizalie Roman, RN, BSN, OCN
Lehigh Valley Health Network Cancer Institute, Allentown, PA
Kathleen Sevedge, RN, MA, AOCN
Lehigh Valley Cancer Institute
Allentown, PA
Jeanne Kenna, RN, OCN
Lehigh Valley Cancer Institute
Allentown, PA
Angela Miller, RN, MEd, OCN
Lehigh Valley Cancer Institute
Allentown, PA
Laura Beaupre, RN, BSN, OCN, CN-BN
Lehigh Valley Cancer Institute
Allentown, PA
Jane Zubia, RN, OCN, CN-BN
Lehigh Valley Cancer Institute
Allentown, PA
Cynthia Smith, RN, BSN, MA, OCN
Lehigh Valley Cancer Institute
Allentown, PA
Alyssa Pauls, RN, BSN, OCN
Lehigh Valley Cancer Institute
Allentown, PA
Tracy Walczer, RN, BSN, OCN
Department of Cancer Support Services, Lehigh Valley Health Network Cancer Institute,
Allentown, PA

Background: With preventive screening, increased focus on early detection, and advances in treatment in lung cancer, the multidisciplinary approach at Lehigh Valley Health Network Cancer Institute (LVHN-CI) continues to evolve, providing innovative care to this patient population. According to US Preventive Services Task Force, “low-dose computed tomography has shown high sensitivity and acceptable specificity for the detection of lung cancer in high-risk persons.”1 Also, “the number and proportion of patients diagnosed with early-stage disease are anticipated to increase.”2 The thoracic multidisciplinary clinic (T-MDC) has experienced changes leading to continuous evolution of the role of the thoracic-oncology nurse navigator (T-ONN). “Oncology nurse navigators play a critical role in cancer screening and coordination of services.”3

Objectives: Identify the multiple roles of the T-ONN. Demonstrate the impact of the increase in early detection on the T-MDC and on the T-ONN role.

Methods: Prior to the emphasis on low-dose CT (LDCT) screening, the T-MDC predominantly saw patients with stage IIIA-III-B disease. Since the increased focus on LDCT, more patients with stage 1 thoracic cancer with high-risk comorbidities are referred to the MDC for team evaluation and discussion of treatment options, including stereotactic body radiation therapy and robotic surgical options. The LDCT program LungRads 4 cases (L-RADS4) are reviewed in T-MDC for team recommendations. In 2018, an increase in the amount of LDCTs led to a higher number of L-RADS4 cases reviewed, contributing to early-stage diagnosis. The T-ONN has a dual role as T-MDC Clinic Coordinator and also as navigator for patients throughout treatment. The T-ONN prepares cases for review and moderates at pulmonary tumor board. A radiologist focusing on LDCT has joined the thoracic team. The T-ONN is point of contact for the radiologist and primary care physician, and is responsible to track data and outcomes for L-RADS4 cases, ensuring follow-up.

Results: The total number of lung cancers at LVHN-CI increased from 408 in 2016 to 522 in 2017, and an annualized number of 430 for 2018. The number of visits to T-MDC was 359 from 2016 to 2018, with an average of 120 per year. The number of LDCT L-RADS4 has increased each year: 2016-12; 2017-17; 2018-35.

Conclusions: The T-MDC’s increase in volume and complexity contributed to the hiring of 1 additional full-time employee (FTE) for a total of 2 FTE T-ONNs plus cross-training of additional ONNs to cover the T-MDC, to allow for increased patient visits per clinic. The workload of the T-ONN has increased with added responsibilities, including increased preparation time, additional coordination of patient visits, ensuring appropriate imaging and testing are completed, and increased caseloads for ongoing navigation services. The T-ONNs participated in Lung Disease Management Team meetings in order to develop a workflow for the L-RADS4 population. An LVHN Network goal of increasing lung screenings ensures continued referrals to the T-MDC. This goal includes development of a comprehensive lung health program, including adding a nurse practitioner and support staff to follow all high-risk patients and ensure referrals to appropriate multidisciplinary care.

References

  1. Final Update Summary: Lung Cancer: Screening. US Preventive Services Task Force. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. July 2015.
  2. Tandberg DJ, Tong BC, Ackerson BG, Kelsey CR. Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: a comprehensive review. Cancer. 2018;124:667-678.
  3. Doerfler-Evans RE. Shifting paradigms continued—the emergence and the role of nurse navigator. J Thoracic Dis. 2016:8(suppl 6):S498-S500.
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Last modified: March 24, 2020

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