Efficacy of the Breast Cancer Navigator Role in Reducing Distress in Newly Diagnosed Breast Cancer Patients: A Pilot Study

Background: Each year at a rural northeastern hospital, approximately 100 women and men are diagnosed with breast cancer. For most patients, this is a first diagnosis with cancer. Patients receive biopsy results from the reading radiologist or their physician by telephone. The next professional discussion occurs during the surgical consult, with no formal referral to the breast cancer navigator (BCN) until after the consult. Patients may spend several days without further information regarding the diagnosis and without emotional support, creating significant emotional distress. It is known that patients gather information while they await their consult; however, the sources of information may not be valid, reliable, or appropriate to their diagnosis and situation.¹ Misinformation can increase their distress. Decisive empiric evidence may assist the BCN to improve practice changes, with the goal of reducing patient distress. Oncology nurse navigation (ONN) is an evolving field, yet there remains a dearth of quality studies on the effect of ONN on patient distress.^2,3

Objective: To discuss the early results of an ongoing pilot study whose specific aim was to evaluate the intervention with the BCN on distress level reduction in newly diagnosed breast cancer patients. We hypothesized that the intervention by the BCN would reduce distress levels. A secondary use of the study results is for the empiric evidence to drive new policy regarding earlier intervention of the BCN prior to the surgical consult.

Methods: A convenience sample of 13 newly diagnosed breast cancer patients in a rural northeastern hospital was recruited for this pretest/posttest mixed methods study with supporting qualitative commentary. The intervention is a BCN visit prior to surgery for education, resources, planning, and emotional support. Patients completed the Distress Thermometer just prior to the intervention and immediately postintervention and provided anecdotal comments regarding their experience.

Results: Preintervention ratings were: mean 8.5 of 10, median and mode both 9 of 10. Postintervention ratings were: mean 3.2 of 10, median and mode both 3 of 10. Emerging themes of feeling “stressed” and “alone” before and feeling “relief” and “empowered” after were seen in the participants’ comments.

Discussion/Conclusions: Early findings relate that the BCN intervention reduces distress in this population. However, the pilot has limited power and therefore is ongoing until a sufficient sample size is achieved. These early results have proved helpful to drive practice change: the BCN is now in contact with the patients shortly after they receive the diagnosis. An unanticipated finding is that patients are increasingly staying with the service rather than having surgery elsewhere. Recommendations are to include the BCN visit prior to the surgical consult so that stress is reduced early; to examine differences in stress levels by age, gender, socioeconomic status, and ethnicity; to change practice protocols to reflect early intervention as best practice; and to continue the pilot program to achieve a larger patient sample.

References

1. Kowalski C, Kahana E, Kuhr K, et al. Changes over time in the utilization of disease-related Internet information in newly diagnosed breast cancer patients 2007 to 2013. J Med Internet Res. 2014;16:e195.
2. Wagner EH, Ludman EJ, Aiello Bowles EJ, et al. Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2014;32:12-18.
3. Carlson LE, Waller A, Mitchell AJ. Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol. 2012;30:1160-1177.