Nurse Navigator Role in Head and Neck Cancer Community Screening

November 2019 Vol 10, No 11
Chinsia Francis-Hill, MSN, MPA, RN, OCN
Orlando Health UF Health Cancer Center,
Orlando, FL
Margaret Boone, ASN, RN, RN-BC
Orlando Health UF Health Cancer Center,
Orlando, FL

Background: More than 80,000 new diagnoses of head and neck cancers are projected in the United States for 2019. It has been reported that early detection and education improve the survival rate to 80%. Annually, in April, the Head and Neck Cancer Alliance (HNCA) focuses on public awareness and early detection through screening. Orlando Health UF Health Cancer Center is a private not-for-profit facility in central Florida that partners with the HNCA to provide free annual community head and neck cancer screenings. Research has shown that head and neck cancer patients are more likely to have a positive outcome with care coordination and tracking. Thus, the nurse navigator plays a key role in head and neck community screening events.

Objectives:

  • Increase community awareness of head and neck cancer screening through partnership with HNCA annual screenings
  • Early identification of possible symptoms of head and neck cancers by oncology providers
  • Purposeful follow-up and timely referrals of individuals with suspicious findings by oncology nurse navigators

Methods: The head and neck cancer screening event took place simultaneously at the downtown campus and the Health Central location in April 2019. Seven physicians, 2 advanced practitioners, 2 nurse navigators, and several clinic nurses and support staff were present for the screenings.

Prescreening questionnaires were provided to community participants by nurse navigators and multiple support staff. These questionnaires captured demographic information, such as age, sex, smoking history, alcohol consumption, and human papillomavirus (HPV) vaccine status, as well as head and neck symptoms such as voice changes, mouth sores, presence of lumps in mouth or neck, difficulty swallowing, presence of white or red patches, etc. The head and neck nurse navigators collected the prescreening papers, entered and reviewed data, made follow-up phone calls, and provided verbal and written education.

Results: A total of 253 participants were screened at the event. Screened participants included a mixture of hospital staff and community members. Some participants were Spanish speaking and needed translated information and follow-up. All the questionnaires were missing some information. Forty-two percent of participants did not know the symptoms of head and neck cancer, and 44% were unaware that HPV is linked to head and neck cancer. Overall, 13% were referred for further head and neck evaluation for suspected malignancy, and 16% were referred to other community providers, such as dermatologists, dentists, oral surgeons, and primary care physicians. Unfortunately, 55% of participants referred for further head and neck evaluation did not return for further workup, citing reasons such as no insurance or asymptomatic findings.

Conclusions: Oncology nurse navigators provide a valuable service to coordinate timely follow-up referrals and education for community members who have suspicious findings for head and neck cancer. For future screenings, designate staff members specifically for reviewing prescreening questionnaires for completion and for identifying barriers such as absence of healthcare insurance. Identify team members versus community participants to improve follow-up processes and referrals. Recruit Spanish and bilingual speaking staff and educational material in Spanish and other languages.

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