Lung Cancer Management Insights

Background: Oncology navigation is evidence-based and plays an important role in lung cancer care, but variation remains in the navigator’s role across the continuum from early- to late-stage lung cancer. Examining nurse and patient navigator roles in lung cancer screening, incidental pulmonary nodule (IPN) management, and lung cancer diagnosis and treatment can ensure quality lung cancer care.

Objectives: To examine the role of navigators and navigation approaches in IPN management and lung cancer screening, as well as across the disease trajectory; to identify from a navigator perspective the operational challenges in lung cancer screening and characterize best practices across multiple stages of disease, including IPN identification and stewardship; and to explore needed tools and resources for navigators across the continuum of lung cancer care.

Methods:

• An online screener was deployed to an initial list of 92 oncology navigators with experience in comprehensive lung cancer screening, IPN management, and management of patients with lung cancer
• Of 41 screener responses, 28 were identified as having key roles in the lung cancer continuum of patient care and were invited to participate in a Real Time Market Intelligence online survey
• 19 healthcare practitioners/navigators (nurses, respiratory therapists, etc) completed the survey

Results: Although the sample size was small, it is likely indicative of the current state and varied practices:

• Almost 90% of practices surveyed have dedicated lung nurse navigators
• Although many programs represented do not utilize different navigators along the care continuum, those that did separated screening navigation from diagnostic through treatment/survivorship/end of life
• Navigator roles vary for centers that do have different nurse navigators along the lung cancer carecontinuum
• While programs did not demonstrate a consensus in utilizing IPN management guidelines, several utilized Fleischer guidelines for follow-up and management of IPNs
• Practitioners, including navigators, identified their main role in caring for patients with non–small-cell lung cancer as providing patient education, closely followed by coordination of treatment planning
• Nearly 75% of respondents attested to providing biomarker education; thoracic surgeons, medical oncologists, and oncology nurse navigators were noted as education providers
• According to 40% of respondents, less than 50% of lung cancer patient cases are presented at tumor conferences
• Almost 90% of respondents claimed a medium-to high awareness of adjuvant treatment options beyond chemotherapy
• Webinars, websites, and printable pdfs are preferred vehicles for receiving professional education
• Significant barriers to care relate to inadequate staffing and coordination of care
• Highlighted best practice: involvement of lung cancer nurse navigator

Conclusions: By analyzing the role of navigators and navigation approaches in IPN management and lung cancer screening across the disease trajectory, and given the implications of these data from the navigator’s perspective, educational tools in the form of 2 best practice papers—a navigation checklist for CT screening and IPN management and a Navigation Patient Roadmap—are deliverables as a survey outcome. In addition, data showed areas of challenge: access, coordination of care, patient, and financial barriers, whereas best practices included the value of the nurse navigator, biomarker education, and a multidisciplinary team approach.

Support: The Real Time Market Intelligence online survey was sponsored by AstraZeneca.

Sources

Gerber DE, Gillam AO, Hamann HA. Lung cancer screening in the “real world” and the role of nurse navigators. Journal of Oncology Navigation & Survivorship. www.jons-online.com/issues/2013/april-2013-vol-4-no-2/1229-lung-cancer-screening-in-the-real-world-and-the-role-of-nurse-navigators. 2013.

Hoopes S, Franco G, Weathers J, et al. The importance of nurse navigation in lung cancer screening. Journal of Oncology Navigation & Survivorship. 2018;9(11):434.

Hunnibell LS. Improving lung cancer care through nurse navigation. Lung Cancer Management. 2014;3(3):229-231.

Hunnibell LS, Slatore CG, Ballard EA. Foundations for lung nodule management for nurse navigators. Clin J Oncol Nurs. 2013;17:525-531.

Watson J, Broome ME, Schneider SM. Low-dose computed tomography: effects of oncology nurse navigation on lung cancer screening. Clin J Oncol Nurs. 2020;24:421-429.