- B1. Achieving Breast Health Equity Through the Effectiveness of Susan G. Komen’s National Telehealth Patient Navigation Model
- B2. Adapting the Breast Cancer Nurse Navigator Model by Leveraging Technology Throughout the COVID-19 Pandemic
- B3. Addressing the Emotional Roller Coaster of Cancer Diagnosis and Treatment: Development of an Oncology Nurse Navigation Demonstration Initiative at an Academic Cancer Hospital
- B4. Complex Care Coordination for Newly Approved Anticancer Therapies
- B5. Developing a Standardized and Innovative Case Submission Process for Multidisciplinary and Multisite Colon and Rectal Tumor Board
- B6. Helping Patients Navigate the Oncology World Through the Use of Patient Navigation
- B7. Implementing Patient Navigation in Rwanda: An 8-Month Impact Review on System Efficiency
- B8. Metastatic Rectal Cancer in Young Adult After Child Cancer Survivor: Challenges for Nurse Navigator—A Case Study
- B9. Oncology Nurse Navigation Pathways: Use of Pathways to Optimize the Disease-Specific Navigation Process
- B10. Reducing Diagnosis-to-Treatment Times Through Nurse Navigation via a Cancer Concierge Service
- B11. Supporting Nurse Navigators’ Efforts in Streamlining Patient Care by Participating in Oncology Site-Specific Tumor Board
- B12. The Emerging Role of Precision Medicine Stewards for Cancer Biomarker Navigation
- B13. The Impact of Nurse Navigation on Timely Access to Cancer Care
- B14. Transition of Care in the Outpatient Setting
- B15. Use of Technology to Support Navigation and Care Coordination of Prostate Cancer Surveillance
B1 Achieving Breast Health Equity Through the Effectiveness of Susan G. Komen’s National Telehealth Patient Navigation Model
Julie McMahon, MPH; Shelby Lautner, PhD; Toni Lee, BS; Mandy Spadine, PhD, MPH, CHES; Janet Okamoto, PhD
Susan G. Komen, Dallas, TX
Background: Despite its effectiveness in reducing inequities in breast cancer outcomes, patient navigation (PN) services are not accessible to all patients across the United States. To improve access, Susan G. Komen established a telehealth PN model, scaled to deliver PN services equitably across the country.
Objective: To demonstrate the feasibility and impact of a national telehealth PN model.
Methods: From April 1, 2022, to March 31, 2023, 1092 individuals were navigated by patient navigators, who administer distress screening and track data and interventions in an online database over a typical engagement period of 62 days. Navigators communicate via the patient’s preferred method: phone, email, text, or video. A patient satisfaction survey is administered 30 days after the start of navigation.
Of 3064 barriers identified, 63% were economic, 20% related to emotional health, 11% indicated lack of access to care, and 6% related to care management. Eleven percent of individuals selected Spanish as their preferred language, 84% had household income at or below 200% of the Federal Poverty Level, and 24% were uninsured.
Distress screening used a modified National Comprehensive Cancer Network distress thermometer (11-point scale) at intake, which was repeated at major transitions in care and at close of case.
Results: Navigated individuals identified as follows: 46% Black or African American, 37% White or Caucasian, 20% Hispanic or Latino, 2% Asian, and 14% preferred not to answer. The average patient age was 54 years, with ages ranging from 20 to 101 years. Of 588 diagnosed patients, stage was as follows: 69% early stage (stage 0-III), 22% metastatic (stage IV), and 8% undesignated.
Distress was an average 6.1 at intake and 4.8 at most recent observation. Financial distress was the highest average (7.46), followed by emotional distress (6.58). During navigation enrollment, financial distress decreased 14% and emotional distress decreased 14% from first to most recent observation.
Survey respondents reported that the program helped them follow their treatment plan (91%); will help them continue their care (92%); enabled them to feel more prepared to talk with their care team (91%); enabled them to get care faster (self-reported, perceived) (88%); and improved their quality of life (91%).
Conclusion: Socioeconomic, survey, and cancer-related distress data indicate Komen’s model succeeded in reaching people who research shows carry high levels of distress and barriers, addressing the most common barriers, especially financial barriers among an uninsured and low-income population, and improving access to timely, high-quality care.
The use of distress screening in a nonclinical setting has required adaptation to ensure appropriate support strategies and interventions are available to patient navigators, within the scope of their role, including emotional support and active listening training, and resource referral.
More bilingual navigators have been added. Komen has launched a research study to improve the quality of navigation available for patients living with metastatic breast cancer.
Sources
Barton MK. Symptoms, cancer-related distress, and overall distress may contribute to racial disparities in the outcomes of patients with early-stage breast cancer. CA Cancer J Clin. 2017;67(4):257-258. Accessed June 12, 2023. https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.3322/caac.21371
Daly B, Olufunmilayo OI. A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin. 2015;65(3):221-238. Accessed June 12, 2023. https://pubmed.ncbi.nlm.nih.gov/25960198/
Dixit N, Rugo H, Burke NJ. Navigating a path to equity in cancer care: the role of patient navigation. American Society of Clinical Oncology Educational Book. 2021;41:3-10. Accessed June 12, 2023. https://ascopubs.org/doi/full/10.1200/EDBK_100026#:~:text=Role%20of%20Patient%20Navigation%20in%20Health%20Equity&text=The%20advantage%20that%20well%2Deducated,and%20informal%20health%20care%20networks
Okeke B, Hillmon C, Jones J, et al. The relationship of social determinants and distress in newly diagnosed cancer patients. Sci Rep. 2023;13:2153. Accessed June 12, 2023. https://www.nature.com/articles/s41598-023-29375-5
Ream E, Hughes AE, Cox A, et al. Telephone interventions for symptom management in adults with cancer. Cochrane Database Syst Rev. 2020;6: CD007568. doi: 10.1002/14651858.CD007568.pub2
Rowett KE, Christensen D. Oncology nurse navigation: expansion of the navigator role through telehealth. Clin J Oncol Nurs. 2020;24(3):24-31. Accessed June 12, 2023. https://pubmed.ncbi.nlm.nih.gov/32441701/
Spelten ER, Hardman RN, Pike KE, Yuen EYN, Wilson C. Best practice in the implementation of telehealth-based supportive cancer care: using research evidence and discipline-based guidance. Patient Edu Couns. 2021;104(11):2682-2699. Accessed June 12, 2023. https://www.sciencedirect.com/science/article/abs/pii/S0738399121002445
Return to TopB2 Adapting the Breast Cancer Nurse Navigator Model by Leveraging Technology Throughout the COVID-19 Pandemic
Shonna Andrews, BSN, RN; Nicole Bravo, MSN, BS, RN, ONN-CG; Carol Kirton, MBA, BSN, RN, OCN, ONN-CG; Reshma Mistry, BSN, RN; Valerie Patterson, MSN, BSN, RN; Janet Pollard, MSW, LCSW
Sarah Cannon Cancer Institute, Houston, TX
Background: The role of the oncology nurse navigator is to alleviate barriers to care by providing patients with support and education, as well as connecting patients to local and national resources. The COVID-19 pandemic posed unprecedented obstacles to the traditional navigation model, as navigators were restricted in their ability to meet with patients in person.
Objective: To adapt to this in-person limitation, our breast oncology nurse navigators in 2 markets evaluated the use of technology to maintain connectivity and patient satisfaction.
Methods: Technology was leveraged throughout the COVID-19 pandemic by:
- participating in virtual visits with patients and physicians using a videoconferencing platform
- corresponding via text message with patients
- converting educational resources to PDF versions to send electronically
- connecting patients with Wellist, a partnered vendor that provides vetted local and national resources to cancer patients and their caregivers
- creating WebEx teams to collaborate and share patient resources with other navigation colleagues
Results: Data reviewed included the frequency and types of navigation-directed communications with patients, as well as the results of a patient satisfaction survey from 2019 to 2022 to evaluate the pre- to post-COVID periods. While in-person meetings decreased by 23%, overall phone calls increased by 47%, and electronic communications increased by 87%. Patient satisfaction scores improved relative to prepandemic scores in the following areas:
- Overall satisfaction with navigation improved by 5.1%.
- Satisfaction with timeliness of communication improved by 7.8%.
- Satisfaction with navigator availability improved by 5.0%.
Conclusion: As evidenced by patient satisfaction scores and navigator communication data, our breast oncology nurse navigators successfully increased patient satisfaction and the volume of communications throughout the COVID-19 pandemic. Using new and existing technology and the adaptation of innovative methods, our breast oncology nurse navigators remained connected with patients, increased access to resources and education, and continued to provide excellent care, despite the presented challenges. In follow-up, breast oncology nurse navigators intend to continue to leverage technology within their workflow, to share resources with navigator colleagues, and to assess for additional methods to further enhance the patient care experience.
Return to TopB3 Addressing the Emotional Roller Coaster of Cancer Diagnosis and Treatment: Development of an Oncology Nurse Navigation Demonstration Initiative at an Academic Cancer Hospital
Cecilia Aguerre, PhD, MA
The University of Texas MD Anderson Cancer Center, Houston, TX
Objective: To develop and implement an oncology nurse navigation demonstration initiative at a National Cancer Institute (NCI)–designated academic cancer center that will lead to recommendations for an institution-wide oncology patient navigation program.
Methods: A comprehensive review was conducted to assess the current state of patient navigation at the cancer center and develop a demonstration initiative with subsequent recommendations for a robust nurse navigation program. This process involved gathering information from prior related workstreams; conducting interviews with a multidisciplinary group of stakeholders; collecting current-state information such as navigator position descriptions, new patient referral data, and patient satisfaction metrics and comments; and identifying reference materials from national groups with expertise in patient navigation.
Results: The data and information collected were used to develop a demonstration navigation program. New patients seeking cancer care who had financial clearance were routed to the nurse navigator for immediate outreach. The nurse navigation demonstration initiative consisted of 13 intervention points throughout the patient journey. The initial intake phase consisted of 4 interventions: a welcome to MD Anderson, an assessment of barriers to care, a clinical review, and a plan for the first-visit day. The treatment journey phase consisted of 9 additional intervention points involving post–first visit, treatment planning, support-shared decision-making, first treatment follow-up, any change in patient status, inpatient encounter, inpatient-outpatient transition, next treatment milestone, and transition from active treatment. Three hundred sixty-five oncology patients received nurse navigation from 7 nurse navigators at intake and treatment, totaling 1735 patient encounters. In addition, 98% of the patients who were navigated during the demonstration initiative reported that they would recommend the navigation program to other patients.
Conclusion: More of the navigated patients accessed and received cancer care treatment at this NCI-designated cancer center than patients overall. This robust gathering of evidence-based nurse navigation information and extensive multidisciplinary stakeholder engagement in the development and process of the demonstration initiative were key factors in the demonstration initiative being successful. Having a successful demonstration initiative was the most impactful element of the decision to resource, design, and begin implementation of an institution-wide patient navigation program at this cancer center.
Return to TopB4 Complex Care Coordination for Newly Approved Anticancer Therapies
Elizabeth Wigozki, MSN, RN, OCN, CNL; Laura Ma, MS, BSN, RN, OCN
Dana-Farber Cancer Institute, Boston, MA
Background: Advances in medical research have led to new cancer therapies seeking US Food and Drug Administration (FDA) approval. The FDA’s Center for Drug Evaluation and Research averages about 43 novel drug approvals per year, which includes all drugs and indications. New anticancer therapies continue to emerge and at times require complicated care coordination.
Objective: To provide tailored education to oncology nurse navigators (ONNs) to address complex care coordination on newly approved anticancer therapies.
Methods: Two new therapies for gynecologic cancers were recently approved by the FDA. The accelerated approvals of both mirvetuximab-soravtansine-gynx and tisotumab require eye exams prior to treatment to ensure safety. ONN leadership brought together pharmacists, clinical specialists, and the drug company educators to create tailored education for the ONNs. The intent was to educate the ONNs on the critical importance of the eye exam requirements and to map out the care coordination workflows. The ONN would need to work with each patient to identify an eye provider. Next, the ONN would need to make sure that the assessment paperwork was sent to the eye provider prior to the appointment. Lastly, they would need to create a tracking workflow to follow up and ensure the results of the eye exam were received and viewable by the oncology treatment team prior to the patient’s first dose or next dose infusion.
Results: Gynecology (GYN) ONNs were able to have upfront education prior to the first patients being treated with new therapies. This education and collaboration enabled the GYN ONNs to anticipate needs of the patients on therapy and to ensure they were providing patient-centered care in a safe and effective manner. They were prepared to reinforce required eye care while on treatment and were able to facilitate and arrange the complex care coordination that was required due to the mandatory eye exams. The up-front education enabled ONNs to understand the impact of the therapies on patient care. Collaboration among the multidisciplinary care team members helped to streamline processes and develop workflows. This led to effective communication and coordination, which enabled safe patient care and eliminated delays in treatment.
Conclusion: The dedicated education sessions equipped the GYN ONNs with the knowledge and tools necessary to navigate the complexities of new anticancer therapies that require eye exams prior to each treatment. This helped to ensure patient safety, to enhance patient care, and to make care coordination more efficient. As new therapies emerge, there will continue to be complex coordination needs. Proactively educating ONNs on the side effect profiles and care coordination needs of new therapies enhances patient care not only when patients are in clinic but also when they are at home preparing for a new treatment or managing throughout their care journey.
Source
US Food and Drug Administration. Center for Drug Evaluation and Research: New drug therapy approvals 2022. Accessed May 8, 2023. https://www.fda.gov/media/164429/download
Return to TopB5 Developing a Standardized and Innovative Case Submission Process for Multidisciplinary and Multisite Colon and Rectal Tumor Board
Rachel Coughlin, DNP, RN, CPHQ, CPPS, CSSGB; Megan Wachlin, BSN, RN, OCN; Mary Pat Lynch, DNP, RN, AOCN, NEA-BC
Pennsylvania Hospital, Abramson Cancer Center, Philadelphia, PA
Background: The National Comprehensive Cancer Network encourages multidisciplinary management of colorectal oncology patients. This aligns with a multidisciplinary tumor board (MTB) framework, supporting precise staging, optimal treatment plans, and decreased delays in diagnosis and treatment. Due to the COVID-19 pandemic, the transition to virtual MTB meetings facilitated collaboration across multiple locations while emphasizing improved coordination needs.
Objective: To establish a uniform, electronic case submission form aiming to enhance the efficiency of case entry, minimize preparation time for MTBs, facilitate data compilation and documentation of vital information, and foster communication and collaboration across diverse geographical locations.
Methods: A Health Insurance Portability and Accountability Act–compliant research electronic data capture (REDCap®) database was implemented for MTB case submissions. The database incorporated branching logic to accommodate various required questions. Customized reports were generated to export case submissions based on their entry dates in REDCap and whether they had undergone previous review. Furthermore, a logic system was established to link the exported REDCap data to a word document using specific variable codes and labels, creating an automated agenda document. This document was filtered based on scheduling conflicts of the presenting provider. Additionally, the REDCap database was utilized for capturing tumor board discussion and follow-up recommendations. A similar logic system was developed to automatically export the MTB discussion information data to a word document, serving as the automated MTB minutes. The REDCap data were further utilized for data visualization purposes through integration with Power BI.
Results: The average number of cases reviewed per MTB remained unchanged at 7.5. The nurse navigator’s average MTB preparation and coordination time decreased from an average of 8 hours per week to 4.5 hours per week, resulting in a 43.75% reduction and estimated savings of $175 (weekly), $700 (monthly), and $9200 (annually). The database's improved data export function enhanced our ability to determine case distribution by diagnosis: rectal (64.44%), colon (15.56%), other (8.89%), anal (6.67%), and appendiceal/neuroendocrine (2.22%). The increased data transparency also allows us to view case submissions by provider (n=25) and location (n=6). The case entry process also supports the entry of appropriate referrals for genetic counseling, with 10.71% of providers specifying they were unsure about the indication for genetics consult. This awareness now allows a prompt for MTB discussion for genetics recommendations. The new process also facilitates needed information gathering from supporting departments, such as pathology and radiology.
Conclusion: Virtual MTB may improve provider participation, communication, travel, and multisite collaboration; reduce delays in diagnosis and treatment; and improve referral coordination. Despite these benefits, the the administrative burden on nursing to obtain, organize, and track cases for clinical review was significant, minimizing top-of-license activities. The recommendation from the Institute of Medicine states nursing should practice to the full extent of their education and training. The use of an electronic database and automated process is an example of allowing the nurse navigator to dedicate more valuable time to top-of-license activities and to lessen administrative documentation. This serves as a model for other oncology teams.
Sources
Dharmarajan H, Anderson JL, Kim S, et al. Transition to a virtual multidisciplinary tumor board during the COVID-19 pandemic: University of Pittsburgh experience. Head Neck. 2020;42(6):1310-1316. doi: 10.1002/hed.26195
Gebbia V, Guarini A, Piazza D, et al. Virtual multidisciplinary tumor boards: a narrative review focused on lung cancer. Pulm Ther. 2021;7(2):295-308. doi: 10.1007/s41030-021-00163-8
Institute of Medicine; Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. National Academies Press; 2011.
National Comprehensive Cancer Network. 2023. Colon cancer. Accessed June 2, 2023. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
National Comprehensive Cancer Network. 2023. Rectal cancer. Accessed June 2, 2023. https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf
Stevenson MM, Irwin T, Lowry T, et al. Development of a virtual multidisciplinary lung cancer tumor board in a community setting. J Oncol Pract. 2013; 9(3):e77-e80. doi: 10.1200/JOP.2013.000882
Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010;143(5):650-654. doi: 10.1016/j.otohns.2010.07.020
Return to TopB6 Helping Patients Navigate the Oncology World Through the Use of Patient Navigation
Jennifer Shickler, MSN, RN; Jackie Barber, RN; Maria Jose Conway, RN
Northwell Health Cancer Institute, Lake Success, NY
Background: Northwell Health Cancer Institute conducted an in-depth analysis to determine the effectiveness of keeping patients within the healthcare system from diagnosis through survivorship. Our findings indicated that 38% of patients diagnosed with breast cancer in Northwell stopped receiving treatment within the health system. In the present healthcare environment, many patients are left to navigate their own care.
Objective: The Northwell Health Breast Navigation Program was developed to ensure our patients receive the most effective services in a timely manner and to coordinate care for patients throughout every step of their cancer journey, so their focus can be on their health and healing.
Methods: Our data collection began with speaking to current patients, who provided 2 major conclusions: First, patients were feeling lost from the onset of their diagnosis and through their journey, and second, they felt overwhelmed in navigating their own healthcare needs. We put together a current-state process map through the patient’s perspective and worked with key clinical teams to create a simplified, future-state process.
Based on research, we knew that oncology patients benefit from early navigation and care coordination, which results in reduced anxiety, reduced hospitalizations, and timeliness to care. With our radiology team, we created a pathway to immediately connect patients with a breast nurse navigator upon the delivery of their cancer diagnosis to offer support and guidance. Patients in our system are identified through our radiology electronic medical record and tagged to a nurse navigator who will serve as a single point of contact and liaison between the patients’ healthcare providers.
Through our tracking database, patients’ time to appointments, referral data, and imaging appointments are actively monitored to ensure there are no delays to treatment.
Results: Early in 2022, our new program consisted of 2 nurse navigators and one coordinator. In the first 6 months, we were able to offer patients a surgical consultation within 48 hours of diagnosis. We increased the percentage of surgical patients who remained with us from diagnosis to consultation from 62% to 91%.
Through anonymous electronic surveys administered to patients via our patient experience team, 95% of our navigated patients gave us a top 5 rating, stating that our navigation program was “extremely helpful” in getting them to the care they needed.
In following the entire patient journey, we were able to identify some areas of opportunity to decrease time to treatment. We implemented a flag in our pathology system to expedite hormone receptor results to our providers. We also standardized how oncotype results were requested through our surgical offices. Both initiatives led to a decrease in average time to appointment from biopsy to surgery from 57.3 days to 47.2 days.
Conclusion: We learned that patients continue to seek care where they feel most comfortable and cared for. To date, the program has successfully navigated over 900 patients, who have continuously rated navigation in its top tier for patient satisfaction. The success of this breast navigation program has further demonstrated the need to replicate this type of navigation service throughout the other cancer specialties.
Sources
Baldwin D, Jones M. Developing an Acuity Tool to Optimize Nurse Navigation Caseloads. Association of Community Cancer Centers. Accessed May 30, 2023. https://www.accc-cancer.org/docs/documents/oncology-issues/articles/2018/ma18/ma18-developing-an-acuity-tool-to-optimize-nurse-navigation-caseloads.pdf?sfvrsn=b0706cfb_7#:~:text=Although%20Mitchell%20Cancer%20Institute's%20nurse,for%206%20to%2012%20monthshttps://www.jons-online.com/issues/2014/june-2014-vol-5-no-3/1272-using-a-nurse-navigation-pathway-in-the-timely-care-of-oncology-patients
Return to TopB7 Implementing Patient Navigation in Rwanda: An 8-Month Impact Review on System Efficiency
Francois Uwinkindi1; Ijeoma Edoka2; Lumbwe Chola3; Marc Hagenimana1; Marlene Mumukunde4; Emile Munyembaraga5; Christina Beck6; Theophile Dusengumuremyi6
1Rwanda Biomedical Centre; 2University of the Witwatersrand; 3Norwegian Institute of Public Health; 4City Cancer Challenge Foundation; 5University of Rwanda; 6All Medical
Background: Rwanda Biomedical Centre, supported by City Cancer Challenge Foundation, launched an interinstitutional, digitally enabled cancer patient navigation (DCPN) to improve access to cancer care for cervical and breast cancer patients. The service, including a digital platform, has been implemented across all the regions in the 5 main cancer hospitals in Rwanda since February 2021. Nurse navigators are in charge of patient navigation and data collection along multidisciplinary pathways.
Objective: To assess the value of the DCPN within the first year of its implementation in the 5 main cancer hospitals in Rwanda.
Methods: The evaluation adopted a mixed-method approach, using qualitative and quantitative methods of value assessment. It was conducted across 3 dimensions: clinical, economic, and contextual. An assessment of the clinical effectiveness and economic implications, including the cost and cost-effectiveness of the program, as well as an assessment of the organizational, ethical, legal, and regulatory implications of the program were included. The evaluation of the pilot project gathered information from a variety of sources, including primary and secondary data sources within participating health facilities. Contextual analysis data were gathered using a semistructured and flexible data collection tool administered in focus group discussions and key informant interviews conducted with nurse navigators, health providers, and patients. Data to inform the clinical effectiveness assessment were drawn from the Rwanda Cancer Registry and from clinical records of all patients included in the study.
Results: Analysis on 1971 patient records (249 DCPN patients; 1722 non-DCPN patients) shows that the DCPN led to a significant decrease in the time to initiate treatment, with a higher proportion of patients commencing treatment within 60 days of diagnosis. The total annual cost of the program was estimated at approximately US $105,000, with personnel costs contributing more than 90% of total costs. With an average program unit cost of approximately US $100 per patient, the DCPN program could be cost-effective. Discussions with hospital managers and clinicians showed that the DCPN filled a critical gap in health service provision and helped facilities to achieve their goals of providing quality patient care. It also increased patient adherence and treatment retention, thus improving patient satisfaction.
Conclusion: Interinstitutional patient navigation reduced the time to initiate treatment in women with breast or cervical cancer in Rwanda. A digital supportive solution helps capture more patient data for decision-making and eases the work of nurse navigators. There is potential to expand the program to lower levels of care.
Return to TopB8 Metastatic Rectal Cancer in Young Adult After Child Cancer Survivor: Challenges for Nurse Navigator—A Case Study
Sandra Cristina dos Santos Martins Paranhos, RN, CNS, ORN
Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal
Background: The link between the diagnosis of cancer in adulthood in survivors of childhood cancer is well known. In a situation of cancer survivorship, the person’s acceptance and adaptation challenges are already high, which also represents a great challenge for the nurse navigator.
Objective: To demonstrate the monitoring and role of the nurse navigator throughout the therapeutic process of a young adult with metastatic cancer of the rectum who is also a survivor of childhood cancer.
Methods: In the course of the life cycle, moments of crisis and transitions are common, and the role of nurses as facilitators of these processes is well known. This case study also intends to demonstrate the importance of follow-up and referral to different elements of the multidisciplinary team in a complex situation, with the aim of maintaining the well-being and quality of life of the patient.
Results: Young adults who have undergone treatment for childhood cancer may have received radiation therapy or certain chemotherapeutic agents, which can increase the risk of developing secondary cancers later in life. This includes the possibility of developing rectal cancer or other types of malignancies. It is important for young adult survivors of childhood cancer with metastatic rectal cancer to have open and honest discussions with their healthcare team to fully understand their prognosis, treatment options, and the potential long-term effects of treatment.
Conclusion: Metastatic rectal cancer in young adults who have previously survived childhood cancer can present unique challenges. While rectal cancer itself is relatively uncommon in young adults, the presence of metastasis and the history of previous cancer treatment can complicate the situation. When metastatic rectal cancer occurs in a young adult who is a survivor of childhood cancer, the treatment approach will depend on several factors, including the extent of metastasis, the previous cancer treatments received, the overall health of the individual, and the specific characteristics of the rectal cancer. Treatment options for metastatic rectal cancer may include a combination of surgery, chemotherapy, radiation therapy, targeted therapies, and immunotherapies. The goal of treatment is to control the spread of cancer, alleviate symptoms, and improve overall survival. However, it is important to note that metastatic rectal cancer is often challenging to cure completely, and the focus may shift towards palliative care to manage symptoms and improve the quality of life. The prognosis for metastatic rectal cancer in young adults can vary widely, depending on the specific circumstances of the individual case. It is essential for young adult survivors of childhood cancer with metastatic rectal cancer to work closely with an oncology team experienced in both pediatric and adult cancer care. This multidisciplinary team can provide comprehensive care, taking into account the unique medical history and treatment considerations of the individual. Furthermore, emotional and psychosocial support should be an integral part of the care plan for young adult cancer survivors. Coping with a new cancer diagnosis after already experiencing childhood cancer can be emotionally challenging, and support from healthcare professionals, counselors, and support groups can be beneficial in navigating these complexities.
Sources
Durno CA, Gallinger S. Genetic predisposition to colorectal cancer: new pieces in the pediatric puzzle. J Pediatr Gastroenterol Nutr. 2006;43(1):5-15. doi: 10.1097/01.mpg.0000221889.36501.bb
Kolsteren EEM, Deuning-Smit E, Chu AK, et al. Psychosocial aspects of living long term with advanced cancer and ongoing systemic treatment: a scoping review. Cancers. 2022;14(16):3889. Accessed June 3, 2023. https://doi.org/10.3390/cancers14163889
Maurice-Stam H, Oort FJ, Last BF, Grootenhuis MA. A predictive model of health-related quality of life in young adult survivors of childhood cancer. Eur J Canc Care (Engl). 2009;18(4):339-349.
van Kalsbeek RJ, Hudson MM, Mulder RL, et al. A joint international consensus statement for measuring quality of survival for patients with childhood cancer. Nat Med. 2023;29:1340-1348. Accessed June 3, 2023. https://doi.org/10.1038/s41591-023-02339-y
Return to TopB9 Oncology Nurse Navigation Pathways: Use of Pathways to Optimize the Disease-Specific Navigation Process
Joanna L. Bellefeuille, BSN, RN, OCN; Carlie J. Barnett, BSN, RN, OCN; Candace R. Bashaw, MSN, RN, OCN; Elizabeth Hess, BSN, RN, OCN; Laura Swift, BSN, RN, ONN-CG; Debra J. Woo, BSN, RN, OCN
Atrium Health – Levine Cancer Institute, Charlotte, NC
Background: General navigators rarely see certain cancers, making it difficult for them to become experts navigating those patients. Creating disease-specific pathways was proposed as a means to provide a reference tool that will standardize workflow and act as a guide for oncology nurse navigators (ONNs) navigating disease sites with which they may be unfamiliar.
Objective: To create disease-specific pathways that will increase ONN confidence, standardize workflow, and increase understanding of the ONN role within the healthcare team.
Methods: Five cancer-specific pathways were created by disease-specific ONNs. These pathways included liver, pancreatic, rectal, esophageal, and lung cancers. Completed pathways were disseminated to 2 cohorts: cohort 1, general ONNs (n=9); and cohort 2, other healthcare providers (n=30). Each cohort completed a cohort-specific pre- and postdissemination survey.
Results: The survey was also sent to physicians, registered nurses, social workers, and dietitians. Thirty completed the presurvey question “How well do you feel you understand the role of the Nurse Navigator?” On a scale of 0 (do not understand) to 10 (fully understand), 73% had a good understanding (score >6) of the ONN role. Sixty- two percent found the pathways helpful in understanding the ONN role.
For ONNs, the predissemination survey asked how effective they felt navigating each cancer type on a scale from 0 to 10, where 0 is not effective and 10 is completely effective. The postsurvey asked the same questions after ONNs reviewed the disease-specific pathways. In the presurvey, 11%, 22%, 33%, 33%, and 67% of ONNs rated themselves as effective (score >6) in navigating liver, pancreatic, rectal, esophageal, and lung cancers, respectively. These ratings increased to 88%, 88%, 88%, 88%, and 78%, respectively, in the postsurvey. The increases were statistically significant, except for lung cancer.
Conclusion: Navigation pathways did increase ONN confidence in navigating sites with which they may not be familiar. Survey results also revealed that other members of the healthcare team better understood the ONN’s role and services provided in the clinical setting. Development of additional disease-specific pathways could impact confidence and understanding for other disease sites.
Source
Chiang AC, Ellis P, Zon R. Perspectives on the use of clinical pathways in oncology care. American Society of Clinical Oncology Educational Book. 2018;37:155-159. doi: 10.1200/EDBK_175533
Return to TopB10 Reducing Diagnosis-to-Treatment Times Through Nurse Navigation via a Cancer Concierge Service
Jill Susanne Hyson, MSN, NP-C
Atrium Health Wake Forest Baptist, Winston-Salem, NC
Background: At many large cancer centers, patients enter the healthcare system through multiple intake processes, leading to delays in quality care. Oncology nurse navigators play a pivotal role in the care of cancer patients. Their understanding of cancer, treatment, and the overall healthcare system provides patients with an overall seamless experience. At our National Cancer Institute (NCI)–designated comprehensive cancer center, patients were entering the system through department-specific practices versus disease-specific practices, which led to delays from diagnosis to treatment. Timeliness to care is a priority in healthcare systems, particularly in cancer, and is used to evaluate and monitor quality of care.
Objective: To create a cancer concierge service to decrease the time from diagnosis to treatment, compared to existing practices, and to facilitate coordination of care between multiple disciplines.
Methods: With the assistance of a consulting group, we were able to create a cancer concierge service consisting of patient service and health information coordinators and oncology nurse navigators. New patient referrals were sent to the concierge service via telecommunications or electronic medical record (EMR) work queue. A telephone encounter was generated by the patient service coordinator and sent to a disease-specific oncology nurse navigator with a brief summary of the patient. Breast, colorectal, thoracic, and bladder nurse navigators reviewed the encounter information, contacted patients for formal assessment and provisional review, collected medical information, and assessed barriers to care. Based on algorithms prepared by clinical practice groups, which included providers from respective disease groups, navigators were able to provide recommended multidisciplinary scheduling for the patient. An outreach encounter flowsheet was created to capture the interaction and assessment between the patient and oncology nurse navigator. Data were collected calendar year 2022 by EMR system.
Results: The new provisional review and cancer concierge service reduced the time from diagnosis to treatment from 35 days to 30 days. This new process allowed navigators to reduce patient contact times from 13 days to 6 days after diagnosis. Additionally, expedited oncology nurse navigator referrals reduced time from diagnosis to consult by 4 days, compared to patients not enrolled in the concierge service.
Conclusions: Having oncology nurse navigators at the point of entry into a comprehensive cancer center provides for higher-quality, coordinated care and facilitates multidisciplinary care, leading to better overall patient experiences. With provisional review, oncology nurse navigators practice at top-of-license scope, promoting clinical decision-making and tailoring a plan specific to each patient. Provisional review by oncology nurse navigators and the coordination of multidisciplinary care decreased the time from diagnosis to treatment compared to existing scheduling practices.
Sources
Binner M, Shanahan J, Putscher T, et al. Oncology nurse navigators’ rapid improvement event: improving processes and identifying metrics. J Oncol Navigation Survivorship. 2019;10(10). Accessed June 14, 2023. https://www.jons-online.com/issues/2019/october-2019-vol-10-no-10/2568-oncolo gy-nurse-navigators-rapid-improvement-event-improving-processes-and-identi fying-metrics
Li X, Scarfe A, King K, et al. Timeliness of cancer care from diagnosis to treatment: a comparison between patients with breast, colon, rectal or lung cancer. Int J Quality Health Care. 2013;25(2):197-204. Accessed June 14, 2023. https://doi.org/10.1093/intqhc/mzt003
Oncology nurse navigation role and qualifications. Oncology Nursing Forum. 2015;42(5):447-448. Accessed June 14, 2023. http://onf.ons.org/onf/42/5/oncology-nurse-navigation-role-and-qualifications
Return to TopB11 Supporting Nurse Navigators’ Efforts in Streamlining Patient Care by Participating in Oncology Site-Specific Tumor Board
Giovanna Zito, BSN, RN, CMSRN
Rush University Medical Center, Chicago, IL
Background: Complex care coordination is usually necessary for patients newly diagnosed with cancer. Emerging trends in cancer care are creating an increasingly complex care-delivery landscape, making options cancer patients face daunting even to those with plentiful support. We know that navigators “can proactively recognize the need for a tumor board consult, champion the unique needs of each patient during the discussion, promote adherence to planned treatment, and support patients during transitions of care regarding future issues related to treatment goals.” As an extension, this research supports the growing initiative that care coordination through a nurse navigator program can facilitate processes and help improve patient outcomes.
Objective: The purpose of this quality improvement project is to improve efforts at Rush to streamline patient care and improve satisfaction for patients diagnosed with cancer by having oncology nurse navigators participate in oncology site-specific tumor boards.
Methods: One week prior to the presence of nurse navigators at every oncology tumor board, 100% of current tumor board staff were notified about the protocol. Oncology nurse navigators are required to attend their oncology tumor boards and coordinate care within 1 week. Nursing managers notified their staff 1 month prior to the project start date. Follow-up meetings aimed at promoting best practice are held every 3 months following the initial implementation with the oncology-specific team. Streamlined care was assessed by auditing charts for patients with newly diagnosed cancer exactly 1 week after the tumor board was held, to ensure multidisciplinary appointments were scheduled and taking place, based on tumor board recommendations. Before initiation of a nurse navigator, appointments were occurring up to months past the tumor board date.
Patient satisfaction surveys were provided to patients on a weekly basis for evaluation. The previously collected hospital-wide satisfaction surveys were utilized, originated by Press Ganey and improved by Rush. The updated patient satisfaction tool included patients giving an ordinal rating for both their satisfaction with access of visits (ie, care coordination) and the experience with their nurse navigator (ie, “nurse,” as indicated on the form). There is also room for comments from patients on these specific areas.
Data points of coordination time and patient satisfaction were taken from the fiscal year before initiation of nurse navigators and compared to the recently completed fiscal year, ensuring that care coordination outcomes continued to improve. The protocol originated from my own recommendations as a nurse navigator.
Results: Patient satisfaction survey date ranges reflected care received during the 6-week period after implementation. The satisfaction surveys were assessed, and chart auditing determined the weekly average of completed coordination, demonstrating a 30% reduction in wait time for newly diagnosed cancer patients to receive comprehensive and interdisciplinary care, and a 20% increase in patient satisfaction.
Conclusion: The participation of a nurse navigator in site-specific tumor boards demonstrated streamlined patient care and increased patient satisfaction rates. Facilities that hold oncology tumor boards should require tumor-site–specific navigators to be active participants. When nurse navigators are at the table, wait times for multidisciplinary care coordination and subsequent time to cancer treatment are greatly reduced. Patients reported they felt better supported by and more trusting of their healthcare team, which correlated with increased patient satisfaction.
Source
Gentry S, Burhansstipanov L. The role of navigation around tumor board participation. In: Shockney LD, ed. Team-Based Oncology Care: The Pivotal Role of Oncology Navigation. Springer; 2018:227-250.
Return to TopB12 The Emerging Role of Precision Medicine Stewards for Cancer Biomarker Navigation
Rifeta Kajdic-Hodzic1; Elana Plotkin, CMP-HC1; Joseph Kim, MD2; Luis E. Raez, MD, FACP, FCCP3; Crystal Enstad, MBA, BSN, RN, OCN4; Courtney Rice, MS, LGC5; Frank De La Rama, RN, MS, AOCNS, AGN-BC6; Leigh Boehmer, PharmD, BCOP1
1Association of Community Cancer Centers; 2Xaf Solutions; 3Memorial Cancer Institute; 4Sanford Cancer Center; 5TriHealth Cancer & Blood Institute; 6Sutter Health Palo Alto Medical Foundation
Background: As more patients with cancer receive biomarker-driven therapies, there is a need to improve multidisciplinary communication and care coordination associated with biomarker testing processes. An emerging approach is to designate a navigator as a precision medicine “steward,” one who ensures timely and equitable biomarker testing for patients with cancer.
Objective: The Association of Community Cancer Centers (ACCC) explored how cancer programs could optimize biomarker testing processes through precision medicine stewards, an innovative role on the multidisciplinary cancer care team dedicated to coordinating and navigating biomarker testing care processes.
Methods: The ACCC identified member cancer programs and clinicians that had implemented various models of biomarker navigation and conducted a series of calls and focus groups. Questions explored how cancer programs had justified and funded these new positions, the scope and responsibilities of the steward roles, and key metrics for measuring the impact of stewards on precision medicine testing processes and care coordination. Examples of job titles included biomarker navigator, genomics navigator, precision medicine test coordinator, and others. The ACCC explored how navigators and other staff may enter this new and emerging role.
Results: The ACCC found that precision medicine stewards improved biomarker testing processes by managing a combination of clinical, administrative, and logistical tasks. Some of these tasks included: educating patients about testing, creating electronic ordering templates, streamlining prior authorizations, tracking tissue specimens, notifying oncologists about results, and preparing case presentations for molecular tumor boards. Stewards also checked the status of financial assistance applications and identified potential clinical trials based on test results. Their previous roles included nurse navigators, genetic counselors, oncology nurses, advanced practice nurses, or laboratory test coordinators. One cancer program found a 12-day reduction in turnaround time from test ordering to receipt of results after implementing a precision medicine stewardship program. Stewards reduced the time required to complete order forms for next-generation sequencing panels by creating templates and electronic orders that send information directly to reference laboratories. They also coordinated liquid biopsy orders when the laboratories reported that the tissue quantity was not sufficient (ie, QNS) for testing.
Conclusion: The role of a precision medicine steward is emerging to improve testing processes and to facilitate better communication across medical oncology, pathology, and reference lab staff. Cancer programs that have implemented this role have seen the benefits, and several have expanded their precision medicine programs to include additional navigators and stewards. More research is needed to better determine the return on investment of precision medicine stewards in various care models. The ACCC will continue to explore how cancer programs are structuring their multidisciplinary cancer care teams to improve biomarker testing efficiency and to ensure that every eligible patient receives appropriate testing.
Sources
Chakravarty D, Johnson A, Sklar J, et al. Somatic genomic testing in patients with metastatic or advanced cancer: ASCO provisional clinical opinion [published correction appears in J Clin Oncol. 2022;40(18):2068]. J Clin Oncol. 2022;40(11):1231-1258. doi: 10.1200/JCO.21.02767
Chakravarty D, Solit DB. Clinical cancer genomic profiling. Nat Rev Genet. 2021;22:483-501. doi: 10.1038/s41576-021-00338-8
Cobain EF, Wu Y-M, Vats P, et al. Assessment of clinical benefit of integrative genomic profiling in advanced solid tumors. JAMA Oncol. 2021;7(4):525-533. doi: 10.1001/jamaoncol.2020.7987
Dias-Santagata D, Heist RS, Bard AZ, et al. Implementation and clinical adoption of precision oncology workflows across a healthcare network. Oncologist. 2022;27(11):930-939. doi: 10.1093/oncolo/oyac134
Fox AH, Nishino M, Osarogiagbon RU, et al. Acquiring tissue for advanced lung cancer diagnosis and comprehensive biomarker testing: a National Lung Cancer Roundtable best-practice guide. CA Cancer J Clin. 2023;73(4):358-375. doi: 10.3322/caac.21774
Yap TA, Johnson A, Meric-Bernstam F. Precision medicine in oncology—toward the integrated targeting of somatic and germline genomic aberrations. JAMA Oncol. 2021;7(4):507-509. doi: 10.1001/jamaoncol.2020.7988
Zeng J, Johnson A, Shufean MA, et al. Operationalization of next-generation sequencing and decision support for precision oncology. JCO Clin Cancer Inform. 2019;3:1-12. doi: 10.1200/CCI.19.00089
Return to TopB13 The Impact of Nurse Navigation on Timely Access to Cancer Care
Avni Patel, MSN, RN; Jeanne Silva, MSN, RN-BC, CMSRN, CN-BN; Portia Lagmay-Fuentes, APN
RWJ Barnabas Health System and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
Background: Cancer incidence rates are expected to increase annually and, according to the World Health Organization in 2020, a lack of resources and underutilized existing resources contribute to long oncology wait times. Evaluating the current scheduling practices for oncology revealed fragmented schedule templates and poor communication for appointments, leading to wait times beyond 72 hours. Additional delays are from a lack of interventions to address barriers. Excessive delays hurt the organization’s bottom line as patients seek competitors with shorter wait times.
Objectives: To (1) improve communication and access to oncology consultation; (2) reduce the wait time for the consultation; and (3) increase access to social determinants of health (SDOH), concerns that would impede or delay a successful oncology visit with closed-loop communication.
Methods: Outpatient clinic schedules are constructed to accommodate new patient consultations and follow-up visits. Using a plan-do-study-act methodology revealed challenges from insufficient providers and inappropriate booking of follow-up patients, resulting in inadequate new openings. Nurse navigation is a proven method to advocate for patient care and address barriers. A centralizing oncology scheduling model with a defined, disease-specific workflow was implemented and provided support from nurse navigators to evaluate the clinical information and appointment timing. Within 24 hours of scheduling a new cancer patient appointment, the patient is assessed for SDOH. Identified practical barriers are referred to the equity patient navigators (EPNs), who work with the patient to overcome obstacles. Any new patient appointment outside the 72-hour criterion is addressed by the nurse navigator, who communicates with the doctor for an earlier date. The documentation was modified to measure outmigration related to the dissatisfaction with the scheduling date.
Results: In 2022, the nurse navigators had 9017 patient outreaches, rescheduling 664 patients with wait times greater than 72 hours. On average, the nurse navigator working with physicians reduced the wait time by 15 days. Adding EPNs to help with practical barriers reduced delays related to charity care applications and transportation. Standardizing the provider’s template is ongoing to optimize availability and appropriate caseload. Moving high-risk and follow-up appointments to advanced practice providers increases the provider’s availability. As a result of long wait times, 3 patients out-migrated due to dissatisfaction with the scheduling date. The ongoing lack of providers is a constant struggle at multiple institutions, causing delays in new patient appointments.
Conclusion: Using the nurse navigator’s clinical knowledge to assess a new cancer patient in a timely manner and provide interventions can reduce the time to the oncologist visit. Timely visits increase the likelihood of in-system utilization and decrease the risk of outmigration. Ongoing research is needed to further understand the benefits of the nurse navigator’s role in the timeliness of care.
Funding: This project was supported, in part, by a grant from the Merck Foundation.
Sources
Benbrahim Z, Zouiten O, Messoudi K, et al. Wait times for diagnosis and treatment of lung cancer: experience of the medical oncology department of Hassan II University Hospital of Fez. Global J Quality Safety Healthcare. 2019;2(3):65-69. Accessed May 13, 2023. https://doi.org/10.4103/JQSH.JQSH_8_19
Keshtzari M, Norman BA. Improving patient access in oncology clinics using simulation. J Ind Eng Manage. 2022;15(3):455-469. Accessed May 13, 2023. https://doi.org/10.3926/jiem.3925
Lotfi V, Torres E. Improving an outpatient clinic utilization using decision analysis-based patient scheduling. Socio-Economic Plann Sci. 2014;48(2):115-126. Accessed May 13, 2023. https://doi.org/10.1016/j.seps.2014.01.002
Return to TopB14 Transition of Care in the Outpatient Setting
Catherine Oplinger, MSN, RN, OCN, AMB-BC
Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, PA
Background: In the face of a hospital or outpatient practice closure, large-scale transitioning of patients to a new provider is a necessity. A gap in available information for the patient population related to the transition of care for oncology patients affected by a closure was identified. As expected, significant stress, emotional turmoil, and unrest resulted among patients, caregivers, and staff at the facility.
Objective: At the time of impending closure of an oncology center, a project was undertaken during the 90-day window that focused on providing guidance and information to this vulnerable population and addressing the emotional aspect of the loss of their trusted provider and care team. This effort centered on the nurse navigation focus of managing the continuum of care in the setting of an outpatient transition for patients with complex diagnoses. The prevention of gaps in care during a transition was the primary goal.
Methods: A bullet-point informational brochure that can effectively address several topics was developed and distributed to patients until the date of closure. To make the brochure more effective and visually appealing, photos and separate informational blocks were utilized, including the recommendation of a checklist related to organizing the transition to a new provider. Urgency in locating a new care team was stressed throughout the brochure, so that patients would have a provider in place well in advance of closure. Tips and suggestions were provided for patients undergoing active treatment and for those who had transitioned to survivorship. The need for additional support during the transition period through resources such as the American Cancer Society or local advocacy groups was addressed, as well as the importance of managing related stress and emotional turmoil with activities such as exercise, yoga, music, and meditation. General oncology resources both online and via phone were included.
Results: Educating patients and caregivers regarding the process, urgency, and importance of transitioning care involved interactive dialogue and written materials in the delivery of direct instruction, as well as options for support through the emotionally challenging transition. A survey, taken by patients, caregivers, and members of the care team, was developed to examine the strengths, weaknesses, and opportunities for improvement of the brochure. An informational brochure could be adapted to any group of patients with a complex diagnosis and used as a guide for the forced transition of care from a patient’s trusted care team to another provider with whom they would continue care. Of the 2800 patients in our care, 97.6% had transitioned to a new care team or been provided their records for transition at the time of our closure.
Conclusion: Transitions of care are well addressed in the inpatient setting, but additional attention and research are needed to prevent gaps in care for those in the outpatient setting. The process of transition of care can be improved for safety and communication through a system of organization, such as the use of an evidence-based checklist. Organized, effective, and safe management of care for every patient is the minimum expectation for each transitional move throughout the healthcare continuum. Transition management is guided by each patient’s current medical concerns and diagnoses, to meet their health needs through effective communication and supportive services. Oncology nurses and navigators are uniquely positioned to address this issue.
Sources
Laughlin CB, Witwer SG, eds. Core Curriculum for Ambulatory Care Nursing. 4th ed. American Academy of Ambulatory Care Nursing; 2019.
Prince M, Allen D, Chittenden S, Misuraca J, Hockenberry MJ. Improving transitional care: the role of handoffs and discharge checklists in hematologic malignancies. Clin J Oncol Nurs. 2019;23(1):36-42. Accessed June 23, 2023. https://doi.org/10.1188/19.CJON.36-42
Return to TopB15 Use of Technology to Support Navigation and Care Coordination of Prostate Cancer Surveillance
Rich Boyajian, APRN, NP
Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
Background: Dana-Farber/Brigham Cancer Center (DF/BCC) Virtual Prostate Cancer Clinic uses a software platform to monitor posttreatment patients for recurrence. Patients can communicate with an advanced practice provider/nurse navigator (APP/NN) by secure email, patient portal, video, or telephone visit; however, technological advances are necessary to improve the navigation and surveillance of patients.
Objective: The DF/BCC and Cancer Insights (CI) have received National Cancer Institute (NCI) funding to pilot an advanced technology to support the tracking and monitoring of prostate cancer patients. The pilot uses algorithms on medical record data to track a patient’s current clinical state, compliance with follow-up, and need for clinical contact.
Methods: Cancer Insights is an oncology data platform capable of ingesting and curating patient medical record data to an oncology data model for advanced analytics. Data from prostate cancer patients seen at DF/BCC between 2016 and 2021 are being analyzed on the CI platform to determine which patient-level primary and derived variables can identify time intervals associated with a treatment “state,” defined as (a) active surveillance, (b) active treatment, or (c) posttreatment surveillance. Additionally, variables that signal the transition from one “state” to another will be identified. A user interface is being built to utilize patient-level variables to triage by acuity levels (ie, 1. Relapse; 2. Significant symptoms; 3. No relapse or significant symptoms). The platform will automate initial communication with level-3 patients via the patient portal with an individualized patient status summary. APP/NNs can filter patients on type of surveillance, missed tests, upcoming tests/encounters, and follow-up alerts.
Results: Correctly labeling treatment states and transitions will underpin the technology support tool being built, which eventually will integrate with the electronic medical record to monitor patient data continuously, flag patients by acuity level, and alert APP/NNs as well as the patient when a patient has missed a surveillance activity, and if a recent test indicates further evaluation is needed to assess the patient for recurrence. (A user-interface demonstration and initial variable analysis will be available during the AONN 2023 meeting.) The tool will support remote care management, saving patients time and cost, promoting clinical efficiency, decreasing administrative and clinical burdens, communicating between patients and providers, and streamlining care coordination between radiation, medical, and urologic oncology specialties. Studies will be needed to determine the tool’s effect on long-term patient outcomes.
Conclusion: Cancer Insights is an oncology data platform that is HIPAA-compliant. In addition, the platform includes a user-friendly interface for interacting with the data and insights. With an NCI-funded grant, DF/BCC is partnering with CI to build first-of-a-kind software that can provide an up-to-date status of prostate cancer patients and recommend the level of follow-up contact (synchronous vs asynchronous) based on the patient’s acuity level or past due status for their disease surveillance. The framework for the software will be easily extendable to other cancers or conditions that require regular patient surveillance, monitoring, and survivorship care follow-up.
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