Patient care navigators push cancer care to the next level

August 1, 2008

An important concept surfacing of late is that of patient care navigators, whose goal it is to decrease the number of cancer deaths caused by healthcare treatment disparities.

It is estimated that almost 1.5 million new cancer cases will be detected in the United States in 2008, and about one-third of those cases will result in death. Yet, it's important to note that there has been a continued significant decrease in cancer death rates since the early 1990s. According to the American Cancer Society, overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% and 10.5%, respectively, resulting in the avoidance of more than 500,000 deaths from cancer during this period.

Cancer research centers worldwide continue to make progress in treatment capabilities, while striving to increase the capabilities, efficiency and effectiveness of their facilities and patient management systems. This is particularly important as the nation faces a wave of aging baby boomers – appropriately deemed the "silver tsunami" -- that promises to change many aspects of how healthcare insurers, hospitals and physicians deliver care.

One important emerging concept is that of patient care navigators. The goal of the PCN is to decrease the number of cancer deaths caused by healthcare treatment disparities, including timely access to treatment, timely continuation of treatment and enhanced efficiency of care. Cancer hospitals are investing substantial money and time in the establishment of PCN programs because delays and gaps in cancer treatment are two leading causes of poor patient outcomes. Evidence shows that PCNs can play an integral role in enhancing patient outcomes. For example, in one of the first studies done on PCNs, the five-year survival rate for women with breast cancer rose from 39% to 70% after PCNs were established.

PCNs help hospitals implement interventions that reduce healthcare disparities, and accelerate treatment for cancer patients. PCNs help to accelerate and enhance patient treatment in many ways. First, a nurse, coordinator or other specialized individual guides patients with suspicious test findings through barriers in the complex cancer hospital system to help ensure timely diagnosis, treatment and support.

PCNs coordinate each patient's workup and subsequent treatment plan with the patient and with the patient's treating doctors. They help patients gain access to individualized support programs, such as symptoms management clinics. By being the patient's central point of contact, PCNs create a customized and relationship-based experience that builds trust and reduces stress for patients and their families.

The cancer research and treatment facility Loma Linda University Cancer Center (LLUCC), in San Bernardino County, Calif., recently embarked on an expansion plan that included establishing 11 new cancer centers, tripling the number of cancer specialists and implementing a PCN program. The PCN program was considered critical to support the increased capabilities, efficiency and effectiveness of its facilities, treatment and patient management systems.

In addition to coordinating each cancer patient's tests, facilitating review of the results, and coordinating the overall treatment scheduling, the hospital's PCNs ensure each patient has access to the hospital's range of support programs, including psycho-social counseling, family counseling, knowledge support and symptoms management classes. The cancer center's PCNs also are trained to be aware of and sensitive to barriers such as financial concerns, language and cultural differences, fear and depression, and lack of understanding about the condition, treatment regimen and expectations.

Additionally, LLUCC designed its PCN process to facilitate problems in other areas that could delay or deter treatment. For example, PCNs are trained to identify new or ongoing barriers to care; facilitate sharing of resources and patient information; and enhance physician/patient communications. Overall, the PCN program will result in improved continuity of care, enhanced outcomes and increased patient/family satisfaction.

Keys to implementation

If your facility is considering establishing its own PCN program, consider the following:

1. Education and "buy in" from key stakeholders is imperative to a successful program launch, ongoing participation and enhanced outcomes.

2. Set clear goals and objectives for the program, and then update them from year to year, depending on the identified gaps.

3. Establish tracking dash boards to monitor progress towards identified goals and objectives.

4. Build multidisciplinary teams around cancer types. Identify a physician leader and an administrative leader for each of these teams to support effective communication and relationship management.

5. Provide for ongoing educational opportunities for the PCN related to best practices, quality and outcomes.

Mark Reeves, MD, PhD, is director of Loma Linda University Cancer Center and associate professor of Surgery at Loma Linda University. Dr. Reeves has been pivotal in the integration of all of LLUMC's cancer treatments into one facility, and spearheaded the integration of multidisciplinary treatment plans to attain the best treatment and care for all of the hospital's cancer patients.