Commentary: Nurse navigator guided me through cancer battle

In August 2009, the shoe dropped. My diagnosis: esophageal cancer.

Overwhelming feelings and needs hit at the same time: I need an oncologist, they fight the cancer; I need a surgeon, they cut out the cancer. Check. Check. Now what?

I had two excellent physicians on my side, but they had two different recommendations. Cut then chemo; chemo then cut. The Internet provided too much information without any direction. I was lost.

My experience is not unusual. Before cancer centers developed a team-based approach to coordinating care plans, physicians often proceeded with what they had seen work best in their own field. What I needed was someone to coordinate the care: a nurse navigator.

Since Hoag expanded our nurse navigator program four years ago, each cancer patient has been assigned a dedicated clinical nurse to guide him or her through the murky waters of diagnosis, treatment and recovery.

As Hoag Hospital's chief quality officer, I am charged with all aspects of quality of care, improvements and patient safety. As a former cancer patient, I know firsthand how important it is to get that quality and coordination of care right.

The journey through a complex system was mine to navigate. That's not impossible as a physician, but it is not easy. For a layperson, it is exponentially more difficult. When you receive a cancer diagnosis, spending weeks deliberating recommendations before starting treatment is maddening and scary.

Eventually, I opted for chemotherapy first, followed by surgery two months later. I have been cancer-free since. My outcome was good, but a navigator would have been able to help better coordinate the team with a consensus care plan that met my needs. This would have greatly reduced the time between diagnosis and treatment with less stress for me and my loved ones.

Nurse navigation is offered now. Unfortunately, it's not offered everywhere. The Institute of Medicine issued a report last year that highlighted some of the challenges of cancer care in this country, including lack of coordination and communication between caregivers — an especially onerous issue for cancer care due to the large number of specialists involved.

In other parts of the nation — and even other parts of our own community — cancer care delivery is in crisis. It needs to become more patient-centered, nimble and resourceful, particularly as technology, genomics and targeted therapy add to the complexity of cancer care.

At Hoag, there was some initial resistance to a nurse navigator model, a hesitation that quickly resolved as these coordinators won over the cancer team. Now, when a new cancer program starts at Hoag, the first thing physicians ask for is a dedicated nurse navigator.

It's what all cancer patients should ask for — and what they should receive.

Dr. JACK COX is the chief quality officer at Hoag Hospital.

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