Nurse Navigators and the Cancer Institute
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Transcript of Nurse Navigators and the Cancer Institute
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Nurse Navigators and the Cancer
Institute
Yousuf A. Gaffar, MD
Hematology / Medical OncologyThe Cancer Institute
University of MarylandSt. Joseph Medical Center
June 6, 2014
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Nurse Navigators at UM-SJMCWe have Navigators for:
Breast Cancer• Surgical Oncology• Medical Oncology
• Thoracic Malignancies• GI Malignancies• Hematolologic / Other• GU Malignancies
• Survivorship
HOW DO WE UTILIZE THEM EFFECTIVELY?
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CASE 1
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64 year old Woman
•Notices a palpable mass in her L breast
•Mammogram and Ultrasound confirm such•3 cm x 4 cm mass
•Biopsy performed SAME DAY AS ULTRASOUND
PAST MEDICAL HISTORY
History of Varicose Veins
PAST OPERATIONS – Venous Stripping
SOCIAL HISTORYDoes not Smoke or
Drink
FAMILY HISTORYNone
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A 66 year-old WomanClinical Presentation
Physical Examination
•Palpable Breast Mass
•Possible Axillary Node
•Exam otherwise Negative.
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BIOPSY RESULTS
•Poorly Differentiated Ductal Carcinoma of the Breast•ER Negative•PR Negative•Her-2 Positive by Immunohistochemistry
•Other tests•MRI of the Breast – confirms said mass. Axillary node suspicious Biopsied – Positive•CT Scans – NEGATIVE for Metastatic Disease
A 64 year-old Woman
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SUMMARY AND TREATMENT PLAN
•Stage IIIA Breast Cancer – Her-2 Positive
•TREATMENT PLAN•Neoadjuvant Chemotherapy
•Carboplatin•Docetaxel•Tratuzumab•Pertuzumab
•Surgery – Lumpectomy planned•Post-Operative Radiation
A 64 year-old Woman
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A 64 year-old WomanNEED NAVIGATOR
ROLECOORDINATION OF CARE / DISCUSSION OF CASE
FACILITATES DISCUSSION AT BREAST CANCER CONFERENCE
Genetic Counseling
MUGA SCAN / ECHOCARDIOGRAM Help Arrange
PORT Placement Help Arrange
Teaching regarding Side-Effects and Benefits of Chemotherapy
EDUCATIONAL ROLE / Chemo Class
Premeds Help Arrange
Emotional Support / Resource for Patient
KEY!
Coordination Between Surgical / Medical / Radiation Oncology
KEY!
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A 64 year-old Woman
NEED NAVIGATOR ROLE
Emotional Support / Resource for Patient
SUPPORTIVE
Coordination Between Surgical / Medical / Radiation Oncology
KEY!
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OUTCOME SO FAR….•Patient Discussed PROSPECTIVELY at Breast Conference
•After 2 CYCLES of Chemotherapy - •NO BREAST MASS!
•Patient to complete 6 cycles of chemotherapy
•Followed by 52 weeks total of Trastuzumab.
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CASE 2
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66 Year Old MalePAST MEDICAL HISTORY
None
PAST OPERATIONS – NONE
SOCIAL HISTORYDoes not Smoke or
Drink
FAMILY HISTORYNone
•Gradual Onset of Pain on Defecation
•Seeks Medical Attention due to RECTAL BLEEDING
•Rectal Exam and Colonoscopy Performed
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Physical Examination – OTHER TESTS
•Palpable Mass on Rectal Exam – no other masses palpates
•No Hepatomegaly
•Exam otherwise Negative.
•COLONOSCOPY PERFORMED – NOTABLE MASS SEEN AT 20 cm.
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BIOPSY RESULTS
•Poorly Differentiated Adenocarcinoma of the RECTUM
•Microsatellite Instability – STABLE
•Other tests•CT – CHEST / ABDOMEN / PELVIS – Only positive for known RECTAL MASS
•Endoscopic Ultrasound – T3 N1 Disease
A 65 year-old Male
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SUMMARY AND TREATMENT PLAN
•STAGE IIIB RECTAL CANCER (uT3uN1)
•TREATMENT PLAN•Neoadjuvant Chemoradiation
•CAPECITABINE and Radiation
•SURGERY
•Capecitabine + Oxaliplatin thereafter.
A 65 y.o. Male
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NEEDS LIST AND NAVIGATOR ROLEA 65 year-old Male
NEED NAVIGATOR ROLE
COORDINATION OF CARE / DISCUSSION OF CASE
DISCUSSION HELD AT GASTROINTESTAL TUMOR CONFERENCE
Rectal Ultrasound Help Arrange
Radiation Oncology Consultation Helps Mediate
Teaching regarding Side-Effects and Benefits of Chemotherapy
EDUCATIONAL ROLE / Chemo Class
Premeds Help Arrange
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NEEDS LIST AND NAVIGATOR ROLEA 65 year-old Male
NEED NAVIGATOR ROLE
Follow-up Tests / Scans Help Arrange
Coordination Between Surgical / Medical / Radiation Oncology
KEY!
Genetic Counseling As Applicable.
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OUTCOME SO FAR….•Patient Discussed PROSPECTIVELY at GI CONFERENCE
•After 5 weeks of Radiation and Capecitabine – patient feels better
•Patient undergoes Loop Ostomy + RESECTION
•pT3 pN0 disease post – radiation.
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OUTCOME SO FAR…. (2)•Patient Started Chemotherapy
•Capecitabine •Oxaliplatin treatment every 3 weeks
•Follow-up on Side Effects…
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LET’s MOVE ON…
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CASE 3
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27 year-old WomanPAST MEDICAL HISTORY
None
PAST OPERATIONS – NONE
SOCIAL HISTORYDoes not Smoke or
DrinkWorks Full Time Lives with Mother
FAMILY HISTORYNone
GYN HISTORYNulliparous
•Several Month History of Fevers / Sweats / Wt Loss
•Notes Palpable Lymph node in R neck
•Seeks Medical Attention
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Physical Examination – OTHER TESTS
•Palpable Lymph nodes in R Cervical posterior chain and R Supraclavicular Area
•No Splenomegaly.
BLOODWORK•Significant Anemia•Leukopenia•Hypoalbuminemia
CT SCANS•Diffuse Adenopathy
•Splenomegaly
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BIOPSY RESULTS
•Classical Hodgkin’s Diease
A 27 year-old woman
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SUMMARY AND TREATMENT PLAN
•Stage IIIB Hodkgin Lymphoma (Classical)
•Prognostic Score 2
•TREATMENT PLAN•Adriamycin•Bleomycin•Vinblastine•Dacarbazine•COMBINATION TREATMENT x 6 CYCLES
A 27 year-old
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A 27 year-old Woman
NEED NAVIGATOR ROLE
COORDINATION OF CARE / DISCUSSION OF CASE
DISCUSSION HELD AT GENERAL ONCOLOGY CONFERENCE
Fertility Evaluation Help Arrange
PORT Placement Help Arrange
Chemotherapy Class EDUCATIONAL ROLE / Chemo Class
Premeds Help Arrange
Echocardiogram andPulmonary Function Tests
Help Arrange
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A 27 year-old Woman
NEED NAVIGATOR ROLE
Follow-up Tests / Scans Help Arrange
SURVIVORSHIP
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OUTCOME SO FAR….•Patient Discussed at General Oncology Multi-Disciplinary Conference
•After 2 DOSES OF CHEMOTHERAPY•Patient feels much better•Anemia Resolving•Lymphadenopathy Resolving.