My name is Alaina Mokhtarnejad and I work as a Thoracic Oncology Nurse Navigator at Ochsner Medical Center in New Orleans, LA. I’m sure the question of “what is a nurse navigator?” comes to mind. I will simplify this complicated terminology and also discuss the impact of nurse navigators in the field of lung cancer and mesothelioma.
My role as a thoracic oncology nurse navigator simply means that I “navigate” or guide patients with a new diagnosis of lung cancer or mesothelioma from the time of diagnosis through the end of their care or treatment. There are multiple other thoracic diseases or abnormalities that I also work with, but I will focus on lung cancer and mesothelioma.
Nurse navigators play a huge role in coordinating patient care with a new diagnosis of lung cancer. Here are a couple of examples of the way nurse navigators work in the field of oncology.
Example A: The patient has a cough that just wouldn’t go away for months and months, so they finally see their primary care doctor and he/she orders a chest xray. Some patients go through multiple tests before they receive a diagnosis; others have abnormalities found right away with a simple chest xray or chest CT scan. This is when the physician makes the referral to a thoracic surgeon, Oncologist, or pulmonologist based on the size of the concerning area.
The size and location of the nodule/mass noted on a scan is what determines the extent of the possible disease and to whom will take over the next phase of care for the patient. This is the hardest part… waiting…. and waiting… and waiting. Thoughts are consumed with the inevitable “Am I going to die?” “What did I do to deserve this?” “How will I afford treatment?” and the list goes on.
The nurse navigator is the next key player after an abnormality has been noted and discussed with the patient. Often times, the PCP calls the local cancer center or pulmonology department to continue the work up for the abnormality. The nurse navigator then “navigates” the patient to the next phase of care.
The pulmonologist will typically perform a CT chest if it has not been done at this point and possibly explore deeper by performing a bronchoscopy or an endobronchial ultrasound (EBUS) to gather a sample. Other times, patients are sent directly to the thoracic surgeon to have a nodule or mass of a certain size surgically removed. Other times, a sample may be obtained through a needle biopsy by the Interventional Radiology department.
Upon removal of the mass or nodule, pathology is performed to determine if this is a cancer and the specifics of the cancer. There are also instances in which the cancer is advanced in stage and surgical intervention is not medically possible, so the patients are directed to the Oncologist and/or Radiation Oncologist to begin immediate treatment. Other times, treatment is required before any surgical intervention may be considered.
Example B: A patient goes to their primary care doctor with similar symptoms, a cough or shortness of breath. A chest xray is performed and the xray shows a chest wall thickening or an accumulation of fluid (pleural effusion) which is concerning for mesotheolioma. Patients are sometimes able to pinpoint direct asbestos exposure, other times the exposure is unknown. The next step is likely a CT scan and a referral for a pulmonologist to obtain a sample of the pleural fluid to confirm this diagnosis. Other times, a patient may be referred to the thoracic surgeon to obtain a pleural biopsy to confirm a diagnosis of mesothelioma.
The nurse navigator is now entered into the picture once a patient has a positive pathology for mesothelioma. The ideal situation for the patient at this point is to proceed with both oncology and thoracic surgery to discuss a plan for chemotherapy and possibility for surgery. Not every patient with mesothelioma is a surgical candidate; this will be determined by the oncologist and thoracic surgeon as a multidisciplinary/team approach. The multidisciplinary approach is of utmost importance for a patient with mesothelioma as it involves the services of the pulmonologist, thoracic surgeon, and oncologist. This approach is spreading to just about every area of oncology and enhances the patient experience with a new diagnosis of any cancer type.
Another important role of the nurse navigator is guiding the patient to legal assistance for the known or unknown asbestos exposure. By this point, the patient is so overwhelmed with the diagnosis, costs, and quality of life issues; they often feel too bombarded to address the culprit of this disease. Navigators must hold the patient’s hand through this entire experience, so seeking legal assistance is a big part of the patient’s acceptance of mesothelioma.
As a nurse navigator, it is important to be at the patient’s side through the entire process of diagnosis and treatment. It has been most rewarding for me to be the first phone call about a patient with a new diagnosis and see them through surgery, chemotherapy, and radiation. The way patients and families grow through such a terrifying experience is truly magnificent. Not every outcome is positive, however, it is up to the nurse navigator to make the experience and journey worthwhile.