Nurse navigators help cancer patients cope early in care

When Group Health patients received support from a nurse navigator, or advocate, soon after a cancer diagnosis, they had better experiences and fewer problems with their care-particularly in health information, care coordination, and psychological and social care-according to a randomized controlled trial in the Journal of Clinical Oncology.

“Patients linked with a nurse navigator reported feeling better supported emotionally, more involved in their care, better able to plan ahead, and better informed,” said lead author Ed Wagner, MD, MPH, a senior investigator at Group Health Research Institute and director emeritus of the Institute’s MacColl Center for Health Care Innovation. “They also experienced fewer problems receiving the information and emotional support they needed, and in the coordination of their care.”

Dr Wagner and colleagues found that following a cancer diagnosis, patients and their families often need extra help with information, translating medical jargon, psychological and social support, and coordinating care from various health providers.

In the randomized controlled trial, half of the 251 adult patients newly diagnosed with cancer were assigned to an oncology nurse navigator to help them for 4 months. Starting 2 weeks after the diagnosis, the nurse navigator initiated weekly phone calls and contacted each patient an average of 18 times, including meeting in person at least once with each patient: for example, accompanying them to a doctor’s appointment.

The other group of the patients received “enhanced usual care” consisting of educational material designed by a patient advisory committee. Most (190) of the patients had breast cancer, but 30 had lung and 31 had colon or rectal cancer. Patient-reported outcomes were measured at baseline, 4 months, and 1 year.

Some of the differences between the groups persisted for 8 months after patients’ last contact with a nurse navigator, suggesting that the nurse navigators helped patients to develop the confidence and skills to manage their illness and treatment more effectively, according to the researchers.

Overall costs of healthcare, including the costs of the intervention, didn’t rise at all with the nurse navigator intervention-and in lung cancer patients, they might have actually declined. No overall changes were detected in patients’ quality of life or depression.

“Many hospitals and cancer centers are already offering navigator programs, but they vary widely in who the navigators are, and what they do,” Dr Wagner told Formulary. “This is the first randomized trial to show a positive impact on patients, and should offer useful information for program development and improvement.”

The oncology nurse navigators had experience with cancer patients, received special training to deal with psychosocial distress, and were familiar with the Group Health system. Group Health has already incorporated an oncology nurse navigator into usual care for women newly diagnosed with breast cancer at its Capitol Hill campus-even before the research was published.