Jay Swanson, RN, BSN, OCN Shanna Gillming, RN, BSN

1. Multisite Tumor Navigators Jay Swanson, RN, BSN, OCN Saint Elizabeth Cancer Institute Shanna Gillming, RN, BSN Good Samaritan Hospital Cancer Center

2. Objectives Discuss concerns with navigation Identify potential best practices Review case study highlighting the strengths and difficulties of multisite navigation

3. Why Navigate Multiple Sites? Small amount of cancer for service area Program can only support 1 navigator Referral systems not in place “Don’t want to leave anyone out”

4. Brainstorming Time Take 5 minutes to think about… Why are you/do you have a multisite navigator? What are the benefits? What are the concerns? Would you want to be or wish you were specialized? Do you have a preferred disease site to navigate?

5. J.M. 75-year-old woman with stage IV lung cancer Navigated at time of diagnosis through treatment Including 2 different cycles of chemotherapy WB XRT Cyberknife to left rib cage Now on PO TKI for therapy

6. Thoughts What are some thoughts about… How often to follow up with this patient? What are the main areas of focus for her care?

7. Next Patient E.L., 28-year-old woman with gastric cancer Navigated for financial assistance through treatment and beyond Patient had minimal side effects to chemotherapy Always acted like it was not a big deal to be on treatment Always had 12-year-old daughter in room Admitted over weekend for anxiety and nausea

8. Thoughts What are your thoughts about… Her care, and what concerns should be addressed with her? How does she differ from the patient you saw before her? How often should we follow up with her?

9. Then… J.C., plasmacytoma - spine 44-year-old man, lives with significant other Uninsured, has worked as a truck driver Unable to work as a result of tumor Undergoing radiation Tolerated radiation treatment fairly well Has applied for public assistance

10. Thoughts What are your thoughts… Regarding his care? How does he differ from everyone else today?

11. GYN Patient J.N., 56-year-old patient with advanced cervical cancer Waitress, uninsured Was symptomatic for 2 years with spotting, pain, and weight loss. Waited to see an MD Has a sister from California here to care for her Borrowing a car from patient’s ex-husband to get back and forth to treatment Hospitalized for several weeks with side effects from concurrent chemo/XRT

12. Thoughts What are your thoughts… What are the barriers here? How can a navigator assist this patient?

13. H&N Patient S.S., 56-year-old life-long smoker/drinker Receiving radiation for 6 weeks Using American Cancer Society for rides Wife calls daily about concerns Pain meds Swallowing Eating Patient never has any concerns; rates distress level 0 on numerous occasions

14. Thoughts on This Case… What can we do for this gentleman? Is his score concerning? What can we do for his wife? How is this different from other cancer navigation?

15. Final Thoughts on Case Study The purpose of specialization is to be able to provide a more focused knowledge base for care How to specialize the following morning? Stage IV lung Gastric Plasmacytoma GYN H&N

16. Resources Utilized by Navigators American Cancer Society Med companies Local resources (food, lodging) National resources – Healthwell, Chronic Disease Fund, Cancer Care, Patient Advocate Foundation, LLS Cleaning for a Reason Centers for Medicare & Medicaid Services

17. Next Steps Within AONN we have a network We have an ability to provide a safe place for multisite navigators Certification for Navigation is happening on some level and will only become more prevalent in the coming year

18. Next Steps What are your thoughts about… Building a place on the AONN site for multisite navigation What would we include on the site? Any tools that we use that would be helpful? Contact information? Resources? Networking throughout the year to help address concerns, maybe as a teleconference or webinar?