Purpose: Describe how case management by a nurse navigator has positively impacted the coordination and timeliness of care for Veterans newly diagnosed with esophageal cancer.
Background: Veterans with esophageal cancer have a complicated work-up and treatment course, involving many providers and ancillary services to support them through multi-modality treatment. Veterans are at high-risk for experiencing delays in care due to the complex coordination required.
Methods: A Cancer Care Navigation Team (CCNT) RN is dedicated to the case management of all newly diagnosed esophageal cancer cases. The RN completes an intake to identify barriers to completing timely work-up and accessing treatment and identifies education deficits related to their new suspicion or diagnosis. The RN provides an overview of the work-up process, identifies the providers involved in caring for the patient, and describes the ancillary supportive services, such as a specialized dietician and social worker. The RN educates the Veteran on possible treatment modalities and lodging options for treatment. The RN involves caregivers in education and treatment planning. Advance directives and release of information are completed to facilitate care planning and communication. The RN accompanies the Veteran to all treatment planning appointments with thoracic surgery, medical oncology, radiation oncology, and attends esophageal tumor board when the case is discussed. The RN facilitates communication and collaboration between providers and ancillary services as needed. The RN stays in close contact with the Veteran and caregivers throughout treatment to keep updated on the plan of care, provide support, and proactively identify barriers. The relationship developed by the RN with the patient and caregivers allows for ongoing discussions related to goals of care and, when necessary, end-of-life support.
Results: In the two years a CCNT RN has been case managing esophageal cancer cases, there has been an increase in patients verbalizing satisfaction with the education they receive about their disease, improved clustering of appointments and reduction of travel, and improved
coordination between VA and non-VA treating facilities. The multidisciplinary team has expressed increased satisfaction with the management of these cases. Next steps include formalizing a multidisciplinary clinic for esophageal cancer and finalizing esophageal cancer-specific educational materials.