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The Nurse Navigator Role in the Management of Non-Hodgkin Lymphoma and Hodgkin Lymphoma

Best Practices in Patient Navigation - First Issue: Lymphoma Edition published on May 27, 2015

The Oncology Nursing Society (ONS) uses the definition of oncology nurse navigator (ONN) to include a professional registered nurse with oncology-specific clinical knowledge.1 ONNs offer individualized assistance to patients, families, and caregivers with the goal of helping them to overcome barriers in the healthcare system that can impact the ability to receive quality oncology care.1 Navigation has become a key component of cancer care, and, in 2015, the American College of Surgeons Commission on Cancer will require that cancer programs seeking to obtain accreditation have an established patient navigation process in place.2

The current role of the ONN involves cancer care across the continuum of the disease, from prevention to survivorship and to end-of-life care. However, various institutions actualize the ONN role differently, depending on the needs of the institution. For example, many larger, comprehensive cancer centers employ ONNs to address the issues and barriers related to access. These issues include entry into the system as well as access within the institution (eg, from one department to the next). These larger institutions employ other nurses, such as ambulatory care or primary care nurses, to carry out alternate functions of navigation. Smaller practices, on the other hand, may have only 1 nurse who must perform all functions related to access, as well as other functions of the ONN role. These additional duties may include educating patients on the plan of care and specific therapies, managing treatment-related side effects, and helping patients locate appropriate psychological and financial support.

As discussed in a 2011 article in the Clinical Journal of Oncology Nursing, ONN interventions can improve patient mood and overall satisfaction, lower distress scores, and decrease the time from diagnosis to appropriate treatment.3 Influencing positive patient outcomes is a key role of the ONN, as is the promotion of positive system outcomes through improved interdisciplinary communication, patient retention, and downstream revenues.4,5 In addition, ONNs can be instrumental in ensuring continued quality cancer care in an era of tightening healthcare dollars.

There is a great need for navigation services in the setting of lymphoma, a heterogeneous group of neoplasms that affect the lymphatic system.6 For example, not all oncologists have been certified both in oncology and in hematology; therefore, a potential function of the ONN may be to navigate the patient to the most appropriate practitioner who is knowledgeable regarding his or her specific type of malignancy.

There are numerous subtypes of lymphoma, and goals of therapy may vary from curative to disease control and symptom management.7,8 A wide array of treatments is available for patients with these diseases, including standard chemotherapy, immunotherapy, and various targeted agents. The choice of appropriate therapy is based on disease-specific factors,8,9 as well as patient-related characteristics including comorbidities and physical status, personal preference, and socioeconomic status.

A significant role of the ONN is to provide education to the patient about the diagnosis, plan of care, and overarching goals of treatment. Many of the newer targeted agents for lymphoma are associated with toxicity profiles that differ substantially from those seen with standard chemotherapeutic agents. The potential adverse events a patient may encounter are largely dependent on the type of agents or combination regimens being administered. For example, infusion reactions are common during the administration of monoclonal antibodies.10 However, many of the agents used in the treatment of lymphomas cause toxicities such as myelosuppression, nausea and vomiting, hair loss, oral mucositis, peripheral neuropathy, and constipation or diarrhea.10 Long-term effects of therapy may also occur, including cognitive changes and cardiac toxicity, as well as sexual dysfunction. Patients with lymphoma are at long-term risk for second cancers and infections, which warrants adherence to cancer screening guidelines and immunizations such as seasonal influenza vaccine and pneumococcal vaccines.10

Thoroughly educating patients on the toxicities associated with treatment, as well as available interventions, can often minimize their incidence and severity, thereby allowing continuation of therapy to achieve optimal outcomes.

Many of the newer treatments approved for lymphomas are orally administered agents. Unfortunately, an individual’s healthcare coverage may not fully cover the cost of such agents. The ONN can serve as an advocate for the patient to assist with obtaining financial support for the copay costs of treatment, thereby affording patients the opportunity to choose from more options to manage their disease.

Another role of the ONN is the coordination of care. Patients with lymphoma often see various practitioners, such as their local oncologist, an oncologist at a tertiary care center (if additional opinions are desired), a radiation oncologist, a bone marrow transplant team, and clinical trials staff (if referred for a trial at an outside institution). In addition, patients may need to see specialists to address other health issues related to their lymphoma or its treatment. The ONN can help patients transition between these various healthcare providers.

ONNs can play a pivotal role in the care of the individual with lymphoma. Patients may transition to various practitioners, receive numerous treatments, and experience a wide range of emotions during the course of their disease and treatment. It is through the various roles of the nurse navigator that such patients can adjust to the various components in the trajectory of their diagnosis. 

References

1. Oncology Nursing Society. Oncology Nurse Navigator Core Competencies. Pittsburgh, PA: Oncology Nursing Society; 2013.

2. American College of Surgeons Commission on Cancer. (2012). Cancer Program Standards 2012: Ensuring Patient-centered Care. Version 1.2.1. 2012. http://www.facs.org/cancer/coc/programstandards2012.pdf. Accessed January 5, 2015.

3. Case MA. Oncology nurse navigator: ensuring safe passage. Clin J Oncol Nurs. 2011;15:33-40.

4. Desimini EM, Kennedy JA, Helsley MF, et al. Making the case for nurse navigators: benefits, outcomes, and return on investment. Oncology Issues. 2011;26:26-33.

5. Fillion L, Cook S, Veillette AM, et al. Professional navigation framework: elaboration and validation in a Canadian context. Oncol Nurs Forum. 2012;39:E58-E69.

6. Campo E, Swerdlow SH, Harris NL, et al. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117:5019-5032.

7. Goodrich A, McNally G, Ridgeway J, Zitella L. Mature B-cell neoplasms. In: Olsen M, Litella LJ, eds. Hematologic Malignancies in Adults. Pittsburgh, PA: Oncology Nursing Society; 2013:201-361.

8. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 5.2014. October 28, 2014. www.nccn.org/professionalphysician_gls/pfdf/nhl.pdf. Accessed November 24, 2014.

9. Olsen M. Overview of hematologic malignancies. In: Olsen M, Zitella LJ, eds. Hematologic Malignancies in Adults. Pittsburgh, PA: Oncology Nursing Society; 2013:1-17.

10. Erb C, Vogel W. Management of the complications of hematologic malignancy and treatment. In: Olsen M, Litella LJ, eds. Hematologic Malignancies in Adults. Pittsburgh, PA: Oncology Nursing Society; 2013:537-647.

Last modified: July 22, 2021