Program Improves Care and Decreases Costs for Patients With Cancer
The estimated cancer prevalence by age in the United States is expected to increase from 216 million in 1975 to 380 million in 2040. With older cancer survivors, the severity of disease and treatment will increase, and the physiologic effects of aging, such as pre-existing conditions and new-onset morbidity, will impact the level of care needed for older adults.
During a session at the Oncology Nurse Advisor Navigation Summit (http://media.oncologynurseadvisor.com/documents/303/ona_navsum_2017_meneses-webver_75663.pdf), ONS member Karen Meneses, PhD, RN, FAAN, professor and associate dean for research at the University of Alabama at Birmingham School of Nursing, discussed an innovative strategy to care for the aging population.
Meneses discussed the Patient Care Connect Program (PCCP), which is an integrated navigation program taking place at 12 cancer centers in Tennessee, Mississippi, Alabama, Georgia, and Florida to provide care for older adults (≥ 65 years) with cancer. The program has 12 nurse site managers and approximately 40 nonclinical navigators. The lay navigators coordinate and address barriers to care and empower and support patients and survivors.
Patients are enrolled in the PCCP through referral from providers and consensus reports on hospitalizations. Priority enrollment is provided to those with high acuity cancers (such as lung, ovarian, brain, hematologic, and head and neck), stage 4 and metastatic disease, comorbidities, minorities, and recipients of higher-risk drugs (such as warfarin).
PCCP navigators then administer a distress assessment (scores range from 0 [no distress] to 10 [extreme distress]), with survivor-centered interventions triggers by those receiving distress scores > 4 and/or for those who request assistance for specific distress items.
The most commonly reported distress items are fatigue, pain, functional mobility, concern regarding treatments, nervousness or anxiety, insurance or financial concerns, transportation, scheduling, nausea or vomiting, and breathing. Patients with reports of at least one distress item or those who request assistance most commonly have pancreatic, hematologic, lung, head and neck, or gynecologic cancers.
Meneses said that most (90.7%) requests for assistance were resolved with patient satisfaction with just 1.1 required interventions and a resolution time of approximately 11 days. She said that within the program, distress requests declined over time from 18.6 in the third quarter of 2013 to approximately 9 in the second quarter of 2015. According to surveys of navigated patients in the PCCP, 82% were “very satisfied” or “satisfied” and 88.3% would recommend PCCP to other patients with cancer.
She noted some other responses from surveyed patients regarding the PCCP:
- Helped find necessary information: 72.2%
- Helped learn about disease treatment or side effects: 69.4%
- Can rely on the navigator: 67.2%
- Have someone to check in on the patient: 66.7%
- Helped sorting out preferred medical care: 56.3%
- Helped understand doctors’ orders: 53.9%
- Helped get in touch with doctor: 53.6%
- Helped prepare for doctor visits: 50.9%.
“In the PCCP, healthcare costs and healthcare use declined for navigated patients compared with a matched group of comparison patients,” Meneses concluded. “Lay navigation programs can be expanded as health systems transition to value-based health care.”