ACCC Goes to Washington

By Leah Ralph, ACCC Director of Health Policy

With the transition to a new administration just days away, the Association of Community Cancer Centers (ACCC) this week joined with other leading cancer organizations to speak out for community cancer care providers and the patients they serve. On January 11, the Obama White House, in conjunction with Vice President Biden’s Cancer Moonshot initiative, hosted a morning-long event Making Health Care Better – Community Oncology.

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ACCC delegation at the White House

ACCC leadership—representing community providers from practices and cancer programs across the country—contributed to the conversation during moderated panel discussions, and provided real-world community perspectives on addressing disparities in access to prevention, diagnosis, and treatment; advancing clinical trials, new technologies, and innovative models of care; and providing support and survivorship services to patients with cancer. The event capped off a year’s worth of work between the Vice President’s office and oncology stakeholders across the country, including multiple meetings with ACCC members, to advance the priorities of Vice President Biden’s Cancer Moonshot Initiative and a commitment to achieving a decade’s worth of progress in cancer research in five years.  Don Graves, Counselor to the Vice President, thanked the cancer patients and providers in the room for their work to advance the goals of the Cancer Moonshot and, addressing the uncertainty around the future of the Vice President’s initiative, told the audience “the Cancer Moonshot will continue through you.” The Vice President recently announced he would start a nonprofit organization to continue to address the broad – and complex – issues around cancer research and funding. And late last year, Congress passed the 21st Century Cures Act, which provides $1.8 billion for Cancer Moonshot efforts at NIH.

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ACCC Advocates Heading to Capitol Hill

In the afternoon, ACCC co-sponsored a Capitol Hill briefing on Innovation and Access in Quality Cancer Care. Addressing the uncertain political environment, Senator Jon Tester (D-MT) highlighted some of the achievements realized by the Affordable Care Act (ACA), while Representative Fred Upton (R-MI) and Representative Diana DeGette (D-CO) described the bipartisan effort behind passage of the 21st Century Cures Act. Advocates were assured that funding provided under the Cures Act will be secure, regardless of the fate of the ACA. Co-sponsoring the briefing along with ACCC were the Cancer Support Community, the American Cancer Society Cancer Action Network, the Community Oncology Alliance, McKesson Specialty Health, Sarah Cannon, and The US Oncology Network.

As the U.S. healthcare system continues to grapple with transformative change, sharing the story of cancer care delivery in communities where patients live, work, and vote is critical to helping policymakers and legislators understand the impact of policies, regulations, and legislation. Join ACCC for Capitol Hill Day on March 29, in Washington, D.C., and share your story.  Learn more here.

8 Ways Your Cancer Registry Can Support Your Cancer Committee

by Linda Corrigan, MHE, RHIT, CTR

Check boxCommission on Cancer (CoC)-accredited facilities must establish a cancer committee and charge it to develop and monitor all cancer program activities and cancer-education initiatives. The CoC Cancer Program Standards require that the cancer committee has multidisciplinary representation that includes physicians, other allied health professionals, and a cancer registrar.

Cancer registrars play a critical role on the cancer committee, since they are the only member who has a complete picture of the facility’s cancer burden in their database. The cancer registrar can serve as the committee’s data expert by analyzing data and bringing those findings to the committee for use in program planning. Here are eight ways in which cancer registrars can support their organization’s  cancer committee in meeting CoC Standards, and more:

  • Standard 1.12 Public Reporting of Outcomes is a commendation standard that lists seven possible other standards that can be included and at least three of these are based on cancer registry data. Accountability and quality measures are regularly reviewed by the cancer committee and your registrar may provide guidance on which measures demonstrate the best outcomes.
  • Standard 2.1 CAP Protocols and Synoptic Reporting. Most cancer registry databases can be set up to track CAP synoptic summary adherence, allowing the cancer registrar to provide an important piece of needed data.
  • Standard 3.3 Survivorship Care Plans. Procedures can be established such that the registrar and nurse navigator work as a team to implement and monitor survivorship care plans (SCPs). In many cases, the registry data can be downloaded directly to create and update the SCP, saving the nurse navigator hours of work and ensuring these plans are up-to-date and patients are kept informed.
  • Standard 4.1 Prevention Programs target risk factors that contribute to a diagnosis of cancer. Effective prevention programs start with data, which can be community-wide data or facility-specific data. Either way, your cancer registrar can assist with data collection and also search the CoC Cancer Forum for examples of best practices for this standard.
  • Standard 4.2 Screening Programs start with data. Your cancer registrar can create graphs to illustrate and explain which sites of cancer present to your facility at an advanced stage at diagnosis. Then the cancer committee can discuss whether there is an evidence-based intervention your facility could implement to diagnose these cancers earlier. Your registrar may also be able to assist with collecting this screening data and the subsequent lower stage at diagnosis.
  • Standard 4.6 Monitoring Compliance with Guidelines. To help meet this requirement, the cancer registrar can look at how many breast cancers are being treated in accordance with the National Comprehensive Cancer Network (NCCN) guidelines and identify the cases not meeting the recommendations.
  • Help with the recruitment of new physicians by providing data on the number of cancer sites diagnosed at the facility. For example, a hospital with a high-volume of lung cancer diagnoses may consider hiring more specialists or establishing a lung cancer institute to meet the community’s needs. Registrars can also evaluate in- and out-migration patterns to help hospital administration understand and address patient-retention patterns. For example, if a patient is diagnosed at the facility, but seeking care and treatment elsewhere, this might be an indication that the facility-of-diagnosis does not have the specialists on staff to address patient care. Registrars can also analyze the time from diagnosis to treatment or from biopsy to final surgery to help the cancer committee spot where improvements can be made. Registrars can also review the distances patients travel for their care, what insurance they carry, and other factors that can be barriers to care.
  • Serve as a resource on CoC standards by reporting on information learned at the National Cancer Registrars Association’s annual conference. The CoC offers a standard Q&A session at this conference, providing an opportunity for cancer registrars to better understand the intent of the standards and clarify any questions. For example, in 2016 Daniel McKellar, MD, FACS, chair of the Commission on Cancer, explained which standards surveyors are reporting as being “noncompliant” and how to make sure your program is compliant on those standards. This was vital information that attending registrars brought back to their cancer committees.

Your cancer registry is a valuable resource for your cancer committees,  housing the data needed to help meet CoC standards and ensure patient-centered care. Key to success, however, is a cancer registrar who knows how to analyze and present the data. Hiring registrars who hold the Certified Tumor Registrar (CTR) credential is a good first step, but providing ongoing training on advancements in cancer treatments and data analysis and informatics is critical.


Contributing blogger ACCC Member Linda Corrigan, MHE, RHIT, CTR, is currently serving as President of the National Cancer Registrars Association.

 

Immuno-Oncology: Moving Forward Together

By Lee S. Schwartzberg, MD, FACP, Chair, ICLIO Advisory Committee

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As the momentum surrounding immuno-oncology continues to build, the Institute for Clinical Immuno-Oncology (ICLIO) is meeting the need for practical, real-world resources and education for all members of the multidisciplinary cancer care team.  Find out how in this just-released ICLIO white paper, which illuminates current progress with these exciting therapies, real-world challenges, and emerging concerns around continued access as immunotherapy moves into the community setting.

You’ll want to read Immuno-Oncology: There’s More to Discover for:

  • A concise recap of 2016 immunotherapy clinical highlights
  • An update on ICLIO education, resources, and what to expect in 2017
  • A snapshot of policy issues and pressing concerns impacting the future of immuno-oncology in practice.

In this rapidly changing landscape, I encourage all you to partner with the ICLIO. Whatever your role in caring for patients with cancer, the latest ICLIO white paper will provide insight and perspective on the evolving field of immuno-oncology.  Through ICLIO, let’s continue to move forward together on the exciting immuno-oncology journey.

Explore the hub of immuno-oncology information and resources available for the entire multidisciplinary cancer care team at accc-iclio.org and follow ICLIO for updates. ICLIO is an institute of the Association of Community Cancer Centers (ACCC).

Fasten Your Seat Belts. . .

By Leah Ralph, Director of Health Policy, ACCC

Overlapping roadways As we head into the New Year, 2016 is rapidly receding in the rear view mirror. Still, it was quite a year. We saw the Obama Administration finalize regulations for sweeping physician payment reform in Medicare, oncology practices nationwide navigate the first year of the Oncology Care Model (OCM), policymakers try – and fail – to push through drug pricing reform with a national mandatory demonstration program, the 21st Century Cures Act signed into law, and the drug pricing debate hit a fever pitch, fueled by public scrutiny of recent spikes in drug spending and prompting a range of policy proposals to reduce spending on pharmaceuticals, raising bigger questions about how to define value in cancer care.

And after nearly eight years of a healthcare system shifting to achieve the aims – and requirements – of President Obama’s signature health reform law, the surprise election of Donald Trump and transition to a Republican administration and Congress who have prioritized repealing the Affordable Care Act (ACA) in early 2017 – combined with unprecedentedly thin policy prescriptions on the campaign trail – mark the beginning of an uncertain, tumultuous, perhaps even bumpy period for health policy. And fasten your seat belts because it may happen fast: the first 18 months of a new presidency and congress is the most active period of policymaking in the U.S.

ACA’s Uncertain Future

With respect to the ACA, while the health reform law encompasses far more than the insurance exchanges, the public debate to date has been focused on the coverage mandate and subsidies in the individual marketplace. It’s important to note that regardless of the election results, the health insurance exchanges are doing worse than expected. The exchange markets are facing sicker-than-expected risk pools and lower enrollment, causing high premium increases and insurer withdrawals. To survive, the exchanges would have needed stabilization under any administration – meaning a Trump Administration could simply leave the exchanges untouched and effectively allow them to wither on the vine, leaving 20 million uninsured.

But President-Elect Trump has signaled that he favors politically popular consumer protections in the ACA, such as banning insurers from discriminating against people with pre-existing conditions and allowing children to remain on their parents’ health plan until age 26. However the path to achieve this without a requirement that individuals either obtain coverage or pay a penalty remains unclear. And while there’s no agreed-upon replacement plan, Congressional Republicans have also supported allowing the sale of health insurance across state lines, expanding the use of health savings accounts (HSAs), replacing the ACA’s health insurance subsidies with tax credits, and establishing high-risk pools. But none of these proposals would meaningfully restore access to insurance coverage for the more than 20 million people who have gained coverage under the ACA, creating a long road ahead to find ways to cover this newly expanded population in any replacement plan.

What will these changes mean for cancer patients and providers? While the scope and details remain unclear, generally, under the proposals put forward to date, cancer providers may see an increased number of patients who are under- or uninsured, and higher uncompensated care costs. For the exchange population, benefits and cost-sharing assistance will likely be less generous, which could pose significant access barriers to quality cancer care.  At the same time it’s important to note that the ACA overpromised and underperformed – while patients without access to subsidies are seeing out-of-pocket costs spike, concurrently providers’ expectations of gaining fully insured patients under the ACA have not necessarily been realized. Patients with exchange coverage have generally been sicker and more expensive to treat and, on top of that, some providers are starting to see their Disproportionate Share Hospital (DSH) payments evaporate, as agreed to under the law. Fixes to the ACA – beyond what Republicans are proposing – are needed to shore up the long-term viability of our healthcare system for both patients and providers.

The Path Ahead

As the New Year rings in the changes in Washington, D.C., there will undoubtedly be significant impact on the direction of federal policy with respect to access and coverage in 2017. Still, we expect that key market trends such as value-based purchasing will continue. While the fate of the Center for Medicare and Medicaid Innovation (CMMI), which was created by the ACA, remains uncertain, we suspect that Medicare’s push towards value-based payment is inherently non-partisan and the movement to test different ways to pay providers based on cost and quality is here to stay. In fact, many experts predict that 2017 will be the year value-based purchasing moves from concept to reality. CMMI has implemented more than 50 demonstration programs. Some of these are becoming mandatory, including bundled payments for cardiac care and joint replacement.  (At the same time, the Republican-controlled Congress may create some guardrails for CMMI, including limiting its ability to implement mandatory demonstrations.)  Just around the corner, Medicare physician payment is shifting from fee-for-service (FFS) to value-based purchasing as required under MACRA . Reporting on MACRA measures begins in 2017 and will determine provider Medicare reimbursement in 2019. And the pharmaceutical industry is also engaged in value-based purchasing, increasingly pursuing outcomes-based contracts with private plans.

Where the Rubber Meets the Road

In 2017, ACCC members will need to consider how value-based payments will increasingly shift responsibility for managing cost and quality to providers, and how your cancer program is positioned to engage in a risk-based reimbursement structure. Providers should also prepare for a shift in coverage for patients, and anticipate how to respond to changes in access to care.

Now more than ever is the time for oncology care providers’ voices to be heard – join us in Washington, D.C., March 29-31 for ACCC’s annual policy meeting, Cancerscape, to understand how policy changes will impact your program and patients, engage in policy discussions with your colleagues, and help shape the future of healthcare policy in 2017 and beyond.  So buckle up, check out the Cancerscape agenda, and register today.

Medicare Oncology Care Model: Opportunities for Social Work Participation

By Fran Becker, LCSW, OSW-C

ThinkstockPhotos-467463476The oncology community continues to follow developments with the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM), a program that aims to improve patient care, efficiency, effectiveness, and lower costs.

As participating cancer programs implement the changes mandated by the OCM, increased responsibilities for social work are clear.  In fact, under the model, the involvement of, and coordination with, social work is needed in a number of areas.

The OCM mandates that all patients receive patient navigation and supportive services during their treatment. These services encompass assistance in a number of areas, including financial, transportation, and facilitation of follow-up services.

As a component of the OCM, Medicare is requiring the documentation of a comprehensive Care Management Plan described in the National Academies (formerly, known as the Institute of Medicine) report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. All patients are to receive a care plan consisting of 13 items.  Among these, there are two areas that call for social work services:

Advance Care Plans – Social work has been involved in these conversations for some time in many settings. In fact, Medicare has revised payment policies to include advance care planning (CPT code 99497; add-on CPT code 99498). While the physician is the primary provider in advance care planning conversations, members of the cancer care team, including social work and other allied healthcare professionals, have an opportunity to be involved in these conversations

Distress Screening – Another important requirement under the OCM is screening for depression during each episode of care. As part of the patient’s care plan, OCM participants are required to screen and document a plan to address a patient’s psychosocial health needs. While many cancer programs screen for distress using the NCCN Distress Thermometer, Medicare has determined that this tool is not sufficient to screen for depression under the OCM, and asks OCM participants to use the PHQ-2 and PHQ-9 for depression screening.  The PHQ-2 self-report asks two questions to determine if a more extensive evaluation is needed.  If the patient scores at a three or above, the patient is asked to complete the lengthier PHQ-9.  During this meeting, if the patient screens in for depression, social work involvement escalates.  Social work has several options for helping patients, including offering counseling services in-house or referral to an outside agency, referral to the patient’s primary care provider, oncologist, or a psychiatrist. Even if the program is providing clinical social work services, follow-up on these referrals is needed to ensure patients follow through. In addition, social work is required to follow the patient to assess improvement or the need for additional services.

Social workers play an important role in helping OCM participating programs succeed under this innovative new model. Practices that are not participating in the OCM should do a self-assessment in terms of their social work capabilities, and their ability to support patients’ psychosocial health needs. As signaled through CMMI’s inclusion of social work and patient navigation services in the OCM model, this holistic approach to cancer treatment is sure to be the future of oncology care.

If you are a participating OCM practice, be sure to join ACCC’s OCM Collaborative, an online community of OCM practices sharing best practices, tools, and tips to succeed in the OCM. Join today.


Guest blogger Fran Becker, LCSW, OSW-C, is manager of Cancer Support Services, Carl & Dorothy Bennett Cancer Center, Stamford Hospital, and a past member of the ACCC Board of Trustees.

Navigators: Communicating Your Role

By Tricia Strusowski, RN, MS

Patient Navigation Healthcare CompassAlthough patient navigation services are becoming more common at cancer programs nationwide, physicians and administrators still frequently ask, “What are the responsibilities of the navigator?” Navigators coordinate care and remove barriers across the care continuum, which can potentially include many responsibilities. It is very important for navigators to be able to articulate their role concisely so that there is no room for misinterpretation. It is also important to share the Commission on Cancer Standards, Chapter 3: Continuum of Care Services, and navigator competencies/position statements from national organizations such as the Association of Oncology Social Work (AOSW), the Academy of Oncology Nurse & Patient Navigators (AONN+), and the Oncology Nursing Society (ONS), just to name a few.

Over the past year I’ve had several cancer programs request a tool to educate their physicians, office staff, and other departments on the role of the navigator and oncology support staff.  For programs looking for a similar tool, here are two sample questions and suggested answers. These can be customized to reflect your cancer program’s structure and its navigation and support staff responsibilities.

Example 1:

What is a navigator and what are the Commission on Cancer (CoC) Standards for Navigation?

Navigation Definition:
C-Change defines navigation as “individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality medical and psychosocial care from pre-diagnosis through all phases of the cancer experience.”

Commission on Cancer Standards, Chapter 3: Continuum of Care Services

Standard 3.1: Patient Navigation Process
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the Cancer Committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.

Standard 3.2: Psychosocial Distress Screening
The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care.

The psychosocial representative on the cancer committee (oncology social worker, clinical psychologist or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the cancer committee annually.

Timing of screening: Patients with cancer are offered screening for distress a minimum of 1 time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, presurgical and postsurgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy) and transitions off treatment.

Standard 3.3: Survivorship Care Plan

The cancer committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in the minutes.

Include navigation position statements based on your navigation model. Use the following organizations:

Oncology Nursing Society Nurse Navigation Core Competencies

Academy of Oncology Nurse and Patient Navigators, Definition of Models of Navigation

Oncology Nursing Society, Association of Oncology Social Work, and National Association of Social Workers joint Position Statement on Navigation

Example 2:

How can the Navigator and Support Staff help your office?
Call us at _______________________________________

Nurse Navigator:
A nurse navigator provides patients and their families with education and assistance to overcome healthcare barriers and assist with timely access to quality medical and psychosocial care across the continuum of care.

 How can the nurse navigator help? 

  • Provide a comprehensive assessment/psychosocial distress screening of the patient/family needs, introduction of appropriate support services.
  • Reinforce education with patient patients/families regarding disease, treatments, side effects, and adverse reactions.
  • Link patients with community agencies and resources.
  • Make follow-up calls to patients/families at home.
  • Review support groups and educational programs for patients/families.
  • Educate patients on reportable signs/symptoms, based on physician’s plan of care.
  • Follow-up with patients’/families’ status post (s/p) discharge to ensure services are set up as planned. Coordinate with inpatient staff.
  • Conduct performance improvement (PI) projects.
  • Participate in Tumor Site Team and tumor conferences.

Social Worker:
A social worker can assist patients and their families with information on internal and external resources, financial, practical, and emotional concerns during their cancer journey.

 How can the social worker help? 

  • Provide counseling for patients and families.
  • Perform psychosocial assessments.
  • Offer and facilitate Support Groups.
  • Assist with completion of charitable application/patient assistance applications.
  • Assist with medication applications.
  • Evaluate patient for Medicaid/Medicare eligibility.
  • Provide transportation resources.
  • Identify community resources.
  • Coordinate Community Assistance Program.
  • Educate on Hospice.
  • Assist with end-of-life decision making.
  • Provide bereavement follow-up.

Registered Dietitian:
A registered dietitian is an expert in dietetics; that is, human nutrition and the regulation of diet. A dietitian advises oncology patients on what to eat in order to lead a healthy lifestyle or to achieve a specific health-related goal.

 How can a registered dietitian help?

  • Screen high-risk patients.
  • Provide group and individual nutrition counseling.
  • Connect patients with community and national resources.

 Genetic Counselor:
A genetic counselor can offer education, testing and counseling for patients (and families) with a history of cancer. Cancers may or may not be inherited.

How can a genetic counselor help? 

  • Provide risk assessment.
  • Provide genetic testing.
  • Provide genetic counseling.
  • Discuss strategies for risk reduction.

These are just two examples of how to create a tool to clearly and concisely explain the roles and responsibilities of navigators and support staff at a cancer program. These can be modified to describe the specific responsibilities for these roles at your cancer program. I encourage navigators to go forth and educate about your role.


Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

CMS Part B Drug Demo Unlikely to Move Ahead

By Leah Ralph, Director of Health Policy, ACCC

Centers_for_Medicare_and_Medicaid_Services_logoJust before Thanksgiving, top Senate Democrats asked the White House not to issue a final rule on the Center for Medicare and Medicaid Innovation (CMMI) proposed Part B Drug Payment Model – a national program that would significantly reduce reimbursement for Part B drugs. This was  a good sign for our efforts against the proposal, and on November 21, we passed an important deadline for CMMI to release a final rule. We are now within a 60-day window of the new Administration taking office, which, if a final rule were to be released, due to a series of administrative rules in Congress, makes it much easier for the new Administration to simply pull back the rule rather than having to do it legislatively.

Simply put: we passed a critical deadline, and we’re very optimistic that we will not see a final rule on the Medicare Part B Drug demonstration for the remainder of the current Administration. ACCC spoke out strongly against this ill-conceived proposal. Hundreds of ACCC members weighed in with their members of Congress, and ACCC produced financial analysis that we shared with the committees of jurisdiction in both the Senate and House of Representatives that showed precisely how devastating cuts to Part B drug reimbursement under this proposed model would be on both practices and hospitals. ACCC thanks you for your efforts to block this poorly-conceived experiment. This is a victory for cancer patients and providers across the country who can now continue to provide high-quality cancer care close to home.

With a new year and a new Administration upon us, we will continue to face both opportunities and challenges in the oncology policy landscape. ACCC is committed to preserving the cancer delivery infrastructure, and we will continue to work with policymakers to develop thoughtful policies around value-based care and an appropriate, sustainable reimbursement system for all settings of care.

The Cancer Registry’s Role in Creating Survivorship Care Plans

by Barbara J. Dearmon, BS, CTR

Solutions on corkboard (small)Survivorship Care Plans  are required by facilities accredited by the American College of Surgeons Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC). These plans assist patients in being active participants in their post-treatment plan of care. The Survivorship Care Plan (SCP) helps promote continuity of care, provides a plan for future care, alerts the patient to delayed effects long after treatment has concluded, and provides a source document to share with future providers. Having a SCP helps patients maintain appropriate follow-up, such that late effects can be properly managed and recurrences identified and treated quickly. The SCP also provides the opportunity to address psychosocial and other health issues related to the cancer experience. The CoC’s Survivorship Care Plan requirements are outlined in Standard 3.3; the NAPBC’s requirements are detailed in Standard 2.20.

St. Vincent’s Medical Center Riverside in Jacksonville, Florida, is accredited by both the CoC and NAPBC. To meet these organizations’ SCP standards, St. Vincent established a Survivorship Committee in 2014 to examine the requirements and develop a process for disseminating SCPs and comprehensive treatment summaries to cancer patients who completed cancer treatment at the facility. The process also included a system to monitor and evaluate these efforts annually. The Survivorship Committee was multidisciplinary and included representatives from administration, cancer registry, information services, medical oncology, radiation oncology, surgery, clinical staff (physicians and nursing), and the survivorship nurse navigator.

The Survivorship Committee unanimously agreed that the cancer registry was the most complete data source for creating SCPs and treatment summaries to meet compliance with both standard-setting organizations. The cancer registry currently captures the majority of required data elements that will ultimately be included in these care plans. Some cancer registry software applications have the ability to interface data into a preformatted care plan template or Word document. St. Vincent’s reviewed several resources and decided to use Journey Forward, which interfaced easily with its cancer registry database. Policies and procedures were established to guide the process. Specific policies outlined the roles of the cancer registry staff and the survivorship nurse navigator and detailed the purpose, case eligibility, and dissemination process for the Survivorship Care Plans.

Role of the Cancer Registry:

  • The cancer registry generates a list of eligible cases abstracted using the cancer registry software and exports the data into Journey Forward.
  • The information for the care plans derived from the cancer registry database includes: cancer diagnosis, demographics, first course of treatment, stage of disease, and treating physicians. Treatment information to be captured includes chemotherapy, drugs administered (start and end dates), hormones, immunotherapy, radiation, and surgery.
  • Follow-up information on date-of-last contact is captured on the template. Cases are selected retrospectively, eight months from date-of-first contact at facility.
  • The cancer registry interfaces (exports) registry data into Journey Forward’s breast, colon, and lung templates.
  • For the primary sites that to do not correspond with Journey Forward templates, the cancer registry saves the information in a secured Excel file on a shared drive. The survivorship nurse navigator, with assistance from the cancer registry, manually enters demographics, treatment, stage, physician contact, and prognostic indicators into the Journey Forward’s generic template. The completed templates generated monthly from the registry database are saved in a folder located on the secured shared drive for the survivorship nurse navigator to access.

Role of the Survivorship Nurse Navigator:

  • The survivorship nurse navigator accesses the shared drive and selects the current cases for the month. The survivorship nurse navigation obtains from patient records and/or the physician office the clinical documentation necessary to complete the survivorship care plan and treatment summary.
  • The survivorship nurse navigator reviews information for accuracy and contacts the cancer registry if there are questions related to data interfaced from the registry database.
  • The survivorship nurse navigator works with outside physician offices to obtain necessary information to complete the remaining care plans.
  • The survivorship nurse navigator contacts the patient and offers an appointment to review the SCP in-person.
  • If the patient declines an appointment, a hard copy of the SCP with a cover letter and contact information is mailed to both the patient and the patient’s primary care provider.
  • All correspondence with the patient is documented in Nursenav Oncology, St. Vincent’s nurse navigator software. In addition to generating templates in Journey Forward, clinical staff use Nursenav to chart information and all correspondence with patients.
  • The survivorship nurse navigator maintains an electronic copy of all completed SCPs.

The Survivorship Care Plan process at St. Vincent’s is evaluated and monitored on a regular basis by the survivorship nurse navigator and the facility’s Cancer Committee. Tracking to ensure compliance with the process is presented to the Cancer Committee and the breast program leadership annually at a minimum.

Implementation of a Survivorship Care Plans benefits patients, who will be better informed about the treatment they’ve received and the resources available to ensure continuity of care. There are a variety of ways for a facility to develop Survivorship Care Plans and to ensure these plans are disseminated and the needed follow-up conducted. At St. Vincent’s, the multidisciplinary team that formed its Survivorship Committee, believed the cancer registry and the survivorship nurse navigator played critical roles. As facilities develop their process for implementing SCP plans, they too may want to consider the role of the cancer registry. Resources to help a facility get started include the American Cancer Society; American Society of Clinical Oncology; Institute of Medicine; Journey Forward; LIVESTRONG; and the National Cancer Institute.


Guest blogger Barbara J. Dearmon, BS, CTR, is manager, Oncology Support Services, at ACCC Cancer Program Member St. Vincent’s Medical Center, Jacksonville, Florida.

Creating a Navigator Orientation Checklist

By Tricia Strusowski, MS, RN

Compass pointing at answers-SMALLI remember when I first started our oncology navigation program in 1998; there were no national standards or core competencies for navigation. The only model I was aware of that followed the patient through different levels of care was the case management model. The goals of the case management model were to coordinate the patient’s care at the appropriate setting while keeping costs down. We discussed the plan of care with the physician and also spoke with the patient and their family to discuss their specific needs and whether their care could be handled at home or whether they needed an alternative care setting or level of care.  

Fast forward to 2016. Today navigation has support from the Institute of Medicine,  the Commission on Cancer has added a navigation standard to its Cancer Program Standards, the Oncology Nursing Society (ONS) has developed oncology nurse navigator  core competencies, and there is a joint position statement on the role of oncology nursing and oncology social work in patient navigation from ONS,  the Association of Oncology Social Work (AOSW), and the National Association of Social Workers (NASW). (Note: The George Washington University Cancer Center has developed core competencies for non-clinical patient navigators.) Today, our navigation programs follow the patient across the care continuum from the earliest point of entry though survivorship or end-of-life services.

Despite the fact that we now have navigation standards and core competencies in place, I still hear from navigators, “I was hired and told, ‘Go navigate.’ I had no idea what that meant.”

So, how do we teach our new navigators? Typically nurses come to the navigator role from varied backgrounds—the inpatient oncology unit, chemotherapy infusion suite, radiation oncology, and home care, just to name a few.

As with any new job, a robust orientation is key; a full navigation curriculum including an orientation checklist and annual competencies is essential for a solid foundation. Here is one example of the elements a navigator orientation checklist might include:

Navigator Orientation Checklist

  • Hospital-specific policies/procedures and mandatory educational programs
  • Navigation history, definition, and models of navigation
  • Benefits and goals of navigation
  • Job description, roles and responsibilities of navigator, and support staff
  • Commission on Cancer Standards and Cancer Committee responsibilities
  • Institute of Medicine; Delivering High-Quality Cancer Care
  • NCCN, ASCO, and other national guidelines
  • Referrals to the navigation program
  • Internal resources, roles and responsibilities:
    Social workers
    Registered dietitian
    Financial assistant/advocate
    Health psychologist
    Pastoral Care
    Genetic counseling
    Cancer  registry
    Rehabilitation team
    Palliative Care team
    Hospice team
    Other, __________________________________________________
  • Community resources, list_____________________________________________
  • Patient educational materials, i.e., disease–site-specific information, clinical trials, patient journal, etc.
  • Caregiver toolkit and resources
  • Assessment tools, documentation and reporting
  • Communication and managing transitions with the patient, family and/or caregiver
  • Communication among the healthcare team, internal and external resources
  • Patient experience survey process
  • Performance improvement models and initiatives:
    Patient experience
    Clinical outcomes
    Business performance
  • Support groups and educational programs
  • Tumor conference responsibilities
  • Multidisciplinary participation and responsibilities
  • Professional organizations and certification
    AONN, Academy of Oncology Nurse Navigators
    Association of Oncology Social Work
  • Other, list _________________________­­­­­­­­­­­­­­­­­­­­­­­­_____________________________________

This orientation checklist is just a foundation for your new oncology navigator; adjust to your specific needs and navigation model. Remember: a good orientation is key for your new navigator’s success.


Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

A Message to New Oncology Nurses

By Sandy Balentine, MSN, RN,OCN, MBA

Nurse and Patient Holding Hands(small)Although it’s been many years since I was a “new oncology nurse,” I still remember those first few days as a new graduate nurse.

Nurses touch people’s lives in many ways. They usually spend more time with the oncology patient than the patient’s physician or any other professional caregiver, and can develop a very intimate bond with their patients. Patients and families will remember their nurses for the care they provide during a very difficult time of the patient’s life. The public has a high level of respect and trust in the nursing profession. As a new oncology nurse, you are entering one of the most rewarding professions in the world in one of the most challenging specialties in healthcare.

Having completed your training, as a new nurse you are now responsible for everything you do. You try to do everything the right way, just as your clinical instructor taught you, only to find out that the oncology area in which you are working operates a little differently from the way that you learned to do things in nursing school. This sometimes causes your mind (and your stomach) to do a somersault.

A number of stressors make the job of nursing for cancer patients one of the most challenging— as well as rewarding—of all fields. With that in mind, here are some realities to consider so that you can be prepared and manage the stresses that come with this noble profession—especially when you are a new graduate.

Coping with the Challenges of Your New Role

How will you handle some of the stressors of your work environment—fulfilling the high-pressure job demands of nursing, floating to other nursing units, and struggling with the work load, while adjusting to a new role? Here are some tips to help you adjust to your new reality:

  • Build relationships with your colleagues.
  • Never be afraid to ask questions. It is okay to let people know that you do not have all the answers. Nursing is a lifelong learning profession.
  • Know your limitations. Don’t be afraid to express them, in a professional manner, if you feel uncomfortable when asked to do something.
  • Soak up information as much as you can—watch and listen—and you will learn so much more than you learned in school.
  • If your hospital doesn’t assign one, find a personal mentor to be your support person for the first year. You will need someone to talk to about your first days in nursing.
  • Take the time to do things right the first time, even if you think there is no time. Chances are, you won’t have to do it over.
  • Develop good organizational skills.
  • Do not complain about something unless you have a solution. Simply put: be a part of the solution rather than a part of the problem.
  • Always have integrity—you will gain the trust and respect of everyone you come in contact with.
  • Listen to your patients and their families; they know their bodies better than you do.

A Few Words of Advice . . .

So what advice do I have to share with upcoming new graduate nurses?  First, believe in yourself, it is the key to having self-confidence in what you do. Second, everyone has different learning patterns. Know your learning style and seek resources to complement how you learn best. And one last piece of advice: don’t let anyone make you feel discouraged.  As a new nurse, it can be easy to feel discouraged. You are working with other nurses who have more experience than you. You may sometimes feel uncomfortable when talking to a physician about a situation and don’t want to appear as “new.” A patient might even question your ability because they can sense that you are nervous. But always remember that you have been trained for this, and you have others to support you. You care about others and that is why you joined this profession.

Nurse to Nurse Support

We “seasoned” oncology nurses also have a responsibility to the new nurse. We must recognize the difficult transition that a new nurse has to make. Nurse orientation programs need to be personalized to nurses’ individual training and development needs. Such customized development to meet new nurses’ needs creates engaged employees. They will be working with cancer patients who have very specialized needs.  So in addition to teaching our new nurses about these special needs, we must also provide the support they need in their new role. Nurse residency programs are the best programs to help a new nurse through the challenges of their first year of practice. The best mentoring programs guide new nurses through career progression and show them how to be good nurses.

Leadership Training

You also may have heard the saying: “Nurses don’t leave organizations; they leave managers”; thus, leadership training is essential. Investing in leadership training benefits the entire organization. An organization’s leadership must foster a healthy work environment and set clear expectations. They must pay attention to staff’s professional development. The best leaders set realistic expectations, and inspire their nurses through their example.  They coach and nurture new graduates and create a patient care environment to support their staff.

Encourage new nurses to become involved with committees and councils that affect their practice. This can not only help them to feel more a part of their nursing environment, but also encourages them to have a voice in their organization.

Caring and Compassion

The Chief Nursing Officer at The Valley Hospital had a message for our nursing staff recently: Nursing has its roots in caring, and equally important for nurses is their ability to be compassionate with patients, and to use themselves as a therapeutic vehicle for healing.  Nurses’ compassion and their empathy is really just as important as their technical skills. And it is that relationship between the patient and the nurse that really brings healing to the patient. This message should also hopefully touch the hearts of new graduate nurses. Remember why you decided to join this profession. You will make such a difference in the lives of the patients you touch!


ACCCBuzz contributing blogger Sandy Balentine, MSN, RN, OCN, MBA, is the Director of Clinical Oncology at ACCC Member Program, The Valley Hospital. Her article for Oncology Issues (May/June 2016) describes the development of “The Oncology Nursing Fellowship Program” at her institution.