Navigators guide cancer patients through complex process

September 27, 2016
Judy Horton is part of a team of nurse navigators
Judy Horton is part of a team of nurse navigators who help cancer patients at MUSC Health. Photo by Dawn Brazell

An extraordinary display of teamwork got a Hilton Head woman the cancer care she needed at MUSC Health almost overnight. Patient Leslie Cosacchi said much of the credit should go to nurse navigator Judy Horton.

“Judy is so empathetic,” the Hilton Head retiree said, “and so knowledgeable.” 

Her case is a testament to the increasingly important role nurse navigators are playing in cancer care. The MUSC Hollings Cancer Center has eight nurse navigators. A big part of their job is to help patients get to the right specialists. But navigators are also experts who can answer patients’ questions and even offer emotional support.

Horton, who works with Rochelle Ringer, M.D., an MUSC Health breast surgeon in Bluffton, wrote about what happened in Cosacchi’s case in a letter to the leaders of Hilton Head Hospital and MUSC Health. She was inspired by how well their employees worked together. Horton’s Bluffton clinic is part of Hilton Head Hospital, which is affiliated with MUSC Health and the Hollings Cancer Center.

Helping an anxious patient

Cosacchi had recently been diagnosed with breast cancer, Horton wrote, and a follow-up scan showed something troubling on her lung as well. “Understandably, the patient and her husband were very anxious, scared and confused about the need for so many tests and then the results of those tests.”

What happened next showed that Cosacchi was anything but a number to the nurses, radiologists, doctors and others who jumped into action to help her, in Bluffton, Hilton Head and at MUSC Health.

The images from her lung scans were quickly burned onto disks and rushed to FedEx for overnight delivery to Charleston, and Horton was able to schedule a biopsy for Cosacchi at MUSC Health before the images even arrived. “The patient had her biopsy within two days of the results because of this coordination and commitment to excellent patient care,” Horton wrote.

“The story doesn’t stop there,” she continued. She got in touch with MUSC Health surgeon Chad Denlinger, M.D. “Even though he was out of town, he took a look at her images and made a recommendation.” Cosacchi had an appointment with Denlinger three days later.

Since then, she’s had surgery and treatment for both breast and lung cancer and is now going about her life happily again. Cosacchi said Horton is a big part of that. “She’s become kind of like a friend.” A friend, who happens to be a nurse certified as an oncology specialist who has great connections, almost two decades’ worth of experience and a passion for helping her patients.

Nurse navigators 

Being a nurse navigator is more than a job for Horton. “I love making that connection with the patient and being with them through their journey. Not just ‘treat ‘em and street ‘em.’ It’s forming those bonds and getting to know them and what’s going on in their lives, when their children are graduating and are getting married. That is fulfilling to me. That’s what keeps me wanting to do this.”

She knows from her own experience with her father’s colon cancer how important that can be. At one point, he was in the hospital for about five months. “I stayed with him every weekend,” Horton said. “He had an incredible nursing staff.”

So incredible that Horton, who had an undergraduate degree in English, decided to become a nurse who worked with cancer patients. She graduated from the MUSC College of Nursing and worked at MUSC Health in Charleston at the Hollings Cancer Center, then shifted to the Breast Health Center where she now works. It’s affiliated with MUSC Health.

Patient navigators have been around since 1990, after a report found the kind of help they provide saves lives by getting people from cancer diagnosis to treatment much more quickly and ultimately survivorship.

Some navigators also educate the public about the disease they specialize in and offer cancer screening to people who might otherwise not get it.

Jim Brook, who serves as a clinical oncology manager at Hollings Cancer Center, said the center sees about 3,000 new cancer cases each year. There’s a team of nurse navigators on hand to help, with an emphasis on:

  •  Connecting patients with the right doctors
  •  Scheduling imaging, procedures and multiple medical appointments 
  •  Discussing results and treatment recommendations

“Patients just love our navigators because they connect with them early in the process of cancer care. Getting started is very daunting to patients,” Brook said.

Navigation process for cancer patients

Once patients connect with nurse navigators, they can ask them all of the questions that arise after a diagnosis. The navigators typically specialize in a particular type of disease. In Horton’s case, it’s breast cancer. She is a certified oncology nurse.

“Some have a lot of questions,” she said. “‘What stage am I? What are we gong to do? Do I have to have surgery? Do I have to have chemo?’”

She sits with patients and their doctors for an hour-long conversation about what lies ahead. The patients are encouraged to bring along a family member or friend. “We give them a notebook, and the hospital auxiliary provides a phenomenal book on breast cancer. And we go through everything,” Horton said. 

“We start off with, ‘This is the kind of cancer that you have. This is the stage you have, this is how aggressive or not aggressive it is. These are the surgical options. This is the treatment path that is best for you.’”

Horton also tries to educate her patients and their loved ones. “For example, the timing of chemotherapy and endocrine therapy and side effects of both radiation treatment and chemotherapy. I sometimes coordinate behind the scenes with their other providers to ensure continuity of care, making sure everyone is on the same page.”

But she never forgets the emotional toll that cancer takes on her patients. “Sometimes the doctor doesn’t have the time to do the talking and psychological counseling, and the nurse does. I think that’s just as important as the surgery itself or the treatment.”

Not all navigators are able to follow their patients through treatment and beyond, but Horton is. “I had two patients at Hollings Cancer Center that I learned had passed within a couple of months from each other,” she said. “I wrote to both of their husbands. Both of them wrote me a very long letter back. That’s justification for why I do my job,” she said.

“Getting to know each patient on a personal level is fulfilling but ultimately helps me provide the highest quality and compassionate nursing care to each person who comes in our office.” 

Cosacchi, the breast and lung cancer patient Horton wrote about, said Horton’s navigation had a big impact on not only easing her anxiety but also ensuring she knew exactly what to do and who to see. “I was so impressed,” Cosacchi said.