The University of Arizona Cancer Center

Coordinating Care for Patients With Breast Cancer

The University of Arizona Cancer Center is a National Cancer In- stitute (NCI)-designated comprehensive cancer center, providing excellence in patient care as well as a focus on the development and delivery of therapies to reduce cancer-associated morbidity and mortality. The center is 1 of 2 NCI-designated comprehensive cancer centers in the 5-state region comprising Arizona, Colorado, Nevada, New Mexico, and Utah.

Programs at the University of Arizona Cancer Center cover cancer biology, imaging technology, development of therapeutics, and cancer prevention and control. More recently, the center has added a biobehavioral and social sciences program aimed at improving the delivery and quality of care for patients and providing support to them throughout the continuum of cancer care.
The Oncology Nurse-APN/PA spoke with Beth High, RN, BSN, OCN, CBCN, CBPN-IC, Breast Oncology Nurse Coordinator, about her role at the University of Arizona Cancer Center in Tucson.

Can you describe the various duties that come with your title?
Beth High (BH): Although I am a certified Breast Navigator, my job title is Nurse Coordinator. Basically, the roles for a navigator and a coordinator are similar, but in our institution, instead of meeting the patient at the time of diagnosis and navigating her through the cancer continuum, I meet the patient when she has her initial visit with the medical oncologist.

As Nurse Coordinators on the breast medical oncology team, my colleague, Magdalena, and I typically attend the first appointment with the patient when the oncologist discusses systemic therapy. Knowing the treatment plan helps us to provide education on therapies, side effects, and what to expect in the future. Our patients can put a face to their nurse’s name when they call on the phone with questions and concerns. One of our main roles is Telephone Triage for patients needing symptom management. Our NP [nurse practitioner] is available to us for prescribing medications and for advice on complicated issues. We also coordinate with personnel in many other services such as pharmacy, social work, nutrition, pain and palliative care, survivorship clinic, and hospice, to name a few. A fair portion of our time is spent assisting patients with FMLA [Family and Medical Leave Act] and disability documents and, unfortunately, insurance issues. We are lucky to have an associate who is great at obtaining prior authorizations!

What is the approach to cancer care at your institution?
BH: Our top-notch academic Breast Health program is not all under one roof, but we function as a well-oiled multidisciplinary machine! When a patient is at the Imaging Center, she is assisted by an expert nurse who guides her through the diagnostic process of imaging and biopsy. A patient with a cancer diagnosis is then handed off to a nurse experienced in breast surgery. That nurse may collaborate with the nurse who is knowledgeable about reconstruction. I encounter the patient in the neoadjuvant or adjuvant setting and continue to follow her through systemic treatments and beyond. If radiation therapy is part of the treatment plan, patients will be cared for by a nurse certified in radiation oncology.

Communication between the highly specialized Nurse Coordinators is essential for keeping patients on track during each phase of cancer care. Additionally, I frequently engage with the infusion nurses when their assessment uncovers an unmet need or problem that I can facilitate solving. Don’t let me forget to mention the research nurses who coordinate our patients on clinical trials. It takes the whole team to ensure that our patients have the best possible outcome!

What was the path that led to your present career?
BH: After I graduated from nursing school, I joined the Air Force because I was offered a 6-month internship in obstetric nursing, which was the field I was interested in pursuing. Everything was great until, 6 years later, when my pilot husband and I were stationed in Germany and the first Gulf War was declared. I was pregnant at the time, so I opted to leave military service. I did not return to my nursing career until 16 years later when my kids decidedly no longer needed their mama. This is one of the really great things about nursing: you can always go back! My goal after taking the Nursing Refresher course was to work in women’s health. Eventually, I found a job at the University of Arizona Women’s Cancer Center in a position that did not involve much patient care. About a year later, I was recruited by Dr Alison Stopeck, Director of the Clinical Breast Cancer Program, to work in her clinic as a Nurse Coordinator. The prospect of working with patients again appealed to me; however, knowing very little about breast cancer, it required that I hit the books. It’s been 2 years since I started, and I have learned a great deal from the oncologists, the patients, and especially Katy Clarke, our Breast Team NP.

I also took advantage of the online education courses offered by ONS [Oncology Nursing Society]. In September 2012, I embarked on a big trip that started in Phoenix, where I attended the Academy of Oncology Nurse Navigators Annual Conference. From there I flew to Atlanta for the EduCare, Inc. 4-day Breast Health Navigator training program, which was valuable and extremely worthwhile. The last leg of my journey brought me to Chicago, where I sat for and passed the National Consortium of Breast Centers’ certification exam for Breast Patient Navigator in both Imaging and Cancer. I would like to add that the trip would not have been possible for me financially without help from the ONS Foundation. I am very grateful to have been the recipient of a Pearl Moore education grant, and I would encourage my fellow oncology nurses to explore all the resources that ONS has to offer. And then finally, a few months ago, I became an ONS Certified Breast Care Nurse.

What are you excited about right now in the field of oncology?
BH: I am excited to be the captain of our team for the American Cancer Society “Making Strides” event in Tucson on October 27. National Breast Cancer Awareness Month is the perfect opportunity for those of us who care for breast cancer patients to get together outside of work and show our support for the strong women facing this disease.

What are some of the challenges of your job?
BH: While it’s great that so much progress is being made in breast cancer treatments, like TDM-1 and pertuzumab, it is a challenge to keep up with all the new developments. Plus, there is so much about breast cancer in the general news. Angelina Jolie stirred up a lot of business for our genetic counselors! I try to read something every day in order to keep up with my patients.

For the most part, breast cancer patients are a savvy bunch. Recently, a patient read about long-term use of calcium channel blockers being related to increased risk of breast cancer. She wanted to know if she should stop taking her blood pressure medication. Much to my surprise, when I looked it up, I found out she was referring to a legitimate study reported in JAMA [Journal of the American Medical Association]. The author recommended confirmation of the results by other studies before anyone changed clinical practice, so I encouraged the patient to stay on her antihypertensive therapy and let her primary care provider know about the study.

Another patient read about iodine deficiency leading to breast cancer. I learned that researchers are looking at iodine to see if it can be used for prevention. Patients teach me something every day and keep me on my toes!

What advice would you give to a nurse or nurse practitioner entering the field?
BH: I would say join ONS! You can learn only so much on the job. The ONS online course, “Site-Specific Cancer Series: Breast Cancer,” is about the best way I can think of to get detailed information about the entire spectrum of breast care (CEUs too!). As an added benefit to your ONS membership, you can sign up for the ONS Special Interest Group for breast care. Read the breast cancer information on the NCI, ACS [American Cancer Society], and NCCN [National Comprehensive Cancer Network] websites. Another great site aimed at patients is Breastcancer.org. I go there again and again for information. I especially recommend the downloadable pamphlet “Your Pathology Report” from that site.

What would you be doing if you were not a breast cancer nurse?
BH: I would definitely stay in oncology: so many cancers, so much to learn, so many patients to help.