Northside Hospital Cancer Institute is Georgia’s largest and most comprehensive community cancer care provider. With a network of more than 55 cancer locations and the highest number of board-certified oncologists in the state, it diagnoses and treats more new cases of cancer each year than any other community cancer program in Georgia. The Institute has more than 25 oncology nurse navigators and cancer care liaisons available to help patients through their cancer journey.
The Oncology Nurse-APN/PA (TON) spoke with Penny Daugherty, RN, MS, OCN, ONN-CG, Head and Neck Cancer Oncology Nurse Navigator, at Northside Hospital Cancer Institute, Atlanta, GA, about some of the rewards and challenges of her job, how the COVID-19 pandemic has affected cancer care, her role as Co-Chair of the Conference Planning Committee of the Academy of Oncology Nurse & Patient Navigators (AONN+), and new treatment advances on the horizon.
TON: What are your responsibilities at Northside Hospital Cancer Institute?
Ms Daugherty: As an oncology nurse navigator I work with patients with head and neck cancer following their diagnosis. I connect with them before they begin treatment and assist as needed in coordinating care for them.
Patients with head and neck cancer have unique and specific needs, as this cancer type and its treatments can affect speech, swallowing, taste, and the ability to enjoy food. These patients need consults regarding potential disease- and treatment-related adverse events, including nutritional consults. My navigation effort is generally front-end. I educate and prepare patients regarding what to expect as they go forward through their care, so they are not blind-sided or overwhelmed. Once patients begin treatment, their medical oncologists will use their own resources to coordinate care.
Patients can fall through the cracks if they need to be referred elsewhere for specialized procedures. In those cases, I become their coach. Their caretakers also need education and preparation. In addition, many patients need financial assistance because insurance issues are a major aspect of coordination of care. Patients with low socioeconomic status often have resource needs that need to be addressed as soon as possible. With these patients, I become more involved as they go forward into treatment.
TON: What are the biggest rewards related to your job?
Ms Daugherty: When I see patients come out the other end of a very dark tunnel, I feel rewarded. I worked with a patient who was a retired painting contractor; he was very accustomed to running his own business. Because of the aggressive nature of his cancer, it was necessary for his tongue to be surgically removed. This was very debilitating for him. His wife helped him through all the complications of treatment, including bleeding stomas. After a 3-month course of treatment, he was able to function.
His wife called and told me that she wanted me to hear something. She held the phone out so I could hear his motorcycle starting. I said that I hoped he had a mask on! Two minutes later, his wife relayed the following message from him: ‘She would find something to scold me about!’ That showed me that he still had his sense of humor and was up and running on his Harley.
It is wonderful when I can see patients get out from under the burden of challenging diagnosis and treatments and get back to functioning. It is a kind of magic to help someone reestablish their sense of self. In the past, head and neck surgeries were disfiguring and required hospitalization, and morbidity was almost certain. Now, advanced techniques and new therapies allow us to perform ambulatory surgeries; this is a huge advancement.
TON: What are some of the major challenges related to your job?
Ms Daugherty: Patients with head and neck cancer are a special population with a debilitating disease. These patients have obvious difficulty swallowing and speaking, and sometimes, they will drool. It is a very visible cancer that cannot be hidden in public. In addition, many patients feel guilty because they were smokers, chewed tobacco, or had oral sex, all of which could have triggered the cancer.
One of the biggest challenges I face is that each department in our hospital has a different platform for its database. It can be difficult for me to follow the patients electronically, and I sometimes must go in person to another department to get the information I need. However, we all make it work so our patients are cared for in a timely manner. If patients were diagnosed at a different institution, it is almost impossible to get their records. Many times, I need to find someone I know at that hospital to help me obtain these files, which is one of the perks of being part of a navigation network.
TON: How has your hospital adjusted to the challenges of the pandemic?
Ms Daugherty: I am impressed with the COVID-19 response at our institution. The situation is, of course, traumatic, and has required adaptation. The internal medicine physicians rose to the challenge, as did the nurses and care coordinators. Following the first wave of the pandemic, everything was calm and flowing smoothly. However, the second wave has caused some stress. Nevertheless, our medical professionals continue to overcome any challenges that come our way. I do miss the “hands on” experiences with my patients and I find it difficult to not be able to see their faces because of the need for masks. My greatest concern is that individuals are not coming in for their regular cancer screenings because of the pandemic. I worry that this will lead to cancers being diagnosed at much later stages when they are more difficult to treat.
TON: Tell us about your involvement with AONN+
Ms Daugherty: I am honored to have been a contributing chapter co-author in the first AONN+ textbook on nurse navigation, Team-Based Oncology Care: The Pivotal Role of Oncology Navigation, developing an algorithm for practice. Oncology nurse navigation is now a standardized subspecialty with an accredited certification exam offered by AONN+ as well as certification for patient navigators.
Our Conference Planning Committee is working on a session on electronic health records and telehealth for the Virtual Midyear Conference on May 13-16, 2021. As I mentioned, we are still facing challenges when it comes to accessing electronic health records for some of our patients, which is an important step in helping them navigate the care continuum, so this is an important topic.
TON: What are you excited about in the field of oncology right now?
Ms Daugherty: We are making huge strides with immunotherapies and targeted therapies. Patients receiving these therapies can have longer-lasting remissions that were previously unheard of. These advances have led to rapid FDA approvals, with many drugs being fast-tracked. That is a good thing, although it can create a lag in the education of providers and patients regarding how best to use these new drugs and what to expect. Thanks to these advances, many of my patients are still alive and have adapted to a new “normal.” Having cared for patients with head and neck cancer back in the 1980s, this is a wonderful thing to see.