A cancer diagnosis can feel like being dropped into deep waters, with ripples of fear, disbelief, anger, sadness and stress radiating from its center. In the wake of such a life-altering moment, many patients feel disoriented and overwhelmed, unsure of what comes next. Roper St. Francis Healthcare follows a team-care model, leaning on multidisciplinary conferences and clinical nurse navigators to keep patients afloat from diagnosis to cure and deliver them safely to shore.
WRITTEN BY Stratton Lawrence
PHOTOGRAPHS BY Scott Henderson
Everything stops when a doctor says the word cancer. Suddenly, that deadline at work seems unimportant, and the kitchen remodel doesn’t feel nearly as pressing. When faced with a deadly disease, people shift into survival mode.
If you’ve been diagnosed with cancer, you’re not alone. Nearly two million cancer diagnoses are made annually in the United States—that’s a new case every 30 seconds. Fortunately, the majority of cancer cases are curable.
At Roper St. Francis Healthcare, a team-care approach means patients receive personalized treatment designed to get them back to living life as soon as possible. Following a diagnosis, patients may see oncologists, surgeons and even a rehab specialist. Nurse navigators—part of the comprehensive program offered by the Donna Fielding Cancer Wellness Institute—are on hand to walk side-by-side with them through the entire treatment process.
A dedicated navigator is always available for questions and support in the weeks and months after receiving what may be the most terrifying news of a person’s life. “It’s normal to feel a sense of shock,” says Renee Litton, Roper St. Francis Healthcare’s Lung, Esophageal and Head & Neck Oncology Clinical Nurse Navigator. “Hearing that diagnosis can feel overwhelming. That’s where we come in, to support people through the process.”
Dr. Megan Baker, Director of the Roper St. Francis Cancer Center and breast cancer specialist, echoes the importance of immediate support after a cancer diagnosis, when identifying and beginning the most effective treatment is critical. To do this, each patient’s case is reviewed at weekly cancer conference meetings with the multidisciplinary team of more than 35 doctors, nurses and clinical trial specialists. “The only thing more important than treating cancer quickly is doing it right,” says Dr. Baker. “We don’t run, but we walk fast, because time matters.”
A cancer diagnosis can prompt disbelief, and it’s natural to want to seek a second opinion. Just don’t put off treatment while shopping around. “Getting a second opinion is never wrong. It can often build confidence in an established plan or uncover something you don’t already know,” says Dr. Baker. “For many cancers, the sooner we treat, the more effective we are, so you never want a second opinion to delay receiving care.” Instead, she encourages patients to explore a second opinion simultaneously to the first.
She advises patients to seek additional input at a center that offers more than where they started. If a provider doesn’t practice team care with clinical trial opportunities (a model in which a group of experts reviews and weighs in on every case), level up to a team system like that at Roper St. Francis Healthcare. If you’re already in a mature program, the next step would be a National Cancer Institute (NCI)-designated Comprehensive Cancer Center.
Dr. Baker also advises doing online research with trusted experts such as the American Cancer Society and National Comprehensive Cancer Network websites. She cautions against other sources that may not reflect the latest knowledge around specific cancers.
One area that’s particularly confusing for patients is genetics and genomic testing. These tools have enabled personalization of treatment plans, so a friend or loved one’s prior experience with a disease may not be applicable to another case. “Cancer care is now more targeted and more effective,” Dr. Baker explains. “Family and friends may chime in and ask if you’ve tried things that aren’t necessarily appropriate for you. Among any 10 of my breast cancer patients, there are at least seven different care and treatment plans.”
Developing a Plan
Depending on the cancer type, patients could receive a diagnosis following routine blood work or after a colonoscopy, CT scan or mammogram. The doctor who informs a patient about a malignancy may not be a cancer specialist, so most people are immediately referred to a medical oncologist or surgeon. They are also assigned a specialty-specific a nurse navigator.
Pinpointing the most effective treatment often includes additional evaluation with CT scans, MRIs, other imaging and genomic testing. These steps help ensure patients are recommended for the treatments with the best chances of being successful and the fewest side effects. The Roper St. Francis Healthcare team works to compassionately progress from diagnosis to care with rigor, timeliness and support.
Dr. Baker gives the example of a breast cancer patient diagnosed on a Wednesday. Within a week, the woman had met her surgeon, medical oncologist and radiation oncologist before undergoing surgery six days later. During that 13-day span, her doctors presented her case at a multidisciplinary cancer conference and clinical trials evaluation, part of that team-care approach. Rather than one or two doctors offering opinions about this breast cancer case, nearly three dozen specialists developed the patient’s treatment plan. “It’s a very robust group that includes teammates from every cancer specialty, clinical trials, genetics, palliative care and social work,” says Dr. Baker. “It’s our job to speak up—we’re not bashful or shy if we think we can improve a plan.”
Treating the Disease
Not all cancers are curable, but they are all treatable. Fighting cancer may take the form of chemotherapy to shrink a tumor, radiation to kill a tumor, surgery to remove a tumor or immunotherapy to bolster the body’s natural defenses. Some treatments alleviate symptoms, while others can make a patient temporarily feel worse while attacking the disease. With many cancers, including lung, gastric and colorectal cancer as well as about a third of breast cancers, the first step is medication via neoadjuvant chemotherapy, helping to shrink a cancerous tumor, often before surgical removal.
One consistent part of the treatment process is the frequency of appointments. That’s where nurse navigators can be especially helpful. They prioritize removing barriers to care, provide education to ensure patients understand their diagnosis and treatment plan, help patients find financial assistance, coordinate transportation to appointments and connect patients to a legal clinic for support with things like insurance coverage and disability benefits.
Dr. Baker shares the story of another patient who works paycheck to paycheck. As a massage therapist, she couldn’t work a physically demanding job during her cancer treatment. “When you’re trying to navigate your job, your finances and your treatment, it’s overwhelming,” says the surgeon. Through Roper St. Francis Healthcare’s navigation program, the patient connected with philanthropic funds to take the pressure off her family and stay on track with her treatment.
Similarly, another of Dr. Baker’s recent patients emigrated from Russia to live with her daughter and soon discovered a large mass in her breast. She didn’t have money, couldn’t drive, isn’t a U.S. citizen and doesn’t speak English. But with the help of nurse navigation, “she did not experience one ounce of delay in her care,” says Dr. Baker.
Navigators follow along behind the scenes, helping patients schedule referral appointments. “Sometimes I feel like Oz behind the curtain, watching to make sure everything is progressing in a timely manner for the treatment a patient needs,” says Litton.
In head and neck cancer cases, that often means a dental visit before treatment. Radiation and chemotherapy can lead to cavities and infections in patients with preexisting oral health issues. Patients may also need a feeding tube if their swallowing is compromised followed by an appointment with a speech pathologist, who can help them regain the ability to eat, drink or speak.
Navigators also stay current on clinical trials that patients may be eligible for, especially when the first course of action is not sufficiently effective. Trials benefit future patients, but as new treatments are developed, they can be life-saving alternatives to people fighting cancer today. Roper St. Francis Healthcare has a long-standing clinical trials program, giving patients access to state-of-the-art care locally, and also partners with other large centers where a trial may benefit a patient. “We make sure that every patient has access to the newest and most effective care they can get,” says Dr. Baker.
In addition, navigators participate in team conferences with the doctors caring for their patients. “They make sure that everyone on the team knows where a patient is in the treatment process,” explains Dr. Baker. “The navigators are the glue that keeps it all together.”
“Cancer is never easy, but it is our job to make it easier,” Dr. Baker reflects. At the conclusion of treatment, many patients are considered cancer free, though they will require regular monitoring to ensure their cancer doesn’t return.
At many points along a patient’s journey, traditional care is complemented through Roper St. Francis Healthcare’s cancer survivorship program, THRIVE, which is offered by the Donna Fielding Cancer Wellness Institute. “During and after cancer care, many patients feel depleted—physically, emotionally and spiritually,” says Dr. Baker. “Recovery requires building them back up while recognizing what they’ve been through.”
Some cancer treatments zap a patient’s energy, making them feel even sicker. Chemo, for example, can cause numbness and tingling in the hands and feet. That makes strength-building after treatment difficult, since patients may be prone to falls or unable to hold weights. Acknowledging that cancer patients need special care to recover, the Donna Fielding Cancer Wellness Institute offers group classes and one-on-one help to encourage six facets of a healthy post-cancer life: healthy living, mindfulness, nutrition, exercise, sexual health and long-term symptom management and surveillance.
That all plays into Roper St. Francis Healthcare’s commitment to treating the whole patient as a team, rather than one doctor treating a single patient’s symptoms. “It’s not enough to be alive and to live longer,” says Dr. Baker. “We want you to live well and thrive.”
A stage number often accompanies a cancer diagnosis. Stages help to determine the best treatment. Although a stage IV diagnosis is scary, these patients can still enjoy a high quality of life. Specifics of each stage vary by cancer type:
Stage I: Early-stage cancer isolated to a single area
Stage II: Cancer beginning to spread to surrounding tissue or the lymph nodes
Stage III: Cancer spread deeply into tissue around the original tumor
Stage IV: Advanced cancer spread to other organs or throughout the body
Root for the Team
Cancer patients at Roper St. Francis Healthcare don’t just have a single doctor. Every patient’s case receives the attention and input of multiple doctors and nurses, often adding up to hundreds of years of cumulative experience behind a treatment decision. “There’s a huge amount of evidence showing that patients fare better when they’re taken care of in this format,” says Dr. Baker. “Every patient in our community deserves team care because it’s better care with better survival rates.” Dr. Baker emphasizes that following a cancer diagnosis, finding a team-care model should be a patient’s priority.
What Is a Nurse Navigator?
The Donna Fielding Cancer Wellness Institute provides much of the support for cancer patients at Roper St. Francis Healthcare. Its comprehensive cancer care services include social workers, legal aid, dietitians, exercise specialists and wellness programs like smoking cessation guidance, music therapy and mental health counseling. At the Institute’s core is a dedicated team of nurse navigators, one for each group of cancers. From diagnosis to remission, the navigator helps patients stay on track as their appointments reach the dozens. They also identify barriers to care (work, finances, childcare) and help patients fight the disease as quickly as possible. “By involving a nurse navigator, we make sure that we’re caring for the patient as a person and not just treating their disease,” says Dr. Baker.