In August 2009, the shoe dropped. My diagnosis: esophageal cancer.
feelings and needs hit at the same time: I need an oncologist, they
fight the cancer; I need a surgeon, they cut out the cancer. Check.
Check. Now what?
I had two excellent physicians on my side, but
they had two different recommendations. Cut then chemo; chemo then cut.
The Internet provided too much information without any direction. I was
My experience is not unusual.
Before cancer centers developed a team-based approach to coordinating
care plans, physicians often proceeded with what they had seen work best
in their own field. What I needed was someone to coordinate the care: a
Since Hoag expanded our nurse navigator program
four years ago, each cancer patient has been assigned a dedicated
clinical nurse to guide him or her through the murky waters of
diagnosis, treatment and recovery.
As Hoag Hospital's chief
quality officer, I am charged with all aspects of quality of care,
improvements and patient safety. As a former cancer patient, I know
firsthand how important it is to get that quality and coordination of
The journey through a complex system was mine to
navigate. That's not impossible as a physician, but it is not easy. For a
layperson, it is exponentially more difficult. When you receive a
cancer diagnosis, spending weeks deliberating recommendations before
starting treatment is maddening and scary.
Eventually, I opted for
chemotherapy first, followed by surgery two months later. I have been
cancer-free since. My outcome was good, but a navigator would have been
able to help better coordinate the team with a consensus care plan that
met my needs. This would have greatly reduced the time between diagnosis
and treatment with less stress for me and my loved ones.
navigation is offered now. Unfortunately, it's not offered everywhere.
The Institute of Medicine issued a report last year that highlighted
some of the challenges of cancer care in this country, including lack of
coordination and communication between caregivers — an especially
onerous issue for cancer care due to the large number of specialists
In other parts of the nation — and even other parts of
our own community — cancer care delivery is in crisis. It needs to
become more patient-centered, nimble and resourceful, particularly as
technology, genomics and targeted therapy add to the complexity of
At Hoag, there was some initial resistance to a nurse
navigator model, a hesitation that quickly resolved as these
coordinators won over the cancer team. Now, when a new cancer program
starts at Hoag, the first thing physicians ask for is a dedicated nurse
It's what all cancer patients should ask for — and what they should receive.
Dr. JACK COX is the chief quality officer at Hoag Hospital.