Navigating Difficult Waters after a Cancer Diagnosis

The MemorialCare Todd Cancer Institute (TCI) at Long Beach Memorial has a cancer patient navigation program – designed to help patients and their families navigate through the health care system, while making sure that their needs are addressed.

Dr. Rebecca Crane-Okada, PhD, RN, speaks about the overall goal of the navigation program – to ensure seamless and coordinated care, while offering education, support and guidance to help patients and families cope with their challenges.
Navigating Difficult Waters after a Cancer Diagnosis
Featured Speaker:
Dr. Rebecca Crane-Okada, PhD
Crane-Okada is an Advanced Oncology Certified Registered Nurse (AOCN) Clinical Nurse Specialist (CNS) with 35 years experience and two graduate degrees in nursing specific to cancer patient and family care. She is a researcher and author on quality-of-life for cancer patients, with emphasis on emotional, spiritual and holistic needs. Crane-Okada has been recognized by the Oncology Nursing Society as an oncology nurse leader in psychosocial care. She is a member of the American Holistic Nurses Association, Oncology Nursing Society and the American Psychosocial Oncology Society.

Organization: Long Beach Memorial Medical Center

This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here’s Deborah Howell. Deborah Howell (Host): Hello and welcome to the show. Hope everybody is having a great day so far. You’re listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell, and today’s guest is Rebecca Crane-Okada. She’s a clinical nurse specialist and nurse navigator at MemorialCare Todd Cancer Institute at Long Beach Memorial. Rebecca has over 35 years of experience and two graduate degrees in nursing specific to cancer patient care and family care. She’s also a researcher and author on quality of life for cancer patients. We’ll be talking a little bit about that today and also how to navigate those rough routers after getting a diagnosis of cancer. So, welcome, Rebecca, to the show.

Rebecca Crane-Okada (Guest): Good morning – pleasure to be here.

Deborah: A lot of people are scratching their heads these days because there’s a new term going around; it’s a “nurse navigator.” We didn’t grow up with nurse navigators. Can you tell me what they are?

Dr. Crane-Okada: Well, a nurse navigator at Long Beach Memorial is a registered nurse who has a Master’s Degree in a specialized area of nursing, and is either a nurse practitioner or a clinical nurse specialist. They also have a great deal of experience in a specific area of health, in this case at the Cancer Institute, either in breast or lung cancer, for example.

Deborah: Okay. So, how would a nurse navigator help a specific patient?

Dr. Crane-Okada: Well, my goal is to help patients and their families know what they need to do to be partners in their care with their health care team. I want them to be their own best advocates and know best how and when to utilize the resources available to them when help is needed. So, a lot of what I do is information-giving, guidance support, validation, reassurance – that type of thing.

Deborah: This is radically different, I mean, in the olden days [laughter] when we were growing up, if you had a problem, you’d go to the doctor, you’d expect the doctor to fix it, end of story, and give you a little popsicle and then you go home. Now, you’re asking us to do some of the work and that’s kind of different.

Dr. Crane-Okada: Well, it is and it isn’t. I think we’ve always tried to have patients and families be partners in their care. A long time ago, people went to the doctor and just did what they said, but I think with all the information that we have now and our desire for people to see more self-sufficient, we try to partner with people to help them be their own best advocates by being knowledgeable and therefore empowered to receive the best possible care.

Deborah: Right. So, let’s get a little bit more specific. What services does a nurse navigator provide to a patient?

Dr. Crane-Okada: Some of what I do is patient education; we call it helping people understand what the diagnosis means, what to expect when they have their first consultations with a surgeon, a medical oncologist, a radiation oncologist, a plastic surgeon in the case of breast cancer, really knowing how to formulate questions to ask their doctors, learning about what steps will occur in what order, often validating what patients are saying: “I’m wondering about this. Do you think that’s a good question to ask?”

Deborah: Right.

Dr. Crane-Okada: So, reassurance in that regard. Some people have concerns about young children and informing them about the diagnosis. So in will often connect patients with social workers to help them with family support or more tangible needs, such as transportation assistance, financial concerns, that type of thing.

Deborah: This is wonderful. We’ve often needed a liaison in the process and haven’t had one in the past. This is a great development for patients.

Dr. Crane-Okada: Yes, it is.

Deborah: Now, you are also involved with aftercare, is that true?

Dr. Crane-Okada: Aftercare as in post-operative care or –

Deborah: Therapy, if they need occupational therapy or things like that. Do you help arrange for those?

Dr. Crane-Okada: Well, I work with the patient and their treating team, so I may offer suggestions. Some of the procedures that are needed or services that are needed actually need a physician referral, but we work together to help ensure that patients have all the support they need, including rehabilitation, whether that’s occupational therapy, physical therapy, lymphedema therapy, speech therapy. We try to make sure that the patient is looking towards survivorship, getting through their treatment and having a long and healthy life.

Deborah: Excellent. And how is a nurse navigator different than, say, a social worker or a registered nurse?

Dr. Crane-Okada: Well, most registered nurses in the oncology field we’re seeing more today becoming certified at a national level. And so they have a great deal of expertise in the clinical needs of patients and often work in direct patient care roles as in the hospitals or in chemotherapy clinics, and often have a lot of information that they can share and do share on a regular basis with patients. So, I see myself as a navigator stepping in where either the time involved or the complexity of the situation can be better benefited by my flexibility and expertise. A social worker tends to focus on family support, counseling and coping with the cancer diagnosis, as well as the great deal of tangible support needs, such as financial and transportation, insurance questions, financial support resources in the community as well.

Deborah: Boy, it takes a village, doesn’t it?

Dr. Crane-Okada: Yes. Deborah: It really does. I mean, getting the diagnosis is just the very beginning of the story when it comes to cancer patients.

Dr. Crane-Okada: And it’s terrifying.

Deborah: Of course. And there’s so much to learn and so many big word and all kinds of visions that pop into your head. And it’s got to be just wonderful when you get the diagnosis to have a nurse navigator on your team.

Dr. Crane-Okada: I hope so; that’s our goal.

Deborah: Do you specialize in patients who have a certain type of cancer?

Dr. Crane-Okada: I specialize in breast cancer and gynecologic malignancy such as ovarian, uterine or cervical cancer. And those are the patients that I am focused on, and Long Beach Memorial has about 700 new newly diagnosed women with breast or gynecologic cancers every year.

Deborah: Oh, I’m so sorry to hear that.

Dr. Crane-Okada: So I try to see as many as I can. Well, it just goes to show that we’re providing wonderful service to the community and we’re getting the patients coming to Long Beach because of our expertise.

Deborah: Right.

Dr. Crane-Okada: Unfortunately, we have so many cases, but at the same time we’re able to provide them expert care, and hopefully diagnose patients at an earlier stage where we expect them to live long and healthy lives.

Deborah: At what point does the nurse navigator step in? You go to the doctor, the doctor does the tests, the tests come back, it’s confirmed, you have uterine cancer or whatever it is – at what point would that patient come to you?

Dr. Crane-Okada: Patients can come to me in my specialty area, either directly, by self-referral or by recommendation of the physician. Or because I participate in interdisciplinary rounds, I may find out about a patient and contact them that way. In the breast unit, for example, all patients having a breast biopsy are informed about my services and therefore they are aware of my ability should the diagnosis be made of breast cancer. And that’s one way for us to make contact.

Deborah: So, it's optional, you know; it’s like an amenity at a hotel, “By the way, there’s a concierge that you might want to refer to.” But I have a feeling most people do take advantage when they hear that there is a nurse navigator available to them.

Dr. Crane-Okada: I think, particularly for the breast cancer patients who are waiting to be referred to their surgeon oncologist, it’s a wonderful time for a nurse navigator to step in because they don’t know what to do yet and it’s unclear what order things need to happen and I can give a great deal of assurance, reassurance, during that critical time. Some patients find that they need the support later on down the road when treatment starts and they have symptoms and those need managing. So, I think the idea is to be a resource to patients and let them know that we are the person they can call when they’re stuck. And if we don’t know the answer, we will find someone who does, or help facilitate an answer to the question or a problem resolution.

Deborah: So, say, you’re the 21-year-old caretaker kid, they also could get in touch and say, “My mum is not doing so well today and I am a little worried about her.”

Dr. Crane-Okada: Absolutely.

Deborah: Okay. Oh, that is just such a wonderful service. I’m so glad. How long has the nurse navigator career path been available?

Dr. Crane-Okada: Well, actually, it’s been around for many, many years, but was never called the navigator; we had nurse coordinators, case managers in a variety of positions for many, many years often behind the scene. The actual navigation term was coined in late 80s and 90s in Harlem Hospital when they used lay navigators to help get women in for breast cancer screening. Deborah: I see. We have about 30 seconds. So, where can I learn more?

Dr. Crane-Okada: I would refer people to the cancer answer helpline and those nurses, Kitty and Kathy, will direct people to the appropriate nurse navigator resource. Their number is 562-933-0900.

Deborah: And one more time with the number.

Dr. Crane-Okada: 562-933-0900.

Deborah: Thank you so much, nurse navigator, nurse specialist, Rebecca Crane-Okada today talking about the quality of life for cancer patients. We loved having you on this show.

Dr. Crane-Okada: Thank you.

Deborah: Be with us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a wonderful day, everybody.