After a Cancer Diagnosis: The Next Steps

Receiving bad news at the doctor is always a bit scary, but three specific words can strike fear into the bravest of hearts: “You have cancer.” Once a patient gets the news, often feelings of being completely unprepared and overwhelmed set in. What’s the next step?

We spoke with two oncology nurse navigators at Texas Health Dallas to find out how they work with cancer patients to provide guidance after a new diagnosis.

Erin Prendergast, R.N., a registered nurse and oncology nurse navigator at Texas Health Dallas, works specifically with breast cancer patients. She says often patients who receive a cancer diagnosis don’t even know where to start.

“I provide lists of questions to ask the various professionals they might see, including the breast surgeon, medical oncologist, radiation oncologist, plastic surgeon, genetics counselor, financial counselor and so on,” she explains. “Providing tools and resources is extremely important. I also encourage my patients to have someone with them at every appointment, especially in the beginning.

“Stress and anxiety build walls and can prevent good communication. I encourage my patients to take a notepad and pen to all appointments. Write things down, if not for themselves, for their family members and friends who will ask many questions out of love and concern.”

After prompting patients to ask questions, Prendergast encourages them to keep asking them until they know everything they want to know.

“My role as an oncology nurse navigator is to listen carefully to my patients’ questions and answer them with evidence-based knowledge and information,” she says. “If I don’t know the answer, I will find it for them. If I am not the one to answer the question, I steer them to the right person. I try to never leave a patient without ensuring that there are no more questions.”

Kay Smith, R.N., a registered nurse and oncology nurse navigator at Texas Health Dallas, says that no matter how the patient takes the news or what the next steps in their treatment plan are, the role of an oncology patient navigator is to help with just about anything and everything.

“The first reaction the cancer patient may have is disbelief, fear, worry that they are going to die, anger, denial … it can be one or all,” she says. “Once cancer is diagnosed, the patient is referred to a surgeon or oncologist, who will start the treatment plan. Sometimes the patient may have a physician they want to see, and we help them make those appointments. Or they may want to go to a different hospital for another opinion, and we try to facilitate this as well. As a nurse navigator, this is the best time to meet the patient to help them start on this journey.

“Even though we see patients with different diagnoses, they all have concerns, fears and questions about how they are going to manage their cancer. Making sure they have the resources and support they need is so very important. Everyone’s journey is different, so adjustments are always being made and considered. One size definitely does not fit all. My ability to readjust and switch gears quickly is important to the patient and their families.”

Prendergast agrees that building trust is important to creating a strong bond between a nurse navigator and patient during a difficult time.

“Cancer is frightening, but fear can prevent a patient from moving forward toward healing and hope,” she says. “Hope is critically important from day one! The most challenging aspect of my job is to provide EVERY patient with hope. Not every patient is ready to hear healing thoughts and words right away. Timing is very important to discuss what they are most afraid of and how I can help them. I have laughed and cried with many, many of my patients.

“Without hope, we are lost in a sea of events and circumstances, but we have a choice of how to respond. I give my patients tools to learn to accept their current situation so they can move forward in a purposeful manner.”

In addition to serving as an emotional lifeline for patients, nurse navigators are a resource for practical information as well.

Texas Health oncology nurse navigators complete a thorough assessment of the patient’s needs and provide the following resources:

  • Treatment tracker to keep all important information in one place, such as imaging information, care providers names and phone numbers, medications, treatments (including chemo, radiation and hormone therapy) and staging information pre- and post-treatment.
  • Evidence-based information from accredited sources, including the American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN) and American Cancer Society (ACS).
  • Support resources such as the THR Cancer Support Community, which is located on the Texas Health Presbyterian Dallas campus in the lower level of the Cancer Center. Support and resources are crucial parts of the cancer journey for patients as well as their families. Cancer does not just affect the patient. Family members can be overwhelmed as well, especially if the patient has young children.
  • Resources for care gaps, including transportation, spiritual needs, emotional support for the patient and their caregivers, childcare concerns and financial concerns (including medication assistance), which can be an enormous burden.

Smith says often patients with young children require extra support, but that all patients will need a helping hand while navigating the journey of cancer treatment.

“Our cancer patients with young children create a different set of challenges, so we find age-appropriate resources. The Cancer Support Community on campus has an excellent program for children, and we are available to meet with the children of patients to address any needs they may have. Additionally, the American Cancer Society has coloring books which address a cancer diagnosis that we give to children.

“Friends and family can offer significant support and should plan to be available as needs arise. Many patients don’t want to be asked what they need, but they DO need help. Starting a Meal Train or taking turns helping with transportation to and from their appointments can be a tremendous help to the patient and their family.”

Another common concern for patients is knowing how or when to tell friends and co-workers about a new diagnosis.

“When it comes to telling family, friends and co-workers about a cancer diagnosis, it is really a personal decision,” Smith explains. “Many patients don’t want to burden family and friends, so they don’t share the news. As a navigator, we give emotional support and let them discuss the decisions they make regarding their next steps. We provide brochures and literature that will help them start discussions if they need them, and we also use pastoral referrals for someone that has questions and concerns about sharing their diagnosis.”

Prendergast says that while there is no set timeline for a nurse navigator’s role in a patient’s cancer journey, being alongside patients and their families can last for months and sometimes years. It is a role she and her colleagues find rewarding.

“Oncology nurse navigators fulfill the true mission of Texas Health as providers of care for the body, mind and spirit,” she says. “Strong bonds form between oncology nurse navigators and their patients. Some feel as though they had a friend rather than a nurse, because of the additional supporting roles we play outside of our clinical expertise.

“There is nothing more rewarding than to be invited to attend a patient’s last chemo treatment and witness them hitting the gong as a celebration of their bravery and strength.”

Knowledge is power in the fight against cancer. The physicians and employees of Texas Health Resources hospitals are dedicated to providing information to help you make sense of your cancer diagnosis and treatment options. To learn more about oncology nurse navigators and other cancer services available at a Texas Health hospital near you, please visit TexasHealth.org/Cancer.

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