“When the surgeon told me I had stage 4 cancer, my first thought and then question was, how many stages are there, 8?”
“No,” the surgeon replied, “there are 4 stages. Your cancer has spread, and I’m sorry, surgery is no longer an option.”
“It felt like a death sentence.” These were the words of my patient whose cancer had metastasized to her liver.
The patient described the exchange with the surgeon as a matter-of-fact dialogue with no room for a miracle. The possibility of surgically removing all of this “thing” that was wreaking havoc inside her body was now out of reach. While other treatments like chemotherapy and radiation were presented as options, the thought of enduring them left her feeling terrified and defeated. The stories she had heard about those treatments only intensified her anxiety.
My initial conversation with her occurred soon after she had seen the surgeon. To say she felt overwhelmed would be an understatement. During our hour-long phone conversation, I found myself listening more than speaking. She shared her plans, like the trips she and her now-retired husband had dreamt of taking. These plans were now overshadowed by thoughts of how to tell her children and “getting her affairs in order.”
We discussed her diagnosis, the path forward, available support, and resources. The patient knew that her disease had no cure and that the coming days and weeks would be difficult. Nonetheless she expressed gratitude for our conversation. She found solace in knowing she would not be facing this journey alone. She was grateful for the call.
A cancer diagnosis, often referred to as the “Big C,” carries with it a profound sense of doom, fear, hopelessness, and helplessness. Like many others, I’ve seen cancer impact the lives of loved ones—some who survived and others who, unfortunately, did not.
Every individual with a cancer diagnosis can benefit from the support of an oncology nurse navigator (ONN), who is essential beginning at diagnosis and throughout the care journey. The website Vocabulary.com contains a definition of a navigator as “…the person whose job is to steer the ship. The navigator plans and charts the course and then points the boat in the right direction.”1 This description mirrors the role of an ONN, who guides patients through their cancer journey, helping them navigate the complex healthcare system.
The Oncology Navigation Standards of Professional Practice define an ONN as “A professional registered nurse with oncology-specific clinical knowledge who offers individual assistance to patients, families, and caregivers to help overcome healthcare system barriers. Using the nursing process, an oncology nurse navigator provides education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum.”2 In my interactions with patients, my observation is that when they first hear about their diagnosis, they are overwhelmed, and sometimes focus solely on “I have cancer.” The navigator plays a crucial role in compassionately redirecting their focus from fear to support and outlining the next steps in their journey.
Creating a safe space for patients to ask questions and share concerns that sometimes they are hesitant to discuss with others is a part of the ONN’s role. These professionals undergo specialized training to provide comprehensive education covering diagnosis, treatment options, surveillance, survivorship, and end-of-life care.
Knowing that cancer does not wait, and understanding the urgency of initiating care, nurse navigators play a pivotal role in ensuring timely access to necessary treatments and services. Patients newly diagnosed with cancer face a sudden influx of appointments, tests, and potential insurance or funding challenges. The navigator serves as a guide, coordinating care among various multidisciplinary teams to alleviate the burden on patients adjusting to this significant life change.
Ensuring patients adhere to their treatment plans is another vital aspect of the ONN’s role. One way the navigator achieves this is by identifying and addressing barriers and distress experienced by patients. Unaddressed barriers can significantly impact patient outcomes. Examples of such barriers include financial constraints, lack of social support, transportation issues, accommodation difficulties, and nutritional challenges. Navigators play a crucial role in connecting patients with available resources to help them overcome these barriers and stay on track with their care. Identifying and alleviating barriers to care may arguably be the most critical responsibility of the ONN.
As patients transition through their cancer journey, from treatment to surveillance, survivorship, or end of life, the ONN provides compassionate guidance every step of the way.
As patients transition through their cancer journey, from treatment to surveillance, survivorship, or end of life, the ONN provides compassionate guidance every step of the way. Whether meeting with patients in hospitals or clinics, or reaching out via phone calls, ONNs play a vital role in ensuring comprehensive oncology care. Their presence as advocates and empathetic supporters is indispensable for every individual diagnosed with cancer.
In addition to supporting patients, nurse navigators also extend their support to caregivers. The role of caregiver can sometimes be overlooked. Caring for a loved one battling cancer is stressful and immensely challenging. Nurse navigators recognize the importance of providing resources and supporting caregivers.
I would like to mention an organization dedicated to promoting and advocating for the ONN’s role in enhancing the quality of care and life for oncology patients—the Academy of Oncology Nurse and Patient Navigators (AONN+). As the largest national specialty organization of its kind, AONN+ is committed to advancing patient navigation in cancer care. Their mission focuses on fostering collaboration, leadership, and the development of best practices. The goal is to improve patient access to care, evidence-based treatment, and overall quality of life.
A wealth of educational resources on oncology navigation is available through AONN+ at the Academy of Oncology Nurse and Patient Navigators website.3 Their highly acclaimed midyear and annual conferences are “must attend” events for ONNs and provide invaluable opportunities for learning, networking, and professional development. These conferences, attended by navigators, social workers, physicians, administrators, pharmaceutical representatives, and others, serve as platforms to advance the role of the navigator in cancer care.
During one memorable session at the 2023 annual conference in San Antonio, a speaker shared her personal experience as a cancer patient without the support of an ONN. Her personal story reinforced the urgent need for ONNs to be accessible to every cancer patient. Having attended the conference, I can attest that it was a transformative experience. I gained valuable insights, forged meaningful connections, and renewed my resolve to continue to advocate for every cancer patient I navigate and for navigation as an essential component of care.
Prior to becoming an ONN, I worked as a staff nurse on a busy medical surgical oncology floor. My work hours consisted of performing assessments, administering medications, dressing wounds, educating patients, and more. As a navigator, I was no longer performing these tasks. There were days when I questioned if I were making a difference as a nurse because I was not doing the “clinical tangible stuff.” I missed seeing patients going home after recovering from what brought them to the hospital.
Attending the conference helped to reinforce my role as a navigator. There were so many of us in attendance, and sharing our experiences was definitely beneficial. I may not be hanging intravenous bags, dressing wounds, or starting intravenous catheters, but I am providing valuable support to patients on their journey with cancer. I am more confident in my role when I interact with patients, colleagues, and providers. I am a better advocate, better listener. I know that I am making a difference. Every cancer patient needs an oncology nurse navigator.
Acknowledgments
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare- affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
References
- Navigator. vocabulary.com. Accessed February 21, 2025. www.vocabulary.com/dictionary/navigator
- Franklin E, Burke S, Dean M, et al. Oncology Navigation Standards of Professional Practice. Journal of Oncology Navigation & Survivorship. 2022;13:74-85. Accessed February 21, 2025. www.jons-online.com/issues/2022/march-2022-vol-13-no-3/4399-oncology-navigation-standards-of-professional-practice
- Academy of Oncology Nurse and Patient Navigators. Educational resources. Accessed February 21, 2025. https://aonnonline.org/education
The ESSAY column in Conquer is devoted to lifting the voices of people touched by cancer.
Read more essays or submit yours.
