Intermountain Cedar City Hospital in Cedar City, UT, one of the top 20 rural hospitals in the United States, offers comprehensive treatment care for patients with cancer. The Intermountain Southwest Cancer Center of Cedar City Hospital provides hematology and oncology services, radiation therapy and chemotherapy, clinical research trials, navigation services, and rehabilitative/survivorship programs.
The Oncology Nurse-APN/PA (TON) spoke with Cheryl Bellomo, MSN, RN, OCN, ONN-CG, Nurse Navigator and Clinical Trials Coordinator, Intermountain Southwest Cancer Center of Cedar City Hospital, about her role in helping patients and families obtain access to optimal cancer care.
TON: Can you describe your role as nurse navigator?
Cheryl Bellomo: Patients are referred to us for cancer care by their primary care physician or surgeon, our hospital mammography department, or our pathology/tumor registry database. Upon verifying that patients are aware of their diagnosis, I begin working with patients, as well as their families and caregivers, to help overcome barriers to care and facilitate timely access to quality care. This includes addressing medical and psychosocial needs from the time of diagnosis and through all phases of the cancer experience. As a nurse navigator, I act as the patient’s liaison to the multidisciplinary oncology team. I am the patient’s advocate; I provide education, resources, and emotional support; assist in coordination of appointments and treatments; and help to empower patients and their families along the continuum of care.
TON: What about your role as a clinical trials coordinator?
Ms Bellomo: In conjunction with my role as nurse navigator, I also serve as a clinical trials coordinator for our facility, working closely with the clinical trials team of our hospital region. The cancer centers of the statewide Intermountain Healthcare System offer oncology clinical research trials through our Institutional Review Board, as well as participation in national clinical trials, such as the MATCH (Molecular Analysis for Therapy Choice) trial.
As a nurse navigator, I am in a key position to advocate for clinical trials, to introduce the concept of a clinical trial at an earlier stage of care and treatment decision-making, and to educate patients about available clinical trials. It is exciting to see how clinical trials are now branching out from studies of standard chemotherapy to research genomics and targeted therapies. With our Intermountain Precision Genomics program, we are conducting tumor genomic profiling trials, as well as genome sequencing of breast tumor samples, to determine genomic biomarkers predictive of severe adverse reactions to chemotherapy.
TON: How did you become a nurse navigator?
Ms Bellomo: I joined the cancer center 10 years ago as a clinical trials coordinator and quickly learned that the individuals living in southwest Utah in the mid-1950s had been exposed to fallout from the aboveground nuclear testing conducted by the government at that time—this nuclear testing has been linked to several types of cancer. Sometimes it is difficult to discuss clinical trial enrollment with patients, as many feel they were “already experimented on” when they were exposed to nuclear radiation fallout.
As a clinical trials coordinator, I found that there was a gap in meeting patients’ medical and psychosocial needs, including patient education, providing resources, and addressing barriers to care. I met with the management of the cancer center and the hospital administrator to propose the role of an oncology care coordinator. We designed and developed the position of a care coordinator for me, which has evolved into the role of nurse navigator.
TON: What are the biggest challenges for you in each of your roles?
Ms Bellomo: One of the biggest challenges of my job as a clinical trials coordinator is encouraging older patients to enroll in clinical trials, especially those who were exposed to nuclear radiation fallout. They do not want to participate in “experiments.”
As a clinical trials coordinator and nurse navigator, I must be knowledgeable about clinical trials so that I am able to educate patients about specific trials. Patients considering a clinical trial need to understand the benefits and risks associated with participation. It is also imperative that any unfamiliar terms are explained to them and that they fully understand their responsibilities as a patient before they enroll in a trial.
As an oncology nurse navigator, one of the major challenges I see patients face is transportation issues. Many times it is difficult for patients to get to the hospital or to clinics for treatments. Although there are resources available around the country that can help patients with transportation, such as the American Cancer Society’s Road to Recovery program, these services are not always available in our area. However, we are fortunate to have community volunteers who raise funds to help with transportation costs. Our Iron County Young Survivors group does fund raising to provide gift cards for gasoline and to assist other young patients with financial needs. Our local police department has also raised funds for these gift cards.
TON: What is the biggest reward related to your job?
Ms Bellomo: My biggest reward is being able to support and advocate for patients and their families so that they can navigate the cancer journey. Watching their transformation from being frightened and overwhelmed by a cancer diagnosis to feeling empowered, as I provide them with the tools, coping skills, and resources they need, is deeply satisfying to me.
TON: Can you tell me about your institution’s Precision Genomics program?
Ms Bellomo: Our innovative Precision Genomics program provides patients with stage IV cancer the opportunity to undergo genomic sequencing that detects mutations. If particular mutations are discovered, patients may be able to receive targeted therapies that are specific to those mutations. This type of sequence testing is usually covered by insurance. In addition, our hospital system is able to help provide financial assistance to patients if needed.
TON: What are you excited about in the field of oncology right now?
Ms Bellomo: Oncology has changed dramatically since I first became a nurse in the field. The personalized medicine approach and genomic sequencing has revolutionized cancer care.
I am also excited about the evolving role of the nurse navigator. We are a driving force at the table for the multidisciplinary care of patients with cancer; we have role competencies and certification for nurse and non-nurse clinical patient navigators, and we now have standardized metrics developed by the Academy of Oncology Nurse & Patient Navigators that allow navigators to measure aspects of care provided to patients, especially with regard to patient satisfaction, clinical outcomes, and return on investment. These metrics allow us to use evidence-based resources and national guidelines to show the value of our services, which we need to demonstrate to our administrators, especially in the era of value-based cancer care.