Since the world of oncology nurse and patient navigators is in constant change, we have compiled a glossary of terms to help you better understand and navigate it.
Access to care
In cancer, access to care refers to one person’s entry into cancer care that is on par with another’s.
Activities of Daily Living
An assessment used to measure how well a patient is able to complete the tasks of everyday life without assistance. These activities include the ability to get in/out of a bed or chair, dressing, toilet hygiene, bathing, grooming, and eating.
Any drug or medication that is received after the primary cancer treatment, often surgery, in an effort to decrease the risk of recurrence. Examples of adjuvant therapies are chemotherapy, radiation therapy, immunotherapy, targeted therapy, hormone therapy, or biological therapy.
In oncology, hospital or practice administrators are responsible for the general management of operations.
A legal document that provides guidance for the type of treatment or care a patient wishes to receive (or not receive) in the event that the patient becomes unable to make medical decisions, such as being unconscious. An advance directive may be in the form of a living will or a power of attorney for health care. It is important for patients who are terminally ill to discuss advance directives with their families and health care providers.
A prescribed drug that is taken to prevent or treat nausea and vomiting. Multiple types of antiemetics exist and may be are often prescribed alone or in combination to relieve side effects from cancer treatment.
Barriers to care
Individuals may face a number of impediments to receiving optimal cancer care, including a lack of clear understanding of all treatment options, transportation, social support, insurance/financial concerns, and problems communicating with healthcare providers. Navigators play a key role in helping patients overcome these barriers.
A benign tumor is a mass of cells (tumor) that lacks the ability to invade neighboring tissue or metastasize. These characteristics are required for a tumor to be defined as cancerous and therefore benign tumors are non-cancerous.
A noticeable, involuntary weight loss in patients with cancer caused primarily by loss of muscle mass, with some fat loss as well. Patients with cachexia have a reduced quality of life and may experience pain, fatigue, and functional impairment. Cachexia is not reversible, but supportive care may be provided, such as nutritional support.
A systematic, ongoing collection of data about patients with cancer, including patient history, diagnosis, treatment, and health status.
Screening tests can help find cancer at an early stage, before symptoms appear. Early identification can result in better health outcomes.
The member of the cancer care team, often a nurse, who coordinates the patient’s care throughout diagnosis, treatment, and recovery.
Chemotherapy is a targeted drug treatment that kills rapidly growing cells in the body and is used to treat cancer. Chemotherapeutic drugs may be used alone or in combination with other treatments and are often administered over multiple treatment cycles. Treatment may be administered orally, intravenously, or intramuscularly. Although chemotherapy is an effective way to treat cancer, side effects of the drug may range from mild to severe due to cytotoxicity.
Abbreviation for “chemotherapy-induced nausea and vomiting”. CINV is one of the most severe and distressing side effects of chemotherapy. CINV may be classified as anticipatory, acute, delayed, breakthrough, and/or refractory. It is important to assess the patient for CINV risk factors and the chemotherapeutic regimen for emetogenic risk, so steps can be taken to reduce the occurrence of CINV.
A clinical trial is any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.
Support provided to patients who have experienced impairment of memory, concentration, or behavior. Some cancer treatments and medications may contribute to cognitive changes.
Commission on Cancer
Established by the American College of Surgeons (ACS) in 1922, the multidisciplinary Commission on Cancer (CoC) establishes standards to ensure quality, multidisciplinary, and comprehensive cancer care delivery in health care settings; conducts surveys in health care settings to assess compliance with those standards; collects standardized data from CoC-accredited health care settings to measure cancer care quality; uses data to monitor treatment patterns and outcomes and enhance cancer control and clinical surveillance activities; and develops effective educational interventions to improve cancer prevention, early detection, cancer care delivery, and outcomes in health care settings.
Community Health Worker
Community health workers (CHW)s are members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments. The World Health Organization maintains that community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. They usually share ethnicity, language, socio-economic status and life experiences with the community members they serve. CHWs can offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening. (WHO, Community health workers brief; also see HRSA).
Community outreach is the practice of conducting local public awareness activities through targeted community interaction. In cancer, community outreach frequently seeks to encourage early screening and detection for different malignancies, include breast cancer, colorectal cancer, melanoma, and other tumor types.
The simultaneous presence of two or more chronic diseases or conditions in a patient.
Continuity of care
The provision of healthcare services to patients in a coordinated manner and without disruption despite involvement of different practitioners in different care settings.
Coordination of care
Deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer, more effective care and better health outcomes.
Cost of cancer care
The cost of cancer care can refer to the out-of-pocket cost incurred by the patient during treatment OR it can refer to the societal burden, which is the actual cost of all goods and services associated with cancer treatment incurred by the health care system in a fixed period of time.
The identification of the cause of an illness or other problem by examination of the symptoms and test results.
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. In cancer, blood tests, urine analyses, and biopsies are frequently performed to help make (or rule out) a cancer diagnosis.
A licensed health professional who has specialized training in food and nutrition and helps patients with dietary choices. Dietitians create therapeutic nutrition plans and promote healthy eating habits.
Emotional, social, spiritual, or physical pain or suffering that may cause a wide range of feelings as patients cope with their cancer diagnosis and treatment. Patients experience distress along a continuum, which ranges from normal adjustment through diagnosable mental disorders. Nurse Navigators should monitor patient distress levels to make sure that adequate psychosocial resources are made available.
Do not resuscitate (DNR) order
A legal document written by a physician that allows the patient, or healthcare proxy, to request that cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) be withheld if the patient’s heart stops beating or if they stop breathing. A DNR is prepared in advance of a medical emergency and allows the patient to have a natural death.
Duration of therapy
The length of time that a patient is expected to require treatment for a medical condition. In cancer, chemotherapy is often given intermittently and is described as “cycles of treatment".
End-of-life care provides physical, mental, and emotional comfort, as well as social support, to people who are living with and dying of advanced illness.
Financial counselors work closely with the patient to discuss their insurance benefits, out-of-pocket cost obligations, and, for patients in need, the resources available to assist them in defraying their out-of-pocket cost burden.
The first treatment given for treatment of a disease (including cancer). It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, first-line therapy is the one accepted as the best treatment.
Refers to financial assistance and other support programs provided by not-for-profit organizations. Some foundations, such as Lustgarten (pancreatic) and Susan G. Komen (breast) are tumor-type specific, while others such as LIVESTRONG, provide assistance to eligible patients across different tumor types.
Front-line (or first-line) therapy
In cancer, front-line therapy refers to the first treatment given to the patient. When used by itself, front-line therapy is generally accepted as the best available treatment option.
A process to evaluate and understand a family's risk of an inherited medical condition. A genetic counselor is a healthcare professional with specialized training in medical genetics and psychological counseling, who work as a patient advocate as well as a genetic resource to physicians.
Convening 2 or more patients with the same cancer diagnosis for educational sessions to help them learn about their cancer and the course of treatment. Multiple treatment team members, including nurse navigators, may have a role in conducting group educational sessions.
A type of complementary medicine that takes into account the entire person, including physical, emotional, mental, social, and spiritual health. Holistic medicine uses conventional, alternative, and natural methods to treat the patient in an effort to create balance within the body and promote health and wellness.
Patients who are homebound may require the assistance of another person or supportive devices, such as wheelchairs or walkers, to be able to leave the home. Homebound patients may also be individuals who have a medical condition that may worsen when they leave the home environment. Cancer patients who are homebound need assistance securing special transportation services to receive medical care outside of their home.
Medical services, emotional support, and spiritual resources for people who are in the last stages of a serious illness.
The first form of treatment, often referred to as first-line therapy, used to treat cancer. Induction therapy is often considered the best therapeutic option and may be part of a standard set of treatments. An example of induction therapy is surgery followed by chemotherapy and radiation.
A site of care where patients receive intravenous treatments and injections for the treatment of cancer and other chronic conditions.
The administration of medication through a needle or catheter. Infusion therapy is prescribed when a patient's condition is so severe that it cannot be treated effectively by oral medications.
A patient who stays in a hospital while under treatment.
The extent to which patients take medications as prescribed by their health care providers.
Metastatic cancer is cancer that has spread from the place where it first started to another place in the body.
Multidisciplinary treatment team
Refers to clinicians who specialize in different medical areas working together to provide the most comprehensive treatment plan for their patients. In cancer, multidisciplinary treatment teams may include medical oncologists, radiation oncologists, nurse practitioners, nurse navigators, advanced practice nurses, social workers, pharmacists, and other specialists.
Helping patients overcome health care system barriers and providing them with timely access to quality medical and psychosocial care from before cancer diagnosis through all phases of their cancer experience.
Any drug or medication that is administered prior to surgery in an effort to reduce the size of tumors. Examples of neoadjuvant therapies are chemotherapy, radiation therapy, targeted therapy, and hormone therapy.
NSAIDs, or nonsteroidal anti-inflammatory drugs, are one of the most commonly used pain relief medications. NSAIDs reduce inflammation, pain, redness, swelling, and fever. NSAIDs may be prescribed by physicians or purchased over the counter.
A clinically trained individual responsible to identify and address barriers to timely and appropriate cancer treatment. They guide the patient through the cancer care continuum from diagnosis through survivorship. More specifically, the nurse navigator acts as a central point of contact for a patient and coordinates all components involved in cancer care including surgical, medical, and radiation oncologists; social workers; patient education; community support; financial and insurance assistance; etc. This person has the clinical background and is a critical member of the multidisciplinary cancer team.
The process of providing or obtaining the food necessary for health and growth. Maintaining good nutrition by having the proper knowledge about healthy foods in the right combinations is important for optimal health. Patients undergoing oncology care often work with Oncology Nutritionists to help develop a personalized nutrition plan.
Occult Primary Tumor
A cancer of unknown primary origin that is determined to be in the metastatic stage. Occult cancers are relatively rare, but often have a poor prognosis.
An oral therapy is a medication that is administered by mouth. Oral therapies have many advantages for patients, such as the convenience to take medications at home and avoiding the discomfort of IV therapies.
However, it is important that the patient’s maintain adherence to the recommended treatment schedule, taking the medication as prescribed without missing a dose.
A patient who receives medical treatment without being admitted to a hospital.
Specialized medical care to prevent or treat the symptoms and side effects of the disease and treatment with a goal of improving overall quality of life. Palliative care should be offered to cancer patients at the time of diagnosis through survivorship or end of care. The goal of palliative care is not to cure, but to provide supportive care and symptom management as early as possible.
Communication between healthcare providers and patients, where healthcare providers seek to educate a patient by providing information or advice to help patients make informed decisions about their healthcare.
The phases of cancer treatment from beginning to end, which includes recognition and awareness, diagnosis, treatment, and survivorship care and/or hospice care.
Patient or non-clinically licensed navigator
An individual who does not have or use clinical training to provide individualized assistance to patients and families affected by cancer to improve access to health care services. A patient navigator may work within the health care system at point of screening, diagnosis, treatment or survivorship or across the cancer care spectrum or outside the health care system at a community based organization or as a freelance patient navigator. The patient navigator, unlike a "lay" navigator is a paid professional and serves as a broker between the patient and the health care system.
The patient navigator is a primary point of contact for the patient and works with other members of the care team to coordinate care for the patient. This critical person on the multidisciplinary team provides important perspective on logistical, structural and social needs of the patient as well as cultural considerations, patient values and care preferences. In general, a patient navigator provides assistance with identifying challenges to cancer care, identifying potential solutions with patients and families, identifying financial assistance to address patient needs, helping patients identify priority questions about their care, helping patients use time effectively with clinical providers and working with social work and nurse navigator colleagues to provide psychosocial and community support. A social worker or nurse may perform the role of a patient navigator, but in this instance they should discuss their scope of practice with their supervisor to ensure they perform duties within their hired role as opposed to within their clinical training.
A process that occurs between the time of cancer diagnosis and the beginning of acute treatment, and includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments.
Psychosocial distress screening
The use of a brief tool to identify patients at greatest risk for an unpleasant experience of a psychological (cognitive, behavioral, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Referral for further assessment and/or to community resources for information and support along with follow-up to see if distress is reduced is key.
Quality of Life
An assessment of the patient’s ability to have an enjoyable and fulfilling life. Quality of life (QOL) is a measurement of the patient’s well-being, including mental status, stress level, sexual function, self-perceived health status, and ability to perform activities of daily living. Nurse Navigators must be aware of factors, such as medical treatments, that may impair or improve a patient’s quality of life.
Treatments that facilitate the recovery from physical, sensory, and/or cognitive impairment with the intention of restoring functional ability to the original capacity. Patients with cancer may have lasting deficits as a result of their disease or treatment. Rehabilitation helps patients compensate for disabilities that cannot be restored medically and regain strength, functioning, and independence.
The return of a disease (including cancer) or the signs and symptoms of a disease after a period of improvement.
A decrease in or disappearance of signs and symptoms of cancer.
Side effect management
Cancer treatments such as chemotherapy frequently cause side effects. The types and intensity of these side effects vary from person to person and depend on the type and location of cancer, the treatment dose, and the person's overall health. Clinicians work to minimize the impact of side effects to allow the patient to continue receiving treatment.
Social/economic disparities in cancer
An individual’s socioeconomic status and other factors may affect their ability to get health insurance, which in turn may affect their ability to access quality health care and screening tests for cancer.
Stage I, II, III, IV cancers
Staging describes the severity of a person’s cancer based on the size and/or reach of the original tumor and whether or not cancer has spread in the body. Stage IV means that the cancer has spread to other organs or parts of the body, and therefore can be described as metastatic cancer.
Supportive care (or palliative care) is care that focuses on relieving symptoms caused by serious illnesses like cancer. It can be given at any point during a person’s illness to help them feel more comfortable.
Cancer survivorship refers to anyone who has been diagnosed with cancer. Survivorship starts at the time of disease diagnosis and continues throughout the rest of the patient’s life.
Survivorship care plan
An individualized care plan for patients for patients who have been treated for cancer. The survivorship care plan includes guidelines for monitoring and maintaining patient health.
Highly specialized medical care usually over an extended period of time that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities, or tertiary care centers.
Transitions of care
Refers to changes in the level, location, or providers of care as patients move within the health care system. One role of nurse navigators is to facilitate smooth, coordinated transition from one site of care to another or from one provider to another.
Because of the need for repeated visits for cancer treatment on either an outpatient or an inpatient basis, one of the major issues that patients with cancer must confront is that of arranging for transportation to care.
A structured treatment plan designed to improve and maintain health. In cancer treatment, treatment regimens frequently include multiple drugs taken concurrently.
The process of determining the priority of patients' treatments based on the severity of their condition.
Tumor boards are interdisciplinary meetings specifically intended to bring together members of a cancer patient’s treatment team to determine the best plan of action and ensure coordinated care.
Classification of tumors by cell type and location of origin in the body.
The inability to remove an entity through surgery. A cancer that is unresectable must be treated by other means such as with chemotherapy and/or radiation.
In medicine, value refers to the benefit of the services provided to the patient relative to the cost of those services.