Nurse navigators help guide patients through breast cancer journey

09/23/2013 12:00 AM

08/08/2014 10:19 AM

She’d spent 48 hours anticipating the call that would confirm she had breast cancer, but she still wasn’t prepared. On Aug. 22, Kathryn Regier became one of more than 200,000 U.S. women this year who would hear the words, “you have breast cancer.”

She would spend the next afternoon in a clinic conference room, listening to a breast care surgeon map out a treatment plan. Sitting beside her was registered nurse Terri Leschuk. With a 1-inch binder chock full of resources to give to Regier – dubbed “My Breast Cancer Journal” – and a cellphone in her hand, Leschuk was helping Regier understand what was happening and texting fellow nurse Cindy Hall to start setting up appointments.

“When you get that call, you’re thrust into this arena of fear,” Regier, 61, said. “I can’t explain the horror of getting that call and then by the end of that appointment feeling some composure and peace. With Terri right beside me, helping me, I felt it immediately – this was going to work.”

As a breast health nurse navigator, Leschuk’s role at Via Christi Clinic is simple, yet complex: help women and their families navigate the maze of appointments, information and the emotional roller coaster of a breast cancer journey.

Since 2007, when her position was created, Leschuk has helped about 120 women, and a few men, every year understand their diagnosis. She sits with them through the hours-long initial appointment when treatment plans are developed, she’s there in the recovery room after surgery, and she has a gentle way of getting patients to open up to her.

On the day Regier went to the clinic to have her drainage tube removed after her double mastectomy, she remembers telling Leschuk everything was OK. As Leschuk visited with her about family and other things non-cancer, Leschuk asked again how she was doing. Regier answered more honestly, telling her she was feeling pretty emotional about losing her breasts. So Leschuk guided her to a private room to talk.

“Having breast cancer is a physical thing, but it’s very emotional,” Regier said. During another post-op visit, Regier had talked to Leschuk about how angry she was that she had breast cancer.

Nurse navigators are becoming a more common position in health care, particularly in cancer centers. According to the National Cancer Institute, the concept was developed in the late 1980s by a surgeon in Harlem, N.Y., who wanted to help African-American women with breast cancer get access to and understand their treatment plans.

In 2011, the American College of Surgeons issued a new standard, requiring all U.S. cancer centers have nurse navigators in place by 2015 for accreditation. Via Christi Cancer Institute, the only accredited cancer center in Wichita, recently hired an oncology nurse navigator.

Clinics, however, don’t have that same standard. That’s what makes Leschuk’s position unusual.

At another Wichita clinic, Breast Care Specialists, nurse practitioner Connie Luty is a certified nurse navigator; however, her role is more of a hybrid of providing direct care and information. “In terms of being a true breast health navigator, Terri is more of the classic role,” Luty said.

Nurse navigators aren’t revenue-producing positions, but health care providers realize they are important in providing quality patient care and in healthy outcomes.

Regier said she sees Leschuk as another soldier in her battle against cancer. “I didn’t know her job title was navigator. I look at her as an advocate. It’s makes a huge difference to know I can call her.”

At the back of every My Breast Care Journal, Leschuk tucks in her card, which includes her cellphone number, and tells patients to call her anytime.

“During that first appointment we spend a lot of time with the patients,” Leschuk said. “I know we’ve given them a lot of information and they walk out of there often remembering little. It’s kind of like the Snoopy carton where all they hear is the teacher going ‘wonk, wonk, wonk.’”

When Leschuk visits patients in the recovery room after surgery, she delivers a care package that includes hand-sewn items such as drainage bag pouches, seat belt covers and tiny pillows that slip under the arm where lymph nodes are removed. Leschuk buys the material that volunteers use to make the items. Zebra prints are her favorite. “It goes well with pink and white,” she said, referring to the colors commonly associated with breast cancer.

As an advocate for breast health, Leschuk puts together the clinic’s monthly mammogram parties, organized for area businesses and companies. The parties help turn getting a mammogram into a celebration, with chocolates, wine, cheese, paraffin waxes and massages.

Leschuk knows she is often seeing patients at their most vulnerable times in life. She talks about how she appreciates the patients’ “willingness” to let her be a part of their journey. She calls it “powerful” to see them face their fears.

“You just want to do whatever you can,” said Leschuk, who realized she wanted to work with oncology patients during clinical rotations as a nursing student at Wichita State University. After graduating in 1991, she worked as an oncology nurse at Wesley Medical Center. “Anything you can do to help them is so vital.”

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