Nurse navigators at Inova Loudoun chart a course for patients through breast cancer

December 2, 2013

Shortly after Beth received her breast cancer diagnosis, she returned for a follow-up mammogram at Inova Loudoun Hospital. The mammographer suggested that Beth speak with Barb McDonnell, one of the hospital’s breast nurse navigators.

Beth, an Ashburn resident who asked that her last name be withheld for privacy reasons, was reluctant at first. But when McDonnell came down the hall to see whether she wanted to talk, she changed her mind. And she is glad she did.

“I ended up spending an hour in her office, and after the hour was done, we had laughed, I had cried. I had gotten so much information,” Beth said.

McDonnell is one of the hospital’s two breast nurse navigators, specialists who provide information and support to patients from the time they first receive an irregular mammogram reading and, if cancer is diagnosed, continue through the entire treatment process. McDonnell and her co-worker, Christine Stone, help patients deal with issues such as treatment options, reconstructive surgery, insurance, financing and effects on the patients’ jobs and family members.

McDonnell has been a breast nurse navigator at Inova Loudoun Hospital since it launched the program in March 2009. Stone joined her in a job-sharing arrangement in January. They share one full-time position, working alternating weeks.

The navigators typically meet with patients after they have a mammogram that shows an irregularity. Stone said that 80 percent of those cases turn out to be benign. But if a biopsy shows that cancer is present, they help explain what patients might expect with various treatment options, including chemotherapy, radiation, or various types of surgery.

“If they have an abnormal mammogram, many times they’re coming here tearful, really scared. . . . So then we can talk with them and step them through,” Stone said. “We’ll guide them and help with emotional support, which is huge.”

“A lot of times our role is to reinforce what the doctors have already told them,” McDonnell said. But the patients are often so upset by the diagnosis that they might not remember what the doctor said. She encourages patients to bring someone with them to medical appointments, to provide “another set of ears.”

“They imagine the worst,” McDonnell said. “You go from zero to 100 all of a sudden. You wonder, ‘Am I going to make it to Christmas?’ You feel like you’re facing your mortality for the first time.”

Finances are a major concern for some patients. Stone said that although Loudoun is seen as a wealthy county, there is a “donut hole” of people who lack funds for treatment. Some can’t continue in their jobs during cancer treatment, and others can’t afford to take time off.

“We’ve had patients who got denied [insurance coverage] because they had been diagnosed, then tried to find insurance,” McDonnell said. “So that’s gone at least. With Obamacare [the insurance companies] can’t do that anymore.

“We try to make it as easy on them as possible, because they’re going through so much,” McDonnell said. “It’s heartbreaking to see them having to deal with all of the money issues.”

“It’s actually more stressful sometimes than having to go through chemo,” Stone added.

If needed, the navigators also help patients find programs to help them with day-to-day challenges such as housework, transportation or meals.

When patients undergo surgery — which can take as long as eight hours — the navigators serve as liaisons to the patient’s family, letting them know how everything is progressing.

Beth said that it helped that her husband was able to meet with McDonnell before her surgery. McDonnell explained what her husband needed to do and what his role as a caregiver would be.

“That set him up,” Beth said. “When she was his liaison [during the surgery], they already had that connection.”

Both navigators agreed that the hardest part of their job comes when a patient learns that cancer has returned, or that it is untreatable.

“You always have to give them hope, and the hope changes,” Stone said. “Maybe not that you’re going to be cured, or you’re not going to be going through treatment, but maybe it’s making it to that wedding or graduation. . . . Hope might be that things are stable, that things haven’t progressed.”

After she was diagnosed with breast cancer, Melissa Watson, 32, of Purcellville was comforted in knowing that McDonnell is a breast cancer survivor.

“She was able to relate very easily and tell me everything I needed to know from start to finish,” Watson said.

Although “you know a lot of women have gone through it and are going through it, you still feel like you’re all alone,” Beth said. “Actually talking to Barb and seeing her looking healthy and working and laughing, it definitely made a huge difference.”

“After you go through it, you want to help other women,” McDonnell said. “You want to do something to help people coming behind you. It’s almost like a sisterhood.”

McDonnell said the hospital has started a mentor program, in which breast cancer survivors serve as mentors to new patients. Some women in the program have built lasting friendships, she said.

Despite advances in cancer treatment and diagnosis, McDonnell said that the rate of breast cancer has not declined. But she thinks that a cure will be found in her lifetime.

“Our biggest hope is that our job goes away,” she said.

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