- Coordinate complex interdisciplinary care to establish a diagnosis and treatment plan (which may include surgery, chemotherapy, and radiation)
- Coordinate care with other health-care providers such as pharmacists, dieticians, social workers, case managers and counselors
- Collaborates with all members of the medical team
- Serves as a liaison to referring physicians
- Supports patients and families during diagnosis through treatment
- Assists with scheduling initial tests and consultations
- Help patients understand their diagnosis and available treatment options
- Improve patient outcomes through education, support and monitoring
- Help the patient and family connect with existing community resources
- Ease the burden on patients and families
- Watch closely for any problems that may arise over the course of treatment and recovery
Why Upper GI Cancer?
 The management of patients who have been newly diagnosed with cancer can involve a number of different specialists, which can make for both inefficient and fragmented care. This is especially true for patients who have been diagnosed with upper gastrointestinal (GI) malignancies.
Cancer treatment has become more complex for many GI tumors that were once treated with surgery alone and that now often require tri-modality care with surgery, chemotherapy and radiation therapy. GI cancer, specifically esophageal, gastric and pancreatic cancer, is an optimal diagnosis to study the impact of an alternative healthcare delivery system designed to enhance coordination and communication of cancer specialists.
While working as a primary nurse in the Surgical Oncology department at Fletcher Allen Health Care, it was not uncommon to see patients who had been diagnosed up to six weeks earlier just coming in to discuss surgery. It often took weeks to complete imaging studies and all appropriate consultations necessary for treatment planning because so many different specialists were involved. We are a regional referral center for Vermont and upper state New York, so a large percent of the patients we see are traveling from over two hours away. These patients were often making multiple trips here for tests and consultations due to the lack of coordinated care. The entire process was very inefficient for everyone involved.
Hence the development of the Upper GI Multidisciplinary Cancer Care clinic led by physician-researcher and surgical oncologist, Laurence E. McCahill, MD in early 2007. The Upper Gastrointestinal (GI) Multidisciplinary Cancer Care Clinic, otherwise known as the Upper GI MDC, was initiated to help streamline and improve the care of patients with esophageal, gastric, pancreatic, liver and biliary tract cancers, and includes myself as the dedicated nurse navigator. This program is essentially “one-stop shopping” for these patients that has allowed for more efficient and timely workup, evaluation and treatment in a well coordinated fashion.
The Upper GI Multidisciplinary Care team consists of surgeons, medical oncologists, radiation oncologists, gastroenterologists, pathologists, radiologists, nurses, research staff, and our cancer patient support specialists. Our team approach means that patients have experts in every aspect of their care, working together, to ensure that they get the very best care.
 Our GI multidisciplinary team provides a complete evaluation of each patient and develops a personalized treatment plan – in one day – that includes all appropriate resources. And as an integral part of the care team, patients are encouraged to take an active roll in all of their treatment decisions.
When referred to the Upper GI MDC clinic, patients are scheduled to see a medical oncologist, radiation oncologist and surgical oncologist, while also having the opportunity to meet with our Patient Navigator from the American Cancer Society as well as the Cancer Patient Support specialists, which include a nutritionist, social worker and psychologists-all in a single visit. We make every effort to complete all necessary diagnostic testing prior to the patient’s GI MDC clinic visit, see patients in less than 14 days of being referred to the clinic, initiate treatment within 30 days of referral, and provide both patients and their physicians with a clear treatment plan at the conclusion of their clinic visit.
The goals of the Upper GI MDC clinic are to:
- Provide high quality multidisciplinary care and increase efficiency of care
- Assure that both staging studies and clinical treatment are concordant with evidence-based practice guidelines from the National Comprehensive Cancer Network (NCCN)
- Increase the opportunity for physician interaction, education and research
- Increase patient satisfaction
 Since the initiation of the Upper GI MDC clinic in 2007, we have seen more timely cancer staging in accordance with the National Comprehensive Cancer Network (NCCN) guidelines with a decrease in the number of unnecessary tests performed prior to treatment therefore resulting in a decrease in costs. We have been able to decrease the number of visits needed to complete necessary staging and begin treatment. There has been increased input and collaboration from multiple cancer specialists prior to the first treatment. Overall, we are seeing increased satisfaction not only from our patients and their families, but also from our Upper GI MDC team.
Patients with newly diagnosed cancer can feel lost in the complicated landscape of the health care system. However, by successfully navigating patients through this complex healthcare system, nurse navigators have the opportunity to improve the patient experience and to help identify and remove barriers to timely and appropriate cancer care, while ensuring quality outcomes by combining knowledge and skills with support and compassion.
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