Melanie Cole, MS (Host): Welcome to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. Join our outstanding team of physicians, nurses, and medical staff as they help us navigate the latest and greatest in healthcare today.

I'm Melanie Cole. And today, we're highlighting oncology patient navigation. Joining me is Theresa Bell. She's an oncology navigator with Northern Inyo Healthcare District. Theresa, thank you so much for being with us today. So many people may not really be familiar with your job, your role. What does an oncology navigator really do?

Theresa Bell: Thank you, Melanie. Appreciate you having me. So, what I like to say or describe with my job is that I'm very much a behind-the-scenes nurse. So, a lot of what I do is indirect patient care. I'm absolutely happy to meet with patients in person, but a lot of what I do is making sure that these rural location patients get all of the resources that they need.

A lot of that entails traveling long distance to get, say, advanced imaging, chemotherapy, injections, ongoing maintenance, and seeing their medical oncologists and their teams at facilities that are usually about three to five hours away at the shortest distance. So, it can be a challenge with folks who need transportation assistance as well as reimbursement for a lot of the out-of-pocket expenses that accumulate.

Melanie Cole, MS: Well, it can certainly be challenging and dizzying and frightening, and all of those emotions come into play, and you really help to put it all together and sort it all out, which is really the biggest help to patients that are starting this particular journey. So when someone first hears the words that they have cancer, what's usually the most helpful support that they need right away?

Theresa Bell: I think especially when it's an in-person visit, they are overwhelmed with information. So to keep things kind of basic and simple at first, I think, is very important because I'm not overloading them with additional information that they're probably not going to remember right then and there. One of my preferred techniques is to wait a little bit and reach out to them within a day or two after that appointment or that new diagnosis, and then give them more detail on how I can further assist them with their oncology treatment journey.

Melanie Cole, MS: So, how do you help patients understand what comes next after diagnosis? What happens?

Theresa Bell: A lot of times, they ask me, "You know, the doctor said I was referred to this location. what do I need to do? How do I get that started?" And I kind of briefly describe to them how a referral is sent out on their behalf. A lot of times it's a stat referral. So within two weeks on average, that person is being scheduled out to a facility, say for example, City of Hope, or for us here in the Eastern Sierra Nevada, Carson Tahoe has a cancer center. Renown also has an excellent oncology department. So, I briefly describe to them how I will make sure that that referral is being processed correctly, that they can call me for any of their needs, I can assist with scheduling, and that they usually hear from the facility directly to get them scheduled out, and that usually entails an initial consult with a medical oncologist.

Melanie Cole, MS: Now, you mentioned, Theresa, at the beginning some of the barriers, especially in rural areas, the travel, the reimbursement, insurance. What other kinds of barriers do patients in rural communities sometimes face when they're beginning this cancer treatment?

Theresa Bell: For us specifically, weather is a massive barrier. That will be a huge deciding factor on whether someone is going to travel north or south in order to continue their oncology treatment. Once we have the snowpack on the ground, driving up to places such as Carson City or Reno, Nevada, is not ideal, and the folks who live here are obviously very aware, very experienced with that.

So, that further reduces their options for cancer treatment, and that might entail taking flights through Angel Flight somewhere else, say down south towards the Greater Los Angeles area or even over to San Francisco Bay Area. So, these are pretty huge roadblocks for folks, especially those who cannot drive themselves or are not allowed to actually go by themselves. There's a number of procedures where they have to have a companion. It might be due to anesthesia or a minor surgical or major surgical procedure. And so, there's a lot of factors going into whether we can get a person from A to B smoothly and in a timely manner.

Melanie Cole, MS: One of the things, Theresa, that I feel is so amazing about the job that you do is how you help coordinate care between providers, specialists, and services, because that used to be, back in the day, the most difficult part, the most confusing part. But you really help to sort that out. Tell us how you do that.

Theresa Bell: So, I definitely have an extensive contact list. I kind of joke, I use the computer a whole lot, but I'm also old school with my Rolodex. And that Rolodex has so many resources in it. And I think the most important part is getting a hold of the care team members directly for each of the patients.

That streamlines the communication. It puts us all on the same page with as far as, you know, sharing records, health information, and also chart access. So, one of the biggest things for me in accomplishing that is being able to directly access patient charting to some of those outside facilities. There are mutual agreements so that I can see, you know, when someone is scheduled, when their next appointment is, or what is the plan of care following that appointment so that I kind of am anticipating what happens next. And everyone's unique, so some folks need a whole lot of coordination, and some are very self-advocating and just kind of reach out to me as needed.

Melanie Cole, MS: I'm sure there's really a broad spectrum of the needs of people that are starting this cancer treatment journey. Now, when we think of patients, and you said that some people can't come alone, they need an advocate, or certainly if it's a youth or a young adult or somebody really new to this, what role do family members and caregivers play? How do you help them stay informed and involved?

Theresa Bell: Absolutely. I think that their role is massive. And when they realize that it can be very overwhelming. So a lot of the conversations that I have with the actual patients, I also have with family members. And they reach out to me a lot of times directly as the advocate for the patient and ask kind of the same questions, "What is it I need to do next? How do we get this plane flight?" Or, " What do I need to be looking for?" Or, "What are the questions I need to ask when I'm sitting in on these patient visits with my loved one down at a facility that's five hours away?" And so, those conversations can be pretty straightforward or they can be very complex depending on what the plan of care for a patient is.

I think with family members, a lot of them, they make huge sacrifices. They take time off of work. Some of them go on paid family leave through their jobs in order to just dedicate that time and that effort to their loved one. A lot of them are, you know, their chauffeur, so to speak, right? They are driving them. They are making sure they've got all their appointments lined up and they make it happen. And a big part of my job is to continue that communication with them and reassure them that what they're doing is substantial, and that this patient couldn't really get the care that they need without them. And I think that's important for family members. Because a lot of times, they don't think that their role is that important.

Melanie Cole, MS: Well, you choked me up a little bit there because it's true. And so, it really is so important, that caregiver role, and for them to get the support from you that they need is just extra special. Are there local resources, Theresa, available that people might not realize that exist closer to home?

Theresa Bell: Absolutely. And that's one of the big topics I bring up right away for folks, especially new diagnoses. We have the Eastern Sierra Cancer Alliance. So, that's specific to our area, and they do a number of events fundraising. And what happens is that money is strictly for reimbursing patients for out-of-pocket costs, say that driving to and from, so gas, lodging in a lot of places. The patients have to figure out hotel stays. So, what they can do is save their receipts, and they get reimbursed through the alliance. I basically line up the paperwork for them. I make sure that all their applications are active and up-to-date. And so, that's a huge local resource right there.

And then, a lot of the work that I do kind of aligns with social work in regard to what the county has available for supportive services for these folks, obviously depending on their insurance type, whether they can get someone to help them out around the house do grocery shopping, light housekeeping, things like that, especially when patients are, let's be real, they're feeling very sick, very tired. They're in the middle of their chemotherapy cycles, and they can't do the things on their own that they used to. So those are two.

And then, I did mention Angel Flight earlier. And so, we use Angel Flight West, that's the region, and they will actually have small aircraft fly directly into Bishop Airport. So, a patient can go from, say, Bishop, California, down to Duarte, California, with these smaller municipal airports, and they even assist with ground transportation once the patient is there. So, it's not necessarily a local resource, but because they can fly right into Bishop, that really helps a lot of folks out who just can't drive those long trips.

Melanie Cole, MS: Wow. That is amazing. Those are such helpful resources. Now, I mean, obviously, we're saying it in this whole podcast today, but how does having a navigator help patients to feel more confident as they move through their treatment?

Theresa Bell: I think the conversations we have, and I know it's a nursing term, but that therapeutic communication goes a long way. Some of the talks that I have with patients is a lot of reassurance that not everything needs to be done by them. I know a lot of folks feel a sense of control when they are doing all the scheduling themselves, making sure X, Y, and Z is taken care of.

But a lot of the conversations I have with patients is to remind them it's okay to pass that task on to someone like me. You can put it on my plate so you don't have as much on your plate, and we can continue to connect and make sure that all of those things are being taken care of. I think that's a very important aspect of the talks I have with folks.

Melanie Cole, MS: I think so too. And this has been so informative. Theresa, as we wrap up, what message would you most want someone newly diagnosed with cancer in the Eastern Sierra to hear today? And how do they reach out to you? You said that you contact them a day or so later. How do they know? Does it magically happen? How do you know? Tell us how we find you.

Theresa Bell: So a lot of times, providers or specialists here will contact me directly or, in cases with breast cancer or urological related cancers, I will be in the specialty clinic in person sometimes. They will kind of flag me to come in for a patient visit. So, there is that option where I am face-to-face with that person shortly after they've been diagnosed.

But also, through our charting system and then I don't want to say word-of-mouth, but I definitely get also people calling who are loved ones saying, "Is it okay if someone calls you? Can I give them your direct information?" And so, there's that. And we have some outside facilities as well, like Toiyabe, which is nearby the Indian Health Project, and there's also Valley Health.

And so, it is a lot of providers and specialists reaching out to me. That's how patients are put on my radar, and then I go ahead and reach out to them, and I kind of let them know, you know, "Your breast specialist or your urological specialist let me know that you need some assistance," and then I briefly describe what I can do to help.

And I think one of the biggest things to tell them is, it's okay to ask for help. You are not alone, and you are never a burden by calling and asking questions. I think that's one of the biggest ones as humans. We feel we are bothering someone by asking for help. And so, I think that's a huge message. Just reassure that person, "It's okay. Call me, even if it's a silly question." I say, and I know this is a longstanding quote, "The only dumb or silly question is the one that isn't asked."

Melanie Cole, MS: That's so reassuring and what a lovely message. Letting people know that they are not alone and that you're there for them and that any questions that they have you can help to clear up and steer the ship. So important what you do, Theresa. Thank you so much for joining us and sharing your expertise.

And patients and families do not have to navigate complex healthcare challenges alone. Patient navigation services are designed to help people find support, connect with resources, and move forward with confidence. For more information, you can go to nih.org/navigation. I'm Melanie Cole. And that concludes today's episode of Mountain Medicine, the official podcast of Northern Inyo Healthcare District. We'd like to invite our audience to download, subscribe, rate, and review Mountain Medicine on Apple Podcasts, Spotify, iHeart, and Pandora.