Patient Navigation in the Advanced Prostate Clinic for Lutetium-177 PSMA Therapy - Christina Fareri
October 6, 2023
In this discussion, Phillip Koo converses with Chrissy Fareri focusing on the patient journey in a Lutetium-177 PSMA program. Dr. Fareri outlines the nurse navigator's role in guiding patients through a nine-month treatment period, including lab reviews and side effect management. She emphasizes the importance of hydration and provides insights into the personalized service offered at Summit Health, where patients have direct access to a dedicated nurse navigator. Common patient concerns, such as side effects and radiation safety, are addressed twice—once during the initial consultation and again prior to the first infusion. Dr. Fareri notes that the program has been well-tolerated by patients, who are closely monitored through lab work and follow-up calls.
Biographies:
Christina Fareri, Nurse Navigator, Summit Health Cancer Treatment Center, New Jersey
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Arizona
Biographies:
Christina Fareri, Nurse Navigator, Summit Health Cancer Treatment Center, New Jersey
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Arizona
Read the Full Video Transcript
Phillip Koo: Hello, my name is Phillip Koo from UroToday. We're continuing our five-segment series on how you operationalize a Lutetium-177 PSMA program into urology practice. Today we're on segment four to discuss the patient journey, and we're very fortunate to have with us Chrissy Fareri, who's a nurse navigator at the Summit Health Cancer Treatment Center. Welcome, Chrissy. So first off, I want to thank you. I think nurse navigators really provide an invaluable service for patients. And when it comes to some of these radioligand therapies, I think it's playing an ever-increasing role and importance in the patient journey. So walk us through your first conversation with the patient after they're authorized and ready to undergo, let's say, PLUVICTO.
Christina Fareri: So one of the roles of the nurse navigator is we discuss with the patient what the timeline looks like over a nine-month treatment period. We discuss labs that would be obtained and reviewed and set forth in terms of getting them into the seat. We manage them by reviewing a CBC and their LFTs. If those things work out and they are eligible for their treatment, then we review the side effect profile that has already been discussed during the consultation. We talk them through what day one will look like sitting in the chair starting the IV and who's present in the room; the nuclear med tech, Dr. Gejerman, and the nursing team. We review the side effect profile and management of their care.
Phillip Koo: Are there any specific instructions that you give the patients before their first visit, let's say hydration or anything else?
Christina Fareri: Yes, hydration is reviewed. How the product is excreted through the GI tract and they have one-on-one nurse access. So in the event that they should experience any side effects, they know that they have a direct line to call and we're available for them to either triage or if we had to send them to the ER.
Phillip Koo: Great. And I think that's a great point. So being a large urology practice here within Summit Health, you're able to create a more personalized service with patients where they contact you directly as opposed to going through, let's say, a patient portal. Is that correct?
Christina Fareri: Yes. Once they're enrolled and they're deemed a candidate for this, they have their own patient navigator and two nurses that are behind them during the whole nine months of the process.
Phillip Koo: You obviously interact very often with these patients. What are some of the common questions or concerns that they bring to your attention before and during this treatment?
Christina Fareri: So the most common question we get at the time of enrollment is what have other patients experienced? Overall, this product is tolerated very well. Hydration is key. And understanding possible side effects or outcomes is always important to set realistic outcomes for the patients. We manage them accordingly on a case-by-case basis.
Phillip Koo: So I imagine they're given the radiation safety precautions ahead of time. Do you feel like from the feedback that you're hearing, are they comfortable with that or are there challenges that they're expressing to you, that often they're scared to ask the physician?
Christina Fareri: So this is reviewed two times. It's reviewed lightly during the consultation in the room with the physician, the patient, and maybe family members. It's again reviewed one to two days prior to the first infusion. This allows them to ask more questions that they weren't able to, or if questions came up during that timeframe, it gives them another chance to express any concerns or fears that they may be having.
Phillip Koo: Have you noticed any specific concerns? Are patients worried about their home situations or things of that nature, that they're bringing to your attention?
Christina Fareri: No, from a urology standpoint, if it was a urology concern, it's discussed during the consultation. And for the pre and post discussions, we revisit that one more time.
Phillip Koo: So you mentioned earlier that so far, your experience has been that it's been very well tolerated and you haven't seen many significant adverse events, at least brought to your attention. Overall, how's your experience been beyond that, now that you're I think a few months into this program?
Christina Fareri: Yes, I think overall patients do extremely well. They're monitored very closely with their lab work. They get a call the day after their infusion just to check in with them. And two weeks after that, they get one more call. If there's any concerns, we'll repeat labs and if there's anything that we feel is necessary, we'll bring them into the office to have a full workup.
Phillip Koo: Great. And if there are no concerns and the patient's doing really well, when do you draw the labs before the next dose?
Christina Fareri: One week prior.
Phillip Koo: And the results then are sent to the radiation oncologist, Dr. Gejerman?
Christina Fareri: Yes, we receive them through their chart and then Dr. Gejerman and the nurses review them and approve them for the next infusion.
Phillip Koo: Great. And is there a deadline by which it needs to be approved in order to order the dose?
Christina Fareri: We have a deadline one week prior. So if they're infused on a Tuesday, they're getting labs the Tuesday prior. And then medication is ordered the Friday before.
Phillip Koo: The Friday before. Great. Well, thank you very much for sharing your experience.
Christina Fareri: Of course. Yes, thanks for having me.
Phillip Koo: Hello, my name is Phillip Koo from UroToday. We're continuing our five-segment series on how you operationalize a Lutetium-177 PSMA program into urology practice. Today we're on segment four to discuss the patient journey, and we're very fortunate to have with us Chrissy Fareri, who's a nurse navigator at the Summit Health Cancer Treatment Center. Welcome, Chrissy. So first off, I want to thank you. I think nurse navigators really provide an invaluable service for patients. And when it comes to some of these radioligand therapies, I think it's playing an ever-increasing role and importance in the patient journey. So walk us through your first conversation with the patient after they're authorized and ready to undergo, let's say, PLUVICTO.
Christina Fareri: So one of the roles of the nurse navigator is we discuss with the patient what the timeline looks like over a nine-month treatment period. We discuss labs that would be obtained and reviewed and set forth in terms of getting them into the seat. We manage them by reviewing a CBC and their LFTs. If those things work out and they are eligible for their treatment, then we review the side effect profile that has already been discussed during the consultation. We talk them through what day one will look like sitting in the chair starting the IV and who's present in the room; the nuclear med tech, Dr. Gejerman, and the nursing team. We review the side effect profile and management of their care.
Phillip Koo: Are there any specific instructions that you give the patients before their first visit, let's say hydration or anything else?
Christina Fareri: Yes, hydration is reviewed. How the product is excreted through the GI tract and they have one-on-one nurse access. So in the event that they should experience any side effects, they know that they have a direct line to call and we're available for them to either triage or if we had to send them to the ER.
Phillip Koo: Great. And I think that's a great point. So being a large urology practice here within Summit Health, you're able to create a more personalized service with patients where they contact you directly as opposed to going through, let's say, a patient portal. Is that correct?
Christina Fareri: Yes. Once they're enrolled and they're deemed a candidate for this, they have their own patient navigator and two nurses that are behind them during the whole nine months of the process.
Phillip Koo: You obviously interact very often with these patients. What are some of the common questions or concerns that they bring to your attention before and during this treatment?
Christina Fareri: So the most common question we get at the time of enrollment is what have other patients experienced? Overall, this product is tolerated very well. Hydration is key. And understanding possible side effects or outcomes is always important to set realistic outcomes for the patients. We manage them accordingly on a case-by-case basis.
Phillip Koo: So I imagine they're given the radiation safety precautions ahead of time. Do you feel like from the feedback that you're hearing, are they comfortable with that or are there challenges that they're expressing to you, that often they're scared to ask the physician?
Christina Fareri: So this is reviewed two times. It's reviewed lightly during the consultation in the room with the physician, the patient, and maybe family members. It's again reviewed one to two days prior to the first infusion. This allows them to ask more questions that they weren't able to, or if questions came up during that timeframe, it gives them another chance to express any concerns or fears that they may be having.
Phillip Koo: Have you noticed any specific concerns? Are patients worried about their home situations or things of that nature, that they're bringing to your attention?
Christina Fareri: No, from a urology standpoint, if it was a urology concern, it's discussed during the consultation. And for the pre and post discussions, we revisit that one more time.
Phillip Koo: So you mentioned earlier that so far, your experience has been that it's been very well tolerated and you haven't seen many significant adverse events, at least brought to your attention. Overall, how's your experience been beyond that, now that you're I think a few months into this program?
Christina Fareri: Yes, I think overall patients do extremely well. They're monitored very closely with their lab work. They get a call the day after their infusion just to check in with them. And two weeks after that, they get one more call. If there's any concerns, we'll repeat labs and if there's anything that we feel is necessary, we'll bring them into the office to have a full workup.
Phillip Koo: Great. And if there are no concerns and the patient's doing really well, when do you draw the labs before the next dose?
Christina Fareri: One week prior.
Phillip Koo: And the results then are sent to the radiation oncologist, Dr. Gejerman?
Christina Fareri: Yes, we receive them through their chart and then Dr. Gejerman and the nurses review them and approve them for the next infusion.
Phillip Koo: Great. And is there a deadline by which it needs to be approved in order to order the dose?
Christina Fareri: We have a deadline one week prior. So if they're infused on a Tuesday, they're getting labs the Tuesday prior. And then medication is ordered the Friday before.
Phillip Koo: The Friday before. Great. Well, thank you very much for sharing your experience.
Christina Fareri: Of course. Yes, thanks for having me.