Patient Navigation Strategies in NSCLC: Expert Panel Shares Insights

At the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, a panel of multidisciplinary experts convened to discuss non–small cell lung cancer (NSCLC).

Moderated by medical oncologist Balazs Halmos, MD, of the Montefiore Einstein Comprehensive Cancer Center, the roundtable featured perspectives from thoracic surgeon Jay Lee, MD, of the University of California, Los Angeles (UCLA), nurse practitioner Mary Pasquinelli, DNP, APRN, FNP-BC, of the University of Illinois Chicago (UIC), and interventional pulmonologist Momen Wahidi, MD, MBA, of Northwestern Medicine.

In the fourth segment of this roundtable discussion, the panel discusses how multidisciplinary teams and nurses help patients navigate throughout the lung cancer screening, diagnostic, and treatment processes.

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Dr. Halmos: If you think about it, patients are getting first, a screening CAT scan and diagnostic studies, PET scan, brain MRI, an EBUS [endobronchial ultrasound], and other procedures, etcetera. This is so complex and so difficult for a patient to work through.

Mary, if I may ask, you mentioned patient navigation already, timelines of care, and getting patients to start treatment is so critical—where does that navigation come in, and how does it make a difference?

Dr. Pasquinelli: It starts even before the patient is diagnosed. We see the patient coming down the pathway with a suspicious nodule, or through lung screening, or for the nodule program we presented at the tumor board.

We already have this pathway set up. When we see the patient and we give them the diagnosis, that navigation with the patient happens right then. For them to go to the surgeon, we need those PFTs [pulmonary function tests], we get cardiac clearance on them, and we need to get it done very quickly. Having a strong multidisciplinary team and our navigation team to guide patients through the process is incredibly important. The timing is important. We want to be sure that it’s done in a timely manner.

Dr. Halmos: Fantastic. You mentioned the multidisciplinary team. Perhaps I can ask Momen and Jay to comment on the critical role of the team and how their specialty contributes to maximizing the benefits from our tumor board and multidisciplinary clinics.

Dr. Wahidi: Yes. I can’t imagine practicing with the collective wisdom of the multidisciplinary team, which includes thoracic surgery, radiation oncology, thoracic oncology, pulmonary radiology, and pathology. It’s really a big team. It takes a village.

One thing that I really believe in is the colocation of clinics. We try to have clinics—some of us at least in thoracic surgery, interventional [pulmonology] and oncology—together so that we can consult with each other, we can see [and] add-on patients quickly between the different specialties. Then, the other thing is the multidisciplinary discussion, which is extremely valuable.

I love the famous saying, “If you have a hammer, everything looks like a nail.” We want to avoid that. We want the collective wisdom of the team. What is the best for that patient? Is it surgery? Is it radiation? Is it neoadjuvant [therapy] before surgery? Is it adjuvant? All these discussions are so valuable for our patients’ best outcomes.

Dr. Halmos: Great. Jay, you don’t have a hammer; you have a lancet or a robot. I heard that you have multidisciplinary clinics and regular tumor boards. How does the surgeon participate in those? How do you ensure that you utilize the knowledge base of other specialties to make the best decision for your patient?

Dr. Lee: Yes. Our setup at UCLA is that every Friday, we have a multidisciplinary thoracic oncology program, a tumor board, which is done virtually, but once a month, it’s in-person. Then, we have a multidisciplinary clinic right afterwards for about 3 hours. Between the two, we try to get in as many patients as we can. The multidisciplinary clinic is virtual.

Between the two, we try to get as many patients in [as possible] to have a multidisciplinary discussion. It’s not possible to see every single patient who comes through UCLA with lung cancer, but I do think we start to develop our institutional algorithms for how we handle patients; there’s some consistency to it, at least for the majority of patients. I think it’s good to have that discussion.

We’re also very active in enrolling patients and screening them for targeted therapy trials and IO [immuno-oncology] trials in the early-stage setting, as well as for unresectable stage III patients or those who are medically inoperable. With the cadre of trials that are available, we’re always looking to see what the best treatment for that patient is to complete, not only a local therapy, but also a systemic therapy, and that could be operative or non-operative local therapy.

Dr. Wahidi: Balazs, I have a question for you. Now, as a medical oncologist, it’s become very complex to pick the best regimen for your patients and [consider] adjuvant, neoadjuvant. Every two to three months, there’s a new drug, a new trial. How do you keep up as a medical oncologist? How do you implement a personalized approach to your patients’ treatment?

Dr. Halmos: My answer is that you can see why we gray quickly. It’s certainly a challenge, but at the same time, it’s also exciting. We attend meetings like the ASCO meeting, where we are today, and you can anticipate that by Monday or Tuesday, when we return, a couple of things will change in our practices next week. We have to be able to facilitate those changes to be made quickly so our patients can benefit from it.

I’m used to it by now, having made 20 years of constant progress; it’s been a tremendous time. Now [we have] biomarker-driven care for metastatic disease, precision medicine for earlier stage, higher cure rates— and not just higher cure rates—if you look at statistics, we’ve cut lung cancer mortality by 50% over the last 20 years, 50%. The curve is dropping fast, so that improvement should continue.

We need to continue bringing the excitement back to the clinic, but we must rely on each other, as that knowledge base is difficult to sustain. We rely on our molecular pathologists to ensure that we carefully understand the molecular reports. All of our other fantastic support specialties ensure that we get everything done right.

We have guidelines, fortunately, national guidelines that we tend to rely on. [There are] a lot of clinical trials in a place like Montefiore Einstein. Being able to offer the next wave of new therapies to our patients is very rewarding, and then seeing them benefit from it.

But coming back to the patients that we serve: Mary, you’re working in a place where many of the patients are maybe socioeconomically more challenged, so the role of the nurse, the navigator, is even more critical. Tell us about how you participate in that multidisciplinary world.

Dr. Pasquinelli: We’re there, the nurse practitioners, the lung cancer navigators, our lung screening navigators. It is so important to know the plan as we walk the patient through that pathway.

If there’s a clinical trial or a new treatment that the medical oncologist says this patient would be a candidate for, we need to know that upfront because it may change where the patient is seen next. Providing the patient with that knowledge is incredibly important. The multidisciplinary team and our clinical trials team are present at each multidisciplinary tumor board. They’re screening every patient that comes through the door. Every patient, if we have a trial for them, we discuss it before, at the very beginning, when they receive their diagnosis.

Dr. Halmos: I just hope that maybe some patients will watch this conversation, and maybe they can see the excitement [and how] our heart rate just went up, considering how hard the team works to make sure that individual patient’s care is optimized with the most innovative knowledge that we can deliver. It’s such an exciting time of teamwork.

Dr. Pasquinelli: One of the other things—[Mary], I know that the population that you work with, too—we have a lot of different languages that come through. All our materials are in multiple languages. We have translators there for them. So, when they receive that diagnosis, they have written material in their language and translation services available for them and their families.

View the first segment of this roundtable series, titled “Lung Cancer Screening: Multidisciplinary Experts Discuss Barriers, Opportunities.”

View the second segment of this roundtable series, titled “From Biopsy to Biomarkers: Panel Shares Insights on NSCLC Diagnostic Process”

View the third segment of this roundtable series, titled “Treatment for NSCLC: How Multidisciplinary Teams Define Options, Strategies.”