Multi-agency effort tackles IRC Lung Cancer initiative

Wednesday, December 20th, 2017

VERO BEACH, Fla. (December 20, 2017) — According to The National Institutes of Health Journal of Radiology, lung cancer causes 25 percent of all cancer deaths in the United States (159,900 deaths each year). In addition, it reports that “roughly 90 million individuals in the U.S. had a history of cigarette smoking, with half reporting to be current smokers. This continues to be a major health problem and strategies need to be put in place to reduce its toll.”

The Indian River County Health Needs Assessment of 2015 supports this data and summarizes that not only is cancer the number one cause of death, but lung cancer deaths are the number cause of death from cancer in our community. Earlier diagnosis results in higher cure rates.

Today, there is a new screening test for lung cancer called a low-dose CT scan. Those who are at risk (see Table 1 below for high risk guidelines) can now receive a physician’s order to be screened for lung cancer prior to having symptoms.

Table 1. Groups Eligible for Screening: Vary slightly depending on the organization

National Comprehensive Cancer Network (NCCN) Guidelines indicate:

  1. Age 55 to 74 years with ? 30 pack-year smoking history and smoking cessation < 15 years.
  2. Age ? 50 years and ? 20 pack-year smoking history and 1 additional risk factor (other than secondhand smoke).
  3. Additional risk factors include cancer history, lung disease history, family history of lung cancer, radon exposure, occupational exposure, and history of chronic obstructive pulmonary disease or pulmonary fibrosis. Cancers with increased risk of developing new primary lung cancer include survivors of lung cancer, lymphomas, cancer of the head and neck, and smoking-related cancers. Occupational exposures identified as carcinogens targeting the lungs include silica, cadmium, asbestos, arsenic, beryllium, chromium (VI), diesel fumes, and nickel.

For high-risk patients, lung cancer screening is covered by Medicare, and most major insurance companies have followed with coverage. For those not covered, The Scully-Welsh Cancer Center’s oncology lung navigator will assist with accessing funding for financial hardship cases.

In 2016, the Scully-Welsh Cancer Center at Indian River Medical Center invited local health agencies to form The IRC Lung Cancer Screening Task Force with the overall goal to increase the number of screenings of community members at risk for lung cancer.

The 20 task force members included representatives from the following agencies: Indian River Medical Center; Scully-Welsh Cancer Center; Vero Radiology Associates; IRC Tobacco-Free Partnership; The American Cancer Society; The Visiting Nurses Association; Whole Family First; Treasure Coast Community Health; IRC Health Department; Senior Resource Association; and Substance Abuse Awareness Council. The task force organized and implemented an action plan which resulted in significant improvements in achieving our overall goal. The action plan included:

  1. Physician-to-Physician Education
    • IRMC pulmonologists Diego Maldonado, MD, and Hermes Velasquez, MD, provided one-on-one education to over 250 physicians across all health agencies, including private practices.
  2. Clinical Education
    • Provided a 1.5-hour CNE class for clinical staff working at the patient bedside to learn how to approach a current smoker with a conversation in order to help them seek help to quit smoking and get screened.
  3. Medical Office Staff Education
    • A Series of three medical office staff lunch-and-learn classes have been held to date, with several additional classes still to be completed in 2018, providing education to nurses, medical assistants, physician assistants, nurse practitioners, receptionists and practice managers.
  4. Community Education
    • Designed educational materials including:
      1. Oncology lung navigators contact information
      2. Lung Cancer Screening Educational Brochure (see below)
      3. Lung Cancer Screening Assessment Cards
  5. One-on-one education has been provided to over 10,000 community members through:

    • “Shine a Light on Lung Cancer,” a community education program that kicked off the campaign in November 2016.
    • A total of 18 community health fairs held at various businesses, private communities and public venues,
    • Quit smoking programs offered three times per week throughout the county.
    • Life Skills Educators education program
    • “Ride the Community Bus” education initiative
    • Radio interviews with a radiologist and a pulmonologists designed to educate the community
    • Chamber of Commerce networking meetings designed to educate employers at large
  6. Designed and implemented a Lung Nodule Clinic to monitor those who have a lung nodule and provide follow up pulmonology care as needed.
Results

We are making a difference. In just one year, the screening numbers went from 98 in 2015 to 358 in 2016 (Table 2). The results have been impressive, however, the IRC Multi-Agency Task Force Initiative will continue with the goals and action plan through 2018 so that we may continue to capture those community members who remain at risk and who have not yet been screened. Get screened!

Table 2. Results Data
Results from 2016 Results from 2017
2016 2017
98 Low dose CT screenings 358 Low dose Screenings
References
  1. American Academy of Family Physicians. Lung cancer clinical recommendations. Available at: http://www.aafp.org/patient-care/clinical-recommendations/all/lung-cancer.html. Accessed September 9, 2016.
  2. Jaklitsch MT, Jacobson FL, Austin JH. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. Journal of Thoracic and Cardiovascular Surgery 2012;144(1):33–38. DOI: 10.1016/j.jtcvs.2012.05.060. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22710039.
  3. Smith RA, Andrews K, Brooks D, DeSantis CE, Fedewa SA, Lortet-Tieulent J, et al. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians 2016;66(2):96–114. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26797525.
  4. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e78S–92S. DOI: 10.1378/chest.12-2350. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23649455.
  5. Bach PB, Mirkin JN, Oliver TK. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012;307(22):2418–2429. DOI: 10.1001/jama.2012.5521. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22610500.
  6. American Lung Association. Providing guidance on lung cancer screening to patients and physicians. An update from the American Lung Association Screening Committee. April 30, 2015. Available at: http://www.lung.org/assets/documents/lung-cancer/lung-cancer-screening-report.pdf. Accessed September 9, 2016.
  7. Wood DE, Eapen GA, Ettinger DS. Lung cancer screening. Journal of the National Comprehensive Cancer Control 2012;10(2):240–265. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22308518. 8. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Lung cancer
  8. US National Library of Medicine, National Institutes of Health, Radiology Journal 2011 Jan; 258(1) 243-253 Published online 10.1148/radiol.10091808 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009383/

*Oncology Lung Navigator @ Scully-Welsh Cancer Center – Call (772) 563-4673.