Implementing a Free Lung Cancer Screening Program in a Teriary Healthcare Network
Doraid Jarrar, MD, Hank Simms, MD, William Tester, MD, Thomas Reilly, MD, Julie Gubernick, MD, Tracy Kane, Chris Minnick, Marc Schaller, Gary Drizin, MD, Einstein Healthcare Network, Philadelphia, PA
OBJECTIVE: Lung cancer remains the number one cause of cancer related death both in the United States and worldwide. Despite great advances in imaging and surgical technique, there has been minimal improvement in 5 year survival over the last 40 years. The National Lung Screening Trial reported a 20% relative reduction in lung cancer specific mortality using low-dose computed tomography in high risk patients. Lung Cancer Screening is now endorsed by the US Preventitive Services Task Force.
METHODS: We initiated a lung cancer screening program in line with the USPSTF and NCCN guidelines using low-dose computed tomography. Tobacco cessation counseling was offered to current smokers. Biweekly meetings with all the stakeholders (Pulmonary Medicine, Surgery, Medical Oncology, Radiology and Hospital Administration) were held using the Delphi method for structured communication. A 1.0 FTE position for patient navigation was created and time from conception to initial rollout to employees was 8 months.
RESULTS: After reaching out to referring physicians, 82 eligible patients underwent screening. Two lung cancers (2.4% incidence) were found, in keeping with the published literature. Positive findings were discussed at a multidisciplinary Tumor Board and reports issued using Lung-RADS.
CONCLUSIONS: Implementing a Free Lung Cancer Screening Program requires close cooperation between different specialties and Hospital Administration. Positive CT scans should be discussed in a multidisciplinary Tumor Board/lung nodule conference. Tobacco cessation should be an integral part of a screening program. Our experience reflects published reports of about 2% incidence of lung cancer in a high risk population.