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Mobile lung cancer screening unit may reduce disparities, late-stage diagnoses
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Levine Cancer Institute at Carolinas HealthCare System launched what institute officials are calling the first-of-its-kind mobile CT unit for lung cancer screening.
The program provides free lung cancer screenings to uninsured individuals who meet age and smoking history criteria. Grant support from the Bristol-Myers Squibb Foundation will help offer 1,300 screenings over 3 years.
The U.S. Preventive Services Task Force recommends adults aged 55 to 80 years with a 30 pack-year smoking history who either still smoke or quit within the prior 15 years undergo annual lung cancer screening with low-dose CT. More than 8 million Americans meet those criteria.
However, financial barriers and a lack of adequate public transportation have made it difficult for many people in rural areas — including the Carolinas — to adhere to those recommendations.
The 35-foot mobile unit — constructed through a partnership between Samsung and Frazer Inc. — houses a Samsung NeuroLogica BodyTom, a portable, full-body, 32-slice CT scanner. The unit is designed to ensure uninsured individuals in these often underserved populations have access to screening, lung cancer education and, if necessary, treatment interventions.
HemOnc Today spoke with Mellisa Wheeler, director of disparities and outreach at Levine Cancer Institute, about how the mobile unit works and its potential impact.
Question: Can you describe the need for the mobile unit and how it came about?
Answer: We began to realize that about seven in 10 patients were coming in with stage III or IV disease, for which there are very few treatment options. Smoking history — particularly in the Tobacco Belt, where we reside — is very prevalent in this patient population. We knew we had to act, and that it had to be something significant and bold. We previously had success using mobile mammography for disadvantaged populations. We thought carefully about whether the mobile model would work for lung cancer screening. We developed a program we thought could address the problem, and we sent a proposal to the Bristol-Myers Squibb Foundation. They loved the idea that our program is comprehensive. We provide guidance on the front end — before the patient comes out to the bus — and if the patient has a positive screen, they transition to our thoracic navigator.
Q: What is the potential impact?
Images courtesy of Levine Cancer Institute.
A: The primary goal is to ensure uninsured individuals at risk for lung cancer in our region have access to low-dose CT scanning and comprehensive navigation. We hope that, by increasing the screening availability and, thus, getting patients in earlier for care, we will catch lung cancer at a much earlier, much more treatable stage. Historically, we haven’t found lung cancer early. Consequently, we don’t know a lot about the disease. Imagine if we start finding the majority of lung cancers at stage I or stage II, and the impact that could have on treatment and outcomes. We also hope to address the stigma against lung cancer. If someone is diagnosed with breast cancer, the immediate reaction almost invariably is, “I’m so sorry to hear that.” If someone is diagnosed with lung cancer, they often are asked, “Did you smoke?” We want to normalize lung cancer screening and emphasize that these individuals deserve the same quality of care.
Q: How many staff are required?
A: One CT tech runs the scan. We have an EMT driver. It is not required, but with this being a pilot project — and because we are working with a high-risk population — we felt it was smart. We also have a nurse program coordinator, who is responsible for navigation. If a provider contacts her and tells her he has an uninsured patient who qualifies for lung screening, the nurse program coordinator reaches out to the patient and walks them through an assessment that encompasses their health history and their barriers to care. The nurse program coordinator also will follow up with patients after screening.
Q: Can you describe the screening process?
A: Patients do not have to undress. They simply lay on the table, and the CT scanner performs noninvasive imaging. We send the images to a radiologist. Within 2 days, results are reported to the patient’s primary care physician and our nurse navigator. Members of our interdisciplinary team will meet to determine the next step, such as a repeat scan or a biopsy. The nurse program coordinator will make sure patients get follow-up appointments or additional screening as needed.
Q: Is payment required?
A: This program is strictly for uninsured patients, and screenings are free. In addition to paying for screening, we can pay for smoking cessation and nicotine replacement therapy for those individuals who undergo screening and continue to struggle with smoking. We think it will be more cost-effective to conduct screening sooner and potentially diagnose lung cancer earlier rather than having these patients present to the ED with advanced-stage disease.
Q: Do the unit’s operators follow U.S. Preventive Service’s Task Force recommendations for lung cancer screening frequency and eligibility?
A: Yes, and a physician must conduct a shared decision-making visit with the patient before they can write the order for screening. Our program coordinator, Darcy Doege, RN, created an extensive educational program that targets primary care and front-line staff. In the past year, we educated hundreds of providers in rural communities. Some of these providers were not aware of the screening changes, and some were still using chest X-rays as the mechanism to detect lung cancer. We have helped them understand who qualifies, what is involved in a shared decision-making visit, how to write the order and how to process a follow-up appointment.
Q: Can this program serve as a model for other institutions?
A: Yes, for a couple reasons. First, it just makes sense. It brings care to people. Getting underserved and disadvantaged individuals to brick-and-mortar medical facilities is a challenge. This breaks down that access barrier, and it helps overcome the transportation barrier because people don’t have to go out of town to undergo screening. Our model also addresses the financial barrier. In some states, it could be a reimbursable model; perhaps patients with insurance could be screened like they are with mobile mammography.
Q: Do you have plans to expand or enhance this service?
A: One of the benefits to the navigation component is the ability to generate data. The navigation assessment goes into the medical record and, at the end of the year, we will be able to aggregate the data and assess where the biggest barriers are. That will help us plan for additional supplements to the program. We anticipate growth and additional need. – by Kyle Doherty
For more information:
Mellisa Wheeler can be reached at mellisa.wheeler@carolinashealthcare.org.
Disclosure: Wheeler reports she has no relevant financial disclosures.