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Mobile screening unit identifies early-stage lung cancer in underserved populations
CHICAGO — Researchers from Atrium Health’s Levine Cancer Institute reported at the ASCO Annual Meeting that a first-of-its-kind mobile CT unit improved lung cancer screening rates among underserved patients in rural areas.
Mellisa Wheeler, MHA, director of disparities and outreach at Levine Cancer Institute, and colleagues launched the mobile CT lung cancer screening program in April 2017. The program is designed to provide free lung cancer screenings, education and, if necessary, treatment interventions to uninsured and under-insured individuals who meet age and smoking history criteria.
“Back in 2016, we started looking at our cancer data registry and saw that, just like the rest of the country, many of our patients were coming in with late-stage — stage 3 and stage 4 — disease,” Wheeler told HemOnc Today. “Our institution has a program that screens underserved populations with a mobile mammogram unit, and we thought, why can’t we do the same thing for lung cancer?”
Wheeler and colleagues collaborated with Samsung Neurologica to develop the technology. The 35-foot mobile unit houses a BodyTom — a portable, full-body, 32-slice CT scanner. The unit has a waiting area and high-speed, wireless internet for rapid image transfer. There are also electronic tablets that patients can use to receive information on smoking cessation and health education.
The Lung Cancer Alliance certified the mobile CT unit as a “Screening Center of Excellence.” It uses the LUNG RADS approach for lesion classification, yielding high sensitivity and specificity, according to the researchers. All images are reviewed by a panel of oncologists, pulmonologists and radiologists. In addition to lung cancer, every patient receives a head and neck screening, as well, according to Wheeler. The researchers also assess whether patients qualify for other free screening programs, including ones for breast cancer, high-risk prostate cancer and colorectal cancer.
The Bristol-Myers Squibb Foundation funded the initial cost of the mobile CT unit and will support 1,200 lung cancer screenings over the first 3 years. The foundation will also fund tobacco-cessation counseling and nicotine-replacement therapy for all patients who still smoke cigarettes.
At the time the data were presented, Wheeler said the researchers had screened 636 uninsured or under-insured patients (mean age, 61 years) in North Carolina with the mobile CT unit. So far, they have completed analysis on 470 cases. Among them, 10 are confirmed lung cancer cases — four of which are stage 1 or stage 2 disease — and four are confirmed non-lung cancer cases. Seven final diagnoses are pending.
“The results are pretty comparable to what we see with the National Lung Screening Trial, the difference being that we are directly focusing on more underserved patients,” Wheeler said. “Our theory all along has been, this is the population with the highest smoking rate. They have poor health follow-up, poor health behaviors, and many of them do not have primary care. We knew we were going to find cases, including early stage.”
The researchers reported that patients with earlier-stage disease will have “better anticipated outcomes at a lower cost than if they had first presented with metastatic disease.”
A second mobile lung cancer screening unit is being constructed, as screening efforts continue to expand in the region, according to Wheeler. Currently, the researchers have screened individuals from more than 10 counties in North Carolina, but they plan on implementing the mobile screening unit in South Carolina, as well. Most patients who are screened — more than 70% — live in rural areas.
“We are going to continue to grow and hopefully screen more folks,” Wheeler said.
Additional research projects surrounding this intervention are underway. The researchers’ efforts also go beyond cancer screening.
“If a patient comes to screening and says they do not have primary care or they tell us that they do not have water at home, our team works to resolve these issues, regardless of what the screening outcome is,” Wheeler said. “We believe that if we address those issues in advance, the patient will be that much further ahead and will more likely have a positive outcome if he or she is eventually diagnosed with a cancer. We also believe that there is good evidence to show that we have a better chance of diagnosing EARLY cancer in this very underserved population, who often present with incurable disease because they don’t have access to screening.” – by Stephanie Viguers
Reference:
Raghavan D, et al. Abstract 6567. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.
Disclosure: Wheeler reports no relevant financial disclosures. Please see the abstract for a list of all other authors’ relevant financial disclosures.