2015 Annual Report Lung Cancer Screening

Transcription

1 2015 Annual Report Lung Cancer Screening Cancer and Blood Specialists (from left to right): Mohammad Iltaf Khan, MD, PhD; Christopher C. Croot, MD; Khuda Dad Khan, MD, PhD; Vijay Raghavan, MD; Subhash P. Sheth, MD CANCER SERVICES PROGRAM

2 KentuckyOne Health Cancer Care is pleased to share with you the Lung Cancer Screening Report for With Kentucky leading the nation in lung cancer incidence and mortality, we are working hard to provide education and increase screening volumes in the zip codes served by Sts. Mary & Elizabeth Hospital in southwest Jefferson County, Kentucky. Through this valuable data about our lung cancer screening initiative, lung measure outcome data and diagnosis information for patients in these zip codes, we are able to glean a better understanding about opportunities to improve and close the healthcare gap in access to prevention and screening and reduce the rates of advanced lung cancer in our service area. Mark Milburn Vice President, Oncology Service Line KentuckyOne Health Nancy Bowles Vice President, Oncology Service Line Louisville Market James Graham Brown Cancer Center 1

3 Overview KentuckyOne Health Cancer Care has nine locations across the state of Kentucky. In southwestern Jefferson County, KentuckyOne Health Cancer Care provides clinic and infusion services at the practice, Cancer and Blood Specialists. Cancer and Blood Specialists has been providing medical oncology care to southwestern Jefferson County for over 30 years and is accredited with silver commendation through the Commission on Cancer and recognized as a high quality cancer practice. Cancer and Blood Specialists has five board-certified medical oncologists, onsite lab services and PET CT. The cancer care team includes oncology certified nurses, nurse navigator, social worker, research coordinator and support team members focused on patient centered care. Cancer and Blood Specialists service area includes these six zip codes: 40118, 40214, 40215, 40216, 40258, and In 2014, there were 118 lung cancers diagnosed for these zip codes. The data by stage and zip codes are displayed in the corresponding graphs. Lung Cancer is the top cancer diagnosed at Sts. Mary & Elizabeth Hospital and treated by Cancer and Blood Specialists. In comparison with 2012 and 2013, stage 3 and 4 lung cancers have increased in On average, three to four times a month, a patient is diagnosed through the emergency room with late stage cancer. 77% of the patients treated at Cancer and Blood Specialists have stage 3 or 4 lung cancer as their initial diagnosis. These statistics align with the high smoking rates in the service area. Non Small NSC Lung Cell Lung Stage Stage by Year by Year Small Cell Lung Stage by Year 60% 70% 50% 60% Axis Title 40% 30% 20% Stage 1 Stage 2 Stage 3 Stage 4 Axis Title 50% 40% 30% 20% Stage 1 Stage 2 Stage 3 Stage 4 10% 10% 0% % Lung Cancer Diagnosis by Stage, Zip Code TOTALS Stage Stage Stage Stage Totals

4 Lung Cancer Screening KentuckyOne Health has offered lung cancer screening since September As a result of the National Lung Screening Trial results from 2004, in December 2013, the United States Preventative Task Force announced a grade B recommendation for screening high risk individuals. Effective January 1, 2015, under the Affordable Care Act, commercial insurances were required to begin covering lung cancer screening at 100%. On February 5, 2015, Centers for Medicare and Medicaid Services (CMS) announced coverage for annual screening for lung cancer with low-dose computed tomography (LDCT) in adults who meet specific eligibility criteria. The Commission on Cancer requires a screening program be provided each year to target decreasing the number of patients with late stage disease. We focused on lung cancer screening in the Sts. Mary & Elizabeth Hospital service area. Tobacco use and cancer prevention were identified as the highest community need for the service area. An analysis of 2013 and 2014 lung cancer screenings performed for residents in the targeted zip codes (40214, 40215, 40216, 40258, and 40118) revealed an opportunity to increase screening volumes in an effort to decrease late stage disease. Sts. Mary & Elizabeth Hospital was added as another screening site to further enhance the ease of access for those identified zip codes. We followed the evidence based national guidelines required by CMS for lung screening criteria. Age pack year smoking history Quit smoking within 15 years For more information, see Program Assessment Worksheet on page 5. Through education and awareness community outreach events, marketing, and primary care physician education and provision of criteria and order forms, we have increased screening volumes by over 500% in 2015, compared to Lung Screening Ini0a0ve Targeted Zip Codes Gender Age Range Female Male Grand Total < Grand Total

5 Lung Cancer Screening Results From January through September 2015, 51 people were screened from the targeted zip codes. 81% or 41 of 51 patients were screened at Sts. Mary & Elizabeth Hospital or Medical Center Jewish Southwest, both located within the target area. Lung Cancer Screening Southwestern Jefferson County 2015 Lung Facility Zip Code MCE MCS MCSW SMEH ULH Grand Total Grand Total Points of Interest Twenty-eight men and twentythree women were screened. 72% or 37 of the 51 patients screened did not require follow up. Of the 28% requiring follow up, one patient was diagnosed with lung cancer and the remaining are being monitored per evidence based guidelines. One of our 2015 screening initiatives was to offer more screening locations to be more accessible. The most common incidental finding was newly diagnosed emphysema. The highest incidence of lung cancer diagnosis is among African American men (CDC*). Prior to this year, no African Americans presented for screening. In 2015, we screened three African Americans Lung Screening Ini0a0ve Screening Findings Age Groups Cancer Follow Up Required No Follow- Up Required Grand Total < Grand Total *Center for Disease Control, 2015 Please see the Program Assessment Worksheet on page 5 for more information. 4

6 Lung CT Cancer Screening Program Assessment and Compliance Worksheet Program Feature Shared Decision Making (SDM) and Counseling Visit (Required for Medicare patients) Lung CT Screening Order Component Practitioner Providing Visit Determination of Patient Eligibility According to Guidelines Initial Screening Follow Up Screening Orders for Both Initial and Annual Follow up Screens Practitioner Providing Visit A shared decision making and counseling visit has to be conducted by qualified practitioners: Physicians :PCP (recommended), Pulmonologist or other Specialists Qualified non-physician practitioner (PA, NP or CNS) Patient Eligibility for Lung CT Screening Guidelines Determined Age: (CMS Medicare Patients), Age (USPSTF - Commercial Patients) At least a 30 pack year smoking history Current smoker or have quit less than 15 years Symptoms Asymptomatic (no signs and symptoms of lung cancer) For Initial Screening: Requires a physician/qualified NPP visit for counseling, shared decision making and written order. May be held same day as an E/M visit, but need to use modifier -25. Practitioner must determine patient eligibility as above Requires discussion of risks and benefits using decision tools Requires discussion of important of smoking cessation Requires counseling on the importance of adherence to annual LDCT lung cancer screening Writes appropriate order as described below For Follow up Screening: Only requires written order, however, if shared decision making visit is held, must meet all the same SDM visit requirements as initial screening. Required Order Elements Beneficiary date of birth Actual pack-year smoking history (number) Current smoking status, and for former smokers, number of years since quitting Statement that patient has no signs or symptoms of lung cancer NPI of ordering practitioner 5

7 Cancer and Blood Specialists Team Cancer and Blood Specialists 1460 Bluegrass Parkway Louisville, KY Medical Center Jewish Northeast 2401 Terra Crossing Boulevard Louisville, KY KYONE KentuckyOneHealth.org/lungcare