Lung Cancer Screening: Who, What, Why? Myths Dispelled

Transcription

1 Lung Cancer Screening: Who, What, Why? Myths Dispelled Presented By: MaryAnn Tateosian, RT (R), M, MM, CIIP MGH Lung Screening Program Manager December 11,

2 Lung Screening Objectives History of Smoking and Lung Cancer Inception of the Lung Screening program What is the Lung Screening program? Why is Lung Screening important for high risk patients? Which patients qualify for Lung Screening? The Lung Screening Program at MGH Lung Screening Tools for patients and physicians 2

3 History of Smoking and Lung Cancer History of smoking dates back as early as 5000BC in Americas by Shamanistic rituals Gained popularity in 16 th century with arrival of Europeans 1960 s smoking controversies 1980 s condemnation

4 History of Smoking and Lung Cancer , 472 Lung Cancer Deaths 436 deaths per day An estimated 154,050 Americans are expected to die from lung cancer in 2018 Accounts for 25% of all cancer deaths Total deaths more than Colon, Breast and Prostate combined 2/3 Lung Cancers people 65 or older <2% under age 45 Overall risk higher for men than women Black men 20% increased risk than white men 5 year survival rate after symptoms occur are only 17.4% (non-screening)

5 History of Smoking and Lung Cancer

6 History of Smoking and Lung Cancer

7 History of Smoking and Lung Cancer

8 History of Smoking and Lung Cancer

9 9 History of Smoking and Lung Cancer

10 History of Smoking and Lung Cancer

11 History of Smoking and Lung Cancer

12 12 Lung Cancer Statistics

13 13 Lung Cancer Statistics

14 The NLST and the Inception of the Lung Cancer Screening Program

15 Results of the NLST US Preventive Task Force (USPS) public health recommendation made for LCS w/ Low dose CT Based on NLST data released in 2011 February CMS CT lung screening with no insurance co-pay for qualifying patients Inception of the Lung Cancer Screening Registry 15

16 The Lung Cancer Screening Registry Audit the quality of interpretation for Lung Screening exams Based on the ACR Lung Imaging Reporting and Data System ( Lung-RADS) Monitors and compares appropriate use of Lung- RADS Outcomes monitoring and reporting CMS approved Provides Checklists and materials for all eligibility- LCS/ACR websites

17 Lung Cancer Screening Program Site Eligibility Performs Low Dose CT (LDCT) w volumetric CT dose index- CTDivol Utilizes Lung-RADS Accessibility of smoking cessation for current smokers Collects and submits data to the LCSR

18 Lung Cancer Screening Program Provider Eligibility Provides shared decision making with patient Harms and benefits of LCS Smoking Cessation counseling Documentation of both in patient LCS order Willingness to seek diagnosis and treatment considering comorbidities Importance to adherence LCS program

19 The Lung Cancer Screening Registry Shared Decision Making

20 Smoking Cessation Benefits Tobacco cessation opportunity Benefits of tobacco cessation Return of smell Increased energy Smaller chance of having a stroke or heart attack If you decide to quit there are resources available for you Medication Group support If you have quit, Congratulations! Staying quit is also very important

21 Smoking Cessation Counseling Tools MGH Counseling programs In Person Counseling Living Tobacco- Free Free phone one-on- one counseling Smoke- Free Support Service MGH Cancer Center Patients 21

22 22 Smoking Cessation Counseling Tools

23 The Lung Cancer Screening Program- Radiologist Eligibility Board certified or eligible Compliance continued medical education documentation Interpretation of a minimum of 300 CT exams in 3 year period Education/ training for the interpretation of LCS exams- Lung- RADS

24 The Lung Cancer Screening Registry- Patient Eligibility CMS Eligibility Asymptomatic patient years old (50/55)- 80 most commercial insurers Minimum of 30 Pack years- cigarettes only Current smokers Former smokers no more than 15 quit years Willingness to pursue diagnosis and treatment

25 The Lung Cancer Screening Registry- Patient Eligibility NCCN Eligibility- National Comprehensive Cancer Network Age Pack years At least one additional risk factor Family HX lung cancer, COPD, Bronchitis No quit years limit Only follow ups covered not screenings

26 The Lung Cancer Screening Registry- Patient Eligibility

27 The Lung Cancer Screening Registry- Patient Eligibility Firemen- Never Smokers, Current Smokers, Former Smokers Check with Insurer for Lung Screening Coverage 27

28 The Patient Lung Screening Experience at MGH and Mass General imaging Centers 28 The MGH Enterprise- Designated Screening Sites Patient will receive Baseline (first) low dose Lung Screening CT scan Radiologist report generated according to LungRads (LR) category Annual Lung Screening- LR1 and LR2 Follow up- LR3 and LR4- Follow up from report recommendations Any significant findings (S) designated to all above Physician receives report with LR category Patient results letters sent for all LR1-3 Categories beginning January 2019

29 Reporting the Size of a Nodule(s) Diameter of nodule is the average of the short and long axes rounded to the whole number

30 Pulmonary Nodules Morphology

31 31 Lung RADS(Lung Imaging Reporting and Data System) = Classification

32 Benign Nodules Immunocompromised Patients Fungal Infections Most common- Aspergillus Fungal spores indoors and out and unavoidable to completely avoid Less common- Coccidioidomycosis- COCCI Found in soil West, South West US, Mexico Bacterial Infections Most common- Tuberculosis

33 Benign Nodules Hamartomas- Disorganized collection of tissue Fibromas- Connective tissue, fibers Lipomas- Collection of fat cells Organizing Pneumonia- Idiopathic Aspiration Pulmonary AVM s- Vascular condition

34 Pulmonary Nodules Morphology- Benign Calcifications in Solid Nodules Granulomas Hamartoma

35 Benign Nodules- Calcified Hamartoma

36 Lung- RADS Category 0 or 1 Category 0 for technical call backs Category 1 negative for nodules

37 Lung- RADS Category 2S (LR2 w/significant finding)

38 Lung- RADS Category 2 (<1%) 4B= Importance Yearly Screening

39 40 Lung- RADS Category 3 (1-2%) Multiple Nodules- LR for Dominant Nodule

40 Lung- RADS Category 4A (5-15%) from Baseline Screening

41 Lung- RADS Category 4B (>15%)

42 Lung- RADS Category 4X (>15%)

43 44 Recommendation for Lung Rad 4 Patients

44 DIGITAL CONTENT ONLY PRACTICE SUPPORT OUTREACH Practice Support made 146 office visits between Oct 4, 2016 and March 31, 2017 Distributed 2,550 brochures between Nov 22, 2016 and March 31, 2017 Distributed 2,744 infographics between Nov 22, 2016 and March 31, 2017 PRACTICE SUPPORT OUTREACH & EDUCATION RADIOLOGIST ENGAGEMENT Practice Support and Dr. Amita Sharma visited and educated 6 MGH offices between Sep-Oct 2017 Practice Support made 89 office visits between Oct 2, 2017 and Feb 28, 2017 Distributed >1.5K brochures between Oct 2, 2017 and Feb 28, 2017 Distributed ~1.2K infographics between Oct 2, 2017 and Feb 28, 2017 Generated over 16.3K visits to key web content Generated over 7.5K visits to key web content

45 Tools for Patients and Physicians Lung Imaging Reporting and Data System Management of Lung Screening Patients Annual Exams Follow up recommendations Patient Result letters- January 2019 Appointment Reminder letters- Pending Physician notifications of patients nearing ineligibility Data Reporting 46

46 Tools for Patients and Physicians- Patient Result Letter for Lung-Rads 2S

47 Patient and Physician To Do s 48 Patient Mindset of smoking in Pack Years- Know what your Pack Years are! Mindset that LS does not take the place of quitting smoking! Remember, Lung Screening currently only for cigarettes Marijuana, e-cigarettes, cigar smoking and vaping not included no current standard for accessing risk If you qualify for Lung Screening engage your physician and have the conversation Physician Engage your patients about Lung Screening and have the conversation with those that appear eligible Document smoking history in Pack Years as best as possible Stress the importance of LS compliance to program patients

48 Lung Cancer Screening Saves Lives 90% Cure Rate Stage 1 Lung Cancer Lung Cancer Screening Saves Lives 90% Cure Rate Stage 1 Lung Cancer 49

49 QUESTIONS?