Faculty Disclosure. Objectives. Lung Cancer in Kentucky: Improving Patient Outcomes 10/28/16. Lung Cancer Burden in Kentucky

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1 Lung Cancer in Kentucky: Improving Patient Outcomes Faculty Disclosure The presenter and members of the development team do not have any conflicts to report. Celeste T. Worth, MCHES Kentucky Collaborative Objectives Diagnose lung cancer at an early, more treatable stage utilizing screening recommendations. Impact smoking behavior in less time. Explain opportunities for more effective, less invasive lung cancer treatment to patients. Identify and address patient survivorship needs through free resources. Provider Education Administrative Core Survivorship Care Prevention & Early Detection Lung Cancer Burden in Kentucky Ø#1 in U.S. for Lung Cancer Incidence Ø#1 in U.S. for Lung Cancer Mortality ØLeading Cause of Cancer Deaths ØMore Deaths from Lung Cancer than f Breast Prostate Colorectal Pancreas Combined! Kentucky Annual Deaths Cause KY Deaths/100k KY Deaths/yr Lung and bronchus ,442 Drug OD Colon Traffic Fatalities Breast Firearm deaths Pancreas Prostate Liver Ovary NCI state data for cancer Kentucky State police traffic fatalities CDC injury prevention and control: opioid overdose CDC National Center for Health Statistics, 1

2 Lung Cancer Incidence in Kentucky Risk Factors for Lung Cancer Radon Exposure Need for Screening 2 nd leading cause of lung cancer Invisible, odorless gas Can accumulate to dangerous levels inside buildings Class A Human Carcinogen Found at elevated levels in every county in KY Elevated radon levels = 200 chest x-rays per year or 8 cigarettes every day PCPs can recommend patients test homes for radon Lung Cancer Survival Rates 2

3 NLST Conclusions Chest X-rays not recommended for early detection Low-dose CT (LDCT) for high-risk patients = 20% relative reduction in mortality 320 screenings = 1 prevented lung cancer death vs. KY Lung Cancer Screening = LDCT USPSTF Lung Cancer Screening Recommendation Eligibility for Annual LDCT Screening: ü55-80 years old (covered by most commercial insurance providers) ücurrent or former smokers (in last 15 years) ü30 pack years or more Pack Year Calculation Multiply # of years smoking x # packs/day Examples: 15 years smoking x 2 packs/day = 30 pack years 40 years smoking x ½ pack/day = Benefits of LDCT Screening Effective for LC diagnosis at early stages Scan is noninvasive and painless Done in a single breath-hold Covered by insurance if eligible 20 pack years Lung Cancer Screening with LDCT Under the Affordable Care Act: Annual lung cancer screening with LDCT is FREE to eligible, insured patients with no out of pocket expense (i.e. no deductible or co-pay). Risks and Limitations False positives 96.4% of abnormal results in NLST (<2% underwent bx or surgery) Additional scans and biopsy or surgery Complications 0.06% major complications when LC not diagnosed in NLST Overdiagnosis Estimated % of screening-detected cases Radiation Exposure Although much less than standard CT 3

4 Centers for Medicare and Medicaid Services (CMS) Coverage Eligibility Criteria* LDCT Does Not: ücurrent smoker or former smoker quit < 15 years üsmoked 30 pack years or more übetween y/o ØNOTE: 3 years younger than USPSTF recommendation üasymptomatic Ø*to be documented in a written order for LDCT ØRule out the chance for lung cancer ØDetect all lung cancers early ØPrevent all deaths from lung cancer Lung Cancer Screening with LDCT: Where? Lung cancer screening with LDCT should be performed at a facility with special expertise in lung cancer screening and treatment. The American College of Radiology and the Lung Cancer Alliance list imaging centers designated as accredited or lung cancer screening centers of excellence on their websites. LDCT Shared Decision Making Patients with Medicare and Medicare replacement plans are required to have a shared decision making (SDM) and counseling visit prior to the baseline screening study. Reimbursement for SDM is ~ $60 Can be billed on the same day as a sick person or well person visit. 4

5 Before and After Screening Program Implementation at Lahey Clinic LDCT is not an alternative to cessation 2011, All patients before screening Screening program patients Stage 1 Stage 2 Stage 3 Stage 4 34% 7% 24% 35% 69% 10% 12% 9% 3 Years Later: Catching up with Lahey s Lung Screening Program The Advisory Board Company. v i s o ry.c o m/re s ea rch /ima g ing -performance. April 14, Treating Tobacco Use and Dependence Clinical Practice Guideline Recommended 5 A s by Provider PCP advice or intervention can be effective in 3 mins or less Advise Ask Assess Assist Arrange Tobacco Cessation Resources 7 FDA Approved Cessation Medications Quit Now Kentucky ntucky. org QUIT-NOW More referrals in Kentucky Resources List Bupropion SR (Zyban) pill (Rx) Varenicline (Chantix) pill (Rx) Nicotine Replacement Therapy Gum not chewed (OTC) Lozenge not sucked (OTC) Inhaler not inhaled (Rx) Nasal Spray not sniffed (Rx) Patch (Rx or OTC) Combination Therapy 5

6 Electronic Cigarettes (E-cigarettes) What if LDCT finds a pulmonary nodule? Regulated by the FDA as of Aug 2016 Not proven safe for use or effective for cessation Risk for cancer/other long term effects unknown Patient use should be discouraged in favor of FDA-approved medications Review ACR Lung- RADS TM for follow up of abnormal results Why Does Lung Cancer Go Untreated? Nihilism Stigma Fatalism Lack of Awareness Treatment Advances Minimally Invasive Surgery Electromagnetic Navigation Bronchoscopy (ENB) Targeted Therapies Radiation Delivery Chemotherapy Smoking Cessation After a Lung Cancer Diagnosis Possible Detrimental Effects of Continuing to Smoke: Doubles the risk of dying in early-stage LC Increase risk of cancer recurrence Increase the likelihood of a second primary tumor Reduce treatment effectiveness Worsen side effects of treatment Increase treatment-related toxicity Increase risk for poor wound healing and for respiratory complications after surgery 6

7 NCI Resources for Health Professionals and Patients Challenges Lung Cancer Survivors Face Age and Comorbidity Getting Lost in the System Transportation Multiple Medical Specialists PCP and Oncology Specialist Collaboration Barriers to Continuity of Care: Less Frequent Visits Poor Communication and Lack of Role Clarity Insurance Coverage Gaps Your Role in Lung Cancer Care See the Evaluation Process Through Request a Copy of the Treatment Plan and Survivorship Care Plan To learn more: Cancer Survivorship E-Learning Series for PCPs A program of the National Cancer Survivorship Resource Center Reach an Agreement about Roles Routine Follow-up Visits Kentucky Cancer Program (KCP) Pathfinder Free online CME opportunity y.or g 7

8 Contact: Thank You! Celeste T. Worth 8