ORLANDO – A novel lung cancer screening program based in part on smoking-related meaningful use criteria proved feasible and was successful for identifying patients at a National Comprehensive Cancer Network cancer center who were eligible for screening.
The program, which was launched in January 2013, led to the screening of 110 patients and the detection and treatment of three stage I lung cancers during the first 7 months, Dr. Dan J. Raz of the City of Hope Medical Center in Duarte, Calif., reported at the annual meeting of the Society of Thoracic Surgeons.
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A novel lung cancer screening program was successful at identifying eligible patients at a National Comprehensive Cancer Network cancer center and resulted in the detection and treatment of stage I lung cancer in the first 7 months.
During the first 3 months of the program, before the tobacco screen was developed, only four patients were enrolled – two by physician referral and two by self-referral. At that point, the tobacco screen was implemented, and 418 patients potentially eligible for screening were identified, Dr. Raz said.
The tobacco screen, which contained smoking-related meaningful use criteria established by the Centers for Medicare & Medicaid Services as part of the standards for electronic health records (EHRs), was easily implemented and took an average of less than 2 minutes to complete and enter into the EHR, he noted.
Pack-year calculations and quit dates for former smokers also were included in the tobacco screen.
The lung cancer screening program – known as the tobacco exposure program – was run by a nurse practitioner who also was a licensed tobacco dependency counselor. The tobacco screen was administered to all ambulatory adult patients every 6 months. Weekly electronic reports were generated to identify patients who met criteria for lung cancer screening eligibility.
Those who met the criteria, and who hadn’t undergone a chest or head computed tomography (CT) scan in the prior 12 months and who weren’t undergoing cancer treatment, were contacted to review the information. The primary treating physician also was contacted regarding the plan for lung cancer screening.
"Disappointingly, only 14% of those [identified as potentially eligible] enrolled," he said.
Of the 110 patients ultimately screened, 53% were identified using the tobacco screen, 29% were self-referred, and 18% were physician-referred.
About half of the 418 patients identified as potentially eligible couldn’t be reached by phone, and another third didn’t meet eligibility criteria or didn’t participate for another reason, but only 10 (2%) refused because of cost. The hospital discounted the cost of the CT to $150 for those without insurance coverage.
A comparison of the groups of patients who were self-referred, physician-referred, and identified using the tobacco screen showed that Asian patients, who made up 25% of the total patient population at the hospital, were underrepresented in the tobacco screen group, and those with a history of cancer comprised 82% of the group identified by the tobacco screen, Dr. Raz said. The former finding could be attributed to a language barrier, and the latter finding is not surprising given that the study hospital is a cancer center, Dr. Raz said.
"Lung cancer screening with low-dose radiation CT scans saves lives, it’s safe, and it’s cost effective. The U.S. Preventive Services Task Force recommends lung cancer screening, as do a number of other professional organizations, including the STS [Society of Thoracic Surgeons]," he said.
Still, it is believed that only a minority of those eligible undergo screening, he added, noting that a 2013 survey suggested that the median number of patients screened per year per lung cancer screening program is only 10.
The current findings suggest that augmenting meaningful use tobacco questions as part of a lung cancer screening program is feasible. This approach increased participation in the City of Hope Medical Center screening program.
"We think it’s a method that other centers can use or that primary care physicians can use to identify patients within their programs or within their systems," he said, noting that use of the tobacco screen also provides clinicians with an opportunity for smoking cessation intervention. In addition, the tobacco screen represents a useful research tool in that it systematically collects data on tobacco history.
As the "resource-consuming" nature of the program might be considered a limitation, efforts are underway to implement an automatic alert system based on the EHR to flag patients who meet lung cancer screening criteria and to automatically book a consultation. The program might also be improved by better outreach to non-English-speaking patients, and through systematic referral of high-risk patients, Dr. Raz said.