Lung Cancer Screening for At-risk Patients Offers Better Outcomes

Monday, October 17, 2016

Lung cancer is the deadliest form of cancer, killing more men and women than any other type. However, when found in its early stages, it can be very treatable.

Via Christi’s four lung cancer screening centers are Wichita’s only facilities accredited by the American College of Radiology.

With new lung cancer screening programs, such as the one offered through Via Christi’s Cancer Outreach and Risk Assessment program (CORA), physicians now can help patients at risk for the disease dramatically improve their lung cancer survival rates through early detection.

According to the American Lung Association, lung cancer has one of the lowest five-year survival rates — only 17.8 percent — of all cancers. In large part, that’s because many cases are not diagnosed until the cancer has reached stage 3 or higher.

“In stage 3B, the patient’s five-year survival rate falls to 5 percent,” says Bassam Mattar, MD, an oncologist with the Cancer Center of Kansas and a member of CORA’s multidisciplinary team that reviews positive screenings.

While screenings exist for breast, colon and other cancers, until three years ago there was no recommended reoccurring screening for patients at risk for lung cancer.

In August 2011, the National Cancer Institute released results from its National Lung Cancer Screening Trial. The randomized clinical trial compared two ways of detecting lung cancer: a low-dose helical computed tomography, commonly referred to as a low-dose CT scan, and the standard chest X-ray. The study, involving more than 53,400 current or heavy smokers 55–74 years of age, found that participants who received the low-dose CT scan — which provides a multiple-image scan of the entire chest — had a 15–20 percent lower risk of dying from lung cancer than those who had the chest X-ray.

Brett Grizzell, MD, is a cardiothoracic surgeon with Wichita Surgical Specialists and Medical Director for Via Christi’s lung cancer screening program.

As a result of the trial, the U.S. Preventive Services Task Force released lung cancer screening recommendations in December 2013 and called for the creation of lung cancer screening centers. For patients who meet the screening criteria, the procedure is covered by Medicare and private insurance.

“There’s a definite set of people who are at high risk for lung cancer, and if we screen them, we can reduce the high rate of mortality,” says Brett Grizzell, MD, of Wichita Surgical Specialists. A cardiothoracic surgeon, Dr. Grizzell is Medical Director for Via Christi’s lung cancer screening program, which is part of a community-wide effort to reduce the number of late-stage lung cancers.

A Dedicated Navigator

In Wichita, Via Christi has four locations that serve as lung cancer screening centers: Via Christi Clinic at 1947 N. Founders’ Circle, Via Christi Clinic at 3311 E. Murdock, Anatomi Imaging at 3636 N. Ridge Road and Anatomi Imaging at 2734 N. Woodlawn. They are Wichita’s only American College of Radiology (ACR)-accredited lung cancer screening centers. ACR accreditation means the facilities demonstrate commitment to providing high-quality screening care and patient safety.

Lyn Pitman, RN, is the lung cancer nurse navigator for Via Christi’s Cancer Outreach and Risk Assessment program.

Earlier this year, Lyn Pitman, a registered nurse at Via Christi for almost 40 years, began serving as CORA’s dedicated lung cancer nurse navigator. Pitman, a certified oncology nurse, has spent most of her career working in Oncology Services, first as a staff nurse with hospitalized cancer patients and then as a radiation therapy nurse at the Via Christi Cancer Center and at the Via Christi CyberKnife Center.

As a lung cancer nurse navigator, Pitman works with patients to schedule their screenings and with the patients’ primary physicians to help implement next steps, based on the findings.

“I have a passion for working in oncology,” says Pitman, who finds her new role particularly satisfying as she’s helping patients get diagnosed earlier so they can live longer lives.

How It Works

Lung cancer screening is a painless, outpatient procedure, lasting about five minutes. Highly detailed images of the patient’s chest area are collected through a low-dose CT scan.

Risk stratification is done using the ACR’s relatively new Lung-RADS system. Those graded Lung-RADS 1 are negative. Anything with a Lung-RADS 2 rating — a benign appearance with nodules present but no suspicion of cancer — is reviewed by Dr. Grizzell. Screenings with ratings of Lung-RADS 3, 4A and 4B are reviewed by a multidisciplinary team that includes Via Christi and community radiologists, thoracic surgeons, pulmonologists, and oncologists, as well as clinical trial and nurse navigators. They collaborate to provide their collective perspectives and recommendations on positive findings.

This team approach to a lung cancer screening program is significant, says Maggie Ward, MSN-APRN, CORA Program Manager, because the referring physician doesn’t get just one opinion. Rather, the approach includes multiple specialties to decide on the best course for the patient.

“The important thing is that the referring physician gets a multidisciplinary recommendation while maintaining his or her autonomy,” says Dr. Grizzell. “We are a tool for the doctors to use in their patients’ care.”

Abed Abu-Samra, MD, Chair of Pulmonology for Via Christi Clinic, agrees.

“Different lesions require different treatments, so the team approach is important,” Dr. Abu-Samra says. “It’s beneficial for the patient and for the primary care physician so patients won’t be overdiagnosed. Also, it’s not a one-treatment-fits-all approach.”

After the Screening

Patients with a negative screening receive a letter recommending that they continue with an annual low-dose CT scan as long as their risk continues.

For patients who receive a positive screening, everything goes back to the referring physician for the decision-making process with the patient, says Pitman, although she continues to serve as a resource for answering patient questions.

Treatment can range from surgery to stereotactic radiotherapy offered at Via Christi CyberKnife Center in Wichita. When the center opened more than a decade ago, it primarily treated patients with prostate cancer. Today, lung cancer is the most frequent cancer treated at the center, says David Bryant, MD, Via Christi’s Medical Director for Radiation Oncology.

“It’s very safe and effective for early-stage lung cancer,” Dr. Bryant says.

It can be an option for treatment in cases in which the cancer is medically inoperable. CyberKnife’s pinpoint radiation beams are accurate to less than 1 millimeter, or about 1/25 of an inch.

Better Outcomes

As with most cancers, early detection makes a difference. Morbidity rates are higher if the cancer has spread, which also makes it more difficult to treat.

Through the screening process, at-risk patients are provided with an opportunity to find lung cancer at an early and easier-to-treat stage.

“Finding something and treating it early can help people have the best outcome,” Pitman says. “That’s our goal with this program.”

If you have an at-risk patient who meets the criteria for lung cancer screening, call 316-689-5700. Via Christi’s dedicated lung cancer nurse navigator will work with your patient and your office to set up the screening at one of its four Wichita screening locations and will answer any questions and provide the results.