Extending Lung Cancer Screening to Primary Care

Project Overview:

This grant proposes to extend a newly developed Lung Cancer Screening-Shared Decision Making (LCS-SDM) program, previously funded by Maine Cancer Foundation in 2013-14, to the primary care setting. The current LCS-SDM program is specialty-based, utilizing pulmonary medicine physicians to assess patient eligibility for Low Dose CT (LDCT) screening, provide in-depth counseling to ensure shared decision making (SDM) about screening, to provide close follow-up of normal and abnormal findings for all patients, to refer patients for smoking cessation counseling services, and to track patient outcomes. The current program focused on establishing reliable processes and procedures for all of these services, and was successful in providing screening services for 25 patients that were studied during the pilot period. The program's eligibility screening process resulted in 13 referred patients being deemed ineligible for screening due to not meeting established criteria.

All of the first 25 eligible patients elected to proceed with LDCT screening after receiving SDM counseling, and scores on a validated survey showed that counseling increased their knowledge and preparedness for undergoing screening. The pilot cohort had an average age of 65.4 years and included 14 men and 11 women. In this cohort, 13 were current and 12 were former smokers, with an average smoking history of 58.7 pack-years. Of these patients, 8 were found to have lung nodules by LDCT, and will receive further follow up imaging studies over the next year; none have been diagnosed with cancer.

The program continues to accept referrals for lung cancer screening service according to the same general model developed during the pilot, with some minor readjustments to improve coordination of services and the overall patient experience. However, the current specialty-based model of LDCT screening is not scalable and feasible for widespread implementation. Now that LDCT screening for lung cancer has been recommended as a covered preventive service by the Centers for Medicare and Medicaid Services (CMS), there is a need to expand LDCT screening to the primary care setting. A delivery model extending LDCT screening to the primary care setting, with primary care physician (PCP) involvement, is the next logical step, and many PCPs in our community have asked for such a model. The current project will respond to this need.

The Challenge:

Lung cancer is the #1 killer within the United States, with only 15% of lung cancers cases found in the early stages, where the survival rate is 53.5%. Most cancers are not diagnosed until later stages, when the survival rate is only 3.9%. Within Maine, the Annual Report (2014) from the Maine CDC Registry reports that an average of 1,282 people were diagnosed per year between 2009-2011. The Maine Comprehensive Cancer Control Plan (2011-2015) identified lung cancer as, by far, the cancer with the highest age-adjusted mortality rate in 2006 for both men and women. Early detection and reducing modifiable risk factors, such as smoking, are major goals embedded in the Maine Cancer Plan, both of which are supported by this project.

The current project addresses the need to establish a reliable and effective process for implementing LDCT screening for lung cancer in the primary care setting. This is a need that numerous practices throughout the country are beginning to address, in response to the recent Centers for Medicare and Medicaid Services (CMS) decision to provide coverage for this service. However, we currently lack evidence regarding the optimal approaches to providing LDCT screening in the primary care setting. The current project will produce preliminary evidence on the feasibility, acceptability, and effectiveness of one approach that builds on our initial experience, and promising evidence, with providing LDCT screening in the specialty care setting.

Project Benefits:

  1. Patients, who are at risk for lung cancer and eligible for LDCT screening, will have the opportunity to engage in the only evidence-based early detection intervention that can lower mortality from lung cancer.
  2. Primary care physicians, will gain knowledge and experience in implementing LDCT screening.
  3. Clinical practices and health care systems, will gain insight on procedures and best practices in implementing LDCT screening in the primary care setting.
Maine Medical Center
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Maine Cancer Foundation Grants to this Organization:

Year Program Amount Category Organization
2016 Building Capacity at MaineHealth to Enahance Colorectal Cancer Screening $28,863 Screening Maine Medical Center
2016 The Maine Lung Cancer Prevention and Screening (Maine LungCAPS) Initiative $400,000 Prevention Maine Medical Center
2015 Extending Lung Cancer Screening to Primary Care $49,899 Screening Maine Medical Center
2013 Lung Cancer Screening Shared Decision-Making $25,536 Screening Maine Medical Center
2013 Endometrial Cancer & Obesity: A Survivorship Program $10,000 Survivorship Maine Medical Center
2012 Improving Colorectal Cencer Screenings in Low-Income Primary Care Settings Using Shared Decision Making $97,860 Research Maine Medical Center
2012 Cancer Survivorship Support $10,000 Survivorship Maine Medical Center
2012 Oncology Pharmacy Practice Residency $5,000 Support Maine Medical Center
2012 Inhibitory Effects of Insulin-like Growth Factor Binding Protein-4(IGFBP-4) on Melanoma Growth and Metastasis $73,848 Research Maine Medical Center
2012 Gas Cards for Emergency Aid $1,000 Beacon Fund Maine Medical Center
2011 FGF Export from Endothelial Cells: Protumorigenic Potential and Methods of Regulation $86,877 Research Maine Medical Center
2011 Validating Prediction Tools for Prostate Cancer Quality of Life Outcomes $71,029 Research Maine Medical Center
2011 Increase Immigrant Screening $8,011 Screening Maine Medical Center
2011 Communicating Risk $9,413 Education Maine Medical Center
2011 Notch Regulation of the Tumor Supressor miR-145 in Breast Cancer Cells $94,184 Research Maine Medical Center
2011 Inceptive Role of miR-199b in Acute Myeloid Leukemia $92,000 Research Maine Medical Center
2011 Small Molecule Inhibitors of Twist1 Function to Inhibit Tumor Progression $73,039 Research Maine Medical Center
2009 Predicting Quality of Life Outcomes after Prostate Cancer Treatment $45,295 Research Maine Medical Center
2006 Reduction of breast cancer by the Notch signaling pathway $35,000 Research Maine Medical Center
2001 Ronald J . Carroll, M.D. Lecture Fund at Maine Medical Center $10,000 Education Maine Medical Center
1979 Pediatric Cancer Seminar Education Maine Medical Center