Navigators Make Screening Easier to Catch Lung Cancers Early
Three hundred fifty deaths daily. That’s the toll taken by lung cancer, the second most common form of cancer in the United States.
It’s the leading cause of cancer death, outstripping deaths from colon, breast and prostate cancer combined.
One of the reasons lung cancer is so deadly is that it is often caught late, when the disease is already well established, and the odds of survival are consequently lower.
Catching lung cancer earlier is at the heart of programs at Einstein Medical Center Philadelphia and Einstein Medical Center Montgomery. Both employ a navigator to expedite early lung cancer screening and follow-up procedures for those at risk, in consultation with their primary care physicians.
The Philadelphia program began in October. Einstein Montgomery’s lung program navigator has been available to patients for two years, with encouraging results.
Screening for More High-Risk Patients
Under recent changes in government guidelines, more patients than ever qualify for screening and early detection.
A low-dose CT scan is now recommended annually for adults 50 to 80 with a 20 pack-year smoking history – for example, one pack a day for 20 years or two packs a day for 10 years. The guidelines apply to current smokers and those who have quit within the past 15 years.
“We’re trying to increase awareness of lung cancer and the screening part of it,” explains Beth Meder, RN, Einstein Philadelphia’s lung cancer nurse navigator within the pulmonary medicine department. “I’m mainly the screening navigator, which deals with the patients who do not have signs and symptoms of lung cancer up to this point.”
“Patients are either referred by their primary care physicians or they can schedule an appointment by calling the screening program to see if they qualify,” Meder says.
Navigating Through Screening and Follow-Up
“If they do have abnormalities, like nodules in the lungs,” Meder says, “we are identifying them immediately and start to navigate patients through the process, so they don’t get lost in the shuffle. There’s no waiting for appointments in six to eight weeks.”
Meder schedules appointments for screenings, examines scans, explains what the findings mean, and sends screening reminders to physicians.
Additionally, nurse practitioner Maggie Shotzbarger, CRNP, oversees shared decision-making appointments between patients and doctors and promotes programs to help patients quit smoking.
The program at Einstein Montgomery is slightly different.
“Our process begins with the ordering providers, and they do components of the program, shared decision-making with the patient, and smoking cessation counseling,” says Einstein Montgomery navigator Stephanie Sylvester. “Then the patients call to schedule. That’s where I start the process.”
At Einstein Montgomery, Sylvester administers a questionnaire to ensure that patients meet all the requirements set up by Medicare for lung cancer screening, which is administered only to the highest-risk patients.
Follow-up tests are ordered at the discretion of the ordering physician. Sylvester also follows patients through screening, maintaining data on results and recommended follow-up.
Education About Risks and Testing
Einstein Philadelphia has a largely minority patient population, and both Blacks and Hispanics with lung cancer are less likely than whites to be diagnosed early or to survive at least five years after diagnosis.
“Our patient population is high risk for many reasons,” Meder says. “It’s kind of a burden when you do lung cancer screenings. It’s only a 30-second scan, but to come in, you might have to take a day off from work. For some patients, to take off work is a hardship. And if we spot any abnormalities, it may take additional tests.”
The importance of a lung cancer navigator can’t be overestimated, explains Sadia Benzaquen, MD, chair of Pulmonary, Critical Care and Sleep Medicine for the Einstein Healthcare Network. Both programs also educate providers about the need for annual lung cancer screenings among qualified patients, which is not as well-known as the need for breast and colon cancer screening.
Dr. Benzaquen says education has the potential to save many lives that might otherwise be lost to lung cancer.
“Despite all the evidence that lung cancer screening can save people and can detect lung cancer early and certainly increases survival related to lung cancer, a lot of people in the community are just not aware of it,” Dr. Benzaquen says.
There are encouraging signs that the word is getting out in both medical centers about early lung cancer screening and management of the process by a nurse navigator.
Signs of Success
“It has been eye-opening,” Dr. Benzaquen says. “We are screening close to a thousand patients a year. That’s an impressive number.”
“We’ve picked up a lot of lung cancers, so that’s important,” Meder says. But she also measures success in other ways.
“I think it’s good when they have a navigator who can explain that a lung nodule we find may not be cancer. It might be an infection or inflammation,” she says. “When you have someone who is walking them through it, alleviating some of their fears, they’re more likely to keep getting their scans.”
Einstein Montgomery also has notable success. “To date, for this calendar year, we’ve screened 480 patients,” says Gorrell. “Right now, Stephanie is tracking 74 patients who have high risk based on lung nodules.”
The program has also been designated a Lung Cancer Screening Center of Excellence by the Go2 Foundation.
Gorrell has a personal interest in the success of lung cancer screening.
“I had a grandfather who died of lung cancer many years ago,” she says. “I would hope that someone like him in this day and age would be able to be cured of his disease instead of going through what he went through.”
To find out more about lung cancer screening, contact the Philadelphia navigator at 215-456-6977 or the Montgomery navigator at 484-622-LUNG.