Lung Cancer Screening Program Focuses on Early Detection, Prevention

Because it has few symptoms early on, lung cancer often isn’t discovered until the disease is well developed. Preventative screenings for high-risk individuals is the answer, but they are of limited benefit without other programs, such as smoking-cessation and follow-up. In short, the best way to head off lung cancer is a multipronged approach, and that’s just what the HCA Cancer Care Network in the Richmond/Spotsylvania, Va., region has done.

The network has 11 sites in the area, including four hospitals within a 75-mile radius, and all are a part of the program. That means patients have many options for where to enter the system, and that has helped boost participation. The goals are to provide a broad program of detection, with multiple entry points for an area with far-flung residents, and one that is streamlined and easily replicable at other HCA facilities, said Esther Muscari Desimini, Vice President, Oncology Services, HCA Virginia. Desimini began working on the concept a few years ago while researching studies being conducted by Cornell University and the National Institutes of Health (NIH) as a part of the National Lung Screening Trial.

National data, local applications

“We believed in the data they were collecting, which showed that more people would survive lung cancer if it was detected very early,” Desimini said. “Our doctors were interested in conducting screenings at the hospitals, but there really hadn’t been any research. The NIH trial looked at heavy smokers, and when the Institute’s results were examined in 2010 there was a significant reduction in deaths thanks to the screenings. We then had the evidence, and began working on the infrastructure.”

Participation in the program begins once someone has expressed interest and is found to be a viable candidate. A screening nurse coordinator conducts a review of the applicant’s health and cigarette-smoking history. He or she will receive a low-dose CT scan, a follow-up visit with a lung specialist and, if necessary, be referred to a smoking-cessation program. That process is repeated yearly for the duration of the participant’s involvement.

“What we created was a program with a comprehensive and personalized process, not just a test that would also perform screenings,” she said. “On the front end, there’s a review of the clinical appropriateness of each applicant, supportive research, and a signed consent. We have a Nurse Navigator who facilitates this part of the process. She puts that person into the system, at the most appropriate location among four hospitals or seven imaging centers.”

Heavy smokers are simultaneously steered to smoking cessation programs, so the screening step has the additional benefit of risk-reduction for people who might not otherwise be inclined to participate, she added.

“Some patients are being encouraged and guided into the screening by family members, rather than self initiation, because they hear about the cessation element and it addresses the family members’ fears,” Desimini said. “That’s been a wonderful, valuable component that we didn’t consider when setting up the program.”

Program provides ongoing patient care

Once a patient is enrolled, he or she is walked through the how-tos of the program. After the CT scan, the patient meets with a pulmonary surgeon or other specialty physician on the screening if a problem is indicated. If everything is clear, the patient will be tracked and 12 months later, a follow up screening occurs.
Since launching the program, cancer and other issues have been tracked by the study team, and in time, data collected should prove the value of early screening and detection in lung-cancer prevention, Desimini said. The program has been recognized by the National Lung Cancer Alliance, and HCA testing sites are prominently listed for those seeking screening.

“One criticism of a lung CT scan is that a benign incidental finding is common, so it raises an alarm for nothing, but the nurse navigator responds to anxieties and connects people with appropriate follow up,” she said. “Even if there’s nothing wrong, smoking cessation is a good side benefit for this population, most of whom are heavy smokers. Our biggest concern is that we don’t provide such a high degree of peace of mind that they continue smoking.”

Desimini said she’d like to see this effort, and others like it, create a screening mentality for lung cancer similar to colonoscopies and how that procedure has become a “must-have” for people who wish to prevent colon cancer. With a cost of $250, the fee is comparable to the cost of other preventative screenings.

“Some of these people are terrified, because they are either heavy smokers, or smoked a lot when they were younger and then quit,” she said. “The test, coaching and education gives people relief and peace of mind, and that’s a beautiful thing to see.”


Cancer Care Network Leadership Team:

Patti Aldredge, Director, The Cancer Center @ Henrico Doctors’ Hospital
Susanne Fessick, Interim Director, Thomas Johns Cancer Hospital @ Chippenham Johnston Willis
Tricia Cox, RN, MSN, ANP, Neuro Oncology & Skin Cancer Program Thomas Johns Cancer Hospital @ Chippenham Johnston Willis
Meg Helsley RN, MSN, AOCN, Breast Care & Genetics Program, The Cancer Center @ Henrico Doctors’ Hospital
Ruth Michaud, Radiation and Gamma Knife Director, Thomas Johns Cancer Hospital
Karen Nelson, Executive Director, Marketing and Communications
Karen Overmeyer, RN, MSN, ANP, Thoracic Oncology Program. The Cancer Center @ Henrico Doctors’ Hospital
Karen Roesser, Colorectal & Genetics Program. Thomas Johns Cancer Hospital @ Chippenham Johnston Willis
Karen Shiner, Decision Support, HCA Virginia
AnnMarie Simmons, Oncology Nurse Navigator, Spotsylvania Regional Medical Center
Pat Steininger, Oncology Director, John Randolph Medical Center
Wendi Snowberger, Sales
Tracey Tatum, RN, MSN, ANP, Breast Care & Genetics Program Thomas Johns Cancer Hospital @ Chippenham Johnston Willis
Mary Wilson, RN, ANP Colorectal &  Hepatobiliary Program. The Cancer Center @ Henrico Doctors’ Hospital
Esther Desimini, Vice President of Oncology, HCA Central Virginia Division

Lung Cancer Advisory Group:

Dr. Peter Buckman, Thoracic Surgeon
Dr. Jamie Hey, Pulmonary Associates; Chair, Advisory Group
Dr. Tony Moore, Radiology Associates of Richmond
Karen Overmeyer, RN, MSN, ANP, Thoracic Oncology NP & Navigator; Co-Chair, Advisory Group
Susan Keen, RN, OCN, Lung Nurse Navigator
Deidre Belcher, RN, OCN, Lung Cancer Screening Coordinator
Karen Nelson, Executive Director, Marketing and Communication
Wendi Snowberger, Sales
Susanne Fessick, Interim Director Thomas Johns Cancer Hospital @ Chippenham Johnston Willis
Patti Aldredge, The Cancer Center @ Henrico Doctors’ Hospital
Esther Desimini, Vice President of Oncology, HCA Central Virginia Division