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Detecting Lung Cancer Early Among Those at Highest Risk

October 2017

The Lung Cancer Screening Program at Siteman Cancer Center at Barnes-Jewish West County Hospital is making access to care and treatment more seamless and effective for those patients most at risk for developing lung cancer.

The program, which recently became part of Siteman Cancer Center, provides services including access to a dedicated nurse navigator to assist patients and their health care providers, as well as the interpretation of screenings by thoracic radiology subspecialists from the Mallinckrodt Institute of Radiology at Washington University School of Medicine.

Why low-dose CT?

Vamsi Narra, MD, MBA, Barnes-Jewish West County Hospital chief of radiology.

As the leading cause of cancer death, nearly 90 percent of lung cancer cases are related to cigarette smoking. In an effort to detect lung cancer early before the appearance of symptoms, a yearly low-dose CT (LDCT) screening may be recommended for some individuals.

Those patients at risk due to their history of smoking, as well as other related criteria, may be eligible to participate in the Lung Cancer Screening Program at Siteman Cancer Center at Barnes-Jewish West County Hospital, where they may undergo a yearly LDCT and help lower their chance of death from lung cancer.

“Screening, early detection and timely treatment of lung cancer can significantly improve outcome, quality of life and in some cases, cure the cancer," says Vamsi Narra, MD, MBA, Barnes-Jewish West County Hospital chief of radiology. “Barnes-Jewish West County Hospital is very well suited for such screening by its convenient location, ease of access with the ability to provide same-day service, and interpretation by sub-specialty trained radiologists.”

The program and criteria developed for lung cancer screening patients is based on the National Lung Screening Trial (NLST), which ran from 2002 to 2009 and had more than 53,000 enrollees from 33 medical centers across the country.

“We enrolled approximately 3,800 people for the trial, with about one-third screened at the Barnes-Jewish West County Hospital 969 Building outpatient imaging facility,” says David Gierada, MD, professor of radiology and a Washington University site co-principal investigator in the NLST, which compared spiral CT to standard chest X-ray for early detection of lung cancer. “Among people screened by low-dose CT in the NLST, there were 20 percent fewer deaths compared to those that were screened by chest X-ray.”

Who benefits from lung cancer screening?

David Gierada, MD, professor of radiology.

Based on the guidelines of the U.S. Preventative Services Task Force, LDCT screening is recommended for high-risk individuals who meet the following criteria:

  • Age 55 to 80
  • Minimum 30-pack-year smoking history (calculate pack-year history at www.smokingpackyears.com)
  • Current smokers and former smokers who quit less than 15 years ago
  • No symptoms of lung cancer
  • Prior participation in a documented shared decision-making session with a primary care provider
  • Prior counseling on the importance and availability of smoking cessation and abstinence if applicable

As a National Comprehensive Cancer Network (NCCN) institution, the Siteman program also supports the NCCN recommendation of screening persons at high risk based on the following criteria:

  • Age greater than or equal to 50
  • Minimum 20-pack-year smoking history (click here to access to website for calculating pack-year history)
  • At least one of the following additional risk factors:
    • -History of COPD or pulmonary fibrosis
    • -Occupational exposure to arsenic, asbestos, beryllium, cadmium, chromium, coal smoke, nickel, silica or soot.
    • -Radon exposure
    • -Family history of lung cancer in first-degree relative
    • -History of lung cancer, lymphoma, head and neck cancer, or smoking-related cancer

Dr. Gierada and several of his colleagues have developed a tool for primary care physicians and other health care providers to share with their patients to ensure they meet this criteria, entitled “Yearly Lung Cancer Screening: Is It Right for Me?” This brochure can be accessed by clicking here.

Following a shared decision-making session, physicians may order an LDCT screening examination by printing and completing this form. The patient or physician office may call the Siteman Cancer Center at Barnes-Jewish West County Hospital to schedule an appointment at 314-996-8080. Screenings are available at Barnes-Jewish West County Hospital during the week and on Saturday mornings.

The Lung Cancer Screening Program is also available at Siteman Cancer Center at Barnes-Jewish Hospital, Siteman Cancer Center – South County and Siteman Cancer Center at Barnes-Jewish St. Peters Hospital and Progress West Hospital.

The Screening and Beyond

Andrew Bierhals, MD, director of cardiothoracic imaging at Barnes-Jewish West County Hospital.

Patients undergoing LDCT screenings will be in contact with Anne Stilinovic, RN, BSN, nurse navigator for the Siteman Cancer Center Lung Cancer Screening Programs.

“I have found as a nurse navigator that there is a real need for patients to have one person that they can communicate with about their care,” she says. “It’s also important that the same person is talking to their provider and ensuring that continuity of care for the patient and referring physician.”

As nurse navigator, Stilinovic stays in contact with both the primary care provider and the patient following the screening and interpretation by one of several thoracic radiologists.

Negative results are mailed to the patient and their physician. Patients will then be recommended for regular screenings with a physician order and will receive an annual reminder letter.

If patients require further follow-up, the nurse navigator contacts the physician first and then the patient. An automatic referral to a Washington University thoracic surgeon for monitoring and management of abnormalities due to lung cancer will be made, as will referrals to other specialists when necessary.

As director of cardiothoracic imaging at Barnes-Jewish West County Hospital, Andrew Bierhals, MD, regularly reads screening results for the Lung Cancer Screening Program. He says there are many advantages for both patients and physicians who choose the Lung Cancer Screening Program at Barnes-Jewish West County Hospital.

“Patients at Siteman Cancer Center at Barnes-Jewish West County Hospital are all receiving the exact same service that they would at Barnes-Jewish Hospital, but in a location that may provide more convenience and efficiency,” Dr. Bierhals says. “If an abnormality is detected, patients have access to all of the resources in the system, including surgeons, medical oncologists and radiation oncologists, as well as other specialists. In addition, the nurse navigator is there for both the patient and for the referring physician to ensure their patients are receiving quality, timely results and all necessary services to meet their needs.”

CONTACT US

To schedule an appointment for a screening, call Siteman Cancer Center at Barnes-Jewish West County Hospital at 314-996-8080.

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