Connecticut Cancer Partnership (CCP) Lung Cancer Workgroup Meeting
Wed., March 1, 2023, 9 am to noon, in person at Middlesex Hospital
- Amanda Parkins, DPH Radon
- Amber Kapoor, Middlesex Health
- Brenda Cartmel, Yale University
- Erin Nielsen, ACS
- Gean Brown, Yale NHH
- Ilana Richman, MD, Yale New Haven
- Jason Bohn, Middlesex Health
- Jennifer McQueeney, Middlesex Health
- Jessica Poetzsch, Middlesex Health
- Juana Adams, ACS
- Katie Shuttleworth, CT DPH, CCP
- Kim Hackett, UConn Health
- Kim Silcox, Hartford Health
- Lucinda Hogarty, CCP Director
- Megin Iaccarino, Yale NHH
- Melissa Torres, UConn Health
- Peter Greenwald, MD, retired, NCI
- Polly Sather, Yale
- Ruth Canovi, American Lung Assoc.
- Seth Baker, DPH Tobacco
- Tom Berte, Merck
[Regrets: Dilpreet Kaur, Alessandra Cornelio, Joanna Moore, Andy Salner, Bryte Johnson]
- Welcome and Introductions, Lucinda Hogarty, CCP
- Quitline/local cessation program collaboration. Katie Shuttleworth, DPH.
- Katie noted the low screening/eligibles rate and described how using a tool either paper or electronic informing current smokers who have reached out to cessation programs about lung cancer eligibility and resources could improve screening rates. It was noted that there are many tools currently in use and we could asses them, take the best of them and develop one to be used by the state Quitline (which is now in the process of being re-negotiated ) or share it with health districts and hospital systems that have their own cessation program. Discussion ensued about the value of using a patient education video. Ilana Richman has developed one that could be posted on our own org. websites, the radon program’s site, in PCP office and linked to in cessation materials. We viewed the video. It could be used at shared decision-making visits.
- Ruth Canovi of the American Lung Association described pending proposed legislation, #5894 Expanding the breast and cervical early detection program to include lung cancer screenings.C G A (ct.gov). This group could write a letter or testimony in support of this bill. The bill has been referred to the Public Health Committee and then can be expected to go to the appropriations Committee. The bill reads “that section 19a-266 of the general statutes be amended to expand the breast and cervical cancer early detection and treatment referral program to include education regarding, and the promotion of, lung cancer screenings. Statement of Purpose: To promote lung cancer screenings” There are questions to be worked out concerning the population currently covered by the existing program, since it is currently a women’s health program with age guidelines that do not coincide with eligibility for lung cancer screening.
- Highlights of hospital systems’ programs addressing outreach/publicity barriers/ facilitators, navigation process, internal partnerships. Members of the group described their programs.
Metrics used: volume, follow-up, the time between screening to diagnosis to treatment,
Outreach through messaging to eligibles not yet screened determined through EPIC fields was a productive approach. Documented smoking history was assessed. The outreach message was co-signed by the patient’s PCP.. Outreach was also done to patients for whom an order was made but no appointment was scheduled. For un-/underinsured patients a $99 fee for total out-of-pocket was charged.
Shared decision-making (SDM) visits are done by ordering MD.
Middlesex has its own cessation program. Resource limitations, specifically a shortage of providers are a challenge.
Bridgeport (Yale New Haven system)
Discussion of the required SDM with Megin reduces anxiety and improves follow-through. The SDM is scheduled at the same time as the LDCT scan. There is an EPIC dashboard, built within EPIC by YNHH IT after a long process, still, a work in progress but allows better tracking. Incidental nodules are tracked ( those found through other tests) as well as nodules found in the LDCT which are addressed in the Nodule Clinic. Lung rads reviews are done monthly by Zoom. For Lung cancer awareness month (November) there are tables at existing events, coinciding with Veterans’ events in some cases.
UConn’s system was described as one that supports the providers by previewing patient needs before the encounter. So that barriers can be addressed. SDM can be done by UConn fellows, transportation and parking is offered, and Saturday clinics are available. The stigma and fear associated with smoking and lung cancer risk were discussed. A foundation at UConn pays for lung cancer screening so there is no billing or pre-authorization involved. Outreach is done at Farmers’ Markets and other community events with freebies and info flyers. Cancellations or ordered- but- not- scheduled are followed up. The radiology work queue is reviewed. Population Health software flags findings.
American Lung Association: Saved by the Scan tried to reduce stigma. “Anyone who has lungs could get lung cancer.” Looking for lung cancer champions, personal stories.
Messaging about risks associated with both radon exposure and smoking may have a synergistic effect that gets people’s attention, in terms of the value of both testing for radon and testing for lung cancer. Handing out radon test kits at lung cancer tabling events is usually well received. ( We acknowledge that we don’t know what compliance is for radon test return, but the point is the messaging. )
There is an opportunity to distribute information kits to participants in ACS events such as Relay for Life or Making Strides and other organizations’ events. This is attended by members of the public who are already concerned about cancer or are cancer survivors or caregivers of patients. It had been noted that it may take many repetitions of info about lung cancer screening before eligible patients pay enough attention to the issue to actually ask their doctors about it or in fact follow through.
- The issue of biomarker testing with blood tests was described as an approach which will be used increasingly for early detection of cancers in the future.
- Issues related to hard stops or BPAs in EPIC discussed, with the barrier of PCPs needing to fit so many issues into a time-limited wellness visit was discussed as a major barrier. UConn’s support of wellness visits through pre-screening patient records to identify screening needs was discussed as a way to reinforce the follow-through on screening while not putting the burden on the PCP. It was noted that stigma about lung cancer’s link to smoking is a barrier and a nuanced approach to shared decision-making can address that. The question of insurance plans using lung screening rates as a health improvement metric was raised.
- Is there a way to share Epic LCS dashboards to share ideas and learn from each other? We would have to find a way to do this without showing any PHI (protected Health Information).
Discussion of Priorities
Focus on public messaging:
- Issue a joint statement from all the state hospital systems.
- Work with Hartford Health Care’s paid advertising programming (Channel 8)
- Work with UConn Health’s paid advertising messaging ( CTPublicRadio)
- Work with DPH Communications Dept. to create a news segment ( perhaps with the Commissioner talking about it the way she has done Covid spots.)
- Distribute links to existing videos that explain lung cancer screening and encourage inclusion of these short videos in electronic communications, in waiting rooms and on websites. Find out how content is distributed.
- Here is the link to the video made by Dr. Ilana Richman : https://vimeo.com/531415178.
Who else to involve:
- Connecticut Hospital Association
- Other hospitals and systems
- Insurers, such as commercial or Husky
- National Lung Cancer Roundtable; https://nlcrt.org/
- Data & Progress – National Lung Cancer Roundtable (nlcrt.org)
- VA: screenLC.com This is an academic tool that does a great job estimating risk as well as considering pros/cons of screening. It also generates a note template that includes shared decision-making language that can simply be copied to a clinical note in the EMR.
- A college and university initiative, which undertakes a number of public messaging approaches. “The American Lung Cancer Screening Initiative (ALCSI) is a nonprofit founded in 2018 and led by both students and doctors across the country whose mission is to increase awareness of lung cancer and lung cancer screening. Ongoing initiatives include our lung cancer screening eligibility assessment to help individuals determine if they are eligible for lung cancer screening and connect with our team at ALCSI to help guide them through the screening process. Another initiative is our Leaders for Lung Cancer project in which we engage local government officials to share public service announcements to encourage individuals at high risk for lung cancer to get screened. We also have a podcast where we invite survivors, caregivers, and doctors to share their stories and experiences with lung cancer, and have recently started the Not Just a Statistic Project to create exhibits honoring loved ones with lung cancer. We have additionally been working with mayors and governors to issue proclamations recognizing November as National lung cancer awareness month and have various events throughout the year to further raise awareness. We are happy to share the infographics and flyers on lung cancer screening that we hand out at our canvassing campaigns in which we go out into communities to talk with individuals 1:1 about screening. We have ALCSI chapters at universities across the United States and are open to collaborations with any organization to hold such awareness events. For students interested in joining ALCSI or starting a chapter, we invite them to visit [https://www.alcsi.org/about-us] for information on how to join our team or start a chapter at their university.”
Structure of Workgroup:
- Leadership: Co-Chairs: Gean Brown, Andy Salner and Jessica Poetszch
- Meetings: monthly, at noon by Zoom for one hour. Next meeting Wed. March 29 (timed to avoid Easter, Passover and school break conflicts)
- Expected timeframe: Progress to be assessed by end of 2023—a ten-month course of work.
For next time:
- Please send Lucinda any patient educational tools that may be out there so we can look at them.
- Please let us know how we could determine how the waiting room television loops that you may have in your facilities are handled. Who controls the content?