HEALTH SYSTEM PROGRAM GUIDE - The Lung Cancer Project · mammogram or a colonoscopy. Supporting...

HEALTH SYSTEM PROGRAM GUIDE

Think.Screen.Know.

A Genentech lung cancer screening initiative

WHY FOCUS ON LUNG CANCER SCREENING?

* In a population of current or former smokers (who quit within 15 years) aged 55 to 74, with at least a 30-year

pack history.

Think. Screen. Know.2

Lung cancer is the number one cause of death from cancer in the United States.1 In 2018, an estimated 234,030 new cases of lung cancer were diagnosed, with an estimated 154,050 deaths.2 Because lung cancer symptoms usually do not present until the cancer is advanced, lung cancer screening with low-dose spiral computed tomography (LDCT) is critical for an early intervention. Screening can identify cancer early in its disease course and increase the chance for survival.3 In 2011, the National Lung Screening Trial (NLST) demonstrated that LDCT screening reduced lung cancer mortality in high-risk patients by approximately 20% versus standard chest X-ray.4* Adding further evidence, in 2018, the Dutch NELSON trial demonstrated a 26% overall reduction in the risk of lung cancer-related mortality at 10 years for high-risk male patients who received LDCT screening versus those who did not.5 When discussing the risks associated with LDCT, it is important to broach the possibility of false positives—a review of data from the NLST showed that 13% of patients received false positive results.6 It is also important to discuss the potential harm that may result from overdiagnosis, radiation exposure, and unnecessary invasive investigations.

WHAT IS AN LDCT SCAN?

LDCT is a way of obtaining a 3D image of a patient's lungs that uses 79% less radiation than a traditional CT scan and shows more detail than a standard chest X-ray.7,8 An LDCT is the only method recommended for lung cancer screening in high-risk individuals.9 It is covered by Medicare for high-risk patients 55 to 77 years old and by most commercial insurance plans for patients 55 to 80 years old.10,11

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WHY FOCUS ON LUNG CANCER SCREENING?


Despite the clear benefits, lung cancer screening remains relatively rare, with just 2% of eligible patients being screened in 2016 across the United States.12 An additional barrier to screening is the stigma associated with smoking, the primary cause of lung cancer.13,14

Health systems are in a unique position to help reduce lung cancer mortality through increased screening. As trusted partners in maintaining the health of the community, providers and health systems should work together to remove barriers and engage, motivate, and ultimately encourage high-risk patients to utilize LDCT screening.

The Think.Screen.Know. program offers educational resources to help health systems streamline screening processes and encourage patients to get screened. As each health system is unique, please use this program guide as a catalogue of best practices, workflow, and resources to optimize your own LDCT screening program.

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CONTENTS


Think.Screen.Know. Screening Program Overview 5

Lung Cancer Screening Program Overview 7

Best Practices for Lung Cancer Screening 8

Process Workflow 15

Program Resources 17

Patient Resources

Patient Posters 18

Patient Screening Guide 19

Patient Animated Video: Think.Screen.Know. 20

Patient Screening Letter 20

Patient Screening Overview Card 21

Patient Emails 21

Patient Reminder Cards 22

Digital Banners 22

Provider Resources

Think.Screen.Know. Posters 23

Healthcare Provider Emails 24

Screening Trials Flashcard 24

Getting Started 25

References 26

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THINK.SCREEN.KNOW.SCREENING PROGRAM OVERVIEW

Think.Screen.Know. is a campaign designed to boost awareness of the importance of lung cancer screening and to encourage appropriate candidates to get screened. This program:

• Encourages at-risk patients to think of lung cancer screening in the same way they do other routine cancer screenings (eg, colonoscopies, mammograms)

• Raises awareness of the benefits of lung cancer screening

• Decreases perceived barriers to lung cancer screenings

• Drives patients to action (ie, scheduling an LDCT screening)

HOW CAN YOU USE THIS PROGRAM IN YOUR HEALTH SYSTEM?

This guide is designed to help you maximize your lung cancer screening efforts through a dual approach, including program resources and a process workflow.

• Program resources: Resources that convey facts about lung cancer screening, address common concerns, and encourage candidates to get screened. These resources leverage distinct branding and use a consistent set of messages designed to optimize engagement with screening candidates, and to overcome possible objections to screening

• Process workflow: Step-by-step workflow that educates health systems and providers about the roles of key stakeholders across the screening process

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While these approaches can be used independently, it is optimal for health systems and provider offices to work together for a coordinated lung cancer screening effort. It is also important to consider other key stakeholder groups, such as employers or payers, who may also play a key role.

As every health system is different, you may want to tailor the program to fit the needs of your patients.

On the following page, you will find the Lung Cancer Screening Overview, which provides a high-level view of the program’s key attributes, including:

• Candidate identification and procedure workflow

• USPSTF guidelines for lung cancer testing

• Program resources

• Success metrics

NOTE: The Think.Screen.Know. program offers many additional resources that you may find useful. Please go to www.thinkscreenknow.org for additional information and to download these resources for free.

USPSTF=United States Preventative Services Task Force.

THINK.SCREEN.KNOW.SCREENING PROGRAM OVERVIEW

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*Patient portraits can be used to send appointment reminders when possible/appropriate.PCP=primary care physician.

LUNG CANCER SCREENING PROGRAM OVERVIEW

• Schedule appointment for LDCT scan

• Send appointment reminder*

• Follow up on missed appointments

• Perform LDCT scan

• Code and capture completion

• Follow up with patient resultsPR

OC

ED

UR

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WO

RK

FL

OW LDCT SCAN

Screening rate • Patient/provider satisfaction

• Late-stage lung cancer rates

• Lung cancer detection rates

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PRIMARY SECONDARY

Program Guide

Eligible population15

• Men and women 55 to 80 years old

• Asymptomatic for lung cancer

• Current or former smoker (quit ≤15 years ago)

• Smoking history of ≥30 pack-years

Screening procedures

• Annual screening for eligible patients

PR

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SELIGIBLE POPULATION EXAMPLES AND SCREENING PROCEDURES

Patient Screening Letter

1

Patient Screening Guide

2

Patient Emails

3

Patient/Core Campaign Posters

4

Patient Reminder Cards

5

• Identify screening candidates

• Conduct candidate outreach

• Create order for LDCT

• Conduct candidate outreach and engagement*

Office Coordinator/Program Navigator

• Make initial call to screen candidate

• Discuss screening with candidate




Physician Role

• Discuss screening with candidate

Physician Extender Role

• Identify care gaps




• Create order for LDCT scan

• Reimbursement and billing

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CLINIC/PROVIDER OFFICE

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BEST PRACTICES FOR LUNG CANCER SCREENING


This section offers guidelines, suggestions, and tips as a starting point for further discussion with your internal stakeholders and patients.

ALIGN WITH KEY STAKEHOLDERS TO ENSURE PATIENT ENGAGEMENT

The success of an LDCT screening program requires coordination between many key stakeholders.

It is helpful to gain alignment early to define organizational objectives, identify challenges, define solutions, and optimize workflows. Primary care physicians are critical stakeholders. Other key stakeholders include:

• Radiation oncologists

• Patient navigators

• Physician advocates

• Quality directors

• Medical directors

• Oncology (or lung cancer) service line directors

• Preventive programs coordinators

• Marketing directors

• Electronic health record (EHR)/ information technology leads

• Employer groups

• Health plans

• Call centers

• LDCT screening centers

ESTABLISH MEASURABLE GOALS FOR PATIENT SUCCESS

Nothing helps a screening program’s potential for success more than setting measurable goals. Start by deciding what you want to improve, measure your baseline, set a goal for improvement, and then measure progress toward your goal. Here are a few options to consider:

• Lung cancer screening rate

• Patient and provider engagement and satisfaction

• Improvements in patient outcomes (eg, stage at diagnosis)

• Smoking cessation rate

1.

2.

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3. EVALUATE AND REMOVE OPERATIONAL BARRIERS TO SCREENING

Consider the following suggestions as ways to streamline your screening efforts:

• Preauthorize LDCT screening: Ensure that LDCT centers have insurance authorization to conduct screenings ahead of patient appointments

• Centralize identification of screening candidates: Generate a process to identify screening candidates for all associated provider offices, and ensure that referrals for screening across networks get appropriately routed to centralized tracking

• Utilize support staff: Consider assigning nonconsultative tasks such as generating referrals or processing reimbursement to nonclinical staff

ANALYZE CURRENT LUNG CANCER SCREENING WORKFLOWS AND ESTABLISH FORMAL PROCESSES Alignment is critical to ensure success of the screening program. It may be helpful to identify any unique challenges that exist in your health system and formalize processes to ensure consistency. Items for consideration may include:

• Data capture in the EHR system

• Authorizations for LDCT screenings

• Patient communication

• Timing of patient follow-ups after each touchpoint

• LDCT center referrals and scheduling

• Reimbursement and billing

4.

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USE A PATIENT NAVIGATOR

Various challenges can delay or prevent patients from completing an LDCT screening. A centralized patient coordinator/navigator can help streamline efforts and alleviate confusion. Centralized tasks that may improve patient engagement may include:

• Identifying and documenting screening candidates

• Initiating contact after identification through direct outreach

• Tracking office visits and other touchpoints by monitoring centralized and shared EHR records

• Reminding patients of upcoming appointments

• Following up with patients when provider visits are missed

• Running reports on outstanding referrals to screening centers

6.

USE YOUR EHR SYSTEM

An EHR strategy is an essential component of coordinating your screening efforts. Here are some considerations for leveraging your EHR system to its highest potential:

• Evaluate how your EHR system can be used to identify appropriate screening candidates and track screenings across a system

• Determine how orders for screening can be implemented into healthcare professionals’ workflows in a way that is sustainable and standardizes reporting

• Ensure that all completed screenings are documented within structured EHR data fields

5.

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ENCOURAGE SMOKING CESSATION

Lung cancer screening is a powerful “teachable moment” for current smokers, with more favorable smoking-cessation and relapse rates among patients enrolled in an LDCT program than in the general population.16 Ways of taking advantage of this teachable moment include:

• Integrating smoking-cessation counseling into your practice

• Referring current smokers to local support groups, as well as quit lines and other telephone counseling resources

• Providing print, web, and app-based smoking-cessation resources to current smokers

USE STRUCTURED REPORTING (LUNG-RADSTM)

The American College of Radiology (ACR) recently adopted a new standard for LDCT screenings and reports called Lung-RADSTM (Lung Imaging and Reporting Data System). Using a quality assurance tool like Lung-RADSTM will result in17:

• Standardized LDCT reporting and management recommendations

• Reduced ambiguity in LDCT interpretations

• A reduction in the number of false positives

To learn more about Lung-RADSTM, please visit www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads.

NOTE: All scans must be submitted to the ACR registry as required by Medicare for reimbursement.

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Key messages

Lung cancer screening is a regular preventive health check, like a mammogram or a colonoscopy.

Supporting messages:

• It’s about your health

• Lung cancer is the leading cause of cancer death among both men and women1

• Lung cancer screening is meant to find lung cancer at an earlier stage, when survival rates are better3

• Empowers patients by encouraging them to take charge of their lung health, not by making them feel guilty for smoking

• Normalizes lung cancer screening by comparing it with other routine health checks

• Elevates the seriousness of lung cancer and the urgency behind screening

• Positions LDCT as a way of maintaining good health

Potential message impact



USE CONSISTENT MESSAGING

It is important that information be presented in a way that the majority of potential screening candidates can understand. The Think.Screen.Know. program provides a set of messages that were written to optimize engagement with the screening candidate and to overcome possible objections to screening. These messages are pulled through in the patient outreach material.

10.

PROMOTE SHARED DECISION-MAKING (SDM)

The discussion between physician and patient about the benefits and risks of lung cancer screening is a vital way of ensuring that patients are making decisions that align with their personal values. The discussion should be balanced to include the benefits of screening as well as the potential harms. When discussing the risks associated with LDCT, it is important to broach the possibility of false positives, and the potential harms that may result from unnecessary invasive investigations, overdiagnosis, and radiation exposure.

Smoking cessation should always be part of shared decision-making conversations with current smokers and presented as the most effective way of reducing lung cancer risk.

9.

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Key messages

Many patient groups and organizations, including the American Cancer Society, recommend lung cancer screening with LDCT for patients at high risk.8,18-20


• Yearly LDCT screening is recommended if you meet all of the following criteria: 55 to 80 years old, a current smoker or have quit within the past 15 years, a heavy smoker or used to be a heavy smoker (30 pack-years)15

• Lung cancer screening is covered by Medicare for patients 55 to 77 years old, and by most commercial insurance plans for patients 55 to 80 years old10,11

• Your insurance plan may require that you talk to your healthcare provider about quitting smoking21

• Reinforces that there is broad medical consensus behind LDCT screening

• Helps patients identify themselves as high risk

• Opens the door for smoking-cessation conversations


An LDCT scan is the only method recommended for lung cancer screening in high-risk individuals:


• This picture shows more detail than a standard chest X-ray7

• This type of scan uses 79% less radiation than a regular CT scan and does not require any needles7

• A study of more than 53,000 patients, called the National Lung Screening Trial, showed the benefit of screening with LDCT4

• Reinforces confidence in results of LDCT

• Alleviates fear of radiation exposure

• Reinforces that there is solid medical support behind LDCT screening


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Key messages

Just because your doctor recommends lung cancer screening, it doesn’t mean he or she thinks you have cancer.


• Most people screened do not have cancer4

• Out of 100 smokers and former smokers screened with LDCT at baseline, 86% will have negative results, 13% will be false alarms, and 1% will have cancer (based on a review of data from the National Lung Screening Trial using Lung-RADSTM criteria)6

• If you are diagnosed with lung cancer, you have more options than ever before22,23

• Alleviates patient anxiety about scan results




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PROCESS WORKFLOW


This process workflow offers a framework to help organize a lung cancer screening program within your organization. The workflow highlights steps for making patient communication efficient, removing patient barriers, and improving overall effectiveness. The workflow also provides a series of tasks that could help enhance operational efficiencies and help ensure that screening candidates are identified and followed.

Steps captured in this workflow include:

• Identification of candidates for screening

• Lung cancer screening discussion, typically with primary care physician

• Appointment scheduling for LDCT screening

• Preauthorization or referral of appropriate candidates to an LDCT screening center

• Screening candidate outreach

• Follow up with screening candidates

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PROCESS WORKFLOW

1

2

3

4



Available program resources



Patient Emails

Patient presents to PCP

Identify screening candidates

Patient and PCP engage in SDM

Is the patient a

screening candidate?

PCP refers patient to

LDCT center

No action required

YesNo

Send Patient Screening Letter,

Brochure, or Email to remind patient to

make a screening appointment

No

Center staff evaluate patient

eligibility

Refer patient back to

PCP

Credentialed radiologist interprets

scan

After 2 weeks, program navigator

calls patient to make sure PCP

has shared results

Enter scan results into a standardized

database

Discuss scan results with

patient

Is the patient a

screening candidate?

Contact patient to schedule

screening

Obtain PCP

order

Screen patient Send patient

Reminder Card

Confirm patient insurance and

copay

Send patients annual

Reminder Cards

1 2 3

4

4

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PROGRAM RESOURCES


Visit www.thelungcancerproject.org/screening/resources/ to learn more and to download resources, all of which are available to use for free.

The Think.Screen.Know. program offers a variety of educational resources and marketing resources to communicate the value of lung cancer screening to potential candidates and other referring clinicians. The Think.Screen.Know. brand and utilization of consistent messages are designed for optimal patient understanding and engagement.

The following resources were developed to be used together at various points throughout the patient journey (see lung cancer screening overview and process workflow). Consider using these resources in conjunction with an existing screening program. On the following pages, you will find a description of each resource included in the Think.Screen.Know. health system program guide.

Patient Materials

• Patient Posters*

• Patient Screening Guide*

• Patient Animated Video: Think.Screen.Know.

• Patient Screening Letter

• Patient Screening Overview Card

• Patient Emails

• Patient Reminder Cards

• Digital Banners

Provider Materials

• Think.Screen.Know. Posters*

• Healthcare Provider Emails

• Screening Trials Flashcard

*Resources available in Spanish.

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PROGRAM RESOURCES


PATIENT RESOURCES

© 2017 Genentech USA, Inc. All rights reserved. ALE/070617/0053 08/17

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Patient Posters

Three posters that can be printed on any printer and displayed in your practice to encourage people at high risk to consider annual lung cancer screenings. The posters all contain the same Think.Screen.Know. campaign headline (“You get these checked. Why not your lungs?”) but feature different people. These posters are also available in Spanish.

Considerations for use

• Print and display in your office and/or waiting room

• PDFs are customizable—add your own logo and contact information


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PROGRAM RESOURCES


PATIENT RESOURCES (CONT'D)


An 8-page brochure that can be printed on any printer and distributed to appropriate screening candidates. This brochure includes information about the importance of LDCT, who should get screened, what happens during a screening, how to understand the results, and what to discuss with a healthcare provider. Available for download with 2 different cover options. The version with the bikers is also available in Spanish.


• Print and mail directly to eligible screening candidates or send via email as a PDF attachment, making sure to follow all privacy and HIPAA regulations

• Give hand-printed copies to patients after having the initial conversation about screening

• Provide a digital version to affiliated providers in your network to print and mail to patients

• Mail as a follow-up to reminder/recall notices for candidates who have not scheduled an appointment



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PROGRAM RESOURCES



Patient Animated Video: Think.Screen.Know.

This is a short animated video about the importance of lung cancer screening with LDCT and who should get screened. Key messages include eligibility criteria, insurance coverage, and the preventive nature of LDCT screening.


• Download for use on your practice's website

• Can be played on video monitors in your practice's waiting room

• Links to the video can be embedded in electronic patient communications

This editable letter, which can be printed on any printer, encourages patients to make an appointment to learn more about lung cancer screening. It contains a brief explanation of why screening is important and who should get screened, as well as insurance coverage information. Also available in a customizable version so you can add your practice logo and contact information.


• Send directly to eligible screening candidates after having initial conversation about screening

• Provide a digital version to affiliated providers in your network to print and mail to patients




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PROGRAM RESOURCES


Patient Screening Overview Card


Brief overview of key information about lung cancer screening that can be printed on any printer and given to patients to encourage them to learn more. Contains the Think.Screen.Know. campaign headline (“You get these

checked regularly. What about your lungs?”) and high-level eligibility criteria.


• Give to affiliated providers in your network for placement on tables, counters, or kiosks in waiting areas, cafeterias, or other central areas where potential screening candidates congregate

• Place on tables at health fairs, community events, or other public events


Two downloadable PDFs that can be inserted into emails or sent as attachments. The first (“Who should get screened?”) describes in patient-friendly language why screening is important and who should get screened. The second (“Benefits of screening”) describes the benefits and risks of yearly screening, what LDCT is, and who should get screened.

• Email to patients after having the initial conversation about screening

• Provide to affiliated providers in your network to email to patients



• Send directly to eligible screening candidates

Medicare covers screening for lung cancer if you are in the high-risk group. Private insurance may also cover screening. Check with your insurance plan to find out about your screening coverage.

Whether you smoke now or you have quit smoking, lung cancer screening may be right for you. If you are unsure if you should get screened for lung cancer, talk to your doctor.

Contact your healthcare team to learn more about lung cancer screening.

LDCT screening for lung cancer is supported by many professional groups, including

• The American Lung Association• The American Cancer Society• The Centers for Medicare & Medicaid Services• The United States Preventive Services Task Force

LDCT lung cancer screening is recommended if you are at high risk. You may be at high risk if you meet all of the following criteria:

• Are 55 to 77 years old

•• Smoke now, or if you have quit smoking in the past 15 years

• Are a heavy smoker, or you were a heavy smoker

• Lung cancer screening is an important preventative health check, like mammograms and colonoscopies

• A low-dose computed tomography (LDCT) scan is recommended for people at high risk for lung cancer as part of a yearly health check

—You will be exposed to a low dose of radiation during the scan —The scan may show something, but often this can be a false alarm. If the scan

ddoes show something unusual, your doctor will discuss the next steps with you

www.thinkscreenknow.org

WHO SHOULD GET SCREENED FOR LUNG CANCER?

WHAT IS LUNG CANCER SCREENING?

DID YOU KNOW?

WHAT IS HEAVY SMOKING?Examples of heavy smoking are

• 1 pack a day for 30 years• 2 packs a day for 15 years• 3 packs a day for 7.5 years


SHOULD YOU GET SCREENED FORLUNG CANCER?

LOGOPLACEMENT


Make the decision together—talk to your healthcare team about the benefits and risks of screening.


WHAT IS HEAVY SMOKING?Examples of heavy smoking are

• 1 pack a day for 30 years• 2 packs a day for 15 years• 3 packs a day for 7.5 years

LUNG CANCER SCREENING:WHY START NOW?

WHAT HAPPENS DURING A LUNG CANCER SCREENING?

SHOULD YOU GET SCREENED?

ARE YOU COVERED?

IT’S A YEARLY CHECK

WHY SCREEN FOR LUNG CANCER?

LDCT is recommended for people at high risk for lung cancer, based on a study of over 53,000 patients

Yearly lung cancer screening is recommended if you are at high risk. You may be at high risk if you meet all of the following criteria:

• Are 55 to 77 years old

•• Smoke now, or if you have quit smoking in the past 15 years

• Are a heavy smoker, or you were a heavy smoker

Lung cancer screening is a regular preventive health check, like a mammogram or a colonoscopy. Lung cancer screening checks your lungs while you are healthy and looks for any changes from year to year. This screening is for patients at high risk. Read below to learn more about who should be screened.

Medicare and most private insurance plans will cover screening if you are in the high-risk group. Check with your insurance plan to find out about your screening coverage.

During the screening, an LDCT scan creates a detailed 3-D picture of your lungs. This scan will expose you to a low dose of radiation. LDCT uses 75% less radiation than a traditional CT scan and does not require any needles or medicines.

Your doctor may ask for more tests if he or she sees something on the scan. Often, these are false alarms and turn out to be nothing. Most patients who get screened do not have cancer.

• A lung cancer screening may find nothing, or it can find something before you have symptoms

• If a lung cancer screening finds something unusual, it is more likelyto find it at an early stage. You may have more options when cancer is found at an earlier stage

•• A low-dose computed tomography (LDCT) scan is recommended as part of a yearly health check for people at high risk for lung cancer


Patient Emails

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PROGRAM RESOURCES



Digital Banners

Cards to give patients the information they need about their screening appointment. Can be downloaded and printed on any printer.


• Hand directly to patients to provide them with the necessary information about their upcoming screening appointment

• Provide to affiliated providers in your network to mail to patients


Teasers suggesting that potentially eligible patients find out more about lung cancer

screening can be linked to your practice’s website or placed on social media. Banners are

available in different standard sizes, including sizes appropriate for Facebook, Instagram,

and Twitter. One version contains the Think.Screen.Know. campaign image and headline

("You get these checked regularly. What about your lungs?"), along with eligibility criteria;

the second version uses a lung icon and includes high-level eligibility criteria and a

call to action (CTA) ("Ask your doctor about screening").


• Place on practice's website or social media page



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PROGRAM RESOURCES


PROVIDER RESOURCES

Think.Screen.Know. Posters


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4.4%6.8% 8.4%

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PERCENTAGE OF CANCER DEATHS BY TYPE2-5

9 MILLION


LUNG CANCER IS• Diagnosed in approximately 1 of every 7

cases of cancer1

• The leading cause of cancer deaths in the United States at 25.9%1,2

• The cause of more cancer deaths than prostate, breast, and colorectal cancers combined1-5

ANNUAL SCREENING FOR LUNG CANCER: WHO IS MOST AT RISK?

THERE ARE APPROXIMATELY

current and former smokers at high risk for lung cancer in the United States6*

LDCT SCREENING MAY DETECT LUNG CANCER EARLY IN THESEPATIENTS7,8

WHO IS AT HIGH RISK?Patients at high risk include those who meet all of the following criteria9: • Are 55 to 77 years old • Have a smoking history of ≥30 pack-years†

• Are currently smoking or who have quit within the last 15 years

© 2017 Genentech USA, Inc. All rights reserved. ALE/070617/0056 08/17 Printed in USA.

Make time to talk about screening.

The Centers for Medicare & Medicaid Services endorses screening for patients defined as high risk who are asymptomatic for lung cancer.9

References: 1. American Cancer Society. Key statistics for lung cancer. American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html. Revised January 5, 2017. Accessed May 30, 2017. 2. National Cancer Institute. SEER stat fact sheets: lung and bronchus cancer. National Cancer Institute website. https://seer.cancer.gov/statfacts/html/lungb.html. Accessed May 30, 2017. 3. National Cancer Institute. SEER stat fact sheets: colon and rectum cancer. National Cancer Institute website. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed May 30, 2017. 4. National Cancer Institute. SEER stat fact sheets: female breast cancer. National Cancer Institute website. https://seer.cancer.gov/statfacts/html/breast.html. Accessed May 30, 2017. 5. National Cancer Institute. SEER stat fact sheets: prostate cancer. National Cancer Institute website. https://seer.cancer.gov/statfacts/html/prost.html. Accessed May 30, 2017. 6. National Cancer Institute. Enhanced risk-based lung cancer screening may prevent more deaths than current approaches. National Cancer Institute website. https://www.cancer.gov/news-events/cancer-currents-blog/2016/risk-profile-lung-screening. Published June 2, 2016. Accessed May 30, 2017. 7. American Cancer Society. Can non-small cell lung cancer be found early? American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/detection.html. Revised May 16, 2016. Accessed May 30, 2017. 8. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of CT lung cancer screening strategies. A comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. 9. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Published February 5, 2015. Accessed May 30, 2017.

† Number of cigarette packs smoked per day multiplied by the number of years a person has smoked.

*According to United States Preventive Services Task Force criteria.LDCT=low-dose computed tomography.


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4.5%

LOCALIZED (confined to primary site)

REGIONAL (spread to regional lymph nodes)

DISTANT (cancer has metastasized)

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ANNUAL SCREENING FOR LUNG CANCER: EARLY DETECTION MATTERS

>50% OF PATIENTS HAVE ADVANCED-STAGE LUNG CANCER AT DIAGNOSIS5-year relative survival is substantially higher in earlier stages1

*Data were collected from 2007 to 2013.

of patients found to have cancer in the LDCT arm of the National Lung Screening Trial (NLST) were diagnosed in the early stages6

EARLY DETECTION WITH ANNUAL SCREENINGLow-dose computed tomography (LDCT) screening can detect lung cancer at earlier stages, when patients have more options.2-5

70%70%

In the NLST, the mortality rate for patients at high risk receiving LDCT screening for lung cancer was reduced by

REDUCTION IN MORTALITY WITH LDCT

Only 320 LDCT screenings are needed to prevent 1 death.6

Although mammograms and colonoscopies may be better known, LDCT screening has a well-defined population of patients at high risk.†

†High-risk criteria: 55 to 77 years old; asymptomatic for lung cancer; smoking history of ≥30 pack-years; currently smoking or quit ≤15 years ago. Pack year=number of cigarette packs smoked per day multiplied by the number of years a person has smoked.

Risks of LDCT screening include exposure to radiation and false-positive results.7

Think prevention. Talk about regular lung cancer screening.

References: 1. National Cancer Institute. SEER stat fact sheets: lung and bronchus cancer. National Cancer Institute website. https://seer.cancer.gov/statfacts/html/lungb.html. Accessed May 30, 2017. 2. American Cancer Society. Can non-small cell lung cancer be found early? American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/detection.html. Revised May 16, 2016. Accessed May 30, 2017. 3. Centers for Disease Control and Prevention. Lung cancer screening programs. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/ncccp/pdf/lungcancerscreeningprograms.pdf. Accessed May 30, 2017. 4. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of CT lung cancer screening strategies. A comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. 5. American Cancer Society. Surgery for non-small cell lung cancer. American Cancer Society website. https://www.cancer.org/cancer/ non-small-cell-lung-cancer/treating/surgery.html. Revised May 16, 2016. Accessed May 30, 2017. 6. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. 7. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed May 30, 2017.



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RADIATION

MEDICARE AND MOST PRIVATE INSURANCE PLANS COVER SCREENING FOR ELIGIBLE PATIENTS6

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The National Lung Screening Trial analyzed the effect of LDCT screening vs chest X-ray in a study of 53,000 patients at high risk for lung cancer.4

LOW-DOSE COMPUTED TOMOGRAPHY (LDCT) SCREENING IS Recommended by the United States Preventive Services Task Force: Grade B

(high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial)1

Endorsed by the Centers for Medicare & Medicaid Services2

The only preventive measure recommended to detect lung cancer2-4

IN THIS STUDY, LDCT SCREENING4

ANNUAL SCREENING FOR LUNG CANCER: RECOGNIZE THE VALUE

• Demonstrated a 20% decrease in mortality from lung cancer vs chest X-ray

• Showed benefit in detection vs chest X-ray


Make it a priority—talk about screening.

References: 1. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. 2. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed May 30, 2017. 3. Centers for Disease Control and Prevention. Lung cancer screening programs. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/ncccp/pdf/lungcancerscreeningprograms.pdf. Accessed May 30, 2017. 4. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. 5. American Cancer Society. Can non-small cell lung cancer be found early? American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/detection.html. Revised May 16, 2016. Accessed May 30, 2017. 6. Schmidt C. Lung cancer screening poised to expand. J Natl Cancer Inst. 2015;107(4):1-3. doi: 10.1093/jnci/djv114.


*High-risk criteria: 55 to 77 years old; asymptomatic for lung cancer; smoking history of ≥30 pack-years; currently smoking or quit ≤15 years ago. A pack-year is the number of cigarette packs smoked per day multiplied by the number of years a person has smoked.

• Detect lung cancer at earlier stages3,5

• Prevent 1 cancer death per every 320 patients at high risk4*

• Provide results using less radiation than a standard chest CT scan2

LDCT CAN

Three posters that can be downloaded, printed on any printer, and displayed in your office. Each poster contains unique messaging:

• Poster #1 (“Who is at risk?”): Summarizes the prevalence of lung cancer, who is most at risk, and who should get screened

• Poster #2 (“Early detection matters”): Emphasizes the increased chances of survival with early diagnosis of lung cancer and how LDCT can help with early detection

• Poster #3 (“Recognize the value”): Highlights the benefits and risks of LDCT, its endorsement by several federal agencies, and the survival benefit shown by the National Lung Screening Trial

All 3 posters are also available in Spanish.


• Print and display in your exam room

• Print and send to affiliates in your network



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PROGRAM RESOURCES


PROVIDER RESOURCES (CONT'D)Healthcare Provider Emails

Two downloadable PDFs that can be inserted into emails or sent as attachments. The first (“Patient eligibility”) focuses on criteria for people at high risk of lung cancer and the benefits of LDCT. The second (“Benefits of screening”) identifies the benefits of LDCT, highlights outcomes of the National Lung Screening Trial, and stresses the importance of talking to patients about screening.


• Download as PDFs and send to affiliates in your network



References: 1. National Cancer Institute. Enhanced risk-based lung cancer screening may prevent more deaths than current approaches. National Cancer Institute website. https://www.cancer.gov/news-events/cancer-currents-blog/2016/risk-profile-lung-screening. Published June 2, 2016. Accessed July 17, 2017. 2. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of CT lung cancer screening strategies. A comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. 3. American Cancer Society. Can non-small cell lung cancer be found early? American Cancer Society website. https://wwhttps://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/detection.html. Revised May 16, 2016. Accessed July 17, 2017. 4. Centers for Disease Control and Prevention. Lung cancer screening programs. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/ncccp/pdf/lungcancerscreeningprograms.pdf. Accessed July 17, 2017. 5. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. 6. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. 7. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed July 17, 2017. Accessed July 17, 2017. 8. US Preventive Services Task Force. Final recommendation statement: lung cancer: screening. US Preventive Services Task Force website. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening. Revised December 2016. Accessed July 17, 2017. 9. Schmidt C. Lung cancer screening poised to expand. J Natl Cancer Inst. 2015;107(4):1-3. doi: 10.1093/jnci/djv114.

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• Can detect lung cancer at earlier stages3,4

• Can prevent 1 cancer death in every 320 patients at high risk6


• Uses less radiation than a standard chest CT scan5

• 55 to 77 years old• Current smoker or ex-smoker who quit within the last 15 years• Smoking history of ≥30 pack-years

High risk is defined as meeting all ofthe following criteria:

Identifying patients at high risk7

Putting their health first7,8

Eligibility for lung cancer screeningis not dependent on smoking cessation; however, this should always be part of your discussions and may be required for coverage.

Give them their best chance. Start the conversation.


The USPSTF recommends annual LDCT screening for lung cancer in patients at high risk (Grade B recommendation: high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial)6

The Centers for Medicare & Medicaid Services endorses screening for patients at high risk. Patients should receive a written order for LDCT screening. Please see the Medicare National Coverage Determination for all eligibility requirements7

ARE YOU TALKING TO YOUR PATIENTS AT HIGH RISKABOUT ANNUAL LUNG CANCER SCREENING?

There are approximately 9 million current and former smokers at high risk for lung cancer.1*

*According to United States Preventive Services Task Force (USPSTF) criteria.

Medicare covers screening for patients at high risk who are asymptomatic for lung cancer.

Private insurance plans may also cover screening.9

5-year relative survival is substantially higher when lung cancer is diagnosed in earlier stages3


References: 1. American Cancer Society. Can non-small cell lung cancer be found early? American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/detection.html. Revised May 16, 2016. Accessed July 17, 2017. 2. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of CT lung cancer screening strategies. A comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. 3. National Cancer Institute. SEER stat fact sheets: lung and bronchus cancer. National Cancer Institute website. https://seeInstitute website. https://seer.cancer.gov/statfacts/html/lungb.html. Accessed July 17, 2017. 4. Centers for Disease Control and Prevention. Lung cancer screening programs. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/ncccp/pdf/lungcancerscreeningprograms.pdf. Accessed July 17, 2017. 5. American Cancer Society. Surgery for non-small cell lung cancer. American Cancer Society website. https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/surgery.html. Revised May 16, 2016. Accessed July 17, 2017.6. The National Lung Screening TTrial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. 7. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. 8. National Cancer Institute. Computed tomography (CT) scans and cancer. National Cancer Institute website. https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet. Reviewed July 16, 2013. Accessed July 17, 2017. 9. Massachusetts General Hospital. Lung screening: FAQ for patients. Massachusetts General Hospital website. http://wwhttp://www.massgeneral.org/imaging/services/lung-screening-faq-patients.aspx. Accessed July 17, 2017. 10. McKee BJ, Regis SM, McKee AB, Flacke S, Wald C. Performance of ACR Lung-RADS in a clinical CT lung screening program. J Am Coll Radiol. 2015;12(3):273-276. 11. American College of Radiology. Lung CT screening reporting and data system (Lung-RADS™). American College of Radiology website. https://www.acr.org/Quality-Safety/Resources/LungRADS. Accessed July 17, 2017. 12. Pinsky PF, Gierada DS, Black W, et al. Performance of Lung-RADS in the National Lung Screening Trial: a retrospective analysis. Ann Intern Med.Ann Intern Med. 2015;162(7):485-491. 13. US Preventive Services Task Force. Final recommendation statement: lung cancer: screening. US Preventive Services Task Force website. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening. Revised December 2016. Accessed July 17, 2017. 14. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed July 17, 2017. 15. National Cancer Institute. NCI dictionary of cancer terms. National Cancer Institute website. https://wwdictionary of cancer terms. National Cancer Institute website. https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46171. Accessed July 17, 2017. 16. Schmidt C. Lung cancer screening poised to expand. J Natl Cancer Inst. 2015;107(4):1-3. doi: 10.1093/jnci/djv114.

LDCT scans use 75% less radiation than traditional CT scans and do not require contrast dyes8,9

Low-dose computed tomography (LDCT) screening can detect lung cancer in patients at high risk at earlier stages, when patients have more options.1,2,4,5


Reduction in mortality vs chest X-ray in the National Lung Screening Trial (NLST), a study of 53,000 patientsIn the NLST, the mortality rate for patients at high risk† receiving LDCT screening for lung cancer was reduced by 20% vs chest X-ray.


†High-risk criteria: 55 to 77 years old; asymptomatic for lung cancer; smoking history of ≥30 pack-years; currently smoking or quit ≤15 years ago.

*Data were collected from 2007 to 2013.

Lung-RADS is a trademark of the American College of Radiology.

LDCT screening may be one of the most important preventive care recommendations that you can make for a patient at high risk. Having a shared decision-making conversation about the benefits and risks of screening will help you make better health decisions with your patients.1,4,7,13

Remind patients that• If they are at high risk, lung cancer screening should be considered as part of a regular health check14 • • They should think of it like other screenings, such as a mammogram or a colonoscopy1,15

• Medicare covers screening for patients at high risk and many private insurance plans may cover it as well16

IF YOU’RE CONCERNED ABOUT FALSE-POSITIVE RESULTS WITH LDCT• Data suggest that applying Lung-RADS™ (lung imaging reporting and data system)

criteria to a lung cancer screening program may improve the positive predictive value (PPV), or percentage of positive screening results with cancer present, and potentially improve cost effectiveness.1,10-12

•• A retrospective study published in the Annals of Internal Medicine has shown that applying Lung-RADS criteria from the American College of Radiology (ACR) to the NLST lowered the false-positive result rate. The potential effect of reduced sensitivity of the mortality benefit of LDCT in the NLST is unknown.12

• Another retrospective study showed that applying Lung-RADS criteria to a clinical lung cancer screening program improved the PPV of screening from 6.9% to 17.3% (a 150% relative increase) without increasing the number of false-negative results.10

Early detection matters. Refer appropriate patients for screening.

LDCT screening is proven to decrease mortality6

Talk to your patients about why lung cancer screening is important

ANNUAL LDCT SCREENING CAN DETECT LUNG CANCER IN PATIENTS AT HIGH RISK AT EARLY STAGES1,2

Presents an overview of the National Lung Screening Trial and subsequent reanalysis of false-positive rates using the American College of Radiology's Lung-RADS™ reporting system. May be downloaded and printed on any printer.


• Download and use for your own reference



Screening Trials Flashcard

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GETTING STARTED


Lung cancer screening rates remain low, in part due to low awareness and the stigma associated with smoking. These resources were created to provide health systems like yours with the necessary resources to increase awareness and motivate as many eligible patients as possible to get their lungs screened. We encourage you to use those aspects of the program that work best within the context of your unique health system, and to use this Program Guide as a catalogue of best practices, workflow, and program resources to help your health system streamline and optimize its LDCT screening program.

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REFERENCES

1. American Cancer Society. Key statistics for lung cancer. https://www.cancer.org/cancer/non-small-cell-

lung-cancer/about/key-statistics.html. Accessed February 6, 2019. 2. American Cancer Society. Cancer facts &

figures 2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-

cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Accessed February 6, 2019. 3. American

Cancer Society. Can non-small cell lung cancer be found early? https://www.cancer.org/cancer/non-small-

cell-lung-cancer/detection-diagnosis-staging/detection.html. Accessed February 6, 2019. 4. The National

Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic

screening. N Engl J Med. 2011;365:395-409. 5. NELSON study shows CT screening for nodule volume

management reduces lung cancer mortality by 26 percent in men [press release]. Toronto, Canada: IASLC

World Conference on Lung Cancer; September 25, 2018. 6. Pinsky PF, Gierada DS, Black W, et al. Performance

of Lung-RADS in the National Lung Screening Trial. Ann Intern Med. 2015;162:485-491. 7. National Cancer

Institute. Computed tomography (CT) scans and cancer. https://www.cancer.gov/about-cancer/diagnosis-

staging/ct-scans-fact-sheet. Accessed February 6, 2019. 8. LUNGevity Foundation. Screening and early

detection. https://lungevity.org/for-patients-caregivers/lung-cancer-101/screening-early-detection. Accessed

February 6, 2019. 9. Centers for Disease Control and Prevention. Lung cancer screening programs: policies

and practices for cancer prevention. https://www.cdc.gov/cancer/ncccp/pdf/LungCancerScreeningPrograms.

pdf. Accessed February 6, 2019. 10. US Centers for Medicare and Medicaid Services. Your Medicare coverage:

lung cancer screening. https://www.medicare.gov/coverage/lung-cancer-screenings. Accessed February 6,

2019. 11. US Centers for Medicare and Medicaid Services. Preventive care benefits for adults. https://www.

healthcare.gov/preventive-care-adults. Accessed February 6, 2019. 12. Pham D, Bhandari S, Oechsli M, et al.

Lung cancer screening rates: data from the lung cancer screening registry. J Clin Oncol. 2018;36:6504 [online

supplement]. doi:abs/10.1200/JCO.2018.36.15_suppl.6504. Accessed January 11, 2019. 13. Walter M. 4 barriers

that keep patients from participating in lung cancer screening. https://www.radiologybusiness.com/topics/

care-delivery. Accessed February 7, 2019. 14. Centers for Disease Control and Prevention. What are the risk

factors for lung cancer? https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm. Accessed February

13, 2019. 15. Moyer VA, on behalf of the US Preventive Services Task Force. U.S. Preventive Services Task Force

recommendation statement. Ann Intern Med. 2014;160(5):330-338. 16. Borondy Kitts AK, McKee AB, Regis SM, et al.

Smoking cessation results in a clinical lung cancer screening program. J Thoracic Dis. 2016;8(suppl 6):S481-S487.

17. American College of Radiology. Lung CT screening reporting & data system. https://www.acr.org/Clinical-

Resources/Reporting-and-Data-Systems/Lung-Rads. Accessed May 13, 2019. 18. Wender R, Fontham ET,

Barrera E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63:106-

117. 19. US Preventive Services Task Force. Final recommendation statement: lung cancer: screening. https://

www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-

screening. Accessed February 1, 2017. 20. Lung Cancer Alliance. Coverage of CT screening for early detection

of lung cancer. https://lungcanceralliance.org/advocacy/our-legislative-priorities/screening-coverage.

Accessed February 27, 2019. 21. Centers for Medicare and Medicaid Services. Decision memo for screening for

lung cancer with low dose computed tomography (LDCT) (CAG-00439N). https://www.cms.gov/medicare-

coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed February 27, 2019. 22. Centers

for Disease Control and Prevention. How is lung cancer diagnosed and treated? https://www.cdc.gov/cancer/

lung/basic_info/diagnosis_treatment.htm. Accessed February 27, 2019. 23. American Cancer Society. What's

new in non-small cell lung cancer research? https://www.cancer.org/cancer/non-small-cell-lung-cancer/

about/new-research.html. Accessed February 27, 2019.


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