Sponsored By AstraZeneca In Partnership With The Lung ...

With lessons from Wellstar Health System

Strategies to build and grow a comprehensive lung cancer

detection program

Sponsored By AstraZeneca

In Partnership With The Lung Ambition Alliance

© 2021 Advisory Board • All rights reserved • advisory.com Advisory Board interviews and analysis.

2

Managing your audio

Use Telephone

(Recommended)

If you select the “Telephone” option,

please use the dial-in phone number and

access code provided on your GoTo panel.

If you select the “Mic & Speakers” option,

please be sure to check that your

speakers/headphones are connected.

Use Microphone and Speakers

All attendees will be muted during the presentation

http://www.advisory.com/


3

Managing your GoTo panel

How to Ask a Question

To ask the presenter, please type your

question into the “Questions” box on your

GoTo panel and press send.

Minimizing and maximizing your screen

Use the orange and white arrow to

minimize and maximize your GoTo panel.

Use the blue and white square to

maximize the presentation area.



4

Webinar Survey

Please note that the survey does not apply to webinars

viewed on demand.

Please take a minute to

provide your thoughts on

today’s presentation.

Thank You!


With lessons from Wellstar Health System

Strategies to build and grow a comprehensive lung cancer

detection program

Sponsored By AstraZeneca

In Partnership With The Lung Ambition Alliance

US-55142 Last Updated 7/21


6

Today’s presenters and goals

GOALS

01

Discuss the current state of lung cancer

detection today, including the recent

expansion of annual screening guidelines,

eligibility, and coverage

02Learn Wellstar’s strategies to develop and

grow their lung cancer detection program

03Facilitate Q&A on topics related to lung

cancer screening and incidental pulmonary

nodules findings

PRESENTERS

Dr Deirdre SauletExpert Partner

Advisory Board

Dr Bill MayfieldChief Surgical Officer

Director of Lung Cancer Screening and

Nodule Programs

Wellstar Health System

SPONSORED BY

This webinar contains details of healthcare provider's experience treating this patient and does not represent

the views or opinions of AstraZeneca. Individual experiences and recommendations may vary with patients.



7

Lung cancer screening and detection today

01



8

In 2021, lung cancer is the leading cause of cancer death for men and women#1

Average five-year survival rate for lung cancer patients, 2011-201722%

Source: “Cancer of the Lung and Bronchus - Cancer Stat Facts.”

SEER, seer.cancer.gov/statfacts/html/lungb.html#, Accessed July

2021.

The current status of lung cancer in the United States

Estimated percent of all new cancer cases in the US that are lung cancer, 202112%



9

1) CT, computed tomography;

2) NLST, National Lung Screening Trial;

3) IPN, incidental pulmonary nodule.

Source: US Preventive Services Task Force. “USPSTF Evidence Report: Screening for Lung

Cancer.”; Soneji, S. et al., "Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival",

Chest 2017;152(3): 587–597, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812758/; JAMA,

JAMA Network, 9 Mar. 2021, jamanetwork.com/journals/jama/fullarticle/2777244; Tanner, N.T., et

al., "Racial differences in outcomes within the National Lung Screening Trial." Amer J Respir Crit

Care Med 2015;192:200–208.; Gould MK, Tang T, Liu IL, Lee J, Zheng C, Danforth KN, et al.

Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med.

2015;192:1208–14.

Persistent lung cancer detection challenges

14% Estimated average percentage of

eligible patients that receive the

recommended low-dose CT1 lung cancer

screening exam

50.4%Black Americans had an average five-

year survival rate of 50.4% for localized

lung cancer compared with 59.3% of

white Americans, 2005 - 2011

4% Percentage of Black Americans that

were represented in the NLST2

Percentage of chest CT

scans at an integrated health system

that had a positive IPN3, 2006-2012

Only about 5% of those nodules were

diagnosed as lung cancer within two

years

24-31%

Health equityScreening ratesIncidental pulmonary nodules management



10

AUDIENCE QUESTION

What is your program’s biggest challenge

with early lung cancer detection?



11

Sources: JAMA, 2021, https://jamanetwork.com/journals/jama/fullarticle/2777244; USPSTF, 2021,

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

Haiman, 2006, https://www.nejm.org/doi/full/10.1056/NEJMoa033250;

Nearly twice as many patients eligible for screening1

Eligible population

Adults aged 50 to 80 with a

20 pack-year smoking history

Recommendation

The US Preventive Services Task Force

(USPSTF) recommends annual

screening for lung cancer with low-

dose computed tomography (LDCT)

Why it matters

2021 guidelines 13%Estimated potential reduction in mortality

6.4MEstimated increase in Americans eligible

for lung cancer screening from the 2013

recommendations

Adults aged 55 to 80 with a

30 pack-year smoking history

2013 guidelines

1. Under the 2021 recommendations.


https://jamanetwork.com/journals/jama/fullarticle/2777244

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

https://www.nejm.org/doi/full/10.1056/NEJMoa033250


12

1. AI, artificial intelligence.

AI1 innovations to support lung cancer detection

Illustrating how AI could aid in incidental pulmonary nodule (IPN) detection

RadiologistAI system

Detect lung nodule

on image

Rejects or validates

AI proposalProvider notifies referring provider

and patient; coordinates care

Result

Patient receives

imaging exam

Imaging

exam



13

Components of a

comprehensive

early lung cancer

detection program

Components of best-in-class early detection programs

Lung cancer

screening

Pulmonary nodule

management

Incidental pulmonary

nodule findings



14

Incidental pulmonary

nodule finding

Pulling the pieces together

Abnormal LDCT1

screening results

Patient entry points

Ongoing management

of pulmonary nodules

1. Low dose CT.

SCREENING EXAM

UNRELATED IMAGING



15

The fundamentals of growing a lung cancer screening programPresented by Dr. Bill Mayfield, Chief of Surgery, Director of the Lung Screening and Incidental Nodule Program, Wellstar Health System

02



16

Program overview

PROBLEM

• Time from abnormal CT to diagnosis is 65

days in ACR Screening Registry; in 2007 at

Wellstar it was 58 days

• Time from diagnosis to treatment increased

from 21 days in 2004 to 29 days in 2013

• A six week delay in TTI (time to initiate

therapy) results in a 13% reduction in

five-year survival rate for lung cancer

STAT CLINICS OVERVIEW

• Patient-centered versus physician-centered

• Patient is in the next room with all clinicians present

• One set of images and tests

• Consensus plan is developed in real time:

➢ Diagnosis plan goal: 7 days

➢ Time to treatment initiation goal: 7 days

• Navigation is the glue and facilitator

• The STAT Clinics have seen over 10,000 patients since 2007

Wellstar Health System

Based in Georgia

Source: Khorana, Alok A, et al. “Time to Initial Cancer Treatment in

the United States and Association with Survival over Time: An

Observational Study.” PloS One, Public Library of Science, 1 Mar.

2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6396925/.

Adapted from “Fundamentals for Growth of a Lung Cancer Screening Program” and “The

STAT Clinics User Guide” by William Mayfield, MD, FACS, Wellstar Health System, 2021.



17

Adapted from “Fundamentals for Growth of a Lung Cancer Screening Program” and “The STAT Clinics

User Guide” by William Mayfield, MD, FACS, Wellstar Health System, 2021.

Key steps to early lung cancer detection success

2

Enlist

executive

sponsor

3

Engage

primary care

providers

4 5 6

Focus

on program

quality

1

Identify

a physician

champion

Create

multi-disciplinary

team

Empower

a program

navigator



18

Without teamwork and discipline,

lung cancer screening is a really good way

to practice really bad medicine.





19

Combine passion with data to foster trust, gain buy-in

Having a strong physician champion secures executive support for the lung screening program

• Passion for eliminating lung cancer

• Proven leader and convener

• High trust factor

• Strong communicator

Qualities needed in your champion:

1. Evaluate the lung cancer burden in

your community

2. Illustrate the potential of treating with

curative intent early-stage lung cancer,

reducing mortality, and lowering cost

of care

3. Build a pro forma based on your

community needs (tools available

through GO2 Foundation for Lung

Cancer)

How to secure an executive sponsor:

Step 2: Enlist executive sponsorStep 1: Identify a physician champion

Adapted from “Fundamentals for Growth of a Lung Cancer Screening Program” and “The STAT Clinics

User Guide” by William Mayfield, MD, FACS, Wellstar Health System, 2021.


https://go2foundation.org/


20

Go straight to the source to recruit patients

STRATEGY EXECUTION

Make it easy for primary care providers to refer patients

Create a digital form to

help qualify the patient

for care

Educate providers

on the burden of

undiagnosed lung

cancer in their practice

Adapt the medical record

smoking history

Establish clear

communication

protocols so that “one

call does it all”

Step 3: Engage primary care providers

Adapted from “Fundamentals for Growth of a Lung Cancer Screening Program” and “The STAT

Clinics User Guide” by William Mayfield, MD, FACS, Wellstar Health System, 2021.



21

Practice “synchronous” multi-disciplinary care

PULMONARY

MEDICINE

MEDICAL

ONCOLOGY

RADIATION

ONCOLOGY

RADIOLOGY

THORACIC

SURGERY

Actively collaborate on patient management

PHYSICIAN

CHAMPION

PATHOLOGY

BENEFITS OF WELLSTAR’S SYNCHRONOUS APPROACH

REDUCTION

78%WellStar’s STAT program

approach to patient management

reduced the time from abnormal

CT to treatment initiation from

over 63 days to just 14 days



Step 4: Create multi-disciplinary team



22

Navigation is the glue to facilitate synchronous care

Step 5: Empower a program navigator

Responsibilities

• Lay outreach

• Primary Care outreach

• Pulmonary Medicine outreach

• Results management

• Comfort patient through their journey

• Assure compliance of Multi-

disciplinary Clinic (MDC) Team

with protocols

• Refer patients with critical findings

to MDC

Navigation is the glue facilitating synchronous care

Adapted from “Fundamentals for Growth of a Lung Cancer Screening Program” and “The STAT

Clinics User Guide” by William Mayfield, MD, FACS, Wellstar Health System, 2021.

Radiology

Lung cancer, pulmonary

nodule clinical team

Primary care providers

PATIENT

NAVIGATION



23

Two major components to program quality

• Radiology

– Nodule detection rate

– Nodule table creation

• Multi-disciplinary Care

– Time from image to appointment

– Time from image to diagnosis

– Time from diagnosis to treatment

• Negative biopsy rate

– Should be less than 20%

– Avoid excessive procedures

• Collective accountability for metrics and

adherence to protocols

Quality metricsThe Quality Triad

We’ve already discussed the importance of…

1. Navigation

2. Multi-disciplinary care

…but the other key piece of the

Quality Triad is:

3. ACR CT chest module accreditation

Accreditation is required for providers that

bill for CT under part B of the Medicare

Physician Fee Schedule



Step 6: Focus on program quality



24

Conclusion

Physician champion

Executive sponsor

Primary care engagement

Focus on quality and reducing harms

Synchronous multi-disciplinary team care

Navigation, navigation, navigation

Having the right approach to lung cancer screening can helpsave lives.





25

Q & A Dr Bill MayfieldWellStar Health System

Dr Deirdre SauletAdvisory Board



26

Webinar Survey

Please note that the survey does not apply to webinars

viewed on demand.

Please take a minute to

provide your thoughts on

today’s presentation.

Thank You!


Date post:	02-Jan-2022
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

Sponsored By AstraZeneca In Partnership With The Lung ...

Documents