Navigation program for LDCT lung cancer screening implementation: A quality initiative.

Abstract

10568 Background: Lung cancer remains the leading cause of cancer-related death worldwide. Despite recommendations from experts, the lung cancer screening has not been well adopted in practice. Methods: We started a pilot program in our cancer center in collaboration with Pulmonary medicine in November 2021 as we identified that the rates of Low Dose CT scan (LDCT) are meager in our community. Two areas that needed attention were identified. The first was the need for shared decision-making by the primary care physician (PCP) before ordering LDCT. The second was the follow-up for patients with positive lung nodules. A lung nodule patient navigator was assigned exclusively for this initiative. Reports were obtained from EPIC every month to identify patients who fit the criteria. PCPs of the respective patients were then reminded to discuss LDCT in the upcoming visit. The lung nodule navigator then followed the ordering and test results of LDCT. A dedicated lung nodule conference discussed all patients with positive lung nodules. Follow-up interventions included referrals to pulmonology, interventional radiology, or further imaging with PET scan. Per guidelines, patients who did not need acute intervention were kept on track for their follow-up CT as recommended. Results: We reviewed our baseline performance in LDCT from January to June 2021.The total screening included 271(32%) patients compared to 836 eligible patients who fit the criteria. From January 2022 to June 2022, out of 749 eligible patients who were expected to meet their PCP, 574(76%) patients received LDCT. Of the patients screened, 436(75%) had their baseline CT chest, with the remaining patients having follow-up CT. Fifteen patients had findings needing immediate intervention. Conclusions: The USPSTF has updated its annual lung cancer screening guidelines with LDCT for adults aged 50 to 80 years who have a 20-pack-year smoking history and current smoker or have quit within the past 15 years. With our approach, the screening rates have more than doubled compared to previous year. LDCT does carry certain risks, including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test. We identified the shared decision process as the rate limiting step across our institution. Our contact with PCP was a significant intervention that improved the screening. The second obstacle was the follow-up for positive LDCT, and we alleviated it with the multidisciplinary lung nodule conference. This process is undoubtedly difficult to achieve without a lung nodule navigator. Each hospital system is unique and has various difficulties implementing screening guidelines. We show that, with the help of a lung nodule navigator, the rates of lung cancer screening can be significantly increased.