Experts give advice on planning a successful lung cancer screening program

Carey C. Thomson, MD, MPH

Screening for lung cancer in high-risk individuals with low-dose computed tomography is an effective and recommended approach to reducing disease-related mortality. That said, planning for a lung cancer screening program (LCS) can be difficult because a successful program requires strategic multidisciplinary collaboration.

Clinicians planning to launch a new LCS program would do well to comply with the new guide developed by the American Thoracic Society and the American Lung Association, particularly in the section on program implementation.¹

The section, Implementation Guide for Lung Cancer Screening, was written by Carey C. Thomson, MD, MPH, Director of the Lung Cancer and Pulmonary Nodes Care Program at Mount Auburn Hospital, Cambridge, Mbadachusetts, and Andrea McKee, MD, Co-Chair of the Committee Director of Lung Cancer Screening at Lahey Hospital. Medical Center, Burlington, Mbadachusetts, and is available online.²

In the "Planning a LCS Program" section of the guide, pulmonologists from various successful LCS programs in the United States describe the strategies used by their institutions to overcome common obstacles encountered during implementation and ensure the success of the program. an effective program.

Establishment of program resources and structure

The first step in starting an LCS program is to mobilize resources to fund a multi-compartment program.

"We asked hospital leaders to stress the importance of developing an LCS program and ensuring that the program has the right infrastructure and staff," said Katrina Steiling, MD, MSc, co-chair of the LCS Steering Committee at Boston University School of Medicine in Mbadachusetts.

Depending on the resources available, the governance structure of each LCS program may vary and is generally clbadified into two categories: centralized, decentralized or hybrid. A centralized structure gives the program most of the responsibilities of the LCS service, while a decentralized structure leaves most tasks, with the exception of examination and interpretation, to the provider. . Most programs are governed by a hybrid structure, using both centralized and decentralized processes.

"This [hybrid structure] means that referrals for LCS exams can be made from the patient's primary care provider [decentralized referral] or our pulmonary nodule clinic, where subspecialty providers conduct a shared decisional visit with patients to examine the potential benefits and harms of screening. [centralized referral], Explains Dr. Steiling.

"One of the benefits of a hybrid structure is that patients have more options to discuss the LCS with a health care provider and request the test." Some patients may feel more comfortable talking about their lung cancer risk factors to their primary care provider and will determine if the LCS suits them, while others may prefer it. -to consult a specialist, "added Dr. Steiling.

According to Kim L. Sandler, MD, co-director of the Lung Cancer Screening Program at Vanderbilt University Medical Center in Nashville, Tennessee, although a centralized structure requires more resources than other structures, such as staff who can performing the shared decision visit can significantly reduce the burden on referral providers.

"We meet with each patient for 20 to 30 minutes to discuss all components of the shared decision-making visit, including providing smoking cessation counseling to our active smokers. This is the time when our referrers may not have a lot of work, "said Dr. Sandler.

Determining quality metrics

"Another important element to ensuring an efficient and effective workflow and communication is the regular review of program performance and quality measures," said Dr. Steiling.

Quality measures commonly collected and tracked in LCS programs include program access, smoking habits, radiology results, cancer detection rate, non-invasive procedures, and invasive procedures. Data collection on these metrics is necessary both to report to an approved registry and to track the quality of the program.

Build and set up a successful team

Regardless of the type of program structure, most experts agree that a program coordinator is essential to the development of a successful program.

"I think you have to have a champion of the program, someone who is willing to say," It's my responsibility. I'm going to get there. This does not mean that the person does it alone, but is responsible for ensuring that all the elements are in place for the program to be operational. Then you rely on collaborations with people from other departments for their expertise, "said Dr. Sandler.

In addition to a program coordinator who oversees administrative detail, a multidisciplinary steering committee is essential to guide the development of the program. A steering committee is often composed of officials from various departments, including radiology, oncology, pulmonary medicine, thoracic surgery and primary care.

"We have put in place a multidisciplinary steering committee to develop and implement the LCS program," said Dr. Steiling. "This committee reviews performance data and quality measures quarterly and discusses operational opportunities and challenges."

"A high-quality LCS system requires careful attention to detail to ensure that only eligible patients are screened, referrals are screened and abnormal results are badessed in time. An LCS Program Coordinator and a Patient Navigator are the important links, "concluded Dr. Steiling.

References

1. Thomson CC, McKee A, Borondy-Kitts A, et al; American Thoracic Society, American Lung Association. Implementation Guide for Lung Cancer Screening. lung.org/badets/documents/lung-cancer/implementation-guide-for-lung.pdf. Accessed October 31, 2018.
2. National Research Team on Lung Cancer Screening Trials, Aderle DR, Adams AM et al. Reduction of lung cancer mortality with low dose CT screening. N Engl J Med. 2011; 365 (5): 395-409. doi: 10.1056 / NEJMoa1102873.