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P. Mondragon

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    MS 18 - Advocacy Snapshots (ID 36)

    • Event: WCLC 2015
    • Type: Mini Symposium
    • Track: Advocacy
    • Presentations: 5
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      MS18.01 - Tobacco Controls Impact on Lung Cancer (ID 1926)

      14:15 - 15:45  |  Author(s): G. Colburn

      • Abstract
      • Presentation

      Abstract not provided

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      MS18.02 - Advocates Making a Responsible Case for High-Risk Screening (ID 1927)

      14:15 - 15:45  |  Author(s): T. Sawa, K. Eguchi, Y. Nakanishi, K. Nakagawa, T. Mitsudomi

      • Abstract
      • Presentation

      Abstract:
      Purpose: The purpose is to discuss how to advocate to make a Responsible Case for the Screening of lung cancer high risk group. Background and fact: Screening is looking for cancer at an early stage before a person has any symptoms. For the better screening, efficiency is determined as well as sensitivity and specificity. In these forty years, three screening tests have been studied to find if they decrease the risk of dying from lung cancer. Chest X-rays were evaluated at the earliest time in the lung cancer screening history while it is no longer recommended for screening.. Sputum cytology is a procedure in which a sample of sputum is viewed under a microscope to check for cancer cells, so it is required to good mucus that is coughed up from the lungs. Now, it is used as a non-invasive examination of a patient with a sputum symptoms rather than screening. Low-dose spiral CT (LDCT) scan is a special kind of x-ray that takes many pictures as you lie on a table that slides in and out of the machine. A computer then combines these pictures into a detailed picture of a slice of your body. In this procedure, low-dose radiation is used to make a series of very detailed pictures of areas inside the body with reduction of radiation exposure.. The National Lung Screening Trial (NLST) provided the first evidence that lung screening can reduce cancer deaths, when data from the study was published in 2011. The National Lung Screening Trial began in 2002 and enrolled more than 53,000 participants who were current or former heavy smokers, ages 55 to 74. The trial randomly assigned people to receive lung screening either by low-dose helical CT scans or chest X-rays. The trial was sponsored by the National Cancer Institute, and the University of Michigan was one of 33 places across the country to take part. U-M enrolled 850 participants. The study found that screening individuals with low-dose CT scans could reduce lung cancer mortality by 20 percent compared to chest x-ray. Now, it is concluded that the only recommended screening test for lung cancer is LD-CT, which result Medicare's decision to cover lung cancer screening in US. However, the evidence at the present time in LD-CT screening is only one report from US, the results of additional studies from Europe (NELSON) and Japan (Sagawa team) is awaited. Discussion: To raise up the efficiency of screening, It is important who is suitable as subjects. According to “ the Lung Cancer Screening Guidelines and Recommendations” by CDC, many organizations in US definite that lung cancer screening with LDCT is recommended for people of age 55 to 74 years with ≥ 30 pack year smoking history, who either currently smoke or have quit within the past 15 years while some difference of subjects who are in relatively good health or age 55 to 80 years across organizations. However, major obstacles are lying that smokers are lack of awareness or information for risks and benefits with attention to the specifics of each person making a decision about screening as well as the risk of lung cancer, in order to operate LD-CT screening effectively. GLCC poll in 2013 showed that in Australia and Great Britain current smokers are less aware of the symptoms of lung cancer than former smokers and people who have never smoked regularly. Even if screening system was developed, the risk of death due to lung cancer can not be reduced unless the people of high risk group do not visit to appropriate screening service that has been ensurring quality. In addition, Assessment of smoking and the provision of smoking cessation services must be part of any lung cancer screening program. Advocate movement based on research is urgently needed to develop approaches that will maximize cessation rates among smokers undergoing screening. Even more, it is required to enlightenment for smokers in cooperation with the international community by utilizing a variety of public relations means. In November 2014, lung cancer awareness month, Japan Lung Cancer Society approved the Kyoto Declaration. This declaration has been included that the tackle in the prevention of lung cancer and development of effective treatment by alliance with lung cancer Society, lung cancer patient, government, people, medical personnel, advocacy organizations, and healthcare industry. While the evidence from the NLST supports the implementation of lung cancer screening for high-risk individuals via LDCT, the experience to date also must validates the prior recommendations around institutional approaches to lung cancer screening, including the need for the availability of multidisciplinary clinical teams. In order to advocate making responsible case, several ways should be developed like a “Shared Decision-Making” toolkit(s) by the Lung Association that would act as a “consumers’ guide” for those considering lung cancer screening. After examine such a tool, it is also one of the ideas to take advantage according to the circumstances of each country.

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      MS18.03 - Developing a Framework for Excellence in Lung Cancer Screening - The Lung Cancer Alliance Experience (ID 1928)

      14:15 - 15:45  |  Author(s): L. Fenton-Ambrose

      • Abstract
      • Presentation

      Abstract:
      The development and release of scientific validation and national guidelines and recommendations for lung cancer screening over the past several years has resulted in a profound paradigm shift in clinical opinion and outcomes for those at high risk for lung cancer. No other cancer is poised to realize the scale and magnitude of benefit that is now being reported for the lung cancer community. Given the import and potential of this opportunity, it was evident that there was a lack of vigor and focus by public health leadership to move aggressively and to take the next steps to develop programs and guidance to ensure the safe, responsible and equitable implementation of lung cancer screening and to bring proper health messages to those at risk. Lung Cancer Alliance (LCA), a national non-profit cancer advocacy organization, recognized this absence and stepped in to bridge these gaps and create an environment to support the adoption of best practices and consumer safety measures, as well as public service messaging about screening risk and benefit. Immediately upon the scientific validation of the mortality benefit of lung cancer screening, LCA moved rapidly to convene a multi-disciplinary team of health care professionals to devise a blueprint or framework to guide the responsible implementation of screening. The overarching goal embedded in this discussion was to ensure the public understood that they had right to know they could be risk for lung cancer and that they had a right to responsible care. This was particularly important after the National Cancer Institute (NCI) announced it was halting the National Lung Screening Trial (NLST) as the end point was reached proving at a minimum a 20% mortality benefit. And thus, the LCA National Framework for Excellence in Lung Cancer Screening and Continuum of Care was born in February 2012. Embedded within this National Framework are the following guiding principles and elements: 1. Increasing the public’s awareness about risk and their rights to responsible care, including educational resources and campaigns to spread this message; 2. Creating a framework of agreed upon best practices to guide the safe and responsible development of a screening center of excellence medical center network that then leveraged member resources to support each other; 3. Creating collaborations and relationships with other professional and advocacy societies and outreach to public and private payers to effect change at the policy level. Today, there are currently 350 hospitals within the LCA National Network of Screening Centers of Excellence who have committed to following certain best practice principles of care. Dozens of other medical centers continue to contact LCA for technical assistance and are in varying stages of program development. LCA launched an ad campaign in 2014 to raise risk awareness which received 90 million impressions through TV, print, and social media in 15 paid markets and about 20 PSA markets. In addition, LCA has helped successfully lead first-ever public health coalitions to advocate for coverage and other policy changes linking together diverse partnerships. This has included engaging the current screening centers of excellence in communication with the US Preventive Services Taskforce (USPSTF), Congress and other regulatory agencies, working with an alliance of stakeholders including ACR and STS to encourage swift action on the part of Centers for Medicare Medicaid Services (CMS) to ensure coverage for at-risk seniors, and communicating with lawmakers and encouraging them to take oversight action to ensure public health strategies by our Health and Human Services (HHS) Departmental move forward as efficiently, effectively and equitably as possible. With the finalization of the USPSTF recommendation for lung cancer screening and coverage for Medicare beneficiaries, lung cancer screening is now a covered benefit for those at high risk, with no cost sharing, co-pays or deductibles. The LCA experience is an example of how an agile and responsive patient advocacy charity can provide critical institutional support and a national public health blueprint for the scale up of a new preventive service – that is patient focused and patient driven. By creating what in effect is a national pilot program for lung cancer screening, LCA proved that responsible screening and outreach could be reproduced in medical centers all across the country at the community level. And by working closely and directly with screening centers – we have established a deeper understanding of their needs which in turn has helped us tailor our continued outreach and support to better suit their needs. Our consumer-targeted awareness campaigns have shape a culture of consciousness among the public which in turn have allowed us to better design educational materials. LCA is committed to continuing to build knowledge about the importance of screening among the at-risk public, healthcare providers, and policymakers alike. LCA is proud to have seized an important moment in time to have built a foundation for responsible care when people at risk for lung cancer needed it most. Figure 1



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      MS18.04 - Lung Cancer - a Health Issue for Women (ID 1929)

      14:15 - 15:45  |  Author(s): S. Vallone

      • Abstract
      • Presentation

      Abstract:
      For a long period of time, lung cancer has been considered a malignancy affecting only men, but epidemiological data have shown a dramatic increase of the incidence among women and the gender gap has been narrowing steadily since the 1980s,mainly as a consequence of the huge spread of tobacco consumption during the past 60 years. Although more men are diagnosed with lung cancer, incidence is leveling off or decreasing in men, but is increasing among women.Lung cancer is the leading cause of cancer death for women in the United Statesand other countries, with about 105,600 new cases and 71,000 estimated deaths in 2015 for the female gender, whereas in European countries lung cancer is predicted to kill 87,500 women in 2015, but such predictions require caution. In Europe, for the first time in 2015 (unlike in the U.S. where it has been happening for some decades)lung cancer death rates in females are expected to overtake those of breast cancer. This trend is largely driven by women in the UK and Poland, confirming that the continuous increase in lung cancer mortality among women represents a challenge for cancer control. This disease is classified as a significant global women’s health issue. Unfortunately, women still lack awareness and knowledge about lung cancer, it is not considered a priority because most of them still believe that breast cancer is the number one cancer in women. They have misperceptions and in most cases they are not concerned because they are too young or are non-smokers. Gender differences in terms of susceptibility to carcinogens have been reported and several studies suggestthat women are more vulnerable to tobacco carcinogens than men, however this data remains controversial. Although smoking increases the risk of lung cancer dramatically, it's not the only cause. Freedman et Al reported on a cohort of nearly 500,000 individuals aged from 50 to 71 years, in which asignificant increase of cases occurred in women who never smoked, compared with male non-smokers. The rate of lung cancer in those who never smoked is higher for women in every population, counting approximately 20% of women who never smoked. The reason is unclear, but studies suggest that the hormonal status may be one potential explanation and researchers are devoting energies in this area to better understand the implication of gender differences in epidemiology, pathogenesis, prognosis and tumor response, considering that women have better survivalrates than men at any stage regardless of the type of lung cancer and the therapeutic approach. At the moment there are no gender-based approaches on diagnosis and treatment for lung cancer, but an improvement in understanding genetic, metabolic and hormonal factors could stimulate research towards further personalized gender-based investigations. Despite recent advances in treatment, lung cancer still remains a largely incurable disease with a physical impact upon women, as well as social, psychological, practical and emotional consequences. The diagnosis and subsequent treatments are traumatic events for patients and their loved ones. Serious disruptions in social and psychological aspects of their quality of life have been reported and younger women are most at risk. This type of cancer is normally associated with older people, where the disease is often diagnosed accidentally, while in young adults it is relatively rare, the incidence has been found to be around 1.2% to 6.2% (under 40 years), 5.3% (under than 45 years), and 13.4% (under 50 years),but previous reports have shown trends of increasing incidence rates of lung cancer among young patients. Unfortunately in this group this malignancy is more common in women, who are diagnosed at an advanced stage and normally receive aggressive treatments. It can be very difficult to cope with a diagnosis of lung cancer, both practically and emotionally, because the news can generate a wide range of emotions: fear, anxiety, anger, confusion, that could worsen the situation if patients are younger women because they often have to face challenges different than other patients. The worst are mothers of children or teenager, telling them the diagnosis is hard and traumatic, it means dealing with their emotions and reactions and helping them to face a daily routine affected by this event. Many feel unable to manage changes caused by lung cancer and this may create a state of distress that is increasingly recognized as a factor that can reduce the quality of life of patients. Moreover they feel hopeless, worried and sad about the uncertainty of their future and their children’s future. The disease and its treatments often may cause physical changes in the way they look, which is difficult to cope with and may affect the way women feel about themselves. Such body changes can diminish their self-esteem and change the way they relate to other people, especially family and friends. Disease progression, symptoms orside effects may force women to change the daily management of their family and house. The consequence is the inability to keep the pace of motherhood and to keep on doing things like they were used to do (for example working around the house), especially if children are young and energetic.These physical issues may also jeopardize their career and in many situations forcing them to quit job, increasing the frustration of losing their independence. Lung cancer may affect the dynamics of intimate relationships. This is connected to body image changes,in whichwomen may feelless attractive or desirable by their partner. Common symptoms of lung cancer, such as cough, fatigue or shortness of breath may affect their sexual life. Women with lung cancer have a number of unmet needs that require assistance. It is important to identify them efficiently and effectively so that patients can be provided with appropriate resources so they can find help. Physical needs are experienced by the majority of women, but emotional, psychological, social, spiritual, practical and informational needs are also present for some. Interventions must be developed to assist these women to cope with these needs and worldwide several gender focused educational and support programs have already been designed with this purpose. References: Silvia Novello & Tiziana Vavalà Lung cancer and women, Future Oncology Vol. 4, No. 5, Pages 705-716 Cancer 2010, 116(15):3656-3662. PubMed Abstract | Publisher Full Text Subramanian J, Morgensztern D, Goodgame B, Baggstrom MQ, Gao F, Piccirillo J, Govindan R: Distinctive characteristics of non-small cell lung cancer (NSCLC) in the young: a surveillance, epidemiology, and end results (SEER) analysis. J ThoracOncol 2010, 5(1):23-28. Ak G, Metintas M, Metintas S, Yildirim H, Erginel S, Alatas F: Lung cancer in individuals less than 50 years of age. Lung 2007, 185(5):279-286. Skarin AT, Herbst RS, Leong TL, Bailey A, Sugarbaker D: Lung cancer in patients under age 40. Lung Cancer 2001, 32(3):255-264. Bourke W, Milstein D, Giura R, Donghi M, Luisetti M, Rubin AH, Smith LJ: Lung cancer in young adults. Chest 1992, 102(6):1723-1729. Schnoll RA, Patterson F, Lerman C. Treating tobacco dependence in women. J Womens health 2007;16:1211-1218 Freedman ND, Leitzmann MF, Hollenbeck AR et al. Cigarette smoking and subsequent risk of lung cancer in men and women: analysis of a prospective cohort study.Lancet Oncology 2008;9:649-656 Donington JS, Colson YL. Sex and gender differences in non-small cell lung cancer. Seminars Thoracic Surgery2011;23:137-145 American Society of Cancer Oncologists. 2009. Women and Lung Cancer. Margaret I. Fitch, Rose Steele Supportive care needs of women with lung cancer- Canadian Oncology Nurses Vol 18, No 1 (2008)

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      MS18.05 - Excellence in Treatment - Exporting Teaching Hospital Standards of Care to the Community Hospital Setting (ID 1930)

      14:15 - 15:45  |  Author(s): B.J. Addario, S. Santarella, D. Hicks

      • Abstract
      • Presentation

      Abstract:
      The Community Hospital Centers of Excellence (COE) seal and program is a paradigm shift in lung cancer care to greatly increase positive patient outcomes. This necessity is driven by the reality that the 5-year patient survival rate has remained unchanged and abysmally low at approximately 16% for 40+ years. 80% of lung cancer patients in the US receive treatment by a general oncologist at community hospitals, most often without disease-specific cancer doctors. Unfortunately, generalists lack access to the most up-to-date knowledge to specifically treat lung cancer, the world’s number one cancer killer that takes more lives annually than the other top five cancer killers combined. Because of the tremendous volume and pace of scientific discovery, it is impossible for community general oncologists to stay abreast of emerging treatment options, the complexities of each disease state (lung, breast, colon, etc) and practice-changing clinical information. Due to this gap generalists cannot fully inform patients about all treatment options that exist, are expected and used every day by specialists at academic institutions where the enhanced standard of care includes molecular testing, tumor board review, clinical trials, personalized/targeted treatment, multi-disciplinary care, etc. Health literacy of physicians and patients impacts survival. The lung cancer knowledge gap especially affects patients who have limited education, are low income, ethnic minorities, recent immigrants and non-native English speakers. Knowledge and access are the currency of success and the pathway for all patients/physicians to get the right information leading to the right treatment at the right time. Information is also key for patients and their families to act as their own advocates. EVERY PATIENT NEEDS TO KNOW EVERY OPTION. ALCF acknowledges this problem and provides an innovative, first-of-its-kind solution – Community Hospital Centers of Excellence (COE) – to give all patients 360[0] care. Our solution provides community hospitals access to the same standard of care used at academic institutions to ensure that every physician and patient has access to and is educated about the newest, most effective diagnostic and therapeutic techniques, clinical resources, partners and people. Increasing lung cancer patient survival to the same high level as other cancers (breast/89.2%; prostate/98.9%) depends upon addressing disparities at the root – community hospitals – and to providing access to multi-institutional, collaborative, comprehensive care based on existing best practices. Equalizing access benefits all populations – insured, uninsured, underserved, geographically disadvantaged – fighting this disease. Physicians/hospitals in the COE national network commit to being fully informed partners with their patients in understanding, sharing and discussing treatment options. ALCF lung-specific community centers of excellence will be tracked by metrics to improve outcomes and reinforce ALCF’s belief that enhanced standard of care can extend survivability, improve quality of life, and some cases, save lives. ALCF, along with GE Healthcare and El Camino Hospital in California, has already shown success in its pilot program launched in 2012. Simultaneously, underlying research projects will be conducted to achieve milestones and increase discovery of treatment regimens for individualized therapy and survival acceleration through ALCF’s sister organization, the Addario Lung Cancer Medical Institute (ALCMI). At Centers of Excellence an on-site Patient Navigator oversees each patient’s care from the initial diagnosis. Care includes molecular testing for all patients to determine the unique genetic profile of the individual’s lung cancer. This knowledge will determine the best first-line treatment to achieve a positive outcome and will ensure that the right patient gets the right treatment at the right time. Community Hospital Centers of Excellence (COE) – Primary objectives are: ● Provide lung cancer patient program participants with multi-disciplinary, multi-institutional, collaborative, extensive, and comprehensive access to best care available. This “big picture” approach includes a Patient Navigator overseeing each patient’s care to include prospective tumor board review, molecular testing, targeted radiation therapy, and access to clinical trials, from a fully integrated team (oncologist, pulmonologist, radiologist, pathologist, immuno-oncologist, etc). ● Establish and implement improved standard of care (SOC) at community hospitals nationwide by giving patients and physicians access to the SOC used at academic institutions. This standard will be measured through patient data tracking, follow-up and patient surveys, and benchmarked against national data and statistics. In addition, ALCF will actively support the adoption and scaling of its lung cancer “standard of care” model to apply across the cancer spectrum and to other diseases and disciplines, as applicable. ● Improve progression free and overall survival rate and quality of life for patients. ● Implement best practices with expected outcomes being a new patient-centric paradigm for lung cancer patient treatment with best practices managed and documented by ALCF and findings shared with ALCF key partners and prospective Community Hospital COE sites. Because outcomes/data are essential to determine program success, tracking and measurement of all COE patients will include: Method of Diagnosis Early Detection vs. Incidental Findings Diagnosis Date Lung Cancer Type Lung Cancer Stage at Diagnosis Molecular Testing - % of Patients Received Tumor Board Review 30 Day Survival Number of ER Visits 1 and 5 Year Survival (Progression Free and Overall) Clinical Trial Referral Quality of Life (i.e. Pulmonary Function, Neuropathy, Fatigue, Appetite etc) Patient Satisfaction Survey Line of Treatment Where Applicable: Dollars Lost/Impact on Community due to Early vs. Late Stage Diagnosis Business Impact on Hospital During our pilot program's first year (El Camino Hospital, Mtn View, CA) metrics have already shown a dramatically improved standard of care (diagnosis to treatment time improved from a national average of 40+ days to 14.5 days; 100% of patients have had molecular testing; 61% have had tumor board review vs. 15% pre-program; 26% diagnosed at stage 2b or below). In adopting this collaborative, integrated standard of care, each hospital must have capacity to enroll at least 200 patients yearly. At minimum, ALCF excpects 10,000 patients will be served by 2015 end thriough 20 COEs. By equalizing physician/patient access to education and a standard of care, all populations affected by lung cancer--insured, uninsured, underserved, geographically disadvantaged--will benefit. COE will clearly be able to track outcomes and will define success through lives extended and in some cases, saved. By redesigning lung cancer patient health care delivery, COE provides an unprecedented coordination of care using technology and access to existing expertise/knowledge.

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