Lung cancer is the leading cause of cancer deaths in the United States and worldwide. Approximately 85% of lung cancer occurs in current or former tobacco smokers. Lung cancer forms in the tissues of the lungs, usually in the cells lining air passages. The two most common types are small cell lung cancer and non-small cell lung cancer.
Listen in as Doug McCormick, Nurse Practitioner, explains that early detection of lung cancer is key to more successful treatments and better outcomes.
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GHS Lung Cancer Screening Program
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Learn more about Doug McCormick
Doug McCormick, Nurse Practitioner
Doug McCormick is a Nurse Practitioner with the GHS Cancer Institute, CIOS program.Learn more about Doug McCormick
Transcription:
Melanie Cole (Host): Lung cancer is the leading cause of cancer deaths in the United States and worldwide. Greenville Health System has a comprehensive lung cancer screening program housed at both the Cancer Institute Center for Integrative Oncology and Survivorship and the GHS Lung Center. My guest today is Doug McCormick. He’s a nurse practitioner with the GHS Cancer Institute. Welcome to the show, Doug. Tell the listeners what is lung cancer screening?
Doug McCormick (Guest): Thanks, Melanie. We screen, typically, for many types of cancers, prostate cancer, breast cancer, colon cancer, and most patients are familiar with those tests, for example PSA for prostate, mammograms for breast, colonoscopies for colorectal cancer. We've known for years we could screen for lung cancer using a technology called “low-dose CTs”, but there was no reimbursement for that. So, about two years ago in February of 2015, Center for Medicare Medicaid Services came out with an edict stating that for people that met criteria, they would cover cancer screening, specifically looking at the lungs.
Melanie: So, why get screened? People think of those other types of screening but this one they think, “Well, is there a point to it? If you catch it early can it still be treated?”
Doug: That’s a great question. Historically, in this country, and certainly in the state of South Carolina, most lung cancers are caught late in disease, so, Stages 3 to 4. Late stage disease for any cancer is not necessarily good news, but lung cancer is especially hard to treat the later the stage. So, the goal that makes sense would be to catch it early on. Early lung cancers can actually be cured through surgery alone, depending on several factors, but, as a general rule, the earlier the better.
Melanie: So, who's eligible for lung cancer screening?
Doug: There are several different types of guidelines that you can look at. Currently, GHS utilizes the guidelines put forth by the Center for Medicare Medicaid Services. Those are folks that are 55-77 years old with at least a 30 pack-year history of smoking. That would mean that over the course of their lives they've averaged to pack a day for 30 years. They're currently smoking or they have quit within the past 15 years, and they have no symptoms of lung cancer. Those symptoms, generally, are coughing up blood, losing weight. That’s part of the issue with screening for lung cancer is that symptoms tend to only show up in late-stage disease.
Melanie: What are you looking for on the CT scan?
Doug: We’re looking for any abnormalities but, specifically, we’re looking for pulmonary nodules. A nodule on a CAT scan shows up as somewhat like a shadow. There are different ways to describe them, being ovoid, being round, being what we call “speculated”. We look at the size of nodules and we look at number of nodules if they’re present. And then, we utilize a national standardization that was put out by the American College of Radiology on how to classify those nodules.
Melanie: Are there any risks to the screening?
Doug: That's another great question. One of the things we try to be clear about at GHS is both the benefits and the risks of this particular scan, although patients should consider talking about benefits and risks with their health care providers for anything that they undergo. So, the biggest risk would be what we call false-positives or overdiagnosis. What that simply means is there’s something on the scan that we're not quite sure: is that cancer or is that not. So, that drives further diagnostic testing. Testing can be, obviously, more expensive; can cause anxiety for the patient; and can cause additional intervention that may have potential side effects as well that had we otherwise not screened or looked at that patient’s lungs, we would never have gone there, so to speak. So, we try to take a common sense approach where we attempt to not underreact to what we find and not overreact. We have what's called a “shared decision-making” conversation with the patient to make sure that they understand that this is a potential issue up front; and then, if we find abnormalities on the scan, what might we consider doing about that. So, we talk about that before we even send the patient to radiology to be scanned.
Melanie: Is insurance recognizing this screening?
Doug: Yes. Again, this initially started with the Center for Medicare Medicaid Services, actually February 5th of 2015, and slowly private insurers have come on board. If you meet the eligible criteria that we discussed and you are a Medicare patient, then generally you are covered at 100%. If you are a privately insured patient, then you may have applicable co-pays that you would be responsible for depending on your individual private insurance plan.
Melanie: What can patients expect from the exam itself? How is it performed? Do they have to get into a gown? Is there a lot of waiting? What is involved in the exam itself?
Doug: They do not have to have any type of special IV fluid. They don't have to eat or drink anything special because this is a non-contrast CT. The scan itself, once the patient is positioned on the table, takes about three minutes. It takes longer to actually get the patient positioned properly. There is no tube or tunnel that you go through when you go through a CT scan. It kind of looks like a big doughnut with a small table that you would lay on and either the doughnut goes over you or you go through that doughnut, so to speak. Generally, you do not have to wear a gown or any other special hospital clothing. You would just be in your street clothes.
Melanie: Tell us about the comprehensive lung cancer screening program at GHS and tell us about your team.
Doug: Generally, what we do is we kind of pre-assess patients over the phone looking at those risk factors, looking at their age, looking at their current smoking status, so that we’re, hopefully, bringing in patients that already meet the criteria. They come in and meet with both a nurse navigator and a nurse practitioner at CIOS, and we go through this shared decision-making visit. So, we sit down with the patient and talk about the potential benefits and risks of this particular type of screening exam. We talk about what the patient feels about health care, what their thoughts and feelings and family issues are related to how they want to be treated. Assuming that we go through all that and they decide to go ahead, they then proceed to Greenville Radiology. They can either have an appointment made for them or they can walk in and have the scan done the same day. Generally, those scans come back in about 24 to 48 hours. There are three particular radiologists that have additional training for reading these scans through Greenville Radiology, and those are the three physicians that read them. They are then interpreted via electronic medical record by the nurse navigator and myself. We have a medical director, Dr. Mark O'Rourke, who is a medical oncologist, and then we work with Dr. James Stephenson who is thoracic oncology surgeon for any abnormalities. There is actually a nodule clinic that meets once a week that is comprised of Dr. Stephenson, our thoracic surgeon; one of the three radiologists we previously described; and a pulmonologist, who, in real-time, review any abnormal scans and make recommendations.
Melanie: What a great multidisciplinary approach, Doug. Give your best advice in these last few minutes for people that are considering lung cancer screening, what do you tell them every day? What do you really want them to know?
Doug: What I really want them to know is if they're still smoking I really want them to stop smoking and I want to assist them in getting into the smoking cessation program that is right for them. Number two, I want them to have the appropriate information to help stratify risk, which, again, is generally based on their years of smoking, pack-years, and other potential co-morbidities. And I want them to understand the potential risks and benefits of the screening exam, and, again, there are risks and benefits to every type of screening exam that we would do looking for different types of cancers.
Melanie: Thank you so much for being with us. It’s great information. You're listening to Inside Health with Greenville Health System. For more information you can go to www.GHS.org. That’s www.GHS.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Lung cancer is the leading cause of cancer deaths in the United States and worldwide. Greenville Health System has a comprehensive lung cancer screening program housed at both the Cancer Institute Center for Integrative Oncology and Survivorship and the GHS Lung Center. My guest today is Doug McCormick. He’s a nurse practitioner with the GHS Cancer Institute. Welcome to the show, Doug. Tell the listeners what is lung cancer screening?
Doug McCormick (Guest): Thanks, Melanie. We screen, typically, for many types of cancers, prostate cancer, breast cancer, colon cancer, and most patients are familiar with those tests, for example PSA for prostate, mammograms for breast, colonoscopies for colorectal cancer. We've known for years we could screen for lung cancer using a technology called “low-dose CTs”, but there was no reimbursement for that. So, about two years ago in February of 2015, Center for Medicare Medicaid Services came out with an edict stating that for people that met criteria, they would cover cancer screening, specifically looking at the lungs.
Melanie: So, why get screened? People think of those other types of screening but this one they think, “Well, is there a point to it? If you catch it early can it still be treated?”
Doug: That’s a great question. Historically, in this country, and certainly in the state of South Carolina, most lung cancers are caught late in disease, so, Stages 3 to 4. Late stage disease for any cancer is not necessarily good news, but lung cancer is especially hard to treat the later the stage. So, the goal that makes sense would be to catch it early on. Early lung cancers can actually be cured through surgery alone, depending on several factors, but, as a general rule, the earlier the better.
Melanie: So, who's eligible for lung cancer screening?
Doug: There are several different types of guidelines that you can look at. Currently, GHS utilizes the guidelines put forth by the Center for Medicare Medicaid Services. Those are folks that are 55-77 years old with at least a 30 pack-year history of smoking. That would mean that over the course of their lives they've averaged to pack a day for 30 years. They're currently smoking or they have quit within the past 15 years, and they have no symptoms of lung cancer. Those symptoms, generally, are coughing up blood, losing weight. That’s part of the issue with screening for lung cancer is that symptoms tend to only show up in late-stage disease.
Melanie: What are you looking for on the CT scan?
Doug: We’re looking for any abnormalities but, specifically, we’re looking for pulmonary nodules. A nodule on a CAT scan shows up as somewhat like a shadow. There are different ways to describe them, being ovoid, being round, being what we call “speculated”. We look at the size of nodules and we look at number of nodules if they’re present. And then, we utilize a national standardization that was put out by the American College of Radiology on how to classify those nodules.
Melanie: Are there any risks to the screening?
Doug: That's another great question. One of the things we try to be clear about at GHS is both the benefits and the risks of this particular scan, although patients should consider talking about benefits and risks with their health care providers for anything that they undergo. So, the biggest risk would be what we call false-positives or overdiagnosis. What that simply means is there’s something on the scan that we're not quite sure: is that cancer or is that not. So, that drives further diagnostic testing. Testing can be, obviously, more expensive; can cause anxiety for the patient; and can cause additional intervention that may have potential side effects as well that had we otherwise not screened or looked at that patient’s lungs, we would never have gone there, so to speak. So, we try to take a common sense approach where we attempt to not underreact to what we find and not overreact. We have what's called a “shared decision-making” conversation with the patient to make sure that they understand that this is a potential issue up front; and then, if we find abnormalities on the scan, what might we consider doing about that. So, we talk about that before we even send the patient to radiology to be scanned.
Melanie: Is insurance recognizing this screening?
Doug: Yes. Again, this initially started with the Center for Medicare Medicaid Services, actually February 5th of 2015, and slowly private insurers have come on board. If you meet the eligible criteria that we discussed and you are a Medicare patient, then generally you are covered at 100%. If you are a privately insured patient, then you may have applicable co-pays that you would be responsible for depending on your individual private insurance plan.
Melanie: What can patients expect from the exam itself? How is it performed? Do they have to get into a gown? Is there a lot of waiting? What is involved in the exam itself?
Doug: They do not have to have any type of special IV fluid. They don't have to eat or drink anything special because this is a non-contrast CT. The scan itself, once the patient is positioned on the table, takes about three minutes. It takes longer to actually get the patient positioned properly. There is no tube or tunnel that you go through when you go through a CT scan. It kind of looks like a big doughnut with a small table that you would lay on and either the doughnut goes over you or you go through that doughnut, so to speak. Generally, you do not have to wear a gown or any other special hospital clothing. You would just be in your street clothes.
Melanie: Tell us about the comprehensive lung cancer screening program at GHS and tell us about your team.
Doug: Generally, what we do is we kind of pre-assess patients over the phone looking at those risk factors, looking at their age, looking at their current smoking status, so that we’re, hopefully, bringing in patients that already meet the criteria. They come in and meet with both a nurse navigator and a nurse practitioner at CIOS, and we go through this shared decision-making visit. So, we sit down with the patient and talk about the potential benefits and risks of this particular type of screening exam. We talk about what the patient feels about health care, what their thoughts and feelings and family issues are related to how they want to be treated. Assuming that we go through all that and they decide to go ahead, they then proceed to Greenville Radiology. They can either have an appointment made for them or they can walk in and have the scan done the same day. Generally, those scans come back in about 24 to 48 hours. There are three particular radiologists that have additional training for reading these scans through Greenville Radiology, and those are the three physicians that read them. They are then interpreted via electronic medical record by the nurse navigator and myself. We have a medical director, Dr. Mark O'Rourke, who is a medical oncologist, and then we work with Dr. James Stephenson who is thoracic oncology surgeon for any abnormalities. There is actually a nodule clinic that meets once a week that is comprised of Dr. Stephenson, our thoracic surgeon; one of the three radiologists we previously described; and a pulmonologist, who, in real-time, review any abnormal scans and make recommendations.
Melanie: What a great multidisciplinary approach, Doug. Give your best advice in these last few minutes for people that are considering lung cancer screening, what do you tell them every day? What do you really want them to know?
Doug: What I really want them to know is if they're still smoking I really want them to stop smoking and I want to assist them in getting into the smoking cessation program that is right for them. Number two, I want them to have the appropriate information to help stratify risk, which, again, is generally based on their years of smoking, pack-years, and other potential co-morbidities. And I want them to understand the potential risks and benefits of the screening exam, and, again, there are risks and benefits to every type of screening exam that we would do looking for different types of cancers.
Melanie: Thank you so much for being with us. It’s great information. You're listening to Inside Health with Greenville Health System. For more information you can go to www.GHS.org. That’s www.GHS.org. This is Melanie Cole. Thanks so much for listening.
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