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From screening to follow-up care

UH lung cancer screening and lung nodule programs aim to improve diagnosis, treatment for at-risk patients

Division of Pulmonary, Critical Care and Sleep Medicine - May 2018

CATALINA TEBA, MD

Division of Pulmonary, Critical Care and Sleep Medicine, UH Cleveland Medical Center; Assistant Professor of Medicine, Case Western Reserve University School of Medicine

Since the results of the National Lung Cancer Screening Trial (NLST) were published in 2011, University Hospitals Cleveland Medical Center has built a robust, multidisciplinary program to screen at-risk individuals for lung cancer and to provide these patients, and those with incidental lung nodules, with ongoing care and follow-up.

LUNG CANCER SCREENING
The NLST randomly assigned 53,454 current and former smokers to undergo either low-dose helical computed tomography (spiral CT) or standard chest X-ray to screen for lung cancer. The participants had no signs or symptoms of lung cancer at the start of the trial.

Over the subsequent seven years of follow up, patients who received the CT scans had a 20 percent reduction in lung cancer mortality than those who received the standard chest X-ray.

Because of the trial, the National Cancer Institute now recommends that adults ages 55 to 74 with a 30-pack year smoking history and who currently smoke — or have quit within the past 15 years — undergo yearly CT scans for lung cancer screening. Screening should stop once patients have been smoke-free for at least 15 years or they have become too fragile to undergo curative treatment if lung cancer is found.

“We’ve screened approximately 2,380 patients since 2011, and have found 65 cases of cancer,” says Catalina Teba, MD, Division of Pulmonary, Critical Care and Sleep Medicine at University Hospitals Cleveland Medical Center.

Once patients enter the screening program, UH incorporates them into its database and our lung cancer screening nurse coordinator follows up to ensure they get any subsequent studies and the annual CT scans.

“It’s important that patients don’t get lost in follow-up,” Dr. Teba says. “Our nurse coordinator also reaches out to patients regarding findings and if they have other follow-up needs.”

UH is trying to spread the word about the importance of screening for high-risk patients, she explains.

“We want physicians to know that UH can help support their patients through screening and, if needed, diagnosis and treatment for lung cancer,” Dr. Teba says. “Smoking cessation is also required as part of the screening program. This helps reduce patients’ risk of lung cancer death even further.”

UH offers lung cancer screening at multiple sites throughout the health system. The scans are read by a thoracic radiologist at UH Cleveland Medical Center. For more information about the lung cancer screening program at UH, contact our lung cancer nurse coordinator, Karyn Markle, RN, BSN at 216-286-9657.

MULTIDISCIPLINARY CARE
Whether clinicians find a nodule or mass through lung cancer screening or incidentally, patients may need additional testing or procedures to make a diagnosis, according to Dr. Teba. Sometimes physicians need to get a sample of the patient’s tissue to determine the etiology of the abnormal lung imaging.

Masses and larger nodules are more concerning when it comes to cancer, especially if the patient is a current or prior smoker. “You can’t always tell by CT imaging,” she says, “you need tissue to formally diagnose lung cancer.”

In addition to screening patients and ensuring proper follow-up, the multidisciplinary team at UH offers advanced diagnostic procedures to obtain tissue samples, says Dr. Teba. Their arsenal of diagnostic tools includes advanced bronchoscopy, endobronchial ultrasound and navigational bronchoscopy to help determine the etiology of lung nodules and evaluate abnormal lymph nodes.

“We work with thoracic specialists: surgeons, oncologists, radiologists and pathologists to help determine the best course of evaluation and treatment for complicated patients,” she notes.

UH also offers pulmonary function testing to evaluate patients for chronic obstructive pulmonary disease and restrictive lung disease. “We have a multifaceted program that cares for patients through the full spectrum of needs, from screening for lung cancer, to nodule diagnosis and treatment,” Dr. Teba says.

 

To refer your patients to the UH lung nodule program, call 216-844-3201. UH staff will coordinate all the required information for a successful patient visit.