Background: Lung cancer is the leading cause of cancer death, with 81% of lung cancer diagnoses directly linked to smoking. Nursing administration for the cancer center felt that screening for lung cancer was important and something that the lung cancer navigator should facilitate. Lung cancer screening was available from 2013 to 2015 at a $300 flat, out-of-pocket fee. Not surprisingly, there were very few people screened. However, in 2015 this changed. When insurance companies began covering lung cancer screening, the interest in lung cancer screening increased, and the job of developing an effective screening program became more complicated.
Objectives: The goal of early detection and increased curative treatment of lung cancer through screening high-risk individuals will impact the health of our community in a positive way. We utilize a nurse navigator as the coordinator for the lung cancer screening program in our hospital-based community cancer center.
Methods: Key components of this program were to market it to primary care providers as well as to the public, arrange for a shared decision-making visit, schedule the low-dose CT scan, ensure insurance authorization, make lung cancer screening affordable regardless of copay/deductible/uninsured status, manage reporting results to patients and referring providers, managing annual and short-term follow-up imaging, report lung screening information to the Centers for Medicare & Medicaid Services, and manage positive results. One of the key benefits of having a nurse navigator in this role is the management of positive results. There are valid concerns related to overdiagnosis, complications from evaluation of false-positives, and the anxiety of the evaluation of positive results. The nurse navigator is able to utilize clinical experience and a multidisciplinary approach to evaluate positive results. This results in fewer unnecessary procedures, less anxiety, and improved outcomes.
Results: The number of lung screenings have grown greatly over the past 4 years. So much so, that in January 2018, a second nurse navigator was hired to allow the original navigator to focus exclusively on lung cancer screening. This resulted in a 44% increase in initial lung cancer screening participants in 2018 compared with 2017. Overall, this 238-bed hospital-based community cancer center has had 965 total lung cancer screening participants, most of whom continue to have annual lung screening scans. Among these patients, there have been 39 lung cancer diagnoses, with only 6 diagnosed at stage III or IV.
Conclusion: The oncology nurse navigator is uniquely well suited to market, coordinate, and manage positive findings of a lung cancer screening program.
- American Cancer Society. Lung Cancer Prevention and Early Detection. www.cancer.org/cancer/lung-cancer/prevention-and-early-detection.html.