Background: Lung cancer has the highest mortality of all tumor sites, with more deaths than breast, colon, and prostate cancers combined.1 The national average for early-stage (I or II)2 diagnosis is currently 23%.3 Beginning in 2017, select facilities in HCA Healthcare’s North Florida Division implemented thoracic-focused initiatives to identify lung cancers and provide care coordination for earlier intervention.
Objectives: To shift lung cancers to early-stage diagnosis, consequently improving overall patient outcomes.
Methods: Multidisciplinary, quarterly thoracic workgroups were established in Ocala and Gainesville to identify gaps, set programmatic goals and quality initiatives, and oversee execution.
HCA’s Lung Nodule Program was established in Ocala and Gainesville in 2019, identifying incidental lung nodules and providing care coordination to ensure timely follow-up postdischarge. Care coordination was also established for patients receiving low-dose CT lung screenings with an LRADS score of 3 or 4.
Multidisciplinary, thoracic conferences were established with radiology, pathology, pulmonology, cardiothoracic surgery, and medical and radiation oncology reviewing cases for diagnostic and treatment planning.
Gap analyses of physician talent, equipment, technology, and care coordination identified strategic opportunities to fill gaps, expand service, and provide education in these communities. Identified gaps were prioritized and filled in several facilities.
Multiple community outreach and education events targeted healthcare providers and community members for education on the Lung Nodule Program and criteria for low-dose CT lung cancer screening. Education was presented in person and virtually, beginning in 2019, with community reach expanded further in 2020 during the COVID pandemic with Facebook Live presentations.
Results: Excluding facilities that had 50 or fewer early- stage lung cancer diagnoses over the reporting period, cancer registry data reported early-stage lung cancer diagnoses in the North Florida Division at 28.03% in 2017, 29.14% in 2018, and 28.75% in 2019, well above the national average of 23%. Hospital facilities included in these data are located in Tallahassee, Fort Walton Beach, Panama City, Gainesville, Ocala, Kissimmee, and Pensacola.
Specifically for Gainesville and Ocala, facilities that had an established Lung Cancer Workgroup and Lung Nodule Program in 2019, Gainesville’s early-stage lung cancer diagnoses were 45.88% in 2017, 42.42% in 2018, and 45.81% in 2019, and Ocala’s early-stage lung cancer diagnoses were 18.59% in 2017, 21.92% in 2018, and 31.54% in 2019.
Conclusion: HCA Healthcare’s thoracic-focused programmatic development and implementation were successful in identifying early-stage lung cancers at a significantly higher rate than the national average. This promising trend validates best practices of utilizing multiple health system access points for early lung nodule identification, early-onset care coordination, multidisciplinary approach to diagnosis and treatment, physician talent with a high skill set in thoracic intervention, staying current with diagnostic tools and technology, and community outreach and education.
Three additional facilities in the division launched the Lung Nodule Program in 2020 and 2021. As gaps continue to be filled, it is expected that thoracic program growth will continue to yield stage shift toward early-stage diagnosis in these facilities; additional analysis will be required to confirm this hypothesis.
References
- American Cancer Society. Key Statistics for Lung Cancer. How Common is lung cancer? www.cancer.org/cancer/lung-cancer/about/key-statistics.html. 2021.
- LUNGevity Foundation. Lung Cancer 101. www.lungevity.org/for-patients-caregivers/lung-cancer-101. 2021.
- American Lung Association. State of Lung Cancer 2020: Florida. www.lung.org/research/state-of-lung-cancer/states/florida. 2021.
