Erika Schneider, PhD1; Amie Mendez2; Tiffany Dean2; Natalia Rodnova, MS1; Parthiv Mehta, MD3
1Eon Health; 2Lifepoint Health; 3UroPartners Cancer Treatment Center Glenview
Background: Breast cancer is the most common cancer in women, and if detected early—before the onset of symptoms— has an excellent prognosis. While rare in men (occurring in 1 in 726), breast cancer has a death rate doubling that of women (~20%), according to the American Cancer Society.
Objectives: Lifepoint Health and Eon Health have collaborated to conduct a pilot study evaluating the frequency of breast lesions incidentally identified in radiology reports. These incidental findings are from exams that were conducted outside of a screening program or explicitly ordered to follow a concerning mammogram.
Methods: Approximately 5.6 million radiology reports acquired over 18 months from 65 Lifepoint Health facilities were analyzed. These reports were from hospital-based imaging and included all modalities and anatomic regions (eg, not specific to the chest or breast). The Computational Linguistics (CL) model was created to identify breast and lymph node findings and has a >96% accuracy, with positive and negative predictive values of 95% and 97%, respectively, based on 2 people annotating over 1000 rec-ords. The CL model was run on all imaging reports, with positive results classified based on imaging modality and anatomy as known (eg, breast imaging or follow-up) or unknown (eg, potential incidental findings). The unknown findings were then categorized by patient age and gender, as well as by the exam imaging modality and anatomy based on which they were identified.
Results: Approximately 506,500 (9%) exam records mentioned breast somewhere in the report. Among these exams, only 32,693 (6.45%) positive measurements of breast lesions were identified by the CL model. The majority of these exams were screening or diagnostic mammograms, ultrasounds of the breast or axilla, or breast magnetic resonance imaging. Unknown (“incidental”) findings accounted for only 5.2% of positive breast lesions, and 86% were identified in CT exams of the neck, chest, and abdomen. Most (91.6%; n=1544) of the unknown breast findings were identified in women, and 8.4% were identified in men. Of these women, 931 (55.3%) were within the American Cancer Society’s average risk breast screening age bracket of 45 to 75 years, with 21.4% above and 14.6% below the range. In other words, >50% of patients with incidentally found breast lesions did not qualify for breast screening.
Conclusion: The incidentally identified breast lesions in all males and females outside screening programs would likely not have been found until clinical symptoms appeared. Our findings support the need to linguistically identify and track follow-up care for patients with incidental breast lesions reported via non–breast-imaging modalities. As a result, Lifepoint Health has begun rolling out a systemwide initiative across 58 facilities to track and manage all incidentally identified breast lesions, in addition to their breast cancer screening program.
Breast cancer statistics. Cancer.org. Accessed September 5, 2024. www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
Key statistics for breast cancer in men. Cancer.org. Accessed September 5, 2024. www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html
Meller MT, Cox JEM, Callanan KWR. Incidental detection of breast lesions with computed tomography. Clin Breast Cancer. 2007;7:634-637.
Poyraz N, Emlik GD, Keskin S, Kalkan H. Incidental breast lesions detected on computed thorax tomography. J Breast Health. 2015;11:163-167.
Austin Matt-Beal1; Caroline Mulligan1; Margo Leighliter1; Keyri Lopez-Godoy1; Jessica Roark1; Sarah Knight1; Lindsay Hauser1; Wendy Cohn2
1University of Virginia Comprehensive Cancer Center, Charlottesville, VA; 2Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA
Background: The University of Virginia’s Comprehensive Cancer Center serves Virginia communities through a patient navigation program that identifies community members who may be due for cancer screenings through local outreach and partnerships. Our cancer screening team developed a Cancer Screening Navigation Tool (CSNT) to capture individual screening recommendations, barriers to care, resources to address these barriers, and documentation for all interactions with community members.
Objective: The CSNT was developed to provide the patient navigation team with the means to document all facets of a community member’s cancer screening navigation journey, and to run reports highlighting key program metrics. In doing so, the CSNT provides a platform for both navigation documentation and program evaluation.
Methods: The CSNT was developed by navigators for navigators. Instead of outsourcing the CSNT’s development to IT, the University of Virginia’s cancer screening navigation team worked together to build this project using real-world insights from field experience.
Because our patient navigation program does not use any electronic medical records, we chose to build the CSNT using REDCap, a “secure web application for building and managing online surveys and databases and is specifically geared to support online and offline data capture for research.”1 This allows the CSNT to focus on the following core functions: determining which cancer screenings a community member may need (according to US Preventive Services Task Force and American Cancer Society guidelines), documenting all community member interactions, identifying barriers to screening, indicating which resources were provided to address these barriers, and tracking community member navigation over time (from days to years). In addition, because the CSNT is housed in REDCap, our patient navigators can use this tool via tablet or computer in the field.
Results: The development of the CSNT resulted in a comprehensive documentation instrument for cancer screening patient navigators, and one that does not require information from an electronic medical record. Important highlights of this REDCap project include a 1-page community member dashboard that includes an overview of an individual’s entire navigation journey, data tracking for key metrics related to community patient navigation, and the ability to create reports that navigators can use to guide and inform their navigation efforts.
Conclusion: The results from our CSNT program are very promising. The mobile nature of the CSNT allows our navigators to document key metrics across 87 counties throughout central, southern, and western Virginia, providing us with a platform to address local health disparities directly in the communities we serve.
Data from the CSNT show that our navigation team provided resources for some of the most significant barriers to care in these communities, including 96% of community members who had no current primary care provider (PCP); 69% of community members who had financial and/or insurance concerns; and 91% of Hispanic community members who did not have a PCP.
Our team’s experience with the CSNT demonstrates that it provides health systems with increased flexibility to deploy patient navigators throughout local communities, with the goal of providing cancer screening awareness and navigation services outside of the clinical setting.
Rochelle Waddell, RN; Lenae Stacy
Appalachian Regional Healthcare, Hazard, KY
Background: As of 2019, Appalachian Regional Healthcare (ARH) had low lung cancer screening rates for its eligible population. Barriers identified were a lack of streamlined processes and education with the healthcare team and community. To address the low screening rates, ARH formed a multidisciplinary team to develop a comprehensive early detection lung program.
Objectives: To increase lung cancer screening uptake by educating healthcare team members, with an emphasis on primary care and streamlining the ordering and follow-up process. Providers can then have the shared decision-making discussion with their patients, thereby increasing baseline and annual referrals to lung cancer screening.
Methods: After creation of the multidisciplinary team, which included physician champions and navigators, it was decided to educate other healthcare team members by using physician liaisons and navigators because they had existing relationships among the primary care providers (PCPs). Education techniques included grand rounds, medical staff updates, and lunch and learns. In addition to PCP education, another focus has been on community outreach, including participation in health fairs and other community events.
Following this, the program’s goal was to increase lung cancer screening uptake in 2020 and evaluate yearly thereafter. Nodule review discussion was also used to help build the trust of the PCP in determining follow-up. After 1 year, it was determined that an additional navigator and program management software were necessary. By 2023, with the addition of Thynk Health software, both the annual and baseline screening volumes increased, and an additional navigator was needed.
Results: Although the ARH lung cancer screening program began in 2016, the multidisciplinary team focused on an initiative to increase lung cancer screening uptake beginning in 2020. After program planning, adequate staffing, electronic medical record, direct ordering, and program management software were implemented in 2022, the program results were evaluated.
By 2022, a total of 1571 outreach touchpoints had been made by physician liaisons and navigators, including a combination of PCP clinic visits, grand rounds, and medical updates. By 2023, there were 2409 touchpoints. Overall, 2245 lung cancer screening exams were completed, 749 and 1496 of which were annual repeats and baseline exams, respectively.
In 2023, there were 3065 lung cancer screening exams completed, 1043 and 2022 of which were annual repeats and baseline exams, respectively. This represents an increase of 39.3% and 35.2% in annual and baseline screening volumes, respectively, with an overall increase of 36.5%.
Conclusion: Navigators are a trusted source within the PCP community and among individuals at high risk for lung cancer. Ongoing provider education, refining the scheduling and ordering processes, and reducing barriers to follow-up appointments are needed to increase lung cancer screening uptake.
Additionally, increasing community awareness of lung cancer screening through outreach presentations and health fairs will be ongoing. By focusing on PCP and community education, lung cancer screening rates are expected to continue to increase.
Collar N, O’Neill B, Parham K, et al. Identifying Best Practices and Gaps in Early-Stage Lung Cancer: From Screening and Early Detection Through Resectable Disease Treatment. Accessed September 5, 2024. www.jons-online.com/issues/2022/february-2022-vol-13-no-2/4384-identifying-best-practices-and-gaps-in-early-stage-lung-cancer-from-screening-and-early-detection-through-resectable-disease-treatment
Megan E. Templo, BSN, RN, CNOR, CBCN, HWNC-BC; Kathryn A. Pratt, BSN, RN, OCN, CBCN, ONN-CG; Michelle Luong, BS; Sayoni Lahiri, MS, CGC; Sara Pirzadeh-Miller, MS, CGC; Rachel Wooldridge, MD, FACS
University of Texas Southwestern Medical Center, Dallas
Background: Approximately 10% of cancers are hereditary, caused by underlying pathogenic variants (PVs).1 Improved survival among members of this population who receive recommended cancer risk reduction/prevention options has been described.2-4 In their comprehensive literature review, Raspa et al highlighted the challenges with providing genetics care, with the need to expand access to genetics services.5 Our institution launched a multidisciplinary clinic for individuals at an increased risk for cancer due to a known PV.
Objective: The GCPC mission is to prevent and reduce cancer incidence through education, care coordination, implementation of longitudinal cancer risk reduction efforts, promotion of cascade testing, and research. This clinic meets an established need for the institution’s high-volume cancer genetics program with >8000 PVs identified.
Methods: Patients are seen annually by a genetic counselor, advanced practice provider or physician, and genetic nurse navigator (GNN). Before the appointment, the GNN extensively reviews the patient’s chart, personal and family history, and status of recommended screenings, and confirms genetic test results. Each case is discussed in a multidisciplinary conference prior to the patient’s clinic visit along with pertinent updates, plan of care, and potential barriers to care. National Comprehensive Cancer Network guidelines and recommended screenings are shared with the patient and each of the patient’s relevant providers. The GNN follows up with patients after they visit the clinic to answer any questions and facilitate referral scheduling or cascade testing of family members. A retrospective chart review was conducted, and descriptive statistics were calculated using the REDCap secure web platform. Analysis was determined to be nonregulated research through the Institutional Review Board.
Results: From January through December 2023, a total of 156 patients attended the GCPC—81% (n=127) were female; 65% (n=99) were aged <50 years; 99% (n=154) spoke English; and 82% (n=128) were White. Almost 100% (n=155) of participants reported a family history of cancer, and 74% (n=115) were previvors. Patients residing in 30 unique counties were served across 4 states.
We saw 28 unique genes with 65% (n=102) in ATM, BRCA1, BRCA2, CHEK2, and PALB2, and 5% (n=8) of patients had 2 PVs. Among 19% (n=31) of patients who underwent updated genetic testing because of their GCPC visit, 16% (n=5) had a newly identified PV, with 10% (n=3) considered clinically actionable. There were 223 referrals and orders placed, and 1023 educational materials provided.
Patient Satisfaction Survey feedback has been very positive. All respondents answered, “Yes, definitely” when asked whether they feel empowered to make healthcare decisions as it relates to their cancer risk after attending their GCPC appointment.
Conclusion: Patient volumes have continued to grow. In September 2023, a second clinic type was added to include a gastroenterologist specializing in hereditary colorectal cancer. The GNN has played an integral role within the multidisciplinary team in the development and ongoing adjustments to the GCPC. Future areas of study include evaluating patient adherence with recommended guidelines and downstream revenue generated by referrals.
Christin Brown, MBOE, RN, LSW, OCN; Kathy Magee, MSN, CNP-BC
Columbus Cancer Clinic, OH
Background: The rate of breast cancer incidence among Black and White women in the United States is close, but Black women are 42% more likely to die from this disease. Poverty is a critical social player driving health disparity. Women with low incomes have significantly lower rates of breast cancer screening, greater probability for late-stage diagnosis, and very often receive inadequate and disparate treatment.
Objective: To describe a free cancer screening clinic model and its impact on enrollment in the National Breast and Cervical Cancer Program (BCCP), cancer screening, care coordination, and addressing barriers to care/social determinants of health.
Methods: With support of a grant from the Ohio Department of Health, LifeCare Alliance Cancer Services hired a community health worker to perform targeted outreach and BCCP enrollment in areas with the highest needs, densely populated with African American/ Black women, and uninsured or underinsured. The clinic infrastructure supporting the community health worker included a nurse practitioner, a medical coordinator, a case manager, and a mammography technologist who provided coordination assistance.
Over the course of 2 years (July 1, 2022-June 30, 2024), the Ohio Department of Health (ODH) evaluated our model of care for outcome measures monthly. Based on development of new partnerships/referral sources, clients engaged for breast and/or cervical cancer screening, enrolled in BCCP, and engaged for linkage to a medical home, and we were able to see significant trends in addressing social determinates of health. Clients who did not qualify for BCCP benefited from donor funding.
Results: All women are screened for BCCP enrollment when scheduling their breast or cervical cancer screening at LifeCare Alliance. Interpreters are provided when needed. The team works together to coordinate the care between the patient, ODH, and the provider to address all barriers to care. Per ODH, in the 2022 to 2023 fiscal year, LifeCare Alliance successfully navigated and screened 13.2% of all BCCP enrollments for breast and cervical cancer in Ohio. LifeCare Alliance has the highest enrollment data of approximately 360 BCCP providers.
Conclusion: LifeCare Alliance outpaced all other entities in Ohio, delivering care to those who typically have lower access. High-touch models of care, with attention to awareness, care access, and insurance coverage, can lead to improved rates of breast and cervical cancer screening.
Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. Adv Exp Med Biol. 2019;1152:31-49.
Cara Horner1; Michael Velasquez, BSN, RN2; Nicole Santapola, BS2; Andrew D. Nguyen2
1Orlando Health Colon & Rectal Institute, FL; 2Orlando Health Cancer Institute, FL
Background: Colon cancer is the third leading cause of cancer deaths among men and women in the United States, and rates among both sexes aged ≤55 years are increasing. It is now the first cause of cancer death in men and the second cause in women aged <50 years.
Objective: To engage, educate, and evaluate the Orlando community and Orlando Health team members by means of a guided, inflatable colon tour with pre- and post-tour surveys to measure knowledge and increase decision-making toward screening.
Methods: Orlando Health Cancer Institute partnered with WellFlorida Council, a not-for-profit health council in North Central Florida, to provide 2 colon health exhibits at 2 of the largest hospitals at Orlando Health in Orange County. Orlando Regional Medical Center, downtown, and Health Central Hospital in Ocoee were selected sites for a 4-hour exhibit on 2 different dates in March.
A 12-foot tall, 10-foot long, blow-up section of the colon was used to provide visual detail, noting healthy tissue, protruding polyps, and progression of cancerous tissue to advanced cancer. WellFlorida staff provided tours at both locations using pre- and post-tour surveys to assess knowledge and increase decision-making for screenings starting at age 45 years.
Along with knowledge about colon health and cancer, the tests captured demographics including race, ethnicity, age, and gender. Participants visited team members from the Orlando Health Colon & Rectal Institute to gather information and schedule their colonoscopies.
Results: The inflatable colon exhibit attracted 72 total participants over 2 tours from a diverse community surrounding Orlando, including team members from within each hospital.
Approximately 25% of the participants were Black/African American and 30% of the attendees were Hispanic/ Latino or of Spanish origin. More than 50% of those who visited the colon were aged 18 to 39 years and 38% were aged 40 to 49 years.
Participants grew in their knowledge of the colon, colon screening, and colon cancer.
When comparing results of pre- and post-tour surveys for both tours, the greatest increase of knowledge was in understanding malignant polyps and learning about common colon cancer screening tests. A total of 5 patients eligible for a colonoscopy were scheduled on site.
Conclusion: The inflatable colon is a visual tool attracting engagement from people, especially those aged <40 years, resulting in an increase in knowledge of prevention, colon cancer, and colon cancer screening options. Information on screening options and the ability to schedule colonoscopies on-site for those who meet the requirements was important to include at the events.
Due to the success of the colon health exhibit and inflatable colon tours, Orlando Health is purchasing their own inflatable colon. A committee has been established to work on an annual plan with targeted demographics to educate the public and other hospital locations next year.
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