Lung Cancer Screening: One Size Does Not Fit All

Gregory A. Hood, MD; Laura Lee Hall, PhD


January 17, 2019

In This Article

Practical Strategies for Primary Care

A collaborative approach between practice staff and physician-driven protocols improves adherence to the guidelines. The protocol at one of the author's practice (Laura Lee Hall, PhD) was developed using a lung cancer screening checklist developed by the Kentucky LEADS collaborative. This allows staff at her facility to identify eligible patients at each encounter and offer assistance.

A planning meeting between key physicians/providers, administration, and clinical staff to review best practices for effective screening methods is critical.[9] Personalizing the plan to your patient population and practice assets is highly recommended.

Key steps include:

  1. Familiarize yourself with the screening recommendations, especially those followed by the Centers for Medicare & Medicaid Services and your most commonly represented insurer, which will often vary.

  2. Review lung cancer screening facilities in your area and/or organization. Cost may vary substantially. Don't forget the potential impact of transportation costs for your patient.

  3. Establish a clear office protocol for identifying prospective patients, tracking results, and ensuring timely as well as annual patient follow-ups.

  4. Identify and coordinate with local resources to provide smoking cessation and additional patient support.

  5. Know your referral resources when results require further evaluation, including pulmonary medicine, cardiothoracic surgery, and oncology. Track to ensure that you are receiving full and appropriate communication.

  6. Emphasize to patients that:

    1. Screening may detect a case of cancer earlier that has a better chance of being at a curable stage.

    2. The practice has a protocol to facilitate the initial screening as well as appropriate follow-up measures, including:

      1. Coordination of any needed follow-up care through a patient navigator employed at an experienced screening facility;

      2. Established lines of communication and referral to medical and surgical oncologists; and

      3. Appropriate follow-up visit(s) with the primary care office to discuss results and concerns, and to schedule on-time future physical exams and screening.

Early detection combined with new surgical approaches and newer medication options translates into real hope for many patients. On the basis of our own local experience, we would argue that the changes in response and survival rates seen will rewrite the textbooks for at least some subtypes and stages of lung cancers.

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