Strategies for Expanding CT Screening and Tobacco-Cessation Programs

Strategies for Expanding CT Screening and Tobacco-Cessation Programs

Dr. Christopher S. Lathan, credit Sam Ogden
In 2013, the U.S. Preventive Services Task Force issued its screening guidelines for individuals at high risk for lung cancer.1 The guidelines called for annual screening of low-dose CT for individuals age 55 to 80 with a history of heavy smoking and who currently smoke or have stopped within the past 15 years.

Since then, oncologists have found it challenging to implement lung cancer screening programs, encountering obstacles such as lack of access to appropriate screening facilities and difficulties communicating the value of the screening to patients and primary care physicians. During the Education Session “Tobacco Cessation and CT Screening Recommendations for Patients With Lung Cancer,” to be held on June 4, experts will discuss strategies for overcoming these and other challenges.*

Meet Patients Where They Are

Session Chair Christopher S. Lathan, MD, MS, MPH, of the Dana-Farber Cancer Institute, will focus on outreach efforts to take the screening message to people who need it the most: blue-collar workers, immigrants, and people of color.

“We see patients at a community health center and talk to them about the importance of screening,” Dr. Lathan said. “Then they go to an academic center to receive the screening but can go back to their own health center to get their results. This model has been so successful that we are now expanding to another center.”

In his work out in the community, Dr. Lathan has seen firsthand the importance of engaging primary care providers. “We need to focus our message on getting primary care providers to advocate for this population and to help them see the benefits of CT screening,” he said.

Nonetheless, it is easy for this message to be overshadowed by the “shame and blame” noise in the background—the remorse people feel about having smoked in the first place and the implicit recriminations they sometimes experience. For Dr. Lathan, however, this undercurrent makes his resolve that much stronger. “Patients need to know that we can find lung cancer earlier and treat it successfully,” he said. “Part of the conversation should be about smoking cessation and the value of CT screening.”

[Tobacco control: a long war with a new front]

Speaker Peter J. Mazzone, MD, MPH, of the Cleveland Clinic, will discuss his experiences building a comprehensive screening program at his institution, including the challenges of developing such a program and ways to overcome those challenges.

Dr. Mazzone continues to modify his program, as shown by the recent addition of a counseling and shared decision-making session. The counseling component is designed to inform patients about the benefits and harms associated with lung cancer screening.

To assess the impact of counseling, Dr. Mazzone and his team conducted a small research study. The findings supported the value of education: They showed that counseling upfront added to patients’ understanding of the pros and cons of screening and helped them make more informed decisions.

The Importance of Smoking-Cessation Programs

The third speaker, Irina Veytsman, MD, of PinnacleHealth Cancer Center, will focus on another aspect of cancer care: smoking-cessation programs for patients with lung cancer. Working with patients with all levels of disease—from early, localized tumors to advanced metastatic disease—Dr. Veytsman is involved in a community-based program that has proven successful.

“The program includes counseling and a combination of nicotine products,” Dr. Veytsman said. “The combination helps patients deal with the side effects of nicotine and dependence, and the counseling helps reinforce their determination to stop. Smoking is very addictive, and stopping is not easy.”

Dr. Veytsman added that many of her patients are very motivated to quit and welcome the help the program provides. In addition, from a medical standpoint, smoking cessation offers many advantages. “Chemotherapy usually doesn’t work as well if the patient is still smoking,” she said. “To ensure greater success, we meet with the whole family to explain the program and the importance of their role.”

Dr. Veytsman also advises the family to remove all cigarette-related products from the house and to not smoke in front of the patient. “During the process, we find that family members also stop smoking,” she said.

The session will also touch on insurance issues, as well as which components of smoking-cessation programs may be covered. For the PinnacleHealth program, counseling is free, but the products are expensive. Nonetheless, they are effective and used for good reasons, Dr. Veytsman said, which she will explain in detail during the session.

“The fact is, medications like [varenicline] are not well tolerated among patients undergoing chemotherapy,” she said. “Patients and their physicians need to learn about other treatment approaches that are as effective. Even physicians are not always aware of the reasoning behind the nicotine combination and rely on only one product.”

Smoking cessation programs have the potential to help patients with lung cancer respond better to treatment and have better outcomes overall. “We need to advocate for these patients and raise awareness among primary care physicians about the value of these programs,” Dr. Veytsman said.  

–Marilyn Fenichel

*Program information updated as of March 21. For session time and location information, please refer to the ASCO iPlanner on the Attendee Resource Center.