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By Derek Raghavan, MD, PhD and Mellisa Wheeler, MHA

When the National Lung Screening Trial (NLST) showed that low-dose CT screening reduced lung cancer mortality among high-risk patients, it raised a pivotal question: How do we bring that screening to patients in underserved, low income and geographically isolated communities?

Patients in these communities have the highest risk of presenting with unresectable lung cancer. But only 1% of them have access to CT screening due to transportation barriers and/or because they don’t have insurance that covers its cost.

Our team at Levine Cancer Institute (LCI) developed an innovative solution: the nation’s first mobile lung cancer screening unit. We launched the unit in 2017 and have used it to screen more than 1,000 patients. And we recently published a pilot study in The Oncologist showing that our “lung bus” expanded screening in high-risk populations, lowered the cost of care and saved lives by catching lung cancers early enough to pursue curative therapy.

Our team at Levine Cancer Institute (LCI) developed an innovative solution: the nation’s first mobile lung cancer screening unit. We launched the unit in 2017 and have used it to screen more than 1,000 patients. And we recently published a pilot study in The Oncologist showing that our “lung bus” expanded screening in high-risk populations, lowered the cost of care and saved lives by catching lung cancers early enough to pursue curative therapy.

Building a Lung Bus

This project reflects LCI’s broader goal of eliminating barriers to top cancer care. In 2016, we asked ourselves how we could better accomplish this for lung cancer patients, and wondered whether we could follow the mobile mammography model. Unfortunately, we found that no one had ever created a mobile lung cancer screening vehicle. So, we decided to build one ourselves.

Thanks to funding from Bristol Myers-Squibb Foundation and the Leon Levine Foundation, we were able to join forces with Samsung Neurologica and Frazier Ltd. to build a 35-foot mobile CT screening unit. The lung bus includes a waiting room and exam table, and its efficient design enables us to complete intake and screening in 30 minutes or less, with results available in 24 to 48 hours. The mobile unit was recently designated as a Screening Center of Excellence by the Lung Cancer Alliance.

An Unusually Diverse Study Population

Members of the LCI team started taking the lung bus to rural and underserved areas across North Carolina in 2017. To ascertain the mobile unit’s impact, we launched a pilot that was open to people over age 55 who smoked or had recently quit. This mirrored the NLST’s eligibility criteria with one key exception: We excluded patients who had Medicare or other health coverage that paid for CT lung cancer screening, because we wanted to focus only on patients (including Medicaid patients) who didn’t have coverage for this test.

In the pilot study, our team scanned 550 people between 55 and 64 with an average pack-year history of 46.1. Fully 70% of participants lived in rural areas, with 20% of participants being black, 3% Hispanic and .05% Native American. This represents a much more diverse population than has been represented in previously published trials.

Uncovering Lung Cancer When It Can Be Cured

Initial screening uncovered lung cancer in 12 participants (2.2%). Six of these participants (58%) had stage 1-2 cancer, while six had advanced disease. The screening also detected suspicious, lung-RADS4 lesions in 38 participants, who are now being regularly followed.

Our team informed each participant’s primary care provider of the results, and we offered cancer treatment at LCI to every participant who needed it, regardless of their ability to pay. The LCI team treated five primary non-small-cell lung carcinomas via surgical resection, and one primary lung cancer and one incidental head and neck squamous cell carcinoma with radiotherapy. A patient with primary kidney cancer underwent surgical resection with curative intent. Patients with metastatic disease were treated, where appropriate, with systemic agents.

Unexpectedly, we also found that 16% of participants had moderate or severe coronary artery disease and 27% showed vascular atherosclerosis; we referred all of those participants for appropriate work-up and/or treatment.

Lowering the Cost of Care

Our study revealed that mobile screening can significantly reduce cost. Uninsured patients in this demographic often present at the emergency room with late-stage lung cancer. At that point, treatment can cost upwards of $2 million but only moderately prolong a patient’s life. Identifying lung cancer earlier means we can use surgery and radiation to cure many of these patients, typically at a cost of less than $100,000 per patient. It’s the ultimate win-win.

Goal: Expand Mobile Screening Nationwide

Another benefit of the mobile approach was that 66% patients who were screened on the lung bus came back for a second annual scan. This indicates that most patients were highly satisfied with the overall experience and understood the importance of screening. Now we’re building on this success by creating a second lung bus and launching a larger, randomized, multicenter study that will further compare hospital-based CT lung cancer screening with mobile screening.

If this study validates our initial results, we believe it will establish our mobile approach as a model that could (and should) be adopted by centers to bring better lung cancer screening — and therefore cures — to many more patients nationwide.

To learn more about our mobile screening program, contact Mellisa Wheeler, MHA, director of LCI’s Disparities and Outreach Program at Mellisa.Wheeler@atriumhealth.org.

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