5 Ways Sylvester Addresses Lung Cancer Burden
Article Summary
- Sylvester Comprehensive Cancer Center is working to alleviate the impact of lung cancer on individuals in South Florida and beyond.
- Sylvester offers patients the option to self-refer for lung cancer screenings through MyChart.
- Sylvester’s virtual clinics invite patients to meet with their entire care teams during virtual calls.
Lung cancer is the most lethal type of cancer in the United States, as reported by the American Cancer Society. In response, the Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, is working to alleviate the impact of lung cancer on individuals in South Florida and beyond.
“Among the most important things that we do at Sylvester to reduce lung cancer burden has been to take away barriers to prevention, screening and care,” said Erin Kobetz, Ph.D., M.P.H., associate director of community outreach and engagement at Sylvester and its John K. and Judy H. Schulte Senior Endowed Chair in Cancer Research. Dr. Kobetz, along with several other colleagues, has provided a look at five ways Sylvester is improving outcomes for those it serves.
Empower People to Self-refer to Screenings
Individuals at risk for lung cancer can schedule the recommended annual CT scan, which takes about a minute and is often covered by insurance, through the Wellness Passport without needing to see a physician first.
Those at the highest risk of developing lung cancer are usually between the ages of 50 and 80 and are currently smoking cigarettes or have quit within the last 15 years. They have a smoking history that is equivalent to a pack a day for 20 years or half a pack a day for 40 years, according to Nicole Gay, APRN, who orchestrates lung cancer screenings and helps patients understand their options to navigate care through Sylvester’s Lung Cancer Screening Center.
“Individuals who qualify can make an appointment right through their MyUHealthChart,” Gay said. “If everything looks normal, we follow up in one year. In the case of a suspicious finding, we help the patient navigate to the correct area for care.”
Sylvester Chief Medical Informatics Officer Maritza Suarez, M.D., an associate professor of medicine at the Miller School, said the process eliminates one of the biggest hurdles to getting screened.
“Instead of the patient waiting to see a physician to make an appointment for a cancer screening, we empower patients, on their own time, to view which screenings they have coming up and schedule their preventative care,” Dr. Suarez said.
Top-rated Surgical Care
Surgical outcomes differentiate the quality of lung cancer care at Sylvester, according to cardiothoracic surgeon and Sylvester researcher Nestor Villamizar, M.D., an associate professor of surgery at the Miller School.
“Our program has been awarded the highest possible, three-star rating for lung cancer surgery outcomes by the Society of Thoracic Surgeons (STS). This puts Sylvester among the elite for general thoracic surgery in the United States and Canada,” Dr. Villamizar said.
STS’s General Thoracic Surgery Database (GTSD) is the largest and most robust clinical thoracic surgical database in North America, with more than 616,000 general thoracic surgery procedure records and about 1,000 participating physicians. About one-third of GTSD participants, including the Miller School, voluntarily report outcomes.
“We are among a small percentage of hospitals in North America to have significantly lower rates of complications, including death from lung cancer,” he said.
Virtual Clinics to Prevent Care Delays
Sylvester’s virtual clinics invite patients to meet with all of their providers, including surgeons, radiation oncologists and medical oncologists, to discuss the next steps in care.
“Lung cancer care is so complex and can be difficult for patients to navigate. They often have to see several different types of physicians, who then separately discuss the patient’s care before presenting a care plan. This can take months,” Dr. Villamizar said. “We expedite the staging of cancer, meet about the patient’s case during tumor boards and have a virtual meeting with the patient with all the information needed to help the patient make an informed decision about next steps during the virtual call with the patient and family.”
Dr. Villamizar and colleagues are studying the care concept, but he estimates that patients save at least a month of waiting with the approach.
Snuffing Out Smoking
Smoking causes from 80% to 90% of lung cancer deaths.
The Miller School is involved in the Florida Department of Health’s tobacco training and cessation program, Tobacco Free Florida. Sylvester providers refer tobacco users to the program and the University of Miami’s Area Health Education Center (AHEC) helps them quit.
“We contact tobacco users to enroll them in the program, offering free in-person counseling and a free four-week supply of nicotine replacement therapy,” said Asma Aftab, M.D., M.P.H., a research assistant professor and director of the UM AHEC in the Miller School’s Department of Family Medicine and Community Health.
Dr. Aftab and her team of certified tobacco treatment specialists make referrals to Sylvester’s lung cancer screening program and vice versa.
About 90% of those contacted participate in in-person counseling. The quit rate has been between 40% and 45%, which is much higher than benchmarks that hover around 20%, according to Dr. Aftab. About 5,000 people come through the program each year.
“We’ve started to train community health workers to refer eligible people to lung cancer screening and smoking cessation during home health visits,” Dr. Aftab said.
Leading Research to Improve Quality of Care, Quality of Life
Sylvester offers more cancer clinical trials than any other hospital in the region, including studies looking at new combinations and targeted approaches to lung cancer treatment and novel, genetic testing-directed therapies.
In a study published in the Journal of Thoracic and Cardiovascular Surgery Open led by Dao Nguyen, M.D., Sylvester Thoracic Cancers Group co-lead and chief of the Thoracic Surgery Section and the B. and Donald Carlin Endowed Chair of Thoracic Surgical Oncology at the Miller School, researchers addressed an important concern among patients undergoing lung surgery for cancer: pain after the operation.
“One way of addressing that is adopting a minimally invasive surgical approach, such as video-assisted thoracoscopy surgery (VATS) or robotic thoracoscopy surgery (RATS), which we initiated in 2009 and 2012, respectively,” Dr. Nguyen said.
Such approaches have been shown to significantly reduce pain after surgery. They are associated with shorter hospital stays and fewer complications while improving patient comfort compared to the open chest surgery.
“To further reduce pain and reliance on addiction-prone opioids for pain control following chest surgery (even with VATS or RATS), we developed and implemented a postoperative care protocol called Enhanced Recovery After Thoracic Surgery (ERATS) in 2018, which has been shown to significantly reduce not only pain but also the need for opioids postoperatively,” Dr. Nguyen said.
Dr. Nguyen and colleagues optimized this protocol in 2020.
“We have shown that with this new, optimized ERATS protocol, 65% of our patients never need opioids in the 30-day postoperative period, and 30% of our patients were successfully discharged home the day after having a major lung resection for lung cancer,” he said. “The median hospital stay after lobectomy or segmentectomy is two days. Eighty-five percent of our patients experience no postoperative complications, and the risk of death after a major lung cancer operation at our institution is 0.4%,” which is two to three times lower than the national average.
Tags: cancer screening, Dr. Asma Aftab, Dr. Dao Nguyen, Dr. Erin Kobetz, lung cancer, lung cancer surgery, minimally invasive surgery, smoking cessation, Sylvester Comprehensive Cancer Center, tobacco cessation, UHealth Virtual Clinics