Photos by Derek Bell
A cough that does not go away or gets worse. Chest pain that is often worse with deep breathing, coughing or increased activity. Coughing up blood or rust-colored spit or phlegm.” These are three of nine symptoms associated with lung cancer as identified by the American Cancer Society. Robbing over 150,000 lives annually, lung cancer, or pulmonary carcinoma, affects one in 13 men and one in 16 women. But the statistics take on new meaning when it is the account manager one cubicle over, your maid of honor who grew up two doors down, your grandfather, your sister, or you. Lung cancer is a merciless bully, stealing away sweet memories and breaking the hearts of loved ones.
Because of the effects of this malignant and prevalent thief, Redmond Regional Medical Center continues to push back against the disease with new and innovative tactics. Lung cancer screening, a low-dose CAT scan designed to identify concerning lung nodules before the onset of symptoms, is one such strategy, albeit a recent
development. Approved for coverage by Medicare and Medicaid as of Feb. 5, lung cancer screening will better arm the medical community in its battle against the deadliest cancer. With screening increasing the likelihood of finding a cancer in a curable stage, a fact supported by the findings of a National Cancer Institute clinical trial, low- dose CAT scans can reduce the disease’s fatality rate by up to 20 percent.
This significant reduction in mortality and the potential to save thousands of lives each year has motivated the team at Redmond Regional Medical Center to develop a Lung Screening Clinic and promote lung cancer screening to the northwest Georgia community. Dr. Darshak Pandya, a Harbin Clinic pulmonologist, leads Redmond’s lung program as medical director; supervises Lisa Acree, Redmond’s nurse practitioner lung navigator and program coordinator; and chairs the program’s Lung Cancer Work Group.
With over 10 years of experience as an oncology nurse practitioner, Acree holds a key role, acting as the program gatekeeper, streamlining care among specialists and supporting primary care physicians. But most importantly, she works to educate, support and advocate for patients throughout their journey.
“Historically, most lung cancers have been diagnosed at later stages, offering patients fewer options,” she says. “Coordinating this program at Redmond gives me the opportunity to promote lung screening and identify high-risk patients before they develop symptoms, enabling us to find these cancers when they are small, treatable and curable.”
According to Acree, The Center for Medicare and Medicaid Services (CMS) defines “high-risk individuals” as current or former 30 pack-year smokers (equivalent to a pack a day for an average of 30 years) between the ages of 55 and 77. Additionally, the individual may not exhibit current symptoms of lung cancer to be eligible for a lung screen. “These folks are essentially healthy, but are at a risk for lung cancer because of their age and lifestyle choices,” she explains.
An essential part of her role is to work with the primary care physician to assess an individual’s eligibility for lung cancer screening and offer a shared-decision making visit prior to the actual screen. The purpose of this visit (included in the cost of the lung screen) is to ensure the individual fully understands the risks and benefits of lung screening and how they will be followed. Additionally, Acree offers support and education to assist with smoking cessation, including access to free classes offered in partnership with The Northwest Georgia Cancer Coalition.
With many diagnostic procedures demanding hours of tests and weeks of waiting for results, lung cancer screening at Redmond is unique in its expedient, patient-centric timeline. “It is the easiest test you will ever have; it takes less than 20 seconds,” says Acree. “Because we have a 24-hour turnaround time, the very next day I can call the patient with results and recommendations. By this point, I have reviewed the data along with a thoracic radiologist and pulmonology.”
By accelerating the transition from aware-ness to action, the patient no longer has to suffer the extended emotional anxiety of anticipating the phone call. “My very first patient went from CAT scan to pulmonary referral in 24 hours,” Acree says. “My second patient went from CAT scan to biopsy in 24 hours.”
Another attempt to reduce patient anxiety is the implementation of new, cutting-edge lung diagnostic technology at Redmond. In the past, smaller lung nodules were only managed through “watchful wait-ing” or close monitoring with imaging. In addition to Dr. Pandya’s supervisory role, he now drives the use of Veran’s Navigational Bronchoscopy, a GPS-type technology de-signed to diagnose certain smaller lung nodules through the airways of the lung and at times, reduce the need for “watchful waiting.”
A two-time breast cancer survivor and the point person for oncology at Redmond Regional Medical Center, Ann Hook is another advocate for the benefits of lung cancer screening. The oncology service line director is passionate about promoting the early detection of cancers. “Cancer screening is very important to me personally,” Hook says. “Due to a screening mammogram, my cancer was found early and cured. When I heard of advances in lung screening, I wanted this same opportunity afforded to all patients at high risk for lung cancer. I wanted it for Redmond and I wanted it for Rome.”
Already, the low-dose CT lung screen is becoming a well-known practice in the war against lung cancer. Before Acree joined Redmond in April 2015, the hospital had only performed six tests since September 2014. However, with many insurance companies now covering lung screening and increasing awareness, June saw 10 screenings for the month, and July saw a record 13 lung screenings.
Already, success stories are echoing from the doors of Redmond. To date, three of 44 lung screens have found lung cancers, all early stage disease. One of these success stories is Angie Robinson. A new lung cancer survivor, she is a huge supporter of lung screening because the technology, in her words, “saved her life.”
“Lisa and Ann came to one of our public health meetings and were talking about the lung screening program,” she shares. “Being a former smoker, I thought this sounded like something I need to consider.” Having lost two friends in the last year to the disease, Robinson understands being symptomatic usually means the cancer has reached an advanced stage. “My screening discovered a small, suspicious nodule on my lung, which the medical team described as the size of a peanut M&M,” she says. “The biopsy revealed the tumor as a stage 1 lung cancer, and I was able to effectively and expediently have it removed.”
Robinson believes the process may seem overwhelming for many, both logistically and emotionally. This is where one of Acree’s roles, patient advocate, became a com-forting reality. “She helped to arrange all of my appointments,” Robinson says. “She went to those first consultations with me. She explained when I did not understand the medical terminology. She made it all so much more comfortable than if I had gone it alone.”
Because the screening intercepted her tumor before it reached an advanced stage, Robinson says she hopes to see screening for all types of cancer in the near future – as awareness can equal future years of quality life.
Never satisfied with the average or the ordinary, the Redmond Regional Medical Center team has ambitious expectations of its Comprehensive Lung Program. “When a patient is given the diagnosis of a lung nodule, anxiety is a given, and quick results are the expectation,” Acree explains. “Our program manages lung screening findings or referred lung nodules to diagnosis or resolution in a collaborative, expedited manner. Our goal is to meet the individualized needs of the patient, every time.”
With the Institute for Health Metrics and Evaluation in 2012 reporting 28.5 percent of men and 22.6 percent of women as regular smokers in Floyd County, compared to a national average of just under 19 percent, lung cancer screening is a must. “Because we live in an area with a large population of people at high risk for lung cancer, Redmond’s Lung Screening Clinic provides the resources needed to support our primary care physicians in the identification, screening and rapid management of these patients,” explains Hook. “Lisa Acree’s role as lung navigator and program coordinator serves to assure as many people have access to this screening as possible.”
For Redmond Regional Medical Center, the goal is saving lives, and for lung cancer, the answer is screening.
“Our community-based physicians have been providing lung cancer patients in Northwest Georgia with excellent, state-of-the-art medical care for decades,” says Dr. Pandya. “Redmond’s Lung Screening and Nodule Clinics now provide the opportunity to screen and diagnose lung cancers in their earliest stages, potentially offering curative solutions to a greater number of individuals. This is exciting! This will save lives!”