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Targeting Physician Education

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LOUISVILLE The mortality rate for lung cancer in Kentucky is 50 percent higher than the national average. The state ranks second in the nation in number of adult smokers, and first in teenage smokers and pregnant women who smoke. Lung cancer is clearly a major health problem in Kentucky, and yet thousands of lung cancer patients are not pursuing treatment.

“The sad fact is 30 percent of lung cancer patients in Kentucky are not being treated for lung cancer,” says Goetz Kloecker, MD, MBA, MSPH, FACP, co-principal investigator of the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative and director of the Lung Cancer Multidisciplinary Clinic at the James Graham Brown Cancer Center. “That’s thousands of patients per year that are not being treated, and that includes early stage cancer, not just advanced cases.”

While some may argue that Kentucky residents in rural areas have a difficult time gaining access to appropriate treatment, Kloecker says the data does not support that theory. “What we’ve found from the cancer registry data, and this is very surprising, is that there is not a clear urban-rural split among patients who do and do not receive treatment,” he states.

“The Kentucky LEADS Collaborative is a statewide effort to reduce lung cancer mortality and morbidity in Kentucky. It is funded by a three-year, $7 million grant from the Bristol-Myers Squibb Foundation. Currently in its third year, the partnership of the University of Louisville, University of Kentucky, and the Lung Cancer Alliance includes a focus on the role primary care providers (PCPs) play in patients seeking screening and treatment. The Collaborative has three major components: provider education, prevention and early detection, and survivorship care.

Provider Education

Kloecker believes that the main barriers to lung cancer care are mindset and information. That is where the Kentucky LEADS Collaborative comes in.

In March 2015 the LEADS Collaborative convened a Primary Care Task Force made up of 22 members representing multiple physician and advanced provider specialties, insurance providers, health systems, academic medicine, and state organizations to examine lung cancer care across the continuum and identify strategies for improvement. The Task Force created an action plan with five broad recommendations: tobacco cessation, lung cancer screening, management and treatment, survivorship, and continuing education.

The LEADS Provider Education Component, headed by Kloecker and Connie Sorrell, MPH, is a multi-pronged approach coordinated by the Kentucky Cancer Program at U of L that seeks to increase provider knowledge about lung cancer prevention, detection, treatment, and survivorship through a continuing education program. The approach is threefold: delivery of practice toolkits to primary care offices (also known as academic detailing), group presentations, and a free interactive online CME/CE course (

“The most exciting part to me is working to educate primary care physicians about lung cancer on a broad spectrum,” says Kloecker. “We feel that if primary care physicians knew more about the treatment possibilities, the new treatments that are much more effective and much more easily tolerated, they would encourage their patients to do them.”

Early Detection

The new standard of care in lung cancer detection is low-dose CT screening for patients at high-risk. The continuing education offerings of LEADS make PCPs aware of which patients are eligible and how to conduct the CMS-required shared decision making, including smoking cessation counseling. After the screening, it is important that patients are screened annually, and that they are aware of the results of their screenings and follow up as necessary.

“The reason this is the new standard of care is because the National Lung Screening Trial showed twenty percent fewer lung cancer deaths for people screened with low-dose CT than a with chest x-ray,” states Kloecker. “If everyone follows the lung screening guidelines, you could actually cure many more patients because you would find the lung cancer early enough for the lung to be resected, or to perform radiation for those patients who cannot tolerate resection.”

Lung Cancer Survivorship

“Fortunately, more and more patients survive lung cancer, and with screenings, we hope that number will grow exponentially,” says Kloecker. There are many issues to be faced by lung cancer survivors, such as general worries and uncertainty, health effects of the cancer, and health effects of the treatment. The Kentucky LEADS CME offerings highlights these survivorship concerns and provides information about free patient resources.

Join the Effort

While the CME offerings are geared toward primary care, any health care professional is welcome to participate. As LEADS continues its final year of the grant, the program is seeking to increase the number of physicians, nurse practitioners, and physician assistants participating in the online CME course, available in 20-minute individual segments, and to begin evaluating the effectiveness of the program’s interventions. “Now that we’re in our third year, we are looking to see the positive effects of our efforts,” Kloecker says. “We’re going back to healthcare institutions to see if the screening rates, treatment rates, and cessation rates have picked up, and we hope to see an improvement in the mortality rate over the next few years.”

Looking ahead, Kloecker and his team want to continue the work, saying, “We are hopeful that the grant will go beyond three years. We’re also applying to other organizations for funding for related projects that can improve Kentucky’s lung cancer status.”

The LEADS Provider Education Component includes messaging and tools designed to help PCPs:

Find lung cancer at an early, more treatable stage with new screening recommendations.
Have more impact on smoking behavior in less time.
Have better “Shared Decision Making” discussions.
Enhance continuity of care by better information exchange with cancer specialists.
Ensure that patients are offered opportunities for more effective, less invasive cancer treatment.
Better address patient survivorship needs.