Less time, less worry for patients

 

Lung cancer screening takes time. And that time often turns into stress for patients and their loved ones.

That’s one reason that Dr. Amit Mahajan is enthusiastic about the new Inova Saville Cancer Screening & Prevention Center. At Saville Center, physicians like Mahajan are finding ways to screen for lung cancer in less time — and keeping patients happier.

“In a lot of ways, we’ve just centralized all of the screening capabilities and preventative capabilities for lung health into one place in Saville, as opposed to sending them to different practitioners all over the system,” said Dr. Mahajan, the medical director of interventional pulmonology and the complex airways disease program at Inova Fairfax Medical Campus. “Honestly, everything just moves as quickly as possible with lots of flow.”

Patients benefit from the efficiency whether they come for lung cancer screenings because they are in a high-risk category, or because a nodule was detected in their lungs during a different procedure.  

In both cases, tests, follow-ups, important conversations and decisions happen over hours or days instead of the weeks and months it takes in many other hospitals across the country.

The result is less waiting and wondering for patients.

The Challenges of Promoting Lung Cancer Screenings

The evidence that lung cancer screenings lead to better outcomes for patients is relatively new, prompted by a 2011 study. Since then, doctors have recommended screenings via low-dose CT scans for people in high-risk categories (usually those who have had a long smoking habit). 

But the push for screenings has faced some key challenges. Many people and even some primary-care physicians don’t know that the screenings are available, Dr. Mahajan said, nor are they clear on when a patient is eligible for a screening. In Virginia, the screening rate for people who are eligible for the scans sits at just 5 percent.

Lung cancer also carries a stigma because it’s so closely linked with smoking. The American Lung Association has reported that “feelings of fear, guilt and blame” factor into patients’ decisions about detection.

Lung cancer screenings also are not as widely conducted because they are resource-intensive.

“You have to be able to not only get patients in for the scan, they have to be able to be covered [by insurance] for the scan, they have to get appropriate education and counseling on smoking cessation, and then you have to follow those patients for three years after the scan,” Dr. Mahajan said. “There has to be a lot of personnel and resources that go into that. Most hospitals aren’t able to do that efficiently or effectively.”

Saville Center addresses that challenge by putting all the key players under one roof. It makes for easier communication between, for example, an interventional pulmonologist and a thoracic surgeon. It also makes it easy for patients and their primary physicians.

“In Saville,” Dr. Mahajan said, “we have one place where if a patient comes in wanting lung cancer screening, they get seen, they get smoking cessation counseling, they can get their CT scan the same day and then we talk to them about the results of that CT scan.”

Acting on incidental lung nodule detection

Saville Center is also increasing the efficiency of Inova’s incidental lung nodule program.

This program, started in 2019, helps detect lung cancer early in patients who otherwise would not undergo scans, because they are not in a high-risk category and are not exhibiting symptoms.

The program is built around the idea that when any scan or procedure a patient undergoes discovers a nodule in the lungs, the information is passed quickly to Saville Center. 

Depending on the size of the nodule, the patient is referred to their primary care physician or to the incidental lung nodule program at Saville, where they perform a biopsy on the nodule. The program identifies thousands of nodules each year.

“Ours is one of the more robust incidental programs in the country,” Dr. Mahajan said. “A lot of hospitals will come to us to determine how to set things up.”

At most hospitals across the country, Dr. Mahajan said, the time from detection of a lung nodule to diagnosis and treatment is three to three and a half months — “just awful,” he said.

At Saville Center, that time between detection and treatment is typically reduced to two to three weeks.

“If someone calls, we have three interventional pulmonologists,” Dr. Mahajan said. “We see them that week and we get things moving.”

Less waiting and wondering

Saville Center is able to screen for lung cancer more quickly because the team is close — literally and figuratively — Dr. Mahajan said. Lung cancer screening and treatment requires pulmonologists, thoracic surgeons, oncologists and more to work together. And it helps when they are in the same building, just a floor or two away.

It also helps that the physicians have a good relationship, Dr. Mahajan said.

Instead of referring a patient to an appointment with another doctor next week, Mahajan said he can call a colleague and have that doctor join the consultation and give the patient more information right away.

This collaboration allows patients to be treated more quickly — and to be treated by familiar faces at a single facility.

“If we can reduce the amount of time between the imaging or the testing and then being able to go over that testing with the patient, that’s a real victory,” Dr. Mahajan said. “Because, frankly, the waiting and not knowing is worse than a lot of the procedures and the testing that we do.”

Amit Mahajan, MD is board certified in pulmonary disease and critical care medicine. He serves as the medical director of interventional pulmonology and the complex airways disease program at Inova Fairfax Medical Campus.

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