As Joanna Thompson thinks back to the many lung cancer screenings she’s done over the years at Highlands Oncology in Springdale, one patient always springs to mind — the very first one whose screening revealed cancer in its early stages.
“She came in for her scan, and it showed an abnormal spot, so she went through the process of (us) deciding ‘Do we think this is a cancer?’” Thompson says.
In this patient’s case, it was indeed lung cancer. But catching it in stage one meant that treatment included only a surgery to remove the spot. The patient didn’t have to undergo chemotherapy or any of the precarious sickness of the later stages.
Well after the surgery, this first patient went with her son to pick up her grandson from day care and had a complete reality check, Thompson said.
“She tells (us) … ‘Had I not done this (screening), the cancer would have been there anyway. But because they found it early, I was able to be there when (my grandson) was born and be a part of his life.’”
“What keeps me and our physicians going is the positive impact it has on patients,” Thompson says. “These are grandparents, parents, husbands and wives who will get to continue to experience things with their families that they never would have been able to” had they not gotten their cancer detected early enough.
Lung cancer is the leading cancer killer in both men and women in the U.S., according to the American Lung Association. It surpassed breast cancer to become the leading cause of cancer deaths in women starting in 1987.
“More people die from (lung cancer) than from breast, colon and prostate cancers combined,” Thompson says. “But it’s common for people to know to screen for breast cancer. There are PSAs for prostate checks and colonoscopies, but lung cancer screening … is still not a standard of care because it’s only been around for 10 years or so.”
The first of many barriers for people at high risk of lung cancer actually getting it detected is simply knowing about the scan. Many don’t realize there’s a test for lung cancer that is quick, painless and can save lives by detecting cancer well before it causes unwanted symptoms, she says.
A 2011 article in the New England Journal of Medicine that focused on a National Lung $1.8 million savings in healthcare expenses over the course of three years.
“Essentially it’s about 20%- 25% in expense that is saved in the healthcare system when you find a patient at stage one or two rather than at stage three or four,” Hunnicutt says. Highlands Oncology is partnering with UAMS on a database project to publish findings on those savings, which he says are important to an independent operation without the usual nonprofits and support that a hospital might have. “By finding more patients, they are going to come through and receive scans and treatment…
“It’s just worth doing.”
GETTING IT DONE
The process for the free screening is quick and easy, Thompson says. It requires a referral, made typically by a doctor judging that the patient meets two simple criteria: that he or she is age 50 or older and has a long smoking history. An in-depth risk assessment will then establish whether someone is at high-risk for lung cancer.
Following that, a phone call allows patients to be talked through the process and gives them a chance to ask any questions, since most people are unfamiliar with it. The first appointment is about 15-30 minutes with a patient navigator to cover all the necessary information, including going over the risk of the scan.
Lung cancer screening is essentially a low-dose CT scan — with Screen Trial cut the trial off early since the results overwhelmingly showed screening at-risk participants reduced mortality rates by 20%.
“They felt like they had a moral obligation to get the information to the public,” Thompson says.
Without a scan, many lung cancer patients will not be aware of a problem and find care until they are in stage three or stage four, says Jeff Hunnicutt, CEO of Highlands Oncology.
“If you have stage three or four lung cancer, it’s a very grim prognosis and very high expense to healthcare in general, as far as treatment and scans,” he says. “By finding someone at stage one or two, you drastically improve the prognosis and maximize care.”
Hunnicutt spends a lot of time thinking about the exorbitant cost of healthcare in the U.S., which is among the most expensive healthcare in the world. It’s roughly 30 to 40% higher than the average of the next seven most highly developed countries in the world, he says.
“So any chance we have to bring down the cost without sacrificing the quality of care, we have to take advantage of those things,” Hunnicutt says. “This program is massive for that.”
Shortly after Hunnicutt arrived to Highlands as its CEO in 2018, he found a study that followed 67 patients who had undergone the screening and found lung cancer at stage one or two. Compared to the cost of finding it at stage three or four, it ultimately resulted in a no IV contrast — that is followed by visits with physicians to interpret any findings and formulate an action plan if needed.
Radiation in any amount is a risk, but lung screening has far less of it than the average CT scan, Thompson says. The lower levels of radiation make it safe enough to do annually.
The scan itself only takes about one minute — just a good enough picture to catch the cancer early. If the patient doesn’t wear buttons or a bra with an underwire, they won’t even have to get undressed for it.
“The education about the scan is the longest part,” Thompson says. “It’s surprising how easy it is. All cancer screenings are important, but this one is probably the easiest and most comfortable.”
OPEN THE FLOOD GATES
Highlands Oncology’s lung cancer screening program began in 2013, right as lung cancer screening was getting off the ground, but very few patients used it that year — only about 150. Initially the program team was stumped. Why weren’t more people utilizing the service? At the time it cost $200.
Part of the problem, Thompson says, is that many insurance companies weren’t covering it back then, making any participants agree to a self-pay rate. A lot of people didn’t know how to screen or what to do, in addition to paying for it.
While trying to determine what amount of money patients felt would be right to spend on the scan, Hunnicutt said they took advantage of Highlands’ location in Northwest Arkansas by calling for retail analysis to help them land on any of the psychological barriers patients had for getting the screening.
The retail analysis “came back and said $24.99 before they start to think about a purchase” of a lung cancer screening, Hunnicutt says. “So we said, ‘Well, heck. It’s $25; why not make it free?’”
Highlands’ teams wanted to provide the screenings free in part because Arkansas is still among the states with the highest evidence of lung cancer. For Hunnicutt, it also had to do with the stigma attached to the cancer. Breast cancer screening has lots of marketing, he says, and prostate has more now.
“But lung cancer has this blemish, and it’s not fair … this unfair reputation that people who have it got it because they smoked and did it to themselves, so it doesn’t get the attention,” Hunnicutt says.
Highlands began dropping the charges for the scan in 2014 and the program immediately saw a response, drawing 1,500 patients that second year. Last year they scanned roughly 4,300 patients who find them through referrals from 250 providers from Northwest Arkansas, stretching from Harrison to the River Valley and even Oklahoma.
“There’s no one we won’t accept a referral from,” Thompson says. Medical groups often feel comfortable sending patients for the free screening because they then return to the original provider for the treatment. But Highlands has its advantages to lung cancer patients as well, including a sort of one-stop shop for them.
Tuesdays are the busiest day of the week for Highlands. That’s when a multidisciplinary chest clinic takes place, meaning all the patients who had something turn up on their scan can see all the necessary doctors from the region in one place: a medical oncologist, a radiation oncologist, pulmonologist and cardiovascular surgeon.
In 2019 and 2020, Highlands partnered with other groups including Washington Regional, MANA and others so that patients could reduce the number of appointments that would ordinarily take five to eight weeks into roughly five days. That, of course, makes it particularly beneficial for patients with aggressive cancer cases. The model has worked so well to this point that they have expanded to include multidisciplinary clinic for other health areas, such as gastrointestinal and head and neck, Hunnicutt says.
The one thing that never changes is the emotional distress that comes with finding something abnormal on your scan, Thompson says, but not all abnormalities are cancer. They can be something infectious or inflammatory. She often encourages patients that it is better to know if any abnormalities are there and that the team of 10 doctors that are on the case are trustworthy. They follow national guidelines and have been specializing in this care for 23 years.
“We hope that the education we do on the front end will lead to (the patient) not being surprised when they get a call saying there’s something abnormal and compassionately walk them through what we’ll do as a next step for high or low suspicion for cancer,” she says. “Getting screened is quick and painless, and it really is life saving. It impacts your family.”
To this point, Highlands has screened more than 8,000 people for lung cancer, and Thompson says they’re adding more time slots for patients to come in, including one Saturday a month, to accommodate the growing need.
“It’s such an awesome thing to happen in the community,” Thompson says. “We’re excited to continue.”
April Wallace can be reached by email at [email protected] .