Screening helps catch this deadly disease when it’s treatable

Falling down is never a good thing - except when the resulting X-rays discover treatable cancer. This is what happened to one patient seen by Joan Macallister, RN, BSN, OCN, an oncology patient navigator with Cape Cod Healthcare. 

“(The patient) said to me that the best thing she ever did was fall down and break her ribs,” said Macallister, “because they found stage two lung cancer, for which she was able to have surgery.”

As the second most common cancer and the number one cause of cancer-related deaths in the United States, lung cancer is serious and scary. Helping patients at risk with testing and diagnosis is a vital support system that Cape Cod Healthcare (CCHC) has recently enhanced with a new Lung Cancer Screening and Lung Nodule Navigation program.

“I have been a Cape Cod Healthcare patient navigator for oncology, specializing in thoracic cancer, since last year,” said Macallister. She credits Thoracic Surgeon Jeffrey Spillane, MD, FACS as an excellent leader for the Pulmonary Nodule Program, which started with lung cancer screenings at Cape Cod Hospital.  She also noted that Alexander Adduci, MD, PhD, chief of radiology at Cape Cod Hospital, has championed the Lung Cancer Screening program. “The program is similar to that of a breast cancer screening; to catch lung cancer in early stages when it is most treatable,” Macallister said.

Hard to Detect

“The problem with lung cancer is that it's really deadly, and it's hard to detect,” said Dr. Adduci. “People don't have symptoms for a while, and then, when they do come in, it's a very late stage.” He referenced the low five-year survival rate if lung cancer is not discovered until it has reached stage 4. “It is around 10 percent, while if you can find the cancer at stage 1, you’ve increased the five-year survival rate to somewhere between 70 to 90 percent,” he said. “So, you're making a dramatic difference in that patient's life and how things are going to turn out for them if you detect early.”

Many patients self-refer to the screening program after taking an online test on the CCHC website that gauges their overall risk of lung cancer. “It identifies whether someone is at high risk and then they can sit down with their primary care provider and have a conversation about the lung cancer screening,” Macallister said.  

“Annual lung cancer screening with low-dose CT scanning may result in the detection of early lung cancers that are amenable to a number of advanced techniques in the diagnosis and confirmation of lung cancer through specialized Interventional Radiology or Interventional Pulmonology procedures” added Michael Ayers, MD, FCCP, an interventional pulmonologist who is a member of the Thoracic Surgery Department at Cape Cod Hospital, and is an integral part of the lung screening program.

Less than 2 Percent Getting Screened

Low-dose CT screening at Cape Cod Hospital is encouraged for people between the ages of 50 and 80 who are currently smoking or have a 20-year or more history of smoking (at least one pack a day for 20 years or more), regardless of how long ago they quit. The recommendation reflects American Cancer Society guidelines just updated this month, in conjunction with Lung Cancer Awareness Month.

People need to be asymptomatic and not have any other life-limiting conditions (< five year life expectancy) to qualify, said Macallister.  

“It is the goal of this program to identify more folks with these cancers, so we can work to treat and even resolve their issues as soon as possible,” she said. 

About half of the patients she sees come through this lung cancer screening program, but the other half comes from incidental findings.

"We go through the reports every week for people having CAT scans prior to heart surgery or X-rays for other issues.”

If a lung nodule or mass is identified, that gets alerted within the system, and then Macallister works closely with Christine Gould, the lung cancer screening coordinator, and a multidisciplinary group at Cape Cod Hospital to plan the best course of action for the patient.

Dr. Adduci said that he typically sends a message to Macallister if he believes a patient is a candidate for the program.  “Sometimes we'll talk about the patient,” he said, “but often she sees my report and knows exactly what I want to get done, and then she just reaches out and starts working the case. She has been really amazing.”

Going through the testing process and waiting to hear if they have cancer is obviously very stressful and emotional for patients,” he said. “Joan is immediately on the phone with the referring doctors, talking to patients and getting them in for their follow-up scans or biopsies, within days or a week, which is so much faster than what it was previously. That’s the whole premise of this system, to make people feel supported and have somebody on their side looking out for them. That is what Joan is doing, and she's doing a great job.”

Streamlining a Complex Process

“My role as a nurse navigator is to support people as they go through the process,” said Macallister. “There is a lot of testing that they need to get done prior to coming to oncology because often when people have a scan which comes back with concerns for neoplasm or metastatic disease, those sorts of keywords cause people to automatically push the oncology button in their minds.”  She says her aim is to let them know the next steps, the correct tests they need, and the right order for them, all of which can feel overwhelming to patients.  

“They're going to be frightened, and they're not going to know what all the tests they have to take mean, so that’s where I come in,” said Macallister. “I try to streamline the entire complex testing process for them. I help answer questions and work with their primary care doctors and an entire team of individuals in Radiology, Oncology, Radiation Oncology, Pulmonology, Thoracic Surgery, and Shields MRI/PET to efficiently guide them through screening, testing, diagnosis, treatment, and beyond.

Since joining CCHC in August 2022 as a nurse navigator, Macallister has worked with 86 patients, and less than half have had to go into oncology immediately.

“Sometimes the screenings and scans show something that we just need to monitor or have further tests for,” she said. “So I want patients to feel better about the possible outcomes.”

Most of all, Macallister and the rest of the team want anyone who might fit the criteria for lung cancer screening to take the online risk assessment and to speak to their primary care doctor about their options for screening.

“A lot of lung cancers are very slow growing and can be around for years without people being symptomatic, she said. “So, we encourage everyone who might think they might be at risk of lung cancer to go ahead and take the online test, and if appropriate, undergo the screening.” The screening itself takes less than 10 minutes from start to finish, and the radiation dose is relatively low, she added.

“We have identified that we are increasing the number of stage 1 diagnosed patients and have a lower number of stage 4 diagnoses,” said Macallister. “Which really speaks to the Lung Cancer Screening program success.”

And if the screening - or another unrelated test - shows something of concern, the whole team is ready with support and guidance. “We are optimistic that our work will lead to earlier diagnoses, better outcomes, and a happier and healthier Cape Cod,” said Macallister.