Oncology Service Line: A Change in Focus

Marianne Aiello, for HealthLeaders Media , March 21, 2014

Success key No. 3: low-dose CT scans

Cancer Treatment Centers of America, a five-hospital system headquartered in Schaumburg, Ill., has been pioneering ways to improve baseline low-dose CT screening to better detect lung cancer.

Following the National Comprehensive Cancer Network's guidelines to identify those patients at high risk for lung cancer, CTCA uses the CT scan results to study anatomy of the lungs and surrounding tissues to diagnose and monitor tumor growth. A landmark National Cancer Institute–sponsored study found that annual screening for three years with low-dose CT scanning under the guidance of a dedicated comprehensive lung cancer screening program resulted in a 20% decrease in deaths related to lung cancer.

"Utilizing these tools has allowed us to potentially identify lung cancer at an earlier stage, which can decrease lung cancer mortality and improve the quality of life for those we serve," says Derek Strader, director of perioperative and cardiopulmonary services at Western Regional Medical Center, a CTCA hospital in Goodyear, Ariz., 25 miles outside Phoenix.

Screening chest CT scans are done with low doses of radiation, considerably less than the dose in a regular CT scan. And it's worth the risk, because screening individuals who are at an elevated risk of developing lung cancer in this manner can prevent one in five deaths from lung cancer, Strader says.

"In the right population, the risk related to the small amount of radiation from the scan is outweighed by the overall benefit in preventing lung cancer death," he says. "CT scanning allows us to detect small lung abnormalities that a normal chest x-ray cannot identify. If a screening CT results in a diagnosis of lung cancer, it's more likely it will be at an early stage and less likely to be at an advanced stage."

For a CT screening program to be successful, a hospital or health system must make a commitment to acquire the top talent to support clinical excellence and a multidisciplinary approach, Strader says. This approach includes thoracic radiology, pulmonary medicine, thoracic surgery, clinical research, pathology, medical oncology, and radiation oncology.

"It's critical to not only identify and diagnose at the earliest stage possible but to also have the expertise to provide the needed treatment for the best possible outcome," he says. "The true payoff and reward is the impact that identifying earlier-stage cancers will have on our patients' quality of life."

CTCA is already looking to the future of lung cancer detection and treatment and is open to the possibility of another technology or device emerging that may be used for cancer screening.

"There may be other imaging modalities or noninvasive tests that could help determine those individuals most likely to benefit from screening and intervention," says Glen Weiss, MD, MBA, director of clinical research at Western Regional Medical Center. "It's also possible that with improved computational power and algorithms, the amount of radiation required for CT scans will probably decrease in the future. We may also see additional types of testing such as blood, exhaled breath, and saliva that may give a readout of our health status. These types of tests may be used up front and help medical providers determine if and when CT scans or other imaging are necessary."

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