Timothy Mullett, MD, leaned toward his computer screen as he spoke, drowning out the sounds of the busy coffee shop behind him to get his message across.
"This is a message of hope, of opportunity. Things are different today than they were before," he said. "This is not your grandfather's lung cancer."
Dr. Mullett is the medical director of Lexington, Ky.-based UK Healthcare's Markey Cancer Center and a thoracic surgeon. Having lost power due to Hurricane Helene during a visit to Clemson, S.C., he set up camp at the coffee shop to discuss with Becker's — along with his colleagues Jennifer Knight, DrPH, and Jamie Studts, PhD — the next phase of the group's lung cancer screening program.
Following a successful decadelong initiative to turn around Kentucky's lung cancer mortality rate, the Quality Implementation of Lung Cancer Screening program (QUILS) received a four-year, $6.8 million grant from the Bristol Myers Squibb Foundation to replicate the program in Mississippi and Nevada.
Building a social norm
The QUILS system engaged a coalition of clinicians, public health experts and community organizations with the goal of improving lung cancer screening. Within a decade of the program's inception, Kentucky has achieved the second-highest lung cancer screening rate of any state.
"This funding will allow us to apply what we've learned in Kentucky to help create targeted solutions for Mississippi and Nevada, potentially setting a new standard for lung cancer screening nationwide," Dr. Knight said in a Sept. 19 news release from UK Healthcare announcing the Bristol Myers grant. She joined the call with Becker's from Arkansas, though she is an assistant professor in the department of health management and policy at the University of Kentucky.
"What we're trying to do is to build a social norm of lung cancer screening," Dr. Studts said. "Where lung cancer screening becomes just another type of screening that you consider if you're eligible."
Dr. Studts called in from Boulder-based University of Colorado, where he serves as scientific director of behavioral oncology and co-leader of its Cancer Prevention and Control program.
Reducing the stigma, earning trust
The trio highlighted societal awareness as one of the barriers they have encountered, despite the ease and effectiveness in which routine low-dose CT scans detect lung cancer.
"We're starting from a deficit because not only do we have a community that is new to the idea of lung cancer screening, they [also] don't trust us very much," Dr. Studts said.
Unlike most cancers, lung cancer is often associated with modifiable factors or behaviors. While public health messaging has reduced smoking rates, Dr. Studts said it has unintentionally created a stigma around tobacco use.
That messaging has also done little to spread awareness of the advancements in lung cancer treatment, he said.
"The lung cancer community has an incredible amount of optimism built on the foundation of new risk reduction strategies, better early detection, diagnostics, treatments and survivorship," Dr. Studts said. "But our society does not understand that."
A win-win
In addition to the challenge of convincing at-risk populations to seek out care, the program's expansion depended on health systems implementing the screening as part of routine care. Dr. Knight said she considered clinician engagement to be one of the key reasons behind the program's success in Kentucky.
Dr. Mullett said systems of all sizes can benefit from lung cancer screening, citing an increase in earlier stage diagnoses. Patients diagnosed at an earlier stage may undergo surgery and see a short hospital stay before getting back on their feet, as opposed to the "hundreds of thousands of dollars" spent on the therapies required for a similar outcome in late-stage cancer patients.
Additionally, routine screening increases revenue through consistent utilization of the hospital or system's CT scanner.
"It's an opportunity for patients to have an entrance into the healthcare system," Dr. Mullett said. "[Patients] will be funneled into primary care and ultimately more likely to be retained, increasing the utilization of other services as well. It's a real business win."
Finding progress through collaboration
As the group looks toward Nevada and Mississippi, they highlighted the need for each state to develop its own program by engaging with community organizations and health systems.
"We want those communities to really have the skills, training and empowerment to know what lung cancer screening is and how they can work together," Dr. Knight said.
"We've got to help them leverage those statewide resources like we did," Dr. Mullett said. "This is not a cookie-cutter package."
Although the program already is growing from its research project roots, the group has no plans to stop with the initiative's current expansion plans.
Spread across the country themselves, they each mentioned hope for the QUILS system to be implemented nationwide as they reach for their goal of making lung cancer screening an accepted social norm.
"I'm really hoping we can get to that point," Dr. Studts said. "We're happy with progress, but no one believes the work is over."