Changing the Face of Lung Cancer in Kentucky: New Program May Serve as National Model

Jamie L. Studts, PhD

Associate Professor, University of Kentucky

Assistant Director, Cancer Prevention and Control

Director, Clinical and Community Research Shared Resource Facility

Lucille P. Markey Cancer Center

Allyson Yates

Program Director

Kentucky LEADS Collaborative

Lucille P. Markey Cancer Center

Lexington, KY

Lung cancer remains the leading cause of cancer mortality, killing more Americans than breast, colon, and prostate cancer combined—and Kentucky is the epicenter of lung cancer in the United States. Not only do we suffer a rate of lung cancer mortality that is 50% higher than the national average, there are some areas of the state with lung cancer mortality rates that are nearly 2.5 times the national average, prompting some to refer to it as the “Commonwealth’s Cancer.” At the University of Kentucky Markey Cancer Center, lowering our state’s dire mortality and incidence rates is a top priority.

Multipronged Approach

In January 2014, the Kentucky Cancer Consortium— a statewide organization dedicated to reducing the burden of cancer throughout the state—organized a meeting of clinicians, scientists, and advocates to consider responding to a funding opportunity designed to improving lung cancer survivorship offered by the Bristol-Myers Squibb Foundation’s Bridging Cancer Care Initiative. From this meeting, the group identified three strategies that incorporated efforts to change clinical practices, improve survivorship care options, and facilitate implementation of high-quality lung cancer screening.Ultimately, the application adopted a multilevel approach, leveraging the training and expertise of the full team of invested collaborators from the UK Markey Cancer Center, the University of Louisville Brown Cancer Center, and the Lung Cancer Alliance, creating the Kentucky LEADS Collaborative (Lung Cancer Education, Awareness, Detection, Survivorship).

Provider Education

The collective efforts of the Kentucky LEADS Collaborative allowed us to compete successfully for a $7 million grant to conduct a three-pronged initiative over the course of three years. The first year of the project, which began in the fall of 2014, has been dedicated to developing the three interventions, including substantial efforts to partner with more than 50 community organizations and healthcare systems. In the second phase of the initiative, the teams will begin to implement and evaluate the three interventions detailed below. Finally, the third phase of the project will thoroughly analyze the benefits and limitations of the interventions, modifying programs based on provider, survivor, and system feedback, and considering efforts to sustain successful programs.The first component of the project is led by a team at the University of Louisville that has substantial experience working with primary care providers throughout Kentucky to provide education and training efforts regarding lung cancer care and control efforts. To take advantage of the wide-ranging innovations in lung cancer research and practice, the Provider Education team has invested substantial effort in working collaboratively with the primary care provider community to develop a Primary Care Lung Cancer Task Force, which produced Lung Cancer in Kentucky: A Primary Care Action Plan.

Survivorship Care

This work has led to the development of a diverse platform of continuing education programming that will be offered to primary care providers regarding best practices and evidence-based care for lung cancer that includes coverage of the latest innovations related to lung cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care.Lung cancer screening efforts that offer early diagnosis and more effective treatment of lung cancer provide a unique opportunity to place greater emphasis on lung cancer survivorship and meeting the needs of the growing populations of individuals who survive lung cancer as well as the caregivers who provide support.

The Survivorship Care component of Kentucky LEADS is dedicated to developing an innovative program that can be offered by survivorship care specialists throughout the state. The intervention is designed for dissemination and is targeted to the unique needs of the lung cancer survivor population, but it can also be adapted and tailored to the specific symptoms and issues experienced by each lung cancer survivor.

Prevention and Early Detection

This component of Kentucky LEADS, led by a team at UK in collaboration with partners at the University of Louisville and the Lung Cancer Alliance, has spent the first year developing the intervention and is preparing to evaluate the intervention in 10 community settings throughout Kentucky in the second and third years of the project.The third component of the Kentucky LEADS Collaborative seeks to facilitate high-quality lung cancer screening statewide. Led by investigators at the University of Kentucky, this team has translated results of the National Lung Screening Trial (NLST) and subsequent lung cancer screening guidelines into quality screening standards. These quality metrics can help lung cancer screening programs throughout Kentucky offer high-quality lung cancer screening, and deliver the tangible benefits of reducing lung cancer mortality throughout the state. Importantly, this component proactively tackles the issue of healthcare disparities that could be exacerbated if individuals who live in rural and underserved areas of Kentucky do not have access to optimal lung cancer screening programs.

Given that rural and Appalachian residents of Kentucky suffer a disproportionate share of lung cancer risk, incidence, and mortality, it is vitally important that residents have access to quality screening and lung cancer care to prevent even greater health inequalities that are already commonplace in these areas.

A Unique Opportunity

In the upcoming phase of the effort, the team will begin to work with 10 implementation partners throughout Kentucky to support and evaluate lung cancer screening program development, quality, and sustainability.In summary, the efforts of the Kentucky LEADS Collaborative offer a unique opportunity to change the face of lung cancer in Kentucky by harnessing new lung cancer care and control strategies. While the burden is great, this also means that Kentucky stands to benefit most from these innovations, provided they are delivered throughout the state in a manner consistent with quality care standards. Ultimately, this project seeks to make us the transformative leader in lung cancer care and control efforts and reduce the personal, social, and economic toll of lung cancer on Kentucky.