University of Colorado Cancer Center associate member Nina Thomas, MD, has been honored by the Association of Cancer Care Centers (ACCC) with a 2024 ACCC Innovator Award.
Thomas, director of the Thoracic Malignancy Pillar of Center for Lung and Breathing at the CU Cancer Center and assistant professor of medicine in the Division of Pulmonary Sciences and Critical Care Medicine at the CU School of Medicine, led the creation of a communitywide safety net for centralized tracking and management of incidental lung nodule findings.
“An incidental finding is an unexpected finding on a scan or test that was done for a different purpose,” Thomas says. “A lung nodule is a spot or shadow on the lung that is often an incidental finding on scans done for a different reason. Incidental lung nodules are most often not cancer, but some of them may prove to be cancerous, and may often be early stages of lung cancer. This is significant because most patients with early-stage lung cancer present without any symptoms. It’s the early stages when they have the best outcomes, and the cancer is easiest to treat.”
Early detection of lung cancer is an especially difficult task, given that only 6% of people who are eligible get screened for the disease.
“Depending on screenings alone leaves a significant number of patients falling through the cracks,” Thomas says. “For example, a recent study conducted by St. Elizabeth Healthcare shows that 46.2% of patients diagnosed with lung cancer did not qualify for lung cancer screening based on the U.S. Preventive Services Task Force eligibility criteria and were not screened for lung cancer. And despite recent changes in the lung cancer screening guidelines to include high-risk patient communities, there are still complex barriers at the patient, provider, and system level that prevent screening.”
To help solve the problem, Thomas in 2022 oversaw implementation of a systemwide incidental findings program at the CU Cancer Center, paving the way for a more comprehensive, holistic, and proactive approach to patient care.
The program leverages enterprise intelligence software to automatically analyze imaging results from across the UCHealth hospital system (a clinical partner of the CU Cancer Center) and classifies patients with high-risk findings. Once a concerning abnormality is found, the patient and their appropriate providers are alerted about the finding, and the patient is referred to an in-network specialist for additional follow-up if deemed necessary. Nurse navigators actively monitor these at-risk patients to ensure they return for the care that they need in a timely manner.
“We would see patients come into the nodule clinic with stage 3 or 4 lung cancer who, on retrospective review, previously had incidental lung nodules noted on imaging that were never followed up. These were heartbreaking missed opportunities to offer patients curable treatment,” Thomas says. “Without a universal system in place, patients weren’t getting the appropriate follow-up care. Now, thanks to our centralized approach for diagnosing and tracking, we have created a community safety net for patients.”
The new approach led to a more than 2,500% increase in actively managed patients, initially putting strain on the local navigator staff. By adding a centralized care management function, Thomas and her team were able to streamline processes, allowing them to review significantly more patients in a timely manner and ultimately cut the time-to-recommend next steps from 34 days to just five days.
Diligent follow-up, despite a non-diagnostic biopsy, resulted in a multidisciplinary specialized approach with the thoracic oncology tumor board, resulting in curative treatment with radiation for a presumed stage I lung cancer.
“The cancer center has been very supportive with time and resources to support this growing program,” Thomas says. “They even ensured that we could hire a second nurse navigator to help support our patients and ensure their follow up. They continue to support us as we continue to grow the program.
“Our future goals for the lung nodule program are to improve our abilities to predict and prevent lung cancer and shift the treatment of lung cancer to early detection and treatment,” she adds. “Given our success with the lung nodule program, we would like to expand our program to include thyroid nodules and pancreatic lesions.”