Latest / Becker’s Healthcare - Clinical Leadership Podcast / How OSF Is Transforming Lung Cancer Screening with Innovative Blood Testing: Insights from Dr. Mark Meeker

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How OSF Is Transforming Lung Cancer Screening with Innovative Blood Testing: Insights from Dr. Mark Meeker · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  doctor Mark Meeker, vice president and chief medical
• 0:07
  officer of OSF Saint Mary Medical Center, OSF
• 0:10
  Volley Family Medical Center. Doctor Meeker, it's a
• 0:13
  pleasure to have you on the podcast today.
• 0:15
  Good morning. It's great to be here.
• 0:17
  Well, thank you for your time. And, you
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  know, I'm excited for our conversation. We'll be
• 0:21
  talking about your first look lung cancer screening.
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  Certainly, it'll be interesting to dig into that
• 0:26
  program and learn more, on such an important
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  topic and especially,
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  timely given,
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  the challenges that I know so many people
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  are having with,
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  you know, cancer and getting screened and just
• 0:38
  making sure that they are able to have
• 0:40
  access to the care they need. So I
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  think first and foremost, can you tell us
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  what is the first look lung cancer screening
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  and how does it benefit patients?
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  Well, some people term these sort of new
• 0:52
  technologies liquid biopsies. And basically, what what the
• 0:55
  first look lung cancer test is is a
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  blood test
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  where and I can't describe all the chemistry
• 1:01
  to you in detail because it's been way
• 1:02
  too many years since I took that in
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  college. But it's a blood test where,
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  the lab techs look for certain strands of
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  DNA,
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  within within the plasma.
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  Cancer cells have been,
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  shown to shed a certain
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  sequence of DNA,
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  in in the bloodstream.
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  So it's not a diagnostic
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  test, but if we see these strands of
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  of DNA fragments in the blood,
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  it increases the
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  risk category or the risk stratification
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  of that patient having lung cancer quite substantially.
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  So then we we have more evidence to
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  convince them to go on to more specific
• 1:39
  screening.
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  That's great to hear. And, you know, really,
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  it makes a lot of sense and helpful
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  to understand
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  a little bit more background about, the screening
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  and and technology.
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  How has the initial phase been of offering
• 1:52
  these screenings, and and what are the next
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  steps?
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  We, you know, we've been looking for ways
• 1:57
  to to enhance our early detection program
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  because in in lung cancer specifically,
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  the stage at the time of diagnosis is
• 2:06
  critically important to five year survival.
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  If if if you diagnose lung cancer at
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  stage four, for example,
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  the the average five year survival from the
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  national database is around five percent.
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  Now if you if you detect lung cancer
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  early stage stage one,
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  then the five year survival rate goes clear
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  up to fifty five to ninety percent depending
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  on the cell type and and other comorbidities.
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  So that's more than a tenfold increase in
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  five year survival
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  stage one versus stage four. And even if
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  they're just at stage two,
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  which is still relatively early,
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  that that survival at five year survival drops
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  below fifty percent. So early detection in lung
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  cancer is critically important to survival.
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  So we were looking for ways through our
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  innovation team at OSF HealthCare to find new
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  technologies to help us with early detection,
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  And and we've been working with with the
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  first look company,
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  on their technology,
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  which is,
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  evidence driven. They have excellent data published
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  on their performance,
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  and and we latched on to that and
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  have been working with them to, implement this
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  in OSF. So we started off like we
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  often do with with a small pilot project
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  in in in a handful of practices,
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  you know, work out the kinks with the
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  processes and whatnot. But it's gone so well,
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  and we're so impressed with the results that
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  we are gonna spread this across our entire
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  primary care footprint, in the near future.
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  Well, that's great to hear. You know? And
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  certainly,
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  helpful to understand how important that early detection
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  is in
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  terms of the outcomes and the survival rate
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  and and whatnot,
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  for lung cancer patients.
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  Who is eligible for first look?
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  The eligibility criteria, the exact same as low
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  dose CT scanning.
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  Low dose CT scan screening has been around
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  for, I don't know, twelve or fifteen years.
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  But when you look across the country,
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  the average number of eligible patients to get
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  low dose CT screening is
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  just barely above single digits.
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  Now when we first started looking at this
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  at this about eighteen months ago in OSF,
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  we are pleasantly surprised that our low dose
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  CT screening rate was up around twenty five
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  percent.
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  And as soon as we started looking at
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  this and talking about it with our group,
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  we got up over thirty percent just by
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  having the discussion.
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  But the the screening criteria
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  are a a patient,
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  who is age 50 or older with a
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  twenty pack year history of smoking,
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  having not quit within the last fifteen years.
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  So if they quit thirty years ago, they're
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  not eligible. But if they quit fourteen years
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  ago, they're still eligible.
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  So it's fifty years old, twenty pack year
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  history,
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  having not quit more than fifteen years ago.
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  So those people are eligible for a little
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  CT scanning, and that's the exact same criteria
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  for for first look. The advantage to first
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  look is it's a blood test.
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  So a lot of these patients are gonna
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  be getting their blood test done anyway. So
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  simply adding a blood test to their blood
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  draw,
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  it's not, you know, coming in for a
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  CT scan and and taking another day out
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  of work, etcetera.
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  But what it does is it stratifies their
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  risk.
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  If if you take smokers that that meet
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  the criteria for low dose CT screening and
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  and screen a large population,
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  you have to do somewhere around,
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  if I remember right, it's, like, 380
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  CT scans to find one one cancer.
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  If they have
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  a positive first look, that drops down to
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  about one and eighty scans or 75 scans,
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  somewhere in there.
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  So you've really narrowed,
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  the population
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  down that really need that that that CT.
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  If they have a positive first look, you
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  know, they have a one in eighty or
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  eighty five chance of having a lung active
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  lung cancer instead of a one in, you
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  know, two or three hundred chance of of
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  having a lung cancer. So we can really
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  streamline our focus on that, and it also
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  gives the patient
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  another incentive to proceed with with CT screening.
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  And then on the CT screen, if you
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  find a suspicious nodule, you know, we now
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  have the robotic bronchoscopy,
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  etcetera, to really be able to biopsy nodules
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  that are much smaller than what we used
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  to be able to do so you can
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  really find those stage one cancers at a
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  much higher rate than we used to be
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  able to find them. And that has a
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  magnificent
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  substantial
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  effect on survival.
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  So and and that and that's the bottom
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  line.
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  So so this is pretty straightforward. There's some
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  nuances to some of this and and how
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  these workflows go, but it's pretty straightforward as
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  to the impact that this might have on
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  on our cancer survival rates.
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  That's helpful to know. And really, truly, it
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  seems like a a great option and opportunity,
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  to improve that detection and survival rate long
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  term. I'm curious, you know, to dig a
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  little bit deeper here. What is First Look
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  looking for in a blood test, and how
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  does it promote them that early detection?
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  Yeah. As I stated earlier and I and
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  I'm not a a a lab table scientist.
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  You know, I'm a clinical physician.
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  But, basically, what what the first look does
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  is is they use
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  laboratory techniques to find DNA fragments
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  within the bloodstream.
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  And and there are certain sequences of DNA
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  that that have been
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  correlated with the presence of cancer cells,
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  specifically, in this case, lung cancer cells.
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  So as they screen the blood for these
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  DNA fragments, if they find them,
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  that puts the patient at higher risk
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  of having an active lung cancer.
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  It's not diagnostic
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  if the first look it comes and it
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  comes back as a binary result. It's either
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  positive or it's negative.
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  So it's easy to interpret. So if it
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  comes back positive, it's not diagnostic.
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  That doesn't mean that there's a lung cancer
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  there, but it means they're at much higher
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  risk of having a lung cancer there, which
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  as I mentioned before is an incentive then
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  to proceed with a low dose CT scanning
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  and a biopsy if a nodule is found.
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  So so it really streams line the risk,
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  so there's a higher incentive and a higher
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  return on the low dose CT scan. And
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  with limited resources
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  and and a value based care population health
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  scenario,
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  that becomes very important.
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  You know? Instead of shotgunning
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  scans across the spectrum,
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  try and narrow the population down that really
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  need the scan.
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  And and the other the other nice feature
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  of the first look that that I haven't
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  mentioned is the negative predictive value.
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  If the test is negative,
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  there's less than something like a point zero
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  four percent chance of a lung cancer being
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  present.
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  So a negative test really means you're okay
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  right now. We'll screen you again in another
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  year. So so the negative test has a
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  lot of value too,
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  because the risk of having an after count
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  lung cancer with with a negative first look
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  is very, very low.
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  Got it. That makes a lot of sense.
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  And, you know, it really seems like a
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  smart way to go about it and just
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  make sure you're covering all of your bases
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  so that you can, you know, move forward
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  with the right patients.
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  What are the screening numbers for lung cancer,
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  like, currently, and where would OSF's lung cancer
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  program
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  like them to be?
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  Well, as I mentioned earlier, when we first
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  started looking at this eighteen or twenty four
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  months ago, our screening rate was around twenty
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  three to twenty five percent, somewhere in there.
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  I don't remember the exact number, which we
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  were pleasantly surprised because at that time, the
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  national average was, like, eight percent. I mean,
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  it was terrible.
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  And since we've implemented this, our our lung
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  cancer screening rate, the last numbers that I
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  saw, and I haven't seen them in a
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  little while, but the last numbers I saw,
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  I think we were approaching forty five percent.
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  So that still means that we're missing over
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  half of the patients that are eligible for
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  screening. Our ultimate goal is to get this
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  percent up to where we have, you know,
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  breast cancer, lung cancer, and other, you know,
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  routine screenings that we do every day.
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  So we'd like to get this eventually up
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  somewhere between, you know, the seventy, seventy five
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  percent range.
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  You never screen a hundred percent of eligible
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  patients because some patients just don't they don't
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  wanna be screened, you know, and you can't
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  force them to be screened.
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  So it's never going to be a hundred
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  percent,
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  but our ultimate goal is to really get
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  this lung cancer detection
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  through the a combination of first look and
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  low dose CT scanning
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  up to around, you know, seventy, seventy five
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  percent. That's the ultimate goal.
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  Wow. That would be a huge increase,
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  from even where you were a few years
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  ago, and it's really impressive to look ahead
• 10:19
  in that regard and in set big goals.
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  I'm curious if someone has a smoking history
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  and is interested in learning more about the
• 10:26
  screening, how can they do so?
• 10:29
  Well, we've really communicated this frequently and often
• 10:32
  and thoroughly through our throughout our medical group.
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  So for our patients, the best thing to
• 10:36
  do is to talk to their primary care
• 10:38
  physician or their primary care APP about it
• 10:41
  because there's there's widespread knowledge of its availability.
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  And then, of course, if someone is not
• 10:46
  an OSF patient, they can always just contact
• 10:48
  our our,
• 10:50
  health system through the website or through the
• 10:52
  phone number, and we'll get them connected with
• 10:53
  somebody who can help them out with the
• 10:55
  long screen.
• 10:56
  Got it. That's really helpful. And then finally,
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  before we wrap up here,
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  I'm curious, why did OSF choose to pursue
• 11:03
  this collaboration?
• 11:05
  Well, I remember it was probably ten years
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  ago now. The president of OSF at the
• 11:09
  time was sister Diane Marie.
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  And sister Diane Marie made a a comment
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  at a leadership meeting. She said,
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  we don't wanna be transformed in OSF health
• 11:19
  care. We wanna do the transformation of health
• 11:21
  care. We wanna be we wanna actively participate.
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  So we've been pretty aggressive in in
• 11:27
  participating in value based care,
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  and and part of that is develop the
• 11:31
  development of some service line structure,
• 11:34
  to really streamline our evidence based medicine dissemination
• 11:37
  within our our practices.
• 11:39
  And part of that service line development was
• 11:42
  an oncology service line
• 11:43
  with some young dynamic leadership.
• 11:47
  Ryan Lugenbeil,
• 11:48
  specifically, is is a young leader in our
• 11:50
  oncology service line who really wants us to
• 11:52
  become
• 11:53
  a leader in early detection. That's one of
• 11:55
  his personal goals is to get us to
• 11:57
  be a leader in early detection of cancer
• 11:59
  across the spectrum. And this lung cancer,
• 12:02
  program
• 12:03
  was almost a no brainer. When you when
• 12:05
  you look at the effects on survival and
• 12:07
  you look at this new technology
• 12:09
  and the data behind it and the evidence
• 12:11
  behind it and what's been published so far,
• 12:13
  we were just really excited.
• 12:15
  But the fact of the matter is a
• 12:17
  vast majority,
• 12:19
  nearly all, in fact, of true screening for
• 12:21
  these cancers happens in primary care.
• 12:24
  So it doesn't happen in in an oncology
• 12:26
  practice.
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  And so,
• 12:28
  there's been huge collaboration between our primary care
• 12:31
  teams and our community medicine service line, which
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  I was a former leader of,
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  before I took this new position. And so
• 12:38
  I worked directly with Ryan Logan Buell and
• 12:40
  the oncology service line,
• 12:42
  doctor McGee, and others,
• 12:44
  to really forge ahead in the sort of
• 12:46
  detection program because primary care is where this
• 12:48
  actually happens.
• 12:50
  That's great to hear. And I I love
• 12:51
  that notion of doing the transformation instead of
• 12:54
  having it done to you. I I think
• 12:56
  it's, so important to have that kind of
• 12:59
  vision and foresight, and then the leadership team,
• 13:01
  as you mentioned, to carry that through,
• 13:04
  and truly make a difference for how you're
• 13:06
  redesigning the processes, workflows, and systems that help
• 13:09
  patients,
• 13:10
  achieve better outcomes and really leading to healthier
• 13:12
  communities.
• 13:13
  Doctor Meeker, thank you so much for joining
• 13:15
  us on our podcast today. This has been,
• 13:17
  you know, a really fascinating conversation, and I
• 13:19
  look forward to connecting with you again soon.
• 13:21
  Yeah. Appreciate it. Thank you very much for
• 13:23
  having us.