4.6 Assessment of Evaluation and Treatment
2013 Analytic Lung Cancer
2013 Lung Site Specific Study
Presented by
Dr. Sachin Lavania
2014 Cancer Committee Members
Ronald Steis, MD
Medical Oncology
Chairman Cancer Committee
Teresa Urquhart , COO
Administration
Cancer Program Administrator
Laura Pearson, MD
Breast Disease
Medical Director Breast Program
Cancer Liaison Physician
Lisa Ganem, CTR
Cancer Registry
Boyd Byrd, MD
Diagnostic Radiology
Cancer Conference Coordinator
Craig Wilkinson, MD
Radiation Oncology
Thomas Belknap, MD
Neurological Surgery
Malcolm Joel, MD
Pathology
Mark McCord, MD
Radiation Oncology
Harry Rutland, MD
Urology
Sachin Lavania, MD
Pulmonary Disease
Critical Care Medicine
Micah Brown, RN
Breast Navigator
OCN/Clinical Research Coordinator
Lindsey Harber
Director Business Development
Community Outreach Coordinator
Connie Dwyer, RN
Director of Case Management
Psychosocial Services Coordinator
Joyce Robinson, RN
Accreditation Manager
Quality Improvement Coordinator
Robin Richardson, RN
Clinical Nurse Specialist
Anne Reed, RHIA
Director of Health
Information Management
Debbie Keel, CEO
Administration
Nancy Melcher, CNO
Administration
Carol Barone, RN
Director of Clinical Quality
Dorothea Norris, RD
Nutrition Services
Lisa McKinney, O.T.
Rehabilitation Services
Misty Boachie, Ph.D.
Director of Pharmacy
Tracy Wilkinson
Director of Imaging
Alicia Gibson, CTR
Cancer Registry
Ryan Andrews
American Cancer Society
Sonia Patel
Pharmacy
Donna Hopson
Pathology
Silpa Reddy, MD
Medical Oncology
Karthi Subbannan, MD
Medical Oncology
Facts and Figures
American Lung Association www.lung.org

Approximately 373,489 Americans are living with lung cancer. During 2012, an estimated
226,160 new cases of lung cancer were expected to be diagnosed, representing almost 14
percent of all cancer diagnoses.
Lung cancer represents 14.4% of all analytic cancer diagnoses at North Fulton Hospital.

The majority of living lung cancer patients have been diagnosed within the last five years. Lung
cancer is mostly a disease of the elderly. In 2006, 81 percent of those living with lung cancer
were 60 years of age or older.
In 2013, 74% of the North Fulton Hospital patients were 60 years or older.

In 2006, Kentucky had the highest age-adjusted lung cancer incidence rates in both men (124.8
per 100,000) and women (76.6 per 100,000). Utah had the lowest age-adjusted cancer
incidence rates in both men and women (32.0 per 100,000 and 24.7 per 100,000, respectively).
These state-specific rates were parallel to smoking prevalence rates.

Lung cancer is the most common cancer worldwide, accounting for 1.3 million deaths annually.
Cancer accounted for 13 percent of the 58 million total worldwide deaths in 2004.
51% of the 2013 Lung cancer patients at North Fulton Hospital are deceased.

The National Institutes of Health estimate that cancers cost the United States an overall $264
billion in 2010.10 It is estimated that approximately $10.3 billion per year is spent in the United
States on lung cancer treatment alone
Lung cancer is the leading cancer killer in both men and women in the United States. In 1987, it
surpassed breast cancer to become the leading cause of cancer deaths in women.
Lung cancer causes more deaths than the next three most common cancers combined (colon,
breast and prostate). An estimated 160,340 Americans were expected to die from lung cancer in
2012, accounting for approximately 28 percent of all cancer deaths.
Smoking-Attributable Lung Cancer
83% of the 2013 Lung cancer patients at North Fulton Hospital continued
to smoke or have a history of smoking.
 Smoking, a main cause of small cell and non-small cell lung cancer,
contributes to 80 percent and 90 percent of lung cancer deaths in
women and men, respectively. Men who smoke are 23 times more likely to
develop lung cancer. Women are 13 times more likely, compared to never
smokers.
In 2013, 9% Lung cancer patients from North Fulton Hospital had never
smoked.
 Between 2000 and 2004, an average of 125,522 Americans (78,680 men
and 46,842 women) died of smoking-attributable lung cancer each year.
Exposure to secondhand smoke causes approximately 3,400 lung
cancer deaths among nonsmokers every year.
 Nonsmokers have a 20-30 percent greater chance of developing lung
cancer if they are exposed to secondhand smoke at home or work.
Diagnosis of Lung Cancer
86% of the Lung cancer patients had a biopsy to diagnosis their lung
cancer.
 Lung biopsy removes a small piece of lung tissue which can be analyzed
at under a microscope.
2013 Lung Cancer Histology
Diagonsed at NFH
1
1 1
1
1
NEOPLASM, malignant
2
Spindle cell carcinoma
7
Small cell carcinoma
Squamous cell carcinoma
17
4
Adenocarcinoma
Carcinoid tumor
Neuroendocrine carcinoma
Papillary adenocarcinoma
Early Detection by use of Low Dose CT (LDCT) Screening
 In an effort to increase early detection using LDCT screening we
performed a retrospective study to determine the eligibility of patients for
early screening.
 Data was collected through the 2013 Analytical Lung Cases from our
Cancer Register.
 A retrospective chart review with analysis of the patients diagnosed with
Lung Cancer between January 01,2013 and December 01,2013.
 34 patients were reviewed
 Inclusions Criteria:
 High Risk Group #1 - > 55 years old and
> 30 pack years of smoking (unless stopped smoking >15 years)
 High Risk Group #2 - > 50 years old and
> 20 pack years of smoking and
one other risk factor
 Exclusions Criteria:
 Poor health, who if diagnosed with cancer would not be able to receive curative treatment.
 Quit smoking > 15 years
 Non-smoker
2013 Lung Study Results
 Inclusions Criteria met:
 18% of the patients fell into
High Risk - Group #1

over 55 years of age

smoked greater than 30 pack years (unless
stopped smoking > 15 years)
 6% of the patients fell into
High Risk - Group #2

over 50

smoked greater than 20 pack years

And one other risk factor
 Exclusions Criteria met:

55% of the patients were excluded from the study
due to poor health, not able to receive curative
treatment or there was no information available for
health history or smoking history.

9% had a history of smoking but stopped smoking
> 15 years ago.

3 % were non-smokers
2013 Lung Study Conclusion
After reviewing each patient’s medical record, we found 69% of the patients
diagnosed with lung cancer in 2013 fell into a Stage of III to IV.
Of those patients who were diagnosed at Stage III or IV, 21% were eligible to
have had early LDCT.
2013 Lung Study Conclusion
It was determined, if patients are better educated in lung cancer symptoms as
well as educated in the use of Low Dose CT scan screening for lung cancer
screening, the community would be better informed and able to make
decisions about their health and well being.
Early detection leads to…..Survival
The survival rate for patients diagnosed with lung cancer at NFH in 2013
is 50%.
•
The lung cancer five-year survival rate (16.6%) is lower than many other leading
cancer sites.
2013 NFH Lung Cancer Survival
30%
25%
30%
25%
20%
15%
10%
10%
5%
5%
5%
5%
10%
5%
5%
0%
Stage I
Stage II
Stage III
Alive
Deceased
Stage IV
Occult
0 cases
Resources
 Benchmark: NCCN Guidelines for Lung Cancer
http://www.nccn.org/patients/guidelines/lung_screening
/index.html#1
 American Lung Association www.lung.org
 NFH 2013 Analytic Lung Study
 Medical Chart reviews