1. 4.6 Assessment of Evaluation and Treatment 2013 Analytic Lung Cancer

2. 2013 Lung Site Specific Study Presented by Dr. Sachin Lavania

3. 2014 Cancer Committee Members

4. 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 10

5. 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.

6. 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.

7. 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.

8. 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

9. 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

10. 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.

11. 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.

12. 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.

13. Resources Benchmark: NCCN Guidelines for Lung Cancer http://www.nccn.org/patients/guidelines/lung_screening /index.html#1 http://www.nccn.org/patients/guidelines/lung_screening /index.html#1 American Lung Association www.lung.orgwww.lung.org NFH 2013 Analytic Lung Study Medical Chart reviews