When it comes to lung cancer diagnosis, time is of the essence. But due to the complexity of the disease and individual barriers to care, a portion of BWH’s lung cancer patients are at higher risk of falling through the cracks and losing contact with the hospital leading up to and after diagnosis, says thoracic surgeon Yolonda Colson, MD, PhD.
In 2014, thanks to the Brigham Care Redesign Incubator and Startup Program (BCRISP), Colson and her team launched a pilot study called the Lung Cancer Strategist Program (LCSP) to help these vulnerable patients. Established in 2013, BCRISP is an initiative in which teams of frontline clinicians submit proposals for projects that improve quality of care and reduce health care costs.
The LCSP is a patient-centered approach to lung cancer care for vulnerable patients—racial and ethnic minorities, patients with a physical disability or mental illness, individuals with language barriers or difficulties with transportation, and others. These patients are referred to the LCSP by a primary care physician or other care provider, and a dedicated thoracic surgery physician assistant serves as a clinical strategist. The clinical strategist works with a group of physicians and surgeons to create a care plan and then coordinates care for each patient.
“The program is our way of changing the system,” said Colson, who directs the Women’s Lung Cancer Program. “Many of these patients don’t need multiple tests or hospital visits, but rather, more coordinated care. We are streamlining the system and being strategic about the fastest way to get patients the care they need and make it easier for them to access it.”
Once patients are referred to the program, relevant testing is arranged, and patients are often seen on the same day by a multidisciplinary care team tailored to meet their unique needs. The team may consist of a pulmonologist, radiation oncologist, medical oncologist, social worker and other specialists.
“The clinical strategist, Cheryl Arena, PA-C, has extensive expertise in working with lung cancer patients and is able to identify barriers to care and the treatment goals for each patient,” said BWH Surgery resident Sophie-Charlotte Hofferberth, MD, who helped launch the LCSP program with Colson. “The clinical strategist provides a streamlined work-up and organizes the right team around each individual patient, so that at the first clinic visit, each patient is seen by those specialists who are going to be involved in his or her care throughout treatment.”
During the six-month pilot, the LCSP cared for 11 high-risk lung cancer patients. Many of these vulnerable patients previously did not receive treatment for several months due to the logistics of multiple tests and missed appointments, but within the LCSP, the average time to diagnosis was only 15 days. Additionally, LCSP patients received treatment for their lung cancer in an average of one month, as opposed to five months before the pilot. Hofferberth says the pilot study results are highly encouraging and that the team is eager to move on to the next phase—one of the goals of which is to care for at least 50 new patients through LCSP in the coming year.
Since the LCSP pilot ended last year, there have been ongoing referrals to the program. The team will be appointing a new thoracic surgery physician assistant to serve as the dedicated clinical strategist going forward in order to increase referrals and services, and it also hopes to establish key performance metrics for each stage of the program so that it can be reproduced as a model for other programs and institutions.
“We’ve been extremely fortunate to receive funding through BCRISP to enable us to launch the program, and we are excited to be moving to the next phase,” said Hofferberth. “The goal of the program is meeting the needs of high-risk groups of patients using a clinical strategist-led care model beyond the Brigham and ultimately improving care for all patients with lung cancer. BCRISP has been a fantastic support.”