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