Without question, the goal in regard to cancer is prevention. Much progress has been made across the different types of cancer by decreasing risk factors, utilizing immunizations, and catching concerning precancerous findings before they become problematic. Nevertheless, not all cancers can be avoided by removing modifiable risk factors. Take lung cancer, for example. According to the American Cancer Society, as many as 20% of people who die from lung cancer in the United States have never smoked or used any other form of tobacco. Lung cancer in never smokers, if tracked as its own disease, would be the seventh-deadliest cancer worldwide. Although the focus on prevention for all types of cancer should not diminish, a dual focus, with just as much energy, should be provided to ensure that the cancer is caught at its earliest, most treatable stages.
At the Radiological Society of North America (RSNA) meeting in November 2022, encouraging data were presented which further confirms the importance of early diagnosis. The data revealed the 20-year survival rate in lung cancer patients diagnosed at the earliest pathologic stage, 1A, was 92%. Unfortunately, in the United States, only 16% of lung cancers are currently diagnosed at an early stage. When not diagnosed at an early stage, the five-year survival is only 18%.
In this country, 1.6 million incidental pulmonary nodules are identified annually. Fortunately, most do not represent cancer. A recent article by Vachani et al. (2022) attempted to answer the clinical question: Do nodule size and smoking history predict the incidence of cancer in patients with incidental pulmonary nodules? They found that nearly 10% of patients with a nodule measuring greater than 8 mm in size will receive a lung cancer diagnosis. Taking into account smoking status, lung cancer was diagnosed in 5.4% of never smokers, 12.2% of former smokers, and 17.7% of current smokers. This data further emphasizes the need to ensure that patients with incidentally found pulmonary nodules, regardless of smoking status, receive guideline-driven follow-up care.
Care Management is successfully managing patients in seven different disease-state cohorts at more than 125 hospitals, impacting the care of well over 100,000 patients.
The difficulty of ensuring that patients with potentially early-stage cancer have an optimal chance at a cure has always been a twofold problem: The incidental finding must be captured and the patient must adhere to the next appropriate step in their care, all in a timely fashion. Radiologists in general do an excellent job of identifying incidental findings when present. With incidental pulmonary nodules, data would suggest that only 6 out of every 1,000 nodules go unreported (with the majority of these being less than 5 mm). However, in an emergency room setting, patients that have nodules identified by radiologists on chest CTs only successfully follow up for further care 29% of the time. The number of patients following up appropriately decreases further if the finding is only mentioned in the body of the report and not the impression. At the recent RSNA meeting, Dr. Jung H. Yun of Einstein Healthcare Network presented data that confirmed what we at Eon have already realized: Using an artificial intelligence (AI) system to send scheduling reminders to patients needing imaging follow-up significantly increases compliance success rate.
Eon solves both problems (capture and adherence) by combining Eon Patient Management, a software platform, and Eon Care Management, a service offering, to optimize the likelihood of a disease cure. Eon Patient Management uses a form of artificial intelligence called computational linguistics to capture the radiologist-reported finding with both an extraordinarily high sensitivity (patients with a true finding will not be missed) and specificity (only patients with a true finding will be captured). Following the capture of these incidental findings, systemwide improvement in disease-state outcome can only occur if patients follow up successfully for the next expected step in the management of this finding. Eon Care Management is laser-focused on maximizing the rate of successful follow-up to the next step. Our team of navigators combine complex workflow automation, guideline-driven decision analysis, and an omnichannel patient and communication strategy to accomplish this goal. Care Management is successfully managing patients in seven different disease-state cohorts (lung, lung cancer screening, liver, pancreas, abdominal aortic aneurysm, breast and thyroid) at more than 125 hospitals, impacting the care of well over 100,000 patients.
Although prevention of all cancers remains the goal, until this becomes a reality, a dual focus on prevention and detection of disease at its earliest state will be necessary. It has been identified across multiple disease states that detection of disease at its most curative stage, coupled with appropriate and timely follow-up care for these patients, can lead to profoundly improved outcomes and ultimately survival. Combining the computational linguistics power of Eon Patient Management with the proven track record of Eon Care Management allows this to happen.
Scott Skibo is Eon’s Chief Medical Officer. Heather Rasmussen is Eon’s Clinical Transformation and Advanced User Education Manager.