Mortality Benefit of Lung Screening



Lung cancer is the leading cause of cancer death among both men and women. In fact, more people die each year from lung cancer than colon, breast, prostate and pancreatic cancer combined. And although many improvements in diagnosis, staging and treatment have been made, long-term lung cancer survival rates remain extremely poor.


The major risk factors, on the other hand, are well known. 90% of all lung cancer can be attributed to smoking. That means in the U.S., an estimated 94 million current or former smokers have an increased risk for the disease. The huge size of this at-risk group is a major reason why there have been many efforts to find and develop an effective low dose computed tomography (CT) lung cancer screening test over the past several years.


Recent Advances in Low Dose CT Lung Cancer Screening


In the past, efforts to identify an effective screening test have been unsuccessful. Specifically, several randomized screening trials were able to detect early-stage lung cancer, but were inconclusive in showing a mortality benefit from such screening. However, recent advances in multidetector computed tomography have allowed screening studies using low dose CT scan (LDCT) to be performed. With these tests, patients are exposed to acceptable levels of radiation and only need to hold a single breath. The low radiation dose preserves the detection of focal lung lesions because of the inherently high contrast between aerated lung and soft tissue.


National Lung Screening Trial (NLST)


The question the NLST set out to answer was whether low dose CT lung cancer screening would reduce mortality from lung cancer for high-risk individuals. The NLST focused on screening people 55 to 74 years old who have cigarette smoking histories of 30 or more pack-years, and who, if they are former smokers, have quit within the last 15 years.


The initial NLST found that screening with low dose CT scan reduces mortality by 20% and all-cause mortality by 6.7%.

NLST Results (excerpt)
Lung cancer mortality reduction: 20%
(95% confidence interval [CI], 6.8–26.7; P = .004)

All-cause mortality reduction: 6.7%
(95% CI, 1.2–13.5; P = .02)

Study Design: Evidence obtained from a randomized controlled trial.
Internal Validity: Good

Consistency: Not applicable (N/A) – one randomized trial to date.
External Validity: Fair


With these results, the NLST trial is the first randomized screening trial for lung cancer to have shown improvements in both disease-specific and all-cause mortality.




Despite being the number one cause of cancer death, lung cancer isn’t the most heavily researched. In fact, federal funding for lung cancer research is relatively small compared with funding for other major cancers. That’s why, with this clear conclusion that low dose CT lung cancer screening reduces mortality by up to 20%, the NLST is a major step forward in the advancement of more effective lung cancer screening programs. By increasing detection of this potentially curable disease, low dose CT lung cancer screening can drastically change lung cancer examination and management for hospitals and patients across the country.


Eon’s EPM Solution for Lung Cancer Screening helps lung programs across the U.S. screen eligible patients and provide guideline-based next steps for high-risk patients. Eon also offers a white paper on the early detection of lung cancer.




Gutierrez A, Suh R, Abtin F, Genshaft S, Brown K. Lung Cancer Screening. NCBI Website. Accessed October 16, 2018.


Lung Cancer Screening (PDQ) – Health Professional Version. National Cancer Institute Website. Accessed October 16, 2018.

EonCast: Candace Cole from Penn Highlands Healthcare discusses how EonDirect has significantly improved their productivity in Lung Cancer screening management

Candace Cole, RN BSN MPM OCN NCTTP is a Nurse Navigator at Penn Highlands Healthcare. In this EonCast, Candy discusses how EonDirect has significantly improved the productivity in their Lung Cancer screening management program by efficiently identifying exams at the time they were performed and registering them to her dashboard to track appropriate follow-up care.



Danielle Stackrow (Eon):
Hi everyone, it’s Danielle from Eon and we’re doing another EonCast video chat. Today we have Candy and I’ll pass it over to Candy and she’ll introduce herself.

Candace “Candy” Cole (Penn Highlands Healthcare):
Hi, my name is Candy Cole, I’m a nurse navigator for lung cancer screening at Penn Highlands healthcare. Penn Highlands healthcare is a four system hospital in central Pennsylvania and we started our lung cancer screening program in 2015. My responsibilities are all the lung cancer screening patients navigation and smoking cessation.

Danielle Stackrow (Eon):
Awesome, thank you so much, Candy. You have a substantial amount of patients in your EonDirect dashboard, there’s over 1,300 patients in that dashboard. How is EonDirect really helping you manage all of those lung cancer screening patients?

Candace “Candy” Cole (Penn Highlands Healthcare):
It has been quite the advantage working with the EonDirect. EonDirect has helped with the volume of patients, one campus of 1,300 and altogether I have over 3,000 lung cancer screening patients. We’ll be adding the other campuses as I get better with the system. It has helped us with quality and patient management. Before when I didn’t have a tracking system I didn’t always know if a patient came in-between their annual screening and I couldn’t always track properly when their next lung cancer screening was due. EonDirect has really helped with that because of the software system and the way it listens in radiology. When my lung cancer screening patients come in and the scanner goes over their chest those results come into my dashboard. With EonDirect I’m able to see exactly what’s going on with the patient and keep all information current. Whereas before the American College of Radiology required I look at that patient a year later to catch up all that data. Now I work in real time and I’m able to do things that need to be done immediately. EonDirect is really improving the quality of our patient care.

Danielle Stackrow (Eon):
That’s exactly what EonDirect strives for, to change your previous workflow to this new workflow. This software allows you to work in real time. You know exactly when the patient comes in for an annual exam because it’s being registered to your dashboard. All that information is being identified and populated for you to submit to the American College of Radiology and the Lung Cancer Screening Registry (LCSR). I think that’s also been helpful.

Candace “Candy” Cole (Penn Highlands Healthcare):
One other thing I’d like to add and I don’t know if other hospitals have the same problem, when a patient doesn’t show up or they reschedule. Sometimes it’s just rescheduling but I wouldn’t know and I have too many patients to call to asked what happened. With EonDirect no one is lost. Before lung cancer screening patients would reschedule a couple times for a Low dose CT and I used to not find them until they were due again.

Danielle Stackrow (Eon):
I think that EonDirect significantly helps the overall picture.  It helps to identify if the pulmonary nodule has grown which you’re actually getting, like you said in “real-time” with every single patient. I really think it’s making a difference with your workflow and I’m really glad to hear that. You’re only at one campus right now and as we continue to grow and you get more comfortable with the software, we’ll be introducing your other campuses. You’ll be managing easily over 3,000 patients, which will be exciting!

Candace “Candy” Cole (Penn Highlands Healthcare):
I am looking forward to that!

Danielle Stackrow (Eon):
That’s awesome! You’ve kind of touched on this but is there a specific feature that you really love that helps your workflow with these lung cancer screening patients?

Candace “Candy” Cole (Penn Highlands Healthcare):
Yeah, there are two I want to say. First, I like the way the software picks up once my patients get screened and if anything else is done. I’m going to see the information on my dashboard and I’m going to know exactly what’s going on. It’s excellent the way it organizes that information . Second, I like the tumor registry because I can keep track of all my patients that have gone on to be diagnosed with lung cancer, so I really like that feature also.

Danielle Stackrow (Eon):
Yes, I think that’s great because you can continue to track the patient once they have been diagnosed with cancer. You can track their post diagnosis care and have the continued information from the very beginning. For example a patient has been identified with a nodule and EonDirect is there every single step of the way so nothing gets lost during that process. That’s a great feature to touch on and I’m glad that you find that so beneficial for your workflow.

Lastly, what has it been like to work with EonDirect through this process specifically with transitioning from your old workflow to this new workflow.

Candace “Candy” Cole (Penn Highlands Healthcare):
I would really like to commend all the professionals. We started with EonDirect when they were Lungdirect. Before choosing EonDirect I worked with a lot of representatives and a lot of people selling a product or a system and we selected LungDirect (EonDirect) because I found that it was a system that I understood. You’ve got pulmonologists involved, all the other systems we looked at used the mammography model. We weren’t speaking the same language, yet they were trying to sell us the system. That was very frustrating for me, so from day one when I engaged with EonHealth EonDirect, we were speaking the same language. They understood our needs and what I found every step of the way was they’re customer service oriented. I don’t know how they do it 24/7, I work at crazy hours of the night because that’s when I have time to catch up on my data. I hit the chat ask the questions and somebody gets back to me. I have found them to be just wonderful with any type of issue. They will say if they’ve never had the issue, if they don’t know what to do, they’ll figure it out and get back to me which they always do. I appreciate that, I feel like everyone is very responsive and is nice to work with. They are a whole group of professionals that do not get defensive and they are really trying to listen. They even put some things in place for customization that we really needed and more importantly they said “okay, we’ll make that happen”.

Danielle Stackrow (Eon):
I want you to know that we appreciate all the work that you do. Like you said you work “crazy hours” and there have been times where I’m eating dinner and I get a chat from you. I respond, “Hi Candy, how’s it going?”! We at EonDirect think it’s great because we build these amazing relationships with our customers. Like you said we take into consideration if a button isn’t working for you and we’ll try to find a fix for it.  We want to make sure that you’re getting everything you should be getting out of this software. At the end of the day it’s all about working with these patients and making sure they are being identified properly while using the software as it was intended. So, I’m really glad that you had such a positive experience working with Christine, Aki and everyone else on our team. We also really enjoy working with you and everyone else part of Penn Highlands, so thank you so much!

Candace “Candy” Cole (Penn Highlands Healthcare):
Thank you!