Page 23 - Deleware Medical Journal - September/October 2019
P. 23
PUBLIC HEALTH
Cancer Society suggests that LDCT screening may produce a positive effect on smoking cessation when cessation counseling is a precondition of LDCT screening.11 Providers have also cited potential harm associated with LDCT, for lung cancer screening, and questions about insurance coverage as barriers to ordering LDCT scans.20 Patient factors likelihood of LDCT orders include younger patient age, Asian race (vs. Non-Hispanic white), reported current smoker status (vs. former smoker status), lack of severe comorbidity, and access to one’s own primary care provider (PCP).20 Removing provider- and patient-level barriers to LDCT screening will increase the proportion of eligible Delawareans who are screened for lung cancer.
DPH continues to prioritize lung cancer screening and tobacco prevention. Delaware’s aggressive action to curb
lung cancer incidence and mortality
has predominantly focused on primary prevention. Primary prevention is the most effective method for reducing disease burden, and Delaware has successfully implemented legislation
and evidence-based tobacco control interventions aimed at reducing tobacco use, lung cancer incidence, and lung cancer mortality. To build upon these public health successes, Delaware must extend its focus to include secondary prevention (i.e., reducing the impact of lung cancer that has already occurred, treatment). As tobacco use rates continue to decline, DPH anticipates that the percentage of the population who identify as former smokers will increase. In 2017, former smokers.6 This subpopulation
has already acted to reduce their lung cancer risk through lifestyle change; however, their relative risk of developing lung cancer remains elevated even 35 years after cessation.22 Whereas primary
prevention is necessary to reduce risk factor prevalence (namely, tobacco use), secondary prevention is critical to reduce lung cancer risk among former smokers.23
DPH seeks to partner with providers
to help Delawareans understand their personal lung cancer risk, provide access to high-quality LDCT lung cancer screening when appropriate, and ensure follow-up care in the event of
a lung cancer diagnosis. Our existing statewide cancer infrastructure positions Delaware to capitalize on the public health opportunities afforded through LDCT, especially for low-income or otherwise vulnerable populations. The DCC, established in 2001, operates as a public-private entity that advocates for state funding, partners with the Medical Society of Delaware (MSD), advises DPH, and monitors and evaluates the statewide cancer control activities. Delaware’s ability to implement statewide lung cancer prevention efforts stems from the partnership between the DCC and DPH. Under the DCC’s guidance, DPH operates the state’s Comprehensive Cancer Control Program (CCCP), which includes SFL and the Delaware Cancer Treatment Program (DCTP). Additionally, the CCCP partners with the Tobacco Prevention and Control Program (TPCP), located within DPH’s Health Promotion and Disease Prevention Section.
The TPCP, funded through appropriations from the Delaware Health Fund, monitors statewide tobacco use trends and carries out tobacco prevention and cessation activities ranging from grassroots educational campaigns to legislative policy change.24 The TPCP funds the Delaware Quitline, a telephone-based support resource, to help adult smokers who seek to quit using tobacco. Delaware Quitline services include motivational support from a trained specialist or counselor, follow-up support, and educational information about the quitting process. TPCP services are available at no cost to all Delawareans.
Delaware Quitline has expanded its services to include a web-based service, Quitnow.net.24 The Delaware Quitline received 12,325 calls in FY 2018. Telephone-based cessation counseling was provided to 1,789 Delawareans;
an additional 268 individuals received face-to-face cessation counseling through the TPCP. Evaluation survey data show that 33% of adults who received Quitline telephone-based counseling services remained smoke-free seven months following counseling. Since the inception of the Quitline, 565 Delaware health care professionals were trained in tobacco cessation counseling.
SFL, Delaware’s breast- and cervical- cancer early detection program, was established in 1997. In 2015, SFL expanded to include free lung cancer screening with LDCT for uninsured or underinsured eligible men and women aged 50 to 88 who currently smoke or who quit smoking during the past 15 years. SFL nurses and case managers ensure that clients who receive positive LDCT screening results are linked with
a medical home, as well as psychological and social support services. Since 2015, only nine Delawareans received 10 LDCT screenings through SFL.
In 2004, Delaware Regulation 1144 established the DCTP. The DCTP provides medical insurance coverage
to eligible uninsured or underinsured Delawareans for cancer treatment. Under the DCTP program, eligible Delaware residents can receive free cancer treatment for two full years, regardless of cancer type. Since 2004, the DCTP has provided services to more than 1,400 Delawareans, of which 231 clients (approximately 17% of the total population served) received lung cancer treatment.
The TPCP, SFL, and the DCTP provide a continuum of lung cancer prevention and detection services, including free tobacco cessation services, free LDCT screening
Del Med J | September/October 2019 | Vol. 91 | No. 5
215
