Pharma giants take on Appalachian cancer rates in newest screening initiative

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Two portraits, or perhaps stereotypes, of rural Appalachia exist. One conjures images of winding country roads connecting idyllic Leave-It-To-Beaver towns hidden in the shadows of rugged mountain ranges. The other brings to mind rusted suspension bridges, buckling wooden homes and desolate mining towns in the clouds of dust.

The real picture of Appalachia and the people who live there is multi-dimensional, and solving the health disparities in the region, including high lung-cancer mortality rates, requires nuanced solutions, says Richard Martin, a medical oncologist at Meharry Medical College in Nashville , Tenn., and soon-to-be president of the Tennessee Oncology Practice Society.

The region, comprising parts of 13 states from Alabama to Ohio, has the highest rate of lung cancer mortality in the country compared to the rest of the US, that’s 25% higher for men and 8% for women.

Those numbers are particularly striking considering lung cancer accounts for roughly a quarter of all cancer deaths in the US and has an average five-year survival rate of 17.7%. While mortality rates for the disease have slowly decreased in other areas of the country over the last half century due to healthcare advancements and screening programs, they’ve steadily increased in Appalachia.

Richard Martin, medical oncologist at Meharry Medical College

Permission granted by Richard Martin.

There isnt a sole cause for the divergence. Poverty, high rates of obesity and tobacco use, environmental factors, lack of screening and poor access to healthcare all play a part. But one approach Early and regular screening for the disease — could help decrease the mortality rate, Martin says. One study found that in patients where lung cancer is caught early, survival rates can reach as high as 55.2%.

Now, a new initiative by the Association of Community Cancer Centers — a network of over 28,000 healthcare practitioners nationwide — aims to bring together a variety of healthcare and biopharma partners, including AstraZeneca and Bristol Myers Squibb, to increase lung cancer screenings in rural Appalachia with the goal of lowering mortality.

“It may not fix everything, but only 4% or 5% of patients who are currently eligible for lung cancer screening are getting it,” says Martin, who conceived of and is spearheading the Rural Appalachian Lung Cancer Screening Initiative. “We have such a low threshold to make a huge difference. We don’t necessarily expect to capture the other 90% to 95% in the next five years. If we could just show that we’ve doubled or tripled that range to 10% or 15% … that’s a big step forward that’s going to galvanize even more momentum.”

Unique approach

Screening initiatives to address lung cancer mortality in Appalachia are nothing new. The difference this time, however, is ACCC and its partners’ commitment to creating solutions that local communities can continue to implement long after the initiative is over.

“We’ve had years now of people trying to go into communities to just offer something. It works in the short term, and they can get a publication to say, gosh, we brought some CT scanners to this community and everybody got a scan. That’s great, but we’re trying to figure out how we make this sustainable,” Martin says. “How do we actually change communities and change healthcare systems to be resilient and self-actualized? How do we deliver this thing on a long-term basis instead of us coming in and being the difference?”

The initiative’s wide array of partners is key to that mission. The goal, Martin says, is to bring together several types of physicians from primary care to pulmonologists to radiologists As well as patient navigators, community advocates and drug companies to create a “playbook for how to comprehensively address barriers to lung cancer screening.”

AstraZeneca and Bristol Myers Squibb are a good fit for the initiative as both companies have medications — Tagrisso and Opdivo, respectively — aimed at improving outcomes for non-small-cell lung cancer in certain patients. Once they draw that blueprint, the next step is providing local communities with the resources and support structures to actually implement it, screen patients, and set up pathways to treatment or closer examination for individuals who screen positive.

“You can’t just look at the Appalachian region and look at low [screening] numbers and say barriers, barriers, barriers, and think that it’s a one-size-fits-all.”

Richard Martin

Medical oncologist at Meharry Medical College

Most of the initiative’s leaders, particularly from the ACCC, are volunteers. That’s part of the reason why AstraZeneca’s and Bristol Myers’ participation is so integral, Martin says.

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