Lung cancer is the second-most diagnosed type of cancer and the leading cause of cancer-related deaths, claiming nearly 1.8 million lives worldwide in 2020. By mid-2021, an estimated 235,760 new cases and 131,880 deaths from lung cancer were reported in the United States.

August 1 marks World Lung Cancer Day. Cancer therapies have come a long way in recent years. Molecularly targeted therapies based on the expression of specific biomarkers now provide new, optimal treatment options for patients with lung cancer. Such therapies require biomarker testing, through which clinicians can determine whether a person has a biomarker that can be targeted with precision medicine. These therapies are more precise than traditional chemotherapies, and they have fewer harsh side effects. But poor accessibility and high cost can make them out of reach for patients treated in their communities.

ACCC has long been at the forefront of teaching the members of multidisciplinary cancer care teams about how to best implement new and evolving lung cancer therapies into their programs and practices. This guidance has taken the form of focus groups, surveys, research reports, webinars, tools, and other outlets. Our efforts have encouraged and enabled clinicians and their support staff to introduce into their practices more targeted therapies that can provide improved outcomes for their patients.

In 2020, ACCC published a foundational framework for helping community cancer practices and programs improve care coordination for patients on Medicaid who had been diagnosed with lung cancer—the culmination of a three-year effort. The Optimal Care Coordination Model developed during this initiative can help cancer programs objectively assesses how lung cancer care is provided at their institutions, and it provides the scaffolding needed to build quality improvement initiatives that can enhance care coordination for all patients—regardless of insurance status. The solutions produced by this program include an interactive, online evaluation tool, comprehensive report, environmental scan, article, and podcast, among other materials.

Current ACCC projects address the dissemination of best practices, the incorporation of patient feedback into quality improvement initiatives, the education of clinicians about newly approved biomarkers, the availability of molecular testing to patients, and the impact of race-based inequities on patient access to precision therapies.

Below are several ACCC lung cancer projects currently in progress:  

• Changing Care Patterns for Patients with Early Stage IB/IIIA Non-Small Cell Lung Cancer (NSCLC): ACCC will conduct a nationwide initiative to provide guidance to cancer care teams on key issues related to providing optimal care for patients diagnosed with early stage IB/IIIA NSCLC across different practice settings. This initiative will address care coordination and communication within multidisciplinary cancer care teams and educate team members about how to eliminate barriers to optimal care and implement process improvement initiatives to address those barriers.

   

• Best Practices in Early-Stage NSCLC: This initiative will develop an online course for clinicians on how to provide optimal care to their patients with early-stage NSCLC. A small group, social learning model will focus on providing mentoring and peer-to-peer support for clinicians who care for patients with early-stage NSCLC. Groups of 15 clinicians led and mentored by a subject matter expert will take part in a multi-component curriculum that includes self-study materials, live group discussions, and group challenges. Experts will coach and mentor participants throughout the curriculum period and interact with them individually and in groups.

   

• Emerging Biomarkers in NSCLC Training: Recent studies indicate that more than 70 percent of patients with cancer treated in community cancer centers do not receive biomarker testing per National Comprehensive Cancer Network guidelines, and more than 50 percent of the patients tested do not receive appropriate precision medicine therapies based on their test results. To help close this gap, ACCC has launched Emerging Biomarkers in NSCLC Training, the goal of which is to increase the capability of community cancer programs to perform comprehensive biomarker testing and act when a new treatment becomes available for a previously unactionable biomarker (e.g., KRAS G12C) to improve patient outcomes and quality of life.

   

• Eliminating Disparities in Access to Precision Medicine in Lung Cancer: ACCC and its partners at LUNGevity and the Center for Business Models in Healthcare are working with two cancer program sites to develop an intervention for both patients and providers to promote biomarkers testing for patients with lung cancer in underserved communities. ACCC and LUNGevity Foundation will present the project’s research findings at the upcoming IASLC 2021 World Conference on Lung Cancer (Sept. 9) and ASCO Quality Care Symposium conferences (Sept. 24).

   

• Operational Pathways for Molecular Testing in NSCLC: The ACCC-developed Biomarker Testing Implementation Roadmap for NSCLC is an innovative learning tool that can help multidisciplinary care teams obtain the knowledge they need to implement, expand, and sustain biomarker testing for patients with NSCLC. The roadmap gives users information about how to lay the groundwork for biomarker testing, train and prepare their team to offer testing, implement the testing, and evaluate ongoing progress.

   

• Patient-Centered Small Cell Lung Cancer (SCLC) Care: Insights from Patient- and Provider-Facing Surveys: In this initiative, ACCC will conduct patient and provider surveys to garner insights into the care journey of patients with SCLC.  Survey questions will focus on perceptions, barriers, and challenges in the patient/provider relationship and will examine the psychosocial impact of SCLC on patients. The survey will also address existing operational challenges and gaps in current care delivery processes, services, and resources. Responses will be used to identify actionable items with the goal of improving overall care and quality of life. 

   

• Fostering Excellence in Care and Outcomes in Patients with Stage III and IV NSCLC: Growing knowledge of NSCLC subtypes and molecular biomarkers for lung cancer has led to more complexity in treatment planning and decision-making for patients—particularly for those diagnosed with locally advanced stage III and metastatic stage IV disease. In this project, ACCC is conducting a national multi-phase effort to identify and provide guidance to clinicians in different practice settings. This initiative will address care coordination and communication within multidisciplinary cancer care teams and educate them about how to eliminate barriers to optimal care and implement process improvement initiatives.

   

• Optimizing Advanced NSCLC Biomarker Testing, Treatment, and Management: While the evolution of targeted therapies has significantly improved outcomes and quality of life for patients with advanced NSCLC, it also poses challenges for the inter-professional members of the cancer care team. ACCC joined the American Society for Clinical Pathology to provide resources and CME-/CMLE-accredited activities to help members of the cancer care team enhance their coordination of patient care and gain deeper scientific knowledge, skills, and competence in biomarker testing services.

Access more of ACCC’s extensive library of materials on lung cancer:

• National NSCLC Quality Care Initiative
• ACCC Lung Cancer Home Page
• Biomarker Testing Resource List
• Six Steps to Improve Care Coordination