Hollings and Fetter partner to get more people to lung cancer screenings

February 08, 2023
a smiling couple pose in a cancer center hallway
Diane and Alex Juitt are all smiles at MUSC Hollings Cancer Center. After her treatment for lung cancer, Diane now serves as a patient advocate on a Stand Up 2 Cancer grant at Hollings. Photos by Clif Rhodes

The Fetter Health Care Network’s Charleston Health Center is located only blocks from MUSC Hollings Cancer Center – and yet it is a world away, said Marvella Ford, Ph.D., associate director of Population Sciences and Cancer Disparities and director of Community Outreach and Engagement at Hollings.

She hopes to bring the two organizations closer together through a grant that will help patients at Fetter to access lifesaving lung cancer screenings at MUSC Health.

“I’m so excited about this grant,” she said. “Typically, many patients access MUSC’s services through the Emergency Department. Overcoming fear, mistrust, transportation issues, financial barriers, copay issues – we’ll be working on all of those by providing patient navigation to successfully guide people from Fetter through the MUSC system and back to their primary care providers at Fetter.”

Hollings is one of three cancer centers working on this $3 million grant from Stand Up 2 Cancer, which seeks to improve screening rates and cancer outcomes in medically underserved communities. Massey Cancer Center at Virginia Commonwealth University and Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill are also part of the grant.

The grant merges the expertise of researchers like Ford and Gerard Silvestri, M.D., a lung cancer pulmonologist, with the practical experience of Fetter staff and doctors, like Kevin Patel, M.D. It also involves the personal experiences of people who have lived through lung cancer diagnoses – people like Diane Juitt, who has agreed to serve as a patient advocate for the grant.

A shocking diagnosis

Diane, who lives in Columbia, discovered she had lung cancer in the fall of 2021, almost by accident. She was getting ready to retire and went for a physical.

“You know, I'm retiring, and I'm saying, ‘Hey, I'm getting into my golden years; I'm getting ready to travel,’” she said.

At the same time, she had a cough that had stuck around ever since she’d had a bout with COVID in the spring. After a CT scan, her family doctor referred her to a doctor in Columbia, who performed a biopsy but was unable to get close to the suspicious mass. Nonetheless, Diane was told that she was clear.

“Had we left it at that, it could have been catastrophic,” said her husband, Alex Juitt.

Diane’s intuition told her to seek out another doctor. She made her way to Hollings, where she connected with surgeon Barry Gibney, D.O., and oncologist Mariam Alexander, M.D., Ph.D. Gibney recommended that they schedule surgery, rather than waiting for another biopsy – and what he found shocked the Juitts, particularly because Diane Juitt had never smoked a cigarette in her life.

“My husband found out while I was in surgery, when they told him I was stage 3a,” she said. Lung cancer is categorized in five stages, from Stage 0 to Stage 4, with Stage 0 being the very beginning of a cancerous growth. Before she had surgery, Diane said, “I thought it was just in the beginning stage. I’d never had any symptoms but the cough and was feeling fine – nothing out of the ordinary.”

After surgery, the Juitts learned that doctors had removed part of her lung and about 30 lymph nodes.

Diane didn’t have a history of smoking, but it turned out she did have a gene mutation that put her more at risk for lung cancer.

Genetic predisposition

One of the aims of the SU2C grant is to uncover whether there are genetic biomarkers that could potentially identify lung cancer earlier, especially in Black patients.

Research indicates that Black people who smoke are more likely to develop lung cancer than White people who smoke, and they’re also more likely to be diagnosed at young ages, Silvestri said. Screening helps to catch cancer earlier – although Diane, who never smoked cigarettes, wouldn’t have been recommended for routine screening – but lung cancer screening requires access to a health center that offers the low-dose CT scans and has the radiologists to read them.

If researchers could find a biomarker that indicated increased risk, then they could develop blood or saliva tests for the biomarker, and that biomarker test could become the first step in screening, rather than attempting to get everyone with a smoking history to CT scans.

Navigating to care

Right now, though, low-dose CT scans are the best option for screening for lung cancer. They’re recommended for people between the ages of 50 and 77 who have at least a 20-pack-year history of smoking – that means one pack a day for 20 years or two packs a day for 10 years. Unfortunately, only a tiny percentage of people who are eligible actually get the scans.

“The hard part is not identifying those patients. We already know who they are, and that they're at risk, and they qualify. It's trying to determine the social barriers that lead to them not getting the screen."

Dr. Kevin Patel
Fetter Health Care Network

The partnership between Hollings and Fetter will work to identify Fetter patients who are eligible for scans and then refer them to a social worker at Hollings dedicated to this program.

“My job is to identify those patients and train our providers, including physicians, physician assistants and nurse practitioners, to make sure that they discuss with our patients that this is a standard of care for lung cancer,” said Patel, an internal medicine doctor at Fetter.

“The hard part is not identifying those patients. We already know who they are, and that they're at risk, and they qualify,” he continued. “It's trying to determine the social barriers that lead to them not getting the screen. There are a lot of misconceptions out there – that this is not necessary, or ‘What if I get a bill for $500 in the mail?’ So that, I think, will require a lot more work with our patients.”

Letiandrea Hinton, Population Health and Value-Based Care program manager at Fetter, said that among the challenges facing the population they serve, which can include food insecurity, transportation insecurity and financial restraints, is health literacy. It’s important to take the time to ensure that patients understand what a health care provider is saying, she said.

It’s also critically important that patients realize the importance of maintaining a relationship with their primary care providers at Fetter, she said. Too often a patient may begin seeing, for example, a cardiologist, and assume that because they’re under a doctor’s care that they’re covered. But they still need a primary care provider to look at the big picture and assess all those parts that a specialist doesn’t check, she said.

Once the patients have been referred to Hollings, the Stand Up 2 Cancer social workers will work with each individual according to their unique needs to help them to get screened.

Lung cancer screening program

The lung cancer screening program at Hollings has been in place since 2016, growing from 251 patients that first year to 1,485 in 2022.

In the last couple of years, the program has expanded to MUSC Health Regional Health Network locations in the Midlands, Florence and Lancaster areas, where doctors hope to replicate the success of the Charleston program.

Not only has the Charleston program increased the number of people getting scans, but the providers have worked diligently to get people to return for scans in subsequent years. Like mammograms, lung cancer scans should be performed annually. About half of the lung cancers that are found through scans are found in return visits, not on the initial scan, Silvestri said.

The team’s dedication has resulted in a lung cancer detection rate that’s higher than the rate in the National Lung Screening Trial. More than that, the Charleston program is seeing a “stage shift,” meaning that the majority of cancers it finds are still in Stage 1, when they can be surgically removed.

Patient advocate

But it all starts with getting people to the scans. Part of the Stand Up 2 Cancer grant includes having a patient advocate, who can give the social workers, doctors and researchers a firsthand perspective of someone with lung cancer. This is the role that Diane will fill.

After that startling beginning to her lung cancer journey, Diane did remarkably well – so much so that her doctors called her a poster case for recovery, Alex said.

a doctor sits and chats with a female patient in an exam room 
Diane Juitt chats with Barry Gibney, D.O., about holiday meal plans during a follow-up visit in November 2022.

That’s not to say it wasn’t without difficulties. After the diagnosis, Alex found himself searching online for every bit of information he could find – and the data for Stage 3 lung cancer wasn’t great. Alex, who pastors a church in Columbia, wondered whether his wife would still be alive in 15 months.

“Of course, I, being a man of faith, I need to place faith first. But she had already done it. I had to try to practice what I preach, but her reaction was steadfast, full of faith. I was more shocked, more distraught. She never flinched,” he said.

After her surgery, Diane followed a course of chemotherapy and began taking a targeted therapy specific to her molecular alteration that aims to prevent the cancer from returning. She’s also connected with Kevin Hughes, M.D., the director of the Hollings Hereditary Cancer Clinic, who helps people with cancer-associated gene mutations to determine the best course of action to try to prevent or treat cancer.

Now, more than a year later, she feels good. She said she always took in what other people told her about their own experiences with cancer but then gave herself over to God.

“I have to have the mindset that I know I can overcome, not by myself, but with the Lord’s help, I can do that. So it was just, ‘I'm just going to go through it gracefully. I'm not going to complain about it,’” she said.

However, she advises others to advocate for themselves at the doctor’s office – to push for additional tests if they sense that something isn’t right.

“Tell your doctor, ‘Look, I need more.’”