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Lung Cancer Portfolio of Kentucky and Illinois

Flory Ann Evia, Paul John, Brett Seaholm, Caroline Yeager, Andrew Diehn

Epidemiology

Introduction

Economic and Policy Implications


The Prevention and Public Health Fund associated with the
Affordable Care Act (ACA) supports a new focus on prevention and
wellness and is attempting to combat the high incidence rate of lung
cancer
There are discrepancies in federal and state funds and policies for
tobacco control and smoking cessation between Illinois and Kentucky
New screening methods of low-dose computed tomography (LDCT),
has shown to reduce mortality from lung cancer by as much as 20
percent (20%)

Lung cancer is the second most commonly occurring cancer in the United States and is the
leading cause of cancer related death. Lung cancer has been identified as a health disparity
by Healthy People 2020. The biggest risk factor lung cancer is smoking, causing
approximately 85% of lung cancer cases in the U.S. This analysis focused on non-small cell
lung cancer (NSCLC) due to high incidence and association with smoking. Lung cancer rates
vary by geographic region. A complete investigation of the effects of NSCLC was completed
for the state of Illinois and Kentucky.

Table 1. Tobacco Prevention and Cessation Funding

Biology
Lung cancer causes malignant tumors to form in the lungs that destroy
healthy lung tissue and can spread to other areas of the body.
(NSCLC) accounts for 80 to 85% of all lung cancers and is classified by
adenocarcinoma (50%), squamous cell carcinoma (30 35%), and large
cell carcinoma (510%).
Lung cancers are usually asymptomatic until the disease is at an
advanced stage. NSCLC is often diagnosed at an advanced stage when
treatment options are limited.
Smoking is the leading cause of lung cancer with other causes being
environmental exposure and genetic factors. Genetic and epigenetic
factors develop lung cancer through activation of growth promoting
pathways and inhibition of tumour suppressor pathways.
Lung cancer screening through the use of low dose computed
tomographic can detect many tumours at early stages

Figure 3. Lung and bronchus cancer incidence rates for the United States. Kentucky has the highest
incidence rate (92.4). Illinois has an incidence rate of 65.8 per 100,000.

Figure 1. Results of low dose computed


tomography scan. The image shows a lung tumor
in the left upper lobe.

Multi-disciplinary Team and the Lived Experience

Figure 2. Roles in The Lung Cancer Multi-disciplinary Team


(MDT). MDTs are made up of healthcare professionals
whose specialty is treating and supporting patients with lung
cancer.

The Lung Cancer Multi-disciplinary Team (MDT) is extremely


patient-focused. Patient centered care is a team effort.
Meetings are taken place in order to develop the most
efficient treatment plan specifically designed for individual
patient cases. Communication is vital during different points of
lung cancer care between the patient, family, and MDT.
The lived experience of a patient diagnosed with lung cancer
is filled with guilt, shame, and stigmatization.
Lung cancer patients argue that most other illnesses are selfinflicted but are not stigmatized the same way as their illness.
Nicotine dependency makes smoking difficult to quit. Even
after diagnosis patients continue smoking.
Nicotine withdrawal and the physical action of holding a
cigarette can be an internal struggle for some patients.
Patients develop a network of support from friends, families
and healthcare professionals.

Kentucky has high rates of smoking among the adult population (25.2% of
the adult population)
Kentucky also has the highest percentage of youth smokers aged 12 to 18
(15.9%)
The majority of new lung cancer patients are elderly (median = 70yrs)
More men die from lung cancer than women.
Women have a higher risk of developing lung cancer versus men who
smoke the same amount.
The incidence of lung cancer in women has only recently fallen whereas
lung cancer incidence in men peaked in 1984.
Black men have higher incidence and mortality rates than any other racial
Logo for secondary institution
or ethnic group.

Illinois

Kentucky

State Funding for Tobacco Control

3.1mil

2.5mil

Federal Funding for State tobacco


Control

3.1mil

2.3mil

Total Funding for state tobacco


control

6.2mil

4.7mil

136,700,00

56,400,000

Percentage of CDC
Recommended

4.5%

8.4%

State Tobacco-Related Revenue

1.1bil

302mil

CDC Best Practice State Spending


Rec

Table 2. Access To Cessation Services


Illinois

Kentucky

Medications

Covers all seven recommended


cessation medications

All health plans cover NRT Patch;


coverage for NRT Gum, NRT Nasal
Spray, NRT Inhaler, NRT Lozenge,
Varenicline (Chantix) and
Bupropion/Zyban varies by health plan

Counseling

No Coverage

Coverage of individual, phone and


group counseling varies by health plan

Barriers to Coverage

Co-payments required for


prescription meds

Duration, annual limits on quit


attempts, co-payments required,
counseling required to get medications
and prior authorization requirements
vary by health plan

Medicaid Expansion

Yes

Yes

if appropriate

References

Figure 4. Lung and bronchus cancer incidence rates for Race/Ethnicity in the United States. Black men are
disproportionately affected by lung cancer at 90.9 new cases per 100,000 persons.

Cooper WA, Lam DCL, OToole SA, Minna JD. Molecular biology of lung cancer. J Thorac Dis 2013;5(S5):S479-S490. doi: 10.3978/ j.issn.20721439.2013.08.03
Huang, J & Chaloupka, FJ, The Impact of the 2009 Federal Tobacco Excise Tax Increase on Youth Tobacco Use, National Bureau of Economic
Research Working Paper 18026, April 2012
Meza, R., Meernik, C., Jeon, J., & Cote, M. L. (2015). Lung cancer incidence trends by gender, race and histology in the United States, 1973
2010. PloS one, 10(3), e0121323.
Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. (2011). New England Journal of Medicine N Engl J Med,
365(5), 395-409.
Refsgaard, B., & Frederiksen, K. (2013). Illness-Related Emotional Experiences of Patients Living With Incurable Lung Cancer: A Qualitative
Metasynthesis. Cancer Nursing An International Journal for Cancer Care, 36(3). doi:10.1097/NCC.0b013e318268f983

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