CHI Memorial Chest and Lung Cancer Center in Chattanooga, Tennessee is constructing a new bus designed to screen patients for signs of lung cancer, as part of its Breathe Easy program.

The new vehicle will replace a prototype launched two years ago that has since averaged approximately 100 low-dose CT screenings per month throughout all counties in east Tennessee and north Georgia within 90 miles of CHI Memorial. This includes underserved rural areas where rates of lung cancer cases tend to be higher, according to Dr. Rob Headrick.

"The advantage of having a patient in a screening program is that you are likely to diagnose the tumor when it is small and in an early stage when the treatment is simpler and the long-term prognosis is excellent," Headrick, thoracic surgeon at CHI Memorial Chest and Lung Cancer Center, told HCB News. "The country’s challenge has been getting someone to enroll in a screening program, especially when they feel good and are likely completely unaware of their risk as well as the benefits of being in a screening program. This mobile program was designed as a way to travel to those who are most at risk, not only providing that educational component but also making it very easy for those to get screened."

The prototype began operating in early 2018 and screened 548 patients in 104 sites during the 10 months it was available that year, the findings of which were recorded as part of a study on the bus’ efficiency.

The mean age for patients who boarded was 62 years old, with a mean smoking pack years of 41. Screenings revealed significant pulmonary findings in 51 patients. This included five cases of lung cancer, four of which were early stage. It also found non-pulmonary conditions in 152 individuals screened, with moderate to severe coronary artery disease being the most common and found in 101 patients.

The built-from-scratch design includes independent power, climate control, patient comfort, drivability, a portable CT scanner in the front, and a registration and shared decision-making area in the back. Operating it is a cross-trained team of a driver, a CT technician, a program director, a nurse practitioner, and a physician.

The bus can conduct screenings at places of employment, restaurants churches and other public venues. Patients board for 10 to 15 minutes to be scanned, depending on whether they are preregistered or a walk-up. After undergoing their scan, a physician on the bus will review the films directly with the patients. If no physician is present, images are sent wirelessly for immediate, same-day interpretation. Smoking cessation options are also provided, when appropriate. While insurance payments are collected when appropriate, screenings are offered for free to individuals who do not have insurance or cannot afford the $150 price. Patients only need to meet certain National Comprehensive Cancer Network guidelines.

The Breathe Easy bus initially traveled two hours from its home base at CHI Memorial but now travels 1.5 hours to more easily manage patients and provide follow-up assistance. Even during the COVID-19 crisis, the bus continued screening patients in rural Tennessee and added diagnostic scans for patients in the CHI Memorial nodule surveillance program. Each patient enrolled is tracked through a centralized database and receives a follow-up annually. The program expeditiously provides follow-up testing or consultation with a provider, and connects patients with significant findings, such as lung cancer, immediately to a thoracic surgeon. Situations that involve only follow-up imaging can also be completed on the bus close to home, making it more convenient for the patient.

A financial analysis found that the break-even number of scans for the first year was 428. The Breathe Easy bus surpassed this by 120 scans, despite only scanning patients during 10 months in 2018.

The new bus will include a more advanced CT scanner and coronary calcium scoring capabilities, and will be able to implement immunizations and other much-needed population health measures in rural counties. It also will have a separate entry and exit way instead of a shared entrance and exit like the prototype, along with an improved interior to maximize space and throughput.

"This study was a feasibility study to see if this approach to healthcare was not only practical but economically realistic," said Headrick. "Currently, the governor of Tennessee, the speaker of the House and our state legislatures are evaluating a plan to place eight buses across the state of Tennessee covering all 95 counties. Each bus will be tied to a specific medical center with all eight buses working together. It will likely be done in multiple phases with the eastern half of Tennessee operational in the next 12 to 24 months."

He adds that "in this new era of the coronavirus it also provides a way to continue healthcare closer to home while keeping patients safe."

The new Breathe Easy bus is expected to begin screenings in late fall 2020.

The findings for the study on the prototype were published in The Annals of Thoracic Surgery.