I just got a promotion. I'm not a doctor, and I don't play one on TV, but I appreciate that. Welcome to the rebel portion of the program. My name is Melissa Wheeler, and I'm the Administrative Director for Disparities and Outreach, and I am so grateful to be here, really happy to be in this room of really brilliant people. I think my husband's happier because he heard women use 20,000 words a day, so he's hoping by the time I get home Monday, he'll have silent football Monday. I'm going to share with you today about our mobile lung cancer screening program that started in 2016. I have no disclosures other than I am not the smartest person in this room, but I am the most excited to pull you out of brick and mortar and take you on a journey, and that journey's going to lead you to the intersection of the highest quality clinical care, plus community, plus research, with a heavy infusion of humanity along the way. Our team, our mighty team of 17, are in North and South Carolina, and we are entirely dedicated to underserved and underrepresented communities across the Carolinas. We have a 30-county catchment area, and we are also fondly known as the buckle of the tobacco belt, so where much of the country has declined in tobacco use rates, we have seen a very sturdy dedication to keeping those numbers stagnant. And what we do is not just lung cancer screening. We actually screen across five different cancer domains, and from 2012 to 2023, we looked at our numbers just recently, and we screened 19,956 individuals at no cost and navigated them all to follow-up resource as well. So we're really excited, but more than that, we view all of our individuals that we care for through what we call the whole human lens, and that means we're not just looking for a tumor. We're not just looking to diagnose. We're looking at all the things that might prevent someone from getting the care that they deserve. So every piece of what we do has a navigation assessment to that, and I'll talk through that with you as we talk about the mobile lung bus. So there are three primary buckets we focus on. Prevention and education. We want to stop disease in its tracks, so everything that we do includes that educational component. We have our screening programs in lung, breast, colorectal, high-risk prostate, skin, head, and neck, and then most importantly, because we're only a team of 17, we rely heavily on community partnerships, which means we have more than 200 partners across the Carolinas that do things like make referrals to us, that do things like accept referrals to us. If we identify someone without primary care, we need to get them primary care for that follow-up. So those community partnerships are really key to everything that we do. And then along the bottom, again, of every piece of what we accomplish has to have that pre-diagnostic navigation and that whole human care focus. If you're hungry, giving you a scan isn't going to matter to you. If you don't have a roof over your head, finding out you have a cancer is going to be the least of your worries. So we need to take into consideration recognizing and seeing the humanity of individuals that we screen, and really plugging in those resources along the way. So back in 2016, when we looked at our cancer data registry, we looked like much of the rest of the country. About 75% of our patients were coming in at stage three or stage four disease, leaving us very little time for any type of positive outcome, let alone any quality of life. And we knew we had to do something big. We had spent many years building a mobile mammography program and building trust in our communities. So we said to ourselves, and this is when I say ourselves, it was Dr. Derek Raghavan, for those of you who know him, from the Cleveland Clinic. He then came and was the president of Levine Cancer. We looked at each other and said, why can't we do the same thing in lung that we did with breast? Why can't we put a CT scanner on a bus? And we heard no, which is my favorite word in the English language, because I'm going to figure out a way to flip that to on. And so we did a lot of exploration at that point. I made approximately 45 phone calls. On the 46th call, I reached the folks with Samsung Neurologica who built the mobile stroke units for the Cleveland Clinic. They knew the technology and had the ability to put a CT scanner in the field and said, we think we can build it if you can build out the program and you can find support for it. Well, we heard, not possible. Once again, here we go, love a good no. And thanks to the forward thinking and the generosity and the innovative spirit of Bristol Myers Squibb Foundation, we were funded to support our Lung Basis for Life program. Now keeping in mind this was not just screening, we really wanted all components with this underserved communities that we care for to be successful. So it was education. Why are you here today? Do you know why you're here today? We weren't going to bill for the care for these folks. So we weren't required for shared decision making visit, but that's best practice for anything we do for any patient, right? So education. But we also had to educate our primary care. When we did preliminary studies, about 60% of the physicians in our rural communities were still using chest x-ray as a mechanism to identify lung cancer. So we had to do a lot of boots on the ground education. Screening, of course. So we have a mobile coach that is a 32-slice portable scanner, and I'll show you some pictures. But the big piece for us was navigation, right? Because knowing that this is a population that can get very easily lost to follow-up or need help navigating and overcoming barriers like how to get into the next step, navigation was a key component. Then finally, intervention. Doesn't make sense to screen, hand someone their results, and say, good luck on your next steps. We don't know what to tell you what to do. So we work very, very diligently with all of our community partners to navigate our individuals for care in their home county. And I'll share with you what some of those statistics look like. So this was the very first mobile lung cancer screening bus in the United States in 2016. It took us nine months to build her. We called her Hope. And that's because she was bringing hope to communities that otherwise had none when it came to lung cancer. And we started lung cancer screening for uninsured individuals before our healthcare system began screening for insured individuals, and that's something that we're very proud of. It's a little bit like a box-style truck. Due to the weight, did not require a CDL. They won't let me drive it. I can't figure out why for the life of me. I keep trying all these years later. But you can see it's got a bump-out slide, and on the back, there is a wheelchair lift. Because of the initial success of our first two years, we recognized the need to continue to expand the program, so we were able to find funding through the Leon Levine Foundation to build our second unit. And it's a comprehensive program that not only includes the screening and navigation, but we do tobacco cessation and nicotine replacement therapy for every individual. Not just the individual being screened, but the entire household. If you have one person being screened, but four people in the house smoke, and you help one person quit, what is the likelihood the rest of the house is going to help them stay in that state? So we provide nicotine replacement therapy and cessation counseling for the whole family, no matter how many family members need it. So what do we offer through our program? So there's free screening and monitor of all the follow-up. One of the interesting things that we learned very early on in our geography, people started smoking at five, six, and seven years old. It was part of the tobacco farm culture. Folks would spend all day in the fields, come back together and collect in the barn in the evening, and pass around cigarettes. Additionally, two of the largest tobacco manufacturers were located in the North Carolina area, about 19 miles outside of Charlotte, was a Philip Morris plant. And in addition to your paycheck, every Friday you would go home with a complimentary double set of cartons of cigarettes. So we knew we had a lot of work to do. The free nicotine replacement therapy that we provide arrives at the doorstep of the person screened within 48 hours. Our team does all of the assessment, all of the tobacco cessation plans, and all of the follow-up. So there's a really high level of relationship and trust, and we have a significant quit rate as a result. We assess for all those connections to things like, and I don't like the term food insecurity, it's more hunger, lack of food access, because it's not an insecure issue, it's lack of food. So we get grocery carts on the bus with us, and then we refer to long-term supports in the community where the person lives. We also carry bus passes, we carry gas carts, other mechanisms to be able to navigate some of these early immediate barriers. And what that's done in turn is really built trust, right? So we're not just asking the question so we can collect the data point and say, man, there's a lot of problems out here. We're asking people what's keeping you from getting care, and we're providing immediate relief, and then we're following up with long-term relief. We ask about housing, primary care, we also cross them into all the other free screenings. If you qualify for lung cancer screening, chances are you're going to qualify for breast screening or other free screenings that we have. And then we follow up and navigate all of our positive patients. One of the things we also, again, recognizing that the age of smokers was much younger before the Nelson results came out is we started an under 55 clinical trial. And this is actually bringing clinical trials into the field, and our uptake is huge because of that. People trust us, they recognize and now have normalized the lung bus coming out, and so we have a great uptake for that trial. Our first set of data was pretty interesting. In 1,786 patients, we found 43 cancers, 27 were early stage with 63% being treatable with curative intent. Our average pack year was 50, but can you guess the highest? 187 pack per year history, 6.5 packs of cigarettes per day. If you are a scientist researcher, you need to meet this individual because somehow they didn't have a cancer, and I still cannot explain that. 75% were rural. Again, Medicaid was not at the time we started the program screening of the Carolinas with low dose CT, so we started with our Medicaid patients. That population has remained relatively high, though, because of the intense navigation that we provide. So I told you at the beginning I was not the smartest person in the room, but I was able to find the secondary finding on this one. Look at the top of the scan there. Nobody's a half a pack short, right? This was actually from one of our very first scans that we did. The first time the mobile lung bus deployed, we had three patients and a drive-by shooting, but it's a lead line truck, so we did great. But we've been able to connect with specialty populations in a way that no one else has. We worked with the Catawba Indian Nation, and we were able to raise their screening rates for eligible tribe members from 5% to 60% in nine months because we show up at the reservation with all of this resource, and we also care for other needs that they have, not just those cancer needs. So I'll finish up by saying I could talk about this for 10 months, 10 years, forever and ever, but there's a couple of common questions I get. First one is, how do you fund this? How do you afford this? I accept Venmo, PayPal, pocket change, and if it's a check, it's two L's, one S. But my message around funding is to be creative. Don't look to your system to be the one to say no to you, because they might, they probably will, but be creative about who are your corporate champions in your community? Who are other people who are really vested in saving lives because this program does save lives? The second question I get is about sustainability. How do you keep it going? How have we grown it from one screening in one county to 1,200 patients screened in 30 counties each year? I don't want it to be sustainable. I want us to find better ways to screen. I want us to find better access for patients. In fact, my end goal to all of this is to get rid of lung cancer altogether. We can't guarantee any of us are going to be here next Tuesday, right? My brain tried to break up with me with an aneurysm three years ago, but I'm here. I'm sustainable somehow. Don't like that word, no. And my third and final point that I get asked is, what do you wish you knew then that you know now? My answer to that is nothing, because if we would have known some of the road bumps along the way, some of the hard parts, we might have gotten paralyzed. We might have had that analysis paralysis of this isn't possible. There's clearly no one way to bake a cake, right? I could give you all the same recipe, and you're still going to go to different stores. Some of you are going to skip ingredients. Some of you are going to bake a terrible cake the first time. But the key is we all have to start somewhere, and that's by turning the oven on. So my point to you today is to encourage you to think big, turn the oven on, put ourselves all out of a job so we could just enjoy San Diego as friends. Thank you.

mobile lung cancer screening

underserved communities

community partnerships

tobacco cessation

Bristol Myers Squibb Foundation