In almost every industry, COVID-19 provoked temporary changes to what type of work could be done safely. For the radiology community, many hospitals halted non-urgent or elective imaging studies during the early phases of the virus. This notably included preventive cancer screening.

Unfortunately, cancer doesn’t wait for COVID-19 — and the delay in care may result in negative outcomes, delayed diagnosis, or increased cancer burden on hospitals. With November being Lung Cancer Awareness Month, many imagers hope to boost screening back to pre-pandemic momentum. To resume lung cancer screening (LCS) at hospitals where it’s possible, the ACR LCS 2.0 Steering Committee prepared a new toolkit (available at acr.org/lcs), containing vital information and template documents for both referring clinicians and patients.

Debra S. Dyer, MD, FACR, chair of the ACR LCS 2.0 Steering Committee, says that in January, screening at her practice at National Jewish Health in Denver was on the upswing. “And then of course, in March came the pandemic,” she says. “The Steering Committee advised that all LCS programs follow the CDC and the ACR’s recommendations to not do elective or non-emergent imaging.”

As a result, patient navigators and schedulers reached out to patients to postpone screening, without a clear idea of when this imaging would be rescheduled. “None of us has lived through a pandemic, so we were all kind of unsure about what to expect,” says Denise Wojcik, RN, BSN, patient care coordinator for lung CT screening at Northwestern Memorial Hospital in Chicago, who contributed to the ACR toolkit.

In addition to the logistical questions in the early days, Dyer knew practices, physicians, and patients would need additional guidance as the pandemic wore on. She reached out to Eric M. Hart, MD, associate professor of radiology at Northwestern University Feinberg School of Medicine (who works with Wojcik) about forming a new ACR subcommittee to provide this guidance. The subcommittee was made up of seven member volunteers, including one patient advocate.

The subcommittee began drafting essential materials to help ACR members with resumption of LCS — and how to clearly and effectively communicate with other stakeholders, like patients and clinicians, about when to return for these services. “It fell into place pretty easily because everybody was on the same page,” says Dyer. “We all agreed that we need to make sure that whatever we do is safe for patients, and also that facilities can take this toolkit and apply it to their settings. We know that a private practice in a rural setting is quite different from a big metropolitan academic center.”

Most of our patients wanted to come back. They were ready.

Hart addresses many of these initial setting concerns in the toolkit’s “Resumption of Screening Quick Reference Guide.” The document contains general guidance for reopening phases, with sections on patient and staff safety and patient prioritization using lung cancer risk. The subcommittee also created a “Telehealth Quick Reference Guide,” which provides at-a-glance telehealth guidelines and resources for shared decision-making. The toolkit additionally includes an infographic for patients, outlining the low risk of COVID-19 exposure for radiology patients and precautions being taken at imaging centers.

Another key piece of the resources were draft letters to patients, which Hart and Wojcik collaborated to create. There are several different template letters, including letters for patients whose screening has been postponed, as well as draft communications to share with referring provider letters. “I think the letters acknowledged, people are fearful,” says Wojcik. “It’s been stressful for everybody, but we want to acknowledge that we care about patients’ health and prevention.”

In terms of resumed LCS, as of the time of writing, Dyer says screening at her practice is back up to approximately 75% of where it was before the pandemic. However, she remains optimistic that Lung Cancer Awareness Month can help generate renewed interest and commitment. “Most of our patients wanted to come back,” she says. “They were ready.” And there’s another glimmer of hope: the U.S. Preventive Services Task Force’s LCS recommendations dropped the minimum screening age to 50 and pack-years to 20. “That can really inject new energy because we are going to have new patients to include,” Dyer says.

Hart hopes the toolkit will assist LCS centers with the return to screening during the COVID-19 pandemic and reassure patients of updated procedures and precautions. “Lung cancer remains the leading cause of cancer death for both men and women,” he says.1 “Even if only one patient comes in because of the toolkit, it will have made all the work and effort worth it.”