November is Lung Cancer Awareness Month, and a newly released report
shows far too few Nebraskans at high risk for lung cancer are getting the recommended screening.

The American Lung Association's latest "State of Lung Cancer" report ranks Nebraska 33rd for lung cancer screening -- at less than 4% of those who are at risk.

Julia McCarville, executive director of the American Lung Association in Nebraska, said although lung cancer remains the leading cause of cancer deaths for both men and women, the nationwide outlook improved somewhat between 2015 and 2019.

"The five-year survival rate increased from 22% up to 26.6%, and additionally, we're seeing the survival rate increasing at a faster pace among communities of color, so it is no longer significantly lower compared to white individuals," McCarville said.

McCarville stressed that a low-dose CT scan can lead to an earlier diagnosis. And when lung cancer is caught at an early stage, it can increase one's chances of surviving five years by more than 60% . At Savedbythescan.org, people can assess their risk for lung cancer and their eligibility for a low-dose CT scan.

Some 10% to 20% of those diagnosed with lung cancer have never smoked, and McCarville said anyone with concerning symptoms -- such as a lingering cough, chest pain, shortness of breath or frequent lung infections - should talk with their doctor about getting a low-dose CT scan.

Dr. Sumit Mukherjee, medical director of thoracic oncology for Methodist Health System, calls it a "huge missed opportunity" that so few people who are eligible are getting screened. He explained that screening should be done with a low-dose CT scan, not a chest X-ray.

"Because you just don't see these little spots in the lungs on chest X-rays, and by the time you can see them on X-ray, lung cancer becomes more advanced generally at that time," Mukherjee said.

Mukherjee added that part of the explanation for lung cancer being the leading cause of cancer deaths is the fact that it is often diagnosed at a late stage.

He said there is a movement to help women, especially those at high risk, become as accepting of regular screening for lung cancer as they are for breast cancer. More non-smoking women than non-smoking men are diagnosed with lung cancer.

"We all focus so much with women and breast cancer, and there is great screening and education behind breast cancer awareness and screening, and really more women die of lung cancer than breast cancer and colon cancer combined," Mukherjee said.

For those who do receive a diagnosis of lung cancer, Mukherjee added there are a number of better technologies and medications available now than in the past. However, he stressed that lung cancer is still a very deadly form of cancer that can have a profound impact on people's lives.

A new report found New York hospitals are in a precarious financial state.

The New York State Hospitals Fiscal Survey Report showed statewide hospitals are projecting an operating budget margin of 0.0% percent. While it is a slight improvement, hospital administrators said it is still insufficient for hospitals to handle patient care.

Bea Grause, president of the Healthcare Association of New York State, said government reimbursements do not cover the costs of administering health care.

"Those reimbursements are fixed and do not change," Grause pointed out. "They grow a little bit year over year but they're not keeping up with the expense growth that all hospitals are experiencing."

She noted hospitals cannot raise their commercial expenses with the expectation it will make up the difference, arguing the best way to help hospitals is to close the gap on Medicare and Medicaid payments so they keep up with expense growth. Prescription drugs are the largest continuously increasing expense hospitals face since such prices run 83% above the rate of inflation.

Staffing issues are being exacerbated by New York hospital's fiscal challenges. The report found labor expenses have grown more than 36% since 2019. While it is the second year of declining contract labor expenditures, they are double what they were in 2019.

Grause emphasized not having sufficient staff can affect the services hospitals offer.

"If a hospital is going to have a dialysis unit, you need a nephrologist. You'd probably need more than one nephrologist," Grause observed. "But you also need specially trained nurses, you need the right equipment, you need all the medication, you need the IV solution and the peritoneal solution."

Another factor in hospitals' declining operating margins is insurer demands. The report showed some surveyed hospitals project insurers' actions will cut their 2024 operating revenues by 5% or more. Estimates showed it would result in $1.3 billion or more in lost revenue for the hospitals.


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More than half of North Carolina counties have fewer than four dentists per 10,000 people and a few counties have no dentists at all.

The North Carolina Dental Society Foundation is stepping up to meet those residents where they are, for essential dental services.

Dr. Amanda Stroud, dental director and chief dental officer for AppHealthCare and a member of the foundation board, said she sees the need firsthand. She explained the biggest barriers are lack of dental insurance, affordability and the ability to get timely appointments.

"It may be that someone has to wait six to nine months for a dental appointment when they may be having tooth pain," Stroud observed. "And it may be that once they get that appointment, that appointment's just for a planning process and not always something that can help treat the pain or manage the dental issues."

Stroud noted such challenges affect a significant number of people, particularly in rural parts of the state. So, the foundation supports programs like "Give Kids a Smile" and the "Missions of Mercy" clinics, to provide free oral health services.

Stroud emphasized the events are supported by fundraising efforts, like an annual golf challenge. Dentists from across the state volunteer to perform extractions, fillings and cleanings and sometimes offering lifesaving care.

"You can have a dental infection that becomes something that is a cause of death for the patient," Stroud pointed out. "And that's happened in the United States. And you don't want to think about that happening in the United States, but it has."

Sharon D'Costa, fund development and program director for the foundation, said the efforts so far have reached nearly 73,000 patients. Beyond direct care, she stressed they are helping to expand the dental workforce in the state.

"We're working with community colleges to kind of provide students with scholarships," D'Costa outlined. "We're also initiating new programs, we're incentivizing faculty to stay in their jobs as well as get new faculty to take on roles teaching dental assisting and dental hygiene students."

D'Costa added the foundation awards grants and recognizes public health efforts to improve access to dental care. She acknowledged it is challenging to mobilize volunteers and secure funding but strong community partnerships help the foundation improve its impact.

Access to reduced-price medication is vital for many low-income rural Tennesseans and the clinics serving them are concerned about potential cuts to a program that helps with drug costs.

The 340B program allows safety-net providers, like community health centers, to purchase outpatient medications at discounted rates.

Emily Waitt Hise, policy and advocacy manager for the Tennessee Primary Care Association, said the savings are crucial.

"The 340B program allows health center patients to receive the care they need to attain their highest level of health," Waitt Hise asserted. "It ensures that all patients can receive the lifesaving medications they need to manage chronic conditions, like diabetes or high cholesterol."

She pointed out health centers are required to reinvest the savings from the program back into patient care, which helps them provide other services like pediatrics, behavioral and dental health and OB/GYN care. Health centers are concerned that the 340B program will be on the chopping block under the new administration.

Laura Harris, CEO of Chota Community Health Services, said the 340B program offers significant cost savings, which are passed on to low-income and uninsured patients. She noted the costs vary by drug but are generally minimal. Her organization did a recent patient survey, confirming the cost savings.

"This third patient said, 'Eliquis was going to cost me $500, because my insurance denied it. With the program, it only cost $50,'" Harris reported. "A fourth patient said, 'My inhaler was over $100, but I got it for $25.'"

Harris argued the biggest challenge with the program is the pharmaceutical manufacturers' contract pharmacy restrictions, which limit 340B pricing to one pharmacy. She added it forces patients on multiple medications to visit different pharmacies to fill their prescriptions, which is challenging in rural areas.