A nonprofit publication of the Kentucky Center for Public Service Journalism

St. Elizabeth wages war on cancer; Dr. Doug Flora says early diagnosis through screening is key


By Mark Hansel
NKyTribune managing editor

Dr. Douglas Flora delivered a strong message about cancer in the Northern Kentucky region at the November Covington Business Council lunch, but it was conveyed with a commitment to facilitate change.

“We are nationally shamed regularly in Kentucky,” said Flora, Executive Medical Director of Oncology Services for St. Elizabeth Healthcare. “Not only are we diagnosing patients at later stages and in greater numbers than in any other state, but our patients are dying sooner than in any other state.”

Dr. Douglas Flora speaks at Covington Business Council luncheon on the efforts by St. Elizabeth Healthcare to improve outcomes in cancer diagnosis and treatment in the region (photos by Mark Hansel).

The ranking is a function of a lot of issues that Flora says the region’s business leaders are already aware of.

“We have a very, very low health literacy rate here (and) about one-in-five Kentuckians are below the poverty level,” Flora said. “That has marked ramifications for health care. People don’t get screened. People don’t take their medication.”

Education, or an overall lack of it, also contributes to Kentucky’s high lung cancer rates.

“If you did not graduate with a bachelors in college, you’re twice as likely to smoke,” Flora said. “I think we’re at 21 percent of people in this Commonwealth that have bachelor’s degrees, versus 29 percent nationally.”

Flora also sees a direct correlation to a lack of education and the state’s poor screening record. He said that is something that can be changed and is critical because early diagosis is key to an effective treatment plan.

“I’m embarrassed by this. I know you all are and that’s part of why we are all here together today,” Flora said. “When we go through this, it gives me a little bit of pause because we had some bad news this week.”

According to the U.S. Centers for Disease Control and Prevention, cancer has surpassed heart disease as the leading cause of death in the country.

“I think it reflects well on our heart doctors and the fact that we paid attention to this,” Flora said. “The reason (St. Elizabeth physicians) are so busy now as cancer doctors is partly because of the success of keeping people alive from other diseases.”

Because of improvements in diagnosis and treatment, heart problems are no longer a death sentence. 

“So now, at 58, if you have your heart attack, you are very likely to survive,” Flora said. “If you have a stroke at 62, you’re going to be OK, most of the time. You’re going to get cancer at 69 or 72, which, it’s part of aging.”

While Flora is happy that more people are living longer, it also means that there is more work to do, as a generation of Baby Boomers live into their 70s and beyond.

Northern Kentuckians are diagnosed with cancer and dying of cancer at the highest single rate in the country and Flora said that’s a tough crowd to be in.

“Kentucky ranks below West Virginia, below Mississippi, below Arkansas, below Louisiana and these are not places that are known for primary health care,” Flora said. “Not coincidentally, we’re number 49 for second worst smoking in the country and that vacillates between us and West Virginia just about quarterly now, again company that you don’t want to keep.”

“We are looking at 3,400 newly diagnosed cases in our region,” he said. “Each of these is a mom or a dad, or a husband or a wife, or me last year, about 13 months ago with kidney cancer.

A commitment to change outcomes in the region

Unfortunately, as other communities seem to be improving, Northern Kentucky remains behind the curve.

“We’ve seen inroads for a lot of other places that have more successfully prevented and screened than we do in…the Greater Cincinnati/Northern Kentucky area,” Flora said. “We also have quite a bit of late cancer presentation in Appalachia which is contributing to our numbers, but our counties aren’t winning so great either.”

Ground was broken on the St. Elizabeth Cancer Center in Edgewood in August. At that time Dr. Doug Flora was also named Executive Medical Director of Oncology Services for St. Elizabeth Healthcare (file photo).

St. Elizabeth Healthcare CEO Garren Colvin has made it his mission to make Northern Kentucky one of the healthiest regions in the country. Improved cancer diagnosis and treatment  is a cornerstone to that effort.

About two years ago, St. Elizabeth brought a group of about 10 cancer physicians in private practice, including Flora, into the fold. 

“They had a very good cancer program, at that point, but they didn’t have the physicians aligned to adequately address the scope of the problem we are dealing with, so they purchased our practice,” Flora said. “Immediately upon arrival, they said, we’re glad you’re here, this is the final puzzle piece that we needed to start battling cancer in our region.”

The Board of Trustees gave the team a vote of confidence, committing about $140 million to that effort in the form of a new cancer center.

Ground was broken on the St. Elizabeth Cancer Center in Edgewood in August,  at the same time, the word “interim” was removed from Flora’s title.

“The new cancer center had footers poured about two weeks ago and it will rival anything within about 250 miles,” Flora said. “It’s all outpatient care and it’s designed to have a multidisciplinary approach to your cancer, where if you come into this building, you will leave with your plan. Our idea is to recruit the best talent we can in our region and elsewhere.”

The 233,000-square-foot facility will focus on multidisciplinary care and is expected to open in the summer of 2020.

The treatment plan will allow patients to meet everyone that will be a part of the care team in one room as well as a navigator to help with the next steps.

St. Elizabeth is currently in the midst of a $30 million capital campaign to support the Center.

Attendees at the November CBC luncheon listen to Dr. Doug Flora of St. Elizabeth Healthcare speak on the challenges to improving outcomes in cancer care in the region. He said the state’s and the region’s poor ranking in treatment can be improved through early screening and detection.

“This is a major investment in our region. It’s not just in Edgewood,” Flora said. “We’ve probably put about $6-$7 million into our Fort Thomas/Campbell County location. The whole idea is this is going to be the mothership, where we invest a lot in research infrastructure…opening as many cutting-edge clinical trials that we can.”

At the same time, St. E plans to have hubs in all of the major regions of its service areas, to make sure its patients don’t have to travel to get to care.

The Cancer Center is being constructed with a patient-family advisory committee guiding every step, every decision. There are 15 current or former patients or caregivers advising St. Elizabeth on everything it does.

“When this comes together, it will not be a doctor-centric, or nurse-centric hospital,” Flora said. “It’s going to be an outpatient place where people can come and have book clubs with the other cancer patients, or a demonstration teaching kitchen, or pet therapy or music therapy, or art therapy. None of this is for the benefit of St. Elizabeth’s bottom line, but it’s a very worthy investment in the health and welfare of the human beings we are taking care of.” 

Flora acknowledges that St. Elizabeth has a daunting task ahead and said it will require a buy-in from the community at-large.

“Cancer can hit anybody in this room, and probably will, about 40 percent of the time, so this is going to be money well-invested by our community,” he said. “We start with screening and detection. So like anything in business or in health, you can plan, you can prevent calamity, you can fix your roof before you need to replace it. In Kentucky, we don’t do that very well.”

Four cancers represent about 50 percent of overall diagnoses for the disease – lung and bronchis, female breast, colon/rectum and cervix.

“Not coincidentally, those four have FDA-approved, evidence-based, level-one evidence that we can prevent those cancers with screening and prevention,” Flora said. “We’re still losing patients at a brisk pace today because we still have not done a great job of getting that out to our community yet.”

Proof of principle

There is precedent to demonstrate that screening is critical to early detection and effective treatment.

In the past, Kentucky was not great at colon cancer screening, but 19 years ago, an aggressive effort was initiated at the state level to correct that.

A rendering of the St. Elizabeth Cancer Center in Edgewood, which is expected to open in 2020. The Center is envisioned to provide the most comprehensive care and treatment in the region (provided image).

“If you look back at 1999 we were about 49th in the nation, where we rank currently for cancer and smoking,” Flora said. “With good attention to screening…we’ve raised that to about 70 percent of eligible patients are now having their screening tests over the age of 50 and that’s made incredible inroads in terms of the number of patients who have to hear those awful words, ‘I have cancer.’ We’ve saved about 52.8 percent of people by 2016 and our goal in our system is to take it to 80 percent.”

Thanks to upgraded screening techniques and availability, Flora believes the same type of progress can be made with lung cancer.

“If we take lung cancers deaths in Northern Kentucky alone, it outpaces the next four cancers,” Flora said. “If we go to all of the cancers, involved in Kentucky, not just Northern Kentucky, it’s probably the next seven.”

St. Elizabeth Lung Cancer Screening Program was designated a Screening Center of Excellence with the Lung Cancer Alliance in 2015 and continues to be, but increased participation is critical. Click here to read the 2017 St. Elizabeth Healthcare Public Outcomes for Cancer Care report

With the current level of screening in Kentucky, Flora says about 80 percent of patients are still diagnosed when it’s too late to successfully treat them.

“We give them $250,000 of chemotherapy or immunotherapy that might buy them four months, or five months, or six months, if we’re very fortunate, but we can’t fix them by the time we meet them,” Flora said.

Early diagnosis, through screening, ensures patients have a fighting chance.

“If we find you as a stage 1a, or stage 1b, you have a really, really  good chance of beating this cancer,” Flora said. “If we find it when it is a resectable coin lesion in your lung, then we can take that lobal lung out with our surgeon, there’s a really good chance that you avoid chemotherapy or radiation therapy. If I say 80 percent of people are found with Stage 4, the survival rate is less than 10 percent, but with this screening test, we can fix that and we are fixing it already.”

Flora emphasized to the business leaders in the room that while saving lives is the primary reason for screening, it also makes good economic sense. Employers and their workers are increasingly burdened by rising health care costs and screening can greatly reduce that.  

“Assuming current commercial reimbursement rate for treatment, screening costs $1 per insured member per month in 2012 (about $1.08 today),” Flora said. “For each average life year saved, it’s $19,000. To put that in some perspective, dialysis is $60,000 to $70,000 per year, for life year saved. That’s a fine return on investment, for anything in health care, when we are giving $250,000 worth of drugs that don’t work if we miss this.”

If the guidelines had been consistently followed since screening was readily available, Flora said 358,134 individuals with current or past lung cancer would have been saved, as of 2014.

“Those are lives lost and we’re not going to have that happen in our community any longer,” Flora said.

Contact Mark Hansel at mark.hansel@nkytrib.com


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