Improving cancer outcomes in Kentucky
In 2014, Hazard Police Department detective Paul Campbell and his wife, Gracie, had just checked out at the grocery store when he spiked a fever and nearly doubled over.
“Gracie drove me to the ER immediately—groceries still in the car,” explains Campbell, now a captain at the Perry County Sheriff’s office. “I was diagnosed with stage 4 colorectal cancer and given six months to live.”
Campbell was only 34 at the time. He had seen a couple of red flags, such as blood in his stool, in the years leading up to his diagnosis.
“Now, doctors would do a colonoscopy given my symptoms, and that may have led to the removal of precancerous polyps. But at the time, I was in my 20s and working hard to finish my degree and start my family. I didn’t think much of it,” Campbell says. “Never neglect what your body is telling you. We can make excuses until our bodies demand we pay attention, but it’s better to go ahead and get things checked out. I hope we can do more to educate people in Kentucky about recognizing symptoms and getting screened.”
More than 30,000 people in Kentucky will be diagnosed with cancer this year, and the state is No. 1 in the nation for cancer incidence and cancer mortality, according to National Cancer Institute data. Kentucky has an especially high incidence of lung, cervical, colon, rectal, and head and neck cancers. Our death rate from lung cancer is 50% higher than the national average.
Researchers are looking into what makes Kentucky’s cancer rates so staggering. The presence of high amounts of radon in our limestone bedrock contributes to lung cancer rates. Cancer-contributing behaviors such as tobacco and alcohol use also are factors, but they aren’t unique to the Bluegrass State. Two issues that complicate Kentucky’s cancer battle are access to care and attitude toward preventive measures.
Increasing access to care
In the 54-county Appalachian region, cancer rates are high and treatment locations are low. Here and in other parts of Kentucky, many patients drive more than 100 miles to treatment—even before the looming closure of some rural hospitals, which will inevitably cause more disparity in care.
When Campbell was in treatment, his long drive to chemotherapy and the financial challenge of missing work to do so made his cancer journey more difficult. His family was dependent on his income, so he clocked in for work between treatments. A similar scenario plays out for many cancer patients—the course of treatment is just one of many decisions, including how to get back and forth to care and how to pay for hotels and gas.
The Kentucky medical community recognizes the need to reach patients and train oncology personnel in rural areas. Several years ago, leaders at the University of Kentucky Markey Cancer Center had a vision to expand cancer care by creating the Markey Cancer Center Affiliate Network, a network that has grown to 16 hospitals across the state. The hospitals partner for quality, compliance, education and, most importantly, coordinated care for patients. Patients receive as much treatment as close to home as they can but come to Markey for specialized care.
Other providers, like Commonwealth Cancer Center, provide patients close-to-home care by offering multiple clinic locations in rural communities. Specialized doctors rotate to the clinics rather than patients traveling hours to see them.
“No Kentuckian should have to travel long distances to receive quality cancer care,” says Dr. Emmanuel Nidhiry, an oncologist at Commonwealth Cancer Center in Danville.
Mobile units also ease the treatment burden for families. Commonwealth Cancer Center is the first clinic in Kentucky to send out a coach with a combination PET/CT scan called the Reveal RT-Duo, which provides imaging necessary for treatment planning. “The scans are unrivaled in accuracy, so patients don’t give up quality when we come to them,” says Erin Wilcher, the center’s executive director. “Our mobile unit adds comfort and convenience in a difficult time.”
Rural Kentuckians aren’t the only hard-to-reach population. Urban communities benefit from mobile units, too. The Kentucky Cancer Program, the University of Louisville Hospital and the UofL Health Brown Cancer Center provide a mobile mammography coach to reach women in historically underserved neighborhoods in the Louisville area. Mammograms are free for eligible women without insurance. The bus’s strategic stops, including the Kentucky State Fair, provide preventive care for hundreds of Kentuckians who would not otherwise be served.
The Kentucky Cancer Program, Markey Cancer Center and Brown Cancer Center also partner together in community health advocacy, teaching community members about early detection and risk reduction.
New cancer clinics near rural areas also lighten Kentucky’s cancer burden. Mercy Health–Lourdes Hospital in Paducah, a Markey Network affiliate, will open doors to its new 19,000-square-foot, full-service cancer center in 2024.
“Though our cancer program is strong, our biggest challenge is high volume. We serve many rural communities in a two-hour radius, and our practice outgrew our physical space,” says John Montville, a Jackson Purchase Energy Cooperative consumer-member who serves as executive director of the hospital’s oncology service line. “This new facility allows for better collaboration, communication and coordination of services. Any time we can provide more targeted treatment for cancer patients in Kentucky, it improves outcomes, and that’s what this building will do.”
Embracing a prevention mindset
Early detection and prevention are the most direct ways Kentuckians can take control of their health, according to Montville, who is one of only seven professionals nationwide to be given the new credential of certified oncology administrator from the Association of Cancer Executives.
“Progress is being made in awareness—especially in areas where the medical community has come together to promote screenings, such as with tobacco users, but in Kentucky, we are sometimes our own worst enemy,” says Montville. “We underscreen for cancer and we overexpose ourselves to cancer-causing behaviors like smoking, obesity and sun damage. Our rates for routine scans like colonoscopies and mammograms are too low. Those with a smoking history should have regular low-dose CT scans.
“Many new treatments are promising, but they work best when cancer is caught early—so make changes to lower your cancer risk and schedule regular physicals.”
The voice of experience
It was a routine physical that located an area of concern for Meg Gravil eight years ago. At the time, Gravil was in graduate school, working, and had an 8-year-old at home. “Life was busy,” she says, “but I was always a firm believer in following through on my annual physical.”
Gravil’s doctor recommended a mammogram as part of her routine wellness check, and, in spite of her having no family history, risk factors or symptoms, the scan came back with irregularities. She had breast cancer. Driven by her desire to survive for her daughter, she asked questions, took notes, decided on a course of treatment and endured the disappointment of a recurrence one year later.
Gravil, now a cancer survivor and assistant professor of child and family studies at Eastern Kentucky University, encourages Kentuckians to get screenings.
“I would never have suspected cancer. Mammograms save lives,” she says.
For those facing a diagnosis, she recommends being as forward-looking as possible. “Having cancer is an upheaval of sorts. A water hose of information is hitting you. It can be emotionally and financially devastating. Take advantage of every opportunity your clinic offers— including nutrition consulting, exercise therapy and counseling. Fear tries to creep in, and these services help you focus on the next step,” she advises. “It is a difficult season, but it is one you can make it through.”
Gravil, who finished her doctorate, says she loves training the next generation of early childhood educators, and she hopes to encourage students who have a parent or sibling with cancer.
“They can’t help make health care decisions, but they are deeply impacted by the diagnosis,” she says. “They need someone to assure them it is normal to feel scared and worried.”
Gravil says that while Kentucky is “behind the curve” on providing treatment and screenings in every region, she is hopeful for positive change.
“… Kentuckians care. The medical community cares,” she says. “I believe that, together, we can continue to improve cancer treatment in Kentucky.”
Hitting the target
Benefits of biomarker testing
Imagine being a nonsmoker and receiving a lung cancer diagnosis. Your thoughts run to a lengthy course of treatment and a hundred other questions. But when your doctor gets results of your biomarker tests, he explains yours is a type of cancer that can be treated with a therapy drug instead of chemo. You are able to take the medication with relatively few side effects and it halts the progress of your disease. Biomarker data saves you time, money, and discomfort—and it also saves your life. This is the story of some Kentuckians who have taken advantage of biomarker testing after a cancer diagnosis.
Lawmakers in Kentucky revolutionized cancer care in Kentucky by passing House Bill 180 in the 2023 legislative session, making Kentucky the fifth state in the country to adopt a law that expands insurance coverage for biomarker testing. The law affords Kentuckians who have received a cancer diagnosis the opportunity to obtain biomarker data, fully covered by insurance when indicated by their physician.
Biomarker testing is a crucial diagnostic tool that helps physicians determine the best course of treatment for each patient—without the grueling and expensive trial-and-error therapies of past decades and the agonizing wait to see if the treatment worked. Biomarker data is different from genetic testing. Genetic cancer testing looks at a person’s cells. If genes in the DNA of those cells reveal mutations, that person have a higher risk of getting certain cancers. Biomarker testing, on the other hand, looks at the cells of the tumor itself. The tumor’s genes, molecular structure and certain protein levels can reveal information that guides providers to treatments that will be most effective in halting that specific type of tumor.
Doug Hogan, director of government relations for the American Cancer Society Cancer Action Network, says biomarker data increases the odds of finding the best regimen for cancer patients. “For many patients, biomarker testing opens the door to targeted treatments that can be more effective than traditional treatments and have fewer side effects,” Hogan says. “We are finding that, with biomarker data, some patients live longer and better lives.”
Jill Kolesar, director of the Precision Medicine Center and co-chair of the Molecular Tumor Board at the UK Markey Cancer Center, agrees that biomarker data moves treatment beyond the cookie-cutter approach of the past.
“Chemotherapy and radiation therapy used to be our only options. But recent advances in cancer treatment are life changing,” she says. “Just as every person is different, every tumor is different. Biomarker testing gives us a way to look at the tumor on a deeper level. Then we can choose therapies tailored to each patient’s needs.
“Targeted therapy drugs, CAR-T cell therapy, immunotherapy and specially designed radiation—all of these are on the table when our Molecular Tumor Board is creating a treatment plan for a new cancer patient. This kind of precise, personalized care is not futuristic. It’s available today in Kentucky.”
Will House Bill 180 ease Kentucky’s cancer burden? “There’s no doubt in my mind—HB 180 will save lives,” Hogan says.
