Susanna  00:08
Welcome to The Cancer SIGNAL, a podcast presented by GRAIL, where we discuss topics relating to early cancer detection, including multi-cancer early detection testing, cancer genomics and risk, barriers to cancer screening, and much more. I’m your host, Susanna Quinn. Today we are welcoming Dr Patrick McGill. Dr McGill is the Executive Vice President and Chief Transformation Officer at Community Health Network. He has a background in family medicine and has experience in emergency and urgent care. Dr McGill was also named to Becker’s list of 30 most inspiring chief transformation officers. We are honored to have you here today, Dr. McGill. Welcome to The Cancer SIGNAL.

Dr. McGill  00:55
Absolutely, thanks for having me. It’s really my pleasure to be here.

Susanna  00:59
Wonderful. Well, I was doing a little bit of research on your background, and I see that you went to college and medical school in Georgia, and so I just wanted to let you know that I picked Georgia to win on my college football bracket.

Dr. McGill  01:15
Well, if you hadn’t picked Georgia, this was probably going to be a very short podcast, so I’m glad that you did pick Georgia, but yes, I did go. I did. I was raised in Georgia, went to University of Georgia and then medical school and at the Medical College of Georgia in Augusta. So…

Susanna  01:30
Excellent. Well, my son is an Alabama fan. I’m not really sure why, his godfather went to Alabama, but he makes me fill out brackets, and then he laughs at me because they’re always wrong. So let’s hope this one is right.

Dr. McGill  01:42
I’m sure this one will be right.

Susanna  01:44
Great. All right, could you share, Dr McGill, your background in medicine and what your role is with Community Health Network?

Dr. McGill  01:53
Yeah, happy to share it. So like you said in introduction, I’m a family physician, and I’m happy to say that at Community Health Network, we feel strongly that all of our physician executives still practice and see patients. So I do still practice and see patients one day a week. And as the chief transformation officer, I have a broad range of responsibilities, everything from IT and analytics, population health and value based care, clinical and nursing informatics. And I have some operational areas such as care in the home, geriatrics, home care, hospice, palliative care. I also have health equity and strategic partnerships, our direct to employer relationships, and some of our strategic partnerships as well. The way we’ve been organized, we really have married data, technology with organizational transformation. So how do we deliver better care, better experience? I should have said patient experience analytics rolls up underneath the office of transformation too. So it’s really, how do you understand that experience? Our brand promise is exceptional care simply delivered. So that’s what we wake up every day trying to deliver upon, and whether that’s a new innovative treatment, new innovative therapy or screening, like we’ll talk about today, or technology, it’s how do we deliver the best experience and best care for the patients that we serve?

Susanna  03:13
When did you first learn about multi-cancer early detection tests, and what was your first impression of the technology?

Dr. McGill  03:21
So we’ve been leaders, market leaders in oncology. We have a strategic partnership. We’re one of the seven member partners with MD Anderson. So oncology has been very important to us in our strategy for a long time. And actually our introduction to multi-cancer early detection tests came through one of our technology partnerships, actually. So we have a very interesting story about how this came to be at community. One of our tech partners reached out and said, would you be willing to be a pilot site? And I said, well, tell me about this company. Never heard of it. What’s this test? Never heard of it. And I said, they explained it to me. I said, this sounds great. Let me talk to our oncology leader. And interestingly, I called him, and within 10 seconds, he said, absolutely. MCEDs are going to be the future. It’s going to transform how we treat cancers by catching them earlier. So we’ve got to be a leader. We always pride ourselves in being an early adopter, innovator. So it made a lot of sense. And his one caveat was, this cannot be done in oncology. It has to be done in primary care, because that’s really where we’re going to bend the curve on early detection. So he said, I am 100% supportive, but I want it to be done in primary care, and that really is what set the ball rolling. So it came through a kind of an innovative, interesting channel into the organization. But once it started, you know, we’ve gotten this ball rolling. And been I feel fairly successful to get it rolled out.

Susanna  05:04
Interesting. So my next question was, actually, how does MCED testing fit into primary care medicine, which you sort of answered, but if you want to give us any sort of anecdotal response.

Dr McGill  05:16
Yeah, so we took the approach that if we’re going to do this in primary care, it needs to become part of our arsenal of tools, of, you know, mammograms and colorectal screening and pap smears and other, lung cancer screenings that we do. And how do we really augment those screenings with MCED testing, and really drive again, to the front edge of the point of care, earlier detection, earlier screening. So we took the approach. We knew that cost was going to be a question out of the gate, cost of testing and insurance coverage and others. So we have a very active and very helpful, very robust foundation that supports our organization. So we went to the foundation and said, would you be willing to support the cost, cover the cost for a certain number of tests, so that we can get this off the ground and really remove cost as a barrier. So they supported 2000 tests, so we were able to roll out 2000 tests, MCED tests out of the gate throughout primary care, just so that we could understand what happens when you have a positive signal. How do you treat that? How do you get primary care physicians to buy in? How do you get them understanding what the test does? How do you get them trained? This is a new technology, new test to offer. So there’s a fair amount of education that had to occur as well. And so we really didn’t want people to say, well, it’s expensive. I’m not going to I’m not even going to have the conversation. We wanted to take that off the table, and so that has led to additional conversations, additional training, and been very successful with adoption across primary care. We built tools within the EMR to help identify patients eligible. We’re now launching some tools within patient outreach to outreach directly to patients and get them in, our virtual care team orders the test for patients that are coming into the network that want the test that don’t have a primary care physician. So we’ve really tried to spread it across the organization, throughout all the primary care channels.

Susanna  07:15
That’s terrific and so valuable. Could you be a little bit more specific about the types of patients that would be eligible under your program for MCEDs that would be at risk and not have the finances for the MCEDs at this point?

Dr. McGill  07:34
Yeah. So we, we, we offer the test to everybody that’s over 50, doesn’t have cancer, is not pregnant. I mean, that’s, that’s really the criteria that we have. We have some other additional criteria for patients that are high risk, immunocompromised, HIV status, other immunosuppressant conditions. You know, those patients are at higher risk. So we, we make sure to offer the test. We do have some other channels that patients with financial constraints, can come through or request financial assistance for the test. And so that’s really, that’s really the channel that we’ve taken through primary care. And if you think about it, you know to have this test. We, of the two of the 2000 tests, I should give you the results, of the 2000 tests that we did, initially, we detected 35 to 40 cancers. And I think when you look at that, those patients, we detected cancer on those, many of those were pancreatic cancers, leukemias, lymphomas, a few lung cancers and a recurrent breast cancer, which we can talk about that story in a few minutes, if you want. But you know that really has changed the trajectory for many of these patients. And so again, how do you get the test? How do you get the primary care physician to offer the test, the patient educated, and then go through completing the test?

Susanna  08:53
And specifically, I know that there’s patients who are at risk because of environmental exposures. Can you talk a little bit about that?

Dr. McGill  09:01
Yeah, we have some strategic partnerships with local municipalities where we do a broader range array of services for them, whether it’s a direct to employer contracting or on site clinics. And so this came through. We were in a meeting one day with the mayor of one of the cities we work with, and he’s at the end of the meeting, as we were all packing up and walking out. He said, you know, I’ve got a fire department that is absolutely paranoid about getting cancer. These are our first line defenders, first responders that go into any situation that we need them to, put their lives at risk. And they’re paranoid about bringing the carcinogens that they’re exposed to home to their to themselves, but also to their family, their children. He said, guys who get undressed in their garage and leave their stuff in their truck because they don’t want to bring it into their house. And so he said, cancer is top of mind for many of these, for these folks. So how can we help them? I said, I’m glad you asked, because we now have a test that we can offer. So we’ve actually, you know, partnered with four different municipalities to screen over 200 firefighters that are at higher risk due to their occupational exposures, and now we’re in the process of repeat screening for many of these firefighters as well.

Susanna  10:13
That’s terrific. So who in your practice do you recommend take an MCED test? What factors do you look at? And specifically, I know that we’ve talked about this in a podcast before, but I think it’s also interesting to take into consideration how an MCED would fit in for somebody like me who has had cancer and is cancer free. I know you mentioned a recurrent breast cancer situation with a patient. So could you talk a little bit about that?

Dr. McGill  10:44
So we want to offer it really, for patients that have not had cancer or have been remote enough from their cancer three to five years out that you’re not you’re not dealing with a residual or current, currently active cancer. And so you know, really, it does not replace all the other screening. So we still recommend patients get mammograms and colorectal screening, pap smears, lung cancer screenings, but it really helps to augment those cancers, cancer screening. So you know, when you have patients that are a little bit higher risk, maybe they’ve had cancer before, they have a strong family history of cancer, I think we really want to make sure that those patients are offered. One of the things that we’ve really tried to work against is, and I think that as this test becomes more readily available, it’s going to be something that we have to address, is that pre test bias from primary care physicians, and what we saw when we first rolled it out was this idea of you look healthy, I don’t think you’ve got cancer. So why would I offer you an MCED test? Because I’m not concerned, or I have a low risk or low concern, or you’re low risk for cancer. That’s absolutely the patients that we need to be screening for cancer, because the ones that are high risk typically get those other tests, or they get other screenings or closer monitoring. And so this really understanding and educating the primary care physicians to not give in to that pre test bias. And we saw that with some of the 2,000 tests, when we initially rolled it out, that we were seeing patients who were coming in with weight loss, patients that were coming in with other signs and symptoms of potential cancer to be worked up they were being offered the test, but as a screening test, it was not. So we’ve gone back to really re-educate. We also have, at the same time, rolled out a hereditary genetic testing in primary care. So when patients are identified with hereditary gene mutations, how do we like BRCA 1, BRCA 2, how do we get those patients in the pipeline to really get on an early screening, a regimen with an MCED test? And so, you know, I think that’s it’s really this whole continuum of screening for patients to get them the appropriate care.

Susanna  12:55
That’s terrific. I can’t imagine if, as a BRCA 2 carrier, I had been offered an MCED, and taken it, and they had discovered my cancer earlier than when I was barely symptomatic at stage four. It would have saved 16 surgeries, three bouts of sepsis, countless hospital bills. So I’m really happy to hear that.

Dr. McGill  13:20
Yeah, we’ve had two, stage one and stage two, pancreatic cancers that we’ve detected. You know, these are patients that didn’t have any signs or symptoms, and we know that by the time stage three four and they start to have symptoms. You know, the life expectancy is very short, so catching those cancers earlier. Again, ovarian cancers and genital urinary cancers, I think, that sometimes go undetected until very late. Uterine cancer, the cancer, the patient with the breast cancer. One of the things that we really wanted to do out of the gate, out of the beginning, was set up a robust safety net program that when patients did have a positive signal, we didn’t want them to fall through the cracks. We didn’t want them to just have to navigate, or the primary care physician to navigate the workup on their own. So any positive signal is automatically sent and referred to our high risk clinic, which is part of our oncology department, to run through whatever appropriate screening, additional testing, diagnostic testing, and workup is appropriate. The patient I was referring to earlier, patient had a remote history of breast cancer, incomplete treatment for whatever reason. And the details are a little fuzzy. Had the MCED test, had a breast cancer signal positive. The practitioner at the time said, that’s a false positive. We know you had breast cancer in the past. So this is obviously a false positive. The high risk client caught that reached out to the patient said, no, this is not a false positive. We need to work you up. And it actually was a recurrence of her breast cancer that had come back metastatic. So the one thing I always talk about and encourage providers and health systems when they’re developing and implementing these programs is you gotta have redundancies. You gotta have safety nets. You gotta have that back stop to catch patients and practitioners that are unfamiliar with the test and unfamiliar with what the workup and the next steps are. And so how do we create that, again, that exceptional experience, so that patients don’t fall through and they get the appropriate care?

Susanna  15:20
Terrific. It’s cancer treatment, and cancer testing is not a linear process. [Dr McGill: Exactly.] Dr McGill, can you describe your patient’s typical experience when it comes to learning about and undergoing MCED testing?

Dr. McGill  15:36
Most of the patients are, you have your patients that are really questioning. They want to understand the science. They want to understand what does this understand what does this test about? How does it, how does it work? How’s it testing for 50 different types of cancers? So they really want that other information. But other patients, you know, their number one fear – in my 20 plus years of being a primary care physician, I always say there’s two things that patients worry about, that they have a lot of fears about, they have a lot of fears and worries, but the two that overwhelm. One is getting cancer, and two is getting dementia. And I think that when you have patients who come in and they’re really worried about cancer for whatever reason, could be family history, it could be their occupational exposures, and so they’re willing to do anything and everything to catch cancer early, prevent cancer. So those are patients that it’s, you know, it’s a very easy, short conversation. There’s others that are a little bit skeptical. They, they, you know, they want to understand more. And so how do we provide more information for them? They want to understand. Is this something one and done? Is this a yearly test? You have the other patients who say, well, great. Does this mean I don’t have to have a colonoscopy? Again, it’s like, no, that’s not what we’re talking about. And so I think it really is that, how do you deliver that personalized care, that individual treatment, that individual care plan, and really have an informed, shared decision? You know, MCED testing may not be for everyone. There may be reasons that a patient chooses not to have it, just like hereditary genetic testing. They may choose not to have that for whatever reason. So I think it really does require a conversation and some individual shared decision making with patients to have the testing done, and to understand what does it mean when you have a positive signal, what does it mean when you have a negative signal, you know? And what do you what do you have to do to follow up on all those?

Susanna  17:21
And can you talk a little bit about that, if a cancer signal is detected in a patient, what the follow up is?

Dr. McGill  17:27
So for us in our health system, if a positive signal is detected, we refer, we created the easy button for our primary care physicians. We did not want people feeling like they were burdened. One more thing that they had to do was to navigate the system on how to get these patients worked up and treated for whatever cancer signal that they would have. So all of our patients with positive signals are referred into the high risk clinic that’s run by two nurse practitioner, or nurse practitioner and a physician’s assistant, overseen by a personalized medicine physician, and those patients are given, you know, immediate access, immediate workup and treatment, whether that’s they need a CAT scan or an MRI or a PET scan or a colonoscopy or whatever it might be, again, accelerated treatment plan, and then, certainly, if there’s cancer that’s confirmed, then they’re handed off, warm handoff to the appropriate oncologist, surgical oncologist, etc. So again, one of the things we knew we had to do was create that easy button for the primary care physicians and providers, so that they didn’t have to feel burdened with, what do I do with this positive signal on this test that I, I understand the test, but I don’t necessarily understand the workup for it.

Susanna  18:43
Dr McGill, you’ve done about 2,000 MCEDs. Can you talk a little bit about how you approach a patient and what kind of questions and concerns they might have about taking the test?

Dr. McGill  18:54
Absolutely. So actually, the number we’re at, we’re at now, we’re well above about 2,700 MCED tests that we’ve offered throughout the throughout the organization, whether that’s in primary care, the firefighter program or other programs that we have and so you know, when you approach a patient, you identify, just as you would any other screening test, say, hey, we need to get you a mammogram. We need to get a colonoscopy, and talk through why and what, the, what the what the science and the reasoning is behind it? With MCED, it’s a new test, so it’s a little bit different conversation. You have to explain what it is, how it works, and make sure that they’re comfortable getting the test and comfortable understanding what it means afterwards, whether it’s positive or negative. And so it’s just a different it’s just a different conversation than you would have. We’ve tried to get ahead of some of that with some pre visit education for patients that are eligible. We’ve done outreach through email campaigns or other news campaigns or other things so that people are aware this isn’t something that’s just coming out of left field when they come into the doctor’s office.

Susanna  20:00
Yeah, I’m sure, as with any cancer testing, there’s a certain amount of fear around it. How do you handle misconceptions? Are there any common misconceptions about MCED testing, and how do you respond to that?

Dr. McGill  20:16
I think a lot of misconceptions. I think a lot of those misconceptions come from just misinformation or not having information. So a lot of times, I had personally had a situation where patient was very high risk for breast cancer. Her mother passed away in her late 30s, early 40s from breast cancer. So she’s been screening. She sees a high risk specialist at another health system. I had talked to her about MCED, and said, Hey, this test, this we’re going to be offering this test that’s coming next time I see you. We’ll, we’ll, I’ll have it. We’ll get it done. She went to her high risk specialist, and that person said, I would never get that test done. It’s too early. Why are you doing that? That’s craziness. I would not get that test done. And luckily, she came back to me and said, why would that other doctor ever tell me not to get this test done if it could detect, detect my cancer early? And so it really kind of, in a roundabout way, you know, they were trying to kind of discredit the test, and they end up discrediting themselves in a lot of ways. When you’re trying to look for you have those patients are really looking for the cutting edge treatments or cutting edge diagnostics, and so I think it’s it, you know, again, think it goes back to having individual shared decision conversations, the same that we do with many other aspects of healthcare and medicine and procedures, whether it’s a surgical procedure or other treatment, it’s that individual conversation. And cancer is so unique because it impacts everyone’s life. I don’t know of anybody that hasn’t had cancer touch them directly or indirectly, you know, over the course of their of their lifetime.

Susanna  21:53
100%. What would you say to other primary care physicians who might be considering incorporating MCED testing into their practice, and what is your hope for the future of MCEDs?

Dr. McGill  22:07
I would encourage primary care physicians to with many other things, lean in. This is no different than new medications, you know, other medications that are being prescribed that weren’t in existence a few years ago. Lean in and learn. Healthcare is constantly evolving. So to think that you’re never going to have a new test or a new diagnostic or whatever it might be, lean in. Don’t just discount and say, I’m not doing that. Lean in and learn, because it will impact your patients. My hope for MCED testing is a couple things. One, I hope it does become widely accepted, because I do think that it has the potential to change not only how we diagnose but also how we treat in the long term, morbidity and mortality for cancer. I hope that we’re able to garner and gain insurance coverage and insurance acceptance, whether that’s government or commercial insurance, I think we’re seeing some pockets. We’re seeing some interesting results in people being willing to cover it. I think that that has to come. I think that will drive some of the acceptance as well. And the third thing is, I hope that there’s enough patient understanding and enough patient willingness that the patients start to ask for it because they wanted their concern about getting cancer, they want an early diagnosis and treatment. So I think that comes with a lot of these other things right? Comes with education. It comes with knowledge. It comes with as the test evolves, and we can, and we can get the information out there. But I hope that, I really hope that it does become the standard of care, because I do think that it has the potential to really again change the trajectory of cancer, not only in the United States but across the world.

Susanna  23:55
Absolutely, we don’t have a cure for cancer. Early detection is our biggest tool. So I love that tagline. Lean into MCED testing. Dr McGill, it was a pleasure to talk with you today. Thank you so much.

Dr. McGill  24:11
Absolutely. It’s my pleasure to have and appreciate again being on the show.

Susanna  24:16
And, go Georgia Bulldogs.

Dr. McGill  24:18
Exactly, exactly.

Susanna  24:20
Thank you for joining us today. This is The Cancer SIGNAL presented by GRAIL. I’m your host, Susanna Quinn. Be sure to subscribe so you don’t miss an episode, and you can also watch this episode on GRAIL’s YouTube channel. Until next time, thank you for listening.

VoiceOver  24:40
Based on a clinical study of people ages 50 to 79 around 1% are expected to receive a cancer signal detected result, which includes predicted cancer signal origins. After diagnostic evaluation, around 40% of people are expected to have a confirmed cancer diagnosis. The Galleri test is prescription only. The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those age 50 or older. It is not recommended for individuals who are pregnant, 21 years or younger, or undergoing active cancer treatment. Galleri should be used in addition to routine cancer screening. Galleri does not detect a signal for all cancers. False positive and false negative results do occur. For more information, including important safety information, please visit galleri.com.

Important Safety Information
The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. The Galleri test does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. Galleri is intended to detect cancer signals and predict where in the body the cancer signal is located. Use of Galleri is not recommended in individuals who are pregnant, 21 years old or younger, or undergoing active cancer treatment. Results should be interpreted by a healthcare provider in the context of medical history, clinical signs and symptoms. A test result of “No Cancer Signal Detected” does not rule out cancer. A test result of “Cancer Signal Detected” requires confirmatory diagnostic evaluation by medically established procedures (e.g. imaging) to confirm cancer.

If cancer is not confirmed with further testing, it could mean that cancer is not present or testing was insufficient to detect cancer, including due to the cancer being located in a different part of the body. False-positive (a cancer signal detected when cancer is not present) and false-negative (a cancer signal not detected when cancer is present) test results do occur. Rx only.

Laboratory/Test Information
The GRAIL clinical laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accredited by the College of American Pathologists. The Galleri test was developed and its performance characteristics were determined by GRAIL. The Galleri test has not been cleared or approved by the Food and Drug Administration. The GRAIL clinical laboratory is regulated under CLIA to perform high-complexity testing. The Galleri test is intended for clinical purposes.