Drew Moghanaki is Section Chief of Radiation Oncology at the Atlanta VA Health Care System in Georgia. Michael Hagan is Director of the Veterans Health Administration National Radiation Oncology Program in Richmond, Virginia. Correspondence: Drew Moghanaki (drew.moghanaki@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Background: Lung cancer is a leading cause of cancer-related mortality among veterans—as well as the US population—despite veterans’ access to advanced medical technologies within the Veterans Health Administration (VHA). To improve outcomes, the VHA launched 3 lung cancer treatment initiatives in 2016 and 2017.
Observations: This article summarizes the VHA lung cancer initiatives and discusses future programs aimed to improve care for veterans. The US Department of Veterans Affairs (VA) Partnership to Increase Access to Lung Screening aims to reduce lung cancer mortality among veterans at risk by increasing access to low-dose computed tomography lung screening scans. The VALOR study is a randomized phase 3 clinical trial that evaluates optimal treatment for participants with operable early stage non-small cell lung cancer (NSCLC). This trial plans to enroll veterans with stage I NSCLC who will be randomly assigned to treatment with either surgical lobectomy or stereotactic body radiation therapy. Researchers will follow each participant for at least 5 years to evaluate which treatment, if either, results in a higher overall survival rate. The VA Radiation Oncology Quality Surveillance program compares treatment of veterans with lung cancer in the VHA with quality standards recommended by nationally recognized experts in lung cancer care.
Conclusions: The VHA continues to prioritize resources to improve and assure optimal outcomes for veterans with lung cancer. Future efforts include creating a national network of lung cancer centers of excellence to ensure that treatment decisions for veterans with lung cancer are based on all available molecular information, including data on pharmacogenomic profiles.
The Veterans Health Administration (VHA) facilitates care for > 7,700 veterans with newly diagnosed lung cancer each year.1 This includes comprehensive clinical evaluations and management that are facilitated through interdisciplinary networks of pulmonologists, radiologists, thoracic surgeons, radiation oncologists, and medical oncologists. Veterans with lung cancer have access to advanced medical technologies at US Department of Veterans Affairs (VA) medical centers (VAMCs), including the latest US Food and Drug Administration (FDA)-approved targeted radiation delivery systems and novel immunotherapies, as well as precision oncology-driven clinical trials.2
Despite access to high-quality care, lung cancer remains the leading cause of cancer-related mortality among VHA enrollees as well as the US population.3 About 15 veterans die of lung cancer each day; most are diagnosed with advanced stage III or stage IV disease. To address this issue, VHA launched 3 new initiatives between 2016 and 2017 to improve outcomes for veterans impacted by lung cancer. The VA Partnership to increase Access to Lung Screening (VA-PALS) is a clinical implementation project to increase access to early detection lung screening scans at 10 VAMCs. The Veterans Affairs Lung cancer surgery Or stereotactic Radiotherapy (VALOR) is a phase 3 randomized trial that investigates the role of stereotactic body radiation therapy (SBRT) as a potential alternative to surgery for veterans with operable stage I non-small cell lung cancer (NSCLC). The VA Radiation Oncology Quality Surveillance program (VA-ROQS) established national expert-derived benchmarks for the quality assurance of lung cancer therapy.
