The U.S. Department of Veterans Affairs (VA) operates the nation's largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, and other facilities. In 2017, the U.S. veteran population totaled over 20 million. This includes people who have performed many types of military service under a variety of conditions. Unfortunately, American veterans are disproportionately affected by lung cancer, making lung cancer a major concern for many veterans and their families.
Recently, LUNGevity Foundation recognized the U.S. Department of Veterans Affairs for its leadership in improving access to high-quality care for veterans living with and at risk of lung cancer with the 2018 Public Service Face of Hope Award at our annual Musical Celebration of Hope Gala in Washington, DC. Dr. Carolyn Clancy, the Executive in Charge of the Veterans Health Administration, accepted the award on behalf of the VA, and highlighted several key initiatives within the VA that focus on improving outcomes for veterans with lung cancer. These include the VA Partnership to Increase Access to Lung Screening (VA-PALS) initiative, as well as the phase III VA Lung Cancer Surgery or Stereotactic Radiotherapy (VALOR) phase III randomized trial, which are both led by Drew Moghanaki, MD, a LUNGevity Foundation Scientific Advisory Board member.
In honor of Memorial Day, LUNGevity Foundation spoke to Dr. Moghanaki, who, in addition to being an SAB member, is Director of the Clinical Radiation Oncology Research program at Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia, to learn more about lung cancer initiatives at the VA.
LF: What is one interesting fact about the VA?
DM: The Veterans Health Administration (VHA) operates one of the largest health care systems in the world with approximately 350,000 employees and 25,000 physicians. It is the largest of the three VA administrations, which also include the Veterans Benefits Administration and the National Cemetery Administration. Therefore, it’s no surprise that more than half of all physicians in the U.S. received part of their training at a VA medical center and that the VA has helped train many of America’s nurses and other hospital staff.
LF: As you’ve learned more about the VHA, what has surprised you the most?
DM: Since joining the VA in 2011, I’ve continued to be amazed by the vast array of healthcare needs that are fulfilled by the VHA. The VHA has facilities of varying sizes in every state in the country, as it aims to serve every veteran who has healthcare needs. Some of its facilities are rather large and affiliated with world-class medical institutions, while others are tailored to the care of smaller rural populations. Each facility fills a unique niche and works collaboratively within a generalized hub-and-spoke model to provide excellent healthcare for our nation’s veterans and their families.
LF: How has the VA made efforts to improve outcomes for veterans with lung cancer?
DM: The VHA is working rather hard right now for patients and veterans who are at risk or have been diagnosed with lung cancer. It has committed resources to projects like the VA Lung Cancer Screening Demonstration Project, which evaluated the feasibility of introducing lung cancer screening throughout the VHA. Next, it has supported the VA-PALS Implementation Network (VA Partnership to Increase Access to Lung Screening) to ensure VA lung cancer screening programs are utilizing best practices that are high quality and efficient with innovative software tools that can track the hundreds of thousands of veterans who are eligible for annual low-dose chest CT scans. There’s also the phase III VALOR Trial (Veterans Affairs Lung Cancer or Stereotactic Radiotherapy), which is studying whether stereotactic radiotherapy is a suitable alternative to surgery in patients with operable stage I non-small cell lung cancer. Finally, another large project worth mentioning is the VHA’s involvement with the APOLLO Network (Applied Proteogenomics Organizational Learning and Outcomes) project, which entails a collaboration with the Department of Defense and National Cancer Institute to incorporate proteogenomics into patient care as a way of looking beyond the genome―to the activity and expression of the proteins that the genome encodes―with a focus on lung cancer.
LF: How does the VHA leverage its electronic medical record (EMR) systems to improve outcomes for patients?
DM: As many are aware, communication between providers is one of the biggest challenges for anyone with lung cancer, particularly when patients seek care at different medical centers. Take, for example, a rural veteran patient who is diagnosed with lung cancer at one of our smaller clinics. When they transfer their care to a larger and more centralized VA medical center, where thoracic surgery, radiation oncology, and medical oncology services are available, their records could get lost in transition. However, because the VA uses a single EMR, clinical records are simple to find at the touch of a fingertip, and more importantly, they can be seamlessly shared between providers in different specialties. This helps to optimize multidisciplinary clinical decisions, which are often critical for lung cancer patients.
Then, there is the leverage that the VHA’s EMR system has when it comes to national clinical implementation efforts. For example, in our VA-PALS lung cancer early detection project, we will be able to track the clinical workflow and outcomes for all veterans who are screened with this system, regardless of where in the country they’re receiving the care. This provides incredible leverage when it comes to evaluating the impact of a national implementation program such as lung cancer screening. It also helps investigators rapidly evaluate opportunities to improve the quality of care for veterans and to be shared in publications in order to help all Americans in the country who are at risk for lung cancer―which, as we know, might just be anyone who has lungs, given that lung cancer doesn’t affect only smokers, but also affects more than 40,000 non-smokers every year.
LF: Are there any other comments you’d like to share with our community?
DM: I am extremely grateful for all of the ongoing support that the VA continues to provide that helps improve the care of lung cancer. We have an incredible healthcare system that has a long history of solving major healthcare problems. Perhaps now, the VA can also help fulfill LUNGevity Foundation’s mission, which is to get us closer to a day when no one dies of lung cancer.
Juhi Kunde, MA, is a science writer for LUNGevity. 