2021 VA Research Scholar Award Manali Patel, MD Stanford University Medical Center/Veterans Affairs Palo Alto Health Care System Stanford CA Research Summary Veterans suffer from greater rates of lung cancer and lung cancer deaths than non-Veteran populations. Recent clinical advancements have significantly reduced lung cancer death rates, yet, many Veterans do not receive this care due to many factors including chronic and complex medical conditions, limited social support, and psychosocial concerns. In the VA, we developed the Engagement of Patients with Advanced Cancer (EPAC) intervention, which integrates community health workers and Veteran volunteers to assist Veterans with their cancer care at the end-of-life.1 In our randomized pilot study, EPAC improved evidence-based end-of-life care, improved Veteran and caregiver experiences, reduced hospitalizations and emergency department visits and total health care costs.1 In this study, we will refine EPAC to ensure that Veterans receive evidence-based lung cancer care. We established an Advisory Board comprised of Veterans, caregivers, oncology clinicians, and VA facility leaders who will assist in refining EPAC. We will randomly assign 60 Veterans newly diagnosed with lung cancer to either the refined EPAC intervention or to usual care and determine whether the intervention is feasible. Secondarily we will determine whether EPAC improves evidence-based lung cancer care and Veteran activation. This award will support plans to conduct a larger study across other VA facilities. Technical Abstract Veterans have significantly greater rates of lung cancer and mortality as compared to civilians. In our prior work, these disparities are partly due to lack of receipt of evidence-based cancer care especially among patients with complex comorbidities, psychosocial concerns, and limited social support, characteristics common among Veteran populations. The overall goal of this research is to overcome structural barriers to ensure delivery of evidence-based lung cancer care among Veterans. In our prior work we identified workforce shortages along with complex psychosocial factors and medical conditions that prevent Veterans from fully engaging in their care. We used community-based participatory research and expert panel methods to develop Engagement of Patients with Advanced Cancer (EPAC) – an intervention that integrates community health workers into care.1 In our randomized trial, EPAC improved evidence-based end-of-life care, Veteran satisfaction and reduced acute care use and total healthcare costs. In this study, with our established Advisory Board comprised of Veterans, caregivers, oncology clinicians, and VA leaders, we will refine EPAC to incorporate evidence-based lung cancer care (Aim 1). We will randomize 60 Veterans newly diagnosed with advanced lung cancer to establish feasibility of the refined EPAC intervention (primary outcome) and secondarily, the effects on evidence-based lung cancer care and Veteran activation (Aim 2). The results will inform a multisite randomized study in the VA.
