Staying [ACT]IVATED and Empowered as a Veteran Facing Lung Cancer

Patient Empowerment Network (PEN) is committed to educating and empowering patients and care partners in the lung cancer community. Lung cancer testing and treatment is evolving with biomarker testing, and it’s vital for veteran patients and families to inform themselves about services and healthcare options available through the VA healthcare system. With this goal in mind, PEN initiated the [ACT]IVATED NSCLC Support for Veterans program, which aims to inform, empower, and engage veteran patients to stay well-informed about the latest in lung cancer care.

Lung cancer is the leading cause of cancer-related death in veterans. However, not all veterans know their options for receiving care and when they should be receiving lung cancer screenings. PEN is excited to add information about veteran care services and support to aid in screening and treatment of lung cancer via the ACT]IVATED NSCLC Support for Veterans program series.

Cancer survivor Lisa Hatfield interviewed experts Dr. Drew Moghanaki from UCLA Health and Dr. Michael J. Kelley from the Veterans Health Administration and Duke Cancer Institute.

The VA Healthcare System and Healthcare Efforts

The VA healthcare system’s purpose is to care for military veterans who served their country. Dr. Michael Kelley discussed the criticality for veterans to receive adequate care. “…if you are experiencing a challenge in working with the VA healthcare system, regardless of what community you are in, please communicate that to someone at the VA. That could be your provider, that could be the patient advocate. Every VA hospital has a patient advocate or that could be someone else at the medical center. We want to know how we can help you in what problems you’re experiencing.”

With more focus on equitable healthcare, the VA healthcare system has continued to receive scrutiny over the health outcomes of VA patients. Dr. Kelley shared how the VA has transformed outcomes that were documented in patient data from 20 years ago. “So in VA, there are several different ethnic and racial populations, and we’ve looked at the outcomes of Black and white veterans. Latinx veteran population is still relatively small, so we don’t have good statistical power to be able to draw strong conclusions there. But the comparison between Black and white is very clear in VA in lung cancer in terms of the outcomes. And the result is that Black veterans do just as well, or better than white veterans at every stage of lung cancer. That is quite different than it is in the rest of the country.”

VA Clinical Trial Assistance and Serving Rural Patient Groups

Navigation of clinical trials can often feel overwhelming, and the VA healthcare system recognized this fact. Dr. Kelley shared details about some efforts by the VA to assist veterans with locating and participating in clinical trials. “…how do I find a clinical trial? So this is, I think, a barrier that we’ve all realized, and we’ve set up a service that is called the Clinical Trial Navigation Service. So a provider can ask this service to talk with the veteran and to help find a clinical trial that might be appropriate for them and then to report that back to the provider. So they can talk about what geographic area would be appropriate for the veteran and then other characteristics of the veteran and their medical care that would help inform if there’s a clinical trial available. In the VA or outside the VA, we’ve initially partnered a lot with the National Cancer Institute at the NIH Clinical Center in Bethesda, Maryland where they will actually provide transportation for people to enroll in clinical trials at that center.”

In addition to travel assistance through the American Cancer Society and other resources, the VA healthcare system is also making other efforts to help veterans gain access to clinical trials. Dr. Kelley shared some information about CBOCs. “There is another approach that VA is taking for transportation is that the…that question implies that the veteran has to travel to the care and what VA is doing is bringing the care to the veteran. So right now we deliver most of our cancer care at medical centers and we are in the process of pushing that care into our clinics called CBOCs, Community Outpatient Based Clinics. So these services will make it much easier for more veterans to access closer to where they live which would reduce that transportation barrier.”

A high percentage of veterans live in rural areas, and Dr. Kelley discussed how the VA has taken measures to bring expertise to patients rather than patients going to the expertise. “…about a third of enrolled veterans live in rural areas. So this is very common for us. That’s 33 percent and the nation is about 14 percent. So it’s about two-and-a-half times likely that a veteran will be in a rural area. So VA has very mature advanced telehealth capabilities. We have tele ICU. We have tele emergency room services. And we have teleoncology. So there’s a national teleoncology service. It basically provides an expert in your cancer type at your VA. And this is mostly serving rural veterans. I think the last number I saw was 44 percent of the veterans that are served by the national teleoncology service are in rural areas.”

BIPOC Patients and Veterans With Lung Cancer

Though some damaging environmental exposures have improved for veterans, there are some known risk factors. Dr. Drew Moghanaki discussed some information about some known exposures as risk factors. “So yes, it’s true that our veterans, especially if they were working around toxic chemicals or in the Middle East, where the open burn pits were leading to inhalation of a lot of toxic fumes, that these folks are at a higher risk and should be more proactive with any symptoms.”

Veteran and lung cancer patient Derrick shared his story about going to receive lung scans after his friend he served with in Iraq was diagnosed with lung cancer. “I’m sharing my story in the hopes that it will help other veterans. I continue to receive regular scans of my lungs and urge other veterans to start your lung cancer screening on schedule. Ask your doctor or VA administrator if you’re unsure about when you should start. It’s your body and your life, and you deserve to learn all you can to gain knowledge and confidence about your cancer.”

The history of mistreatment of Black Americans in clinical trials has created a situation of mistrust, but there are proactive steps that BIPOC patients can take on their own behalf. Dr. Moghanaki discussed the importance of trust in healthcare. “…healthcare is complicated, especially lung cancer care. And the most important thing for anybody getting care, regardless of what social, economic background or ethnic background they may be from, is to find a team that you trust and who you know will care about you. And that’s the best way to make sure you get the best treatment.”

[ACT]IVATED NSCLC Support for Veterans Program Resources

The [ACT]IVATED NSCLC Support for Veterans program series takes a three-part approach to inform, empower, and engage both the veterans with lung cancer community and patient groups. The series includes the following resources:

Though some veterans may not have all information about the VA care options, the VA healthcare system has instituted support services and strategies that maintain comparable or improved lung cancer outcomes. We hope you can take advantage of these valuable resources to aid in your lung cancer care for yourself or for your loved one.