Can Veterans in Rural Areas Facing Lung Cancer Access Experts Via Telemedicine?

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Can Veterans in Rural Areas Facing Lung Cancer Access Experts Via Telemedicine? from Patient Empowerment Network on Vimeo.

Are there telemedicine options for veterans living in rural areas? Expert Dr. Michael Kelley from Duke University School of Medicine discusses the rural residence rate of veterans, consultation services, and second opinions.

[ACT]IVATION TIP

“And you can actually get a second opinion where you have a video visit with the expert as well. So these things are all available. So patients can ask for these for a second opinion. And there’s somebody else in the VA who would be an expert that we would connect the patient with.”

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 Breaking Barriers: Enhancing Veteran Support in Lung Cancer Care

Breaking Barriers: Enhancing Veteran Support in Lung Cancer Care

 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatfield:

I live in a more rural area of the country, if you have a patient who lives in a more rural area or maybe goes to a smaller VA facility for healthcare and they’re diagnosed with non-small cell lung cancer, can they access maybe through telemedicine visits, somebody who is more specialized in that type of cancer within the VA system, or how is that handled for veterans?

Dr. Michael Kelley:

Yes. So 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. So I practice in South Dakota and Arkansas, and I live in North Carolina. And I do only lung cancer. So this is a service that I think my colleagues also participate in around the country. And we’re able to get the expertise to the patient rather than the patient coming to the expertise.

Lisa Hatfield::

That’s very helpful for patients. I know I have a different type of cancer, a blood cancer, but being able to access at least the expertise of a specialist makes a big difference in my care. And, of course, my local oncologists are great, but they’re willing to work with my specialists. So I appreciate that the VA has such a brilliant advanced system for that. That’s a really impressive statistic that many patients, veterans use that telehealth option.

Dr. Michael Kelley:

Yeah, so in addition to the direct care, we also provide consultation services. So you mentioned that your local provider is willing to work with an expert. So we do that as well. So we can have what are called e-consults, electronic consults, where the local oncologist who might be a generalist is able to ask a question to an expert.

And because we are such a large system, we have an expert in everything. And I literally mean everything. So we have an expert lined up to be able to respond to every question and from any disease that is in the realm of oncology or hematology.

Lisa Hatfield:

Okay. And will that typically happen during a visit, or is it up to the patient to request that e-consult if they would like one?

Dr. Michael Kelley:

So it’s typically up to the provider, if they think they need a second opinion or they need help interpreting this, interpreting an opinion. But the patient can always ask as, you know, that you can ask their provider, talk to their provider, which I understand from a patient’s perspective can be sort of a sensitive issue is, “Hey, I don’t trust you. You’re my doctor, but I don’t trust you. Can you ask someone else for an opinion?” But you can do it in a way which is very respectful, obviously, and it’s totally okay with us, that, I’m always happy to ask a colleague to look at a case if a patient asks.

And you can actually get a second opinion where you have a video visit with the expert as well. So these things are all available. So patients can ask for these for a second opinion. And there’s somebody else in the VA who would be an expert that we would connect the patient with.

Lisa Hatfield:

Thank you for reassuring patients that it’s okay to do that. I know sometimes we’re afraid of offending our providers, but as you said, it’s okay to politely say, “This is very scary for me. I would like to know if there’s any way to do an e-consult with another physician.  So yeah, thank you for reassuring patients that that’s okay to do that.

Dr. Michael Kelley:

Yeah. There should be nothing that any patient ever asks or brings up with us that is offensive to us. Your concern is our concern. So don’t be afraid to ask for it. My biggest concern is that you won’t let me know when you have a concern.

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Breaking Barriers: Enhancing Veteran Support in Lung Cancer Care

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Breaking Barriers: Enhancing Veteran Support in Lung Cancer Care from Patient Empowerment Network on Vimeo.

Are there VA services to help veterans with the financial and mental stress of lung cancer? Expert Dr. Michael Kelley from Duke University School of Medicine discusses transportation and financial barriers to care, Community Outpatient Based Clinics, and support services for mental stress and anxiety.

[ACT]IVATION TIP

“…if you have a concern or a barrier, please talk to your care team. There are many resources that VA has that will try to address any challenge that you’re facing.”

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

 Can Veterans in Rural Areas Facing Lung Cancer Access Experts Via Telemedicine?

Can Veterans in Rural Areas Facing Lung Cancer Access Experts Via Telemedicine?

 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatfield:

Given that transportation and financial coverage for travel are major barriers to lung cancer care for veterans, what strategies or interventions do you believe could be implemented to alleviate these challenges and reduce associated anxiety and stress for veterans?  And maybe a better way to ask that question is, are there any resources within the VA system to help veterans deal not only with the financial impact, but also with the emotional impact of a lung cancer diagnosis?

Dr. Michael Kelley: 

Yes, so there are certainly some resources. So some veterans are eligible for travel pay based on their distance and some other factors that I’m not an expert in, so I won’t try to enunciate those. But there can be other resources. Sometimes the American Cancer Society will have travel funds. There is a volunteer service at most VA hospitals, and sometimes they have funds. The way to access all those different options is generally through a patient navigator that might be a social worker at a particular VA hospital. Talk to your provider or the provider’s team about any barriers that you’re experiencing around transportation or other barriers, but transportation, and they can redirect you to the appropriate person on the team who would be able to discuss that with the veteran.

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.

So that’s one thing. And then you also asked about other types of barriers like anxiety or stress. Many of our practices now have embedded mental health. So that’s one resource which may be available for you. So again, talk to your provider team if you have stress or anxiety and you’d like to talk to someone about that. It should not be a stigma to have a discussion with someone about any of the thoughts that you’re having or reactions to the diagnosis. There are big decisions that have to be made.

It’s understandable that you might want to talk to someone, and so we do provide that service and these are professional mental health people, but there’s also a palliative care team at every medical center. The palliative care team is really good about going through and spending a lot of time talking with you about decisions that you would want to make in the situation about care decisions about how you might want to weigh those decisions. That can also be a resource for veterans. So my activation tip in this area is, if you have a concern or a barrier, please talk to your care team. There are many resources that VA has that will try to address any challenge that you’re facing.

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Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

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Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans from Patient Empowerment Network on Vimeo.

How can veterans with lung cancer access support services for clinical trials? Expert Dr. Michael Kelley from Duke University School of Medicine discusses clinical trials at VA locations, support services to help access clinical trials, and proactive patient advice for transportation costs to clinical trials. 

[ACT]IVATION TIP

“So sometimes the clinical trial will pay for transportation costs. Sometimes the clinical study will pay, and sometimes no one will pay. So you do have to ask whether that is provided, and if not, are there other resources that could be used to help pay for any transportation that would be needed?”

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Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer

 Are There Lung Cancer Clinical Trials Studying Veterans?

Are There Lung Cancer Clinical Trials Studying Veterans?

Transcript:

Lisa Hatfield:

So if a patient finds a clinical trial that’s outside of the VA, will the VA help coordinate that being a part of that clinical trial if it’s outside of the VA? And the other question I would have about that, are clinical trials done at all of the VA facilities or if a person sees one that’s done, maybe they go to a smaller facility, they have to go somewhere else, can they go to that larger facility for the clinical trial?

Dr. Michael Kelley:

Yeah, great questions. So several different answers to that. So there are…some VAs do clinical trials and some don’t. And any clinical trial is not open at every VA. So if it’s open at some VAs, it may not be open at other VAs. So if the veteran finds a clinical trial at another VA and they’re willing to travel to that other location, there are generally no barriers to doing that and to enrolling in that clinical trial at the other VA.

But let me start with the first part of your question is, well, 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.

So that’s one of the areas we’ve been working with and then a few other organizations or systems. So that is one thing is you have to find the clinical trial. And the other part of your question was, you know, will VA help the patient get there? Okay. So sometimes the clinical trial will pay for transportation costs. Sometimes the clinical study will pay, and sometimes no one will pay. So you do have to ask whether that is provided, and if not, are there other resources that could be used to help pay for any transportation that would be needed.

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Are There Lung Cancer Clinical Trials Studying Veterans?

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Are There Lung Cancer Clinical Trials Studying Veterans? from Patient Empowerment Network on Vimeo.

Are veterans with lung cancer under study in clinical trials? Expert Dr. Michael Kelley from Duke University School of Medicine discusses benefits of clinical trials, an early stage non-small cell lung cancer clinical trial, and proactive patient advice about clinical trial access.

[ACT]IVATION TIP

“…if you have a diagnosis of cancer you’re facing and you’re getting your care from the VA, please ask your provider if there’s a clinical trial that might be appropriate for you. That might be at the VA, or that might be somewhere else and both of those would be appropriate to consider to understand what the advantages and disadvantages would be for you, including being able to improve the knowledge that would help future people who also face the same diagnosis.”

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

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Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer

 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatifeld:

Dr. Kelley, can you speak to ongoing clinical trials and research specifically for veterans, or are there any clinical trials or research studies that are available that focus on lung cancer treatments specifically tailored to veterans?

Dr. Michael Kelley:

Yes. So we’re very interested in ensuring that veterans have access to all components of clinical care. And for many individuals who have a diagnosis of cancer and enrollment in a clinical trial is considered appropriate and part of standard clinical care to consider. So there are some studies which are designed by VA for veterans. There’s one ongoing now that is comparing surgery with radiation for early stage non-small cell lung cancer. That study is going to, I think, inform the entire country and maybe the entire world about what the differences are in terms of the outcomes and tolerability of those two treatments.

They’ve both been around quite some time now, and they’re used extensively throughout the world, but they’ve never been compared directly. So the veteran population is helping to answer a very important question, and it is designed specifically for veterans. The population of veterans who have cancer, in particular lung cancer, who are enrolled in VA, tend to have more other diseases in addition to the lung cancer, so more diabetes, hypertension, heart disease.

And when initial drugs or other treatments get approved, they’re oftentimes used in a very select population that don’t have any other diseases. They’re healthy people with cancer, and that means that we don’t know necessarily whether it’s safe or effective to use those treatments in people that have what are called comorbidities or other diseases.

And so veterans can oftentimes not have their treatment informed by the medical studies that have been completed to an exacting degree. So what we’ve done is to design some studies that are specifically for veterans to expand on that knowledge and make sure that we understand what is safe and effective in veterans. So my activation tip is that, if you have a diagnosis of cancer that you’re facing and you’re getting your care from the VA, please ask your provider if there’s a clinical trial that might be appropriate for you.

That might be at the VA, or that might be somewhere else and both of those would be appropriate to consider to understand what the advantages and disadvantages would be for you, including being able to improve the knowledge that would help future people who also face the same diagnosis.

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer? from Patient Empowerment Network on Vimeo.

Do Black and Latinx veterans face lung cancer disparities? Expert Dr. Michael Kelley from Duke University School of Medicine discusses past and current health outcome disparities and comparisons of molecular genetic alterations between Black and white veterans.

[ACT]IVATION TIP

“…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.”

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 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatfield:

Dr. Kelley, what specific challenges do veterans from the Black and Latinx communities face when trying to access lung cancer healthcare services?

Dr. Michael Kelley:

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, 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. So that is one area that I think VA as an integrated healthcare system with wraparound services is able to brag about that we are able to provide all the care that is necessary to derive that outcome.

That wasn’t always the case. In the early 2000s, there was a difference in surgery rates for Black veterans with early stage lung cancer. And we were studying this, and what we saw was that, that difference went away about 2009 or 2010, and it hasn’t come back since we last looked at it. We don’t know what caused it, and we don’t know why it went away, but we’re glad to see it did go away. There are a long list of other possible challenges that veterans in Black or Latinx communities might face. These may be overlapping with those that everyone faces, but VA probably has a service to help with it.

And so my activation tip for you is, is that 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.

Lisa Hatfield:

Are there any differences in the characteristics of the cancer for these populations for the Black and Latinx communities that you have seen?

Dr. Michael Kelley:

We have looked at a lot of comparisons between Black and white groups of veterans, not so much around Latinx because of the smaller numbers. There are not a lot of differences in terms of molecular genetic alterations. And so there are some differences in the geography. So the Black African Americans veterans tend to live more in the Southeast, where actually there’s the largest collection of military veterans who are enrolled in VA care anyways.

But in terms of the outcomes, we don’t really see any outcomes. There are some other differences in medical care that are appropriate, such as a variation of normal in terms of the white blood cell count that happens in some individuals predominantly in of African descent. And those individuals might be at risk for having their chemotherapy doses reduced, because their white count goes down more than other individuals. But in general, we don’t see a lot of differences between those populations medically.

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Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer

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Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer from Patient Empowerment Network on Vimeo.

Do veterans with lung cancer face barriers to precision medicine and targeted therapies? Expert Dr. Michael Kelley from Duke University School of Medicine discusses past and current access to precision medicine, the National Precision Oncology Program, and proactive patient advice to ensure you receive essential testing and optimal care.

[ACT]IVATION TIP

“…if you have advanced lung cancer, ask your provider, what testing has been done on my tumor, what are the results, and what does that mean for my treatment?”

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

 Are There Lung Cancer Clinical Trials Studying Veterans?

Are There Lung Cancer Clinical Trials Studying Veterans?

 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatfield:

Dr. Kelley, what specific challenges do veterans face in accessing precision medicine? And how can these challenges be mitigated to ensure equitable access to advanced treatments?

Dr. Michael Kelley:

So before 2016, the first cancer moonshot, there were major challenges in, not only in the VA, but across the country to access to precision medicine in the oncology field. We launched in that year, and if really now provide access to cutting-edge precision oncology technology, which is a lot of molecular testing and the expertise to be able to interpret the results of that test to apply it to individual patients. So I think we have advanced to the point where this should not be a barrier anywhere in the VA system, but I would say that only about half of veterans are enrolled for VA care.

And outside of VA there still are areas that have a variety of different barriers to getting the testing done on the tumor samples in a way which informs the treatment decision-making for patients. So this is very important. My activation tip for this is to be sure to ask your provider whether your tumor has been tested for molecular tests, and if so, what the results of those tests are, and how that impacts the treatment of your cancer.

Lisa Hatfield:

Dr. Kelley, can you speak to your research around barriers to prescribing targeted therapies for patients with non-small cell lung cancer with highly actionable gene variants, and what should patients and their care partners be aware of related to these barriers?

Dr. Michael Kelley:

So one of the key pieces of information that your providers need to know in order to, how to treat your advanced stage lung cancer is what are the molecular alterations in your tumor, and what types of proteins are expressed on the surface of the proteins that allows them to make good choices around immune therapy and another group of therapies called targeted therapies, and that can make major differences in your care and your outcome.

So when we first started using this type of testing, in particular the genetic testing of tumor samples, there was a lot of complexity in the results that was not well understood by the oncology providers, because it was new and very complex. So VA has instituted a program to provide that testing and the expert consultation service to be able to interpret those results.

And so when we set up that program, which is called the National Precision Oncology Program, we did a study, looking to see how many patients who should have gotten a targeted drug actually got that drug. And the results were similar to what has been reported in other healthcare systems. And that is, is that less than every patient was getting the targeted therapy, and it was about somewhere around a third of patients who did not get the therapy that would’ve been indicated by that test result.

So we wanted to know what the reasons were, and I think we’ve addressed a lot of the reasons that we came upon. A lot of it is education and making sure that the information from those tests gets to the provider and gets to the patient, and that comes with an understanding of what those test results mean. So my activation tip is, if you have advanced lung cancer, ask your provider, what testing has been done on my tumor, what are the results, and what does that mean for my treatment?

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What Impact Does the VA Have on Lung Cancer Care Coordination?

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What Impact Does the VA Have on Lung Cancer Care Coordination? from Patient Empowerment Network on Vimeo.

How does the Veterans Health Administration impact lung cancer care coordination? Expert Dr. Michael Kelley from Duke University School of Medicine explains the different ways that veterans may receive lung cancer care and proactive patient advice to ensure all healthcare team members receive vital information.

[ACT]IVATION TIP

“…make sure that your providers are aware that you’ve had a test and that you see the results of that test, so that that way, you know that the test was done, and somebody has a report, and that way it’s more likely that that is going to be in front of your providers.”

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Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families

 Do Veterans Face Health Disparities in Lung Cancer Care?

Do Veterans Face Health Disparities in Lung Cancer Care?

 What Should Veterans Know About Lung Cancer Screening and Risk?

What Should Veterans Know About Lung Cancer Screening and Risk?

Transcript:

Lisa Hatfield:

Dr. Kelley, how does the coordination of care within the Veterans Health Administration impact the treatment outcomes for veterans with lung cancer? And are there any barriers patients’ families should be aware of?

Dr. Michael Kelley:

So many types of lung cancers need to be treated in a way which involves different members of the healthcare team, and that care needs to be coordinated especially when part of the care is being received in different health systems. So part of it may be in the VA and part of it outside the VA, or if the patient’s not receiving any care within the VA, then there may be multiple different medical institutions which are contributing to the patient’s care, and that care needs to be coordinated and communicated. 

So when you have a test in one location, those results need to get to everyone else who’s involved in that patient’s care. So very important. We don’t make good medical decisions if we don’t have the best information about the patient, all the tests that were done. So my activation tip is, is to make sure that your providers are aware that you’ve had a test and that you see the results of that test, so that that way, you know that the test was done, and somebody has a report, and that way it’s more likely that that is going to be in front of your providers.

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What Should Veterans Know About Lung Cancer Screening and Risk?

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What Should Veterans Know About Lung Cancer Screening and Risk? from Patient Empowerment Network on Vimeo.

What lung cancer screening advice and lung cancer risks should veterans know about? Expert Dr. Michael Kelley from Duke University School of Medicine discusses two factors that drive lung cancer risk in veterans, studies about military exposures, and proactive patient advice for lung cancer screening.

[ACT]IVATION TIP

“…if you are eligible for lung cancer screening, then that should be available from VA. And if you have smoked ever in your lifetime, please talk to your primary care provider to ask if lung cancer screening is right for you.”

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Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families

 Do Veterans Face Health Disparities in Lung Cancer Care?

Do Veterans Face Health Disparities in Lung Cancer Care?

 What Impact Does the VA Have on Lung Cancer Care Coordination?

What Impact Does the VA Have on Lung Cancer Care Coordination?

Transcript:

Lisa Hatfield:

Is there a standard for screening veterans for lung cancer who may have had exposures that create a greater opportunity for lung cancer? Is there a scan that may be done for them, or can they request that?

Dr. Michael Kelley:

Yeah, that’s a great question. So the criteria that are used in the VA for lung cancer screening are the same as they are in the rest of the country. And that’s because the risk of developing lung cancer from all the different possible risk factors is really driven by smoking. Smoking and age are the two factors that really drive the risk of lung cancer. There are some other proposals that are out there to use like lung function and maybe some other characteristics of the patient that we don’t really do right now, but there are some studies that are ongoing.

In terms of military exposures, we can’t really quantify them at this point for lung cancer exposure, so we don’t really integrate that into the medical recommendations around lung cancer screening. But lung cancer screening let me just go to my activation tip is,is that if you are eligible for lung cancer screening, then that should be available from VA. And if you have smoked ever in your lifetime, please talk to your primary care provider to ask if lung cancer screening is right for you.

Lisa Hatfield:

Okay, thank you. That’s really helpful. Dr. Kelley, there is a stigma around military personnel being at higher risk for lung cancer than civilians. Is there an elevated risk for those in the military? And if so, why is that?

Dr. Michael Kelley:

There have been some reports in the medical literature of a higher risk, but those studies were small and initially didn’t control for some important risk factors, in particular, smoking. So smoking is the greatest risk factor for lung cancer. And if you’ve ever smoked, then you should be considered for lung cancer screening, but the military personnel have a higher rate of having smoked sometime in their life. Luckily, there’ve been a lot of people who’ve quit, and that has resulted in the current smoking rate of being about the same as the general population.

But the fact that they have smoked in the past, military veterans have smoked in the past does increase the risk. Military exposures, we don’t really take into consideration right now in terms of lung cancer screening or treatment, but if you do have a particular exposure that you’re concerned about, then please talk to your primary care doctor, and we can discuss with you whether there’s a screening test that might be appropriate. But generally, we don’t do that.

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Do Veterans Face Health Disparities in Lung Cancer Care?

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Do Veterans Face Health Disparities in Lung Cancer Care? from Patient Empowerment Network on Vimeo.

Are there any lung cancer disparities that veterans face? Expert Dr. Michael Kelley from Duke University School of Medicine discusses smoking rates of veterans, the quality of VA care versus the general population, potential environmental exposures during military service, and proactive advice for optimal lung cancer care.

[ACT]IVATION TIP

“… if you have cancer, then you should be taken care of in a way which addresses your needs regardless of what the availability is within the VA system. VA sometimes cannot take care of all patients with cancer, and in that case, VA will purchase a service in the community.”

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Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families

Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families

 What Should Veterans Know About Lung Cancer Screening and Risk?

What Should Veterans Know About Lung Cancer Screening and Risk?

 What Impact Does the VA Have on Lung Cancer Care Coordination?

What Impact Does the VA Have on Lung Cancer Care Coordination?

Transcript:

Lisa Hatfied:

Dr. Kelley, can you discuss any disparities or differences in health outcomes among veterans compared to the general population when it comes to access to treatment? And are there systemic issues within the healthcare system that disproportionately affect veterans?

Dr. Michael Kelley:

So there are some differences between what types of cancers that veterans get and the general population, but there is not a bright line difference between those two groups. They’re really gradations, and if you have the same type of cancer and you’re in the VA versus outside the VA, the treatment approaches and prognosis should be the same.

And that’s actually what we see when you look at systematic studies of the quality of care of inside the VA compared to the rest of the country. The VA care, it looks the same or better almost routinely, and that is, I think, due to the uniform availability of services that are not only the medical care, but some wraparound services that are available to veterans.

There are some differences that we want to talk about. One is related to smoking. So military veterans have a higher rate of previous smoking. The current smoking rate is about the same as the general population, so it’s more likely that they will get smoking-related malignancies, and, of course, lung cancer is one of those cancers.

Military veterans also have exposures during their service to a lot of other physical, chemical, and other types of exposures, which can increase their risk of a variety of different types of cancers. And those can also show up in different subpopulations within the services depending on where they served. But many studies that explored some types of associations that were thought to be existent turned out not to show a difference.

So, for example, breast cancer and active duty military women is actually lower than it is in the general population. So there are some differences, but they go both ways. So I don’t want to make any general statements. But my activation tip is that, if you have cancer, then you should be taken care of in a way which addresses your needs regardless of what the availability is within the VA system. VA sometimes cannot take care of all patients with cancer, and in that case, VA will purchase a service in the community.

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Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families

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Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families from Patient Empowerment Network on Vimeo.

How can non-small cell lung cancer (NSCLC) be explained to veterans and families? Expert Dr. Michael Kelley from Duke University School of Medicine discusses key points that he communicates to patients and proactive patient advice to help ensure their best care.

[ACT]IVATION TIP

“…for the patient to be sure they understand the histologic type of cancer that they have. So what does it look like under the microscope, and what molecular tests have been done on their tumor, and what do those results look like and how do they impact the different therapies that would be offered to them?”

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Do Veterans Face Health Disparities in Lung Cancer Care?

Do Veterans Face Health Disparities in Lung Cancer Care?

 What Should Veterans Know About Lung Cancer Screening and Risk?

What Should Veterans Know About Lung Cancer Screening and Risk?

 What Impact Does the VA Have on Lung Cancer Care Coordination?

What Impact Does the VA Have on Lung Cancer Care Coordination?

Transcript:

Lisa Hatfield:

Dr. Kelley, when explaining advanced non-small cell lung cancer to veterans and their care partners, what approaches or language do you find most effective in ensuring patients fully understand the diagnosis, its implications, and their available treatment options?

Dr. Michael Kelley:

Patients with advanced non-small cell lung carcinoma will usually see a medical oncologist because they’re going to be treated with systemic therapies, which are drugs typically, which are given by vein, sometimes by mouth. When the doctor is analyzing all the data that has been collected to come to the diagnosis, they will have a lot of details, and it’s important to know that there are different types of non-small cell lung carcinoma, and those different types will impact the treatments and sometimes the prognosis.

And also, there is variability in the symptoms that you might experience because of the locations within the body where the cancer has spread. So the really important points for the patient to understand, which are hopefully is communicated in a way from the provider, which is understandable, are, what is the histology? So what does it look like under the microscope? And also what molecular tests have been done on the tumor, and what do those results do in terms of the treatment decisions that are going to be made?

So my activation tip for this question would be for the patient to be sure they understand the histologic type of cancer that they have. So what does it look like under the microscope, and what molecular tests have been done on their tumor, and what do those results look like and how do they impact the different therapies that would be offered to them?

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Advancements in Lung Cancer Clinical Trials | Updates for Veterans

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Advancements in Lung Cancer Clinical Trials: Updates for Veterans from Patient Empowerment Network on Vimeo.

How can veterans help move lung cancer clinical trial advancements forward? Expert Dr. Drew Moghanaki from UCLA Health explains clinical trial groups that need more participants, available support resources for veterans, and patient advice. 

[ACT]IVATION TIP

“…speak up and ask if there is a clinical trial that you may be eligible for to help another veteran. And, of course, when you enroll in a trial, you’ll be getting basically the best treatments that we think are available at this time.”

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Combating Disparities | Veterans' Healthcare Access and Quality

Combating Disparities: Veterans’ Healthcare Access and Quality

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Transcript:

Lisa Hatfield:

Dr. Moghanaki, can you speak to ongoing clinical trials and research specifically for veterans? And are there any clinical trials or research studies available that focus on lung cancer treatments specifically tailored to veterans from underrepresented communities?

Dr. Drew Moghanaki:

Yeah. So we want to focus on the people we care about the most, which for many of us are veterans, but at the end of the day, partnering nationally and globally in clinical trials is probably the best thing that we can do. We don’t really think that the lung cancer is…that our veterans are dealing with is necessarily different than what a civilian may be. So by partnering, we have bigger scale to tackle these problems and get these studies done as quickly as possible.

When it comes to underserved communities, same thing. We do the VA and VA researchers definitely make a point of trying to get more underrepresented communities access to clinical trials. But again, we just usually geographic challenges are our biggest barrier. Someone wants to live in this beautiful part of the country up in a mountainside near a lake, but they’re two-and-a-half hours away from a city. That can be challenging for us.

But the good news is that the VA does provide a lot of housing. So for those veterans who live far away, if they want to come, we’ll take care of them. We’ll provide, if they’re eligible for your VA healthcare, we’ll provide them housing. We can even provide them with their meals. And so, and get them access to the best care. So basically my activation tip here is to be aware that clinical trials are really critical.

It’s how we’ve moved forward. It’s a tremendous opportunity to help other veterans behind themselves who will get lung cancer in the future. There’s nothing we can do at this time to stop the number of people getting lung cancer. And so the more research we can do, the better this world can be. And my activation tip is to speak up and ask if there is a clinical trial that you may be eligible for to help another veteran. And, of course, when you enroll in a trial, you’ll be getting basically the best treatments that we think are available at this time.

 

Lisa Hatfield: Great. Thank you. Thank you so much. Those activation tips were really great and patient-centered. And I think that’s what, at least me as a patient, watching that in the audience, that’s what I want to hear is what can I do to help advocate for myself? So thank you for those responses.

 

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Lung Cancer Care for Veterans: Advancements in Radiation Oncology

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Lung Cancer Care for Veterans: Advancements in Radiation Oncology from Patient Empowerment Network on Vimeo.

What should veterans with lung cancer know about radiation oncology advancements? Expert Dr. Drew Moghanaki from UCLA Health explains recent advancements in radiation oncology and radiotherapy, where the advanced therapies are accessible, and proactive patient advice.

[ACT]IVATION TIP

“…make sure you do your homework and try to make sure that the department of radiation oncology you’re going to really does have the best technologies. And there’s lots of different ways to look at this, including going online and reading more about what the quality of care might be in the community.”

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Combating Disparities | Veterans' Healthcare Access and Quality

Combating Disparities: Veterans’ Healthcare Access and Quality

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Advancements in Lung Cancer Clinical Trials Updates for Veterans

Advancements in Lung Cancer Clinical Trials Updates for Veterans

Transcript:

Lisa Hatfield:

Dr. Moghanaki, are there any promising advancements or techniques in radiation oncology that could potentially improve outcomes for veterans with lung cancer?

Dr. Drew Moghanaki:

Yeah, there really are. So back in the old days, radiotherapy was just an open beam that we would shine towards a general area of the body. And they did a good job of getting control of the cancer, but, unfortunately, it would injure a lot of normal tissues. Today, radiotherapy is much more precise and targeted. In fact, our precision is within less than a millimeter of what we aim at. And so military analogy is this is like your best sharpshooter that can hit a small, less than a one-inch target from a 1,000 yards away.That’s basically what we’re able to do. We’re not a 1,000 yards away. The machine’s right there. We can see inside the human body. We can see the tumor, especially if it’s moving, and we can deliver highly concentrated high dose X-rays specifically to the tumor with a very little amount of exposure to the area around it.

So we’re just not seeing our patients getting injured from radiotherapy, and we’re seeing sometimes some situations up to 100 percent complete tumor control with no further growth. So it’s really important for veterans to know. So my activation tip is if surgery is on the table, you might want to check in with a radiation oncology team as well to see, well, is radiotherapy an option as an alternative? It might be safer and just as good and maybe better. So a lot of people don’t know about this because this is not taught as much, but radiotherapy is really one of the major forms of curative therapy for lung cancer.

Lisa Hatfield:

Okay, thank you. As a patient, I always have follow-up questions to clarify a couple of things. So I have another follow-up question to this, the question you just answered. So I know that not all veterans are seen at VA hospitals or VA facilities. If they are being seen at a VA facility, will they have access to the latest and greatest radiation radiotherapy services, or do only some centers have these special types of therapies?

Dr. Drew Moghanaki:

Yeah, well, when it comes to the VA’s commitment to provide the best care for every single veteran who’s eligible, there’s a logistical challenge in that it’s hard to deliver care to veterans everywhere, especially super sub-specialty care like thoracic surgery or radiation therapy. The equipment’s expensive. There’s a lot of staff that has to be hired. You can just look at airports. We don’t have a major commercial airport in every town and city in the U.S. They’re in major towns, major cities.

And that’s kind of how things are with the VA medical centers. And even when you look at the network of 130 VA medical centers in the 50 states of the U.S. only just more than 40 of them actually have radiotherapy on site at that VA medical center. So a lot of veterans who actually need radiation therapy are going to be getting that through the VA referred out to the community providers.

And so it’s important to if you’re at the VA, you’re very likely to get high-quality radiation therapy because a lot of oversight, the federal government’s watching. In fact, it’s the most regulated radiation oncology service in this country at this time. But if you’re going out into the community, make sure you do your homework. And my activation tip would be then make sure you do your homework and try to make sure that the department of radiation oncology you’re going to really does have the best technologies. And there’s lots of different ways to look at this, including going online and reading more about what the quality of care might be in the community.

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Are There Lung Cancer Outcome Disparities for Veterans?

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Are There Lung Cancer Outcome Disparities for Veterans? from Patient Empowerment Network on Vimeo.

Do lung cancer outcome disparities exist for veterans? Expert Dr. Drew Moghanaki from UCLA Health discusses veteran outcome studies for civilian versus VA healthcare, efforts on improving outcomes over time, and proactive advice for accessing the best lung cancer care.

[ACT]IVATION TIP

“…if you’ve got cancer, to really understand lung cancer, to really appreciate that there’s been a lot of advances and if you’re not feeling that you have access to those advances, get a second opinion and go to a bigger place that actually has an integrated approach to lung cancer care with a multidisciplinary team with the doctors in different specialties are working together and are focused on giving the best lung cancer care.”

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Combating Disparities: Veterans’ Healthcare Access and Quality

 Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

 Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Transcript:

Lisa Hatfield:

Dr. Moghanaki, can you discuss any disparities or differences in health outcomes among veterans compared to the general population when it comes to lung cancer treatment?

Dr. Drew Moghanaki:

Yeah, when it comes to lung cancer treatment, there’s new data that’s showing that since the discovery of better drugs and safer surgery and more effective radiotherapy, that survival rates are improving gradually, especially over the last 10 years. We’ve seen this same trend with VA data as well, that veterans, whether they’re getting care in a community or in the VA, the outcomes are getting better.

Are there disparities? Well, there’s notable disparities that we’ve identified which is that although outcomes in general are getting better for female and male and Black and white and other ethnic sections of the population, there continues to be a disparity in the civilian sector in that our Black patients, whether civilian or veteran, have inferior outcomes. And, of course, we know this is associated largely with other socioeconomic issues related to a long history of racism in this country that’s led to segregation and unequal access to health care and well-being opportunities.

But what we see in the VA, whether you’re Black or white, actually the outcomes are the same. So there’s something that VA is doing that’s addressing the barriers that are affecting people in the general population. And in fact, we see in some of our studies, Black veterans actually have better outcomes. And so we’re learning that it’s much more than just biology by itself, that there really are socioeconomic factors. And when you’ve got a healthcare system that’s more than just a healthcare system, it’s a benefit system as well.

We really provide a nice safety net that helps address those disparities. But the sad truth is that it definitely disparities do continue to exist outside the VA healthcare system. So my activation tip is, if you’re a veteran with maybe some less resources than others, again, check into the VA because the VA provides not just healthcare, but also a lot of support services, especially when you have lung cancer, which as mentioned, is just very difficult to deliver and requires more than just access to a doctor.

Lisa Hatfield:

And I’d like to mention a paper also that you published regarding improving outcomes over a certain time period. There was a paragraph in there where you had a discussion about potential contributing factors to the improvement of outcomes over time. Are you willing to discuss those a little bit, what those potential factors are for improving outcomes in patients with lung cancer?

Dr. Drew Moghanaki:

Yeah, there are three main components. One is making sure you get the diagnosis right. Making sure you do the right biopsies and you send the specimens for what’s called biomarker testing to make sure you know what type of lung cancer. There’s now more than a dozen different types of lung cancer. And if you don’t get that biomarker test, you’re not going to know. You’re just going to be treated with standard therapy. If you get the biomarker testing, you can get personalized medicine with a drug that’s more likely to work and probably safer than the older conventional chemotherapies, which still has a role. But sometimes we can skip chemotherapy altogether and go directly to a targeted therapy.

The second big advancement comes in the treatment delivery itself. So surgical treatments are now much less invasive than ever before. In fact, many of our patients, they go to the operating room, they wake up with four Band-Aids, and half their lung is removed. Remarkable technology using robotic and video-assisted technologies. Same with radiotherapy.

Patients lay on a table and the machine, the very sophisticated machine just rotates around them, zaps these tumors. The patient can actually drive themselves back and forth to treatment and go home and and live their lives. We’ve got patients getting lung radiotherapy, and they’re playing golf the next day. It’s unbelievable. And then the third really comes down to survivorship, which is that our patients, even if we really can’t cure their cancer, like a lot of advanced diabetes, we just can’t cure, we can keep our patients going as they live a high-quality life moving forward and make sure that their journey, unfortunately, with their lung cancer that they obviously didn’t ever want to have, that their journey is the best that it can be. 

So my activation tip here is if you’ve got cancer, to really understand lung cancer, to really appreciate that there’s been a lot of advances and if you’re not feeling that you have access to those advances, get a second opinion and go to a bigger place that actually has an integrated approach to lung cancer care with a multidisciplinary team were the doctors in different specialties are working together and are focused on giving the best lung cancer care.

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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

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Veteran Lung Cancer Risk: Understanding Exposures and Screening Protocols from Patient Empowerment Network on Vimeo.

What’s important for veterans to know about lung cancer risk? Expert Dr. Drew Moghanaki from UCLA Health discusses known veteran lung cancer risk factors, screening recommendations, and proactive patient advice involving the PACT Act.

[ACT]IVATION TIP

“…if you’ve had an office job, well, you probably have the same risk as your neighbor wherever you’re living. But if you were in a combat zone or on a base where there were a lot of chemicals, probably want to pay a little more attention and check in with your primary care doctor to get some appropriate screening tests for yourself.”

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Combating Disparities | Veterans' Healthcare Access and Quality

Combating Disparities: Veterans’ Healthcare Access and Quality

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Transcript:

Lisa Hatfield:

Dr. Moghanaki, there is a stigma around military personnel being at higher risk for lung cancer than civilians. Is there an elevated risk for those in the military? If so, why and who should be screened?

Dr. Drew Moghanaki:

Yeah, the stigma of veterans being at higher risk for lung cancer is real. And I think Hollywood had a big role in it. And is it appropriate? Well, I never liked the word stigma, but I think it’s important for the public. And of course, soldiers or any military personnel who served in the armed forces appreciates that back in the days the bases were much dirtier than they are today. And there was a lot of exposure to a lot of things that can cause cancer and actually other health problems as well, such as diabetes and Parkinson’s disease and Alzheimer’s and other things.

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. So if you’re just a 45-year-old, 55-year-old male or female, and you’ve got a cough, generally speaking, you may not be so worried and just hope it goes away.

But if you’ve been on these dirty bases, it’s important to look into this and find out now how dirty are the bases? Well, there’s been the media I think over exaggerates exactly what was going on and what was on these bases. But there are lots of federal reports that have documented exactly some of the, for example, like if you were stripping aircraft with a certain stripping material, a lot of these substances are currently now chemicals are banned because we as soon as we learn that they’re toxic, we basically ban them.

But generally speaking, yeah, health concerns are a little bit elevated if you’ve served in the military and especially if you’ve been deployed in the field of battle. And so my activation tip is if you’ve had an office job, well, you probably have the same risk as your neighbor wherever you’re living. But if you were in a combat zone or on a base where there were a lot of chemicals, probably want to pay a little more attention and check in with your primary care doctor to get some appropriate screening tests for yourself.

Lisa Hatfield:

Are there any programs in place right now where veterans who’ve had those exposures or potential exposures, where they are being screened regularly or is it up to the veteran to ask that question?

Dr. Drew Moghanaki:

So if a veteran is plugged in with the VA healthcare system, the primary care network here is set up to offer the appropriate screening. But if you’re not, it’s important to look into this. Again, I’m just going to keep saying over and over again, if you’re a veteran who’s not yet eligible, if you know anyone, please check in. Congress has radically expanded the eligibility within the PACT Act is actually primarily centered around this issue of risk. It’s about toxic exposures that the VA is still learning about and VA physicians like myself are still learning about. And so these programs definitely exist to address them, but the best way to do it is to get registered for VA healthcare.

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Combating Disparities: Veterans’ Healthcare Access and Quality

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Combating Disparities: Veterans’ Healthcare Access and Quality from Patient Empowerment Network on Vimeo.

Where can veterans locate quality healthcare and healthcare access? Expert Dr. Drew Moghanaki from UCLA Health shares information from VA healthcare research studies and proactive advice for patients to access the best care.

[ACT]IVATION TIP

“…make sure that the quality of care isn’t inferior, check in with the VA and see how they might be able to help you, especially if you’ve got lung cancer, because lung cancer care is complicated.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Veterans

Related Resources:

Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Advancements in Lung Cancer Clinical Trials Updates for Veterans

Advancements in Lung Cancer Clinical Trials Updates for Veterans

Transcript:

Lisa Hatfield:

Dr. Moghanaki, are there disparities in the quality of care received by veterans compared with other patient populations? And can you speak to the strategies or programs that have been effective in addressing barriers to healthcare access for veterans?

Dr. Drew Moghanaki:

I love this question because it is one of the most informative things that I’ve learned since becoming a VA physician. Study after study has shown that the quality of care received by veterans is equal or superior to that received in the community. And that’s largely in the VA healthcare system. So again, if you’ve got access to VA healthcare, I think you might be eligible, please look into it. The reports have been fantastic, and that’s because it’s a comprehensive approach to care. But for veterans who are receiving care in the community, it’s a little bit harder, actually it’s a lot harder to track. Because they may not be registered with the VA. And what’s happening, I saw the VA is happening outside the VA.

And I think that largely speaking veterans are just going to get the same kind of level of care as their neighbors might who are civilian. And so where they’re going for their care really affects that. Now, veterans may have more resources, because they can tap into the VA to find out where they may go. VA has incredible tracking systems, a lot of data to help us make better decisions and for them to make better decisions. And so my activation tip here is to make sure that the quality of care isn’t inferior, check in with the VA and see how they might be able to help you, especially if you’ve got lung cancer, because lung cancer care is complicated.

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