What Impact Does the VA Have on Lung Cancer Care Coordination?
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.
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“…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 |
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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?
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.
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“…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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Related Resources:
|
Explaining Advanced Non-Small Cell Lung Cancer to Veterans and Their Families |
|
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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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols
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.
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“…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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Related Resources:
Combating Disparities: Veterans’ Healthcare Access and Quality |
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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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Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems
Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems from Patient Empowerment Network on Vimeo.
What can veterans expect for the patient experience in VA versus civilian healthcare systems? Expert Dr. Drew Moghanaki from UCLA Health explains common experiences for veterans in VA and civilian healthcare systems and information about the PACT Act.
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“…be aware of who’s providing care, and obviously give them a break if they don’t understand anything about what it means to be a veteran. The quality of healthcare really builds upon a culture of trust. You may be better served finding other physicians or providers who are veterans themselves.”
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Transcript:
Lisa Hatfield:
Dr. Moghanaki, are there systemic issues within the healthcare system that disproportionately affect veterans?
Dr. Drew Moghanaki:
Well, this makes me realize that healthcare systems aren’t just automatic systems. They’re environments where there are people like myself who work in a healthcare system. And depending on where a veterans getting care, that staff may or may not know much about what it means to be a veteran. So let’s take three different examples. Obviously, if you come to VA Medical Center, our veterans, many of them told me they feel like they’re back on base. We understand the mission. We understand the cause. We understand the victory. We also understand the suffering. And we can connect better than anyone else in this country with veterans.
And we’ve got the access to the best treatments available to truly take the best care that we can with a comprehensive approach through the VA healthcare network, which now consists of over a 1,000 clinics and over 100 high-quality, multi-functioning health care medical centers. But let’s take option number two, where a veteran may be receiving care in a community hospital. And in that situation, you may run across some of the healthcare providers who know something about what it means to be a veteran.
Either, if you’re lucky, they themselves were a veteran and provided some service, or they were raised in a family where they know other people who have served in the military and they understand the basic principles. And so those healthcare providers, even though they may be civilians themselves or veterans working in a community hospital, at least kind of get it.
But then there’s a third scenario where veterans will go to a community hospital, and the people taking care of them don’t really know what it means to be a veteran. They only know the television version or the Hollywood version of it. And they think they know, but they really don’t know. And I’ll tell you, that’s who I was when I first started working in the VA about 12, 13 years ago. And I’ve been so fortunate to get a lot of lessons on what it means to be a veteran. And over time, I’ve gotten to know a lot of soldiers and veterans myself just in my personal life to truly understand. And so I think my activation tip for here is to really be aware of who’s providing care, and obviously give them a break if they don’t understand anything about what it means to be a veteran.
The quality of healthcare really builds upon a culture of trust. You may be better served finding other physicians or providers who are veterans themselves. And, of course, if you’ve got access to VA healthcare, check-in with the VA Medical Center and see, hey, what’s the quality of my care here? And I’ll probably be saying this later on in this recording, which is that if you are a veteran and not yet eligible for VA healthcare, please do check in because the PACT Act recently approved by Congress has truly expanded eligibility, and you may be eligible and not know about it.
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Lung Cancer Strategies for Veterans: Research and Care Insights
Lung Cancer Strategies for Veterans: Research and Care Insights from Patient Empowerment Network on Vimeo.
What’s important for veterans with lung cancer and care partners to know about research and care? Expert Dr. Drew Moghanaki from UCLA Health discusses research initiatives, screening recommendations, and patient advice for proactive care.
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“…if you’ve got a cough that won’t go away, push hard to say, ‘Look, I really just want to take a look inside my chest.’ It won’t be a low-dose screening chest CT. It’ll be a regular chest CT. And that CT, even if normal, can be a nice baseline for future scans in the future if more scans are needed.”
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Transcript:
Lisa Hatfield:
Dr. Moghanaki, can you speak to your research around strategic initiatives for veterans facing lung cancer? And what should your patients, their care partners be asking as they seek care?
Dr. Drew Moghanaki:
I really care about driving down the symptoms and the burden of lung cancer, and there’s a lot of great treatments out there that are safer and more effective than ever before. Our patients are living better lives and longer lives, and I really focus a lot on that type of research. But one of the things that really probably has the biggest benefit is just earlier detection. And early detection takes place by having an annual chest CT scan with a certain type of CT scan that’s a lower dose of radiation that the scan requires. And we don’t scan people who have symptoms.
So I’m talking about people who are at risk. And right now, our best measure of who’s at risk for getting lung cancer are people who smoked a lot of cigarettes in their lifetime. And they basically once a year get a scan, and we’re looking for lung cancers at the earliest time that they’re sprouting, and that’s because if we catch it early, we’ve got the safest treatments and the most effective treatments and the highest cure rates, and so my activation tip is if you know anybody or if you yourself are at risk for lung cancer because there’s a lot of smoking going on, please get your lungs screened and talk to your primary care provider to get that lung screening scan ordered.
Lisa Hatfield:
Okay. And just a follow-up question for that, if a person does have some type of symptoms, or if I guess if they’re a smoker also, but they have some type of symptoms and they say, “Oh, I’d like to have this low dose chest CT scan.” Can they just ask their primary care provider about that? Or are they, are PCPs automatically going to screen people who have symptoms or have been long-time smokers?
Dr. Drew Moghanaki:
It’s really a standard of care to get some imaging of the chest. If you’ve got somebody with a cough that won’t go away or some sort of pain inside the chest. In that situation, we don’t get a low-dose chest CT. We get a regular CT to take a look. Now, one of the things is if a patient has smoked a lot, people really start to worry, this might be lung cancer. But one of the things that we’re seeing is there’s a lot of people getting lung cancer who never smoked or they just smoked a little bit. And the doctor may say, “Well, I don’t think you’re going to get lung cancer.” And they don’t get a scan. And that’s actually a problem.
So for those patients, my activation tip is, look, if you’ve got a cough that won’t go away, push hard to say, “Look, I really just want to take a look inside my chest.” It won’t be a low-dose screening chest CT. It’ll be a regular chest CT. And that CT, even if normal, can be a nice baseline for future scans in the future if more scans are needed. It’s always good to have a baseline at an earlier age, so we can see if new things show up, if they’ve been there for a while, or if they really are new.
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