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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.

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“…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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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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How Can Lung Cancer Experts in Academic and Community Settings Collaborate?

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How Can Lung Cancer Experts in Academic and Community Settings Collaborate? from Patient Empowerment Network on Vimeo.

How can lung cancer collaboration happen in academic and community settings? Experts Dr. Lyudmila Bazhenova and Dr. Jessica Bauman share their perspectives on collaboration challenges and potential ways to decrease these challenges in the future.

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Transcript:

Dr. Nicole Rochester: 

So my next question really has to do with how can lung cancer experts in academic settings partner with, collaborate, work with those experts in the community settings to overcome some of these challenges that you all just talked about as it relates to biomarker testing? So I’ll start with you, Dr. Bauman.

Dr. Jessica Bauman: 

So, that’s a million dollar question. I do think there are many opportunities of educational opportunities to continue to educate everybody in terms of lung cancer. I think lung cancer is a very common diagnosis. And so we know that many community providers absolutely deliver excellent lung cancer care. And so making sure that there are many opportunities for them to participate in, either citywide or nationwide educational opportunities for updates on lung cancer. We have in Philadelphia, we actually have an academic, sort of a multi-multidisciplinary, multi-institutional tumor board, thoracic tumor board that happens quarterly, which we invite community providers to to discuss some of the latest literature. Certainly our emails are always available, so we can always bring them, certainly we get many different questions that come in from other providers, but I’m sure we could do a better job. And I’m very curious to hear what Dr. Bazhenova thinks about this as well, because I think it is such a huge challenge.

Dr. Lyudmila Bazhenova: 

I agree with you fully, and I think my two cents here is I think we have to recognize and accept that one size does not fit all in this situation. And whatever works for my institution is probably not going to work for a smaller community practice. But as long as we recognize that this needs to be done and each community practice can work with their stakeholders in the molecular testing pathway, like molecular pathologists, regular pathologists, surgeons. Each institution has power to establish their own internal pathways. Would it be what Dr. Bauman says, reflex testing, which is probably not going to be an option for a majority of the community setting, because they do not have their own NGS. It’s going to be a sendout. Or like in our institutions, we don’t have a reflex molecular testing. It’s us medical oncologists who are ordering it, but we kind of get it on the backside.

We can get the patient in within 24, 48 hours from the consult was put in. And so that’s why we didn’t do the reflex testing, but as the reason we did it is because we sat down as a team and we decided this is what works for us. So I encouraged the community groups again, sitting down saying, okay, the task in hand is lung cancer patient has to have molecular testing at the time of the diagnosis. How are we going to get it, and how are we going to make sure that we are not missing, you know, have some kind of internal QI, and make sure you know what your practice is doing rather than assuming that your practice is doing molecular testing for all the patients.

Dr. Nicole Rochester: 

Thank you so much. Did you have something you wanted to add, Dr. Bauman?

Dr. Jessica Bauman: 

Yeah, I was just going to say, and I think that so many things are happening before they ever see us, that includes a pulmonologist is going in and doing a biopsy, right? Or an interventional radiologist is getting a biopsy. So it has to start way upfront of the actual diagnosis because the, what you want to try to get to capture the information as soon as you can, right? So you don’t want to get just an FNA biopsy, for example, of a liver lesion knowing that three weeks later what you really need is a core biopsy, right? So it really, the path you do, it involves so many different stakeholders when you’re having conversations about how to streamline this for your own institution and practice. 

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