Strategic Initiatives for Veterans with Lung Cancer
Background: Lung cancer is a leading cause of cancer-related mortality among veterans—as well as the US population—despite veterans’ access to advanced medical technologies within the Veterans Health Administration (VHA). To improve outcomes, the VHA launched 3 lung cancer treatment initiatives in 2016 and 2017.
Observations: This article summarizes the VHA lung cancer initiatives and discusses future programs aimed to improve care for veterans. The US Department of Veterans Affairs (VA) Partnership to Increase Access to Lung Screening aims to reduce lung cancer mortality among veterans at risk by increasing access to low-dose computed tomography lung screening scans. The VALOR study is a randomized phase 3 clinical trial that evaluates optimal treatment for participants with operable early stage non-small cell lung cancer (NSCLC). This trial plans to enroll veterans with stage I NSCLC who will be randomly assigned to treatment with either surgical lobectomy or stereotactic body radiation therapy. Researchers will follow each participant for at least 5 years to evaluate which treatment, if either, results in a higher overall survival rate. The VA Radiation Oncology Quality Surveillance program compares treatment of veterans with lung cancer in the VHA with quality standards recommended by nationally recognized experts in lung cancer care.
Conclusions: The VHA continues to prioritize resources to improve and assure optimal outcomes for veterans with lung cancer. Future efforts include creating a national network of lung cancer centers of excellence to ensure that treatment decisions for veterans with lung cancer are based on all available molecular information, including data on pharmacogenomic profiles.
VA-ROQS
The VA-ROQS was created in 2016 to compare treatment of veterans with lung cancer in the VHA with quality standards recommended by nationally recognized experts in lung cancer care. Partnering with Washington University in St. Louis, Missouri and the American Society for Radiation Oncology, the VHA established a blue-ribbon panel of experts to review clinical trial data and medical literature to provide evidence-based quality metrics for lung cancer therapy. As a result, 26 metrics applicable to each patient’s case were developed, published, and used to assess lung cancer care in each VHA radiation oncology practice.26
By 2019, the resulting data led to a report on 773 lung cancer cases accumulated from all VHA radiation oncology practices. Performance data for each quality metric were compared for each practice within the VHA, which found that VHA practices met > 80% of all 1,278 metrics scored. Quality metrics included those documented within each patient health record and the specific radiation delivery parameters that reflected each health care provider’s treatment. After team investigators visited each center and recorded treatment data, VA-ROQS is now maturing to permit continuous, electronic monitoring of all lung cancer treatment delivered within VHA. As each veteran’s case is planned, the quality of the therapy is monitored, assessed, and reported to the treating physician. Each VHA radiation oncologist will receive up-to-date evaluation of each case compared with these evidence-based quality standards. The quality standards are reviewed by the blue-ribbon panel to keep the process current and valid.
Future of VHA Lung Cancer Care
As VHA continues to prioritize resources to improve and assure optimal outcomes for veterans with lung cancer, it is now looking to create a national network of Lung Cancer Centers of Excellence (LCCE) as described in the VA Budget Submission for fiscal year 2021. If Congress approves funding, LCCEs will soon be developed within the VA regional Veteran Integrated Service Network system to ensure that treatment decisions for veterans with lung cancer are based on all available molecular information, including data on pharmacogenomic profiles. Such a network would create more opportunities to leverage public–private partnerships similar to the VA-PALS project. Creation of LCCEs would help the VA leverage an even stronger learning network to support more research so that all veterans who are impacted by lung cancer have access to personalized care that optimizes safety, quality of life, and overall survival. The lessons learned, networks developed, and partnerships established through VA-PALS, VALOR, and VA-ROQS are instrumental toward achieving these goals.
