Bridging the Gap in Veterans Lung Cancer Screening

Both rural and nonrural veterans are largely satisfied with their lung cancer screening care, according to a recent study. But it’s still a matter of getting screened in the first place: a study found rural veterans in 8 Midwestern states traveled a mean 45 miles each way for health care services, and some traveled as far as 200 miles. 

Rural veterans are at greater risk for lung disease, partly because of high smoking rates, and are more likely to die of lung cancer than nonrural veterans, possibly due to a later diagnosis. Although more veterans who are eligible for screening under US Preventive Services Task Force (USPSTF) criteria live in rural areas, but they are less likely to undergo initial and subsequent lung cancer screening, often because travel time and distances can be barriers to access.

Screening remains low across the Veterans Health Administration. One way to boost screening is via the US Department of Veterans Affairs (VA) Partnership to increase Access to Lung Screening (VA-PALS), a multidisciplinary collaboration that has facilitated > 20,000 lung cancer screens for veterans. 

In 2022, a research team analyzed survey responses from 689 screened veterans. About 86% of the respondents said they felt their health concerns were understood and 94% felt they were treated with respect. They gave equally high marks for being informed about screening and smoking cessation, and being included in decision making. 

Telehealth is an obvious choice, and the VHA has been using it widely. VA researchers conducted a telehealth intervention to increase referrals for screening among at-risk veterans. Results were scored according to the Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1, where 0 indicates the lowest degree of suspicion and 4 the highest. Only 3 of 74 LCS-eligible veterans underwent screening before the intervention began. By the end of the project, 19 (26%) had undergone screening, all 19 had a score of 1 or higher. 

In 2022, the VA Northeast Ohio Healthcare System internal medicine residents and faculty began a quality improvement project to increase early COPD diagnosis in primary care patients. All 11 PCPs whose patients had symptoms said they’d been unaware of them because the patients did not mention them. They also said screening for COPD was not a priority. 

The researchers found that while using questionnaires plus peak flows was the more effective strategy overall, questionnaires alone could also work. Perhaps more effective, though, using LCS as a “dual-action case finding method.” “We can pull the veil back on COPD diagnosis and identify patients with possible COPD earlier in their course using their eligibility for LCS as a yearly reminder to probe them for symptoms. …This is an opportunity we cannot afford to miss.”