Ralph H. Johnson VA Medical Center
Helping Veterans combat lung cancer
According to the Centers for Disease Control (CDC), regular health exams and tests are important to detect problems before they start, or find problems early, when chances for successful treatment and cures are high. Health care screenings are a key step to living a longer, healthier life. It seems like we’ve all heard this before, but we may not always know what screenings are available to us.
In 2012, the Ralph H. Johnson VA Medical Center was selected as one of eight sites to be part of a demonstration project to assess what resources would be needed to have a lung cancer screening program within VA. The project lasted three years, and at the end of those three years, the medical center saw such tremendous value in the program and its contributions to Veteran health, that the facility opted to continue the lung cancer screening program locally at Charleston VA.
Pulmonologist Dr. Nichole Tanner is a member of the Multidisciplinary Thoracic Oncology Clinic (MTOC) at Charleston VAMC and reports that they have identified 47 total cancers through the screening program, with 31 being early stage (stages 1 and 2).
About one year prior to the screening pilot, Charleston VAMC created the MTOC, with the goal of decreasing the time between suspected lung cancer, to testing, to treatment, minimizing Veteran wait times. The screening program, in collaboration with the MTOC, is a two-fold attack, increasing survival rates through early detection.
“We have a cooperative team working together to best serve the Veteran,” said Dr. Tanner.
The MTOC includes a pulmonologist, thoracic surgeon, medical oncologist, nurse practitioner and nurse navigator. They meet each Wednesday to hold a clinic where they bring each of the necessary services to the Veteran.
“The period of time between suspected cancer, to confirmation of diagnosis can be the most stressful,” said Tanner. “We wanted to reduce that stress for our Veteran patients, by bringing the services to them all at once, helping move the process along. The Veterans appreciate being able to get it all done quickly, so we’ve built the clinic to meet their needs.”
The majority of Veterans are referred to the clinic because of an incidental finding on a CT scan performed for another reason. For example, a Veteran evaluated for a symptom such as shortness of breath, chest pain or cough in the emergency department undergoes a CT scan for evaluation and something suspicious is detected. The remaining Veterans seen by the MTOC come through the lung cancer screening program.
Veterans are identified for the lung cancer screening through a clinical reminder during a visit with their Primary Care Provider, based on lifestyle risk factors and age. These Veterans are then referred to the Lung Screening Program. Veterans receive information about lung screening in the mail, then nurse practitioner calls to discuss the information further. This is a crucial point in the process, working with the Veteran for shared decision making in their health care plan. If the Veteran chooses to move forward with the screening, they are tested, and depending on the results, then set up with the MTOC.
Before the start of lung cancer screening, the majority of lung cancers were diagnosed at later stages with worse survival—five year survival ranging from 12 to 30 percent. Now the screening program and MTOC work together to identify lung cancers earlier, stage 1 and 2, boosting the five-year survivorship to 49 to 90 percent.
According to Dr. Tanner, Veterans are at twice the risk for developing lung cancer than the general population, and lung cancer is the number one cancer killer—further solidifying the value of this proactive health screening and follow-up with the MTOC. More than 2,300 Veterans have been screened at Ralph H. Johnson VA Medical Center since 2014, helping these Veterans combat those statics and get help early.