Lung Cancer Screening Program Poses a Challenge for Veterans Health Administration

Implementing a comprehensive lung cancer screening program in the Veterans Health Administration (VHA) would take significant effort for primary care teams, as well as patients. The US Preventive Services Task Force recommends annual lung cancer screening with low-dose CT scans for current and heavy smokers aged 55 to 80 years. In a study published in JAMA Internal Medicine, the VHA implemented a 3-year lung cancer screening demonstration project (LCSDP) at 8 different VHA hospitals to determine the feasibility and implications of a program for clinical staff and patients. The program assessed more than 93,000 primary care patients using the screening criteria, of whom, 4246 met the criteria. Overall, 2106 patients underwent a lung cancer screening between July 2013 and June 2015. Of the 2106 patients, 1257 patients had nodules; 1184 required tracking; 42 required more evaluation, which turned out to be noncancerous; and 31 had lung cancer. “The VHA LCSDP found implementing a comprehensive LCS [lung cancer screening] program that followed recommendations to be challenging and complex, requiring new tools and patient care processes for staff as well as dedicated patient coordination,” the authors wrote. Although the VHA has highly-regarded electronic medical records, developing electronic tools to capture required data in real time to meet the needs of lung cancer screening coordinators would be difficult, according to the study. Low-dose CT scans may stress the capacity of radiology services, according to the authors. Furthermore, accurately identifying patients and explaining the benefits and harms of lung cancer screening would take significant effort by primary care teams. Limitations to the study included that the findings may not be generalized to non-VHA health care systems, the authors noted. “The VHA LCSDP found that a comprehensive LCS program is a complex endeavor for both patients and staff,” the authors concluded. “These results will help the VHA plan for broader implementation of such a program across its health care system and may help other groups considering such screening programs to better understand the multiple components involved and the initial clinical effect on patients.”