Regional project aims to expand lung cancer screening and treatment access among veterans

April 16, 2021
Dr. Nichole Tanner sits at a computer showing a lung cancer scan
With lung cancer incidence among veterans almost double that of the general population, Dr. Nichole Tanner is co-leading a project to make cutting-edge screening and treatments more available for veterans. Photo by Marquel Coaxum

With new funding from the Veterans Affairs VA Lung Precision Oncology Program, researchers from MUSC Hollings Cancer Center hope to expand access to lung cancer screening and precision oncology treatments among veterans in the Southeast.

The project, which is being led by pulmonologist Nichole Tanner, M.D., and oncologist and co-investigator John Wrangle, M.D., will create a national network of sites with expertise in lung cancer screening and precision oncology clinical trials that can help facilitate similar research at smaller VA facilities, which are often located in rural areas.

According to Tanner, the rate of lung cancer among veterans is almost double that of the general population due to higher rates of smoking and exposure to chemicals like tactical herbicides and burn pits, making it a critical health care problem in this population. One study showed that 74.2% of veterans reported that they’ve smoked in their lifetimes, compared to 48.4% of non-veterans.

Lung cancer is the No. 1 cause of cancer-related deaths among both veterans and nonveterans and is the second most common type of cancer diagnosed in veterans. In South Carolina, rates of both lung cancer incidence and mortality are high compared to the rest of the country, especially in rural areas.

map of South Carolina showing lung cancer incidence rates by county 
Lung cancer incidence rates in South Carolina are high compared to the rest of the country, especially in rural areas.

Tanner, who co-directs Hollings’ Lung Cancer Screening Program, said, “While the larger VA medical centers can offer screening and access to medical oncologists and precision oncology trials, there are many veterans serviced by smaller VA medical centers who have not had access to screening. We want our veterans to have access to the same cutting-edge thoracic oncology trials and treatments that we have available at our National Cancer Institute-designated cancer center affiliates. This program leverages what we do at Hollings and makes it available to our veterans.”

While the Charleston VA has been offering lung cancer screening since 2013, many veterans in South Carolina remain without access to screening because of their distance from their central VA medical center. Smaller outpatient clinics in rural areas can offer services like primary care, but many of these sites lack the technology or imaging specialists needed to screen at-risk patients. In fact, access to nearby CT scanners is one important barrier to lung cancer screening for veterans.

As part of the project, Hollings researchers will work closely with VA medical centers in Birmingham and Atlanta and their NCI-designated cancer center affiliates — O’Neal Comprehensive Cancer Center and Emory Winship Cancer Institute — to increase access to and participation in services among veterans across all three states. The cancer center directors from each site will participate in the external advisory committee for the VA Southeast Network (known as VISN7), allowing the centers to stay informed of the health needs of the region and to collaborate on clinical trials.

The project is supported by $5 million in VA funding across all three sites.

Devika Das, M.D., who is co-leading the project at the University of Alabama at Birmingham alongside Mark Dransfield, M.D., said, “Our team is excited and grateful for this collaborative opportunity to use the collective expertise from the three large NCI-designated cancer centers in the Southeast to build a comprehensive program that includes widespread lung cancer screening, care coordination and equitable access to high-quality clinical trials for veterans in our region.”

Badi El Osta, M.D., principal investigator for Emory University’s portion of the study, added, “We serve a diverse population of veterans with lung cancer. This consortium aims to lessen the burden of lung cancer for those who shall have borne the battle.”

“I’m excited to work with other VA medical centers in our regional network that have great cancer center affiliates in disseminating best practices for lung screening, early detection and opening up lung cancer trials across our three states that stand to benefit and reach more veterans.”
— Dr. Nichole Tanner

In South Carolina, Tanner will work with other VA centers across the state, including the VA medical center in Columbia and its outpatient clinics, to train their staffs on best practices for screening. Researchers also are exploring a partnership with the Office of Rural Health to pilot a mobile lung cancer screening program that could help to improve screening access in rural communities.

Wrangle, who is leading the project’s precision oncology efforts, will work with investigators from the other cancer center sites to ensure that all veterans diagnosed with lung cancer undergo molecular testing. These test results can help to guide treatment selections for individuals based on their specific tumors.

Wrangle will also work to improve veteran access and enrollment in precision oncology lung cancer clinical trials.

Tanner hopes the collaboration will allow the sites to come up with new ideas and opportunities to improve the health of veterans who otherwise are not being reached.

“Being in the Southeast, we’re in the tobacco belt, where there’s a high prevalence of lung cancer and lung cancer deaths. I’m excited to work with other VA medical centers in our regional network that have great cancer center affiliates in disseminating best practices for lung screening, early detection and opening up lung cancer trials across our three states that stand to benefit and reach more veterans,” said Tanner.

“Each cancer center brings certain strengths,” she explained. “Our strength at Hollings is in health disparities research and evaluation. More minds are better than one.”

Hollings’ participation in the project is especially important, as the Charleston VA is one of the fastest growing VAs in the country. The VA Southeast Network, which is one of 21 Veterans Integrated Service Networks in the U.S., serves the third largest veteran population, with over 1.4 million veterans living in its geographic area. The network is projected to have the second largest veteran population within a few years.

Program highlights and impact

  • Expands access to lung cancer screening and promising new lung cancer treatment options for veterans.
  • Establishes a network of sites with expertise in screening and precision oncology clinical trials to help to facilitate similar research at smaller or more rural VA facilities.
  • Partnerships with VA medical centers and their NCI-designated cancer center affiliates in Atlanta and Birmingham will expand access across three Southeast states.
  • Builds and supports Hollings’ partnerships with VA sites across South Carolina.
  • Enables sustained ability to participate in investigator-initiated and industry-sponsored clinical trials, including molecular and biomarker-driven studies.
  • Establishes Hollings as a leader in study development.

About the Author

Kelsey Hudnall
MUSC Hollings Cancer Center

Keywords: Cancer, Fitness and Wellness