The Institute for Medical Research
The Institute for Medical Research at the Durham VA will receive $935,766 over two years to develop and pilot a comprehensive lung cancer survivorship program that will provide a coordinated approach to management of life after lung cancer and address depression, debility, and tobacco use while ensuring appropriate surveillance through an integrated electronic medical record for veterans serviced by the Durham VA.
The Veterans Administration is the largest integrated health care system in the United States with 8.7 million veterans receiving care at 1,700 locations annually. Tobacco use, the primary cause of lung cancer, remains a significant concern among the veteran population with 20.1% of the currently enrolled veterans self-reporting active cigarette smoking. In addition, among the non-smoking enrolled veteran population, 70% report prior tobacco use, 20% higher than the civilian population. The high proportion of smokers and former smokers at the VA has resulted in high incidence of lung cancer among the veteran population, lung cancer represents 18.8% of all cancers diagnosed in the VA system. In addition, many veterans who utilize the VA system reside in rural areas, are low income, and older age which often make obtaining adequate care difficult. The Durham VA is the primary referral hospital for the Mid-Atlantic Region (VISN 6) and has active clinical and research programs targeted at improving outcomes for patients with lung cancer, and is participating in a VA pilot program to increase lung cancer screening, making a survivorship. Given the current programs focused on the identification and treatment of lung cancer, it is a natural extension for the Durham VA to develop a survivorship program targeted at the care of patients after their diagnosis and treatment.
Treatment of lung cancer, either through surgical resection or chemotherapy and radiation often results in physical deconditioning, and depression. Furthermore, surveillance following treatment is often not standardized and currently there is no way to ensure adequate surveillance is being performed, and no way to track recurrence or development of new disease within the VA system. In addition, optimizing post-cancer care needs to address risk-factor reduction, specifically tobacco use, in an organized fashion. The proposed program would provide a coordinated approach to management of depression, debility, and tobacco use while ensuring appropriate surveillance using an integrated electronic medical record.