Ensuring precision-medicine delivery for veterans with lung cancer

Veterans have significantly greater rates of lung cancer and mortality as compared to civilians. In our prior work, these disparities are partly due to lack of receipt of evidence-based cancer care especially among patients with complex comorbidities, psychosocial concerns, and limited social support, characteristics common among Veteran populations. The overall goal of this research is to overcome structural barriers to ensure delivery of evidence-based lung cancer care among Veterans. In our prior work we identified workforce shortages along with complex psychosocial factors and medical conditions that prevent Veterans from fully engaging in their care. We used community-based participatory research and expert panel methods to develop Engagement of Patients with Advanced Cancer (EPAC) – an intervention that integrates community health workers into care.1 In our randomized trial, EPAC improved evidence-based end-of-life care, Veteran satisfaction and reduced acute care use and total healthcare costs. In this study, with our established Advisory Board comprised of Veterans, caregivers, oncology clinicians, and VA leaders, we will refine EPAC to incorporate evidence-based lung cancer care (Aim 1). We will randomize 60 Veterans newly diagnosed with advanced lung cancer to establish feasibility of the refined EPAC intervention (primary outcome) and secondarily, the effects on evidence-based lung cancer care and Veteran activation (Aim 2). The results will inform a multisite randomized study in the VA.