Goodman M

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.