The Veterans Affairs (VA) health system is implementing comprehensive initiatives to overcome significant barriers in cancer care delivery for veterans, addressing challenges ranging from geographic distance to mental health support.
Veterans face disproportionately higher rates of several cancers compared to civilian populations. "Veterans have higher rates of lung cancer, prostate and bladder cancer are also pronounced among veterans, and we also see higher rates of melanoma, largely due to exogenous exposure risk," explains Dr. Manali I. Patel, associate professor at Stanford University School of Medicine and staff oncologist at the VA Palo Alto Health Care System.
Addressing Geographic and Access Barriers
With approximately 38% of Veterans Health Administration patients residing in rural areas and only 44% of rural counties having an oncologist, the VA has launched several innovative programs to improve access. The Close to Me Novel Infusion Care Delivery service, initiated in 2022, now operates across 22 new sites, offering cancer treatment at community-based outpatient clinics, mobile infusion units, and patients' homes.
The program has demonstrated remarkable success, reducing patient travel by over 200,000 miles and achieving a 99% treatment adherence rate. Plans are in place to expand services to an additional 9,000 patients across 30 locations by October 2025.
Telehealth and Educational Initiatives
The National TeleOncology Service has emerged as a crucial component in bridging the care gap. To further enhance telehealth services, the National Cancer Institute established the Telehealth Research and Innovation for Veterans with Cancer (THRIVE) center in 2023, focusing on telehealth equity and access for rural and homeless veterans.
Recent clinical trials have shown promising results from educational interventions. A study presented at the 2024 ASCO Annual Meeting demonstrated that patients receiving veteran-tailored education about molecular testing showed significantly improved knowledge scores (2.30 vs 1.16, P=0.014) and higher patient activation scores compared to those receiving usual care.
Mental Health Integration and Care Quality
Mental health support has proven crucial for veterans with cancer. Research shows that veterans participating in mental health treatment programs experience better outcomes, including lower likelihood of late-stage diagnosis (OR, 0.62; 95% CI, 0.58-0.66) and improved survival rates.
Studies consistently demonstrate that veterans receive better outcomes within VA settings compared to non-VA facilities, primarily due to specialized, veteran-specific care approaches. "When veterans receive care in non-VA settings for cancer, their outcomes, including survival, are not as favorable," notes Dr. Patel.
System-Level Challenges
Despite these advances, significant challenges remain. A qualitative study at VA Palo Alto Health Care System revealed that veterans still face social and economic disadvantages affecting care delivery, including long commute times, financial concerns, and limited health literacy impacting treatment decisions.
The VA continues to develop and implement solutions to these challenges, focusing on comprehensive care that addresses both the medical and social aspects of cancer treatment. Through these coordinated efforts, the VA aims to ensure that all veterans have access to high-quality, appropriate cancer care that aligns with their needs and preferences.
