As health care professionals, we frequently encounter patients with complex medical histories. However, treating U.S. military veterans with cancer presents a unique set of challenges that often necessitate a specialized approach. Having been a U.S. Army physician and veteran myself for decades, I know many providers are less familiar with this population. To help, we have developed a new guide on Veterans and Cancer, one of the resources from our pocket guide series. I wanted to take a few moments here to introduce you to what this guide offers.
Understanding the veteran cancer patient
Consider James, a 45-year-old veteran recently diagnosed with lung cancer. James served in Iraq and Afghanistan, and, like many veterans, he presents with multiple service-related conditions, including PTSD and a history of exposure to burn pits. His case exemplifies several key aspects that distinguish cancer care for veterans:
- Service-connected malignancies. The 2022 PACT Act has expanded the list of presumptive service-connected cancers. In James’s case, his lung cancer could be related to burn pit exposure, potentially affecting his treatment options and benefits.
- Complex comorbidities. Veterans often present with multiple service-related conditions. For James, his PTSD significantly impacts his ability to cope with his cancer diagnosis and adhere to treatment plans.
- Diverse health care coverage. Veterans may be eligible for various insurance types. James, for instance, has VA health coverage but lives far away from a VA facility, complicating his care coordination.
- Younger patient cohort. While cancer is typically associated with an older demographic, many veterans of recent conflicts, like James, are under 50. This demographic shift necessitates a nuanced approach to treatment planning and survivorship care.
Key considerations
Identifying service-connected cancers
The PACT Act of 2022 has broadened the scope of presumptive service-connected cancers. As providers, it is crucial to familiarize ourselves with this list. For example, if you are an oncologist, you may encounter a veteran with glioblastoma. Knowing that this is a presumptive condition under the PACT Act would allow you to guide your patient toward additional VA benefits and specialized care options.
Leveraging the VA National Oncology program
The VA’s National Oncology Program offers unique benefits that can significantly enhance patient care. If you are a community care provider, you may have the opportunity to collaborate with the VA’s TeleOncology Service to provide specialized care for rural veterans with cancer or even to help provide care at a community hospital or your office. The Community Care program allows patients to receive expert consultation and treatment without the added burden of long-distance travel.
Supporting veterans and their families
Cancer diagnosis and treatment can be particularly challenging for veterans and their families, and integrated mental health support can be extremely helpful. Cognitive behavioral therapy, for instance, can help a veteran manage cancer-related anxiety, which may be exacerbated by preexisting PTSD.
Navigating financial support and care coordination
Many veterans struggle with the financial aspects of cancer care. Lisa, a social worker, often assists veterans in accessing various support programs. Recently, she helped a veteran’s caregiver apply for the VA Caregiver Support Program, providing much-needed financial relief during the patient’s treatment.
Actionable steps for providers
First, familiarize yourself with the PACT Act, referenced in our guide’s Resources. Understanding the expanded list of presumptive service-connected cancers is crucial for proper diagnosis and treatment planning.
Next, even if you are not a VA provider, consider how you can work with VA programs like TeleOncology to enhance your patients’ care. Also consider how you can incorporate mental health screening and support into your cancer care plans. Familiarize yourself with VA and non-VA resources available to veterans with cancer. This might include support groups, financial assistance programs, or transportation services.
Finally, consider joining the Community Care program if you live in a rural or semi-rural area. Many veterans lack ready access to VA specialty services or may live too far (usually about an hour’s drive or bus trip) from a regular VA clinic to receive care there. In those cases, veterans may receive treatment from contracted providers in their home communities. Becoming a Community Care provider can help you serve more veterans.
Conclusion
Providing cancer care to veterans requires us to think beyond standard protocols. By understanding the unique needs of this population and leveraging available resources, we can significantly improve outcomes and quality of life for our veteran patients.
We hope the Veterans and Cancer Pocket Guide is a helpful resource for you and your patients. As we know, providing optimal care extends beyond treating the cancer—we must care for the whole person, acknowledging all the complexities their service history entails. As we continue to serve those who have served our country, let’s commit to providing the specialized, compassionate care our veterans deserve.