The VA Puget Sound has a large lung cancer footprint as one of 23 national hub sites to host a VA Lung Precision Oncology Program (LPOP, co-lead Dr. Kristina Crothers). Each hub site supports several smaller VA sites to reach Veterans in more rural regions. The LPOP supports both clinical activities such as screening program implementation, clinical trial enrollment, and national cross-VA collaboration in lung cancer screening and treatment studies. The health services research team, based at the Seattle-Denver COIN, also conducts studies on lung cancer risk and outcomes and delivery of lung cancer screening, including trials evaluating strategies for integration of smoking cessation into screening. Specific division-lead research activities are highlighted below.
Studies in the VA LPOP network include optimizing uptake, implementation of and adherence to lung cancer screening, using the VA as a learning health system and assessing the impact of different health care delivery models for how hub sites support less-resourced spoke sites. Additional studies include radiomic analyses to predict lung cancer risk and to assess incidental findings on low dose chest CT scans in collaboration with the Computer Vision and Machine Learning in Precision Oncology (CoMPL) arm of the LPOP network. VA Puget Sound will be participating in several upcoming clinical trials within LPOP, including comparing risk prediction-augmented screening strategies to USPSTF criteria. Dr. Crothers also collaborates with several large, multisite studies to investigate risk factors, screening and outcomes of lung cancer in people with HIV (PWH). These include the Veterans Aging Cohort Study (VACS) and the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Current investigations include tailoring lung cancer screening to PWH based on unique risk factors and differential mortality risk in PWH.
Dr. Crothers leads an NCI-funded clinical trial investigating smoking cessation in PWH, further described under the HIV associated lung diseases page. Dr. Steven Zeliadt and other Investigators in the VA Seattle-Denver COIN are studying ways to integrate of smoking cessation into lung cancer screening within VA, including as part of the NCI-funded Smoking Cessation and Lung Examination Collaboration (SCALE).
