The Veteran's Affairs (VA) Comprehensive Cancer Center in West Haven, an a liate of Yale Cancer Center, serves veterans throughout Connecticut and southern New England. Each year it cares for about 600 new cases of vets diagnosed with cancer.
"We have almost all the specialities of surgery," said Michal G. Rose, MD, Director of the VA Cancer Center, “and we offer almost all types of chemotherapy and biological therapy.” e West Haven VA was also among the first in the country to do robotic surgeries for various cancers in the lung, prostate, head, and neck. e hospital provides a full array of support services, including social workers, care coordinators, and a hospice team. “the one thing we do not offer is radiation therapy,” said Dr. Rose, “so most of our patients go to Smilow Cancer Hospital for that.”
Dr. Rose and her fellow VA oncologists sometimes consult colleagues at YCC about rare cancers and other complex issues. “We’re a small hospital,” she said, “but we have large hospital capabilities because of Yale’s expertise and resources.” Yale, too, benefits from the affiliation. Oncologists at the VA hold Yale academic appointments, and the hospital is an important training ground for the fellowship program.
Because the smoking rate among veterans is higher than in the general population, VA doctors see a lot of lung and bladder cancers. Other cancers— prostate, lymphoma, and sarcoma, as well as lung cancer—are associated with exposure to Agent Orange, a defoliant used in Vietnam. Some veterans respond to the stress of military experience by abusing alcohol and other drugs, which also increase their risk of cancer.
Early diagnosis is critical, and Dr. Rose is especially pleased with the VA’s screening program for lung cancer, which has assessed more than 3,000 patients. “We’ve been able to do that because we have such a good care coordination program,” she said. “We were the first VA to over it. You won’t nd it anywhere else, really, to the extent that we’re doing it.”
She began the program soon a er becoming director in 2005. She noticed that some patients were falling through the cracks because the complications of cancer care—the many appointments and tests, the many disciplines involved— could overwhelm patients who had psychosocial problems or little family support. Dr. Rose combined the VA’s excellent electronic medical records system with a new so ware program that analyzes each day’s list of scans and ags any that suggest cancer. Each morning, a care coordinator makes sure that every flagged patient gets scheduled for any required services. The coordinator also becomes the veteran’s contact person throughout the cycle of care, lessening anxiety and delays. “Patients get diagnosed and staged quicker,” said Dr. Rose.
One area where cancer care for veterans has lagged is enrollment in clinical trials. Recent data showed that veterans are less likely than other populations to have this opportunity. They often are excluded because of co-morbidities that drug companies fear could weaken results.
“But there’s plenty of literature showing that because of so many exclusions, the results are less applicable than they should be,” said Dr. Rose. “We should be studying drugs for the people who actually need them.”
There’s a push to correct this. One example is a nationwide clinical trial called Lung-MAP. e West Haven VA was the first VA to enroll patients on this study, which is testing ve cutting-edge immunotherapies and targeted therapies against lung cancer. Dr. Rose expects VAs to attract more such trials as drug companies realize that the VA’s system of linked electronic medical records is a massive national database of potential enrollees for almost any form or mutation of cancer.
Politicians, pundits, and headlines often create the impression that the VA system is an embarrassing mess. Studies tell a different story. VA hospitals routinely outperform non-VA hospitals in fundamental categories—quality of care, patient satisfaction, and cost. Many attacks on the VA can be traced to entities that would pro t if the system were privatized.
“It’s political,” said Dr. Rose. “ e VA does have problems, and some VAs are better than others. But whenever a study looks at quality indicators, the VA does better than the American healthcare system, because it’s integrated and the incentives are right. It’s a well-kept secret that the only social healthcare system in the country actually gets good results.”
That’s certainly the view of Dr. Rose’s patient Dudley Day, a Vietnam vet from Wallingford who has been going to the West Haven VA since 2007. During a regular check-up he was diagnosed with small cell lung cancer. He received chemotherapy at the West Haven VA with some bene t, but then experienced progression of his cancer. is April, with Dr. Rose’s help, he enrolled on a clinical trial at Smilow Cancer Hospital using an immunotherapy drug.
“ The care is exceptionally better than private,” he said. “ They are hands- on, wonderful, and I love them.”