Improvements Needed in Lung Cancer Screening Through Use of Community Care

The VA Office of Inspector General (OIG) conducted a national review to evaluate lung cancer screening (LCS) with low-dose computed tomography scan (CT scan) provided through the VA community care program. Lung cancer is the leading cause of cancer-related death in the United States. LCS with low-dose CT scan helps identify lung cancer prior to the development of symptoms. The US Preventive Services Task Force first recommended LCS in 2013 and updated the recommendation in 2021. The OIG surveyed 139 Veterans Health Administration (VHA) facilities. The OIG found that while VHA requires facilities that conduct LCS have an LCS coordinator and use a patient management tool/registry to track and manage patients, the same services are not required for community care LCS. Survey respondents identified the top five barriers to the management of community care low-dose CT consults. Through electronic health record reviews, the OIG found 11 VHA facilities with missing community care scan results. Fifty-seven percent of facilities had results that were not relayed to providers within 14 days of appointment completion. More importantly, 13 percent of facilities had abnormal results from the community that were not relayed to providers within 14 days. Thirty-six percent of facilities had patients that were not notified of community care low-dose CT scan results, 21 percent did not have documented patient notification within 14 days for normal results, and 4 percent within 7 days for abnormal results. Thirty-seven percent of facilities had patients that did not have one-year follow-up scans ordered and 23 percent did not have a scheduled follow-up appointment for abnormal results. The OIG found seven patients with abnormal scan results did not receive follow-up per recommendations. The OIG made five recommendations to the Under Secretary for Health related to timely and quality screening for patients who depend on community care LCS.