Lung cancer screening practices among head and neck cancer survivors in U.S. veterans: A pilot survey.

Abstract

e23148 Background: Survivors of head and neck (HNC) cancers constitute a uniquely high-risk population for second primary lung cancers (SPLC). Despite SPLC being a leading cause of mortality in HNC survivors, most major screening trials excluded these patients, creating a critical evidence gap. Methods: We conducted a national, cross-sectional survey of Veterans Affairs (VA) medical centers participating in the VA Lung Precision Oncology Program (LPOP). The survey was developed with input from the LPOP Lung Cancer Screening Outcomes Workgroup and assessed site-level practices, policies, and infrastructure for lung cancer screening (LCS) among HNC survivors. One representative from each center completed the survey. The survey was created using VA REDCap and distributed electronically across the LPOP network. Results: In total, 42 out of 115 sites (21 centers, 24 hub sites, and 91 spoke sites) initiated the survey, and 26 submitted complete responses. Most participating sites were high-complexity facilities (77%) and Commission on Cancer-accredited (62%). While 69% of centers reported awareness of guidelines addressing LCS for HNC survivors, nearly 90% indicated that their site lacked formal guidance or were unsure if guidance existed. Although 92% would consider enrolling HNC survivors in LCS programs, timing of likely enrollment varied: 31% after completion of curative treatment, 23% on a case-by-case basis, 19% two to three years post-treatment if no recurrence, 15% would not consider HNC history, and 3% more than five years post-treatment. Notably, 42% of centers reported routinely performing additional surveillance imaging after curative HNC treatment, and 19% perceived that communication barriers among multidisciplinary teams contributed to LCS being overlooked. Regarding survivorship resources, 34% of centers lacked a formal HNC survivorship clinic, and 50% were unsure. Only 23% agreed that current guidelines adequately address imaging surveillance for HNC survivors, and 15% agreed that guidelines sufficiently define LCS eligibility. Conclusions: Substantial variation exists in LCS practices for HNC survivors across VA medical centers, with inconsistent enrollment timing, frequent additional surveillance imaging, limited site-specific guidance, and gaps in survivorship infrastructure. These findings highlight the need for standardized, evidence-based approaches to address LCS in this high-risk population.