It's no secret that thousands of Veterans are current or former smokers, a major reason why lung cancer is one of the most commonly diagnosed cancers in the VA system. So what about a screening program, using lung imaging, to detect those affected by or at risk for the disease?

Sounds like a vital undertaking. But it's not that simple. That's the finding in a VA study that says developing and implementing a comprehensive lung–cancer screening (LCS) program for the nearly 900,000 Veterans who are eligible is "complex and challenging, requiring new tools and patient care processes for staff, as well as dedicated patient coordination."

The study appeared in the March 2017 issue of JAMA Internal Medicine journal.

"For example, creating electronic tools to capture the necessary clinical data in real time that met the needs of the LCS coordinators proved to be difficult, even with the VHA's highly regarded electronic medical record," the researchers write. "Although computerized clinical reminders about current or recent smoking are widely used in the VHA, more detailed information about pack–years smoked and years since quitting was required. This information is not fully captured in the electronic medical record."

Lead author Dr. Linda Kinsinger says there are staff– and patient–related difficulties with carrying out such a voluntary program. Just getting patients to keep appointments for screenings and follow–ups is a major challenge in itself, and one that could lead to logistical hardships, she says. No data were kept on the number of appointment cancellations, but she says the lung cancer screening coordinators told of many such instances.

"It's not just asking, 'Do you want your flu shot,'" Kinsinger says. "It's a much more difficult conversation. As with anything, you can make appointments, but people sometimes don't show up when they're supposed to. So then you have to stay on top of that to get them rescheduled. We had lots of recalls in the study, so that meant more appointments and more scheduling and more decision–making by the patients on whether they really want to follow up on this. It turned out to be lots of steps for staff and patients."

A recall pertained to patients who had at least one nodule, an abnormal swelling on the lung, found on the screening exam. They were asked to return in three, six, or 12 months for a repeat study to see if the nodule was growing or changing.