Understanding the barriers and experiences of veterans with lung cancer.

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160 Background: Veteran populations have higher lung cancer incidence and lower overall survival rates than non-veterans. Despite clinical advancements in lung cancer which reduce lung cancer death rates and access to care, many Veterans face barriers in receipt of such guideline-based care due to many factors including complex comorbidities, low health literacy, and significant economic and social disadvantages. In fact, the underrepresentation of Veterans in clinical trials confer even more difficulty to ensure cancer treatment and prognosis thoughtfully considers their unique challenges and needs. Few studies have evaluated Veterans’ perspectives regarding unmet needs and potential solutions to address equitable care delivery among these populations. The objective of this study was to evaluate Veterans’ perspectives regarding their lung cancer care to identify modifiable barriers that could be addressed to improve care. Methods: We conducted semi-structured interviews with fourteen Veterans diagnosed with lung cancer at the VA Palo Alto Health Care System. All interviews were recorded, transcribed and analyzed interviews using the constant comparative method of qualitative analysis. Results: All participants noted the main barrier to lung cancer care was transportation with inadequate financial coverage for gas and extensive commutes that contributed to significant anxiety and stress regarding their cancer care. Participants noted challenges in navigating the health system and suggested better understanding of the structure and function of cancer care team members to overcome these barriers. Participants noted difficulty comprehending and interpreting their cancer prognosis and were unaware of advance directives. All participants were unaware of precision medicine, namely molecular tumor testing or genomic cancer sequencing and its implications on their treatments. Conclusions: This study revealed critical gaps in lung cancer among Veterans in one VA facility. Targeted solutions should be considered to address barriers identified which include transportation access, proactive distress management, and knowledge regarding lung cancer care delivery.