Cancer Care Tailored to Veterans and First Responders: An NCCN Patient Advocacy Summit

On December 9, 2025, the National Comprehensive Cancer Network (NCCN) hosted a patient advocacy summit as a forum for providers, advocates, and industry members to discuss the varied and unique cancer care needs of Veterans and first responders. For a recap of the morning sessions, read the previous blog. 

Blueprints From the Field: Evidence-Based Cancer Care for Those Who Serve 

Following the morning panel and fireside chat with Veteran and Congresswoman Representative Mariannette Miller-Meeks, MD, MS (IA-01), the summit shifted to a series of best practices presentations, whereby 4 professionals across disciplines shared successful innovations their organizations employ to improve cancer care for Veterans and first responders.

In the first presentation, Joaquina Baranda, MD, professor of medical oncology at the University of Kansas, discussed barriers to providing care to Veterans in rural areas. Dr. Baranda explained that disparities in access to early-stage clinical trials, which typically occur in academic centers, are much more profound than later stages in rural areas. One of the most impactful strategies she shared was accelerating the clinical trial process by combining or overlapping phases, as doing so significantly shortens time to trial and drug availability in community settings. 

The California Firefighter Cancer Research Study (CAFF-CRS) aims to better understand the health risks of firefighting through both observational and experimental studies. In the second session, Shehnaz Hussain, PhD, ScM, lead researcher at CAFF-CRS, shared techniques, including surveys, wearable technology, occupational records, and blood tests, that are being used to understand the health of career firefighters through observational longitudinal studies. Based on data collected so far, she identified lung cancer screening as one of the biggest opportunities for further action, calling it “an area where we clearly need improvement.”

Vida Passero, MD, MBA, returned the conversation to Veteran care, discussing her role as the chief medical officer of the US Department of Veteran Affairs (VA) National TeleOncology Service. Dr. Passero explained that the rural oncology workforce shortage across the country means that many communities don’t have local access to VA oncologists. This “hub-and-spoke tele-oncology model” uses a virtual hub of cancer care providers, including physicians, pharmacists, and advanced practice providers, to connect patients living in rural areas with VA oncologists. Rural cancer centers can choose the level of support from the National TeleOncology Service that meets their needs, including full-service coverage or specialists unavailable in their community. 

In the final best practices presentation, Joe Schumacher, chief operations officer for the Firefighter Cancer Support Network, shared how his 35 years of experience as a firefighter and his own cancer diagnoses have shaped his work as an advocate and mentor. Over the course of his career, Schumacher was diagnosed with testicular cancer, non-Hodgkin lymphoma, and prostate cancer. While 3 distinct cancers are rare in the general population, he said that, among firefighters, “I know that my story is not unique.” Now, Schumacher leads the Firefighter Cancer Support Network’s 1-on-1 support for first responders and their family members upon receiving a cancer diagnosis, offering mentorship and education across 46 states. Through this work, his organization also recruits firefighters to participate in observational studies and clinical trials. His call to action for the wider research community is to increase research on volunteer firefighters, who are often excluded from studies focused on professionals.

Beyond the Battles: Policy Challenges and Opportunities 

In the final panel discussion of the summit, experts and advocates for both Veteran and firefighter cancer care discussed the strengths and challenges of their respective fields. There was a phrase that came up repeatedly in the panel discussion: “If you’ve seen 1 VA, you’ve seen 1 VA.” It’s a common adage in the industry, referring to inconsistencies in services and operations of VA facilities that lead to navigation challenges for patients and collaborators.

Although there is room for improvement in this area, David Eplin, PharmD, BCOP, president of the Association of VA Hematology/Oncology, pushes back against this stereotype. “We have some phenomenal national, centralized programs that are standardizing care across the VA network,” he said. Eplin pointed to the VA Clinical Pathways as 1 example of success. These clinical guidelines are specifically tailored for Veterans, filling in gaps and complementing existing NCCN guidelines to support clinical decision-making for this population.

Another area of success is the population expertise of VA providers. These individuals have spent their careers building a knowledge base of Veteran culture, which aids in communication and shared decision-making with their patients. Mel Mann, MBA, MEd, a retired US Army Major and survivor of chronic myeloid leukemia, spoke on the value of professionals who specialize in working with Veterans, stressing the need to maintain staffing levels. Mann explained that outsourcing providers and referring patients to care centers outside the VA network means Veterans are receiving less culturally sensitive care.

Eplin said the VA system can and should share its expertise with the wider oncology field through education and shared resources. He called out the Association of Cancer Care Centers’ growing collection of resources addressing care disparities for Veterans receiving cancer care in the community as an example of knowledge sharing that other organizations could replicate. 

There is room for improvement in the VA system, yet Erin Kobetz, PhD, MPH, director and principal investigator for the Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative, pointed out that “there’s nothing like that for firefighters.” Research, policy, and care are all siloed between states and institutions.

Joanna Doran, JD, CEO of Triage Cancer, agreed and took this point further. Firehouses are also distinct from one another in their procedures, which affects the conditions to which first responders are exposed. For example, the personal protective equipment worn by firefighters, often called “turnout gear,” may be cleaned after 2 uses at 1 firehouse or after several months of use at another firehouse. This procedural inconsistency leads to variations in the levels of exposure to toxic chemicals, such as per- and polyfluoroalkyl substances, that cling to equipment. 

Dr. Kobetz hopes that the Make America Healthy Again movement and its focus on environmental exposures will translate to funding opportunities for more research and standardized guidelines in this area. However, with structural and funding changes at the National Institutes of Health, it remains uncertain whether there is a defined place for the research niche of occupational exposures. 

Panelists agreed that researching the risks of exposure for firefighters is vital, with broad applications beyond this occupation. “Firefighters are the canary in the mine,” Kobetz said. Everything they are exposed to on the job is also encountered by the general population, but in smaller amounts. There is an opportunity to learn about the risks of environmental exposures by focusing on this population, which will not only benefit first responders but their loved ones as well. 

Forums such as this patient advocacy summit are essential—not only for the information and resources shared, but also for elevating a population that is particularly vulnerable to certain types of cancers. This event serves as a reminder to honor those who have made the ultimate sacrifice in the service of others through advancing vital research, advocating intentionally, and reimagining how we deliver care.