Personalizing Cancer Care for Veterans

So, when he noticed a swollen lymph node that didn’t go away for several months in 2022, the 51-year-old teacher from Kilgore, Texas didn't panic. He just got it checked out.

The diagnosis hit like a grenade.

Lopez had oropharyngeal cancer, a cancer of the back of the throat. He was angry. He was scared. And when VA doctors began laying out what treatment would look like, his first instinct was to say no.

"The side effects sounded awful," he said. Before a single radiation beam was aimed at his throat, doctors pulled all of his molars and removed his tonsils. Then came surgery, followed by radiation several days a week for months at the Michael E. DeBakey VA Medical Center in Houston. 

The treatment reshaped his world. Dizziness became a constant companion. Eating, something most people take for granted, turned into a battle. So much of human connection happens over a shared meal, and suddenly that was gone. "You don’t think about it, but I found that a lot of socializing happens around food," Lopez said. His relationships were affected and his career as a teacher had to be paused. He was off work for over a year.

There was also what he called "chemo brain", a fog that made concentration difficult and left him feeling unlike himself. Even now, years later, he carries side effects from his treatment. He has made peace with the fact that he will never be exactly who he was before.

"I've had to accept that," he said. "But I'm here. And I'm cancer free.”

A Disease the Data Didn't Capture — Until Now

Lopez's journey is not unique in the Veteran community. It is, in fact, alarmingly common.  For years, researchers have been building the data needed to truly understand and refine treatment for Veterans with head and neck cancer.

This culminated with a recent landmark multi-year study coordinated across nine VA hospitals, involving data from nearly 900 patients collected over two decades. Instrumental in that work is Dr. Vlad Sandulache, MD, Chief of Otolaryngology, Head and Neck Surgery at the Michael E. DeBakey VA Medical Center in Houston.

“The ultimate goal here is precision oncology: matching treatment intensity to disease aggressiveness for each individual Veteran,” Sandulache said. “To do that responsibly, you need data from the actual population you're treating. This study builds that foundation."

According to Sandulache, oropharyngeal cancer is a growing threat in the Veteran population. Veterans face higher rates of tobacco and alcohol use, service-related exposures, and critically, very low HPV vaccination rates. HPV is now the primary driver of oropharyngeal cancer, and without broader vaccination efforts, he warns the problem will only grow.

"This is a growing problem, not a shrinking one," Sandulache said.

Good News and Hard Truths

The study's findings, published in the most recent issue of Oral Oncology, paint an interesting picture. On one hand, the results were encouraging: cancer control, which involves preventing the disease from returning in the throat and neck and stopping it from spreading to other organs, was excellent at the nine VA hospitals, and comparable to the most up-to-date international clinical trials on this disease.

But overall survival rates were lower than what other studies report. The reason, however, tells its own story about the Veteran population.

"Many Veterans die from things unrelated to their throat cancer, like heart disease, lung disease, second cancers," Sandulache explained. "The cancer treatment works, but these patients carry significant other health burdens."

The findings are clear: curing the cancer is only part of the battle. For Veterans, winning the long game requires an integrated approach to their overall health before, during, and long after cancer treatment ends.

"We need to focus on development of integrated treatment teams that can support patients not only during cancer treatment but beyond that, and manage their health in a comprehensive, high-quality manner," Sandulache said.

The Power of the Health Care Team

For Lopez, the Houston VA's integrated care model was more than a convenience…it was a lifeline. His care team included head and neck surgeons, radiation oncologists, medical oncologists, nutritionists, and speech therapists, all coordinating under one roof and working toward a single goal: getting him through treatment and back to his life.

Sandulache says that this team model is not just preferable.  It's clinically superior.

"VA institutions that provide this integrated, co-located care are delivering something genuinely valuable," he said. "Fragmenting that care throughout different systems and specialists in the community creates gaps that can compromise outcomes."

Lopez experienced this firsthand. Even as he drove 400 miles round-trip for every appointment, he never doubted that the Houston VA was where he needed to be.

During his treatment, Lopez, ever the researcher and educator, dove deep into the literature on his condition. He read studies, asked hard questions, and said he sometimes wondered whether parts of his treatment were necessary. But ultimately, he made a decision to put his faith in his VA doctors.

"I decided to trust the docs at the Houston VA," he said. "I learned a lot, but ultimately I trusted them. And it paid off."

The Future: AI and Precision Oncology

The research doesn't end with clinical outcomes. The nine-hospital study also preserved tissue samples and CT scans from all participating institutions to create a biobank that will fuel the next frontier of treatment: artificial intelligence.

“Hypothetically, AI can find patterns in those images and tissue samples that predict how a tumor will behave. The human eye can't reliably detect these kinds of patterns," Dr. Sandulache explained. "The goal is that before treatment starts, we can look at a Veteran's scan or biopsy and make a much more informed decision: this patient needs aggressive treatment, or this patient can be treated more gently. That's precision oncology in action… the right treatment intensity for the right disease biology, for each individual Veteran."

When Lopez heard about the study and its future directions, his reaction was immediate and deeply personal. As a Veteran who had lived through treatment, often wondering whether it was all necessary, the idea of personalization resonated with everything he'd experienced.

"Every patient is different," he said. "You have to treat the individual. If this research helps the next Veteran get exactly the treatment they need, not more, not less, then it's worth everything."

Sandulache shares that conviction and credits the Veterans themselves for making the research possible.

"Nearly 900 people trusted VA hospitals with their care, and their data will help the next generation of Veterans receive smarter, more personalized treatment," he said. "That's a legacy worth recognizing."

Back in the Classroom

Today, Carlos Lopez is back to doing what he loves…teaching. He returned to his classroom slowly, carefully, as his body allowed. Some days are still harder than others. The side effects haven't entirely disappeared, and he's made peace with the idea that they may never fully go away.

But he is cancer free. And he is grateful.

His message to fellow Veterans is clear.

"Pay close attention to your body," he said. "Research your treatment every step of the way. Ask questions. Advocate for yourself. And if you have the VA as an option, consider using it. I found the care at the Houston VA to be so great, that I chose to travel more than three hours one way for my appointments.”

Dr. Sandulache offers three things he'd want any Veteran newly diagnosed with throat cancer to know: seek out a VA hospital with a full, co-located team of specialists; understand that quitting tobacco may do more for long-term survival than any single treatment; and know that the research being done at the VA, built on the trust of nearly 900 Veterans, is working toward smarter, even more personalized care in the future.