Article

Background

Gastric neuroendocrine tumors (GNETs) are slow-growing tumors derived from enterochromaffinlike cells whose prognosis depends on the type. Prior GNET studies have shown an increasing incidence but survival analyses have been more limited. This study aims to investigate if the increasing incidence trend continues and better describe factors associated with survival for GNET patients.

Methods

Patients diagnosed with GNET between 2000-2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Additional variables collected were age, sex, race, stage, presence of metastases, tumor size, treatment status for surgery, radiation, and chemotherapy, median household income, and population size. Descriptive statistics, population-based incidence, log-rank tests with Kaplan-Meier curves, and Cox regression analyses were performed.

Results

A total of 6512 patients were included. The one-, three-, and five-year survival rates were 90.4%, 85.0%, and 83.8%, respectively. The population-adjusted incidence ranged from 0.272/100000 in 2000 to 0.680/100000 in 2018. The total percent change in incidence over the study range was 104.1% with an annual percent change of 4.27%, which met significance <2.0cm and >5.0cm were associated with shorter survival (p’s< 0.05). Additionally, females, Hispanic patients, and recipients of surgery were associated with longer survival (p’s< 0.05).

Conclusions

The findings show GNET incidence has continued to increase over the past two decades. Additionally, clinical factors including stage, extent of metastasis, tumor size and socioeconomic factors like age, gender, and race were associated with changes in GNET survival. In the context of increasing incidence of GNET these findings describe factors associated with lower- and higher-risk tumors. Further assessment of these risk factors can benefit future research to better understand why GNET incidence is increasing, aid in risk stratification of GNET patients, and improve the prognosis of GNET.

Background

Gastric neuroendocrine tumors (GNETs) are slow-growing tumors derived from enterochromaffinlike cells whose prognosis depends on the type. Prior GNET studies have shown an increasing incidence but survival analyses have been more limited. This study aims to investigate if the increasing incidence trend continues and better describe factors associated with survival for GNET patients.

Methods

Patients diagnosed with GNET between 2000-2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Additional variables collected were age, sex, race, stage, presence of metastases, tumor size, treatment status for surgery, radiation, and chemotherapy, median household income, and population size. Descriptive statistics, population-based incidence, log-rank tests with Kaplan-Meier curves, and Cox regression analyses were performed.

Results

A total of 6512 patients were included. The one-, three-, and five-year survival rates were 90.4%, 85.0%, and 83.8%, respectively. The population-adjusted incidence ranged from 0.272/100000 in 2000 to 0.680/100000 in 2018. The total percent change in incidence over the study range was 104.1% with an annual percent change of 4.27%, which met significance <2.0cm and >5.0cm were associated with shorter survival (p’s< 0.05). Additionally, females, Hispanic patients, and recipients of surgery were associated with longer survival (p’s< 0.05).

Conclusions

The findings show GNET incidence has continued to increase over the past two decades. Additionally, clinical factors including stage, extent of metastasis, tumor size and socioeconomic factors like age, gender, and race were associated with changes in GNET survival. In the context of increasing incidence of GNET these findings describe factors associated with lower- and higher-risk tumors. Further assessment of these risk factors can benefit future research to better understand why GNET incidence is increasing, aid in risk stratification of GNET patients, and improve the prognosis of GNET.

Background

Gastric neuroendocrine tumors (GNETs) are slow-growing tumors derived from enterochromaffinlike cells whose prognosis depends on the type. Prior GNET studies have shown an increasing incidence but survival analyses have been more limited. This study aims to investigate if the increasing incidence trend continues and better describe factors associated with survival for GNET patients.

Methods

Patients diagnosed with GNET between 2000-2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Additional variables collected were age, sex, race, stage, presence of metastases, tumor size, treatment status for surgery, radiation, and chemotherapy, median household income, and population size. Descriptive statistics, population-based incidence, log-rank tests with Kaplan-Meier curves, and Cox regression analyses were performed.

Results

A total of 6512 patients were included. The one-, three-, and five-year survival rates were 90.4%, 85.0%, and 83.8%, respectively. The population-adjusted incidence ranged from 0.272/100000 in 2000 to 0.680/100000 in 2018. The total percent change in incidence over the study range was 104.1% with an annual percent change of 4.27%, which met significance <2.0cm and >5.0cm were associated with shorter survival (p’s< 0.05). Additionally, females, Hispanic patients, and recipients of surgery were associated with longer survival (p’s< 0.05).

Conclusions

The findings show GNET incidence has continued to increase over the past two decades. Additionally, clinical factors including stage, extent of metastasis, tumor size and socioeconomic factors like age, gender, and race were associated with changes in GNET survival. In the context of increasing incidence of GNET these findings describe factors associated with lower- and higher-risk tumors. Further assessment of these risk factors can benefit future research to better understand why GNET incidence is increasing, aid in risk stratification of GNET patients, and improve the prognosis of GNET.

Background

Melanoma is one of the leading causes of solid tumor cancers. This study’s objective is to analyze temporal trends in melanoma-related mortality among age groups in the US before and during COVID-19. To date, no previous studies have analyzed year-to-year trends in melanoma mortality by age group using the CDC Wonder database. A 2011 analysis previously showed increasing death rates only among those over age 65 between 1992-2006.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Crude mortality rates per 100,000 and annual percentage change using Joinpoint regression were used to analyze yearly trends among age groups.

Results

From 1999 to 2022, overall mortality rate fell from 2.91 to 2.07, and mortality rates among all age groups decreased with the exception of those over age 85. Age 35-44 crude mortality rate decreased from 1.42 to .7. Age 45-54 crude mortality rate decreased from 3.2 to 1.51. Age 55-64 decreased from 5.6 to 3.61. Age 65-74 decreased from 9.91 to 7.79. Age 75-84 decreased from 15.44 to 15.43. Ages 85+ increased from 21.5 to 33.1. Notably, mortality among those age 75-85 decreased by only .01, and were increased across the timespan of 2000-2020.

Conclusions

These results show that there may be differences between age groups in how mortality due to melanoma of age groups has changed from 1992-2022. While overall mortality attributed to melanoma fell during this period, mortality in those over age 85 increased. Future studies should confirm these results with different data sets and further investigate the reasons for these disparities.

Background

Melanoma is one of the leading causes of solid tumor cancers. This study’s objective is to analyze temporal trends in melanoma-related mortality among age groups in the US before and during COVID-19. To date, no previous studies have analyzed year-to-year trends in melanoma mortality by age group using the CDC Wonder database. A 2011 analysis previously showed increasing death rates only among those over age 65 between 1992-2006.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Crude mortality rates per 100,000 and annual percentage change using Joinpoint regression were used to analyze yearly trends among age groups.

Results

From 1999 to 2022, overall mortality rate fell from 2.91 to 2.07, and mortality rates among all age groups decreased with the exception of those over age 85. Age 35-44 crude mortality rate decreased from 1.42 to .7. Age 45-54 crude mortality rate decreased from 3.2 to 1.51. Age 55-64 decreased from 5.6 to 3.61. Age 65-74 decreased from 9.91 to 7.79. Age 75-84 decreased from 15.44 to 15.43. Ages 85+ increased from 21.5 to 33.1. Notably, mortality among those age 75-85 decreased by only .01, and were increased across the timespan of 2000-2020.

Conclusions

These results show that there may be differences between age groups in how mortality due to melanoma of age groups has changed from 1992-2022. While overall mortality attributed to melanoma fell during this period, mortality in those over age 85 increased. Future studies should confirm these results with different data sets and further investigate the reasons for these disparities.

Background

Melanoma is one of the leading causes of solid tumor cancers. This study’s objective is to analyze temporal trends in melanoma-related mortality among age groups in the US before and during COVID-19. To date, no previous studies have analyzed year-to-year trends in melanoma mortality by age group using the CDC Wonder database. A 2011 analysis previously showed increasing death rates only among those over age 65 between 1992-2006.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Crude mortality rates per 100,000 and annual percentage change using Joinpoint regression were used to analyze yearly trends among age groups.

Results

From 1999 to 2022, overall mortality rate fell from 2.91 to 2.07, and mortality rates among all age groups decreased with the exception of those over age 85. Age 35-44 crude mortality rate decreased from 1.42 to .7. Age 45-54 crude mortality rate decreased from 3.2 to 1.51. Age 55-64 decreased from 5.6 to 3.61. Age 65-74 decreased from 9.91 to 7.79. Age 75-84 decreased from 15.44 to 15.43. Ages 85+ increased from 21.5 to 33.1. Notably, mortality among those age 75-85 decreased by only .01, and were increased across the timespan of 2000-2020.

Conclusions

These results show that there may be differences between age groups in how mortality due to melanoma of age groups has changed from 1992-2022. While overall mortality attributed to melanoma fell during this period, mortality in those over age 85 increased. Future studies should confirm these results with different data sets and further investigate the reasons for these disparities.

Background

Melanoma is the fifth leading cause of cancer in the United States. This study’s objective is to analyze geographical trends in melanoma-related mortality in the US before and during COVID-19. To date, no previous studies have analyzed geographical trends in melanoma mortality using the CDC Wonder data base. Previous literature reports Utah, Vermont, Delaware, Minnesota and New Hampshire as having the highest UV-attributable incidence rates of melanoma.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Age-adjusted mortality rates (AAMR) per 100,000 and annual percentage change (APC) using Joinpoint regression were used to analyze state and regional trends.

Results

From 1999 to 2019, the states with the largest increase in AAMR were Idaho (0.91) and Colorado (0.63) while Oklahoma (-1.07), Nevada (-0.94), and Texas (-0.92) saw the largest decreases. During COVID-19 (2019 to 2021), the states with the largest increase in AAMR were South Dakota (1.42), Oregon (1.09), and Montana (1.08) while Vermont (-1.02), Minnesota (-0.45), and Connecticut (-0.38) had the largest declines. From 2006-2022, except 2020, the Northeast consistently had the lowest AAMR. From 2008-2012 the West consistently had the highest AAMR. From 2013-2022, except 2015, the Midwest had the highest AAMR. From 2009 onwards, all 4 regions have seen an overall decline in AAMR with their lowest values being in 2022.

Conclusions

Idaho had the highest AAMR before COVID-19 while Oklahoma had the lowest. During COVID-19, South Dakota saw the highest AAMR while Vermont had the lowest. AAMRs have been trending downwards across all 4 regions since 2009 and the Northeast has fared the best over that period. These results should be used to increase implementation and enforcement of preventative measures to reduce UV exposure, especially in states with higher AAMRs. Further research should examine statewide sun protection programs to search for any relationship with their AAMRs.

Background

Melanoma is the fifth leading cause of cancer in the United States. This study’s objective is to analyze geographical trends in melanoma-related mortality in the US before and during COVID-19. To date, no previous studies have analyzed geographical trends in melanoma mortality using the CDC Wonder data base. Previous literature reports Utah, Vermont, Delaware, Minnesota and New Hampshire as having the highest UV-attributable incidence rates of melanoma.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Age-adjusted mortality rates (AAMR) per 100,000 and annual percentage change (APC) using Joinpoint regression were used to analyze state and regional trends.

Results

From 1999 to 2019, the states with the largest increase in AAMR were Idaho (0.91) and Colorado (0.63) while Oklahoma (-1.07), Nevada (-0.94), and Texas (-0.92) saw the largest decreases. During COVID-19 (2019 to 2021), the states with the largest increase in AAMR were South Dakota (1.42), Oregon (1.09), and Montana (1.08) while Vermont (-1.02), Minnesota (-0.45), and Connecticut (-0.38) had the largest declines. From 2006-2022, except 2020, the Northeast consistently had the lowest AAMR. From 2008-2012 the West consistently had the highest AAMR. From 2013-2022, except 2015, the Midwest had the highest AAMR. From 2009 onwards, all 4 regions have seen an overall decline in AAMR with their lowest values being in 2022.

Conclusions

Idaho had the highest AAMR before COVID-19 while Oklahoma had the lowest. During COVID-19, South Dakota saw the highest AAMR while Vermont had the lowest. AAMRs have been trending downwards across all 4 regions since 2009 and the Northeast has fared the best over that period. These results should be used to increase implementation and enforcement of preventative measures to reduce UV exposure, especially in states with higher AAMRs. Further research should examine statewide sun protection programs to search for any relationship with their AAMRs.

Background

Melanoma is the fifth leading cause of cancer in the United States. This study’s objective is to analyze geographical trends in melanoma-related mortality in the US before and during COVID-19. To date, no previous studies have analyzed geographical trends in melanoma mortality using the CDC Wonder data base. Previous literature reports Utah, Vermont, Delaware, Minnesota and New Hampshire as having the highest UV-attributable incidence rates of melanoma.

Methods

The CDC Wonder database was used to collect data on melanoma-related mortality rates in the US from 1999-2022. Age-adjusted mortality rates (AAMR) per 100,000 and annual percentage change (APC) using Joinpoint regression were used to analyze state and regional trends.

Results

From 1999 to 2019, the states with the largest increase in AAMR were Idaho (0.91) and Colorado (0.63) while Oklahoma (-1.07), Nevada (-0.94), and Texas (-0.92) saw the largest decreases. During COVID-19 (2019 to 2021), the states with the largest increase in AAMR were South Dakota (1.42), Oregon (1.09), and Montana (1.08) while Vermont (-1.02), Minnesota (-0.45), and Connecticut (-0.38) had the largest declines. From 2006-2022, except 2020, the Northeast consistently had the lowest AAMR. From 2008-2012 the West consistently had the highest AAMR. From 2013-2022, except 2015, the Midwest had the highest AAMR. From 2009 onwards, all 4 regions have seen an overall decline in AAMR with their lowest values being in 2022.

Conclusions

Idaho had the highest AAMR before COVID-19 while Oklahoma had the lowest. During COVID-19, South Dakota saw the highest AAMR while Vermont had the lowest. AAMRs have been trending downwards across all 4 regions since 2009 and the Northeast has fared the best over that period. These results should be used to increase implementation and enforcement of preventative measures to reduce UV exposure, especially in states with higher AAMRs. Further research should examine statewide sun protection programs to search for any relationship with their AAMRs.

Background

The Veterans Affairs Central Cancer Registry (VACCR) is an information system, which collects and organizes data on Veterans with cancer for use in cancer surveillance activities, such as epidemiologic based efforts to reduce the overall cancer burden. Unfortunately, there was no structured standardized data acquisition method in place to ensure accurate or timely data entry of Lexington VA Healthcare System (LVAHCS) statistics. This quality improvement study evaluated the implementation of a Structured Query Language (SQL) code to identify specific documents in the Computerized Patient Records System (CPRS) electronic medical record with associated ICD-10 codes matching the reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) program.

Methods

Outcomes Studied: Accuracy of the SQL code, rates of data entry into the VACCR pre- and postintervention. Cancer Program leadership collaborated with the VISN 9 Program Analyst to write a SQL code identifying the Veteran’s name; social security number; location by city, state, and county; and visit associated data such as visit location, ICD-10 code documented by the provider, and visit year. This code can be run manually or at a pre-determined cadence.

Results

A total of 3,099 incidences of cancer were entered into the VACCR by local Oncology Data Specialists (ODSs) for calendar years 2015 to 2022. This is approximately 238 cases yearly. After the intervention, 1692 patients were entered into the VACCR in 2023. This is an increased rate of data entry of 611%.

Conclusions

This study demonstrated the feasibility of implementing a SQL code to accurately identify Veterans with diagnoses matching the SEER list. Increasing accuracy of identification has led to increased data entry efficiency into the VACCR by local ODS staff. After proving the feasibility of this intervention, we are partnering with the VISN 9 Program Analyst to create a static, daily recurring report provided to the ODS staff. Future application of this intervention could also include expansion into other VHA sites, increasing their accuracy and timeliness of data entry. Overall, improving the timeliness and accuracy of the VACCR would subsequently improve the ability of the VHA to target interventions aimed at reducing the overall cancer burden.

Background

The Veterans Affairs Central Cancer Registry (VACCR) is an information system, which collects and organizes data on Veterans with cancer for use in cancer surveillance activities, such as epidemiologic based efforts to reduce the overall cancer burden. Unfortunately, there was no structured standardized data acquisition method in place to ensure accurate or timely data entry of Lexington VA Healthcare System (LVAHCS) statistics. This quality improvement study evaluated the implementation of a Structured Query Language (SQL) code to identify specific documents in the Computerized Patient Records System (CPRS) electronic medical record with associated ICD-10 codes matching the reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) program.

Methods

Outcomes Studied: Accuracy of the SQL code, rates of data entry into the VACCR pre- and postintervention. Cancer Program leadership collaborated with the VISN 9 Program Analyst to write a SQL code identifying the Veteran’s name; social security number; location by city, state, and county; and visit associated data such as visit location, ICD-10 code documented by the provider, and visit year. This code can be run manually or at a pre-determined cadence.

Results

A total of 3,099 incidences of cancer were entered into the VACCR by local Oncology Data Specialists (ODSs) for calendar years 2015 to 2022. This is approximately 238 cases yearly. After the intervention, 1692 patients were entered into the VACCR in 2023. This is an increased rate of data entry of 611%.

Conclusions

This study demonstrated the feasibility of implementing a SQL code to accurately identify Veterans with diagnoses matching the SEER list. Increasing accuracy of identification has led to increased data entry efficiency into the VACCR by local ODS staff. After proving the feasibility of this intervention, we are partnering with the VISN 9 Program Analyst to create a static, daily recurring report provided to the ODS staff. Future application of this intervention could also include expansion into other VHA sites, increasing their accuracy and timeliness of data entry. Overall, improving the timeliness and accuracy of the VACCR would subsequently improve the ability of the VHA to target interventions aimed at reducing the overall cancer burden.

Background

The Veterans Affairs Central Cancer Registry (VACCR) is an information system, which collects and organizes data on Veterans with cancer for use in cancer surveillance activities, such as epidemiologic based efforts to reduce the overall cancer burden. Unfortunately, there was no structured standardized data acquisition method in place to ensure accurate or timely data entry of Lexington VA Healthcare System (LVAHCS) statistics. This quality improvement study evaluated the implementation of a Structured Query Language (SQL) code to identify specific documents in the Computerized Patient Records System (CPRS) electronic medical record with associated ICD-10 codes matching the reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) program.

Methods

Outcomes Studied: Accuracy of the SQL code, rates of data entry into the VACCR pre- and postintervention. Cancer Program leadership collaborated with the VISN 9 Program Analyst to write a SQL code identifying the Veteran’s name; social security number; location by city, state, and county; and visit associated data such as visit location, ICD-10 code documented by the provider, and visit year. This code can be run manually or at a pre-determined cadence.

Results

A total of 3,099 incidences of cancer were entered into the VACCR by local Oncology Data Specialists (ODSs) for calendar years 2015 to 2022. This is approximately 238 cases yearly. After the intervention, 1692 patients were entered into the VACCR in 2023. This is an increased rate of data entry of 611%.

Conclusions

This study demonstrated the feasibility of implementing a SQL code to accurately identify Veterans with diagnoses matching the SEER list. Increasing accuracy of identification has led to increased data entry efficiency into the VACCR by local ODS staff. After proving the feasibility of this intervention, we are partnering with the VISN 9 Program Analyst to create a static, daily recurring report provided to the ODS staff. Future application of this intervention could also include expansion into other VHA sites, increasing their accuracy and timeliness of data entry. Overall, improving the timeliness and accuracy of the VACCR would subsequently improve the ability of the VHA to target interventions aimed at reducing the overall cancer burden.

Background

The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.

Methods

We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.

Results

From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.

Conclusions

We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.

Background

The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.

Methods

We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.

Results

From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.

Conclusions

We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.

Background

The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.

Methods

We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.

Results

From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.

Conclusions

We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.

Background

The adoption of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer has allowed treatment to be completed in less than 2 weeks, but has predominantly been given to the prostate only. Currently, very few prospective studies have compared delivery of SBRT versus hypofractionated radiotherapy (HFX) when giving concurrent pelvic radiation. The aim of the study is to evaluate the tolerance and efficacy of pelvic node radiotherapy and SIB to the prostate in prostate patients requiring nodal irradiation.

Methods

A total of 58 patients were irradiated with SBRT and initiated ADT therapy between 2014 and 2023. 57 patients were treated with 7.5 Gy to the prostate and 1 to 7.25 Gy. All patients were treated with 5 Gy x 5 fraction to the pelvis. This group was compared to a preselected historical cohort of 65 HFX patients with 57 of these patients treated with 67.5/50 Gy in 25 fractions, 1 with patient 67.5/45 Gy in 25 fractions, and 6 patients with 60/44-46 Gy in 20 fractions. Patients were evaluated for GU and GI toxicities according to Radiation Therapy Oncology Group Toxicity criteria at one year post radiation therapy.

Results

There were 31 grade 0 (53.4%), 1 grade 1 (1.7%), 25 grade 2 (43.1%), 1 grade 3 (1.7%) events in the SBRT group and 29 GU grade 0 (44.6%), 3 grade 1 (4.6%), and 33 grade 2 (50.8%) GU toxicities in the HFX group with no significant difference between the groups (p=0.464). There were 55 grade 0 (94.8%), 1 grade 1 (1.7%), and 2 grade 2 (3.4%) GI toxicities in the SBRT group and 59 grade 0 (90.8%), 1 grade 1 (1.5%), and 5 grade 2 (7.7%) events in the HFX group with no significant difference between the groups (p=0.381).

Conclusions

This prospective study provides data to support the use of concurrent pelvic radiation with SBRT to the prostate. Our findings suggest there is no difference in toxicity between HFX and 25 Gy pelvic radiation (5 Gy/5 fractions) concurrent with SBRT to the prostate, therefore it appears to be a safe and convenient option for veterans with prostate cancer.

Background

The adoption of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer has allowed treatment to be completed in less than 2 weeks, but has predominantly been given to the prostate only. Currently, very few prospective studies have compared delivery of SBRT versus hypofractionated radiotherapy (HFX) when giving concurrent pelvic radiation. The aim of the study is to evaluate the tolerance and efficacy of pelvic node radiotherapy and SIB to the prostate in prostate patients requiring nodal irradiation.

Methods

A total of 58 patients were irradiated with SBRT and initiated ADT therapy between 2014 and 2023. 57 patients were treated with 7.5 Gy to the prostate and 1 to 7.25 Gy. All patients were treated with 5 Gy x 5 fraction to the pelvis. This group was compared to a preselected historical cohort of 65 HFX patients with 57 of these patients treated with 67.5/50 Gy in 25 fractions, 1 with patient 67.5/45 Gy in 25 fractions, and 6 patients with 60/44-46 Gy in 20 fractions. Patients were evaluated for GU and GI toxicities according to Radiation Therapy Oncology Group Toxicity criteria at one year post radiation therapy.

Results

There were 31 grade 0 (53.4%), 1 grade 1 (1.7%), 25 grade 2 (43.1%), 1 grade 3 (1.7%) events in the SBRT group and 29 GU grade 0 (44.6%), 3 grade 1 (4.6%), and 33 grade 2 (50.8%) GU toxicities in the HFX group with no significant difference between the groups (p=0.464). There were 55 grade 0 (94.8%), 1 grade 1 (1.7%), and 2 grade 2 (3.4%) GI toxicities in the SBRT group and 59 grade 0 (90.8%), 1 grade 1 (1.5%), and 5 grade 2 (7.7%) events in the HFX group with no significant difference between the groups (p=0.381).

Conclusions

This prospective study provides data to support the use of concurrent pelvic radiation with SBRT to the prostate. Our findings suggest there is no difference in toxicity between HFX and 25 Gy pelvic radiation (5 Gy/5 fractions) concurrent with SBRT to the prostate, therefore it appears to be a safe and convenient option for veterans with prostate cancer.

Background

The adoption of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer has allowed treatment to be completed in less than 2 weeks, but has predominantly been given to the prostate only. Currently, very few prospective studies have compared delivery of SBRT versus hypofractionated radiotherapy (HFX) when giving concurrent pelvic radiation. The aim of the study is to evaluate the tolerance and efficacy of pelvic node radiotherapy and SIB to the prostate in prostate patients requiring nodal irradiation.

Methods

A total of 58 patients were irradiated with SBRT and initiated ADT therapy between 2014 and 2023. 57 patients were treated with 7.5 Gy to the prostate and 1 to 7.25 Gy. All patients were treated with 5 Gy x 5 fraction to the pelvis. This group was compared to a preselected historical cohort of 65 HFX patients with 57 of these patients treated with 67.5/50 Gy in 25 fractions, 1 with patient 67.5/45 Gy in 25 fractions, and 6 patients with 60/44-46 Gy in 20 fractions. Patients were evaluated for GU and GI toxicities according to Radiation Therapy Oncology Group Toxicity criteria at one year post radiation therapy.

Results

There were 31 grade 0 (53.4%), 1 grade 1 (1.7%), 25 grade 2 (43.1%), 1 grade 3 (1.7%) events in the SBRT group and 29 GU grade 0 (44.6%), 3 grade 1 (4.6%), and 33 grade 2 (50.8%) GU toxicities in the HFX group with no significant difference between the groups (p=0.464). There were 55 grade 0 (94.8%), 1 grade 1 (1.7%), and 2 grade 2 (3.4%) GI toxicities in the SBRT group and 59 grade 0 (90.8%), 1 grade 1 (1.5%), and 5 grade 2 (7.7%) events in the HFX group with no significant difference between the groups (p=0.381).

Conclusions

This prospective study provides data to support the use of concurrent pelvic radiation with SBRT to the prostate. Our findings suggest there is no difference in toxicity between HFX and 25 Gy pelvic radiation (5 Gy/5 fractions) concurrent with SBRT to the prostate, therefore it appears to be a safe and convenient option for veterans with prostate cancer.

Background

Purpose: to review the number of genetic testing referrals for breast cancer at the Stratton VA Medical Center and identify barriers that hinder testing, aiming to improve risk reduction strategies and therapeutic options for patients. National guidelines recommend genetic testing for breast cancer susceptibility genes in specific patient populations, such as those under 50, those with a high-risk family history, high-risk pathology, male breast cancer, or Ashkenazi Jewish ancestry. Despite efforts to adhere to these guidelines, several barriers persist that limit testing rates among eligible patients.

Methods

The medical oncology team selected breast cancer as the focus for reviewing adherence to germline genetic testing referrals in the Stratton VA Medical Center. With assistance from cancer registrars, a list of genetics referrals for breast cancer from January to December 2023 was compiled. Descriptive analysis was conducted to assess referral rates, evaluation visit completion rates, genetic testing outcomes, and reasons for non-completion of genetic testing.

Results

During the study period, 32 patients were referred for germline genetic testing for breast cancer. Of these, 26 (81%) completed the evaluation visit, and 11 (34%) underwent genetic testing. Of these, 7 patients had noteworthy results, and 2 patients (6%) were found to carry pathogenic variants: BRCA2 and CDH1. Reasons for non-completion included perceived irrelevance without biological children, need for additional time to consider testing, fear of exacerbating self-harm thoughts, and fear of losing service connection. Additionally, 2 patients did not meet the guidelines for testing per genetic counselor.

Conclusions

This project marks the initial step in identifying barriers to germline genetic testing for breast cancer based on an extensive review of patients diagnosed and treated at a single VA site. Despite the removal of the service connection clause from the consent form, some veterans still declined testing due to fear of losing their service connection. The findings emphasize the importance of educating providers on counseling techniques and education of veterans to enhance risk reduction strategies and patient care. Further research is essential to quantify the real-world outcomes and longterm impacts of improving genetic counseling rates on patient management and outcomes.

Background

Purpose: to review the number of genetic testing referrals for breast cancer at the Stratton VA Medical Center and identify barriers that hinder testing, aiming to improve risk reduction strategies and therapeutic options for patients. National guidelines recommend genetic testing for breast cancer susceptibility genes in specific patient populations, such as those under 50, those with a high-risk family history, high-risk pathology, male breast cancer, or Ashkenazi Jewish ancestry. Despite efforts to adhere to these guidelines, several barriers persist that limit testing rates among eligible patients.

Methods

The medical oncology team selected breast cancer as the focus for reviewing adherence to germline genetic testing referrals in the Stratton VA Medical Center. With assistance from cancer registrars, a list of genetics referrals for breast cancer from January to December 2023 was compiled. Descriptive analysis was conducted to assess referral rates, evaluation visit completion rates, genetic testing outcomes, and reasons for non-completion of genetic testing.

Results

During the study period, 32 patients were referred for germline genetic testing for breast cancer. Of these, 26 (81%) completed the evaluation visit, and 11 (34%) underwent genetic testing. Of these, 7 patients had noteworthy results, and 2 patients (6%) were found to carry pathogenic variants: BRCA2 and CDH1. Reasons for non-completion included perceived irrelevance without biological children, need for additional time to consider testing, fear of exacerbating self-harm thoughts, and fear of losing service connection. Additionally, 2 patients did not meet the guidelines for testing per genetic counselor.

Conclusions

This project marks the initial step in identifying barriers to germline genetic testing for breast cancer based on an extensive review of patients diagnosed and treated at a single VA site. Despite the removal of the service connection clause from the consent form, some veterans still declined testing due to fear of losing their service connection. The findings emphasize the importance of educating providers on counseling techniques and education of veterans to enhance risk reduction strategies and patient care. Further research is essential to quantify the real-world outcomes and longterm impacts of improving genetic counseling rates on patient management and outcomes.

Background

Purpose: to review the number of genetic testing referrals for breast cancer at the Stratton VA Medical Center and identify barriers that hinder testing, aiming to improve risk reduction strategies and therapeutic options for patients. National guidelines recommend genetic testing for breast cancer susceptibility genes in specific patient populations, such as those under 50, those with a high-risk family history, high-risk pathology, male breast cancer, or Ashkenazi Jewish ancestry. Despite efforts to adhere to these guidelines, several barriers persist that limit testing rates among eligible patients.

Methods

The medical oncology team selected breast cancer as the focus for reviewing adherence to germline genetic testing referrals in the Stratton VA Medical Center. With assistance from cancer registrars, a list of genetics referrals for breast cancer from January to December 2023 was compiled. Descriptive analysis was conducted to assess referral rates, evaluation visit completion rates, genetic testing outcomes, and reasons for non-completion of genetic testing.

Results

During the study period, 32 patients were referred for germline genetic testing for breast cancer. Of these, 26 (81%) completed the evaluation visit, and 11 (34%) underwent genetic testing. Of these, 7 patients had noteworthy results, and 2 patients (6%) were found to carry pathogenic variants: BRCA2 and CDH1. Reasons for non-completion included perceived irrelevance without biological children, need for additional time to consider testing, fear of exacerbating self-harm thoughts, and fear of losing service connection. Additionally, 2 patients did not meet the guidelines for testing per genetic counselor.

Conclusions

This project marks the initial step in identifying barriers to germline genetic testing for breast cancer based on an extensive review of patients diagnosed and treated at a single VA site. Despite the removal of the service connection clause from the consent form, some veterans still declined testing due to fear of losing their service connection. The findings emphasize the importance of educating providers on counseling techniques and education of veterans to enhance risk reduction strategies and patient care. Further research is essential to quantify the real-world outcomes and longterm impacts of improving genetic counseling rates on patient management and outcomes.

Background

Prostate cancer is the most common cancer in the VHA. Telehealth use has increased and has the potential to improve access for patients. We examined patterns of care for VHA patients with prostate cancer, including whether visits were in person, by telephone or by video.

Methods

Using the VHA Corporate Data Warehouse, we extracted data on all incident cases of prostate cancer from 1/1/2016-1/31/2023 with sufficient information (Gleason score, prostate-specific antigen [PSA], and tumor stage) to categorize into National Comprehensive Cancer Network (NCCN) risk strata. We excluded patients who died within 1 year of diagnosis and those with no evidence of PSA testing, prostate biopsy or treatment within 2 years. We categorized all outpatient visits related to a person’s Urology- and Medical Oncology based care – including the visit modality – based on administrative visit stop codes. We defined ‘during COVID’ as visits after 3/11/2020. We calculated the percent of visits performed by modality in each year after diagnosis.

Results

Among the 60,381 men with prostate cancer, 61% were White, 33% Black; 5% Hispanic; 32% rural. For NCCN category, 30% had high risk prostate cancer, which increased with age, 50% had intermediate risk and 20% had low risk. Prior to COVID, for visits to Urology within the first year after diagnosis, 79% were in person, 20% were by telephone and 0.1% were by video. Visits to Oncology within the first year after diagnosis were similar—82% in person, 16% by phone and 0.3% by video.

Discussion

During the COVID period, video visits increased significantly but remained a small proportion, accounting for only 2% of visits for both Urology and Oncology. Video visits increased during the COVID-19 pandemic but remained rare. Across many diseases and conditions, the quality of care for video visits has been at least as good as for in-person care.

Conclusions

There is a missed opportunity to provide care by video within VHA for patients with prostate cancer, particularly given that about 1/3 of patients are from rural areas. Future analyses will examine barriers to video telehealth and the impact of video visits on quality and equity of prostate cancer care.

Background

Prostate cancer is the most common cancer in the VHA. Telehealth use has increased and has the potential to improve access for patients. We examined patterns of care for VHA patients with prostate cancer, including whether visits were in person, by telephone or by video.

Methods

Using the VHA Corporate Data Warehouse, we extracted data on all incident cases of prostate cancer from 1/1/2016-1/31/2023 with sufficient information (Gleason score, prostate-specific antigen [PSA], and tumor stage) to categorize into National Comprehensive Cancer Network (NCCN) risk strata. We excluded patients who died within 1 year of diagnosis and those with no evidence of PSA testing, prostate biopsy or treatment within 2 years. We categorized all outpatient visits related to a person’s Urology- and Medical Oncology based care – including the visit modality – based on administrative visit stop codes. We defined ‘during COVID’ as visits after 3/11/2020. We calculated the percent of visits performed by modality in each year after diagnosis.

Results

Among the 60,381 men with prostate cancer, 61% were White, 33% Black; 5% Hispanic; 32% rural. For NCCN category, 30% had high risk prostate cancer, which increased with age, 50% had intermediate risk and 20% had low risk. Prior to COVID, for visits to Urology within the first year after diagnosis, 79% were in person, 20% were by telephone and 0.1% were by video. Visits to Oncology within the first year after diagnosis were similar—82% in person, 16% by phone and 0.3% by video.

Discussion

During the COVID period, video visits increased significantly but remained a small proportion, accounting for only 2% of visits for both Urology and Oncology. Video visits increased during the COVID-19 pandemic but remained rare. Across many diseases and conditions, the quality of care for video visits has been at least as good as for in-person care.

Conclusions

There is a missed opportunity to provide care by video within VHA for patients with prostate cancer, particularly given that about 1/3 of patients are from rural areas. Future analyses will examine barriers to video telehealth and the impact of video visits on quality and equity of prostate cancer care.

Background

Prostate cancer is the most common cancer in the VHA. Telehealth use has increased and has the potential to improve access for patients. We examined patterns of care for VHA patients with prostate cancer, including whether visits were in person, by telephone or by video.

Methods

Using the VHA Corporate Data Warehouse, we extracted data on all incident cases of prostate cancer from 1/1/2016-1/31/2023 with sufficient information (Gleason score, prostate-specific antigen [PSA], and tumor stage) to categorize into National Comprehensive Cancer Network (NCCN) risk strata. We excluded patients who died within 1 year of diagnosis and those with no evidence of PSA testing, prostate biopsy or treatment within 2 years. We categorized all outpatient visits related to a person’s Urology- and Medical Oncology based care – including the visit modality – based on administrative visit stop codes. We defined ‘during COVID’ as visits after 3/11/2020. We calculated the percent of visits performed by modality in each year after diagnosis.

Results

Among the 60,381 men with prostate cancer, 61% were White, 33% Black; 5% Hispanic; 32% rural. For NCCN category, 30% had high risk prostate cancer, which increased with age, 50% had intermediate risk and 20% had low risk. Prior to COVID, for visits to Urology within the first year after diagnosis, 79% were in person, 20% were by telephone and 0.1% were by video. Visits to Oncology within the first year after diagnosis were similar—82% in person, 16% by phone and 0.3% by video.

Discussion

During the COVID period, video visits increased significantly but remained a small proportion, accounting for only 2% of visits for both Urology and Oncology. Video visits increased during the COVID-19 pandemic but remained rare. Across many diseases and conditions, the quality of care for video visits has been at least as good as for in-person care.

Conclusions

There is a missed opportunity to provide care by video within VHA for patients with prostate cancer, particularly given that about 1/3 of patients are from rural areas. Future analyses will examine barriers to video telehealth and the impact of video visits on quality and equity of prostate cancer care.

Background

Bilateral male breast cancer remains a rare occurrence with limited representation in published literature. Here we present a case of an 82-yearold male with asynchronous bilateral breast cancer.

Case Presentation

Our patient is an 82-year-old male past smoker initially diagnosed with left T1aN0M0 invasive lobular carcinoma in 2010 that was ER, PR positive and HER2 negative. He underwent a left mastectomy with sentinel node biopsy and was given tamoxifen therapy for 10 years. In 2020, the patient was also diagnosed with lung squamous cell carcinoma and was treated with stereotactic body radiotherapy. In September 2023, he started noticing discharge from his right nipple. A PET CT scan revealed hyper-metabolic activity in the bilateral upper lung lobes and slightly increased activity in the right breast. A biopsy of the left upper lobe showed atypical cells. He also underwent a right breast mastectomy and sentinel lymph node biopsy which showed grade 1-2 ductal carcinoma in situ and negative sentinel lymph nodes. The tumor board recommended no further treatment after his mastectomy and genetic testing which is currently pending.

Discussion

Male breast cancer comprises just 1% of breast cancer cases, with asynchronous bilateral occurrences being exceedingly rare. A review of PubMed literature yielded only 2 documented case reports. Male breast cancer usually diagnosed around ages 60 to 70 years. The predominant histopathological diagnosis is invasive ductal adenocarcinoma that more frequently expresses ER/PR over HER2. It often manifests as a painless lump, frequently diagnosed at an advanced stage, possibly due to factors such as lower screening rates in males and less breast parenchyma. Local treatment options include surgery and radiotherapy. Neoadjuvant tamoxifen therapy is appropriate for ER and PR expressing cancers and chemotherapy can be used for non-hormone expressing or metastatic tumors. Given its rarity, management and diagnostic strategies for male breast cancer are often adapted from research on female breast cancer

Conclusions

Our case is of a relatively uncommon incident of asynchronous bilateral male breast cancer, emphasizing the need for expanded research efforts in male breast cancer. An enhanced understanding could lead to improved diagnosis and management strategies, potentially enhancing survival outcomes.

Background

Bilateral male breast cancer remains a rare occurrence with limited representation in published literature. Here we present a case of an 82-yearold male with asynchronous bilateral breast cancer.

Case Presentation

Our patient is an 82-year-old male past smoker initially diagnosed with left T1aN0M0 invasive lobular carcinoma in 2010 that was ER, PR positive and HER2 negative. He underwent a left mastectomy with sentinel node biopsy and was given tamoxifen therapy for 10 years. In 2020, the patient was also diagnosed with lung squamous cell carcinoma and was treated with stereotactic body radiotherapy. In September 2023, he started noticing discharge from his right nipple. A PET CT scan revealed hyper-metabolic activity in the bilateral upper lung lobes and slightly increased activity in the right breast. A biopsy of the left upper lobe showed atypical cells. He also underwent a right breast mastectomy and sentinel lymph node biopsy which showed grade 1-2 ductal carcinoma in situ and negative sentinel lymph nodes. The tumor board recommended no further treatment after his mastectomy and genetic testing which is currently pending.

Discussion

Male breast cancer comprises just 1% of breast cancer cases, with asynchronous bilateral occurrences being exceedingly rare. A review of PubMed literature yielded only 2 documented case reports. Male breast cancer usually diagnosed around ages 60 to 70 years. The predominant histopathological diagnosis is invasive ductal adenocarcinoma that more frequently expresses ER/PR over HER2. It often manifests as a painless lump, frequently diagnosed at an advanced stage, possibly due to factors such as lower screening rates in males and less breast parenchyma. Local treatment options include surgery and radiotherapy. Neoadjuvant tamoxifen therapy is appropriate for ER and PR expressing cancers and chemotherapy can be used for non-hormone expressing or metastatic tumors. Given its rarity, management and diagnostic strategies for male breast cancer are often adapted from research on female breast cancer

Conclusions

Our case is of a relatively uncommon incident of asynchronous bilateral male breast cancer, emphasizing the need for expanded research efforts in male breast cancer. An enhanced understanding could lead to improved diagnosis and management strategies, potentially enhancing survival outcomes.

Background

Bilateral male breast cancer remains a rare occurrence with limited representation in published literature. Here we present a case of an 82-yearold male with asynchronous bilateral breast cancer.

Case Presentation

Our patient is an 82-year-old male past smoker initially diagnosed with left T1aN0M0 invasive lobular carcinoma in 2010 that was ER, PR positive and HER2 negative. He underwent a left mastectomy with sentinel node biopsy and was given tamoxifen therapy for 10 years. In 2020, the patient was also diagnosed with lung squamous cell carcinoma and was treated with stereotactic body radiotherapy. In September 2023, he started noticing discharge from his right nipple. A PET CT scan revealed hyper-metabolic activity in the bilateral upper lung lobes and slightly increased activity in the right breast. A biopsy of the left upper lobe showed atypical cells. He also underwent a right breast mastectomy and sentinel lymph node biopsy which showed grade 1-2 ductal carcinoma in situ and negative sentinel lymph nodes. The tumor board recommended no further treatment after his mastectomy and genetic testing which is currently pending.

Discussion

Male breast cancer comprises just 1% of breast cancer cases, with asynchronous bilateral occurrences being exceedingly rare. A review of PubMed literature yielded only 2 documented case reports. Male breast cancer usually diagnosed around ages 60 to 70 years. The predominant histopathological diagnosis is invasive ductal adenocarcinoma that more frequently expresses ER/PR over HER2. It often manifests as a painless lump, frequently diagnosed at an advanced stage, possibly due to factors such as lower screening rates in males and less breast parenchyma. Local treatment options include surgery and radiotherapy. Neoadjuvant tamoxifen therapy is appropriate for ER and PR expressing cancers and chemotherapy can be used for non-hormone expressing or metastatic tumors. Given its rarity, management and diagnostic strategies for male breast cancer are often adapted from research on female breast cancer

Conclusions

Our case is of a relatively uncommon incident of asynchronous bilateral male breast cancer, emphasizing the need for expanded research efforts in male breast cancer. An enhanced understanding could lead to improved diagnosis and management strategies, potentially enhancing survival outcomes.

Background

Metastatic prostate cancer typically manifests with metastases to the lungs, bones, and adrenal glands. Here, we report a unique case where the initial presentation involved pleural nodules, subsequently leading to the discovery of pleural and pericardial metastases. 

Case Presentation

Our patient, a 73-year-old male with a history of active tobacco use disorder, COPD, and right shoulder melanoma (2004), initially presented to his primary care physician for a routine visit. Following a Low Dose Chest CT scan (LDCT), numerous new pleural nodules were identified. Physical examination revealed small nevi and skin tags, but no malignant characteristics. Initial concerns centered on the potential recurrence of malignant melanoma with pleural metastases or an inflammatory condition. Subsequent PET scan results raised significant suspicion of malignancy. PSA was 2.41. Pleuroscopy biopsies revealed invasive nonsmall cell carcinoma, positive for NKX31 and MOC31, but negative for S100, PSA, and synaptophysin. This pattern strongly suggests metastatic prostate cancer despite the absence of PSA staining. (Stage IV B: cTxcN1cM1c). A subsequent PSMA PET highlighted extensive metastatic involvement in the pericardium, posterior and mediastinal pleura, mediastinum, and ribs. Treatment commenced with Degarelix followed by the standard regimen of Docetaxel, Abiraterone, and prednisone. Genetic counseling and palliative care services were additionally recommended.

Discussion

Prostate cancer typically spreads to bones, lungs, liver, and adrenal glands. Rarely, it appears in sites like pericardium and pleura. Pleural metastases are usually found postmortem; clinical diagnosis is rare. Pericardial metastases are exceptionally uncommon, with few documented cases. The precise mechanism of metastatic dissemination remains uncertain, with theories suggesting spread through the vertebral-venous plexus or via the vena cava to distant organs. Treatment approaches vary based on symptomatic effusions, ranging from pericardiocentesis, thoracocentesis to chemotherapy, radiotherapy, and hormone therapy. Studies have shown systemic docetaxel to be effective in managing pleural and pericardial symptoms. Despite their rarity, healthcare providers should consider these possibilities when encountering pleural thickening or pericardial abnormalities on imaging studies.

Conclusions

Pleural and pericardial metastases represent uncommon occurrences in prostate cancer. Continued research efforts can facilitate early detection of metastatic disease, enabling more effective and precisely targeted management strategies when symptoms manifest.

Background

Metastatic prostate cancer typically manifests with metastases to the lungs, bones, and adrenal glands. Here, we report a unique case where the initial presentation involved pleural nodules, subsequently leading to the discovery of pleural and pericardial metastases. 

Case Presentation

Our patient, a 73-year-old male with a history of active tobacco use disorder, COPD, and right shoulder melanoma (2004), initially presented to his primary care physician for a routine visit. Following a Low Dose Chest CT scan (LDCT), numerous new pleural nodules were identified. Physical examination revealed small nevi and skin tags, but no malignant characteristics. Initial concerns centered on the potential recurrence of malignant melanoma with pleural metastases or an inflammatory condition. Subsequent PET scan results raised significant suspicion of malignancy. PSA was 2.41. Pleuroscopy biopsies revealed invasive nonsmall cell carcinoma, positive for NKX31 and MOC31, but negative for S100, PSA, and synaptophysin. This pattern strongly suggests metastatic prostate cancer despite the absence of PSA staining. (Stage IV B: cTxcN1cM1c). A subsequent PSMA PET highlighted extensive metastatic involvement in the pericardium, posterior and mediastinal pleura, mediastinum, and ribs. Treatment commenced with Degarelix followed by the standard regimen of Docetaxel, Abiraterone, and prednisone. Genetic counseling and palliative care services were additionally recommended.

Discussion

Prostate cancer typically spreads to bones, lungs, liver, and adrenal glands. Rarely, it appears in sites like pericardium and pleura. Pleural metastases are usually found postmortem; clinical diagnosis is rare. Pericardial metastases are exceptionally uncommon, with few documented cases. The precise mechanism of metastatic dissemination remains uncertain, with theories suggesting spread through the vertebral-venous plexus or via the vena cava to distant organs. Treatment approaches vary based on symptomatic effusions, ranging from pericardiocentesis, thoracocentesis to chemotherapy, radiotherapy, and hormone therapy. Studies have shown systemic docetaxel to be effective in managing pleural and pericardial symptoms. Despite their rarity, healthcare providers should consider these possibilities when encountering pleural thickening or pericardial abnormalities on imaging studies.

Conclusions

Pleural and pericardial metastases represent uncommon occurrences in prostate cancer. Continued research efforts can facilitate early detection of metastatic disease, enabling more effective and precisely targeted management strategies when symptoms manifest.

Background

Metastatic prostate cancer typically manifests with metastases to the lungs, bones, and adrenal glands. Here, we report a unique case where the initial presentation involved pleural nodules, subsequently leading to the discovery of pleural and pericardial metastases. 

Case Presentation

Our patient, a 73-year-old male with a history of active tobacco use disorder, COPD, and right shoulder melanoma (2004), initially presented to his primary care physician for a routine visit. Following a Low Dose Chest CT scan (LDCT), numerous new pleural nodules were identified. Physical examination revealed small nevi and skin tags, but no malignant characteristics. Initial concerns centered on the potential recurrence of malignant melanoma with pleural metastases or an inflammatory condition. Subsequent PET scan results raised significant suspicion of malignancy. PSA was 2.41. Pleuroscopy biopsies revealed invasive nonsmall cell carcinoma, positive for NKX31 and MOC31, but negative for S100, PSA, and synaptophysin. This pattern strongly suggests metastatic prostate cancer despite the absence of PSA staining. (Stage IV B: cTxcN1cM1c). A subsequent PSMA PET highlighted extensive metastatic involvement in the pericardium, posterior and mediastinal pleura, mediastinum, and ribs. Treatment commenced with Degarelix followed by the standard regimen of Docetaxel, Abiraterone, and prednisone. Genetic counseling and palliative care services were additionally recommended.

Discussion

Prostate cancer typically spreads to bones, lungs, liver, and adrenal glands. Rarely, it appears in sites like pericardium and pleura. Pleural metastases are usually found postmortem; clinical diagnosis is rare. Pericardial metastases are exceptionally uncommon, with few documented cases. The precise mechanism of metastatic dissemination remains uncertain, with theories suggesting spread through the vertebral-venous plexus or via the vena cava to distant organs. Treatment approaches vary based on symptomatic effusions, ranging from pericardiocentesis, thoracocentesis to chemotherapy, radiotherapy, and hormone therapy. Studies have shown systemic docetaxel to be effective in managing pleural and pericardial symptoms. Despite their rarity, healthcare providers should consider these possibilities when encountering pleural thickening or pericardial abnormalities on imaging studies.

Conclusions

Pleural and pericardial metastases represent uncommon occurrences in prostate cancer. Continued research efforts can facilitate early detection of metastatic disease, enabling more effective and precisely targeted management strategies when symptoms manifest.