Graff JN

Background: Poor adherence to oral anticancer medications (OAMs) is a well-recognized problem in oncology, however adherence to OAMs among veterans is largely unknown. Medication cost is often mitigated, however higher rates of comorbidities within the veteran population may contribute to impaired adherence. Additionally veterans living outside local catchments may be at increased risk for non-adherence or inadequate follow up due to geographic burden.

Cancer rates nationwide are projected to increase over the next 10-20 years. The Veterans Health Administration is the largest integrated health care system in the US, and characterizing OAM adherence and any potential barriers is valuable in improving veterans’ care.

Project Description: The purpose of this study is to investigate and characterize adherence to OAMs and recommend safety monitoring studies among US veterans enrolled at the VAPORHCS, as part of a fellowship quality improvement program initiative. This is a retrospective chart review of all veterans followed within the VAPORHCS hematology/oncology fellows’ clinic, who were taking OAMs from March 1, 2018 to March 1, 2019. Fellows reviewed their own panels, with an internal medicine faculty member performing an independent review on a portion of the charts. Information collected includes adherence to medications as well as recommended monitoring, as determined by provider notes, pharmacy records, and lab and imaging records. Additional information collected includes demographics, co-morbidities, polypharmacy, and service connection.

Results: Primary co-objectives of this project will be determining adherence to both medications and recommended routine monitoring studies (ie labs, imaging, and follow-up appointments). Secondary objectives will be characterizing adherence in relation to other patient factors, such as age, geographic location, primary malignancy, co-morbidities, polypharmacy, and service connection. This project was initiated in fall of 2018. The data has currently been all collected and is undergoing review and analysis. Full results should be available by end of July 2019.

Data Analysis: Initial data processing and univariate analysis is currently ongoing. We currently have plans to pursue multivariate analysis of the results through the Oregon Health and Science University Biostatics Shared Resource (BSR) Department.

Background: Poor adherence to oral anticancer medications (OAMs) is a well-recognized problem in oncology, however adherence to OAMs among veterans is largely unknown. Medication cost is often mitigated, however higher rates of comorbidities within the veteran population may contribute to impaired adherence. Additionally veterans living outside local catchments may be at increased risk for non-adherence or inadequate follow up due to geographic burden.

Cancer rates nationwide are projected to increase over the next 10-20 years. The Veterans Health Administration is the largest integrated health care system in the US, and characterizing OAM adherence and any potential barriers is valuable in improving veterans’ care.

Project Description: The purpose of this study is to investigate and characterize adherence to OAMs and recommend safety monitoring studies among US veterans enrolled at the VAPORHCS, as part of a fellowship quality improvement program initiative. This is a retrospective chart review of all veterans followed within the VAPORHCS hematology/oncology fellows’ clinic, who were taking OAMs from March 1, 2018 to March 1, 2019. Fellows reviewed their own panels, with an internal medicine faculty member performing an independent review on a portion of the charts. Information collected includes adherence to medications as well as recommended monitoring, as determined by provider notes, pharmacy records, and lab and imaging records. Additional information collected includes demographics, co-morbidities, polypharmacy, and service connection.

Results: Primary co-objectives of this project will be determining adherence to both medications and recommended routine monitoring studies (ie labs, imaging, and follow-up appointments). Secondary objectives will be characterizing adherence in relation to other patient factors, such as age, geographic location, primary malignancy, co-morbidities, polypharmacy, and service connection. This project was initiated in fall of 2018. The data has currently been all collected and is undergoing review and analysis. Full results should be available by end of July 2019.

Data Analysis: Initial data processing and univariate analysis is currently ongoing. We currently have plans to pursue multivariate analysis of the results through the Oregon Health and Science University Biostatics Shared Resource (BSR) Department.

Background: Poor adherence to oral anticancer medications (OAMs) is a well-recognized problem in oncology, however adherence to OAMs among veterans is largely unknown. Medication cost is often mitigated, however higher rates of comorbidities within the veteran population may contribute to impaired adherence. Additionally veterans living outside local catchments may be at increased risk for non-adherence or inadequate follow up due to geographic burden.

Cancer rates nationwide are projected to increase over the next 10-20 years. The Veterans Health Administration is the largest integrated health care system in the US, and characterizing OAM adherence and any potential barriers is valuable in improving veterans’ care.

Project Description: The purpose of this study is to investigate and characterize adherence to OAMs and recommend safety monitoring studies among US veterans enrolled at the VAPORHCS, as part of a fellowship quality improvement program initiative. This is a retrospective chart review of all veterans followed within the VAPORHCS hematology/oncology fellows’ clinic, who were taking OAMs from March 1, 2018 to March 1, 2019. Fellows reviewed their own panels, with an internal medicine faculty member performing an independent review on a portion of the charts. Information collected includes adherence to medications as well as recommended monitoring, as determined by provider notes, pharmacy records, and lab and imaging records. Additional information collected includes demographics, co-morbidities, polypharmacy, and service connection.

Results: Primary co-objectives of this project will be determining adherence to both medications and recommended routine monitoring studies (ie labs, imaging, and follow-up appointments). Secondary objectives will be characterizing adherence in relation to other patient factors, such as age, geographic location, primary malignancy, co-morbidities, polypharmacy, and service connection. This project was initiated in fall of 2018. The data has currently been all collected and is undergoing review and analysis. Full results should be available by end of July 2019.

Data Analysis: Initial data processing and univariate analysis is currently ongoing. We currently have plans to pursue multivariate analysis of the results through the Oregon Health and Science University Biostatics Shared Resource (BSR) Department.

Background: Cancer care in academically affiliated settings such as teaching hospitals has been associated with improved clinical outcomes. Historically, Veterans Affairs (VA) medical centers are partnered with academic affiliates; however, there have been few studies examining how this partnership affects clinical care in the Veterans Health Administration (VHA). We therefore examined the variation of first line therapy (1L) in patients with metastatic castrate resistant prostate cancer (mCRPC) in the VHA by degree of academic affiliation.

Methods: Information from the VA Central Cancer Registry was linked to clinical data from the VA Corporate Data Warehouse to identify incident cases of mCRPC, defined as first incidence of radiologic evidence of metastasis and castrate resistance in patients with prostate cancer. Patient demographics, disease characteristics and treatment practices were extracted. The degree of academic affiliation of the treating facility was calculated using the Herfindahl-Hirschman Index (HHI), which reflects how dispersed medical residents are among different specialties and how many specialties are available within a given VA facility.

Results: From 2006 to 2015, 3,637 patients received an mCRPC diagnosis and were treated in 123 VA facilities. Median HHI for treating facilities was 0.374. Of these patients, 1,723 (47%) were treated in a facility with higher academic affiliation (HAA; HHI ≥ 0.374) and 1,914 (53%) were treated in a facility with lower academic affiliation (LAA; HHI ≤ 0.373). There was no difference in patient or disease characteristics by academic affiliation; patients with HAA and LAA had comparable Gleason scores, stage of disease at diagnosis, primary local therapy, age and median PSA levels at time of diagnosis. Patients with mCRPC at HAA facilities were more likely to receive 1L (59% vs 55%, P = .015). Regimens frequently used for 1L were comparable: HAA, docetaxel (29%), abiraterone (22%), and enzalutamide (6%); LAA: docetaxel (25%), abiraterone (21%), and enzalutamide (7%).

Conclusions: Patients with mCRPC had a small but significant increase in likelihood of receiving 1L if treated in HAA vs LAA facilities. Further study will focus on identifying patient, prescriber and facility factors that are associated with the likelihood of initiating 1L and the choice of 1L regimen.

Background: Cancer care in academically affiliated settings such as teaching hospitals has been associated with improved clinical outcomes. Historically, Veterans Affairs (VA) medical centers are partnered with academic affiliates; however, there have been few studies examining how this partnership affects clinical care in the Veterans Health Administration (VHA). We therefore examined the variation of first line therapy (1L) in patients with metastatic castrate resistant prostate cancer (mCRPC) in the VHA by degree of academic affiliation.

Methods: Information from the VA Central Cancer Registry was linked to clinical data from the VA Corporate Data Warehouse to identify incident cases of mCRPC, defined as first incidence of radiologic evidence of metastasis and castrate resistance in patients with prostate cancer. Patient demographics, disease characteristics and treatment practices were extracted. The degree of academic affiliation of the treating facility was calculated using the Herfindahl-Hirschman Index (HHI), which reflects how dispersed medical residents are among different specialties and how many specialties are available within a given VA facility.

Results: From 2006 to 2015, 3,637 patients received an mCRPC diagnosis and were treated in 123 VA facilities. Median HHI for treating facilities was 0.374. Of these patients, 1,723 (47%) were treated in a facility with higher academic affiliation (HAA; HHI ≥ 0.374) and 1,914 (53%) were treated in a facility with lower academic affiliation (LAA; HHI ≤ 0.373). There was no difference in patient or disease characteristics by academic affiliation; patients with HAA and LAA had comparable Gleason scores, stage of disease at diagnosis, primary local therapy, age and median PSA levels at time of diagnosis. Patients with mCRPC at HAA facilities were more likely to receive 1L (59% vs 55%, P = .015). Regimens frequently used for 1L were comparable: HAA, docetaxel (29%), abiraterone (22%), and enzalutamide (6%); LAA: docetaxel (25%), abiraterone (21%), and enzalutamide (7%).

Conclusions: Patients with mCRPC had a small but significant increase in likelihood of receiving 1L if treated in HAA vs LAA facilities. Further study will focus on identifying patient, prescriber and facility factors that are associated with the likelihood of initiating 1L and the choice of 1L regimen.

Background: Cancer care in academically affiliated settings such as teaching hospitals has been associated with improved clinical outcomes. Historically, Veterans Affairs (VA) medical centers are partnered with academic affiliates; however, there have been few studies examining how this partnership affects clinical care in the Veterans Health Administration (VHA). We therefore examined the variation of first line therapy (1L) in patients with metastatic castrate resistant prostate cancer (mCRPC) in the VHA by degree of academic affiliation.

Methods: Information from the VA Central Cancer Registry was linked to clinical data from the VA Corporate Data Warehouse to identify incident cases of mCRPC, defined as first incidence of radiologic evidence of metastasis and castrate resistance in patients with prostate cancer. Patient demographics, disease characteristics and treatment practices were extracted. The degree of academic affiliation of the treating facility was calculated using the Herfindahl-Hirschman Index (HHI), which reflects how dispersed medical residents are among different specialties and how many specialties are available within a given VA facility.

Results: From 2006 to 2015, 3,637 patients received an mCRPC diagnosis and were treated in 123 VA facilities. Median HHI for treating facilities was 0.374. Of these patients, 1,723 (47%) were treated in a facility with higher academic affiliation (HAA; HHI ≥ 0.374) and 1,914 (53%) were treated in a facility with lower academic affiliation (LAA; HHI ≤ 0.373). There was no difference in patient or disease characteristics by academic affiliation; patients with HAA and LAA had comparable Gleason scores, stage of disease at diagnosis, primary local therapy, age and median PSA levels at time of diagnosis. Patients with mCRPC at HAA facilities were more likely to receive 1L (59% vs 55%, P = .015). Regimens frequently used for 1L were comparable: HAA, docetaxel (29%), abiraterone (22%), and enzalutamide (6%); LAA: docetaxel (25%), abiraterone (21%), and enzalutamide (7%).

Conclusions: Patients with mCRPC had a small but significant increase in likelihood of receiving 1L if treated in HAA vs LAA facilities. Further study will focus on identifying patient, prescriber and facility factors that are associated with the likelihood of initiating 1L and the choice of 1L regimen.