In 2003, a retrospective study of VANTHCS Hematology/ Oncology referrals showed 4.5% of 1,038 referrals that year were requests for oral antineoplastic medications that patients could not afford through their outside oncologists. Since then, the field of cancer drug development has expanded dramatically; yet the cost of these drugs remains staggering. The hypothesis was that the proliferation of these new, expensive anticancer medications led to an increase in referrals to VANTHCS Hematology/Oncology. This study sought to determine if referrals had increased since 2003 and to estimate these referrals’ economic impact. All new consults received from 1/2015-12/2015 were abstracted. 1,416 outpatient consults were reviewed for medication requested, disease, age, race, sex, location, and insurance. 1.8% of these referrals was specifically to obtain oral chemotherapy. This is a substantial decrease from 4.5% in 2013. However, 5.6% of total referrals in 2015 were veterans with private oncologists presenting to the VANTHCS because of cost. Of these 79 patients, 26 (1.8% of all consults) requested oral chemotherapy, 17 (1.2%) requested intravenous chemotherapy, and 36 (2.5%) requested transfer of all oncology care. One possible explanation for the decrease in oral antineoplastic
requests since 2003 is the 2006 implementation of Medicare Part D. Evidence to support this program’s role in declining requests is that two-thirds of veterans presenting because of cost in 2015 were not enrolled in Medicare Part D. Even with Medicare Part D, veterans still face a significant cost burden and continue to present for assistance. While the total number of referrals for oral chemotherapy has declined, the cost of providing these medications merits attention. Of the 15 different oral neoplastic medications requested in 2015 by veterans with private oncologists, 10 cost over $3,000 per month per patient. As an example, 4 patients requested and were approved for lenalidomide. Treating these 4 patients cost the VA over $22,000 per month. Thus, though the number of patients is small, the economic impact remains significant.

In 2003, a retrospective study of VANTHCS Hematology/ Oncology referrals showed 4.5% of 1,038 referrals that year were requests for oral antineoplastic medications that patients could not afford through their outside oncologists. Since then, the field of cancer drug development has expanded dramatically; yet the cost of these drugs remains staggering. The hypothesis was that the proliferation of these new, expensive anticancer medications led to an increase in referrals to VANTHCS Hematology/Oncology. This study sought to determine if referrals had increased since 2003 and to estimate these referrals’ economic impact. All new consults received from 1/2015-12/2015 were abstracted. 1,416 outpatient consults were reviewed for medication requested, disease, age, race, sex, location, and insurance. 1.8% of these referrals was specifically to obtain oral chemotherapy. This is a substantial decrease from 4.5% in 2013. However, 5.6% of total referrals in 2015 were veterans with private oncologists presenting to the VANTHCS because of cost. Of these 79 patients, 26 (1.8% of all consults) requested oral chemotherapy, 17 (1.2%) requested intravenous chemotherapy, and 36 (2.5%) requested transfer of all oncology care. One possible explanation for the decrease in oral antineoplastic
requests since 2003 is the 2006 implementation of Medicare Part D. Evidence to support this program’s role in declining requests is that two-thirds of veterans presenting because of cost in 2015 were not enrolled in Medicare Part D. Even with Medicare Part D, veterans still face a significant cost burden and continue to present for assistance. While the total number of referrals for oral chemotherapy has declined, the cost of providing these medications merits attention. Of the 15 different oral neoplastic medications requested in 2015 by veterans with private oncologists, 10 cost over $3,000 per month per patient. As an example, 4 patients requested and were approved for lenalidomide. Treating these 4 patients cost the VA over $22,000 per month. Thus, though the number of patients is small, the economic impact remains significant.

In 2003, a retrospective study of VANTHCS Hematology/ Oncology referrals showed 4.5% of 1,038 referrals that year were requests for oral antineoplastic medications that patients could not afford through their outside oncologists. Since then, the field of cancer drug development has expanded dramatically; yet the cost of these drugs remains staggering. The hypothesis was that the proliferation of these new, expensive anticancer medications led to an increase in referrals to VANTHCS Hematology/Oncology. This study sought to determine if referrals had increased since 2003 and to estimate these referrals’ economic impact. All new consults received from 1/2015-12/2015 were abstracted. 1,416 outpatient consults were reviewed for medication requested, disease, age, race, sex, location, and insurance. 1.8% of these referrals was specifically to obtain oral chemotherapy. This is a substantial decrease from 4.5% in 2013. However, 5.6% of total referrals in 2015 were veterans with private oncologists presenting to the VANTHCS because of cost. Of these 79 patients, 26 (1.8% of all consults) requested oral chemotherapy, 17 (1.2%) requested intravenous chemotherapy, and 36 (2.5%) requested transfer of all oncology care. One possible explanation for the decrease in oral antineoplastic
requests since 2003 is the 2006 implementation of Medicare Part D. Evidence to support this program’s role in declining requests is that two-thirds of veterans presenting because of cost in 2015 were not enrolled in Medicare Part D. Even with Medicare Part D, veterans still face a significant cost burden and continue to present for assistance. While the total number of referrals for oral chemotherapy has declined, the cost of providing these medications merits attention. Of the 15 different oral neoplastic medications requested in 2015 by veterans with private oncologists, 10 cost over $3,000 per month per patient. As an example, 4 patients requested and were approved for lenalidomide. Treating these 4 patients cost the VA over $22,000 per month. Thus, though the number of patients is small, the economic impact remains significant.

Purpose: Patients with chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) are treated with tyrosine kinase inhibitors (TKI), namely, imatinib, nilotinib, and dasatinib. Recent studies suggest that TKI therapy may be linked to the development of an acute kidney injury (AKI) and chronic kidney disease (CKD). This review evaluates current monitoring procedures at the Cincinnati VAMC.

Methods: A retrospective chart review using the electronic medical record was used to identify patients receiving TKI therapy ≥ 1 year with a diagnosis of CML or GIST. Demographics collected include: age, gender, baseline and subsequent serum creatinine, comorbid conditions possibly confounding kidney dysfunction, and receipt of nephrotoxic agents. The average change in renal function for the duration of treatment as well as per year of therapy with TKI and average number of days between lab draws were calculated.

Results: Forty-two patients were identified with active prescriptions for a TKI between January 1, 2005 and December 31, 2014. Twenty-four patients were included, of which 22 did not receive a basic metabolic panel at the recommended interval based on VA PBM Guidance. The average time between lab draws was 114 days. Fifteen patients incurred an acute kidney injury. The average change in serum creatinine for the duration of treatment was a +0.29 mg/dL. Five patients were identified that met manufacturer renal dosing criteria. Of these patients, 2 had an appropriately adjusted dose. Two patients developed CKD during the treatment period who did not have CKD at baseline.

Conclusion: Current monitoring of renal function at the Cincinnati VAMC is not in compliance with VA PBM recommendations for patients receiving TKI therapy. However, they are in line with manufacturer recommendations. While a large portion of patients developed an AKI with therapy, direct causation cannot be established as several of these patients received nephrotoxic agents in the immediately preceding 7 days of the elevated serum creatinine value. The increase in serum creatinine does not appear to be sustained, as the average change in serum creatinine for the duration of therapy was not large. Thus, quarterly monitoring of renal function appears to be appropriate in this population.

Purpose: Patients with chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) are treated with tyrosine kinase inhibitors (TKI), namely, imatinib, nilotinib, and dasatinib. Recent studies suggest that TKI therapy may be linked to the development of an acute kidney injury (AKI) and chronic kidney disease (CKD). This review evaluates current monitoring procedures at the Cincinnati VAMC.

Methods: A retrospective chart review using the electronic medical record was used to identify patients receiving TKI therapy ≥ 1 year with a diagnosis of CML or GIST. Demographics collected include: age, gender, baseline and subsequent serum creatinine, comorbid conditions possibly confounding kidney dysfunction, and receipt of nephrotoxic agents. The average change in renal function for the duration of treatment as well as per year of therapy with TKI and average number of days between lab draws were calculated.

Results: Forty-two patients were identified with active prescriptions for a TKI between January 1, 2005 and December 31, 2014. Twenty-four patients were included, of which 22 did not receive a basic metabolic panel at the recommended interval based on VA PBM Guidance. The average time between lab draws was 114 days. Fifteen patients incurred an acute kidney injury. The average change in serum creatinine for the duration of treatment was a +0.29 mg/dL. Five patients were identified that met manufacturer renal dosing criteria. Of these patients, 2 had an appropriately adjusted dose. Two patients developed CKD during the treatment period who did not have CKD at baseline.

Conclusion: Current monitoring of renal function at the Cincinnati VAMC is not in compliance with VA PBM recommendations for patients receiving TKI therapy. However, they are in line with manufacturer recommendations. While a large portion of patients developed an AKI with therapy, direct causation cannot be established as several of these patients received nephrotoxic agents in the immediately preceding 7 days of the elevated serum creatinine value. The increase in serum creatinine does not appear to be sustained, as the average change in serum creatinine for the duration of therapy was not large. Thus, quarterly monitoring of renal function appears to be appropriate in this population.

Purpose: Patients with chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) are treated with tyrosine kinase inhibitors (TKI), namely, imatinib, nilotinib, and dasatinib. Recent studies suggest that TKI therapy may be linked to the development of an acute kidney injury (AKI) and chronic kidney disease (CKD). This review evaluates current monitoring procedures at the Cincinnati VAMC.

Methods: A retrospective chart review using the electronic medical record was used to identify patients receiving TKI therapy ≥ 1 year with a diagnosis of CML or GIST. Demographics collected include: age, gender, baseline and subsequent serum creatinine, comorbid conditions possibly confounding kidney dysfunction, and receipt of nephrotoxic agents. The average change in renal function for the duration of treatment as well as per year of therapy with TKI and average number of days between lab draws were calculated.

Results: Forty-two patients were identified with active prescriptions for a TKI between January 1, 2005 and December 31, 2014. Twenty-four patients were included, of which 22 did not receive a basic metabolic panel at the recommended interval based on VA PBM Guidance. The average time between lab draws was 114 days. Fifteen patients incurred an acute kidney injury. The average change in serum creatinine for the duration of treatment was a +0.29 mg/dL. Five patients were identified that met manufacturer renal dosing criteria. Of these patients, 2 had an appropriately adjusted dose. Two patients developed CKD during the treatment period who did not have CKD at baseline.

Conclusion: Current monitoring of renal function at the Cincinnati VAMC is not in compliance with VA PBM recommendations for patients receiving TKI therapy. However, they are in line with manufacturer recommendations. While a large portion of patients developed an AKI with therapy, direct causation cannot be established as several of these patients received nephrotoxic agents in the immediately preceding 7 days of the elevated serum creatinine value. The increase in serum creatinine does not appear to be sustained, as the average change in serum creatinine for the duration of therapy was not large. Thus, quarterly monitoring of renal function appears to be appropriate in this population.

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Background: Therapeutic options for men with metastatic castrate-resistant prostate cancer (mCRPC) have expanded significantly over the past 5 years with several new agents demonstrating improved survival, including 2 oral agents. Abiraterone acetate (AA), a CYP-17 androgen synthesis inhibitor, obtained initial FDA approval in 2011 for post-docetaxel (DXT) use and gained expanded approval in 2012 for pre-DXT use. Enzalutamide (ENZ), an androgen receptor signaling inhibitor, also gained FDA approval in 2012 (post-DXT) and indication was expanded in 2014 (pre-DXT).

Purpose: The objective is to provide insight into the uptake of novel therapeutics and its impact on treatment for patients with mCRPC.

Methods: For this observational study, Veterans Affairs (VA) healthcare system data (including hospitalizations, outpatient visits, and pharmacy) were used to identify male veterans who received treatment for mCRPC between fiscal years 2008 and 2014. Sequencing patterns and treatment duration were assessed. Descriptive statistics were employed.

Results: During the study period, 8,774 patients initiated advanced lines of therapy associated with mCRPC. AA, DXT, and ketoconazole (KCZ) were the most commonly used firstlines of advanced therapies (24.6%, 24.8%, 47.0%, respectively). Between 2008 and 2013, the proportion of mCRPC patients treated with first-line DXT or KCZ dropped from 98% to 38% (P < .0001) while the proportion who received first-line AA increased to 58% (P < .0001). Furthermore, among the 4,169 patients treated with AA between 2011 and 2014, the proportion treated pre-DXT increased from 32% to 80% (P < .0001). AA was also the most common second-line treatment received. Between 2012 and 2013, ENZ use was low but increased dramatically. Among patients who initiated DXT, KCZ, or AA as first-line treatment in 2011/2012, median time on initial treatment was 5.9, 9.1, 11.5 months, respectively.

Conclusions: The FDA approval of AA and ENZ had a significant impact on treatment patterns for men with mCRPC within VA and was associated with decreased use of KCZ and delayed use of chemotherapy. Further information regarding patient and disease characteristics is needed. The rapid uptake of these novel agents has significant implications for disease-related outcomes.

Background: Therapeutic options for men with metastatic castrate-resistant prostate cancer (mCRPC) have expanded significantly over the past 5 years with several new agents demonstrating improved survival, including 2 oral agents. Abiraterone acetate (AA), a CYP-17 androgen synthesis inhibitor, obtained initial FDA approval in 2011 for post-docetaxel (DXT) use and gained expanded approval in 2012 for pre-DXT use. Enzalutamide (ENZ), an androgen receptor signaling inhibitor, also gained FDA approval in 2012 (post-DXT) and indication was expanded in 2014 (pre-DXT).

Purpose: The objective is to provide insight into the uptake of novel therapeutics and its impact on treatment for patients with mCRPC.

Methods: For this observational study, Veterans Affairs (VA) healthcare system data (including hospitalizations, outpatient visits, and pharmacy) were used to identify male veterans who received treatment for mCRPC between fiscal years 2008 and 2014. Sequencing patterns and treatment duration were assessed. Descriptive statistics were employed.

Results: During the study period, 8,774 patients initiated advanced lines of therapy associated with mCRPC. AA, DXT, and ketoconazole (KCZ) were the most commonly used firstlines of advanced therapies (24.6%, 24.8%, 47.0%, respectively). Between 2008 and 2013, the proportion of mCRPC patients treated with first-line DXT or KCZ dropped from 98% to 38% (P < .0001) while the proportion who received first-line AA increased to 58% (P < .0001). Furthermore, among the 4,169 patients treated with AA between 2011 and 2014, the proportion treated pre-DXT increased from 32% to 80% (P < .0001). AA was also the most common second-line treatment received. Between 2012 and 2013, ENZ use was low but increased dramatically. Among patients who initiated DXT, KCZ, or AA as first-line treatment in 2011/2012, median time on initial treatment was 5.9, 9.1, 11.5 months, respectively.

Conclusions: The FDA approval of AA and ENZ had a significant impact on treatment patterns for men with mCRPC within VA and was associated with decreased use of KCZ and delayed use of chemotherapy. Further information regarding patient and disease characteristics is needed. The rapid uptake of these novel agents has significant implications for disease-related outcomes.

Background: Therapeutic options for men with metastatic castrate-resistant prostate cancer (mCRPC) have expanded significantly over the past 5 years with several new agents demonstrating improved survival, including 2 oral agents. Abiraterone acetate (AA), a CYP-17 androgen synthesis inhibitor, obtained initial FDA approval in 2011 for post-docetaxel (DXT) use and gained expanded approval in 2012 for pre-DXT use. Enzalutamide (ENZ), an androgen receptor signaling inhibitor, also gained FDA approval in 2012 (post-DXT) and indication was expanded in 2014 (pre-DXT).

Purpose: The objective is to provide insight into the uptake of novel therapeutics and its impact on treatment for patients with mCRPC.

Methods: For this observational study, Veterans Affairs (VA) healthcare system data (including hospitalizations, outpatient visits, and pharmacy) were used to identify male veterans who received treatment for mCRPC between fiscal years 2008 and 2014. Sequencing patterns and treatment duration were assessed. Descriptive statistics were employed.

Results: During the study period, 8,774 patients initiated advanced lines of therapy associated with mCRPC. AA, DXT, and ketoconazole (KCZ) were the most commonly used firstlines of advanced therapies (24.6%, 24.8%, 47.0%, respectively). Between 2008 and 2013, the proportion of mCRPC patients treated with first-line DXT or KCZ dropped from 98% to 38% (P < .0001) while the proportion who received first-line AA increased to 58% (P < .0001). Furthermore, among the 4,169 patients treated with AA between 2011 and 2014, the proportion treated pre-DXT increased from 32% to 80% (P < .0001). AA was also the most common second-line treatment received. Between 2012 and 2013, ENZ use was low but increased dramatically. Among patients who initiated DXT, KCZ, or AA as first-line treatment in 2011/2012, median time on initial treatment was 5.9, 9.1, 11.5 months, respectively.

Conclusions: The FDA approval of AA and ENZ had a significant impact on treatment patterns for men with mCRPC within VA and was associated with decreased use of KCZ and delayed use of chemotherapy. Further information regarding patient and disease characteristics is needed. The rapid uptake of these novel agents has significant implications for disease-related outcomes.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Complex hematological tests aid in establishing hematologic diagnoses, but can be quite costly. We hypothesized that certain diagnostic tests (specifically JAK2 at $175/test, BCR-ABL at $163/test, and flow cytometry at $275/test) that were being ordered without input from a hematologist were generally not indicated and expensive. We reviewed all of these tests sent between September 2013 and September 2015. 20/55 or 36% of JAK2 mutations, 19/37 or 51% of BCR-ABL mutations, and 47/74 or 63% of flow cytometry were completed without hematology input, primarily via primary care (72/86 or 84%). Tests that were ordered or recommended by hematology were excluded from the subsequent cost analysis. In total $19,500 was spent (without hematology input). One hematologist then reviewed the charts on every test that had been ordered not by hematology to determine if the test was clinically appropriate. 12/20 or 60% of JAK2 mutations, 19/19 or 100% of BCR mutations, and 44/47 or 94% of flow cytometry evaluations were felt to be unnecessary. Thus $17,300 of the $19,500 could have been saved had there been hematology input at the outset. This would have amounted to 86 e-consults over 2 years, which would be 1.2 extra consults/week; these consults generally take under 10 minutes, so less than 2 minutes/day. This all translates to ~$1,075 over 2 years of a hematologist’s salary, clearly more cost-effective than permitting everyone to be able to order these tests. We should consider recommending hematology input prior to allowing these tests (and perhaps other costly unusual hematology investigations) to be sent out, perhaps via a pop-up suggestion for a hematology e-consult when ordered; the e-consult would also be a tool to educate other providers on the appropriate use of these tests and may ultimately lead to a decrease in the ordering of these e-consults.

Complex hematological tests aid in establishing hematologic diagnoses, but can be quite costly. We hypothesized that certain diagnostic tests (specifically JAK2 at $175/test, BCR-ABL at $163/test, and flow cytometry at $275/test) that were being ordered without input from a hematologist were generally not indicated and expensive. We reviewed all of these tests sent between September 2013 and September 2015. 20/55 or 36% of JAK2 mutations, 19/37 or 51% of BCR-ABL mutations, and 47/74 or 63% of flow cytometry were completed without hematology input, primarily via primary care (72/86 or 84%). Tests that were ordered or recommended by hematology were excluded from the subsequent cost analysis. In total $19,500 was spent (without hematology input). One hematologist then reviewed the charts on every test that had been ordered not by hematology to determine if the test was clinically appropriate. 12/20 or 60% of JAK2 mutations, 19/19 or 100% of BCR mutations, and 44/47 or 94% of flow cytometry evaluations were felt to be unnecessary. Thus $17,300 of the $19,500 could have been saved had there been hematology input at the outset. This would have amounted to 86 e-consults over 2 years, which would be 1.2 extra consults/week; these consults generally take under 10 minutes, so less than 2 minutes/day. This all translates to ~$1,075 over 2 years of a hematologist’s salary, clearly more cost-effective than permitting everyone to be able to order these tests. We should consider recommending hematology input prior to allowing these tests (and perhaps other costly unusual hematology investigations) to be sent out, perhaps via a pop-up suggestion for a hematology e-consult when ordered; the e-consult would also be a tool to educate other providers on the appropriate use of these tests and may ultimately lead to a decrease in the ordering of these e-consults.

Complex hematological tests aid in establishing hematologic diagnoses, but can be quite costly. We hypothesized that certain diagnostic tests (specifically JAK2 at $175/test, BCR-ABL at $163/test, and flow cytometry at $275/test) that were being ordered without input from a hematologist were generally not indicated and expensive. We reviewed all of these tests sent between September 2013 and September 2015. 20/55 or 36% of JAK2 mutations, 19/37 or 51% of BCR-ABL mutations, and 47/74 or 63% of flow cytometry were completed without hematology input, primarily via primary care (72/86 or 84%). Tests that were ordered or recommended by hematology were excluded from the subsequent cost analysis. In total $19,500 was spent (without hematology input). One hematologist then reviewed the charts on every test that had been ordered not by hematology to determine if the test was clinically appropriate. 12/20 or 60% of JAK2 mutations, 19/19 or 100% of BCR mutations, and 44/47 or 94% of flow cytometry evaluations were felt to be unnecessary. Thus $17,300 of the $19,500 could have been saved had there been hematology input at the outset. This would have amounted to 86 e-consults over 2 years, which would be 1.2 extra consults/week; these consults generally take under 10 minutes, so less than 2 minutes/day. This all translates to ~$1,075 over 2 years of a hematologist’s salary, clearly more cost-effective than permitting everyone to be able to order these tests. We should consider recommending hematology input prior to allowing these tests (and perhaps other costly unusual hematology investigations) to be sent out, perhaps via a pop-up suggestion for a hematology e-consult when ordered; the e-consult would also be a tool to educate other providers on the appropriate use of these tests and may ultimately lead to a decrease in the ordering of these e-consults.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.