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BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.

“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.

A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).

Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.

[email protected]

BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.

“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.

A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).

Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.

[email protected]

BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.

“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.

A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).

Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.

[email protected]

Extending docetaxel chemotherapy significantly improved overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC), regardless of whether they received lenalidomide, according to a retrospective analysis of 1,059 patients from a randomized, phase III trial.

“We found a robust and independent effect on overall survival by the number of docetaxel cycles administered in the setting of mCRPC,” wrote Ellen de Morree of Erasmus MC Cancer Institute (Rotterdam, the Netherlands) and her associates (JAMA Oncol. 2016 Aug 25. doi: 10.1001/jamaoncol.2016.3000).

The association was independent of performance status (Eastern Cooperative Oncology Group score) or baseline levels of lactate dehydrogenase level, hemoglobin, and albumin, they noted. “These data indicate that patients who appear to have clinical, radiological, or biochemical benefit by docetaxel should continue beyond 6 cycles as long as they tolerate their treatment well,” they concluded.

This study, the first to investigate the optimal number of docetaxel cycles in mCRPC, analyzed data from the multicenter Mainsail trial, in which patients received docetaxel, prednisone, and lenalidomide (DPL) or docetaxel, prednisone, and a placebo (DP) until they developed progressive disease or unacceptable adverse effects. Although dose intensity was similar between the two trial arms, DPL patients developed myelotoxicity with lenalidomide and therefore received a median of only six treatment cycles, while DP patients received a median of eight cycles. That difference enabled this analysis, the investigators noted.

Cumulative dose of docetaxel, duration of lenalidomide treatment, and allocated treatment regimen were significant predictors of overall survival in the univariate analysis. Overall survival was associated with treatment arm in a multivariable analysis that did not account for number of docetaxel cycles (hazard ratio, 1.6; 95% confidence interval, 1.2 to 2.1; P less than .001). But that changed after the addition of a number of docetaxel cycles to the model, the researchers said. In this final model, treatment with eight or more cycles of docetaxel led to substantially improved overall survival (hazard ratio, 1.9; P less than .001), regardless of lenalidomide treatment (HR, 1.1; 95% CI, 0.9 to 1.2; P = .4). Sensitivity analyses confirmed the association – patients who received more than 10 cycles of docetaxel had a median overall survival of 33 months (30-37 months), versus 27 months (24-30 months) with 8-10 cycles and about 23 months (18-27 months) with 5-7 cycles (P less than .001).

Extending docetaxel chemotherapy significantly improved overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC), regardless of whether they received lenalidomide, according to a retrospective analysis of 1,059 patients from a randomized, phase III trial.

“We found a robust and independent effect on overall survival by the number of docetaxel cycles administered in the setting of mCRPC,” wrote Ellen de Morree of Erasmus MC Cancer Institute (Rotterdam, the Netherlands) and her associates (JAMA Oncol. 2016 Aug 25. doi: 10.1001/jamaoncol.2016.3000).

The association was independent of performance status (Eastern Cooperative Oncology Group score) or baseline levels of lactate dehydrogenase level, hemoglobin, and albumin, they noted. “These data indicate that patients who appear to have clinical, radiological, or biochemical benefit by docetaxel should continue beyond 6 cycles as long as they tolerate their treatment well,” they concluded.

This study, the first to investigate the optimal number of docetaxel cycles in mCRPC, analyzed data from the multicenter Mainsail trial, in which patients received docetaxel, prednisone, and lenalidomide (DPL) or docetaxel, prednisone, and a placebo (DP) until they developed progressive disease or unacceptable adverse effects. Although dose intensity was similar between the two trial arms, DPL patients developed myelotoxicity with lenalidomide and therefore received a median of only six treatment cycles, while DP patients received a median of eight cycles. That difference enabled this analysis, the investigators noted.

Cumulative dose of docetaxel, duration of lenalidomide treatment, and allocated treatment regimen were significant predictors of overall survival in the univariate analysis. Overall survival was associated with treatment arm in a multivariable analysis that did not account for number of docetaxel cycles (hazard ratio, 1.6; 95% confidence interval, 1.2 to 2.1; P less than .001). But that changed after the addition of a number of docetaxel cycles to the model, the researchers said. In this final model, treatment with eight or more cycles of docetaxel led to substantially improved overall survival (hazard ratio, 1.9; P less than .001), regardless of lenalidomide treatment (HR, 1.1; 95% CI, 0.9 to 1.2; P = .4). Sensitivity analyses confirmed the association – patients who received more than 10 cycles of docetaxel had a median overall survival of 33 months (30-37 months), versus 27 months (24-30 months) with 8-10 cycles and about 23 months (18-27 months) with 5-7 cycles (P less than .001).

Extending docetaxel chemotherapy significantly improved overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC), regardless of whether they received lenalidomide, according to a retrospective analysis of 1,059 patients from a randomized, phase III trial.

“We found a robust and independent effect on overall survival by the number of docetaxel cycles administered in the setting of mCRPC,” wrote Ellen de Morree of Erasmus MC Cancer Institute (Rotterdam, the Netherlands) and her associates (JAMA Oncol. 2016 Aug 25. doi: 10.1001/jamaoncol.2016.3000).

The association was independent of performance status (Eastern Cooperative Oncology Group score) or baseline levels of lactate dehydrogenase level, hemoglobin, and albumin, they noted. “These data indicate that patients who appear to have clinical, radiological, or biochemical benefit by docetaxel should continue beyond 6 cycles as long as they tolerate their treatment well,” they concluded.

This study, the first to investigate the optimal number of docetaxel cycles in mCRPC, analyzed data from the multicenter Mainsail trial, in which patients received docetaxel, prednisone, and lenalidomide (DPL) or docetaxel, prednisone, and a placebo (DP) until they developed progressive disease or unacceptable adverse effects. Although dose intensity was similar between the two trial arms, DPL patients developed myelotoxicity with lenalidomide and therefore received a median of only six treatment cycles, while DP patients received a median of eight cycles. That difference enabled this analysis, the investigators noted.

Cumulative dose of docetaxel, duration of lenalidomide treatment, and allocated treatment regimen were significant predictors of overall survival in the univariate analysis. Overall survival was associated with treatment arm in a multivariable analysis that did not account for number of docetaxel cycles (hazard ratio, 1.6; 95% confidence interval, 1.2 to 2.1; P less than .001). But that changed after the addition of a number of docetaxel cycles to the model, the researchers said. In this final model, treatment with eight or more cycles of docetaxel led to substantially improved overall survival (hazard ratio, 1.9; P less than .001), regardless of lenalidomide treatment (HR, 1.1; 95% CI, 0.9 to 1.2; P = .4). Sensitivity analyses confirmed the association – patients who received more than 10 cycles of docetaxel had a median overall survival of 33 months (30-37 months), versus 27 months (24-30 months) with 8-10 cycles and about 23 months (18-27 months) with 5-7 cycles (P less than .001).

TORONTO – Patients with mild cognitive impairment have a greater likelihood of having neuropsychiatric symptoms if they test positive for amyloid pathology on PET imaging, according to a study of patients in the Alzheimer’s Disease Neuroimaging Initiative.

Amyloid-positive patients were significantly more likely to develop agitation, anxiety, apathy, and other symptoms over 4 years than were amyloid-negative patients, Naira Goukasian said at the Alzheimer’s Association International Conference 2016.

“In MCI [mild cognitive impairment], we found that amyloid pathology was a significant risk factor for developing these symptoms,” said Ms. Goukasian, a researcher at the University of California, Los Angeles.

©giocalde/Thinkstock

She investigated the presence and development of neuropsychiatric symptoms in 1,077 subjects drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. The cohort comprised 275 cognitively normal subjects, 100 with subjective memory complaint, 559 with MCI, and 143 with Alzheimer’s disease. As part of ADNI, all patients had baseline neurocognitive and neuropsychiatric testing, and florbetapir F 18 (Amyvid) scans to determine brain amyloid status. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory (NPI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) at baseline and during every annual visit. Patients were followed for up to 4 years.

At baseline, amyloid pathology was associated with some neuropsychiatric symptomatology in every group except those with subjective memory complaints.

Amyloid-positive control subjects were significantly more likely to present with depression than were amyloid-negative controls. Amyloid-positive MCI patients were significantly more likely to present with anxiety when they had amyloid pathology than when they did not. Amyloid-positive dementia patients were significantly more likely to present with apathy than were amyloid-negative dementia patients.

There were no amyloid-dependent differences in neuropsychiatric symptoms among those with subjective memory complaints.

Over the 4-year follow-up period, no new neuropsychiatric symptoms developed in the control, subjective memory complaint, or dementia groups, whether they were amyloid positive or negative.

Amyloid-positive MCI patients, however, were significantly more likely to develop new symptoms than were amyloid-negative MCI patients, including delusions (13% vs. 2%), hallucinations (8% vs. 2%), anxiety (36% vs. 25%), apathy (38% vs. 22%), agitation (36% vs. 27%), disinhibition (24% vs. 15%), irritability (46% vs. 33%), and motor disturbances (18% vs. 9%).

Ms. Goukasian did not elaborate on the pathophysiologic relationship between amyloid and these symptoms. However, a 2015 study using a similar ADNI cohort localized some of them to specific amyloid-burdened brain regions (J Alzheimers Dis. 2016;49[2]:387-98).

The study by David Bensamoun, MD, and colleagues comprised 657 ADNI participants (230 controls, 308 MCI patients, and 119 Alzheimer’s patients).

In the entire group, Dr. Bensamoun, of the Regional Memory Center, Nice, France, found positive significant correlations between anxiety and global cerebral florbetapir F 18 uptake, as well as uptake in the frontal and cingulate regions. Irritability was associated with global florbetapir F 18 uptake and increased signal in the frontal, cingulate, and parietal regions.

In the MCI subgroup, there was an association between anxiety and frontal and global cerebral uptake. In the Alzheimer’s subgroup, there was an association between irritability and parietal uptake.

“Anxiety and irritability appear to be associated with greater amyloid deposition in the neurodegenerative process leading to Alzheimer’s,” the investigators said.

Ms. Goukasian had no financial disclosures.

[email protected]

On Twitter @alz_gal

TORONTO – Patients with mild cognitive impairment have a greater likelihood of having neuropsychiatric symptoms if they test positive for amyloid pathology on PET imaging, according to a study of patients in the Alzheimer’s Disease Neuroimaging Initiative.

Amyloid-positive patients were significantly more likely to develop agitation, anxiety, apathy, and other symptoms over 4 years than were amyloid-negative patients, Naira Goukasian said at the Alzheimer’s Association International Conference 2016.

“In MCI [mild cognitive impairment], we found that amyloid pathology was a significant risk factor for developing these symptoms,” said Ms. Goukasian, a researcher at the University of California, Los Angeles.

©giocalde/Thinkstock

She investigated the presence and development of neuropsychiatric symptoms in 1,077 subjects drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. The cohort comprised 275 cognitively normal subjects, 100 with subjective memory complaint, 559 with MCI, and 143 with Alzheimer’s disease. As part of ADNI, all patients had baseline neurocognitive and neuropsychiatric testing, and florbetapir F 18 (Amyvid) scans to determine brain amyloid status. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory (NPI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) at baseline and during every annual visit. Patients were followed for up to 4 years.

At baseline, amyloid pathology was associated with some neuropsychiatric symptomatology in every group except those with subjective memory complaints.

Amyloid-positive control subjects were significantly more likely to present with depression than were amyloid-negative controls. Amyloid-positive MCI patients were significantly more likely to present with anxiety when they had amyloid pathology than when they did not. Amyloid-positive dementia patients were significantly more likely to present with apathy than were amyloid-negative dementia patients.

There were no amyloid-dependent differences in neuropsychiatric symptoms among those with subjective memory complaints.

Over the 4-year follow-up period, no new neuropsychiatric symptoms developed in the control, subjective memory complaint, or dementia groups, whether they were amyloid positive or negative.

Amyloid-positive MCI patients, however, were significantly more likely to develop new symptoms than were amyloid-negative MCI patients, including delusions (13% vs. 2%), hallucinations (8% vs. 2%), anxiety (36% vs. 25%), apathy (38% vs. 22%), agitation (36% vs. 27%), disinhibition (24% vs. 15%), irritability (46% vs. 33%), and motor disturbances (18% vs. 9%).

Ms. Goukasian did not elaborate on the pathophysiologic relationship between amyloid and these symptoms. However, a 2015 study using a similar ADNI cohort localized some of them to specific amyloid-burdened brain regions (J Alzheimers Dis. 2016;49[2]:387-98).

The study by David Bensamoun, MD, and colleagues comprised 657 ADNI participants (230 controls, 308 MCI patients, and 119 Alzheimer’s patients).

In the entire group, Dr. Bensamoun, of the Regional Memory Center, Nice, France, found positive significant correlations between anxiety and global cerebral florbetapir F 18 uptake, as well as uptake in the frontal and cingulate regions. Irritability was associated with global florbetapir F 18 uptake and increased signal in the frontal, cingulate, and parietal regions.

In the MCI subgroup, there was an association between anxiety and frontal and global cerebral uptake. In the Alzheimer’s subgroup, there was an association between irritability and parietal uptake.

“Anxiety and irritability appear to be associated with greater amyloid deposition in the neurodegenerative process leading to Alzheimer’s,” the investigators said.

Ms. Goukasian had no financial disclosures.

[email protected]

On Twitter @alz_gal

TORONTO – Patients with mild cognitive impairment have a greater likelihood of having neuropsychiatric symptoms if they test positive for amyloid pathology on PET imaging, according to a study of patients in the Alzheimer’s Disease Neuroimaging Initiative.

Amyloid-positive patients were significantly more likely to develop agitation, anxiety, apathy, and other symptoms over 4 years than were amyloid-negative patients, Naira Goukasian said at the Alzheimer’s Association International Conference 2016.

“In MCI [mild cognitive impairment], we found that amyloid pathology was a significant risk factor for developing these symptoms,” said Ms. Goukasian, a researcher at the University of California, Los Angeles.

©giocalde/Thinkstock

She investigated the presence and development of neuropsychiatric symptoms in 1,077 subjects drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. The cohort comprised 275 cognitively normal subjects, 100 with subjective memory complaint, 559 with MCI, and 143 with Alzheimer’s disease. As part of ADNI, all patients had baseline neurocognitive and neuropsychiatric testing, and florbetapir F 18 (Amyvid) scans to determine brain amyloid status. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory (NPI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) at baseline and during every annual visit. Patients were followed for up to 4 years.

At baseline, amyloid pathology was associated with some neuropsychiatric symptomatology in every group except those with subjective memory complaints.

Amyloid-positive control subjects were significantly more likely to present with depression than were amyloid-negative controls. Amyloid-positive MCI patients were significantly more likely to present with anxiety when they had amyloid pathology than when they did not. Amyloid-positive dementia patients were significantly more likely to present with apathy than were amyloid-negative dementia patients.

There were no amyloid-dependent differences in neuropsychiatric symptoms among those with subjective memory complaints.

Over the 4-year follow-up period, no new neuropsychiatric symptoms developed in the control, subjective memory complaint, or dementia groups, whether they were amyloid positive or negative.

Amyloid-positive MCI patients, however, were significantly more likely to develop new symptoms than were amyloid-negative MCI patients, including delusions (13% vs. 2%), hallucinations (8% vs. 2%), anxiety (36% vs. 25%), apathy (38% vs. 22%), agitation (36% vs. 27%), disinhibition (24% vs. 15%), irritability (46% vs. 33%), and motor disturbances (18% vs. 9%).

Ms. Goukasian did not elaborate on the pathophysiologic relationship between amyloid and these symptoms. However, a 2015 study using a similar ADNI cohort localized some of them to specific amyloid-burdened brain regions (J Alzheimers Dis. 2016;49[2]:387-98).

The study by David Bensamoun, MD, and colleagues comprised 657 ADNI participants (230 controls, 308 MCI patients, and 119 Alzheimer’s patients).

In the entire group, Dr. Bensamoun, of the Regional Memory Center, Nice, France, found positive significant correlations between anxiety and global cerebral florbetapir F 18 uptake, as well as uptake in the frontal and cingulate regions. Irritability was associated with global florbetapir F 18 uptake and increased signal in the frontal, cingulate, and parietal regions.

In the MCI subgroup, there was an association between anxiety and frontal and global cerebral uptake. In the Alzheimer’s subgroup, there was an association between irritability and parietal uptake.

“Anxiety and irritability appear to be associated with greater amyloid deposition in the neurodegenerative process leading to Alzheimer’s,” the investigators said.

Ms. Goukasian had no financial disclosures.

[email protected]

On Twitter @alz_gal

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.

Purpose: Intravenous unfractionated heparin (UFH) remains an important anticoagulation (AC) agent, particularly in the inpatient setting. Historically, the activated partial thromboplastin time (aPTT) has been the primary laboratory test used to monitor and adjust UFH. Given that several biologic factors can influence the aPTT, independent of the effects of UFH, institutions have transitioned to monitoring heparin with anti-Xa levels. Clinical data show that conversion from aPTT to anti-Xa monitoring may offer a smoother dose-response curve, such that levels remain more stable, requiring fewer blood samples and dosage adjustments.

Background/Problem: The Cleveland VA Medical Center (CVAMC) provides annual care to over 105,000 veterans. It was recently designated as a center for implantation of left ventricular assist devices (LVADs.) As part of the AC monitoring for these patients, a hematologist introduced the use of anti-Xa assay as the test of choice to monitor heparin. Favorable results in this patient cohort prompted consideration for a hospital-wide change in heparin monitoring and a new heparin dosing protocol.

Methods: A multidisciplinary group assembled in November 2015 and developed a low-intensity and high-intensity heparin protocol with anti-Xa as the test to monitor heparin. Laboratory staffing was increased to accommodate phlebotomy rounds. Alaris IV pumps were re-programmed. Physicians developed a specific order set. Nurses designed an AC nurse’s note, and pharmacists devised safe-guard strategies when dose changes are made. Clinical Nurse Specialists developed an educational program for all 228 inpatient registered nurses which will be completed on July 3rd. All stakeholders are expected to meet and confirm their readiness to fully implement the new protocol.

Data Analysis: Anti-Xa equipment was purchased and validation tests were completed. In LVAD patients, therapeutic levels within 24 hours were noted in 86% of the cases.

Results: Hospital-wide implementation of the new heparin protocol is projected for August 1, 2016.

Implications: Presently, there are only 9 VAMCs using the anti-Xa assay to manage heparin anticoagulation. The CVAMC has developed a comprehensive implementation process that consists of new order sets, templates, training programs, and tools for common references. A poster at the AVAHO meeting will illustrate the process and provide postimplementation updates.

Purpose: Intravenous unfractionated heparin (UFH) remains an important anticoagulation (AC) agent, particularly in the inpatient setting. Historically, the activated partial thromboplastin time (aPTT) has been the primary laboratory test used to monitor and adjust UFH. Given that several biologic factors can influence the aPTT, independent of the effects of UFH, institutions have transitioned to monitoring heparin with anti-Xa levels. Clinical data show that conversion from aPTT to anti-Xa monitoring may offer a smoother dose-response curve, such that levels remain more stable, requiring fewer blood samples and dosage adjustments.

Background/Problem: The Cleveland VA Medical Center (CVAMC) provides annual care to over 105,000 veterans. It was recently designated as a center for implantation of left ventricular assist devices (LVADs.) As part of the AC monitoring for these patients, a hematologist introduced the use of anti-Xa assay as the test of choice to monitor heparin. Favorable results in this patient cohort prompted consideration for a hospital-wide change in heparin monitoring and a new heparin dosing protocol.

Methods: A multidisciplinary group assembled in November 2015 and developed a low-intensity and high-intensity heparin protocol with anti-Xa as the test to monitor heparin. Laboratory staffing was increased to accommodate phlebotomy rounds. Alaris IV pumps were re-programmed. Physicians developed a specific order set. Nurses designed an AC nurse’s note, and pharmacists devised safe-guard strategies when dose changes are made. Clinical Nurse Specialists developed an educational program for all 228 inpatient registered nurses which will be completed on July 3rd. All stakeholders are expected to meet and confirm their readiness to fully implement the new protocol.

Data Analysis: Anti-Xa equipment was purchased and validation tests were completed. In LVAD patients, therapeutic levels within 24 hours were noted in 86% of the cases.

Results: Hospital-wide implementation of the new heparin protocol is projected for August 1, 2016.

Implications: Presently, there are only 9 VAMCs using the anti-Xa assay to manage heparin anticoagulation. The CVAMC has developed a comprehensive implementation process that consists of new order sets, templates, training programs, and tools for common references. A poster at the AVAHO meeting will illustrate the process and provide postimplementation updates.

Purpose: Intravenous unfractionated heparin (UFH) remains an important anticoagulation (AC) agent, particularly in the inpatient setting. Historically, the activated partial thromboplastin time (aPTT) has been the primary laboratory test used to monitor and adjust UFH. Given that several biologic factors can influence the aPTT, independent of the effects of UFH, institutions have transitioned to monitoring heparin with anti-Xa levels. Clinical data show that conversion from aPTT to anti-Xa monitoring may offer a smoother dose-response curve, such that levels remain more stable, requiring fewer blood samples and dosage adjustments.

Background/Problem: The Cleveland VA Medical Center (CVAMC) provides annual care to over 105,000 veterans. It was recently designated as a center for implantation of left ventricular assist devices (LVADs.) As part of the AC monitoring for these patients, a hematologist introduced the use of anti-Xa assay as the test of choice to monitor heparin. Favorable results in this patient cohort prompted consideration for a hospital-wide change in heparin monitoring and a new heparin dosing protocol.

Methods: A multidisciplinary group assembled in November 2015 and developed a low-intensity and high-intensity heparin protocol with anti-Xa as the test to monitor heparin. Laboratory staffing was increased to accommodate phlebotomy rounds. Alaris IV pumps were re-programmed. Physicians developed a specific order set. Nurses designed an AC nurse’s note, and pharmacists devised safe-guard strategies when dose changes are made. Clinical Nurse Specialists developed an educational program for all 228 inpatient registered nurses which will be completed on July 3rd. All stakeholders are expected to meet and confirm their readiness to fully implement the new protocol.

Data Analysis: Anti-Xa equipment was purchased and validation tests were completed. In LVAD patients, therapeutic levels within 24 hours were noted in 86% of the cases.

Results: Hospital-wide implementation of the new heparin protocol is projected for August 1, 2016.

Implications: Presently, there are only 9 VAMCs using the anti-Xa assay to manage heparin anticoagulation. The CVAMC has developed a comprehensive implementation process that consists of new order sets, templates, training programs, and tools for common references. A poster at the AVAHO meeting will illustrate the process and provide postimplementation updates.

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.