INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

INTRODUCTION

We present an unusual case of autoimmune hemolytic anemia (AIHA) associated with Kikuchi-Fujimoto Disease (KFD) and systemic lupus erythematosus (SLE) that resolved with steroid therapy.

CASE PRESENTATION

A 25-year-old female with no medical history presented with 6 weeks of high fevers, syncope, and 10-lb weight loss. Exam revealed generalized lymphadenopathy (LAD) and tiny malar papules. Labs showed IgG and IgM Coombs-positivity, hemoglobin of 5 g/dL, hyperbilirubinemia, low haptoglobin, LDH >2000 IU/L, thrombocytopenia, and leukopenia. Cryoglobulins were absent. Hemophagocytic lymphohistiocytosis (HLH) markers showed ferritin of 18,000 ng/mL, moderately elevated soluble IL-2 receptor, negative CD107, minimally elevated CXCL9, borderline transaminitis, and high-normal triglycerides. ANA was 1:1280, speckled, with high anti-RNP, high anti-Smith, and negative anti-dsDNA antibodies. CT confirmed LAD without organomegaly. A 4cm excised node reviewed at 2 institutions showed necrotizing lymphadenitis without granulomas, consistent with KFD. Flow cytometry and gene rearrangement assay showed no monoclonality. Bone marrow biopsy demonstrated erythroid hyperplasia, normal flow cytometry, and no hemophagocytosis. Infectious workup was unremarkable. Treatment was initiated with 50mg prednisone daily, weaned off over 5 months. 2 months post-initiation, the fevers resolved, hemoglobin increased, and LDH normalized. 3 months later, rheumatology service diagnosed SLE based on 2019 ACR/EULAR Criteria and initiated hydroxychloroquine. 9 months later, patient remains without recurrence.

DISCUSSION

KFD presents subacutely with LAD, fever, weight loss, and varying skin findings, often self-resolving. Diagnosis requires lymph node biopsy. Etiology is unclear, with infectious, neoplastic, and autoimmune mechanisms implicated. Studies suggest up to 15% of patients have SLE.

CONCLUSIONS

This case is a rare combination of AIHA, KFD, and SLE successfully treated with steroids and, later, hydroxychloroquine. It calls for vigilance for KFD in patients with LAD and AIHA. A successful treatment strategy could include highdose steroids. The presentation may mimic lymphoma and HLH, which must be ruled out with careful pathologic and lab evaluation. To our knowledge, this is the 3rd reported case of KFD with AIHA, and 2nd case of concomitant SLE, KFD, and AIHA. The only similar patient was treated with methylprednisolone and cyclophosphamide and did not have longer-term follow-up.

INTRODUCTION

We present an unusual case of autoimmune hemolytic anemia (AIHA) associated with Kikuchi-Fujimoto Disease (KFD) and systemic lupus erythematosus (SLE) that resolved with steroid therapy.

CASE PRESENTATION

A 25-year-old female with no medical history presented with 6 weeks of high fevers, syncope, and 10-lb weight loss. Exam revealed generalized lymphadenopathy (LAD) and tiny malar papules. Labs showed IgG and IgM Coombs-positivity, hemoglobin of 5 g/dL, hyperbilirubinemia, low haptoglobin, LDH >2000 IU/L, thrombocytopenia, and leukopenia. Cryoglobulins were absent. Hemophagocytic lymphohistiocytosis (HLH) markers showed ferritin of 18,000 ng/mL, moderately elevated soluble IL-2 receptor, negative CD107, minimally elevated CXCL9, borderline transaminitis, and high-normal triglycerides. ANA was 1:1280, speckled, with high anti-RNP, high anti-Smith, and negative anti-dsDNA antibodies. CT confirmed LAD without organomegaly. A 4cm excised node reviewed at 2 institutions showed necrotizing lymphadenitis without granulomas, consistent with KFD. Flow cytometry and gene rearrangement assay showed no monoclonality. Bone marrow biopsy demonstrated erythroid hyperplasia, normal flow cytometry, and no hemophagocytosis. Infectious workup was unremarkable. Treatment was initiated with 50mg prednisone daily, weaned off over 5 months. 2 months post-initiation, the fevers resolved, hemoglobin increased, and LDH normalized. 3 months later, rheumatology service diagnosed SLE based on 2019 ACR/EULAR Criteria and initiated hydroxychloroquine. 9 months later, patient remains without recurrence.

DISCUSSION

KFD presents subacutely with LAD, fever, weight loss, and varying skin findings, often self-resolving. Diagnosis requires lymph node biopsy. Etiology is unclear, with infectious, neoplastic, and autoimmune mechanisms implicated. Studies suggest up to 15% of patients have SLE.

CONCLUSIONS

This case is a rare combination of AIHA, KFD, and SLE successfully treated with steroids and, later, hydroxychloroquine. It calls for vigilance for KFD in patients with LAD and AIHA. A successful treatment strategy could include highdose steroids. The presentation may mimic lymphoma and HLH, which must be ruled out with careful pathologic and lab evaluation. To our knowledge, this is the 3rd reported case of KFD with AIHA, and 2nd case of concomitant SLE, KFD, and AIHA. The only similar patient was treated with methylprednisolone and cyclophosphamide and did not have longer-term follow-up.

INTRODUCTION

We present an unusual case of autoimmune hemolytic anemia (AIHA) associated with Kikuchi-Fujimoto Disease (KFD) and systemic lupus erythematosus (SLE) that resolved with steroid therapy.

CASE PRESENTATION

A 25-year-old female with no medical history presented with 6 weeks of high fevers, syncope, and 10-lb weight loss. Exam revealed generalized lymphadenopathy (LAD) and tiny malar papules. Labs showed IgG and IgM Coombs-positivity, hemoglobin of 5 g/dL, hyperbilirubinemia, low haptoglobin, LDH >2000 IU/L, thrombocytopenia, and leukopenia. Cryoglobulins were absent. Hemophagocytic lymphohistiocytosis (HLH) markers showed ferritin of 18,000 ng/mL, moderately elevated soluble IL-2 receptor, negative CD107, minimally elevated CXCL9, borderline transaminitis, and high-normal triglycerides. ANA was 1:1280, speckled, with high anti-RNP, high anti-Smith, and negative anti-dsDNA antibodies. CT confirmed LAD without organomegaly. A 4cm excised node reviewed at 2 institutions showed necrotizing lymphadenitis without granulomas, consistent with KFD. Flow cytometry and gene rearrangement assay showed no monoclonality. Bone marrow biopsy demonstrated erythroid hyperplasia, normal flow cytometry, and no hemophagocytosis. Infectious workup was unremarkable. Treatment was initiated with 50mg prednisone daily, weaned off over 5 months. 2 months post-initiation, the fevers resolved, hemoglobin increased, and LDH normalized. 3 months later, rheumatology service diagnosed SLE based on 2019 ACR/EULAR Criteria and initiated hydroxychloroquine. 9 months later, patient remains without recurrence.

DISCUSSION

KFD presents subacutely with LAD, fever, weight loss, and varying skin findings, often self-resolving. Diagnosis requires lymph node biopsy. Etiology is unclear, with infectious, neoplastic, and autoimmune mechanisms implicated. Studies suggest up to 15% of patients have SLE.

CONCLUSIONS

This case is a rare combination of AIHA, KFD, and SLE successfully treated with steroids and, later, hydroxychloroquine. It calls for vigilance for KFD in patients with LAD and AIHA. A successful treatment strategy could include highdose steroids. The presentation may mimic lymphoma and HLH, which must be ruled out with careful pathologic and lab evaluation. To our knowledge, this is the 3rd reported case of KFD with AIHA, and 2nd case of concomitant SLE, KFD, and AIHA. The only similar patient was treated with methylprednisolone and cyclophosphamide and did not have longer-term follow-up.

PURPOSE

Reduce financial toxicity of housing costs associated with cancer treatment for rural Veterans.

BACKGROUND

Veterans diagnosed with cancer experience financial burdens associated with treatments: financial toxicities (FT). New Mexico (NM) an underserved and socioeconomically challenged state has one VA facility. Veterans commonly experience increased FT in the form of financial burdens related to travel distance, housing, and time off from work for caregivers as required to seek specialized care and cancer treatments. Travel pay and the Mission Act does little to alleviate this burden, and many still experience financial hardships.

METHODS

NMVAHCS Fisher House is reserved for families seeking housing accommodations during their loved one’s hospitalization. Surgical Service coordinated an additional plan to provide services for rural Veterans requiring 4-6 weeks of daily radiation therapy. Special accommodations were granted. Each case is reviewed via consult. Veteran requires an accompanying caregiver. Prior available Veteran discounted hotel rates averaged $96 per night. A 6-week course of shelter during radiation therapy could be $4,032.00, before taxes. No discounts or vouchers were available for meals, or other expenses.

RESULTS

Since FY23, 38 families seeking oncology care were welcomed into the Fisher House, reflecting a potential Veteran cost savings of $153,216.00 related to housing alone. Veterans also experienced cost saving related to food, as most meals were provided through community donations. Veteran satisfaction was improved, evidenced by Fisher House journal for families. Entries were heartwarming, with an outpouring of gratitude to the staff and VA for providing care and hospitality in a difficult time. Several Veterans stated they would not have been able to complete treatment without the Fisher House.

IMPLICATIONS

Although most Veterans have manageable associated out of pocket expenses with cancer treatments, many have associated extensive financial burdens related to receiving treatments. Even with the Mission Act, many live 4-6 hours from the closest oncology center providing radiation therapy, making a round trip for daily treatment up to 12 hours. Consideration in the reduction of travel time and housing expenses, can mean the difference of Veterans accepting treatments resulting in improved overall quality of life and survival outcomes.

PURPOSE

Reduce financial toxicity of housing costs associated with cancer treatment for rural Veterans.

BACKGROUND

Veterans diagnosed with cancer experience financial burdens associated with treatments: financial toxicities (FT). New Mexico (NM) an underserved and socioeconomically challenged state has one VA facility. Veterans commonly experience increased FT in the form of financial burdens related to travel distance, housing, and time off from work for caregivers as required to seek specialized care and cancer treatments. Travel pay and the Mission Act does little to alleviate this burden, and many still experience financial hardships.

METHODS

NMVAHCS Fisher House is reserved for families seeking housing accommodations during their loved one’s hospitalization. Surgical Service coordinated an additional plan to provide services for rural Veterans requiring 4-6 weeks of daily radiation therapy. Special accommodations were granted. Each case is reviewed via consult. Veteran requires an accompanying caregiver. Prior available Veteran discounted hotel rates averaged $96 per night. A 6-week course of shelter during radiation therapy could be $4,032.00, before taxes. No discounts or vouchers were available for meals, or other expenses.

RESULTS

Since FY23, 38 families seeking oncology care were welcomed into the Fisher House, reflecting a potential Veteran cost savings of $153,216.00 related to housing alone. Veterans also experienced cost saving related to food, as most meals were provided through community donations. Veteran satisfaction was improved, evidenced by Fisher House journal for families. Entries were heartwarming, with an outpouring of gratitude to the staff and VA for providing care and hospitality in a difficult time. Several Veterans stated they would not have been able to complete treatment without the Fisher House.

IMPLICATIONS

Although most Veterans have manageable associated out of pocket expenses with cancer treatments, many have associated extensive financial burdens related to receiving treatments. Even with the Mission Act, many live 4-6 hours from the closest oncology center providing radiation therapy, making a round trip for daily treatment up to 12 hours. Consideration in the reduction of travel time and housing expenses, can mean the difference of Veterans accepting treatments resulting in improved overall quality of life and survival outcomes.

PURPOSE

Reduce financial toxicity of housing costs associated with cancer treatment for rural Veterans.

BACKGROUND

Veterans diagnosed with cancer experience financial burdens associated with treatments: financial toxicities (FT). New Mexico (NM) an underserved and socioeconomically challenged state has one VA facility. Veterans commonly experience increased FT in the form of financial burdens related to travel distance, housing, and time off from work for caregivers as required to seek specialized care and cancer treatments. Travel pay and the Mission Act does little to alleviate this burden, and many still experience financial hardships.

METHODS

NMVAHCS Fisher House is reserved for families seeking housing accommodations during their loved one’s hospitalization. Surgical Service coordinated an additional plan to provide services for rural Veterans requiring 4-6 weeks of daily radiation therapy. Special accommodations were granted. Each case is reviewed via consult. Veteran requires an accompanying caregiver. Prior available Veteran discounted hotel rates averaged $96 per night. A 6-week course of shelter during radiation therapy could be $4,032.00, before taxes. No discounts or vouchers were available for meals, or other expenses.

RESULTS

Since FY23, 38 families seeking oncology care were welcomed into the Fisher House, reflecting a potential Veteran cost savings of $153,216.00 related to housing alone. Veterans also experienced cost saving related to food, as most meals were provided through community donations. Veteran satisfaction was improved, evidenced by Fisher House journal for families. Entries were heartwarming, with an outpouring of gratitude to the staff and VA for providing care and hospitality in a difficult time. Several Veterans stated they would not have been able to complete treatment without the Fisher House.

IMPLICATIONS

Although most Veterans have manageable associated out of pocket expenses with cancer treatments, many have associated extensive financial burdens related to receiving treatments. Even with the Mission Act, many live 4-6 hours from the closest oncology center providing radiation therapy, making a round trip for daily treatment up to 12 hours. Consideration in the reduction of travel time and housing expenses, can mean the difference of Veterans accepting treatments resulting in improved overall quality of life and survival outcomes.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

PURPOSE

To improve veteran surgical literacy, satisfaction, and overall outcomes.

BACKGROUND

For years, discharge education at the New Mexico VAHCS consisted of a fill-in templated non-specific and limited facility wide CPRS note written above an 8th grade reading level. Specific surgical instructions were not provided regarding drain/catheter/ostomy/wound care, activity and bathing instructions, and signs and symptoms to notify the provider. This resulted in post-discharge anxiety, provider calls, and avoidable re-admissions.

METHODS

Nurse Navigator/Patient Educator position was created and filled with intent to create discharge education database specific to diagnosis and procedure, 1:1 patient centered education, and direct access to subject matter expert. The Navigators collaborated with surgeons to develop concise post-operative, evidence- based education, which included easy to read diagrams, 8th grade reading level, and 14 font. Packets were approved through the VHEC/I committee for distribution and stored on the VA Intranet for afterhours ward access to ensure consistency.

RESULTS

28 educational packets were created for the most common surgeries completed to customize education to fit individual needs of the Veteran. Each packet contains basic information regarding the procedure and wound care, but is customizable to include specific drain, catheter, or ostomy teaching. The Navigators meet with the Veteran prior to surgery to develop trusting relationships and begin the education process. After surgery, they visit daily to reinforce education with teach back demonstrations and encourage self-care. Family members are included in education sessions and are provided time for questions. The Navigators ensure veterans do not leave the hospital without necessary equipment and medications. As a result, the NMVAHCS has experienced improvements in the Survey of Healthcare Experiences of Patients (SHEP) scores. Prior to improvements in the educational process, SHEP scores related to discharge education identified areas of concern. After hiring Nurse Navigators, SHEP scores for discharge information increased to 90.3%. General Surgery 14-day readmission rate improved (2.9% in FY 21 to 1.7% FY 22); and 30-day readmission rate improved (12.8% FY21 to 8.7% FY 22), despite increased operative volume.

IMPLICATIONS

Providing Veteran Centered Care with comprehensive education improves selfcare, patient satisfaction, and decreases avoidable readmissions.

PURPOSE

To improve veteran surgical literacy, satisfaction, and overall outcomes.

BACKGROUND

For years, discharge education at the New Mexico VAHCS consisted of a fill-in templated non-specific and limited facility wide CPRS note written above an 8th grade reading level. Specific surgical instructions were not provided regarding drain/catheter/ostomy/wound care, activity and bathing instructions, and signs and symptoms to notify the provider. This resulted in post-discharge anxiety, provider calls, and avoidable re-admissions.

METHODS

Nurse Navigator/Patient Educator position was created and filled with intent to create discharge education database specific to diagnosis and procedure, 1:1 patient centered education, and direct access to subject matter expert. The Navigators collaborated with surgeons to develop concise post-operative, evidence- based education, which included easy to read diagrams, 8th grade reading level, and 14 font. Packets were approved through the VHEC/I committee for distribution and stored on the VA Intranet for afterhours ward access to ensure consistency.

RESULTS

28 educational packets were created for the most common surgeries completed to customize education to fit individual needs of the Veteran. Each packet contains basic information regarding the procedure and wound care, but is customizable to include specific drain, catheter, or ostomy teaching. The Navigators meet with the Veteran prior to surgery to develop trusting relationships and begin the education process. After surgery, they visit daily to reinforce education with teach back demonstrations and encourage self-care. Family members are included in education sessions and are provided time for questions. The Navigators ensure veterans do not leave the hospital without necessary equipment and medications. As a result, the NMVAHCS has experienced improvements in the Survey of Healthcare Experiences of Patients (SHEP) scores. Prior to improvements in the educational process, SHEP scores related to discharge education identified areas of concern. After hiring Nurse Navigators, SHEP scores for discharge information increased to 90.3%. General Surgery 14-day readmission rate improved (2.9% in FY 21 to 1.7% FY 22); and 30-day readmission rate improved (12.8% FY21 to 8.7% FY 22), despite increased operative volume.

IMPLICATIONS

Providing Veteran Centered Care with comprehensive education improves selfcare, patient satisfaction, and decreases avoidable readmissions.

PURPOSE

To improve veteran surgical literacy, satisfaction, and overall outcomes.

BACKGROUND

For years, discharge education at the New Mexico VAHCS consisted of a fill-in templated non-specific and limited facility wide CPRS note written above an 8th grade reading level. Specific surgical instructions were not provided regarding drain/catheter/ostomy/wound care, activity and bathing instructions, and signs and symptoms to notify the provider. This resulted in post-discharge anxiety, provider calls, and avoidable re-admissions.

METHODS

Nurse Navigator/Patient Educator position was created and filled with intent to create discharge education database specific to diagnosis and procedure, 1:1 patient centered education, and direct access to subject matter expert. The Navigators collaborated with surgeons to develop concise post-operative, evidence- based education, which included easy to read diagrams, 8th grade reading level, and 14 font. Packets were approved through the VHEC/I committee for distribution and stored on the VA Intranet for afterhours ward access to ensure consistency.

RESULTS

28 educational packets were created for the most common surgeries completed to customize education to fit individual needs of the Veteran. Each packet contains basic information regarding the procedure and wound care, but is customizable to include specific drain, catheter, or ostomy teaching. The Navigators meet with the Veteran prior to surgery to develop trusting relationships and begin the education process. After surgery, they visit daily to reinforce education with teach back demonstrations and encourage self-care. Family members are included in education sessions and are provided time for questions. The Navigators ensure veterans do not leave the hospital without necessary equipment and medications. As a result, the NMVAHCS has experienced improvements in the Survey of Healthcare Experiences of Patients (SHEP) scores. Prior to improvements in the educational process, SHEP scores related to discharge education identified areas of concern. After hiring Nurse Navigators, SHEP scores for discharge information increased to 90.3%. General Surgery 14-day readmission rate improved (2.9% in FY 21 to 1.7% FY 22); and 30-day readmission rate improved (12.8% FY21 to 8.7% FY 22), despite increased operative volume.

IMPLICATIONS

Providing Veteran Centered Care with comprehensive education improves selfcare, patient satisfaction, and decreases avoidable readmissions.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

BACKGROUND

Prostate cancer is one of the most common oncologic diagnoses in VA. Follow-up after radiation treatment involves PSA lab work and a provider visit every 6 months to evaluate for recurrence and longterm side effects. This requires a large amount of VA resources in terms of staff time and can lead to reduced provider access and increased outsourcing costs. If the veteran has in person appointments, this also increases time and travel costs for the veteran.

METHODS

The Cleveland VA Radiation Oncology department has designed a novel Prostate Cancer Tracker to monitor veterans for prostate cancer follow-up. The novel workflow uses a combination of data analysis and sorting techniques along with a dedicated clinical team to triage patients to (1) direct counseling for biochemical recurrence or (2) continued follow-up through the tracker. This process improves resource utilization, efficiently tracks patients, and reduces the risk of a patient lost to follow-up. The program started in August 2022 and has been running in a pilot phase until January 2023. Patient statistics using VA analytics were collected for January 2023 to March 2023.

RESULTS

At the end of March 2023, the tracker contained 250 patients. 56 veterans had their lab work coordinated with PCP labs to avoid unnecessary needle sticks. 50 letters for overdue labs were sent out of which 31 resulted in returning to standard of care follow up. 6 patients were converted from the tracker to in person for counseling regarding biochemical recurrence. The number of in person appointments saved was 80 per month, resulting in better access for providers and savings for veterans for miles driven and veteran’s time. In addition, we have reduced outsourcing costs by re-capturing outsourced veterans back to VA for prostate cancer follow-up.

CONCLUSIONS

The prostate cancer tracker workflow is a novel workflow that has had a successful pilot as a VA iNET seed investee. We plan to expand its use within our department and further quantify improvements for the VA. We are actively looking to expand to other VA sites.

BACKGROUND

Prostate cancer is one of the most common oncologic diagnoses in VA. Follow-up after radiation treatment involves PSA lab work and a provider visit every 6 months to evaluate for recurrence and longterm side effects. This requires a large amount of VA resources in terms of staff time and can lead to reduced provider access and increased outsourcing costs. If the veteran has in person appointments, this also increases time and travel costs for the veteran.

METHODS

The Cleveland VA Radiation Oncology department has designed a novel Prostate Cancer Tracker to monitor veterans for prostate cancer follow-up. The novel workflow uses a combination of data analysis and sorting techniques along with a dedicated clinical team to triage patients to (1) direct counseling for biochemical recurrence or (2) continued follow-up through the tracker. This process improves resource utilization, efficiently tracks patients, and reduces the risk of a patient lost to follow-up. The program started in August 2022 and has been running in a pilot phase until January 2023. Patient statistics using VA analytics were collected for January 2023 to March 2023.

RESULTS

At the end of March 2023, the tracker contained 250 patients. 56 veterans had their lab work coordinated with PCP labs to avoid unnecessary needle sticks. 50 letters for overdue labs were sent out of which 31 resulted in returning to standard of care follow up. 6 patients were converted from the tracker to in person for counseling regarding biochemical recurrence. The number of in person appointments saved was 80 per month, resulting in better access for providers and savings for veterans for miles driven and veteran’s time. In addition, we have reduced outsourcing costs by re-capturing outsourced veterans back to VA for prostate cancer follow-up.

CONCLUSIONS

The prostate cancer tracker workflow is a novel workflow that has had a successful pilot as a VA iNET seed investee. We plan to expand its use within our department and further quantify improvements for the VA. We are actively looking to expand to other VA sites.

BACKGROUND

Prostate cancer is one of the most common oncologic diagnoses in VA. Follow-up after radiation treatment involves PSA lab work and a provider visit every 6 months to evaluate for recurrence and longterm side effects. This requires a large amount of VA resources in terms of staff time and can lead to reduced provider access and increased outsourcing costs. If the veteran has in person appointments, this also increases time and travel costs for the veteran.

METHODS

The Cleveland VA Radiation Oncology department has designed a novel Prostate Cancer Tracker to monitor veterans for prostate cancer follow-up. The novel workflow uses a combination of data analysis and sorting techniques along with a dedicated clinical team to triage patients to (1) direct counseling for biochemical recurrence or (2) continued follow-up through the tracker. This process improves resource utilization, efficiently tracks patients, and reduces the risk of a patient lost to follow-up. The program started in August 2022 and has been running in a pilot phase until January 2023. Patient statistics using VA analytics were collected for January 2023 to March 2023.

RESULTS

At the end of March 2023, the tracker contained 250 patients. 56 veterans had their lab work coordinated with PCP labs to avoid unnecessary needle sticks. 50 letters for overdue labs were sent out of which 31 resulted in returning to standard of care follow up. 6 patients were converted from the tracker to in person for counseling regarding biochemical recurrence. The number of in person appointments saved was 80 per month, resulting in better access for providers and savings for veterans for miles driven and veteran’s time. In addition, we have reduced outsourcing costs by re-capturing outsourced veterans back to VA for prostate cancer follow-up.

CONCLUSIONS

The prostate cancer tracker workflow is a novel workflow that has had a successful pilot as a VA iNET seed investee. We plan to expand its use within our department and further quantify improvements for the VA. We are actively looking to expand to other VA sites.