Cancer

Background

19.8% of all deaths in the US in 2023 were due to cancer. Despite its prevalence, there is minimal literature analyzing geographical trends in end-of-life care in cancer patients. This study aims to assess the evolution of end-of-life preferences in cancer patients, particularly during the COVID-19 pandemic, and account for geographical disparities to optimize palliative care delivery.

Methods

The CDC WONDER database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old that died with malignant neoplasms (ICD 10: C00- C97) in the US from 2003-2023. Deaths were stratified by region and urbanization. Proportional mortality was calculated, and statistically significant trends in mortality over time were identified using Joinpoint regression.

Results

There were 13,654,631 total deaths from malignant neoplasms over the study period. Home (40.3%) was the most common place of death followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decreased in proportion except for home which rose 7.0% from 41.7% to 48.7%. The South had the highest hospice rates (11.3%); 5.0% greater than the next highest region (Northeast; 8.3%). The West had the highest home rates (47.1%); 6.2% greater than the next closest region (South; 40.9%). The Northeast had the highest medical facility rates (36.0%); 5.5% higher than the next highest region (South, 30.5%). Nonmetro areas (< 50,000 population) had the lowest hospice (4.9%) and highest nursing home rates (15.8%). They also saw a substantial jump (+15.4%) in home deaths from 2019-21. All urbanizations saw a drop in medical facility deaths in 2020 but all have since climbed to surpass their 2019 rates except for nonmetro areas which have dropped 7.3% from 2020-2023.

Conclusion

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Geographical disparities persist in end-of-life care, particularly in nonmetro areas. This highlights the need to increase education and access to palliative care. Further research should aim at why the rural populations have failed to revert to pre-COVID trends like the other urbanization groups.

Background

19.8% of all deaths in the US in 2023 were due to cancer. Despite its prevalence, there is minimal literature analyzing geographical trends in end-of-life care in cancer patients. This study aims to assess the evolution of end-of-life preferences in cancer patients, particularly during the COVID-19 pandemic, and account for geographical disparities to optimize palliative care delivery.

Methods

The CDC WONDER database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old that died with malignant neoplasms (ICD 10: C00- C97) in the US from 2003-2023. Deaths were stratified by region and urbanization. Proportional mortality was calculated, and statistically significant trends in mortality over time were identified using Joinpoint regression.

Results

There were 13,654,631 total deaths from malignant neoplasms over the study period. Home (40.3%) was the most common place of death followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decreased in proportion except for home which rose 7.0% from 41.7% to 48.7%. The South had the highest hospice rates (11.3%); 5.0% greater than the next highest region (Northeast; 8.3%). The West had the highest home rates (47.1%); 6.2% greater than the next closest region (South; 40.9%). The Northeast had the highest medical facility rates (36.0%); 5.5% higher than the next highest region (South, 30.5%). Nonmetro areas (< 50,000 population) had the lowest hospice (4.9%) and highest nursing home rates (15.8%). They also saw a substantial jump (+15.4%) in home deaths from 2019-21. All urbanizations saw a drop in medical facility deaths in 2020 but all have since climbed to surpass their 2019 rates except for nonmetro areas which have dropped 7.3% from 2020-2023.

Conclusion

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Geographical disparities persist in end-of-life care, particularly in nonmetro areas. This highlights the need to increase education and access to palliative care. Further research should aim at why the rural populations have failed to revert to pre-COVID trends like the other urbanization groups.

Background

19.8% of all deaths in the US in 2023 were due to cancer. Despite its prevalence, there is minimal literature analyzing geographical trends in end-of-life care in cancer patients. This study aims to assess the evolution of end-of-life preferences in cancer patients, particularly during the COVID-19 pandemic, and account for geographical disparities to optimize palliative care delivery.

Methods

The CDC WONDER database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old that died with malignant neoplasms (ICD 10: C00- C97) in the US from 2003-2023. Deaths were stratified by region and urbanization. Proportional mortality was calculated, and statistically significant trends in mortality over time were identified using Joinpoint regression.

Results

There were 13,654,631 total deaths from malignant neoplasms over the study period. Home (40.3%) was the most common place of death followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decreased in proportion except for home which rose 7.0% from 41.7% to 48.7%. The South had the highest hospice rates (11.3%); 5.0% greater than the next highest region (Northeast; 8.3%). The West had the highest home rates (47.1%); 6.2% greater than the next closest region (South; 40.9%). The Northeast had the highest medical facility rates (36.0%); 5.5% higher than the next highest region (South, 30.5%). Nonmetro areas (< 50,000 population) had the lowest hospice (4.9%) and highest nursing home rates (15.8%). They also saw a substantial jump (+15.4%) in home deaths from 2019-21. All urbanizations saw a drop in medical facility deaths in 2020 but all have since climbed to surpass their 2019 rates except for nonmetro areas which have dropped 7.3% from 2020-2023.

Conclusion

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Geographical disparities persist in end-of-life care, particularly in nonmetro areas. This highlights the need to increase education and access to palliative care. Further research should aim at why the rural populations have failed to revert to pre-COVID trends like the other urbanization groups.

Background

In 2024, it was estimated that 2,001,140 new cases of cancer were diagnosed in the United States with 611,720 people succumbing to the disease. There is scant literature analyzing how the place of death in cancer patients has evolved over time, particularly during the COVID-19 pandemic, and how it varies demographically. This study aims to analyze the evolution of end-of-life preferences in cancer patients and assess for racial or sexual disparities to optimize palliative care and ensure it aligns with the patient’s wishes.

Methods

The CDC Wonder database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old who died with malignant neoplasms (ICD-10: C00-C97) in the US from 2003-2023. Deaths were stratified by sex and race. Proportional mortality was calculated, and statistically significant temporal trends in mortality were identified using Joinpoint regression.

Results

From 2003 to 2023, there were 13,654,631 total deaths from malignant cancer. Home deaths were the most common (40.3%) followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decrease in proportion except for home which rose 7.1%. From 2003-2023, home (+4.0%) and hospice (+10.0%) rose in frequency while medical facility (-10.9%) and nursing home (-6.8%) declined. Females died in nursing homes at a greater proportion than males (15.8% vs. 13.1%) while males died in medical facilities more frequently (32.4% vs. 28.8%). Black patients were the least likely to die at home (33.1%), 5.9% less than the next lowest (Asian/ Pacific Islander; 39.0%), while Hispanic patients were most likely (46.9%); 5.7% more than the next highest (White, 41.7%). White patients were the least likely to die in medical facilities (28.4%) but were also most likely to die in nursing homes (15.3%).

Conclusions

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Disparities persist in end-of-life care across both sex and racial groups. This highlights the need to increase education and access to palliative care. Further research should elucidate cultural and racial discrepancies surrounding end-of-life treatment and preferences to provide context for these differences.

Background

In 2024, it was estimated that 2,001,140 new cases of cancer were diagnosed in the United States with 611,720 people succumbing to the disease. There is scant literature analyzing how the place of death in cancer patients has evolved over time, particularly during the COVID-19 pandemic, and how it varies demographically. This study aims to analyze the evolution of end-of-life preferences in cancer patients and assess for racial or sexual disparities to optimize palliative care and ensure it aligns with the patient’s wishes.

Methods

The CDC Wonder database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old who died with malignant neoplasms (ICD-10: C00-C97) in the US from 2003-2023. Deaths were stratified by sex and race. Proportional mortality was calculated, and statistically significant temporal trends in mortality were identified using Joinpoint regression.

Results

From 2003 to 2023, there were 13,654,631 total deaths from malignant cancer. Home deaths were the most common (40.3%) followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decrease in proportion except for home which rose 7.1%. From 2003-2023, home (+4.0%) and hospice (+10.0%) rose in frequency while medical facility (-10.9%) and nursing home (-6.8%) declined. Females died in nursing homes at a greater proportion than males (15.8% vs. 13.1%) while males died in medical facilities more frequently (32.4% vs. 28.8%). Black patients were the least likely to die at home (33.1%), 5.9% less than the next lowest (Asian/ Pacific Islander; 39.0%), while Hispanic patients were most likely (46.9%); 5.7% more than the next highest (White, 41.7%). White patients were the least likely to die in medical facilities (28.4%) but were also most likely to die in nursing homes (15.3%).

Conclusions

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Disparities persist in end-of-life care across both sex and racial groups. This highlights the need to increase education and access to palliative care. Further research should elucidate cultural and racial discrepancies surrounding end-of-life treatment and preferences to provide context for these differences.

Background

In 2024, it was estimated that 2,001,140 new cases of cancer were diagnosed in the United States with 611,720 people succumbing to the disease. There is scant literature analyzing how the place of death in cancer patients has evolved over time, particularly during the COVID-19 pandemic, and how it varies demographically. This study aims to analyze the evolution of end-of-life preferences in cancer patients and assess for racial or sexual disparities to optimize palliative care and ensure it aligns with the patient’s wishes.

Methods

The CDC Wonder database was used to collect data on place of death (home, hospice, medical facilities, nursing homes) in patients over 25 years old who died with malignant neoplasms (ICD-10: C00-C97) in the US from 2003-2023. Deaths were stratified by sex and race. Proportional mortality was calculated, and statistically significant temporal trends in mortality were identified using Joinpoint regression.

Results

From 2003 to 2023, there were 13,654,631 total deaths from malignant cancer. Home deaths were the most common (40.3%) followed by medical facilities (30.4%), nursing homes (14.3%), and hospice (8.9%). In 2020, all places experienced a decrease in proportion except for home which rose 7.1%. From 2003-2023, home (+4.0%) and hospice (+10.0%) rose in frequency while medical facility (-10.9%) and nursing home (-6.8%) declined. Females died in nursing homes at a greater proportion than males (15.8% vs. 13.1%) while males died in medical facilities more frequently (32.4% vs. 28.8%). Black patients were the least likely to die at home (33.1%), 5.9% less than the next lowest (Asian/ Pacific Islander; 39.0%), while Hispanic patients were most likely (46.9%); 5.7% more than the next highest (White, 41.7%). White patients were the least likely to die in medical facilities (28.4%) but were also most likely to die in nursing homes (15.3%).

Conclusions

Hospice and home deaths have increased in frequency with home deaths spiking during the COVID-19 pandemic. Disparities persist in end-of-life care across both sex and racial groups. This highlights the need to increase education and access to palliative care. Further research should elucidate cultural and racial discrepancies surrounding end-of-life treatment and preferences to provide context for these differences.

Purpose

Skin adnexal tumors (SAT) include a group of benign and malignant appendageal tumors that arise from hair follicles, sebaceous glands, or sweat glands. They typically appear as small, painless bumps or nodules on the skin, and are more common in men compared to women. The 5-year overall SAT survival rate ranges from 74-90%. To better understand the differences in survival outcomes based on subtypes of SAT, the National Cancer Database (NCDB) was analyzed.

Methods

A retrospective cohort study of 11,627 patients with histologically confirmed SAT between 2004 and 2021 was conducted across 1,500 Commission on Cancer facilities located in the US and Puerto Rico. Demographic factors such as sex, age, and race were analyzed using Pearson Chi-squared tests, and survival outcomes were analyzed by Kaplan- Meier survival analysis. P value < 0.05 was considered statistically significant.

Results

Most patients with SAT were male (57.3%). The average age at diagnosis was 65.9 (SD=14.4, range 0-90). Of the patient sample, 87.2% were White, 7.6% Black, 2.5% Asian, and 2.7% other. Several subtypes disproportionately affected Black individuals, including apocrine adenocarcinoma (15.7%) and hidradenocarcinoma (13.6%). The estimated 5-year survival of SAT was 74.9% with an overall survival of 135.8 months (SE=1.1). Sebaceous carcinoma (which accounts for 41.8% of all cases) had the lowest average survival time of 119.6 months (SE=1.8), while digital papillary adenocarcinoma had the highest survival at around 183.5 months (SE=4.6).

Conclusions

This study supports a higher frequency of SAT among men. While White patients were more likely to get SAT overall, including the most common sebaceous carcinoma, Black race were associated with higher frequency of rarer subtypes. The average age of diagnosis of SAT mimics other non-melanoma skin cancers, but has a lower overall survival rate. Future studies should consider other risk factors that may be impacting the differences in survival outcomes to guide treatment and address health disparities among the various subtypes.

Purpose

Skin adnexal tumors (SAT) include a group of benign and malignant appendageal tumors that arise from hair follicles, sebaceous glands, or sweat glands. They typically appear as small, painless bumps or nodules on the skin, and are more common in men compared to women. The 5-year overall SAT survival rate ranges from 74-90%. To better understand the differences in survival outcomes based on subtypes of SAT, the National Cancer Database (NCDB) was analyzed.

Methods

A retrospective cohort study of 11,627 patients with histologically confirmed SAT between 2004 and 2021 was conducted across 1,500 Commission on Cancer facilities located in the US and Puerto Rico. Demographic factors such as sex, age, and race were analyzed using Pearson Chi-squared tests, and survival outcomes were analyzed by Kaplan- Meier survival analysis. P value < 0.05 was considered statistically significant.

Results

Most patients with SAT were male (57.3%). The average age at diagnosis was 65.9 (SD=14.4, range 0-90). Of the patient sample, 87.2% were White, 7.6% Black, 2.5% Asian, and 2.7% other. Several subtypes disproportionately affected Black individuals, including apocrine adenocarcinoma (15.7%) and hidradenocarcinoma (13.6%). The estimated 5-year survival of SAT was 74.9% with an overall survival of 135.8 months (SE=1.1). Sebaceous carcinoma (which accounts for 41.8% of all cases) had the lowest average survival time of 119.6 months (SE=1.8), while digital papillary adenocarcinoma had the highest survival at around 183.5 months (SE=4.6).

Conclusions

This study supports a higher frequency of SAT among men. While White patients were more likely to get SAT overall, including the most common sebaceous carcinoma, Black race were associated with higher frequency of rarer subtypes. The average age of diagnosis of SAT mimics other non-melanoma skin cancers, but has a lower overall survival rate. Future studies should consider other risk factors that may be impacting the differences in survival outcomes to guide treatment and address health disparities among the various subtypes.

Purpose

Skin adnexal tumors (SAT) include a group of benign and malignant appendageal tumors that arise from hair follicles, sebaceous glands, or sweat glands. They typically appear as small, painless bumps or nodules on the skin, and are more common in men compared to women. The 5-year overall SAT survival rate ranges from 74-90%. To better understand the differences in survival outcomes based on subtypes of SAT, the National Cancer Database (NCDB) was analyzed.

Methods

A retrospective cohort study of 11,627 patients with histologically confirmed SAT between 2004 and 2021 was conducted across 1,500 Commission on Cancer facilities located in the US and Puerto Rico. Demographic factors such as sex, age, and race were analyzed using Pearson Chi-squared tests, and survival outcomes were analyzed by Kaplan- Meier survival analysis. P value < 0.05 was considered statistically significant.

Results

Most patients with SAT were male (57.3%). The average age at diagnosis was 65.9 (SD=14.4, range 0-90). Of the patient sample, 87.2% were White, 7.6% Black, 2.5% Asian, and 2.7% other. Several subtypes disproportionately affected Black individuals, including apocrine adenocarcinoma (15.7%) and hidradenocarcinoma (13.6%). The estimated 5-year survival of SAT was 74.9% with an overall survival of 135.8 months (SE=1.1). Sebaceous carcinoma (which accounts for 41.8% of all cases) had the lowest average survival time of 119.6 months (SE=1.8), while digital papillary adenocarcinoma had the highest survival at around 183.5 months (SE=4.6).

Conclusions

This study supports a higher frequency of SAT among men. While White patients were more likely to get SAT overall, including the most common sebaceous carcinoma, Black race were associated with higher frequency of rarer subtypes. The average age of diagnosis of SAT mimics other non-melanoma skin cancers, but has a lower overall survival rate. Future studies should consider other risk factors that may be impacting the differences in survival outcomes to guide treatment and address health disparities among the various subtypes.

Background

Studies show that early referral to Specialty Palliative Care (SPC) can improve patient- reported outcomes among Veterans with cancer; quality metrics include referral within 8 weeks of an advanced cancer diagnosis. In this study, we explored timeliness of specialty referrals and compared various factors.

Methods

We identified our cohort using Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW). Eligibility criteria included active or history of cancer—using a peer-reviewed, in-house list of ICD-9 and ICD-10 codes—between 2013-2023. We stratified our cohort of Veterans using factors including cancer stage, rurality, and care assessment needs (CAN) scores. We performed survival analyses to look at time to SPC from initial diagnosis and peak CAN score. Predictors of utilization were evaluated using multinomial regression and Cox proportional hazards models through R.

Results

Using CDW’s oncology domain, we identified 475,775 Veterans. 28% received SPC. Most received it near the end of their life as evidenced by the mortality rates (79.5%) in the early period following SPC consultation. Median time to SPC was 515 days. There was a significant difference in utilization rates between urban and rural Veterans (Wilcoxon W-statistic = 2.31E+10, p < 0.001). Peak CAN scores ranged from 0 to 0.81, median peak of 0.057 and interquartile range of 0.1. Multinomial regression model indicated statistically significant associations of advanced cancer (Stages 3 and 4) with timing of SPC. Stage 4 cancer showed the strongest association with receipt of palliative care within 60 days of initial diagnosis (OR 4.8, 95% CI: 4.69-4.93, p < 0.001), suggesting higher stage disease increases the likelihood of palliative care referral and accelerates the timing of these referrals.

Conclusions

We found Veterans received SPC from a broad range of peak CAN scores (0 to 0.81), suggesting that absolute CAN scores may not be clinically actionable indicators but perhaps indicative of changes in condition warranting referral. Stage IV cancer at diagnosis was associated with early SPC. The significant differences in utilization rates between urban and rural patients highlight potential access barriers that should be addressed.

Background

Studies show that early referral to Specialty Palliative Care (SPC) can improve patient- reported outcomes among Veterans with cancer; quality metrics include referral within 8 weeks of an advanced cancer diagnosis. In this study, we explored timeliness of specialty referrals and compared various factors.

Methods

We identified our cohort using Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW). Eligibility criteria included active or history of cancer—using a peer-reviewed, in-house list of ICD-9 and ICD-10 codes—between 2013-2023. We stratified our cohort of Veterans using factors including cancer stage, rurality, and care assessment needs (CAN) scores. We performed survival analyses to look at time to SPC from initial diagnosis and peak CAN score. Predictors of utilization were evaluated using multinomial regression and Cox proportional hazards models through R.

Results

Using CDW’s oncology domain, we identified 475,775 Veterans. 28% received SPC. Most received it near the end of their life as evidenced by the mortality rates (79.5%) in the early period following SPC consultation. Median time to SPC was 515 days. There was a significant difference in utilization rates between urban and rural Veterans (Wilcoxon W-statistic = 2.31E+10, p < 0.001). Peak CAN scores ranged from 0 to 0.81, median peak of 0.057 and interquartile range of 0.1. Multinomial regression model indicated statistically significant associations of advanced cancer (Stages 3 and 4) with timing of SPC. Stage 4 cancer showed the strongest association with receipt of palliative care within 60 days of initial diagnosis (OR 4.8, 95% CI: 4.69-4.93, p < 0.001), suggesting higher stage disease increases the likelihood of palliative care referral and accelerates the timing of these referrals.

Conclusions

We found Veterans received SPC from a broad range of peak CAN scores (0 to 0.81), suggesting that absolute CAN scores may not be clinically actionable indicators but perhaps indicative of changes in condition warranting referral. Stage IV cancer at diagnosis was associated with early SPC. The significant differences in utilization rates between urban and rural patients highlight potential access barriers that should be addressed.

Background

Studies show that early referral to Specialty Palliative Care (SPC) can improve patient- reported outcomes among Veterans with cancer; quality metrics include referral within 8 weeks of an advanced cancer diagnosis. In this study, we explored timeliness of specialty referrals and compared various factors.

Methods

We identified our cohort using Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW). Eligibility criteria included active or history of cancer—using a peer-reviewed, in-house list of ICD-9 and ICD-10 codes—between 2013-2023. We stratified our cohort of Veterans using factors including cancer stage, rurality, and care assessment needs (CAN) scores. We performed survival analyses to look at time to SPC from initial diagnosis and peak CAN score. Predictors of utilization were evaluated using multinomial regression and Cox proportional hazards models through R.

Results

Using CDW’s oncology domain, we identified 475,775 Veterans. 28% received SPC. Most received it near the end of their life as evidenced by the mortality rates (79.5%) in the early period following SPC consultation. Median time to SPC was 515 days. There was a significant difference in utilization rates between urban and rural Veterans (Wilcoxon W-statistic = 2.31E+10, p < 0.001). Peak CAN scores ranged from 0 to 0.81, median peak of 0.057 and interquartile range of 0.1. Multinomial regression model indicated statistically significant associations of advanced cancer (Stages 3 and 4) with timing of SPC. Stage 4 cancer showed the strongest association with receipt of palliative care within 60 days of initial diagnosis (OR 4.8, 95% CI: 4.69-4.93, p < 0.001), suggesting higher stage disease increases the likelihood of palliative care referral and accelerates the timing of these referrals.

Conclusions

We found Veterans received SPC from a broad range of peak CAN scores (0 to 0.81), suggesting that absolute CAN scores may not be clinically actionable indicators but perhaps indicative of changes in condition warranting referral. Stage IV cancer at diagnosis was associated with early SPC. The significant differences in utilization rates between urban and rural patients highlight potential access barriers that should be addressed.

Background

To close the food insecurity gap by providing food assistance and increasing opportunities for screening in Veterans receiving cancer treatment at a VA outpatient cancer clinic. Food Insecurity is associated with chronic disease such as cancer given insufficient access to nutritious foods leading to nutritional deficiencies and worsening health outcomes. The rates of food insecurity among Veterans revealed 28% of female veterans and 16% overall in male Veterans were faced with limited or uncertain access to adequate food.

Methods

A pivotal distress screening occurs at time of education consult or cycle 1 day 1 of antineoplastic therapy. A positive screening for any practical concern generates a discussion about food insecurity. A positive distress screen triggers an oncology social work referral to complete a systematic screening assessing circumstances and offering resources for needs (ACORN).

Results

Root cause analysis uncovered 24% of Veterans with cancer screened positive for food insecurity in the 9E oncology outpatient clinic. Post-implementation of robust screenings and conversation initiatives identified 36 unique Veterans who received 251 meals from July to December 2024.

Sustainability/Scalability

Prospective screening of Veterans at the time of a cancer diagnosis and ongoing screening during cancer treatment is the first step toward uncovering food insecurity and addressing this social determinate of health. A standard operating procedure following VA guidance and distress management guidelines should be updated as required. Oversight of the cancer leadership team annually evaluates the distress process, and the findings are reported to the cancer committee.

Conclusions

Uncovering food insecurity in Veterans at time of diagnosis and during cancer treatment is critical to optimize treatment outcomes. A systematic and robust screening standard operating procedure is key to implement. Veterans are a unique population with a spectrum of socioeconomic needs. Case management conferences or weekly huddles to discuss the Veteran’s needs will ensure food insecurity is addressed. Collection and analysis of screening data will highlight a program’s food insecurity need and supports community partnerships to available food resources and the opportunity to create a cancer outpatient clinic food hub for Veterans receiving cancer treatment.

Background

To close the food insecurity gap by providing food assistance and increasing opportunities for screening in Veterans receiving cancer treatment at a VA outpatient cancer clinic. Food Insecurity is associated with chronic disease such as cancer given insufficient access to nutritious foods leading to nutritional deficiencies and worsening health outcomes. The rates of food insecurity among Veterans revealed 28% of female veterans and 16% overall in male Veterans were faced with limited or uncertain access to adequate food.

Methods

A pivotal distress screening occurs at time of education consult or cycle 1 day 1 of antineoplastic therapy. A positive screening for any practical concern generates a discussion about food insecurity. A positive distress screen triggers an oncology social work referral to complete a systematic screening assessing circumstances and offering resources for needs (ACORN).

Results

Root cause analysis uncovered 24% of Veterans with cancer screened positive for food insecurity in the 9E oncology outpatient clinic. Post-implementation of robust screenings and conversation initiatives identified 36 unique Veterans who received 251 meals from July to December 2024.

Sustainability/Scalability

Prospective screening of Veterans at the time of a cancer diagnosis and ongoing screening during cancer treatment is the first step toward uncovering food insecurity and addressing this social determinate of health. A standard operating procedure following VA guidance and distress management guidelines should be updated as required. Oversight of the cancer leadership team annually evaluates the distress process, and the findings are reported to the cancer committee.

Conclusions

Uncovering food insecurity in Veterans at time of diagnosis and during cancer treatment is critical to optimize treatment outcomes. A systematic and robust screening standard operating procedure is key to implement. Veterans are a unique population with a spectrum of socioeconomic needs. Case management conferences or weekly huddles to discuss the Veteran’s needs will ensure food insecurity is addressed. Collection and analysis of screening data will highlight a program’s food insecurity need and supports community partnerships to available food resources and the opportunity to create a cancer outpatient clinic food hub for Veterans receiving cancer treatment.

Background

To close the food insecurity gap by providing food assistance and increasing opportunities for screening in Veterans receiving cancer treatment at a VA outpatient cancer clinic. Food Insecurity is associated with chronic disease such as cancer given insufficient access to nutritious foods leading to nutritional deficiencies and worsening health outcomes. The rates of food insecurity among Veterans revealed 28% of female veterans and 16% overall in male Veterans were faced with limited or uncertain access to adequate food.

Methods

A pivotal distress screening occurs at time of education consult or cycle 1 day 1 of antineoplastic therapy. A positive screening for any practical concern generates a discussion about food insecurity. A positive distress screen triggers an oncology social work referral to complete a systematic screening assessing circumstances and offering resources for needs (ACORN).

Results

Root cause analysis uncovered 24% of Veterans with cancer screened positive for food insecurity in the 9E oncology outpatient clinic. Post-implementation of robust screenings and conversation initiatives identified 36 unique Veterans who received 251 meals from July to December 2024.

Sustainability/Scalability

Prospective screening of Veterans at the time of a cancer diagnosis and ongoing screening during cancer treatment is the first step toward uncovering food insecurity and addressing this social determinate of health. A standard operating procedure following VA guidance and distress management guidelines should be updated as required. Oversight of the cancer leadership team annually evaluates the distress process, and the findings are reported to the cancer committee.

Conclusions

Uncovering food insecurity in Veterans at time of diagnosis and during cancer treatment is critical to optimize treatment outcomes. A systematic and robust screening standard operating procedure is key to implement. Veterans are a unique population with a spectrum of socioeconomic needs. Case management conferences or weekly huddles to discuss the Veteran’s needs will ensure food insecurity is addressed. Collection and analysis of screening data will highlight a program’s food insecurity need and supports community partnerships to available food resources and the opportunity to create a cancer outpatient clinic food hub for Veterans receiving cancer treatment.

Purpose

The Veterans Affairs Central Cancer Registry (VACCR) is a data management system for cancer surveillance and epidemiologic-based efforts, seeking to reduce the overall cancer burden. In 2024, the local VACCR successfully implemented a Structured Query Language (SQL) code, created to identify documents in the electronic medical record (EMR) with associated ICD-10 codes matching reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) list. In 2025, code application expansion began at four additional VISN9 sites.

Outcomes Studied

Accuracy and usefulness of SQL code application in a significantly larger population and a diagnosis-specific population.

Methods

Local Cancer Program leadership collaborated with VISN9 leadership to expand the SQL code to the four sites’ EMR, identifying the Veteran’s name, social security number, location by city/state/county, and visit-associated data including location, ICD-10 code, and visit year. Data validation focused on ICD- 10-specific data and quality replication.

Results

After SQL code application to Mt Home TN VACCR data, 750 unique, randomized charts from 2015-2025 were selected for accuracy review. Data validation found that 90.5% (679) had a reportable cancer; 14.9% (112) were not entered into VACCR. 9.5% (71) were not reportable. The SQL code was applied to Lexington data to identify colorectal cancer (CRC) (ICD-10 codes C17-C21.9). 746 charts from 2015-2025 were identified. 88.9% (663) had a reportable CRC; 14.9% (111) of those were not entered into VACCR, and 11% (83) were not reportable. Most cases not entered into VACCR at both sites were cases in which the majority of care was provided through Care in the Community (CITC). Historically, identification of CITC-provided oncologic care has been manual and notoriously difficult.

Conclusions

This study demonstrated the feasibility and accuracy of the SQL code in the identification of Veterans with diagnoses matching the SEER list in a large population and at a diagnosis-specific level. VISN-wide use of the report will increase efficiency and timeliness of data entry into VACCR, especially related to care provided through CITC. An improved understanding of oncologic care in the VISN would provide critical data to VISN executive leadership, enabling them to advocate for resources, targeted interventions, and access to care.

Purpose

The Veterans Affairs Central Cancer Registry (VACCR) is a data management system for cancer surveillance and epidemiologic-based efforts, seeking to reduce the overall cancer burden. In 2024, the local VACCR successfully implemented a Structured Query Language (SQL) code, created to identify documents in the electronic medical record (EMR) with associated ICD-10 codes matching reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) list. In 2025, code application expansion began at four additional VISN9 sites.

Outcomes Studied

Accuracy and usefulness of SQL code application in a significantly larger population and a diagnosis-specific population.

Methods

Local Cancer Program leadership collaborated with VISN9 leadership to expand the SQL code to the four sites’ EMR, identifying the Veteran’s name, social security number, location by city/state/county, and visit-associated data including location, ICD-10 code, and visit year. Data validation focused on ICD- 10-specific data and quality replication.

Results

After SQL code application to Mt Home TN VACCR data, 750 unique, randomized charts from 2015-2025 were selected for accuracy review. Data validation found that 90.5% (679) had a reportable cancer; 14.9% (112) were not entered into VACCR. 9.5% (71) were not reportable. The SQL code was applied to Lexington data to identify colorectal cancer (CRC) (ICD-10 codes C17-C21.9). 746 charts from 2015-2025 were identified. 88.9% (663) had a reportable CRC; 14.9% (111) of those were not entered into VACCR, and 11% (83) were not reportable. Most cases not entered into VACCR at both sites were cases in which the majority of care was provided through Care in the Community (CITC). Historically, identification of CITC-provided oncologic care has been manual and notoriously difficult.

Conclusions

This study demonstrated the feasibility and accuracy of the SQL code in the identification of Veterans with diagnoses matching the SEER list in a large population and at a diagnosis-specific level. VISN-wide use of the report will increase efficiency and timeliness of data entry into VACCR, especially related to care provided through CITC. An improved understanding of oncologic care in the VISN would provide critical data to VISN executive leadership, enabling them to advocate for resources, targeted interventions, and access to care.

Purpose

The Veterans Affairs Central Cancer Registry (VACCR) is a data management system for cancer surveillance and epidemiologic-based efforts, seeking to reduce the overall cancer burden. In 2024, the local VACCR successfully implemented a Structured Query Language (SQL) code, created to identify documents in the electronic medical record (EMR) with associated ICD-10 codes matching reportable cancer cases in the Surveillance, Epidemiology, and End Results (SEER) list. In 2025, code application expansion began at four additional VISN9 sites.

Outcomes Studied

Accuracy and usefulness of SQL code application in a significantly larger population and a diagnosis-specific population.

Methods

Local Cancer Program leadership collaborated with VISN9 leadership to expand the SQL code to the four sites’ EMR, identifying the Veteran’s name, social security number, location by city/state/county, and visit-associated data including location, ICD-10 code, and visit year. Data validation focused on ICD- 10-specific data and quality replication.

Results

After SQL code application to Mt Home TN VACCR data, 750 unique, randomized charts from 2015-2025 were selected for accuracy review. Data validation found that 90.5% (679) had a reportable cancer; 14.9% (112) were not entered into VACCR. 9.5% (71) were not reportable. The SQL code was applied to Lexington data to identify colorectal cancer (CRC) (ICD-10 codes C17-C21.9). 746 charts from 2015-2025 were identified. 88.9% (663) had a reportable CRC; 14.9% (111) of those were not entered into VACCR, and 11% (83) were not reportable. Most cases not entered into VACCR at both sites were cases in which the majority of care was provided through Care in the Community (CITC). Historically, identification of CITC-provided oncologic care has been manual and notoriously difficult.

Conclusions

This study demonstrated the feasibility and accuracy of the SQL code in the identification of Veterans with diagnoses matching the SEER list in a large population and at a diagnosis-specific level. VISN-wide use of the report will increase efficiency and timeliness of data entry into VACCR, especially related to care provided through CITC. An improved understanding of oncologic care in the VISN would provide critical data to VISN executive leadership, enabling them to advocate for resources, targeted interventions, and access to care.

Background

In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.

Results

Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.

Conclusions

Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.

Background

In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.

Results

Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.

Conclusions

Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.

Background

In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.

Results

Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.

Conclusions

Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.

Background

Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.

Results

Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.

Discussion

This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.

Conclusions

Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.

Background

Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.

Results

Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.

Discussion

This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.

Conclusions

Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.

Background

Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.

Results

Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.

Discussion

This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.

Conclusions

Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.

Background

The American College of Surgeons’ Commission on Cancer (CoC) Accreditation requires establishment of a comprehensive cancer program, multi-disciplinary tumor boards, active cancer registry, quality improvement activities and cancer research.

Methods

In 2022, the Tibor Rubin VA Medical Center (TRVAMC) set out to obtain accreditation through enhancing workforce practices. Changes in workforce practices included (1) leadership engagement; (2) acquisition of staff; (3) enhancing staff efficiency and (4) inter-departmental collaboration, leading to CoC accreditation in August 2024. executive leadership team (ELT) buy-in was essential. ELT engagement included communicating the benefits of accreditation, alignment with organizational mission and values, protected time for Cancer Committee members, Chief of Staff presence in Cancer Committee, commitment to recruiting new staff, and membership in the Medical Executive Council to voice cancer program needs. New staff included a cancer program manager, cancer case conference RN care coordinator, certified oncology data specialist and survivorship nurse practitioner. Staff development included structured and focused training. Enhancing staff efficiency included developing standards of work with clear delineation of duties (delegation of specific CoC standards), decentralizing decision making, a shared governance council, and weekly Cancer Program meetings. These changes allowed staff members to be active, autonomous decision-making participants, and increased efficiency. Inter-departmental collaboration involved Hematology/Oncology, Surgery, Radiation Oncology, Pharmacy, Nutrition, Pathology, Palliative Care, Rehabilitation, Chaplaincy and Cancer Research, with key individuals serving as Cancer Committee members. Each department set performance goals and metrics. Each employee’s contribution was rated in annual performance reviews.

Results

TRVAMC thus elevated cancer care delivery standards through structured workforce practices within the framework of CoC standards required for accreditation. Additionally, the accreditation process achieved desirable and measurable outcomes, e.g. 100% growth in oncology dietitian referrals, 75% increase in early palliative care referrals (TRVAMC ranked in the top 5 in the US), and more than 200 patients enrolled in cancer clinical trials (TRVAMC was the highest enrolling VA in the US to NCI trials in 2024).

Conclusions

Our model demonstrates how strategic improvements in healthcare workforce practices at a VA can directly contribute to sustained improvements in quality and delivery of cancer care services.

Background

The American College of Surgeons’ Commission on Cancer (CoC) Accreditation requires establishment of a comprehensive cancer program, multi-disciplinary tumor boards, active cancer registry, quality improvement activities and cancer research.

Methods

In 2022, the Tibor Rubin VA Medical Center (TRVAMC) set out to obtain accreditation through enhancing workforce practices. Changes in workforce practices included (1) leadership engagement; (2) acquisition of staff; (3) enhancing staff efficiency and (4) inter-departmental collaboration, leading to CoC accreditation in August 2024. executive leadership team (ELT) buy-in was essential. ELT engagement included communicating the benefits of accreditation, alignment with organizational mission and values, protected time for Cancer Committee members, Chief of Staff presence in Cancer Committee, commitment to recruiting new staff, and membership in the Medical Executive Council to voice cancer program needs. New staff included a cancer program manager, cancer case conference RN care coordinator, certified oncology data specialist and survivorship nurse practitioner. Staff development included structured and focused training. Enhancing staff efficiency included developing standards of work with clear delineation of duties (delegation of specific CoC standards), decentralizing decision making, a shared governance council, and weekly Cancer Program meetings. These changes allowed staff members to be active, autonomous decision-making participants, and increased efficiency. Inter-departmental collaboration involved Hematology/Oncology, Surgery, Radiation Oncology, Pharmacy, Nutrition, Pathology, Palliative Care, Rehabilitation, Chaplaincy and Cancer Research, with key individuals serving as Cancer Committee members. Each department set performance goals and metrics. Each employee’s contribution was rated in annual performance reviews.

Results

TRVAMC thus elevated cancer care delivery standards through structured workforce practices within the framework of CoC standards required for accreditation. Additionally, the accreditation process achieved desirable and measurable outcomes, e.g. 100% growth in oncology dietitian referrals, 75% increase in early palliative care referrals (TRVAMC ranked in the top 5 in the US), and more than 200 patients enrolled in cancer clinical trials (TRVAMC was the highest enrolling VA in the US to NCI trials in 2024).

Conclusions

Our model demonstrates how strategic improvements in healthcare workforce practices at a VA can directly contribute to sustained improvements in quality and delivery of cancer care services.

Background

The American College of Surgeons’ Commission on Cancer (CoC) Accreditation requires establishment of a comprehensive cancer program, multi-disciplinary tumor boards, active cancer registry, quality improvement activities and cancer research.

Methods

In 2022, the Tibor Rubin VA Medical Center (TRVAMC) set out to obtain accreditation through enhancing workforce practices. Changes in workforce practices included (1) leadership engagement; (2) acquisition of staff; (3) enhancing staff efficiency and (4) inter-departmental collaboration, leading to CoC accreditation in August 2024. executive leadership team (ELT) buy-in was essential. ELT engagement included communicating the benefits of accreditation, alignment with organizational mission and values, protected time for Cancer Committee members, Chief of Staff presence in Cancer Committee, commitment to recruiting new staff, and membership in the Medical Executive Council to voice cancer program needs. New staff included a cancer program manager, cancer case conference RN care coordinator, certified oncology data specialist and survivorship nurse practitioner. Staff development included structured and focused training. Enhancing staff efficiency included developing standards of work with clear delineation of duties (delegation of specific CoC standards), decentralizing decision making, a shared governance council, and weekly Cancer Program meetings. These changes allowed staff members to be active, autonomous decision-making participants, and increased efficiency. Inter-departmental collaboration involved Hematology/Oncology, Surgery, Radiation Oncology, Pharmacy, Nutrition, Pathology, Palliative Care, Rehabilitation, Chaplaincy and Cancer Research, with key individuals serving as Cancer Committee members. Each department set performance goals and metrics. Each employee’s contribution was rated in annual performance reviews.

Results

TRVAMC thus elevated cancer care delivery standards through structured workforce practices within the framework of CoC standards required for accreditation. Additionally, the accreditation process achieved desirable and measurable outcomes, e.g. 100% growth in oncology dietitian referrals, 75% increase in early palliative care referrals (TRVAMC ranked in the top 5 in the US), and more than 200 patients enrolled in cancer clinical trials (TRVAMC was the highest enrolling VA in the US to NCI trials in 2024).

Conclusions

Our model demonstrates how strategic improvements in healthcare workforce practices at a VA can directly contribute to sustained improvements in quality and delivery of cancer care services.