Oncology

Background

With the onset of precision oncology, findings from germline mutational analysis have been helpful in treating patients with cancer and aids in cancer prevention, early detection, and improved overall outcomes. Germline genetic testing is now part of the standard of care for certain types of patients with prostate cancer. There is a very limited body of work that investigated demographic, disease- related and social factors that may be influencing Veterans’ participation in germline genetic testing. This study helps to identify whether certain factors may be influencing decisions on participation in prostate germline testing among Veterans with prostate malignancy.

Methods

The study was conducted using retrospective chart review. Data was collected from the periods of August 1, 2022 to December 31, 2023 among Veterans with prostate cancer who met criteria for germline genetic testing. Demographic and clinical information were collected including age, race, extent of disease (high risk, very high-risk or metastatic disease), significant co-morbidities, educational level, family and personal history of cancer, travel time, germline genetic test findings, impact on treatment approaches, referral for genetic counseling, and whether Veterans agreed or declined germline genetic testing. Data was analyzed using descriptive statistics. A total of 180 charts were reviewed, with 171 meeting the criteria for inclusion. The mean age of the participants is 73, with the youngest being 55 and the oldest being 101 years old. Majority of the participants were African American (77%).

Results

Only about two percent of those who met the inclusion criteria declined to undergo testing with the one living the farthest away from the testing hospital residing 18 miles away. Those who declined testing ranged in age from 67 to 88, majority had high risk prostate cancer and no family history of malignancy, and had 0-1 serious co-morbidity. None of their educational informational was available for review.

Conclusions

Participation in germline genetic testing can be enhanced with adequate patient education and availability of accessible resources, even among patient populations that are not always well-represented in clinical research. The presence of multiple serious co-morbidities and distance from a testing facility do not seem to contribute to hesitancy in germline genetic testing participation.

Background

With the onset of precision oncology, findings from germline mutational analysis have been helpful in treating patients with cancer and aids in cancer prevention, early detection, and improved overall outcomes. Germline genetic testing is now part of the standard of care for certain types of patients with prostate cancer. There is a very limited body of work that investigated demographic, disease- related and social factors that may be influencing Veterans’ participation in germline genetic testing. This study helps to identify whether certain factors may be influencing decisions on participation in prostate germline testing among Veterans with prostate malignancy.

Methods

The study was conducted using retrospective chart review. Data was collected from the periods of August 1, 2022 to December 31, 2023 among Veterans with prostate cancer who met criteria for germline genetic testing. Demographic and clinical information were collected including age, race, extent of disease (high risk, very high-risk or metastatic disease), significant co-morbidities, educational level, family and personal history of cancer, travel time, germline genetic test findings, impact on treatment approaches, referral for genetic counseling, and whether Veterans agreed or declined germline genetic testing. Data was analyzed using descriptive statistics. A total of 180 charts were reviewed, with 171 meeting the criteria for inclusion. The mean age of the participants is 73, with the youngest being 55 and the oldest being 101 years old. Majority of the participants were African American (77%).

Results

Only about two percent of those who met the inclusion criteria declined to undergo testing with the one living the farthest away from the testing hospital residing 18 miles away. Those who declined testing ranged in age from 67 to 88, majority had high risk prostate cancer and no family history of malignancy, and had 0-1 serious co-morbidity. None of their educational informational was available for review.

Conclusions

Participation in germline genetic testing can be enhanced with adequate patient education and availability of accessible resources, even among patient populations that are not always well-represented in clinical research. The presence of multiple serious co-morbidities and distance from a testing facility do not seem to contribute to hesitancy in germline genetic testing participation.

Background

With the onset of precision oncology, findings from germline mutational analysis have been helpful in treating patients with cancer and aids in cancer prevention, early detection, and improved overall outcomes. Germline genetic testing is now part of the standard of care for certain types of patients with prostate cancer. There is a very limited body of work that investigated demographic, disease- related and social factors that may be influencing Veterans’ participation in germline genetic testing. This study helps to identify whether certain factors may be influencing decisions on participation in prostate germline testing among Veterans with prostate malignancy.

Methods

The study was conducted using retrospective chart review. Data was collected from the periods of August 1, 2022 to December 31, 2023 among Veterans with prostate cancer who met criteria for germline genetic testing. Demographic and clinical information were collected including age, race, extent of disease (high risk, very high-risk or metastatic disease), significant co-morbidities, educational level, family and personal history of cancer, travel time, germline genetic test findings, impact on treatment approaches, referral for genetic counseling, and whether Veterans agreed or declined germline genetic testing. Data was analyzed using descriptive statistics. A total of 180 charts were reviewed, with 171 meeting the criteria for inclusion. The mean age of the participants is 73, with the youngest being 55 and the oldest being 101 years old. Majority of the participants were African American (77%).

Results

Only about two percent of those who met the inclusion criteria declined to undergo testing with the one living the farthest away from the testing hospital residing 18 miles away. Those who declined testing ranged in age from 67 to 88, majority had high risk prostate cancer and no family history of malignancy, and had 0-1 serious co-morbidity. None of their educational informational was available for review.

Conclusions

Participation in germline genetic testing can be enhanced with adequate patient education and availability of accessible resources, even among patient populations that are not always well-represented in clinical research. The presence of multiple serious co-morbidities and distance from a testing facility do not seem to contribute to hesitancy in germline genetic testing participation.

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.

Background

Prostate cancer is the most common non-cutaneous malignancy at the Veterans Health Administration (VHA) and every year approximately 15,000 Veterans are diagnosed and treated. Many advanced prostate cancer cases harbor genetic mutations that significantly impact prognosis, treatment decisions, and familial screening. In February 2021, the Prostate Cancer Molecular Testing Pathway (PCMTP) flow map was developed to increase appropriate genetic testing.

Methods

VHA initiated the Oncology Clinical Pathways (OCP) program to standardize cancer care for Veterans. The PCMTP was developed by a multidisciplinary team that created interactive templates within the Computerized Patient Record System (CPRS), to facilitate identification of eligible Veterans for germline and comprehensive genomic profiling (CGP). Clinical decision-making for these tests is documented as Health Factors (HF), in CPRS, allowing for assessment of pathway adherence and overall uptake.

Results

The PCMTP has achieved success, as there is over 90% compliance to molecular testing among participating Veterans which exceeds the pathway benchmark of 80%. PCMTP has been utilized at 88 VA sites, by over 700 distinct VA providers, with over 7,000 Veterans participating. This implementation has yielded over 19,200 Health Factors within CPRS.

Conclusions

The PCMTP has markedly improved the documentation and application of germline and CGP testing among Veterans diagnosed with prostate cancer. By facilitating genomic testing in appropriate patients, the PCMTP aims to enhance patient outcomes and optimize the quality of care. Prior to PCMTP establishment, assessing the prevalence of germline and CGP testing in eligible Veterans posed significant challenges. Future work will concentrate on increasing PCMTP utilization, evaluating downstream outcomes from genomic testing, including the identification of pathogenic variants, utilization of genetic counseling services, referrals to clinical trials, and the genomic impact on treatment strategies.

Background

Prostate cancer is the most common non-cutaneous malignancy at the Veterans Health Administration (VHA) and every year approximately 15,000 Veterans are diagnosed and treated. Many advanced prostate cancer cases harbor genetic mutations that significantly impact prognosis, treatment decisions, and familial screening. In February 2021, the Prostate Cancer Molecular Testing Pathway (PCMTP) flow map was developed to increase appropriate genetic testing.

Methods

VHA initiated the Oncology Clinical Pathways (OCP) program to standardize cancer care for Veterans. The PCMTP was developed by a multidisciplinary team that created interactive templates within the Computerized Patient Record System (CPRS), to facilitate identification of eligible Veterans for germline and comprehensive genomic profiling (CGP). Clinical decision-making for these tests is documented as Health Factors (HF), in CPRS, allowing for assessment of pathway adherence and overall uptake.

Results

The PCMTP has achieved success, as there is over 90% compliance to molecular testing among participating Veterans which exceeds the pathway benchmark of 80%. PCMTP has been utilized at 88 VA sites, by over 700 distinct VA providers, with over 7,000 Veterans participating. This implementation has yielded over 19,200 Health Factors within CPRS.

Conclusions

The PCMTP has markedly improved the documentation and application of germline and CGP testing among Veterans diagnosed with prostate cancer. By facilitating genomic testing in appropriate patients, the PCMTP aims to enhance patient outcomes and optimize the quality of care. Prior to PCMTP establishment, assessing the prevalence of germline and CGP testing in eligible Veterans posed significant challenges. Future work will concentrate on increasing PCMTP utilization, evaluating downstream outcomes from genomic testing, including the identification of pathogenic variants, utilization of genetic counseling services, referrals to clinical trials, and the genomic impact on treatment strategies.

Background

Prostate cancer is the most common non-cutaneous malignancy at the Veterans Health Administration (VHA) and every year approximately 15,000 Veterans are diagnosed and treated. Many advanced prostate cancer cases harbor genetic mutations that significantly impact prognosis, treatment decisions, and familial screening. In February 2021, the Prostate Cancer Molecular Testing Pathway (PCMTP) flow map was developed to increase appropriate genetic testing.

Methods

VHA initiated the Oncology Clinical Pathways (OCP) program to standardize cancer care for Veterans. The PCMTP was developed by a multidisciplinary team that created interactive templates within the Computerized Patient Record System (CPRS), to facilitate identification of eligible Veterans for germline and comprehensive genomic profiling (CGP). Clinical decision-making for these tests is documented as Health Factors (HF), in CPRS, allowing for assessment of pathway adherence and overall uptake.

Results

The PCMTP has achieved success, as there is over 90% compliance to molecular testing among participating Veterans which exceeds the pathway benchmark of 80%. PCMTP has been utilized at 88 VA sites, by over 700 distinct VA providers, with over 7,000 Veterans participating. This implementation has yielded over 19,200 Health Factors within CPRS.

Conclusions

The PCMTP has markedly improved the documentation and application of germline and CGP testing among Veterans diagnosed with prostate cancer. By facilitating genomic testing in appropriate patients, the PCMTP aims to enhance patient outcomes and optimize the quality of care. Prior to PCMTP establishment, assessing the prevalence of germline and CGP testing in eligible Veterans posed significant challenges. Future work will concentrate on increasing PCMTP utilization, evaluating downstream outcomes from genomic testing, including the identification of pathogenic variants, utilization of genetic counseling services, referrals to clinical trials, and the genomic impact on treatment strategies.

Purpose

Biorepositories are critical to scientific research within the VA. They offer high-quality, well-characterized biospecimens linked to clinical, demographic, and molecular data. Biorepositories support studies on disease mechanisms, personalized therapies, and emerging infectious diseases by systematically collecting, processing, storing, and distributing biological materials, including tissue, blood, and DNA samples. Within the Department of Veterans Affairs (VA), biorepositories provide essential support to clinical and translational research on service- related conditions such as PTSD, traumatic brain injury, cancers, and toxic exposures. While the need for harmonized quality processes and resource allocation has long been acknowledged within the biorepository community (Siwek, 2015), each biorepository operates independently, limiting scalability and standardization. This quality improvement project describes a collaboration between two VA biorepository sites supporting a national genomic study investigating disease risk and treatment outcomes. The project aimed to expand capacity, improve processing times, and enhance quality control. Each site mirrors the other’s functions, including receiving, accessioning, processing, storing, and shipping biospecimens, and serves as a contingency site to strengthen operational resilience.

Methods

To address space limitations and improve processing efficiency, one site implemented a custom rack design, expanding storage capacity per freezer. Robotic workflows were optimized, reducing biospecimen processing time. An in-process quality control step was introduced to identify data discrepancies earlier in the workflow, reducing investigation time and supporting overall data integrity. Efficiency was measured by the increase in storage capacity and decreased processing time. Descriptive statistics were used to evaluate changes in performance. Metrics were monitored over twelve months and compared against baseline data.

Results

Following implementation, storage capacity per freezer increased by 20%, and specimen processing time decreased by 30%. The new quality control checkpoint reduced investigation times by 98%, resulting in a more streamlined workflow. These improvements enhanced coordination between sites and improved support for ongoing studies.

Conclusions

This effort demonstrates that collaboration between biorepositories can significantly enhance efficiency, reduce turnaround times, and support high-quality research. Strengthening infrastructure through joint initiatives enables more effective support of large-scale clinical studies and contributes to improved outcomes for Veterans. These findings may also inform process improvements at other VA research facilities.

Purpose

Biorepositories are critical to scientific research within the VA. They offer high-quality, well-characterized biospecimens linked to clinical, demographic, and molecular data. Biorepositories support studies on disease mechanisms, personalized therapies, and emerging infectious diseases by systematically collecting, processing, storing, and distributing biological materials, including tissue, blood, and DNA samples. Within the Department of Veterans Affairs (VA), biorepositories provide essential support to clinical and translational research on service- related conditions such as PTSD, traumatic brain injury, cancers, and toxic exposures. While the need for harmonized quality processes and resource allocation has long been acknowledged within the biorepository community (Siwek, 2015), each biorepository operates independently, limiting scalability and standardization. This quality improvement project describes a collaboration between two VA biorepository sites supporting a national genomic study investigating disease risk and treatment outcomes. The project aimed to expand capacity, improve processing times, and enhance quality control. Each site mirrors the other’s functions, including receiving, accessioning, processing, storing, and shipping biospecimens, and serves as a contingency site to strengthen operational resilience.

Methods

To address space limitations and improve processing efficiency, one site implemented a custom rack design, expanding storage capacity per freezer. Robotic workflows were optimized, reducing biospecimen processing time. An in-process quality control step was introduced to identify data discrepancies earlier in the workflow, reducing investigation time and supporting overall data integrity. Efficiency was measured by the increase in storage capacity and decreased processing time. Descriptive statistics were used to evaluate changes in performance. Metrics were monitored over twelve months and compared against baseline data.

Results

Following implementation, storage capacity per freezer increased by 20%, and specimen processing time decreased by 30%. The new quality control checkpoint reduced investigation times by 98%, resulting in a more streamlined workflow. These improvements enhanced coordination between sites and improved support for ongoing studies.

Conclusions

This effort demonstrates that collaboration between biorepositories can significantly enhance efficiency, reduce turnaround times, and support high-quality research. Strengthening infrastructure through joint initiatives enables more effective support of large-scale clinical studies and contributes to improved outcomes for Veterans. These findings may also inform process improvements at other VA research facilities.

Purpose

Biorepositories are critical to scientific research within the VA. They offer high-quality, well-characterized biospecimens linked to clinical, demographic, and molecular data. Biorepositories support studies on disease mechanisms, personalized therapies, and emerging infectious diseases by systematically collecting, processing, storing, and distributing biological materials, including tissue, blood, and DNA samples. Within the Department of Veterans Affairs (VA), biorepositories provide essential support to clinical and translational research on service- related conditions such as PTSD, traumatic brain injury, cancers, and toxic exposures. While the need for harmonized quality processes and resource allocation has long been acknowledged within the biorepository community (Siwek, 2015), each biorepository operates independently, limiting scalability and standardization. This quality improvement project describes a collaboration between two VA biorepository sites supporting a national genomic study investigating disease risk and treatment outcomes. The project aimed to expand capacity, improve processing times, and enhance quality control. Each site mirrors the other’s functions, including receiving, accessioning, processing, storing, and shipping biospecimens, and serves as a contingency site to strengthen operational resilience.

Methods

To address space limitations and improve processing efficiency, one site implemented a custom rack design, expanding storage capacity per freezer. Robotic workflows were optimized, reducing biospecimen processing time. An in-process quality control step was introduced to identify data discrepancies earlier in the workflow, reducing investigation time and supporting overall data integrity. Efficiency was measured by the increase in storage capacity and decreased processing time. Descriptive statistics were used to evaluate changes in performance. Metrics were monitored over twelve months and compared against baseline data.

Results

Following implementation, storage capacity per freezer increased by 20%, and specimen processing time decreased by 30%. The new quality control checkpoint reduced investigation times by 98%, resulting in a more streamlined workflow. These improvements enhanced coordination between sites and improved support for ongoing studies.

Conclusions

This effort demonstrates that collaboration between biorepositories can significantly enhance efficiency, reduce turnaround times, and support high-quality research. Strengthening infrastructure through joint initiatives enables more effective support of large-scale clinical studies and contributes to improved outcomes for Veterans. These findings may also inform process improvements at other VA research facilities.

Background

Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.

Methods

Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.

Analysis

For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).

Results

From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).

Conclusions

Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.

Background

Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.

Methods

Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.

Analysis

For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).

Results

From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).

Conclusions

Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.

Background

Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.

Methods

Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.

Analysis

For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).

Results

From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).

Conclusions

Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Methods

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator.

Results

The UPCN functions as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. Since the UPCN national deployment on 9/6/24, documentation of high risk prostate cancer pathway utilization has increased 75% from 226 unique Veterans prior to launch to 395 unique Veterans after launch.

Conclusions

This collaborative effort did improve pathway utilization and documentation however other tools will need to be developed to improve provider PCCP documentation.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Methods

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator.

Results

The UPCN functions as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. Since the UPCN national deployment on 9/6/24, documentation of high risk prostate cancer pathway utilization has increased 75% from 226 unique Veterans prior to launch to 395 unique Veterans after launch.

Conclusions

This collaborative effort did improve pathway utilization and documentation however other tools will need to be developed to improve provider PCCP documentation.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Methods

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator.

Results

The UPCN functions as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. Since the UPCN national deployment on 9/6/24, documentation of high risk prostate cancer pathway utilization has increased 75% from 226 unique Veterans prior to launch to 395 unique Veterans after launch.

Conclusions

This collaborative effort did improve pathway utilization and documentation however other tools will need to be developed to improve provider PCCP documentation.