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Findings from (ImPaCT): Improving Patients With Prostate Cancer’s Access to Germline Testing
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.
Papillary Cystadenocarcinoma: NCDB Insights on Outcomes and Socioeconomic Disparities
Background
Papillary cystadenocarcinoma is a rare, aggressive malignancy typically arising in the ovaries, often following malignant transformation of benign precursors. Characterized by local invasion and recurrence, it lacks standardized treatment protocols and comprehensive epidemiological data. Existing literature is limited to case reports and small series, leaving gaps in population-level data to guide clinical decision-making. This study uses the National Cancer Database (NCDB) to assess demographic, socioeconomic, and treatment patterns to identify disparities and inform management.
Methods
A retrospective cohort analysis of 345 patients with histologically confirmed papillary cystadenocarcinoma (ICD-O-3 code 8450) was conducted using the 2004–2020 NCDB. Demographic, treatment, and survival data were described; incidence trends were assessed via linear regression; and survival was analyzed using Kaplan-Meier curves.
Results
The cohort was predominantly female (97.1%), mean age 62.1 years (SD = 14.0), and 87.2% White. Most had private insurance (44.9%) or Medicare (40.9%). Over half (51.9%) resided in metropolitan areas >1 million. Primary tumor sites were ovarian (80.0%) and endometrial (5.2%), with 39.7% presenting at Stage III. Surgery was performed in 90.4% of cases, with 51.9% achieving negative margins. Most were treated at comprehensive community (41.0%) or academic/research programs (28.7%). Primary therapies included chemotherapy (62.3%), radiation (6.4%), and hormone therapy (1.7%). Thirty-day mortality was 1.9%, and 90-day mortality was 5.4%. Survival was 97.7% at 2 years, 94.2% at 5 years, and 88.6% at 10 years. Mean survival was 97.5 months (95% CI: 88.2–106.7).
Conclusions
This is the first NCDB-based analysis of papillary cystadenocarcinoma, offering insight into its clinical characteristics. Ovarian and endometrial origins were most common, reinforcing its gynecologic profile. High surgical rates and margin negativity suggest aggressive local treatment is central to management. Disparities emerged: patients were more likely to live in urban areas, hold private insurance, and receive care at community programs. These findings highlight the need for further investigation into socioeconomic inequities and may inform future guidelines to improve equitable care delivery across health systems, including community-based programs such as the VHA.
Background
Papillary cystadenocarcinoma is a rare, aggressive malignancy typically arising in the ovaries, often following malignant transformation of benign precursors. Characterized by local invasion and recurrence, it lacks standardized treatment protocols and comprehensive epidemiological data. Existing literature is limited to case reports and small series, leaving gaps in population-level data to guide clinical decision-making. This study uses the National Cancer Database (NCDB) to assess demographic, socioeconomic, and treatment patterns to identify disparities and inform management.
Methods
A retrospective cohort analysis of 345 patients with histologically confirmed papillary cystadenocarcinoma (ICD-O-3 code 8450) was conducted using the 2004–2020 NCDB. Demographic, treatment, and survival data were described; incidence trends were assessed via linear regression; and survival was analyzed using Kaplan-Meier curves.
Results
The cohort was predominantly female (97.1%), mean age 62.1 years (SD = 14.0), and 87.2% White. Most had private insurance (44.9%) or Medicare (40.9%). Over half (51.9%) resided in metropolitan areas >1 million. Primary tumor sites were ovarian (80.0%) and endometrial (5.2%), with 39.7% presenting at Stage III. Surgery was performed in 90.4% of cases, with 51.9% achieving negative margins. Most were treated at comprehensive community (41.0%) or academic/research programs (28.7%). Primary therapies included chemotherapy (62.3%), radiation (6.4%), and hormone therapy (1.7%). Thirty-day mortality was 1.9%, and 90-day mortality was 5.4%. Survival was 97.7% at 2 years, 94.2% at 5 years, and 88.6% at 10 years. Mean survival was 97.5 months (95% CI: 88.2–106.7).
Conclusions
This is the first NCDB-based analysis of papillary cystadenocarcinoma, offering insight into its clinical characteristics. Ovarian and endometrial origins were most common, reinforcing its gynecologic profile. High surgical rates and margin negativity suggest aggressive local treatment is central to management. Disparities emerged: patients were more likely to live in urban areas, hold private insurance, and receive care at community programs. These findings highlight the need for further investigation into socioeconomic inequities and may inform future guidelines to improve equitable care delivery across health systems, including community-based programs such as the VHA.
Background
Papillary cystadenocarcinoma is a rare, aggressive malignancy typically arising in the ovaries, often following malignant transformation of benign precursors. Characterized by local invasion and recurrence, it lacks standardized treatment protocols and comprehensive epidemiological data. Existing literature is limited to case reports and small series, leaving gaps in population-level data to guide clinical decision-making. This study uses the National Cancer Database (NCDB) to assess demographic, socioeconomic, and treatment patterns to identify disparities and inform management.
Methods
A retrospective cohort analysis of 345 patients with histologically confirmed papillary cystadenocarcinoma (ICD-O-3 code 8450) was conducted using the 2004–2020 NCDB. Demographic, treatment, and survival data were described; incidence trends were assessed via linear regression; and survival was analyzed using Kaplan-Meier curves.
Results
The cohort was predominantly female (97.1%), mean age 62.1 years (SD = 14.0), and 87.2% White. Most had private insurance (44.9%) or Medicare (40.9%). Over half (51.9%) resided in metropolitan areas >1 million. Primary tumor sites were ovarian (80.0%) and endometrial (5.2%), with 39.7% presenting at Stage III. Surgery was performed in 90.4% of cases, with 51.9% achieving negative margins. Most were treated at comprehensive community (41.0%) or academic/research programs (28.7%). Primary therapies included chemotherapy (62.3%), radiation (6.4%), and hormone therapy (1.7%). Thirty-day mortality was 1.9%, and 90-day mortality was 5.4%. Survival was 97.7% at 2 years, 94.2% at 5 years, and 88.6% at 10 years. Mean survival was 97.5 months (95% CI: 88.2–106.7).
Conclusions
This is the first NCDB-based analysis of papillary cystadenocarcinoma, offering insight into its clinical characteristics. Ovarian and endometrial origins were most common, reinforcing its gynecologic profile. High surgical rates and margin negativity suggest aggressive local treatment is central to management. Disparities emerged: patients were more likely to live in urban areas, hold private insurance, and receive care at community programs. These findings highlight the need for further investigation into socioeconomic inequities and may inform future guidelines to improve equitable care delivery across health systems, including community-based programs such as the VHA.
Demographical Trends in End-of-Life Care in Malignant Neoplasms: A CDC Wonder Analysis Using Place of Death
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.
Demographic and Clinical Factors Associated With PD-L1 Testing of Veterans With Advanced Non-Small Cell Lung Cancer
Background
Programmed death-ligand 1 (PD-L1) checkpoint inhibitors revolutionized the treatment of advanced non-small cell lung cancer (aNSCLC) by improving overall survival compared to chemotherapy. PD-L1 biomarker testing is paramount for informing treatment decisions in aNSCLC. Real-world data describing patterns of PD-L1 testing within the Veteran Health Administration (VHA) are limited. This retrospective study seeks to evaluate demographic and clinical factors associated with PD-L1 testing in VHA.
Methods
Veterans diagnosed with aNSCLC from 2019-2022 were identified using VHA’s Corporate Data Warehouse. Wilcoxon Rank Sum and Chi- Square tests measured association between receipt of PD-L1 testing and patient demographic and clinical characteristics at aNSCLC diagnosis. Logistic regression assessed predictors of PD-L1 testing, and subgroup analyses were performed for significant interactions.
Results
Our study included 4575 patients with aNSCLC; 57.0% received PD-L1 testing. The likelihood of PD-L1 testing increased among patients diagnosed with aNSCLC after 2019 vs during 2019 (OR≥1.118, p≤0.035) and in Black vs White patients (OR=1.227, p=0.011). However, the following had decreased likelihood of PD-L1 testing: patients with stage IIIB vs IV cancer (OR=0.683, p=0.004); non vs current/former smokers (OR=0.733, p=0.039); squamous (OR=0.863, p=0.030) or NOS (OR=0.695,p=0.013) vs. adenocarcinoma histology. Interactions were observed between patient residential region and residential rurality (p=0.003), and region and receipt of oncology community care consults (OCCC) (p=0.030). Patients in rural Midwest (OR=0.445,p=0.004) and rural South (OR=0.566, p=0.032) were less likely to receive PD-L1 testing than Metropolitan patients. Across patients with OCCC, Western US patients were more likely to receive PD-L1 testing (OR=1.554, p=0.001) than patients in other regions. However, within Midwestern patients, those without a OCCC were more likely to receive PD-L1 testing (OR=1.724, p< 0.001) than those with a OCCC. High comorbidity index (CCI≥3) is associated with an increased likelihood of PD-L1 testing in a univariable model (OR=1.286 vs. CCI=0,p=0.009), but not in the multivariable model (p=0.278).
Conclusions
We identified demographic and clinical factors, including regional differences in rurality and OCCC patterns, associated with PD-L1 testing. These factors can focus ongoing efforts to improve PD-L1 testing and efforts to be more in line with recommended care.
Background
Programmed death-ligand 1 (PD-L1) checkpoint inhibitors revolutionized the treatment of advanced non-small cell lung cancer (aNSCLC) by improving overall survival compared to chemotherapy. PD-L1 biomarker testing is paramount for informing treatment decisions in aNSCLC. Real-world data describing patterns of PD-L1 testing within the Veteran Health Administration (VHA) are limited. This retrospective study seeks to evaluate demographic and clinical factors associated with PD-L1 testing in VHA.
Methods
Veterans diagnosed with aNSCLC from 2019-2022 were identified using VHA’s Corporate Data Warehouse. Wilcoxon Rank Sum and Chi- Square tests measured association between receipt of PD-L1 testing and patient demographic and clinical characteristics at aNSCLC diagnosis. Logistic regression assessed predictors of PD-L1 testing, and subgroup analyses were performed for significant interactions.
Results
Our study included 4575 patients with aNSCLC; 57.0% received PD-L1 testing. The likelihood of PD-L1 testing increased among patients diagnosed with aNSCLC after 2019 vs during 2019 (OR≥1.118, p≤0.035) and in Black vs White patients (OR=1.227, p=0.011). However, the following had decreased likelihood of PD-L1 testing: patients with stage IIIB vs IV cancer (OR=0.683, p=0.004); non vs current/former smokers (OR=0.733, p=0.039); squamous (OR=0.863, p=0.030) or NOS (OR=0.695,p=0.013) vs. adenocarcinoma histology. Interactions were observed between patient residential region and residential rurality (p=0.003), and region and receipt of oncology community care consults (OCCC) (p=0.030). Patients in rural Midwest (OR=0.445,p=0.004) and rural South (OR=0.566, p=0.032) were less likely to receive PD-L1 testing than Metropolitan patients. Across patients with OCCC, Western US patients were more likely to receive PD-L1 testing (OR=1.554, p=0.001) than patients in other regions. However, within Midwestern patients, those without a OCCC were more likely to receive PD-L1 testing (OR=1.724, p< 0.001) than those with a OCCC. High comorbidity index (CCI≥3) is associated with an increased likelihood of PD-L1 testing in a univariable model (OR=1.286 vs. CCI=0,p=0.009), but not in the multivariable model (p=0.278).
Conclusions
We identified demographic and clinical factors, including regional differences in rurality and OCCC patterns, associated with PD-L1 testing. These factors can focus ongoing efforts to improve PD-L1 testing and efforts to be more in line with recommended care.
Background
Programmed death-ligand 1 (PD-L1) checkpoint inhibitors revolutionized the treatment of advanced non-small cell lung cancer (aNSCLC) by improving overall survival compared to chemotherapy. PD-L1 biomarker testing is paramount for informing treatment decisions in aNSCLC. Real-world data describing patterns of PD-L1 testing within the Veteran Health Administration (VHA) are limited. This retrospective study seeks to evaluate demographic and clinical factors associated with PD-L1 testing in VHA.
Methods
Veterans diagnosed with aNSCLC from 2019-2022 were identified using VHA’s Corporate Data Warehouse. Wilcoxon Rank Sum and Chi- Square tests measured association between receipt of PD-L1 testing and patient demographic and clinical characteristics at aNSCLC diagnosis. Logistic regression assessed predictors of PD-L1 testing, and subgroup analyses were performed for significant interactions.
Results
Our study included 4575 patients with aNSCLC; 57.0% received PD-L1 testing. The likelihood of PD-L1 testing increased among patients diagnosed with aNSCLC after 2019 vs during 2019 (OR≥1.118, p≤0.035) and in Black vs White patients (OR=1.227, p=0.011). However, the following had decreased likelihood of PD-L1 testing: patients with stage IIIB vs IV cancer (OR=0.683, p=0.004); non vs current/former smokers (OR=0.733, p=0.039); squamous (OR=0.863, p=0.030) or NOS (OR=0.695,p=0.013) vs. adenocarcinoma histology. Interactions were observed between patient residential region and residential rurality (p=0.003), and region and receipt of oncology community care consults (OCCC) (p=0.030). Patients in rural Midwest (OR=0.445,p=0.004) and rural South (OR=0.566, p=0.032) were less likely to receive PD-L1 testing than Metropolitan patients. Across patients with OCCC, Western US patients were more likely to receive PD-L1 testing (OR=1.554, p=0.001) than patients in other regions. However, within Midwestern patients, those without a OCCC were more likely to receive PD-L1 testing (OR=1.724, p< 0.001) than those with a OCCC. High comorbidity index (CCI≥3) is associated with an increased likelihood of PD-L1 testing in a univariable model (OR=1.286 vs. CCI=0,p=0.009), but not in the multivariable model (p=0.278).
Conclusions
We identified demographic and clinical factors, including regional differences in rurality and OCCC patterns, associated with PD-L1 testing. These factors can focus ongoing efforts to improve PD-L1 testing and efforts to be more in line with recommended care.
Survival Outcomes of Skin Adnexal Tumors: A National Cancer Database Analysis
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.
Optimizing Symptom Management in VA Oncology: A Workflow-Based Quality Improvement Initiative
Background
Enhancing symptom assessment and management of patients undergoing cancer treatment presents several challenges, ranging from workflow integration to application of evidenced-based interventions (Minteer, et al., 2023). Previously, our team conducted a VA mixed-methods study and identified a lack of standardized approaches for symptom assessment, lack of technology support to optimize workflows, and the need for adaptable workflows that reflect both facility and patient preferences. In response, the National Oncology Program Office at Palo Alto VA (PAVA) launched the Proactive Patient-Centered Care Program (PPP) to address these care gaps and develop a feasible, replicable, sustainable workflow to guide broader VA-wide implementation based on prior work conducted by the PAVA team (Banks, et al., 2024).
Methods
Prior to launch, the PPP team engaged oncology leadership in VISN21 and VISN22. Long Beach VA (LBVA) was selected as the initial pilot implementation site. A multidisciplinary group from PAVA and LBVA comprised of oncology and palliative care clinicians, nurses, pharmacists, a lay health worker, and project manager guided the workflow adaptations. To support scalability and sustainability, the Empowering Learning, Innovation, and experiences through Implementation of health Informatics (ELIXIR) team designed an electronic health record agnostic technology-enabled tool to support workflow. The group met weekly to bi-monthly over 5 months, virtually and two in-person sessions, to map current practices, co-develop workflows, and identify key decisions regarding patient eligibility criteria, frequency of symptom assessments, triage responsibilities, escalation protocols, and closed-loop communication processes.
Results
A technology-enabled workflow was developed to deploy proactive symptom assessment and management across VA oncology sites with streamlined coordination between peer support staff and clinicians along with technology to support timely interventions.
Conclusions
Process improvement for symptom management requires on the ground adaptation even within an integrated health system like the VA. This initiative underscores the need for multidisciplinary collaboration, sustainability, and technology integration to support long-term intervention fidelity and scalability. The workflow developed will guide the PPP program’s expansion to LBVA, with patient enrollment beginning May 2025. The approach used to develop this workflow will serve as a model for standardizing supportive care processes across the VA to account for local needs.
Background
Enhancing symptom assessment and management of patients undergoing cancer treatment presents several challenges, ranging from workflow integration to application of evidenced-based interventions (Minteer, et al., 2023). Previously, our team conducted a VA mixed-methods study and identified a lack of standardized approaches for symptom assessment, lack of technology support to optimize workflows, and the need for adaptable workflows that reflect both facility and patient preferences. In response, the National Oncology Program Office at Palo Alto VA (PAVA) launched the Proactive Patient-Centered Care Program (PPP) to address these care gaps and develop a feasible, replicable, sustainable workflow to guide broader VA-wide implementation based on prior work conducted by the PAVA team (Banks, et al., 2024).
Methods
Prior to launch, the PPP team engaged oncology leadership in VISN21 and VISN22. Long Beach VA (LBVA) was selected as the initial pilot implementation site. A multidisciplinary group from PAVA and LBVA comprised of oncology and palliative care clinicians, nurses, pharmacists, a lay health worker, and project manager guided the workflow adaptations. To support scalability and sustainability, the Empowering Learning, Innovation, and experiences through Implementation of health Informatics (ELIXIR) team designed an electronic health record agnostic technology-enabled tool to support workflow. The group met weekly to bi-monthly over 5 months, virtually and two in-person sessions, to map current practices, co-develop workflows, and identify key decisions regarding patient eligibility criteria, frequency of symptom assessments, triage responsibilities, escalation protocols, and closed-loop communication processes.
Results
A technology-enabled workflow was developed to deploy proactive symptom assessment and management across VA oncology sites with streamlined coordination between peer support staff and clinicians along with technology to support timely interventions.
Conclusions
Process improvement for symptom management requires on the ground adaptation even within an integrated health system like the VA. This initiative underscores the need for multidisciplinary collaboration, sustainability, and technology integration to support long-term intervention fidelity and scalability. The workflow developed will guide the PPP program’s expansion to LBVA, with patient enrollment beginning May 2025. The approach used to develop this workflow will serve as a model for standardizing supportive care processes across the VA to account for local needs.
Background
Enhancing symptom assessment and management of patients undergoing cancer treatment presents several challenges, ranging from workflow integration to application of evidenced-based interventions (Minteer, et al., 2023). Previously, our team conducted a VA mixed-methods study and identified a lack of standardized approaches for symptom assessment, lack of technology support to optimize workflows, and the need for adaptable workflows that reflect both facility and patient preferences. In response, the National Oncology Program Office at Palo Alto VA (PAVA) launched the Proactive Patient-Centered Care Program (PPP) to address these care gaps and develop a feasible, replicable, sustainable workflow to guide broader VA-wide implementation based on prior work conducted by the PAVA team (Banks, et al., 2024).
Methods
Prior to launch, the PPP team engaged oncology leadership in VISN21 and VISN22. Long Beach VA (LBVA) was selected as the initial pilot implementation site. A multidisciplinary group from PAVA and LBVA comprised of oncology and palliative care clinicians, nurses, pharmacists, a lay health worker, and project manager guided the workflow adaptations. To support scalability and sustainability, the Empowering Learning, Innovation, and experiences through Implementation of health Informatics (ELIXIR) team designed an electronic health record agnostic technology-enabled tool to support workflow. The group met weekly to bi-monthly over 5 months, virtually and two in-person sessions, to map current practices, co-develop workflows, and identify key decisions regarding patient eligibility criteria, frequency of symptom assessments, triage responsibilities, escalation protocols, and closed-loop communication processes.
Results
A technology-enabled workflow was developed to deploy proactive symptom assessment and management across VA oncology sites with streamlined coordination between peer support staff and clinicians along with technology to support timely interventions.
Conclusions
Process improvement for symptom management requires on the ground adaptation even within an integrated health system like the VA. This initiative underscores the need for multidisciplinary collaboration, sustainability, and technology integration to support long-term intervention fidelity and scalability. The workflow developed will guide the PPP program’s expansion to LBVA, with patient enrollment beginning May 2025. The approach used to develop this workflow will serve as a model for standardizing supportive care processes across the VA to account for local needs.
Implementation of Consult Template Optimizes Hematology E-Consult Evaluation
Purpose/Background
The purpose of this project was to understand how implementing a consult template could optimize hematology E-consult evaluation. At the Tampa VA, providers can submit hematology E-consults for interpretation of lab abnormalities and management recommendations that do not require an in-person hematology evaluation. Previously, submission of an E-consult did not require prerequisite labs or imaging or for lab parameters to be met, leading to an increased number of hematology E-consults and subsequently, lower efficiency for hematologists.
Methods
A hematology E-consult template was created through collaboration between the hematology/ oncology and ambulatory care sections, which lists specific diagnoses and required parameters/workup needed for each diagnosis prior to submission of the E-consult. If those criteria were not met, the consult was cancelled. A representative sample of one month pre- and post-implementation data was analyzed.
Results
The E-consult template was implemented in September 2024. From April to August 2024, the average number of E-consults per month was 243, averaging at 11.0 per day, while from October 2024 to February 2025, the average number of E-consults per month was 146.4, averaging at 6.6 per day. In August 2024, the leading reasons for consult were anemia (77), leukocytosis (26), and thrombocytopenia (24). That month, there were 15 consult cancellations, with the primary reason being the patient was established in clinic (9). In October 2024, the leading reasons for consult were anemia (39), leukocytosis (14), and thrombocytopenia (13). That month, there were 34 consult cancellations, with the primary reason being that hematology advised a clinic consultation rather than an E-consult (10).
Implications/Significance
These data reveal that the hematology E-consult template was associated with a decreased number of E-consults per day and per month. Implementation of the hematology E-consult template allows the hematology consultants to focus on interpretation of lab results and providing management recommendations, as opposed to providing standard of care diagnostic recommendations. It also serves as an educational tool to referring providers, to understand appropriate indications for hematology E-consultation. Lastly, the template has created increased efficiency in providing hematology recommendations and ultimately, improved timely care for our veterans.
Purpose/Background
The purpose of this project was to understand how implementing a consult template could optimize hematology E-consult evaluation. At the Tampa VA, providers can submit hematology E-consults for interpretation of lab abnormalities and management recommendations that do not require an in-person hematology evaluation. Previously, submission of an E-consult did not require prerequisite labs or imaging or for lab parameters to be met, leading to an increased number of hematology E-consults and subsequently, lower efficiency for hematologists.
Methods
A hematology E-consult template was created through collaboration between the hematology/ oncology and ambulatory care sections, which lists specific diagnoses and required parameters/workup needed for each diagnosis prior to submission of the E-consult. If those criteria were not met, the consult was cancelled. A representative sample of one month pre- and post-implementation data was analyzed.
Results
The E-consult template was implemented in September 2024. From April to August 2024, the average number of E-consults per month was 243, averaging at 11.0 per day, while from October 2024 to February 2025, the average number of E-consults per month was 146.4, averaging at 6.6 per day. In August 2024, the leading reasons for consult were anemia (77), leukocytosis (26), and thrombocytopenia (24). That month, there were 15 consult cancellations, with the primary reason being the patient was established in clinic (9). In October 2024, the leading reasons for consult were anemia (39), leukocytosis (14), and thrombocytopenia (13). That month, there were 34 consult cancellations, with the primary reason being that hematology advised a clinic consultation rather than an E-consult (10).
Implications/Significance
These data reveal that the hematology E-consult template was associated with a decreased number of E-consults per day and per month. Implementation of the hematology E-consult template allows the hematology consultants to focus on interpretation of lab results and providing management recommendations, as opposed to providing standard of care diagnostic recommendations. It also serves as an educational tool to referring providers, to understand appropriate indications for hematology E-consultation. Lastly, the template has created increased efficiency in providing hematology recommendations and ultimately, improved timely care for our veterans.
Purpose/Background
The purpose of this project was to understand how implementing a consult template could optimize hematology E-consult evaluation. At the Tampa VA, providers can submit hematology E-consults for interpretation of lab abnormalities and management recommendations that do not require an in-person hematology evaluation. Previously, submission of an E-consult did not require prerequisite labs or imaging or for lab parameters to be met, leading to an increased number of hematology E-consults and subsequently, lower efficiency for hematologists.
Methods
A hematology E-consult template was created through collaboration between the hematology/ oncology and ambulatory care sections, which lists specific diagnoses and required parameters/workup needed for each diagnosis prior to submission of the E-consult. If those criteria were not met, the consult was cancelled. A representative sample of one month pre- and post-implementation data was analyzed.
Results
The E-consult template was implemented in September 2024. From April to August 2024, the average number of E-consults per month was 243, averaging at 11.0 per day, while from October 2024 to February 2025, the average number of E-consults per month was 146.4, averaging at 6.6 per day. In August 2024, the leading reasons for consult were anemia (77), leukocytosis (26), and thrombocytopenia (24). That month, there were 15 consult cancellations, with the primary reason being the patient was established in clinic (9). In October 2024, the leading reasons for consult were anemia (39), leukocytosis (14), and thrombocytopenia (13). That month, there were 34 consult cancellations, with the primary reason being that hematology advised a clinic consultation rather than an E-consult (10).
Implications/Significance
These data reveal that the hematology E-consult template was associated with a decreased number of E-consults per day and per month. Implementation of the hematology E-consult template allows the hematology consultants to focus on interpretation of lab results and providing management recommendations, as opposed to providing standard of care diagnostic recommendations. It also serves as an educational tool to referring providers, to understand appropriate indications for hematology E-consultation. Lastly, the template has created increased efficiency in providing hematology recommendations and ultimately, improved timely care for our veterans.
Enhancing Workforce Practices to Achieve Commission on Cancer Accreditation
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.
National Radiation Oncology Program Granular Radiotherapy Information Database
Purpose/Objectives
Radiation oncology treatment planning and delivery systems are predominantly designed as silos, centered around the care of individual patients and generally disconnected from the broader health record. This poses significant challenges for cohort or population scale research, particularly when trying to analyze the nuances and details of treatments. The National Radiation Oncology Program (NROP) sought to design, develop, and implement a platform-agnostic tool to extract clinically meaningful treatment details from DICOM-RT data and applied this in a pilot initiative to centralize data from several VA distinct treatment facilities and merge the resulting dataset with the broader electronic health record to support research and clinical operations.
Methods
Leveraging NROP’s Health Information Gateway Exchange (HINGE) system, we developed the capability to analyze DICOM-RT datasets and output detailed and clinically meaningful radiation treatment information including but not limited to structure-specific dose volume histogram data, individual beam-level treatment details, and verified delivered fraction data. We applied this to historical data from VA facilities participating in NROP’s initial pilot and linked the resulting data with the broader electronic health record on an individual patient level, constituting the Granular Radiotherapy Information Database (GRID).
Results
We demonstrate successful export of clinically meaningful treatment details from a large real-world cohort of VA patients treated between 2012-2024. This constitutes a novel source of authoritative radiation oncology data within the VA CDW. We confirmed the ability to arbitrarily query these cohorts based on both the intrinsic data export as well as its linkages to the broader electronic health record.
Conclusions
This is a proof-of-principle study demonstrating the ability to extract and integrate detailed radiotherapy data with the broader health record, as well as enable unprecedented arbitrary queries at population scale and broad reuse in the VA research and clinical operations.
Purpose/Objectives
Radiation oncology treatment planning and delivery systems are predominantly designed as silos, centered around the care of individual patients and generally disconnected from the broader health record. This poses significant challenges for cohort or population scale research, particularly when trying to analyze the nuances and details of treatments. The National Radiation Oncology Program (NROP) sought to design, develop, and implement a platform-agnostic tool to extract clinically meaningful treatment details from DICOM-RT data and applied this in a pilot initiative to centralize data from several VA distinct treatment facilities and merge the resulting dataset with the broader electronic health record to support research and clinical operations.
Methods
Leveraging NROP’s Health Information Gateway Exchange (HINGE) system, we developed the capability to analyze DICOM-RT datasets and output detailed and clinically meaningful radiation treatment information including but not limited to structure-specific dose volume histogram data, individual beam-level treatment details, and verified delivered fraction data. We applied this to historical data from VA facilities participating in NROP’s initial pilot and linked the resulting data with the broader electronic health record on an individual patient level, constituting the Granular Radiotherapy Information Database (GRID).
Results
We demonstrate successful export of clinically meaningful treatment details from a large real-world cohort of VA patients treated between 2012-2024. This constitutes a novel source of authoritative radiation oncology data within the VA CDW. We confirmed the ability to arbitrarily query these cohorts based on both the intrinsic data export as well as its linkages to the broader electronic health record.
Conclusions
This is a proof-of-principle study demonstrating the ability to extract and integrate detailed radiotherapy data with the broader health record, as well as enable unprecedented arbitrary queries at population scale and broad reuse in the VA research and clinical operations.
Purpose/Objectives
Radiation oncology treatment planning and delivery systems are predominantly designed as silos, centered around the care of individual patients and generally disconnected from the broader health record. This poses significant challenges for cohort or population scale research, particularly when trying to analyze the nuances and details of treatments. The National Radiation Oncology Program (NROP) sought to design, develop, and implement a platform-agnostic tool to extract clinically meaningful treatment details from DICOM-RT data and applied this in a pilot initiative to centralize data from several VA distinct treatment facilities and merge the resulting dataset with the broader electronic health record to support research and clinical operations.
Methods
Leveraging NROP’s Health Information Gateway Exchange (HINGE) system, we developed the capability to analyze DICOM-RT datasets and output detailed and clinically meaningful radiation treatment information including but not limited to structure-specific dose volume histogram data, individual beam-level treatment details, and verified delivered fraction data. We applied this to historical data from VA facilities participating in NROP’s initial pilot and linked the resulting data with the broader electronic health record on an individual patient level, constituting the Granular Radiotherapy Information Database (GRID).
Results
We demonstrate successful export of clinically meaningful treatment details from a large real-world cohort of VA patients treated between 2012-2024. This constitutes a novel source of authoritative radiation oncology data within the VA CDW. We confirmed the ability to arbitrarily query these cohorts based on both the intrinsic data export as well as its linkages to the broader electronic health record.
Conclusions
This is a proof-of-principle study demonstrating the ability to extract and integrate detailed radiotherapy data with the broader health record, as well as enable unprecedented arbitrary queries at population scale and broad reuse in the VA research and clinical operations.
Implementation of a VHA Virtual Oncology Training Pilot Program for Clinical Pharmacists
Purpose/Background
Oncology clinical pharmacist practitioners (CPP) play a critical role in optimizing drug therapy, managing side effects, and ensuring medication adherence. As a specialized clinical area, specific training is needed to ensure quality of care. Oncology pharmacy training programs are commercially available but pose a financial burden and are not specific to the Veterans Health Administration (VHA). A comprehensive, virtual Oncology Bootcamp series was implemented to upskill new oncology pharmacists (or pharmacists seeking to further their understanding of oncology practice), with didactic materials and clinical tools to enhance and standardize quality care delivery.
Methods
This program was comprised of an online platform of 23 one hour-long continuing education accredited sessions, delivered by leading subject matter experts. Pharmacists from two Veteran Integrated Service Networks (VISNs) were invited for the first year of the bootcamp. The curriculum encompassed fundamentals of oncology practice, patient care assessment, chemotherapy protocol review, practice management, and supportive care. Participants also received in-depth training on managing various cancer types, including but not limited to prostate, lung, gastrointestinal and hematologic malignancies. VHA specific information, including utilization of Oncology Clinical Pathways to promote standardized care was included where applicable. The interactive nature of the virtual sessions provided opportunities for real-time discussion and immediate feedback. To measure the impact of this program, a pre and post program evaluation of participants was conducted.
Results
Over the course of the program, more than 40 pharmacists across two VISNs participated in the bootcamp series. Results of the program evaluation showed an increase in self-reported comfort and skill levels in all criteria that were assessed (oncology pharmacotherapy, solid tumor malignancies, hematologic malignancies and oral anti-cancer therapy management). Additionally, 85% of respondents stated the series met their overall goals and over 90% of respondents stated they were either satisfied or very satisfied with the content, speakers and organization of the course.
Implications/Significance
This initiative has established the viability and significance of a highly accessible, VHA pathway specific and Veteran centric platform for oncology pharmacy professional development. Future directions for the program include a broader nationwide audience, increased content coverage and self-paced learning options.
Purpose/Background
Oncology clinical pharmacist practitioners (CPP) play a critical role in optimizing drug therapy, managing side effects, and ensuring medication adherence. As a specialized clinical area, specific training is needed to ensure quality of care. Oncology pharmacy training programs are commercially available but pose a financial burden and are not specific to the Veterans Health Administration (VHA). A comprehensive, virtual Oncology Bootcamp series was implemented to upskill new oncology pharmacists (or pharmacists seeking to further their understanding of oncology practice), with didactic materials and clinical tools to enhance and standardize quality care delivery.
Methods
This program was comprised of an online platform of 23 one hour-long continuing education accredited sessions, delivered by leading subject matter experts. Pharmacists from two Veteran Integrated Service Networks (VISNs) were invited for the first year of the bootcamp. The curriculum encompassed fundamentals of oncology practice, patient care assessment, chemotherapy protocol review, practice management, and supportive care. Participants also received in-depth training on managing various cancer types, including but not limited to prostate, lung, gastrointestinal and hematologic malignancies. VHA specific information, including utilization of Oncology Clinical Pathways to promote standardized care was included where applicable. The interactive nature of the virtual sessions provided opportunities for real-time discussion and immediate feedback. To measure the impact of this program, a pre and post program evaluation of participants was conducted.
Results
Over the course of the program, more than 40 pharmacists across two VISNs participated in the bootcamp series. Results of the program evaluation showed an increase in self-reported comfort and skill levels in all criteria that were assessed (oncology pharmacotherapy, solid tumor malignancies, hematologic malignancies and oral anti-cancer therapy management). Additionally, 85% of respondents stated the series met their overall goals and over 90% of respondents stated they were either satisfied or very satisfied with the content, speakers and organization of the course.
Implications/Significance
This initiative has established the viability and significance of a highly accessible, VHA pathway specific and Veteran centric platform for oncology pharmacy professional development. Future directions for the program include a broader nationwide audience, increased content coverage and self-paced learning options.
Purpose/Background
Oncology clinical pharmacist practitioners (CPP) play a critical role in optimizing drug therapy, managing side effects, and ensuring medication adherence. As a specialized clinical area, specific training is needed to ensure quality of care. Oncology pharmacy training programs are commercially available but pose a financial burden and are not specific to the Veterans Health Administration (VHA). A comprehensive, virtual Oncology Bootcamp series was implemented to upskill new oncology pharmacists (or pharmacists seeking to further their understanding of oncology practice), with didactic materials and clinical tools to enhance and standardize quality care delivery.
Methods
This program was comprised of an online platform of 23 one hour-long continuing education accredited sessions, delivered by leading subject matter experts. Pharmacists from two Veteran Integrated Service Networks (VISNs) were invited for the first year of the bootcamp. The curriculum encompassed fundamentals of oncology practice, patient care assessment, chemotherapy protocol review, practice management, and supportive care. Participants also received in-depth training on managing various cancer types, including but not limited to prostate, lung, gastrointestinal and hematologic malignancies. VHA specific information, including utilization of Oncology Clinical Pathways to promote standardized care was included where applicable. The interactive nature of the virtual sessions provided opportunities for real-time discussion and immediate feedback. To measure the impact of this program, a pre and post program evaluation of participants was conducted.
Results
Over the course of the program, more than 40 pharmacists across two VISNs participated in the bootcamp series. Results of the program evaluation showed an increase in self-reported comfort and skill levels in all criteria that were assessed (oncology pharmacotherapy, solid tumor malignancies, hematologic malignancies and oral anti-cancer therapy management). Additionally, 85% of respondents stated the series met their overall goals and over 90% of respondents stated they were either satisfied or very satisfied with the content, speakers and organization of the course.
Implications/Significance
This initiative has established the viability and significance of a highly accessible, VHA pathway specific and Veteran centric platform for oncology pharmacy professional development. Future directions for the program include a broader nationwide audience, increased content coverage and self-paced learning options.