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Anchors Aweigh, Clinical Trial Navigation at the VA!
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to CancerClinicalTrialsNavigation@va.gov. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to CancerClinicalTrialsNavigation@va.gov. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to CancerClinicalTrialsNavigation@va.gov. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.
Variation in Cardiovascular Risk Assessment Status in Patients Receiving Oral Anti-Cancer Therapies: A Focus on Equity throughout VISN (Veteran Integrated Service Network) 12
Background
Oral anti-cancer therapies have quickly moved to the forefront of cancer treatment for several oncologic disease states. While these treatments have led to improvements in prognosis and ease of administration, many of these agents carry the risk of serious short- and long-term toxicities affecting the cardiovascular system. This prompted the Journal of the American Heart Association (JAHA) to release special guidance focused on cardiovascular monitoring strategies for anti-cancer agents. The primary objective of this retrospective review was to evaluate compliance with cardiovascular monitoring based on JAHA cardio-oncologic guidelines. The secondary objective was to assess disparities in cardiovascular monitoring based on markers of equity such as race/ ethnicity, rurality, socioeconomic status and gender.
Methods
Patients who initiated pazopanib, cabozantinib, lenvatinib, axitinib, regorafenib, nilotinib, ibrutinib, sorafenib, sunitinib, ponatinib or everolimus between January 1, 2019 and December 31, 2022 at a VHA VISN 12 site with oncology services were followed forward until treatment discontinuation or 12 months of therapy had been completed. Data was acquired utilizing the VA Informatics and Computing Infrastructure (VINCI) and the Corporate Data Warehouse (CDW). The following cardiovascular monitoring markers were recorded at baseline and months 3, 6, 9 and 12 after initiation anti-cancer therapy: blood pressure, blood glucose, cholesterol, ECG and echocardiogram. Descriptive statistics were used to examine all continuous variables, while frequencies were used to examine categorical variables. Univariate statistics were performed on all items respectively.
Results
A total of 219 patients were identified initiating pre-specified oral anti-cancer therapies during the study time period. Of these, a total of n=145 met study inclusion criteria. 97% were male (n=141), 80% (n=116) had a racial background of white, 36% (n=52) live in rural or highly rural locations and 23% (n=34) lived in a high poverty area. Based on the primary endpoint, the mean compliance with recommended cardiovascular monitoring was 44.95% [IQR 12]. There was no statistically significant difference in cardiovascular monitoring based on equity.
Conclusions
Overall uptake of cardiovascular monitoring markers recommended by JAHA guidance is low. We plan to evaluate methods to increase these measures, utilizing clinical pharmacy provider support throughout VISN 12.
Background
Oral anti-cancer therapies have quickly moved to the forefront of cancer treatment for several oncologic disease states. While these treatments have led to improvements in prognosis and ease of administration, many of these agents carry the risk of serious short- and long-term toxicities affecting the cardiovascular system. This prompted the Journal of the American Heart Association (JAHA) to release special guidance focused on cardiovascular monitoring strategies for anti-cancer agents. The primary objective of this retrospective review was to evaluate compliance with cardiovascular monitoring based on JAHA cardio-oncologic guidelines. The secondary objective was to assess disparities in cardiovascular monitoring based on markers of equity such as race/ ethnicity, rurality, socioeconomic status and gender.
Methods
Patients who initiated pazopanib, cabozantinib, lenvatinib, axitinib, regorafenib, nilotinib, ibrutinib, sorafenib, sunitinib, ponatinib or everolimus between January 1, 2019 and December 31, 2022 at a VHA VISN 12 site with oncology services were followed forward until treatment discontinuation or 12 months of therapy had been completed. Data was acquired utilizing the VA Informatics and Computing Infrastructure (VINCI) and the Corporate Data Warehouse (CDW). The following cardiovascular monitoring markers were recorded at baseline and months 3, 6, 9 and 12 after initiation anti-cancer therapy: blood pressure, blood glucose, cholesterol, ECG and echocardiogram. Descriptive statistics were used to examine all continuous variables, while frequencies were used to examine categorical variables. Univariate statistics were performed on all items respectively.
Results
A total of 219 patients were identified initiating pre-specified oral anti-cancer therapies during the study time period. Of these, a total of n=145 met study inclusion criteria. 97% were male (n=141), 80% (n=116) had a racial background of white, 36% (n=52) live in rural or highly rural locations and 23% (n=34) lived in a high poverty area. Based on the primary endpoint, the mean compliance with recommended cardiovascular monitoring was 44.95% [IQR 12]. There was no statistically significant difference in cardiovascular monitoring based on equity.
Conclusions
Overall uptake of cardiovascular monitoring markers recommended by JAHA guidance is low. We plan to evaluate methods to increase these measures, utilizing clinical pharmacy provider support throughout VISN 12.
Background
Oral anti-cancer therapies have quickly moved to the forefront of cancer treatment for several oncologic disease states. While these treatments have led to improvements in prognosis and ease of administration, many of these agents carry the risk of serious short- and long-term toxicities affecting the cardiovascular system. This prompted the Journal of the American Heart Association (JAHA) to release special guidance focused on cardiovascular monitoring strategies for anti-cancer agents. The primary objective of this retrospective review was to evaluate compliance with cardiovascular monitoring based on JAHA cardio-oncologic guidelines. The secondary objective was to assess disparities in cardiovascular monitoring based on markers of equity such as race/ ethnicity, rurality, socioeconomic status and gender.
Methods
Patients who initiated pazopanib, cabozantinib, lenvatinib, axitinib, regorafenib, nilotinib, ibrutinib, sorafenib, sunitinib, ponatinib or everolimus between January 1, 2019 and December 31, 2022 at a VHA VISN 12 site with oncology services were followed forward until treatment discontinuation or 12 months of therapy had been completed. Data was acquired utilizing the VA Informatics and Computing Infrastructure (VINCI) and the Corporate Data Warehouse (CDW). The following cardiovascular monitoring markers were recorded at baseline and months 3, 6, 9 and 12 after initiation anti-cancer therapy: blood pressure, blood glucose, cholesterol, ECG and echocardiogram. Descriptive statistics were used to examine all continuous variables, while frequencies were used to examine categorical variables. Univariate statistics were performed on all items respectively.
Results
A total of 219 patients were identified initiating pre-specified oral anti-cancer therapies during the study time period. Of these, a total of n=145 met study inclusion criteria. 97% were male (n=141), 80% (n=116) had a racial background of white, 36% (n=52) live in rural or highly rural locations and 23% (n=34) lived in a high poverty area. Based on the primary endpoint, the mean compliance with recommended cardiovascular monitoring was 44.95% [IQR 12]. There was no statistically significant difference in cardiovascular monitoring based on equity.
Conclusions
Overall uptake of cardiovascular monitoring markers recommended by JAHA guidance is low. We plan to evaluate methods to increase these measures, utilizing clinical pharmacy provider support throughout VISN 12.
Implementing a Prospective Surveillance Physical Therapy Program for Those Affected by Cancer
Background
This program implements a prospective surveillance physical therapy program to prioritize the well-being and quality of life of individuals affected by cancer, particularly veterans, by overcoming barriers associated with the prospective surveillance model (PSM) and lessening negative treatment effects. Recent cancer care research emphasizes the significance of PSM and prehabilitation in improving outcomes and mitigating the adverse effects of cancer and its treatments. However, barriers hinder PSM implementation despite its established efficacy in managing cancer-related dysfunctions. Notably, current cancer treatment lacked physical therapy (PT) consultation for cancer rehabilitation.
Methods
A new care model was developed, incorporating PT consultation at cancer diagnosis for veterans with cancer. Comprehensive clinical education and necessary equipment were provided to PTs for high-quality treatment. A cancer rehabilitation guidebook was created and distributed to educate patients and cancer providers in VA hospital and community-based outpatient clinics. Veterans with cancer diagnoses have access to physical therapy services at any time during cancer treatment and survivorship. Data were collected and analyzed to identify trends in cancer rehab PT consults.
Results
The biggest barrier to PSM was a lack of knowledge about its efficacy and available services. Before FY23, no cancer rehab PT consults were conducted. FY23, 47 PT consults were conducted, increasing to 79 consults in FY24 through 05/31/24.
Conclusions
PT services are needed throughout the cancer journey for veterans, from diagnosis to treatment and survivorship. This project demonstrates the feasibility of developing a PSM with a cancer rehabilitation PT consult. Utilizing established surveillance intervals can minimize cancer-related sequelae. Other VA medical centers can adopt similar PSMs in PT to improve functional outcomes and minimize the negative impacts of cancer and its treatments.
Background
This program implements a prospective surveillance physical therapy program to prioritize the well-being and quality of life of individuals affected by cancer, particularly veterans, by overcoming barriers associated with the prospective surveillance model (PSM) and lessening negative treatment effects. Recent cancer care research emphasizes the significance of PSM and prehabilitation in improving outcomes and mitigating the adverse effects of cancer and its treatments. However, barriers hinder PSM implementation despite its established efficacy in managing cancer-related dysfunctions. Notably, current cancer treatment lacked physical therapy (PT) consultation for cancer rehabilitation.
Methods
A new care model was developed, incorporating PT consultation at cancer diagnosis for veterans with cancer. Comprehensive clinical education and necessary equipment were provided to PTs for high-quality treatment. A cancer rehabilitation guidebook was created and distributed to educate patients and cancer providers in VA hospital and community-based outpatient clinics. Veterans with cancer diagnoses have access to physical therapy services at any time during cancer treatment and survivorship. Data were collected and analyzed to identify trends in cancer rehab PT consults.
Results
The biggest barrier to PSM was a lack of knowledge about its efficacy and available services. Before FY23, no cancer rehab PT consults were conducted. FY23, 47 PT consults were conducted, increasing to 79 consults in FY24 through 05/31/24.
Conclusions
PT services are needed throughout the cancer journey for veterans, from diagnosis to treatment and survivorship. This project demonstrates the feasibility of developing a PSM with a cancer rehabilitation PT consult. Utilizing established surveillance intervals can minimize cancer-related sequelae. Other VA medical centers can adopt similar PSMs in PT to improve functional outcomes and minimize the negative impacts of cancer and its treatments.
Background
This program implements a prospective surveillance physical therapy program to prioritize the well-being and quality of life of individuals affected by cancer, particularly veterans, by overcoming barriers associated with the prospective surveillance model (PSM) and lessening negative treatment effects. Recent cancer care research emphasizes the significance of PSM and prehabilitation in improving outcomes and mitigating the adverse effects of cancer and its treatments. However, barriers hinder PSM implementation despite its established efficacy in managing cancer-related dysfunctions. Notably, current cancer treatment lacked physical therapy (PT) consultation for cancer rehabilitation.
Methods
A new care model was developed, incorporating PT consultation at cancer diagnosis for veterans with cancer. Comprehensive clinical education and necessary equipment were provided to PTs for high-quality treatment. A cancer rehabilitation guidebook was created and distributed to educate patients and cancer providers in VA hospital and community-based outpatient clinics. Veterans with cancer diagnoses have access to physical therapy services at any time during cancer treatment and survivorship. Data were collected and analyzed to identify trends in cancer rehab PT consults.
Results
The biggest barrier to PSM was a lack of knowledge about its efficacy and available services. Before FY23, no cancer rehab PT consults were conducted. FY23, 47 PT consults were conducted, increasing to 79 consults in FY24 through 05/31/24.
Conclusions
PT services are needed throughout the cancer journey for veterans, from diagnosis to treatment and survivorship. This project demonstrates the feasibility of developing a PSM with a cancer rehabilitation PT consult. Utilizing established surveillance intervals can minimize cancer-related sequelae. Other VA medical centers can adopt similar PSMs in PT to improve functional outcomes and minimize the negative impacts of cancer and its treatments.
Developing a Cancer Rehabilitation Program—Improving Access to Ancillary Services to Mitigate the Impact of Cancer and its Treatments for Veterans Diagnosed With Cancer
Background
Approximately 56,000 Veterans are diagnosed with cancer every year in the VA system. Up to 90% of survivors have at least one impairment that decreases their quality of life, but only 2-9% are receiving cancer rehabilitation. Current research in cancer care demonstrates the importance of prospective surveillance, rehabilitation, and a multidisciplinary (MultiD) approach to cancer survivorship. Multi-D treatments help mitigate the effects of cancer and its treatments as the veterans proceed through care, improve outcomes, and streamline the process to meet all rehabilitation needs for those affected by cancer. Prior to the development of this program all services except navigation were available. Those diagnosed with cancer were not receiving prehabilitation and consults to ancillary services did not occur until after active cancer treatment was completed. CCRP united existing Multi-D programs to better serve the needs of veterans with cancer. Development of the CCRP CPRS Consult menu has allowed for improved access for both providers and veterans.
Methods
Identified the need for ancillary services during cancer survivorship, regardless of Veterans treatment location within or outside the VA system. Initiated tracking via CCR consults, developed a CCRP guidebook to identify all services available and how to access them as well as the CCCRP consult menu to create easier access for providers and veterans. Tracking via Multi-D departments that allow for tracking in CPRS via CCRP Consult.
Results
Prior to FY23 no cancer rehab consults existed. Consults received since program implementation: Navigation: 144, Physical Therapy: 102, Occupational Therapy: 7, Speech: 15. All other Multi-D did not track CCRP-specific consults. Other tools for data analysis are utilized in other departments in which gaps in coordination of care have been caught/resolved, and advocacy has increased.
Conclusions
Comprehensive cancer care from diagnosis throughout survivorship improves quality of life. A Multi-D comprehensive Cancer rehabilitation provides an opportunity to streamline care via a CPRS Menu. Other VA medical centers can develop a Multi-D cancer rehabilitation program to coordinate treatments from diagnosis through survivorship. This is an opportunity to make the VA the forefront of oncology care – by providing all services within one system.
Background
Approximately 56,000 Veterans are diagnosed with cancer every year in the VA system. Up to 90% of survivors have at least one impairment that decreases their quality of life, but only 2-9% are receiving cancer rehabilitation. Current research in cancer care demonstrates the importance of prospective surveillance, rehabilitation, and a multidisciplinary (MultiD) approach to cancer survivorship. Multi-D treatments help mitigate the effects of cancer and its treatments as the veterans proceed through care, improve outcomes, and streamline the process to meet all rehabilitation needs for those affected by cancer. Prior to the development of this program all services except navigation were available. Those diagnosed with cancer were not receiving prehabilitation and consults to ancillary services did not occur until after active cancer treatment was completed. CCRP united existing Multi-D programs to better serve the needs of veterans with cancer. Development of the CCRP CPRS Consult menu has allowed for improved access for both providers and veterans.
Methods
Identified the need for ancillary services during cancer survivorship, regardless of Veterans treatment location within or outside the VA system. Initiated tracking via CCR consults, developed a CCRP guidebook to identify all services available and how to access them as well as the CCCRP consult menu to create easier access for providers and veterans. Tracking via Multi-D departments that allow for tracking in CPRS via CCRP Consult.
Results
Prior to FY23 no cancer rehab consults existed. Consults received since program implementation: Navigation: 144, Physical Therapy: 102, Occupational Therapy: 7, Speech: 15. All other Multi-D did not track CCRP-specific consults. Other tools for data analysis are utilized in other departments in which gaps in coordination of care have been caught/resolved, and advocacy has increased.
Conclusions
Comprehensive cancer care from diagnosis throughout survivorship improves quality of life. A Multi-D comprehensive Cancer rehabilitation provides an opportunity to streamline care via a CPRS Menu. Other VA medical centers can develop a Multi-D cancer rehabilitation program to coordinate treatments from diagnosis through survivorship. This is an opportunity to make the VA the forefront of oncology care – by providing all services within one system.
Background
Approximately 56,000 Veterans are diagnosed with cancer every year in the VA system. Up to 90% of survivors have at least one impairment that decreases their quality of life, but only 2-9% are receiving cancer rehabilitation. Current research in cancer care demonstrates the importance of prospective surveillance, rehabilitation, and a multidisciplinary (MultiD) approach to cancer survivorship. Multi-D treatments help mitigate the effects of cancer and its treatments as the veterans proceed through care, improve outcomes, and streamline the process to meet all rehabilitation needs for those affected by cancer. Prior to the development of this program all services except navigation were available. Those diagnosed with cancer were not receiving prehabilitation and consults to ancillary services did not occur until after active cancer treatment was completed. CCRP united existing Multi-D programs to better serve the needs of veterans with cancer. Development of the CCRP CPRS Consult menu has allowed for improved access for both providers and veterans.
Methods
Identified the need for ancillary services during cancer survivorship, regardless of Veterans treatment location within or outside the VA system. Initiated tracking via CCR consults, developed a CCRP guidebook to identify all services available and how to access them as well as the CCCRP consult menu to create easier access for providers and veterans. Tracking via Multi-D departments that allow for tracking in CPRS via CCRP Consult.
Results
Prior to FY23 no cancer rehab consults existed. Consults received since program implementation: Navigation: 144, Physical Therapy: 102, Occupational Therapy: 7, Speech: 15. All other Multi-D did not track CCRP-specific consults. Other tools for data analysis are utilized in other departments in which gaps in coordination of care have been caught/resolved, and advocacy has increased.
Conclusions
Comprehensive cancer care from diagnosis throughout survivorship improves quality of life. A Multi-D comprehensive Cancer rehabilitation provides an opportunity to streamline care via a CPRS Menu. Other VA medical centers can develop a Multi-D cancer rehabilitation program to coordinate treatments from diagnosis through survivorship. This is an opportunity to make the VA the forefront of oncology care – by providing all services within one system.
Whole Health Oncology—Just Do It: Making Whole Person Cancer Care Routine and Regular at the Dayton VA Medical Center (DVAMC)
Background
VA Whole Health (WH) is an approach that empowers and equips people to take charge of their health and well-being. In 2020, 18 WH Flagship sites demonstrated reduced opiate use and smaller increases in pharmacy costs as well as favorable veteran self-reported measures. VA mandated WH integration into mental health and primary care. Purose: To incorporate WH within Dayton VA cancer care, using the Personal Health Inventory (PHI) as an intake tool, a tumor-agnostic WH oncology clinic was established.
Methods
Led by an oncologist, a referral-based clinic opened in 2021. Pre-work included EHR items (stop codes/templates), staff training and leverage of mental health integration. VA’s generic PHI was utilized until an oncology-specific PHI was developed by leaders in the field.(3-5) Clinic data was tracked.
Results
170 visits offered (June 2021-May 2024). 32 referrals received (one without cancer; deaths: two pre-intake/five post-intake); 70 appointments occurred among 30 veterans (30 intake/40 follow-up) for 41% fill rate (up 5% from 1st six months). 96% PHI completion rate. Referral sources: fellows (43%), attendings (17%), PCP (3%), Survivorship Clinic (3%), self-referral (33%)--40% of these from cancer support group members. Cancer types (one dual-diagnosis; total >100%): 24% breast, 17% prostate, 17% NSCLC, 10% NHL, 10% pancreatic, 7% Head/Neck, 7% SCLC, 3% each colon/esophageal/kidney. Cancer Stages represented: I (10%), II (20%), III (23%) and IV (47%). Participant info: Age range (36-85); 69% male and 31% female with 86% on active cancer therapy (hormonal, immune-, chemo- or chemoradiation). Supplements were discussed at 26% of visits and referrals ordered at 27% (4-massage therapy, 1-acupuncture, 1-chiropractic, 2-health coaching, 1-cardiology, 1-lymphedema therapy, 1-social work, 1-survivorship clinic, 1-yoga, 1-diabetes education, 1-ENT, 1-nutrition, 1-pathology, 1-pulmonary, 1-prosthetics).
Conclusions
WH within cancer care is feasible for veterans on active treatment (all types/stages) and at a non-Flagship/unfunded site. Veterans gain introduction to WH through the PHI and Complementary-Integrative Health referrals (VA Directive 1137). Cancer support group attendance prompts WH clinic self-referrals. Next steps at DVAMC are to offer mind-body approaches such as virtual reality experiences in the infusion room and VA CALM sessions via asynchronous online delivery; funding would support WH evolution in oncology.
Background
VA Whole Health (WH) is an approach that empowers and equips people to take charge of their health and well-being. In 2020, 18 WH Flagship sites demonstrated reduced opiate use and smaller increases in pharmacy costs as well as favorable veteran self-reported measures. VA mandated WH integration into mental health and primary care. Purose: To incorporate WH within Dayton VA cancer care, using the Personal Health Inventory (PHI) as an intake tool, a tumor-agnostic WH oncology clinic was established.
Methods
Led by an oncologist, a referral-based clinic opened in 2021. Pre-work included EHR items (stop codes/templates), staff training and leverage of mental health integration. VA’s generic PHI was utilized until an oncology-specific PHI was developed by leaders in the field.(3-5) Clinic data was tracked.
Results
170 visits offered (June 2021-May 2024). 32 referrals received (one without cancer; deaths: two pre-intake/five post-intake); 70 appointments occurred among 30 veterans (30 intake/40 follow-up) for 41% fill rate (up 5% from 1st six months). 96% PHI completion rate. Referral sources: fellows (43%), attendings (17%), PCP (3%), Survivorship Clinic (3%), self-referral (33%)--40% of these from cancer support group members. Cancer types (one dual-diagnosis; total >100%): 24% breast, 17% prostate, 17% NSCLC, 10% NHL, 10% pancreatic, 7% Head/Neck, 7% SCLC, 3% each colon/esophageal/kidney. Cancer Stages represented: I (10%), II (20%), III (23%) and IV (47%). Participant info: Age range (36-85); 69% male and 31% female with 86% on active cancer therapy (hormonal, immune-, chemo- or chemoradiation). Supplements were discussed at 26% of visits and referrals ordered at 27% (4-massage therapy, 1-acupuncture, 1-chiropractic, 2-health coaching, 1-cardiology, 1-lymphedema therapy, 1-social work, 1-survivorship clinic, 1-yoga, 1-diabetes education, 1-ENT, 1-nutrition, 1-pathology, 1-pulmonary, 1-prosthetics).
Conclusions
WH within cancer care is feasible for veterans on active treatment (all types/stages) and at a non-Flagship/unfunded site. Veterans gain introduction to WH through the PHI and Complementary-Integrative Health referrals (VA Directive 1137). Cancer support group attendance prompts WH clinic self-referrals. Next steps at DVAMC are to offer mind-body approaches such as virtual reality experiences in the infusion room and VA CALM sessions via asynchronous online delivery; funding would support WH evolution in oncology.
Background
VA Whole Health (WH) is an approach that empowers and equips people to take charge of their health and well-being. In 2020, 18 WH Flagship sites demonstrated reduced opiate use and smaller increases in pharmacy costs as well as favorable veteran self-reported measures. VA mandated WH integration into mental health and primary care. Purose: To incorporate WH within Dayton VA cancer care, using the Personal Health Inventory (PHI) as an intake tool, a tumor-agnostic WH oncology clinic was established.
Methods
Led by an oncologist, a referral-based clinic opened in 2021. Pre-work included EHR items (stop codes/templates), staff training and leverage of mental health integration. VA’s generic PHI was utilized until an oncology-specific PHI was developed by leaders in the field.(3-5) Clinic data was tracked.
Results
170 visits offered (June 2021-May 2024). 32 referrals received (one without cancer; deaths: two pre-intake/five post-intake); 70 appointments occurred among 30 veterans (30 intake/40 follow-up) for 41% fill rate (up 5% from 1st six months). 96% PHI completion rate. Referral sources: fellows (43%), attendings (17%), PCP (3%), Survivorship Clinic (3%), self-referral (33%)--40% of these from cancer support group members. Cancer types (one dual-diagnosis; total >100%): 24% breast, 17% prostate, 17% NSCLC, 10% NHL, 10% pancreatic, 7% Head/Neck, 7% SCLC, 3% each colon/esophageal/kidney. Cancer Stages represented: I (10%), II (20%), III (23%) and IV (47%). Participant info: Age range (36-85); 69% male and 31% female with 86% on active cancer therapy (hormonal, immune-, chemo- or chemoradiation). Supplements were discussed at 26% of visits and referrals ordered at 27% (4-massage therapy, 1-acupuncture, 1-chiropractic, 2-health coaching, 1-cardiology, 1-lymphedema therapy, 1-social work, 1-survivorship clinic, 1-yoga, 1-diabetes education, 1-ENT, 1-nutrition, 1-pathology, 1-pulmonary, 1-prosthetics).
Conclusions
WH within cancer care is feasible for veterans on active treatment (all types/stages) and at a non-Flagship/unfunded site. Veterans gain introduction to WH through the PHI and Complementary-Integrative Health referrals (VA Directive 1137). Cancer support group attendance prompts WH clinic self-referrals. Next steps at DVAMC are to offer mind-body approaches such as virtual reality experiences in the infusion room and VA CALM sessions via asynchronous online delivery; funding would support WH evolution in oncology.
A Time to Heal for Veterans With Cancer
Background
Cancer diagnosis and treatment can be devastating! After treatment, a person often feels tired, weak, and worried while trying to put their life back together. This transition period is known to be difficult (www.cancer.gov/about-cancer/coping/survivorship/new-normal). A Time to Heal for Veterans and their Caregivers (“wellness rehabilitation”) was created to provide support, information, and skills to help with this transition.
Methods
This 9-week program is based on a successful, well documented, evidence-based book and protocol developed in 2005, that has been updated and adapted for specific populations. The VA program has a customized participant book and is facilitated by a VA social worker and a VA oncology nurse. It includes weekly protocols of research-based educational presentations on the following topics: Building Resilience, Physical Side Effects, Calming Worries and Fears, Nutrition and Exercise for Cancer Survivors, Relationships After Cancer, Nurturing Inner Strength, Planning for the Future, and Happiness Going Forward. It also includes facilitated discussions to share experiences, demonstration/ practices of simple strategies for relaxation or health, and journaling/affirmation writing. The program is held in person at the VA for locals and via Zoom for non-local participants (hybrid format).
Results
A Time to Heal program for Veterans has been offered since 2016. In 2020 it was shortened from 12 weeks to 9 weeks. Since then, 24 veterans and 8 caregivers have completed the program and 13 have completed the evaluation/survey. On a scale of 1 (below expectations) to 5 (exceeded expectations), the program and book have consistently received rating averages of 4.5/5.0. Testimonials include: “Awesome program!” “Was hesitant at first, but so glad I decided to participate. I was able to open up my feelings and express them. I am grateful for the VA to have these resources.”
Conclusions
Recruitment for the program has relied on fliers and education from oncology staff. The feedback received from veterans with cancer, caregivers, and providers indicates a positive impact of this program. More study is needed to evaluate specific aspects of the program, guide participant recruitment, and determine best delivery methods for participants.
Background
Cancer diagnosis and treatment can be devastating! After treatment, a person often feels tired, weak, and worried while trying to put their life back together. This transition period is known to be difficult (www.cancer.gov/about-cancer/coping/survivorship/new-normal). A Time to Heal for Veterans and their Caregivers (“wellness rehabilitation”) was created to provide support, information, and skills to help with this transition.
Methods
This 9-week program is based on a successful, well documented, evidence-based book and protocol developed in 2005, that has been updated and adapted for specific populations. The VA program has a customized participant book and is facilitated by a VA social worker and a VA oncology nurse. It includes weekly protocols of research-based educational presentations on the following topics: Building Resilience, Physical Side Effects, Calming Worries and Fears, Nutrition and Exercise for Cancer Survivors, Relationships After Cancer, Nurturing Inner Strength, Planning for the Future, and Happiness Going Forward. It also includes facilitated discussions to share experiences, demonstration/ practices of simple strategies for relaxation or health, and journaling/affirmation writing. The program is held in person at the VA for locals and via Zoom for non-local participants (hybrid format).
Results
A Time to Heal program for Veterans has been offered since 2016. In 2020 it was shortened from 12 weeks to 9 weeks. Since then, 24 veterans and 8 caregivers have completed the program and 13 have completed the evaluation/survey. On a scale of 1 (below expectations) to 5 (exceeded expectations), the program and book have consistently received rating averages of 4.5/5.0. Testimonials include: “Awesome program!” “Was hesitant at first, but so glad I decided to participate. I was able to open up my feelings and express them. I am grateful for the VA to have these resources.”
Conclusions
Recruitment for the program has relied on fliers and education from oncology staff. The feedback received from veterans with cancer, caregivers, and providers indicates a positive impact of this program. More study is needed to evaluate specific aspects of the program, guide participant recruitment, and determine best delivery methods for participants.
Background
Cancer diagnosis and treatment can be devastating! After treatment, a person often feels tired, weak, and worried while trying to put their life back together. This transition period is known to be difficult (www.cancer.gov/about-cancer/coping/survivorship/new-normal). A Time to Heal for Veterans and their Caregivers (“wellness rehabilitation”) was created to provide support, information, and skills to help with this transition.
Methods
This 9-week program is based on a successful, well documented, evidence-based book and protocol developed in 2005, that has been updated and adapted for specific populations. The VA program has a customized participant book and is facilitated by a VA social worker and a VA oncology nurse. It includes weekly protocols of research-based educational presentations on the following topics: Building Resilience, Physical Side Effects, Calming Worries and Fears, Nutrition and Exercise for Cancer Survivors, Relationships After Cancer, Nurturing Inner Strength, Planning for the Future, and Happiness Going Forward. It also includes facilitated discussions to share experiences, demonstration/ practices of simple strategies for relaxation or health, and journaling/affirmation writing. The program is held in person at the VA for locals and via Zoom for non-local participants (hybrid format).
Results
A Time to Heal program for Veterans has been offered since 2016. In 2020 it was shortened from 12 weeks to 9 weeks. Since then, 24 veterans and 8 caregivers have completed the program and 13 have completed the evaluation/survey. On a scale of 1 (below expectations) to 5 (exceeded expectations), the program and book have consistently received rating averages of 4.5/5.0. Testimonials include: “Awesome program!” “Was hesitant at first, but so glad I decided to participate. I was able to open up my feelings and express them. I am grateful for the VA to have these resources.”
Conclusions
Recruitment for the program has relied on fliers and education from oncology staff. The feedback received from veterans with cancer, caregivers, and providers indicates a positive impact of this program. More study is needed to evaluate specific aspects of the program, guide participant recruitment, and determine best delivery methods for participants.
“It Takes a Village”: Benefits and Challenges of Navigating Cancer Care with the Pacific Community and the Veterans Health Administration
Background
The Palliative Care in Hawaii/Pacific Island Communities for Veterans (PaCiHPIC Veterans) study is a VA-funded research study that explores social determinants of health, cultural values, and cancer disparities impacting Native Hawaiian/Pacific Islander/US-affiliated Pacific Island resident (NHPI/USAPI) Veterans.Cancer prevalence and mortality are increasing among NHPI/ USAPI Veterans which can be partly attributed to nuclear fallout from U.S. military activities in the region. This population faces geographic, financial, and logistical barriers to cancer care. There is an imminent need to understand and address access to cancer care and palliative care to reduce disparities within this population.
Methods
We interviewed 15 clinicians including physicians, nurses, nurse practitioners, social workers, and clinical psychologists specializing in primary care, palliative care, and oncology, self-identifying as White, Asian American, NHPI, and Multiracial. Interviews were transcribed verbatim and de-identified. Using inductive and deductive strategies, we iteratively collapsed content into codes formulating a codebook. Thematic analyses were performed using dual-coder review in Atlas.ti v23. Themes were mapped to the socioecological model.
Results
Clinicians described how NHPI/USAPI Veterans receive healthcare and instrumental support at individual, community, and systems levels, including from family caregivers, “high-talking chiefs,” traditional healers (“suruhanu”), community health clinics, and the VHA. Clinicians identified challenges and opportunities for care coordination: (1) financial and logistical barriers to involve family and decision-makers; (2) clinician understanding of cultural values and influence on medical decision-making; (3) care fragmentation resulting from transitions between community care and VHA; and (4) collaboration with key individuals in Pacific social hierarchies.
Conclusions
Cancer navigation and care coordination gaps create challenges for clinicians and NHPI/USAPI Veterans managing cancer in the Pacific Islands. Better understanding of these systems of care and associated gaps can inform the development of an intervention to improve cancer care delivery to this population. NHPI/ USAPI Veterans may experience care fragmentation due to care transitions between community care and the VHA. At the same time, these sources also create multiple layers of support for Veterans. Interventions to address these challenges can leverage the strengths of Pacific communities, while striving to better integrate care between community healthcare providers and VHA.
Background
The Palliative Care in Hawaii/Pacific Island Communities for Veterans (PaCiHPIC Veterans) study is a VA-funded research study that explores social determinants of health, cultural values, and cancer disparities impacting Native Hawaiian/Pacific Islander/US-affiliated Pacific Island resident (NHPI/USAPI) Veterans.Cancer prevalence and mortality are increasing among NHPI/ USAPI Veterans which can be partly attributed to nuclear fallout from U.S. military activities in the region. This population faces geographic, financial, and logistical barriers to cancer care. There is an imminent need to understand and address access to cancer care and palliative care to reduce disparities within this population.
Methods
We interviewed 15 clinicians including physicians, nurses, nurse practitioners, social workers, and clinical psychologists specializing in primary care, palliative care, and oncology, self-identifying as White, Asian American, NHPI, and Multiracial. Interviews were transcribed verbatim and de-identified. Using inductive and deductive strategies, we iteratively collapsed content into codes formulating a codebook. Thematic analyses were performed using dual-coder review in Atlas.ti v23. Themes were mapped to the socioecological model.
Results
Clinicians described how NHPI/USAPI Veterans receive healthcare and instrumental support at individual, community, and systems levels, including from family caregivers, “high-talking chiefs,” traditional healers (“suruhanu”), community health clinics, and the VHA. Clinicians identified challenges and opportunities for care coordination: (1) financial and logistical barriers to involve family and decision-makers; (2) clinician understanding of cultural values and influence on medical decision-making; (3) care fragmentation resulting from transitions between community care and VHA; and (4) collaboration with key individuals in Pacific social hierarchies.
Conclusions
Cancer navigation and care coordination gaps create challenges for clinicians and NHPI/USAPI Veterans managing cancer in the Pacific Islands. Better understanding of these systems of care and associated gaps can inform the development of an intervention to improve cancer care delivery to this population. NHPI/ USAPI Veterans may experience care fragmentation due to care transitions between community care and the VHA. At the same time, these sources also create multiple layers of support for Veterans. Interventions to address these challenges can leverage the strengths of Pacific communities, while striving to better integrate care between community healthcare providers and VHA.
Background
The Palliative Care in Hawaii/Pacific Island Communities for Veterans (PaCiHPIC Veterans) study is a VA-funded research study that explores social determinants of health, cultural values, and cancer disparities impacting Native Hawaiian/Pacific Islander/US-affiliated Pacific Island resident (NHPI/USAPI) Veterans.Cancer prevalence and mortality are increasing among NHPI/ USAPI Veterans which can be partly attributed to nuclear fallout from U.S. military activities in the region. This population faces geographic, financial, and logistical barriers to cancer care. There is an imminent need to understand and address access to cancer care and palliative care to reduce disparities within this population.
Methods
We interviewed 15 clinicians including physicians, nurses, nurse practitioners, social workers, and clinical psychologists specializing in primary care, palliative care, and oncology, self-identifying as White, Asian American, NHPI, and Multiracial. Interviews were transcribed verbatim and de-identified. Using inductive and deductive strategies, we iteratively collapsed content into codes formulating a codebook. Thematic analyses were performed using dual-coder review in Atlas.ti v23. Themes were mapped to the socioecological model.
Results
Clinicians described how NHPI/USAPI Veterans receive healthcare and instrumental support at individual, community, and systems levels, including from family caregivers, “high-talking chiefs,” traditional healers (“suruhanu”), community health clinics, and the VHA. Clinicians identified challenges and opportunities for care coordination: (1) financial and logistical barriers to involve family and decision-makers; (2) clinician understanding of cultural values and influence on medical decision-making; (3) care fragmentation resulting from transitions between community care and VHA; and (4) collaboration with key individuals in Pacific social hierarchies.
Conclusions
Cancer navigation and care coordination gaps create challenges for clinicians and NHPI/USAPI Veterans managing cancer in the Pacific Islands. Better understanding of these systems of care and associated gaps can inform the development of an intervention to improve cancer care delivery to this population. NHPI/ USAPI Veterans may experience care fragmentation due to care transitions between community care and the VHA. At the same time, these sources also create multiple layers of support for Veterans. Interventions to address these challenges can leverage the strengths of Pacific communities, while striving to better integrate care between community healthcare providers and VHA.
Treatment Patterns and Outcomes of Older (Age ≥ 80) Veterans With Newly Diagnosed Diffuse Large B-Cell Lymphoma (DLBCL)
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Recent Incidence and Survival Trends in Pancreatic Cancer at Young Age (<50 Years)
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Laterality in Renal Cancer: Effect on Survival in Veteran Population
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.