Bullard AJ

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.