Hawley D

Purpose: Assess breast cancer (BC) risk, lifestyle factors, post-traumatic stress disorder (PTSD) status, chemoprevention and genetic consultations in women Veterans.

Background/Rationale: By 2020, women using Veterans Affairs Medical Centers (VAMC) will rise to 15%. For US women at high risk of BC, national guidelines (ASCO/USPSTF) recommend chemoprevention and genetic counseling for which fewer than 10% accept.

Methods: A pilot program was conducted at two VAMCs in the Bronx, NY and Washington, DC. Participants were enrolled at women’s health visits or education/awareness events. A questionnaire included the Gail Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Genetics Referral Screening Tool (B-RST), and lifestyle questions. Body mass index (BMI) and PTSD status were determined. Chemoprevention was recommended based on 5-year BCRAT > 1.66%; the B-RST was used for genetic counseling referrals. Chemoprevention candidates were given pre- and post-consultation knowledge questions.

Results: 99 women Veterans aged > 35 years with no personal history of BC, average age 54 years, participated between 2015-2018. Of these 35 (35%) had a Gail score of > 1.66%. Of this subset, 46% had prior breast biopsies and 86% had a positive family history. PTSD was present in 31%. Twenty-six (74%) accepted consultations for chemoprevention; 19% accepted chemoprevention; 37% patients were referred for genetic counseling; and 85% increased their awareness of chemoprevention. Among all participants, 79% had overweight or obese BMIs; 58% exercise weekly; 51% drink alcohol; 14% were smokers and 21% consumed 3-4 servings of fruits/vegetables daily.

Conclusions/Implications: Our study demonstrated that three times as many women Veterans are at increased risk of BC compared to the general population, based on a high rate of prior breast biopsies or positive family history. PTSD rates were nearly 3 times the national average and are implicated in poor adherence to medical advice. Chemoprevention utilization was nearly twice the national average. Lifestyle factors were similar to general population rates and unlikely to impact risk levels. Limitations included self-referrals and the large percentage of patients with a family history of BC, making them more likely to seek screening. As the number of Women Veterans increases, chemoprevention options should follow national guidelines.

Purpose: Assess breast cancer (BC) risk, lifestyle factors, post-traumatic stress disorder (PTSD) status, chemoprevention and genetic consultations in women Veterans.

Background/Rationale: By 2020, women using Veterans Affairs Medical Centers (VAMC) will rise to 15%. For US women at high risk of BC, national guidelines (ASCO/USPSTF) recommend chemoprevention and genetic counseling for which fewer than 10% accept.

Methods: A pilot program was conducted at two VAMCs in the Bronx, NY and Washington, DC. Participants were enrolled at women’s health visits or education/awareness events. A questionnaire included the Gail Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Genetics Referral Screening Tool (B-RST), and lifestyle questions. Body mass index (BMI) and PTSD status were determined. Chemoprevention was recommended based on 5-year BCRAT > 1.66%; the B-RST was used for genetic counseling referrals. Chemoprevention candidates were given pre- and post-consultation knowledge questions.

Results: 99 women Veterans aged > 35 years with no personal history of BC, average age 54 years, participated between 2015-2018. Of these 35 (35%) had a Gail score of > 1.66%. Of this subset, 46% had prior breast biopsies and 86% had a positive family history. PTSD was present in 31%. Twenty-six (74%) accepted consultations for chemoprevention; 19% accepted chemoprevention; 37% patients were referred for genetic counseling; and 85% increased their awareness of chemoprevention. Among all participants, 79% had overweight or obese BMIs; 58% exercise weekly; 51% drink alcohol; 14% were smokers and 21% consumed 3-4 servings of fruits/vegetables daily.

Conclusions/Implications: Our study demonstrated that three times as many women Veterans are at increased risk of BC compared to the general population, based on a high rate of prior breast biopsies or positive family history. PTSD rates were nearly 3 times the national average and are implicated in poor adherence to medical advice. Chemoprevention utilization was nearly twice the national average. Lifestyle factors were similar to general population rates and unlikely to impact risk levels. Limitations included self-referrals and the large percentage of patients with a family history of BC, making them more likely to seek screening. As the number of Women Veterans increases, chemoprevention options should follow national guidelines.

Purpose: Assess breast cancer (BC) risk, lifestyle factors, post-traumatic stress disorder (PTSD) status, chemoprevention and genetic consultations in women Veterans.

Background/Rationale: By 2020, women using Veterans Affairs Medical Centers (VAMC) will rise to 15%. For US women at high risk of BC, national guidelines (ASCO/USPSTF) recommend chemoprevention and genetic counseling for which fewer than 10% accept.

Methods: A pilot program was conducted at two VAMCs in the Bronx, NY and Washington, DC. Participants were enrolled at women’s health visits or education/awareness events. A questionnaire included the Gail Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Genetics Referral Screening Tool (B-RST), and lifestyle questions. Body mass index (BMI) and PTSD status were determined. Chemoprevention was recommended based on 5-year BCRAT > 1.66%; the B-RST was used for genetic counseling referrals. Chemoprevention candidates were given pre- and post-consultation knowledge questions.

Results: 99 women Veterans aged > 35 years with no personal history of BC, average age 54 years, participated between 2015-2018. Of these 35 (35%) had a Gail score of > 1.66%. Of this subset, 46% had prior breast biopsies and 86% had a positive family history. PTSD was present in 31%. Twenty-six (74%) accepted consultations for chemoprevention; 19% accepted chemoprevention; 37% patients were referred for genetic counseling; and 85% increased their awareness of chemoprevention. Among all participants, 79% had overweight or obese BMIs; 58% exercise weekly; 51% drink alcohol; 14% were smokers and 21% consumed 3-4 servings of fruits/vegetables daily.

Conclusions/Implications: Our study demonstrated that three times as many women Veterans are at increased risk of BC compared to the general population, based on a high rate of prior breast biopsies or positive family history. PTSD rates were nearly 3 times the national average and are implicated in poor adherence to medical advice. Chemoprevention utilization was nearly twice the national average. Lifestyle factors were similar to general population rates and unlikely to impact risk levels. Limitations included self-referrals and the large percentage of patients with a family history of BC, making them more likely to seek screening. As the number of Women Veterans increases, chemoprevention options should follow national guidelines.

Purpose: In oncology, wait times for new consults create stress and adverse outcomes; wait times for acute problems in established patients lead to ER visits with increased cost, inconvenience, and sometimes admissions, which could have been avoided. In addition, VA wait times are under public scrutiny.

Background: The CVAMC, partnering with UC, previously had 12 fellows in the H/O program, 3 of which were funded by the VA. Fellows have a VA continuity clinic staffed by 4 faculty, and rotate on the inpatient consult service. We applied for an additional fellow position through the VACAA GME program, which was granted, funded, and started in 2016; the way in which we have utilized this position forms the basis for this report.

Methods: We created a mandatory monthly outpatient VA Core rotation, which became the Urgent Fellow because of two of its primary mandates: see all urgent non-lifethreatening problems in established patients, and offer all new malignancy referrals a same or next day appointment. We encouraged referral earlier in the diagnostic evaluation. We tracked time from initial CPRS referral to visit, and % actually seen within 2 weekdays, excluding patients who declined to be seen soon. We also counted all ER visits for established patients with lung and prostate cancer.

Results: From March 2016 to Jan 2018, median referral  to visit days decreased from 5 to 1, and the percent seen in < 2 days rose from 12% to 85.7%. Additional and updated numbers will be presented.

The ER visits by our patients with lung and prostate cancer fell from 230 in 2014-2015 to 114 in 2016-2017.

The Urgent Fellow rotation was the highest rated rotation at the VA / UC as judged by the fellows.

Conclusions: The creation of the Heme Onc Urgent fellow VA rotation has reaped dividends in dramatically reducing both ER visits and wait times for new malignancy referrals. Fellows have the opportunity to do the diagnostic and staging work ups, discuss treatment options, then treat and follow the patient for the remainder of their fellowship. It has improved care, reduced costs, and provided an irreplaceable experience for the fellows.

Purpose: In oncology, wait times for new consults create stress and adverse outcomes; wait times for acute problems in established patients lead to ER visits with increased cost, inconvenience, and sometimes admissions, which could have been avoided. In addition, VA wait times are under public scrutiny.

Background: The CVAMC, partnering with UC, previously had 12 fellows in the H/O program, 3 of which were funded by the VA. Fellows have a VA continuity clinic staffed by 4 faculty, and rotate on the inpatient consult service. We applied for an additional fellow position through the VACAA GME program, which was granted, funded, and started in 2016; the way in which we have utilized this position forms the basis for this report.

Methods: We created a mandatory monthly outpatient VA Core rotation, which became the Urgent Fellow because of two of its primary mandates: see all urgent non-lifethreatening problems in established patients, and offer all new malignancy referrals a same or next day appointment. We encouraged referral earlier in the diagnostic evaluation. We tracked time from initial CPRS referral to visit, and % actually seen within 2 weekdays, excluding patients who declined to be seen soon. We also counted all ER visits for established patients with lung and prostate cancer.

Results: From March 2016 to Jan 2018, median referral  to visit days decreased from 5 to 1, and the percent seen in < 2 days rose from 12% to 85.7%. Additional and updated numbers will be presented.

The ER visits by our patients with lung and prostate cancer fell from 230 in 2014-2015 to 114 in 2016-2017.

The Urgent Fellow rotation was the highest rated rotation at the VA / UC as judged by the fellows.

Conclusions: The creation of the Heme Onc Urgent fellow VA rotation has reaped dividends in dramatically reducing both ER visits and wait times for new malignancy referrals. Fellows have the opportunity to do the diagnostic and staging work ups, discuss treatment options, then treat and follow the patient for the remainder of their fellowship. It has improved care, reduced costs, and provided an irreplaceable experience for the fellows.

Purpose: In oncology, wait times for new consults create stress and adverse outcomes; wait times for acute problems in established patients lead to ER visits with increased cost, inconvenience, and sometimes admissions, which could have been avoided. In addition, VA wait times are under public scrutiny.

Background: The CVAMC, partnering with UC, previously had 12 fellows in the H/O program, 3 of which were funded by the VA. Fellows have a VA continuity clinic staffed by 4 faculty, and rotate on the inpatient consult service. We applied for an additional fellow position through the VACAA GME program, which was granted, funded, and started in 2016; the way in which we have utilized this position forms the basis for this report.

Methods: We created a mandatory monthly outpatient VA Core rotation, which became the Urgent Fellow because of two of its primary mandates: see all urgent non-lifethreatening problems in established patients, and offer all new malignancy referrals a same or next day appointment. We encouraged referral earlier in the diagnostic evaluation. We tracked time from initial CPRS referral to visit, and % actually seen within 2 weekdays, excluding patients who declined to be seen soon. We also counted all ER visits for established patients with lung and prostate cancer.

Results: From March 2016 to Jan 2018, median referral  to visit days decreased from 5 to 1, and the percent seen in < 2 days rose from 12% to 85.7%. Additional and updated numbers will be presented.

The ER visits by our patients with lung and prostate cancer fell from 230 in 2014-2015 to 114 in 2016-2017.

The Urgent Fellow rotation was the highest rated rotation at the VA / UC as judged by the fellows.

Conclusions: The creation of the Heme Onc Urgent fellow VA rotation has reaped dividends in dramatically reducing both ER visits and wait times for new malignancy referrals. Fellows have the opportunity to do the diagnostic and staging work ups, discuss treatment options, then treat and follow the patient for the remainder of their fellowship. It has improved care, reduced costs, and provided an irreplaceable experience for the fellows.