Kelley MJ

Background: Next-generation sequencing (NGS) of cancer gene panels is now standard-of-care for patients with advanced solid tumors. In July 2016, the Veterans Health Administration (VHA) launched the National Precision Oncology Program (NPOP) to increase access to NGS testing to VHA cancer patients across the country. A review of the prescription patterns among patients with highly actionable mutations is warranted to measure the impact of NPOP.

Purpose: The objective of this study is to assess the use of targeted therapies among patients with advanced solid tumors who received a Level 1, 2A, or R1 recommendation based on NGS results. For cases in which patients failed to receive targeted agents, underlying reasons will be identified. Study results will be used to improve outcomes of veterans undergoing NGS testing and the cost-benefit of NPOP.

Methods: This study will be conducted as a retrospective analysis of veterans who received oncologic care through the VHA and underwent NGS testing. From program inception in July 2016 until January 2019, the tumor samples of 5,897 patients have undergone NGS testing through NPOP. NGS results were categorized by Watson for Genomics (WfG), an artificial intelligence decision-support system. Among these, 608 (10.3%) samples noted to have at least one genetic variant with Level 1 or 2A actionability. The NPOP database will be queried to identify these patients who had a recommendation to receive a targeted agent. Prescribed and dispensed drugs will be identified from the Corporate Data Warehouse to indicate patients who have received targeted agents through VHA and compute the percentage of those who were not prescribed therapy through VHA. The medical records of patients who did not receive a corresponding targeted drug will be reviewed to identify non-VA drug use and code reasons if no record of drug administration is recorded. These codes will be examined for association with patients and tumor characteristics, sites of treating oncologists, and types of cancers. The most frequent coded reasons will be recorded, and assessment of this data will be performed to identify potential interventions to improve the utility of NGS testing for veterans.

Background: Next-generation sequencing (NGS) of cancer gene panels is now standard-of-care for patients with advanced solid tumors. In July 2016, the Veterans Health Administration (VHA) launched the National Precision Oncology Program (NPOP) to increase access to NGS testing to VHA cancer patients across the country. A review of the prescription patterns among patients with highly actionable mutations is warranted to measure the impact of NPOP.

Purpose: The objective of this study is to assess the use of targeted therapies among patients with advanced solid tumors who received a Level 1, 2A, or R1 recommendation based on NGS results. For cases in which patients failed to receive targeted agents, underlying reasons will be identified. Study results will be used to improve outcomes of veterans undergoing NGS testing and the cost-benefit of NPOP.

Methods: This study will be conducted as a retrospective analysis of veterans who received oncologic care through the VHA and underwent NGS testing. From program inception in July 2016 until January 2019, the tumor samples of 5,897 patients have undergone NGS testing through NPOP. NGS results were categorized by Watson for Genomics (WfG), an artificial intelligence decision-support system. Among these, 608 (10.3%) samples noted to have at least one genetic variant with Level 1 or 2A actionability. The NPOP database will be queried to identify these patients who had a recommendation to receive a targeted agent. Prescribed and dispensed drugs will be identified from the Corporate Data Warehouse to indicate patients who have received targeted agents through VHA and compute the percentage of those who were not prescribed therapy through VHA. The medical records of patients who did not receive a corresponding targeted drug will be reviewed to identify non-VA drug use and code reasons if no record of drug administration is recorded. These codes will be examined for association with patients and tumor characteristics, sites of treating oncologists, and types of cancers. The most frequent coded reasons will be recorded, and assessment of this data will be performed to identify potential interventions to improve the utility of NGS testing for veterans.

Background: Next-generation sequencing (NGS) of cancer gene panels is now standard-of-care for patients with advanced solid tumors. In July 2016, the Veterans Health Administration (VHA) launched the National Precision Oncology Program (NPOP) to increase access to NGS testing to VHA cancer patients across the country. A review of the prescription patterns among patients with highly actionable mutations is warranted to measure the impact of NPOP.

Purpose: The objective of this study is to assess the use of targeted therapies among patients with advanced solid tumors who received a Level 1, 2A, or R1 recommendation based on NGS results. For cases in which patients failed to receive targeted agents, underlying reasons will be identified. Study results will be used to improve outcomes of veterans undergoing NGS testing and the cost-benefit of NPOP.

Methods: This study will be conducted as a retrospective analysis of veterans who received oncologic care through the VHA and underwent NGS testing. From program inception in July 2016 until January 2019, the tumor samples of 5,897 patients have undergone NGS testing through NPOP. NGS results were categorized by Watson for Genomics (WfG), an artificial intelligence decision-support system. Among these, 608 (10.3%) samples noted to have at least one genetic variant with Level 1 or 2A actionability. The NPOP database will be queried to identify these patients who had a recommendation to receive a targeted agent. Prescribed and dispensed drugs will be identified from the Corporate Data Warehouse to indicate patients who have received targeted agents through VHA and compute the percentage of those who were not prescribed therapy through VHA. The medical records of patients who did not receive a corresponding targeted drug will be reviewed to identify non-VA drug use and code reasons if no record of drug administration is recorded. These codes will be examined for association with patients and tumor characteristics, sites of treating oncologists, and types of cancers. The most frequent coded reasons will be recorded, and assessment of this data will be performed to identify potential interventions to improve the utility of NGS testing for veterans.

Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.

Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.

Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.

Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.

Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.

Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.

Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.

Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.

Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.

Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.

Purpose: To assess feasibility of implementing an automated method to identify patients who should have EGFR testing, and whether they have been tested, as a tool for quality improvement.

Background: Approximately 7% of veterans with metastatic, nsNSCLC have sensitizing mutation of EGFR, which predicts sensitivity to oral EGFR inhibitors. Prior studies have shown under testing for EGFR mutations in this population in VHA.

Methods: An endorsed quality measure (NQF and ASCO) for EGFR testing was utilized. Data to implement the measure were extracted from the cancer registry (ONC RAW), problem and encounter ICD codes, national oncology note template-generated health factors, laboratory test results, National Precision Oncology Program NGS testing, vital status, and pharmacy drug file to populate a SQL database. A dashboard in SharePoint allowed users to retrieve data based on national data access permissions. Descriptive statistics were used.

Results: The initial algorithm implementation was evaluated by comparison to manual review of patient records from one medical center. The second generation algorithm was then evaluated in the same manner at a second medical center (MC2). Among 117 cases identified during 2018, 68 (58%) were identified as having been tested and 49 (42%) not tested (31 living and 18 deceased patients). 48 of the non-tested samples were reviewed: 28 had not been tested, 14 had data documentation or coding problems (11 correctable by using the national note template), 1 correctable limitation of the national note template, and 5 limitations of the algorithm (all but 1 of which has been corrected). For stage 3 and stage VA-wide, there were 871 and 2832 cases, respectively, with documented testing rates of 26% and 36%, and a facility testing rate range of 0% to 100%.

Implications: The EGFR testing dashboard, in conjunction with appropriate structured documentation, has high accuracy of EGFR testing in patients with metastatic nsNSCLC. Current documented testing rates vary widely with a low system-wide rate, that can be improved through utilization of the dashboard.

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: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

Background: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

Background: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

Purpose: To inform VA stakeholders of the availability of Precision Oncology (PO) services for Veterans with advanced cancer.

Background: PO offers the promise of effective, lowtoxicity targeted therapies tailored to individual tumor genomics but is unequally available within VHA. A system-wide National PO Program (NPOP) including patients in rural areas launched in July 2016.

Methods: Patients tested with multigene next generation sequencing (NGS) tumor testing through 2 contracted vendors were identified from NPOP records and cancer characteristics were extracted from NPOP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from NPOP records.

Results: In all, 3,981 samples have been sent for NGS sequencing via NPOP. 3,036 samples were sequenced successfully and 597 failed (83.57% successful). Of the successful samples, 99 are liquid biopsies and 2,880 have Watson for Genomics treatment recommendations. Utilization of NPOP services has increased across VHA since the national rollout, from 4 participating facilities in NPOP’s first quarter (Q4 2016) to 51 facilities last quarter (Q3 2018). Average samples sent per month in 2018 is 182, up from 105 in 2017. Despite these increases, NGS testing is not yet systematically utilized at all participating facilities and 79 facilities did not participate last quarter. NPOP is servicing a large rural population (34% rural), which is similar to that of all VHA patients (33%) and more than twice the national rate (14%). The top diagnoses were lung (1,333: 917 adeno, 283 squamous, 133 non-small cell), colorectal (307), prostate (297), skin (154) and head and neck (75). 158 patients have been prescribed 225 of the recommended treatments before (130) and after (95) the NGS results date.

Conclusions: Utilization of NGS testing in the VHA population has grown significantly over the past year throughout most of the country. The higher volume has been facilitated through improvements in NPOP’s data infrastructure. Additional VHA patients can benefit from NGS gene panel testing to guide therapeutic decisionmaking.

Purpose: To inform VA stakeholders of the availability of Precision Oncology (PO) services for Veterans with advanced cancer.

Background: PO offers the promise of effective, lowtoxicity targeted therapies tailored to individual tumor genomics but is unequally available within VHA. A system-wide National PO Program (NPOP) including patients in rural areas launched in July 2016.

Methods: Patients tested with multigene next generation sequencing (NGS) tumor testing through 2 contracted vendors were identified from NPOP records and cancer characteristics were extracted from NPOP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from NPOP records.

Results: In all, 3,981 samples have been sent for NGS sequencing via NPOP. 3,036 samples were sequenced successfully and 597 failed (83.57% successful). Of the successful samples, 99 are liquid biopsies and 2,880 have Watson for Genomics treatment recommendations. Utilization of NPOP services has increased across VHA since the national rollout, from 4 participating facilities in NPOP’s first quarter (Q4 2016) to 51 facilities last quarter (Q3 2018). Average samples sent per month in 2018 is 182, up from 105 in 2017. Despite these increases, NGS testing is not yet systematically utilized at all participating facilities and 79 facilities did not participate last quarter. NPOP is servicing a large rural population (34% rural), which is similar to that of all VHA patients (33%) and more than twice the national rate (14%). The top diagnoses were lung (1,333: 917 adeno, 283 squamous, 133 non-small cell), colorectal (307), prostate (297), skin (154) and head and neck (75). 158 patients have been prescribed 225 of the recommended treatments before (130) and after (95) the NGS results date.

Conclusions: Utilization of NGS testing in the VHA population has grown significantly over the past year throughout most of the country. The higher volume has been facilitated through improvements in NPOP’s data infrastructure. Additional VHA patients can benefit from NGS gene panel testing to guide therapeutic decisionmaking.

Purpose: To inform VA stakeholders of the availability of Precision Oncology (PO) services for Veterans with advanced cancer.

Background: PO offers the promise of effective, lowtoxicity targeted therapies tailored to individual tumor genomics but is unequally available within VHA. A system-wide National PO Program (NPOP) including patients in rural areas launched in July 2016.

Methods: Patients tested with multigene next generation sequencing (NGS) tumor testing through 2 contracted vendors were identified from NPOP records and cancer characteristics were extracted from NPOP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from NPOP records.

Results: In all, 3,981 samples have been sent for NGS sequencing via NPOP. 3,036 samples were sequenced successfully and 597 failed (83.57% successful). Of the successful samples, 99 are liquid biopsies and 2,880 have Watson for Genomics treatment recommendations. Utilization of NPOP services has increased across VHA since the national rollout, from 4 participating facilities in NPOP’s first quarter (Q4 2016) to 51 facilities last quarter (Q3 2018). Average samples sent per month in 2018 is 182, up from 105 in 2017. Despite these increases, NGS testing is not yet systematically utilized at all participating facilities and 79 facilities did not participate last quarter. NPOP is servicing a large rural population (34% rural), which is similar to that of all VHA patients (33%) and more than twice the national rate (14%). The top diagnoses were lung (1,333: 917 adeno, 283 squamous, 133 non-small cell), colorectal (307), prostate (297), skin (154) and head and neck (75). 158 patients have been prescribed 225 of the recommended treatments before (130) and after (95) the NGS results date.

Conclusions: Utilization of NGS testing in the VHA population has grown significantly over the past year throughout most of the country. The higher volume has been facilitated through improvements in NPOP’s data infrastructure. Additional VHA patients can benefit from NGS gene panel testing to guide therapeutic decisionmaking.

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: Symptom assessment in cancer patients is associated with improved quality of life and prolonged survival; we sought to evaluate the use of a systematic symptom assessment tool in VA.

Background: Veterans Affairs (VA) Symptom Assessment Scale (VSAS) is a clinical tool for VA nurses and providers to capture symptom burden in patients with cancer. It includes 10 physical factors (pain, tiredness, anorexia, nausea, vomiting, diarrhea, constipation, shortness of breath at rest and with exertion, and drowsiness) and 3 emotional factors (depression, anxiety, and distress). Each symptom is scored on a scale of 0 (absence) to 10 (worst possible symptom). Here, we report symptom prevalence, VSAS reliability and internal consistency.

Methods: VSAS data were collected from the VA Corporate Data Warehouse. Symptom prevalence at baseline (initial hematology or oncology visit) and at subsequent follow-up is described. Reliability was assessed using factor-level test-retest correlation within a one week time period. Internal consistency and reliability of “physical” and “emotional” factors were assessed using Cronbach’s alpha.

Results: From January 2015 through June 2018, 5,995 patients were administered 21,761 VSAS assessments in two VA medical centers. At baseline, patients were most likely to report tiredness (68%), shortness of breath with exertion (49%), and pain (45%). Severe symptoms (scores 7-10) included tiredness (23%), pain (17%), and shortness of breath with exertion (13%). The most common symptoms recorded on follow-up were tiredness (70%; 21% severe), shortness of breath with exertion (51%; 17% severe), and pain (45%; 11% severe). Factor correlation upon retesting within one week was moderate, ranging from 0.40 to 0.62. Internal consistency across all factors was high with a Cronbach alpha of 0.86. Internal reliability of physical and emotional symptoms was also high at 0.81 and 0.87, respectively.

Conclusions: Cancer patients treated in the VA have a high symptom burden. The most prevalent symptoms were pain, tiredness, and shortness of breath. We evaluated reliability and consistency of VSAS factors, validating this method of measuring and documenting cancer-related symptoms. This preliminary report establishes VSAS as a tool that can be implemented widely within the VA with the goal of improving quality of care in VA oncology patients.

Purpose: Symptom assessment in cancer patients is associated with improved quality of life and prolonged survival; we sought to evaluate the use of a systematic symptom assessment tool in VA.

Background: Veterans Affairs (VA) Symptom Assessment Scale (VSAS) is a clinical tool for VA nurses and providers to capture symptom burden in patients with cancer. It includes 10 physical factors (pain, tiredness, anorexia, nausea, vomiting, diarrhea, constipation, shortness of breath at rest and with exertion, and drowsiness) and 3 emotional factors (depression, anxiety, and distress). Each symptom is scored on a scale of 0 (absence) to 10 (worst possible symptom). Here, we report symptom prevalence, VSAS reliability and internal consistency.

Methods: VSAS data were collected from the VA Corporate Data Warehouse. Symptom prevalence at baseline (initial hematology or oncology visit) and at subsequent follow-up is described. Reliability was assessed using factor-level test-retest correlation within a one week time period. Internal consistency and reliability of “physical” and “emotional” factors were assessed using Cronbach’s alpha.

Results: From January 2015 through June 2018, 5,995 patients were administered 21,761 VSAS assessments in two VA medical centers. At baseline, patients were most likely to report tiredness (68%), shortness of breath with exertion (49%), and pain (45%). Severe symptoms (scores 7-10) included tiredness (23%), pain (17%), and shortness of breath with exertion (13%). The most common symptoms recorded on follow-up were tiredness (70%; 21% severe), shortness of breath with exertion (51%; 17% severe), and pain (45%; 11% severe). Factor correlation upon retesting within one week was moderate, ranging from 0.40 to 0.62. Internal consistency across all factors was high with a Cronbach alpha of 0.86. Internal reliability of physical and emotional symptoms was also high at 0.81 and 0.87, respectively.

Conclusions: Cancer patients treated in the VA have a high symptom burden. The most prevalent symptoms were pain, tiredness, and shortness of breath. We evaluated reliability and consistency of VSAS factors, validating this method of measuring and documenting cancer-related symptoms. This preliminary report establishes VSAS as a tool that can be implemented widely within the VA with the goal of improving quality of care in VA oncology patients.

Purpose: Symptom assessment in cancer patients is associated with improved quality of life and prolonged survival; we sought to evaluate the use of a systematic symptom assessment tool in VA.

Background: Veterans Affairs (VA) Symptom Assessment Scale (VSAS) is a clinical tool for VA nurses and providers to capture symptom burden in patients with cancer. It includes 10 physical factors (pain, tiredness, anorexia, nausea, vomiting, diarrhea, constipation, shortness of breath at rest and with exertion, and drowsiness) and 3 emotional factors (depression, anxiety, and distress). Each symptom is scored on a scale of 0 (absence) to 10 (worst possible symptom). Here, we report symptom prevalence, VSAS reliability and internal consistency.

Methods: VSAS data were collected from the VA Corporate Data Warehouse. Symptom prevalence at baseline (initial hematology or oncology visit) and at subsequent follow-up is described. Reliability was assessed using factor-level test-retest correlation within a one week time period. Internal consistency and reliability of “physical” and “emotional” factors were assessed using Cronbach’s alpha.

Results: From January 2015 through June 2018, 5,995 patients were administered 21,761 VSAS assessments in two VA medical centers. At baseline, patients were most likely to report tiredness (68%), shortness of breath with exertion (49%), and pain (45%). Severe symptoms (scores 7-10) included tiredness (23%), pain (17%), and shortness of breath with exertion (13%). The most common symptoms recorded on follow-up were tiredness (70%; 21% severe), shortness of breath with exertion (51%; 17% severe), and pain (45%; 11% severe). Factor correlation upon retesting within one week was moderate, ranging from 0.40 to 0.62. Internal consistency across all factors was high with a Cronbach alpha of 0.86. Internal reliability of physical and emotional symptoms was also high at 0.81 and 0.87, respectively.

Conclusions: Cancer patients treated in the VA have a high symptom burden. The most prevalent symptoms were pain, tiredness, and shortness of breath. We evaluated reliability and consistency of VSAS factors, validating this method of measuring and documenting cancer-related symptoms. This preliminary report establishes VSAS as a tool that can be implemented widely within the VA with the goal of improving quality of care in VA oncology patients.

Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.

Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.

Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.

Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.

Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).

Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.

Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.

Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.

Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.

Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.

Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).

Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.

Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.

Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.

Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.

Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.

Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).

Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.

Background: The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA health care services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women veterans with cancer.

Methods: We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (eg, stages I-IV) between January 1, 2010 and December 31, 2010 in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage.

Results: We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (P < .01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (P = .03).

Conclusions: Understanding cancer incidence among women veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to US civilian women, the geographic dispersion and small incidence relative to male cancers raises challenges for high-quality, well-coordinated cancer care within the VA.

Background: The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA health care services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women veterans with cancer.

Methods: We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (eg, stages I-IV) between January 1, 2010 and December 31, 2010 in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage.

Results: We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (P < .01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (P = .03).

Conclusions: Understanding cancer incidence among women veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to US civilian women, the geographic dispersion and small incidence relative to male cancers raises challenges for high-quality, well-coordinated cancer care within the VA.

Background: The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA health care services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women veterans with cancer.

Methods: We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (eg, stages I-IV) between January 1, 2010 and December 31, 2010 in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage.

Results: We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (P < .01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (P = .03).

Conclusions: Understanding cancer incidence among women veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to US civilian women, the geographic dispersion and small incidence relative to male cancers raises challenges for high-quality, well-coordinated cancer care within the VA.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.