Venne VL

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/Rationale: Genomic Medicine Service (GMS) fields 100+ consults weekly. Due to an increase in the number of consults received, without an equal increase in staffing, the wait time for a non-urgent appointment approached 6 months. We explored the use of Group Telehealth
appointments (GTAs) for individuals referred for a family history of breast cancer as one way to reduce these wait times.

Background: While oncology specializes in those with cancer, they are often asked to see unaffected individuals with a family history of cancer who need risk assessments, management recommendations, and/or genetic testing. Many of these are then referred to GMS.

GMS uses the VA telehealth infrastructure to provide genetic evaluation to 84 VAMCs. We typically schedule appointments for one-hour, with an inability to double book due to the limitations of multi-site telehealth. As risk assessment for unaffected individuals is not urgent, these Veterans were scheduled routinely. As GMS got busier, wait times for routine appointments approached 6 months.

Methods/Approach: As part of a Leadership Development Institute, one of the authors (RAR) conceived and implemented a process whereby we held GTAs for unaffected individuals with family histories of breast cancer for whom we would most likely recommend testing an affected
relative. Before the GTA, we mailed a Breast Cancer Risk Assessment (BCRA) form to collect personal/family history. Patients who complete the GTA and BCRA were sent letters that included risk assessments and testing and screening recommendations. 4 GTAs are held each month.
We recorded the number of patients scheduled, appointments attended, and BCRA forms returned. The presentation will review results of an initial 3-month period, during which we held 14 GTAs with 97 patients scheduled, 65 seen, and 58 who turned in BCRAs. We compared time
spent on patients, documentation, and risk assessment in GTAs with the time needed for individual visits for the same number of people. We modeled time saved under a range of assumptions.

Conclusions: Our GTAs were successful, allowing our providers to more efficiently use their time and reducing our wait times. We have expanded our GTAs to include non-breast cancers and reasons for referral.

Purpose/Rationale: Genomic Medicine Service (GMS) fields 100+ consults weekly. Due to an increase in the number of consults received, without an equal increase in staffing, the wait time for a non-urgent appointment approached 6 months. We explored the use of Group Telehealth
appointments (GTAs) for individuals referred for a family history of breast cancer as one way to reduce these wait times.

Background: While oncology specializes in those with cancer, they are often asked to see unaffected individuals with a family history of cancer who need risk assessments, management recommendations, and/or genetic testing. Many of these are then referred to GMS.

GMS uses the VA telehealth infrastructure to provide genetic evaluation to 84 VAMCs. We typically schedule appointments for one-hour, with an inability to double book due to the limitations of multi-site telehealth. As risk assessment for unaffected individuals is not urgent, these Veterans were scheduled routinely. As GMS got busier, wait times for routine appointments approached 6 months.

Methods/Approach: As part of a Leadership Development Institute, one of the authors (RAR) conceived and implemented a process whereby we held GTAs for unaffected individuals with family histories of breast cancer for whom we would most likely recommend testing an affected
relative. Before the GTA, we mailed a Breast Cancer Risk Assessment (BCRA) form to collect personal/family history. Patients who complete the GTA and BCRA were sent letters that included risk assessments and testing and screening recommendations. 4 GTAs are held each month.
We recorded the number of patients scheduled, appointments attended, and BCRA forms returned. The presentation will review results of an initial 3-month period, during which we held 14 GTAs with 97 patients scheduled, 65 seen, and 58 who turned in BCRAs. We compared time
spent on patients, documentation, and risk assessment in GTAs with the time needed for individual visits for the same number of people. We modeled time saved under a range of assumptions.

Conclusions: Our GTAs were successful, allowing our providers to more efficiently use their time and reducing our wait times. We have expanded our GTAs to include non-breast cancers and reasons for referral.

Purpose/Rationale: Genomic Medicine Service (GMS) fields 100+ consults weekly. Due to an increase in the number of consults received, without an equal increase in staffing, the wait time for a non-urgent appointment approached 6 months. We explored the use of Group Telehealth
appointments (GTAs) for individuals referred for a family history of breast cancer as one way to reduce these wait times.

Background: While oncology specializes in those with cancer, they are often asked to see unaffected individuals with a family history of cancer who need risk assessments, management recommendations, and/or genetic testing. Many of these are then referred to GMS.

GMS uses the VA telehealth infrastructure to provide genetic evaluation to 84 VAMCs. We typically schedule appointments for one-hour, with an inability to double book due to the limitations of multi-site telehealth. As risk assessment for unaffected individuals is not urgent, these Veterans were scheduled routinely. As GMS got busier, wait times for routine appointments approached 6 months.

Methods/Approach: As part of a Leadership Development Institute, one of the authors (RAR) conceived and implemented a process whereby we held GTAs for unaffected individuals with family histories of breast cancer for whom we would most likely recommend testing an affected
relative. Before the GTA, we mailed a Breast Cancer Risk Assessment (BCRA) form to collect personal/family history. Patients who complete the GTA and BCRA were sent letters that included risk assessments and testing and screening recommendations. 4 GTAs are held each month.
We recorded the number of patients scheduled, appointments attended, and BCRA forms returned. The presentation will review results of an initial 3-month period, during which we held 14 GTAs with 97 patients scheduled, 65 seen, and 58 who turned in BCRAs. We compared time
spent on patients, documentation, and risk assessment in GTAs with the time needed for individual visits for the same number of people. We modeled time saved under a range of assumptions.

Conclusions: Our GTAs were successful, allowing our providers to more efficiently use their time and reducing our wait times. We have expanded our GTAs to include non-breast cancers and reasons for referral.