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Demographic Characteristics of Veterans Diagnosed With Breast and Gynecologic Cancers: A Comparative Analysis With the General Population
PURPOSE
This project aims to describe the demographics of Veterans diagnosed with breast and gynecologic cancers and assess differences compared to the general population.
BACKGROUND
With an increasing number of women Veterans enrolling in the VA, it is crucial for oncologists to be prepared to provide care for VeterS32 • SEPTEMBER 2023 www.mdedge.com/fedprac/avaho NOTES ans diagnosed with breast and gynecologic cancers. Despite the rising incidence of these cancers among Veterans, there is limited characterization of the demographic profile of this population. Understanding the unique characteristics of Veterans with these malignancies, distinct from the general population, is essential for the Veterans Administration (VA) to develop programs and enhance care for these patients.
METHODS/DATA ANALYSIS
Consult records from the VA Corporate Data Warehouse between January 1, 2021, and December 31, 2022, were analyzed to identify Veterans with newly diagnosed breast, uterine, ovarian, cervical, and vulvovaginal cancer. Demographic were evaluated. Data on the general population were obtained data from SEER (Surveillance, Epidemiology, and End Results) 19 database for 2020.
RESULTS
A total of 3,304 Veterans diagnosed with breast cancer and 918 Veterans with gynecologic cancers were identified (uterine, n = 365; cervical, n = 344, ovarian, n = 177; vulvovaginal, n = 32). Veterans were found to be younger than the general population, with a mean age at diagnosis of 59 for Veterans with breast cancer to 63 for non-veterans. Among those with gynecologic cancers, the mean age at diagnosis for Veterans was 55 compared to 61 for non-veterans. Male breast cancer cases were more prevalent among Veterans, accounting for 11% in the VA compared to 1% in SEER. The Veteran cohort also displayed a higher proportion of Black patients, with 30% of breast cancer cases in the VA being Black compared to 12% in SEER.
CONCLUSIONS/IMPLICATIONS
Veterans diagnosed with breast and gynecologic cancers exhibit unique demographic characteristics compared to the general population. They tend to be younger and have a higher representation of Black patients. The incidence of male breast cancer is notably higher among Veterans. As the prevalence of these cancer types continue to rise among Veterans, it is vital for oncologists to be aware of and adequately address the unique health needs of this population. These findings emphasize the importance of tailored strategies and programs to provide optimal care for Veterans with breast and gynecologic cancers.
PURPOSE
This project aims to describe the demographics of Veterans diagnosed with breast and gynecologic cancers and assess differences compared to the general population.
BACKGROUND
With an increasing number of women Veterans enrolling in the VA, it is crucial for oncologists to be prepared to provide care for VeterS32 • SEPTEMBER 2023 www.mdedge.com/fedprac/avaho NOTES ans diagnosed with breast and gynecologic cancers. Despite the rising incidence of these cancers among Veterans, there is limited characterization of the demographic profile of this population. Understanding the unique characteristics of Veterans with these malignancies, distinct from the general population, is essential for the Veterans Administration (VA) to develop programs and enhance care for these patients.
METHODS/DATA ANALYSIS
Consult records from the VA Corporate Data Warehouse between January 1, 2021, and December 31, 2022, were analyzed to identify Veterans with newly diagnosed breast, uterine, ovarian, cervical, and vulvovaginal cancer. Demographic were evaluated. Data on the general population were obtained data from SEER (Surveillance, Epidemiology, and End Results) 19 database for 2020.
RESULTS
A total of 3,304 Veterans diagnosed with breast cancer and 918 Veterans with gynecologic cancers were identified (uterine, n = 365; cervical, n = 344, ovarian, n = 177; vulvovaginal, n = 32). Veterans were found to be younger than the general population, with a mean age at diagnosis of 59 for Veterans with breast cancer to 63 for non-veterans. Among those with gynecologic cancers, the mean age at diagnosis for Veterans was 55 compared to 61 for non-veterans. Male breast cancer cases were more prevalent among Veterans, accounting for 11% in the VA compared to 1% in SEER. The Veteran cohort also displayed a higher proportion of Black patients, with 30% of breast cancer cases in the VA being Black compared to 12% in SEER.
CONCLUSIONS/IMPLICATIONS
Veterans diagnosed with breast and gynecologic cancers exhibit unique demographic characteristics compared to the general population. They tend to be younger and have a higher representation of Black patients. The incidence of male breast cancer is notably higher among Veterans. As the prevalence of these cancer types continue to rise among Veterans, it is vital for oncologists to be aware of and adequately address the unique health needs of this population. These findings emphasize the importance of tailored strategies and programs to provide optimal care for Veterans with breast and gynecologic cancers.
PURPOSE
This project aims to describe the demographics of Veterans diagnosed with breast and gynecologic cancers and assess differences compared to the general population.
BACKGROUND
With an increasing number of women Veterans enrolling in the VA, it is crucial for oncologists to be prepared to provide care for VeterS32 • SEPTEMBER 2023 www.mdedge.com/fedprac/avaho NOTES ans diagnosed with breast and gynecologic cancers. Despite the rising incidence of these cancers among Veterans, there is limited characterization of the demographic profile of this population. Understanding the unique characteristics of Veterans with these malignancies, distinct from the general population, is essential for the Veterans Administration (VA) to develop programs and enhance care for these patients.
METHODS/DATA ANALYSIS
Consult records from the VA Corporate Data Warehouse between January 1, 2021, and December 31, 2022, were analyzed to identify Veterans with newly diagnosed breast, uterine, ovarian, cervical, and vulvovaginal cancer. Demographic were evaluated. Data on the general population were obtained data from SEER (Surveillance, Epidemiology, and End Results) 19 database for 2020.
RESULTS
A total of 3,304 Veterans diagnosed with breast cancer and 918 Veterans with gynecologic cancers were identified (uterine, n = 365; cervical, n = 344, ovarian, n = 177; vulvovaginal, n = 32). Veterans were found to be younger than the general population, with a mean age at diagnosis of 59 for Veterans with breast cancer to 63 for non-veterans. Among those with gynecologic cancers, the mean age at diagnosis for Veterans was 55 compared to 61 for non-veterans. Male breast cancer cases were more prevalent among Veterans, accounting for 11% in the VA compared to 1% in SEER. The Veteran cohort also displayed a higher proportion of Black patients, with 30% of breast cancer cases in the VA being Black compared to 12% in SEER.
CONCLUSIONS/IMPLICATIONS
Veterans diagnosed with breast and gynecologic cancers exhibit unique demographic characteristics compared to the general population. They tend to be younger and have a higher representation of Black patients. The incidence of male breast cancer is notably higher among Veterans. As the prevalence of these cancer types continue to rise among Veterans, it is vital for oncologists to be aware of and adequately address the unique health needs of this population. These findings emphasize the importance of tailored strategies and programs to provide optimal care for Veterans with breast and gynecologic cancers.
Enhancing Usability of Health Information Technology: Comparative Evaluation of Workflow Support Tools
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
First Evaluation and Summary of The Veterans on Anticancer Medications in Rural and Community Settings Support (VA CARES) Program: Pharmacist-Driven Medication Management for Veterans Receiving Oral Antineoplastic Therapies Through the MISSION/ CHOICE Act
BACKGROUND: Oral antineoplastic therapy (OAT) use among Veterans is rising significantly. Through the MISSION/CHOICE Act, Veterans can receive Veterans Affairs (VA)-funded hematology/oncology care from non-VA community providers. These providers can prescribe high-risk, high-cost OATs which the VA then dispenses. However, Veterans receiving hematology/ oncology treatment in rural and community settings often lack access to comprehensive medication management, increasing their risk for suboptimal care.
SYNTHESIS OF RELEVANT LITERATURE: A survey performed within VISN 19 revealed Veterans on OATs prescribed by community providers receive inadequate monitoring and follow-up. Clinical pharmacist- driven medication management programs are established in a variety of clinical settings, including for patients taking OATs for hematologic and oncologic malignancies. Additionally, the American Society of Clinical Oncology (ASCO) considers medically integrated dispensing of OATs, often through hematology/ oncology pharmacist-driven medication management programs, a quality standard.
INTERVENTION(S) PROVIDED: The VA CARES program provides a dedicated clinical pharmacy specialist (CPS) for all phases of OAT treatment prescribed by community providers. During the OAT initiation phase, the CPS ensures appropriate indication and dosing, reviews baseline laboratory results, and performs a thorough drug-drug interaction analysis. The CPS also performs baseline patient assessment and education through a telephone encounter. During the OAT maintenance phase, the CPS ensures necessary monitoring occurs (e.g., labs are drawn and results are within appropriate limits), and schedules regular follow-up encounters with the patient to assess knowledge, adherence, toxicities, and need for OAT refills.
OUTCOME OF THE INTERVENTION/SITUATION: In the first three months, VA CARES enrolled sixteen patients with a total of nineteen community care prescriptions (sixteen for OATs, three for broad-spectrum antifungals). The CPS performed thirty-eight encounters and twenty-nine interventions. The majority of interventions included detection and/or prevention of drug-drug interactions (n=15), followed by prevention of adverse events (n=5). Other interventions included drug not indicated (n=3), alternative therapy suggested (n=2), limited-quantity dispensed (n=1), and unnecessary consultation prevented (n=1). Total cost avoidance and savings in three months were estimated at $52,013.
IMPLICATIONS: A CPS-driven medication management program for Veterans receiving OATs through the MISSION/CHOICE Act is associated with clinical and economic benefits.
BACKGROUND: Oral antineoplastic therapy (OAT) use among Veterans is rising significantly. Through the MISSION/CHOICE Act, Veterans can receive Veterans Affairs (VA)-funded hematology/oncology care from non-VA community providers. These providers can prescribe high-risk, high-cost OATs which the VA then dispenses. However, Veterans receiving hematology/ oncology treatment in rural and community settings often lack access to comprehensive medication management, increasing their risk for suboptimal care.
SYNTHESIS OF RELEVANT LITERATURE: A survey performed within VISN 19 revealed Veterans on OATs prescribed by community providers receive inadequate monitoring and follow-up. Clinical pharmacist- driven medication management programs are established in a variety of clinical settings, including for patients taking OATs for hematologic and oncologic malignancies. Additionally, the American Society of Clinical Oncology (ASCO) considers medically integrated dispensing of OATs, often through hematology/ oncology pharmacist-driven medication management programs, a quality standard.
INTERVENTION(S) PROVIDED: The VA CARES program provides a dedicated clinical pharmacy specialist (CPS) for all phases of OAT treatment prescribed by community providers. During the OAT initiation phase, the CPS ensures appropriate indication and dosing, reviews baseline laboratory results, and performs a thorough drug-drug interaction analysis. The CPS also performs baseline patient assessment and education through a telephone encounter. During the OAT maintenance phase, the CPS ensures necessary monitoring occurs (e.g., labs are drawn and results are within appropriate limits), and schedules regular follow-up encounters with the patient to assess knowledge, adherence, toxicities, and need for OAT refills.
OUTCOME OF THE INTERVENTION/SITUATION: In the first three months, VA CARES enrolled sixteen patients with a total of nineteen community care prescriptions (sixteen for OATs, three for broad-spectrum antifungals). The CPS performed thirty-eight encounters and twenty-nine interventions. The majority of interventions included detection and/or prevention of drug-drug interactions (n=15), followed by prevention of adverse events (n=5). Other interventions included drug not indicated (n=3), alternative therapy suggested (n=2), limited-quantity dispensed (n=1), and unnecessary consultation prevented (n=1). Total cost avoidance and savings in three months were estimated at $52,013.
IMPLICATIONS: A CPS-driven medication management program for Veterans receiving OATs through the MISSION/CHOICE Act is associated with clinical and economic benefits.
BACKGROUND: Oral antineoplastic therapy (OAT) use among Veterans is rising significantly. Through the MISSION/CHOICE Act, Veterans can receive Veterans Affairs (VA)-funded hematology/oncology care from non-VA community providers. These providers can prescribe high-risk, high-cost OATs which the VA then dispenses. However, Veterans receiving hematology/ oncology treatment in rural and community settings often lack access to comprehensive medication management, increasing their risk for suboptimal care.
SYNTHESIS OF RELEVANT LITERATURE: A survey performed within VISN 19 revealed Veterans on OATs prescribed by community providers receive inadequate monitoring and follow-up. Clinical pharmacist- driven medication management programs are established in a variety of clinical settings, including for patients taking OATs for hematologic and oncologic malignancies. Additionally, the American Society of Clinical Oncology (ASCO) considers medically integrated dispensing of OATs, often through hematology/ oncology pharmacist-driven medication management programs, a quality standard.
INTERVENTION(S) PROVIDED: The VA CARES program provides a dedicated clinical pharmacy specialist (CPS) for all phases of OAT treatment prescribed by community providers. During the OAT initiation phase, the CPS ensures appropriate indication and dosing, reviews baseline laboratory results, and performs a thorough drug-drug interaction analysis. The CPS also performs baseline patient assessment and education through a telephone encounter. During the OAT maintenance phase, the CPS ensures necessary monitoring occurs (e.g., labs are drawn and results are within appropriate limits), and schedules regular follow-up encounters with the patient to assess knowledge, adherence, toxicities, and need for OAT refills.
OUTCOME OF THE INTERVENTION/SITUATION: In the first three months, VA CARES enrolled sixteen patients with a total of nineteen community care prescriptions (sixteen for OATs, three for broad-spectrum antifungals). The CPS performed thirty-eight encounters and twenty-nine interventions. The majority of interventions included detection and/or prevention of drug-drug interactions (n=15), followed by prevention of adverse events (n=5). Other interventions included drug not indicated (n=3), alternative therapy suggested (n=2), limited-quantity dispensed (n=1), and unnecessary consultation prevented (n=1). Total cost avoidance and savings in three months were estimated at $52,013.
IMPLICATIONS: A CPS-driven medication management program for Veterans receiving OATs through the MISSION/CHOICE Act is associated with clinical and economic benefits.