AVAHO

Background: Dedifferentiated liposarcoma (DDL) is a high-grade tumor that either forms as a de novo tumor or as a progression from a low-grade, well-differentiated liposarcoma. DDL is a clinically aggressive tumor associated with low survival probabilities. Prognosis variables for DDL have never been reported in a large patient population.

Methods: 3,573 patients with primary DDL were analyzed from the National Cancer Database (NCDB). The 5- and 10-year survival probabilities  were calculated, and the groups were compared using log-rank comparisons. Median survival was also calculated.

Results: Males comprised 65% of the cohort, 65.4% of the patients were between the age of 51-75 years old, and the median age at diagnosis was 64 years of age. Approximately 65% of tumors were > 10 cm, 89% had no metastases and the most common site of metastasis was the lung (2.5%). The most common tumors were found in the retroperitoneum or peritoneum (40.5%). Overall 5- and 10-year survival probabilities were 51.5% and 34.8%, respectively. Head and neck tumors had the best 5-year outcomes (86.4%) followed by extremities (67.1%), pelvis (65.8%), thorax or trunk (58.9%), retroperitoneum or peritoneum (45.3%), and abdomen (36.8%). Best outcomes were noted in the 26-50 year age group (5-year survival, 66.8%; 10-year survival, 52.9%), < 1 0 cm diameter size (5-year survival: 66.1%; 10-year survival, 46%), stage II (5-year survival, 66.7%), and moderately differentiated tumors (5-year survival, 68.3%). Radiation therapy yielded the best 5- and 10-year survival probabilities of 59% and 39.3%, respectively. Out of all the adjuvant therapies, surgery with radiation resulted in the best 5-year survival of 63.4%.

Conclusions: In the largest and most comprehensive study to date on DDL, major findings include that primary anatomical site is a significant prognostic variable and age at presentation, tumor size, stage, grade, and type of adjuvant therapy significantly affect median survival and overall survival probabilities.

Background: Dedifferentiated liposarcoma (DDL) is a high-grade tumor that either forms as a de novo tumor or as a progression from a low-grade, well-differentiated liposarcoma. DDL is a clinically aggressive tumor associated with low survival probabilities. Prognosis variables for DDL have never been reported in a large patient population.

Methods: 3,573 patients with primary DDL were analyzed from the National Cancer Database (NCDB). The 5- and 10-year survival probabilities  were calculated, and the groups were compared using log-rank comparisons. Median survival was also calculated.

Results: Males comprised 65% of the cohort, 65.4% of the patients were between the age of 51-75 years old, and the median age at diagnosis was 64 years of age. Approximately 65% of tumors were > 10 cm, 89% had no metastases and the most common site of metastasis was the lung (2.5%). The most common tumors were found in the retroperitoneum or peritoneum (40.5%). Overall 5- and 10-year survival probabilities were 51.5% and 34.8%, respectively. Head and neck tumors had the best 5-year outcomes (86.4%) followed by extremities (67.1%), pelvis (65.8%), thorax or trunk (58.9%), retroperitoneum or peritoneum (45.3%), and abdomen (36.8%). Best outcomes were noted in the 26-50 year age group (5-year survival, 66.8%; 10-year survival, 52.9%), < 1 0 cm diameter size (5-year survival: 66.1%; 10-year survival, 46%), stage II (5-year survival, 66.7%), and moderately differentiated tumors (5-year survival, 68.3%). Radiation therapy yielded the best 5- and 10-year survival probabilities of 59% and 39.3%, respectively. Out of all the adjuvant therapies, surgery with radiation resulted in the best 5-year survival of 63.4%.

Conclusions: In the largest and most comprehensive study to date on DDL, major findings include that primary anatomical site is a significant prognostic variable and age at presentation, tumor size, stage, grade, and type of adjuvant therapy significantly affect median survival and overall survival probabilities.

Background: Dedifferentiated liposarcoma (DDL) is a high-grade tumor that either forms as a de novo tumor or as a progression from a low-grade, well-differentiated liposarcoma. DDL is a clinically aggressive tumor associated with low survival probabilities. Prognosis variables for DDL have never been reported in a large patient population.

Methods: 3,573 patients with primary DDL were analyzed from the National Cancer Database (NCDB). The 5- and 10-year survival probabilities  were calculated, and the groups were compared using log-rank comparisons. Median survival was also calculated.

Results: Males comprised 65% of the cohort, 65.4% of the patients were between the age of 51-75 years old, and the median age at diagnosis was 64 years of age. Approximately 65% of tumors were > 10 cm, 89% had no metastases and the most common site of metastasis was the lung (2.5%). The most common tumors were found in the retroperitoneum or peritoneum (40.5%). Overall 5- and 10-year survival probabilities were 51.5% and 34.8%, respectively. Head and neck tumors had the best 5-year outcomes (86.4%) followed by extremities (67.1%), pelvis (65.8%), thorax or trunk (58.9%), retroperitoneum or peritoneum (45.3%), and abdomen (36.8%). Best outcomes were noted in the 26-50 year age group (5-year survival, 66.8%; 10-year survival, 52.9%), < 1 0 cm diameter size (5-year survival: 66.1%; 10-year survival, 46%), stage II (5-year survival, 66.7%), and moderately differentiated tumors (5-year survival, 68.3%). Radiation therapy yielded the best 5- and 10-year survival probabilities of 59% and 39.3%, respectively. Out of all the adjuvant therapies, surgery with radiation resulted in the best 5-year survival of 63.4%.

Conclusions: In the largest and most comprehensive study to date on DDL, major findings include that primary anatomical site is a significant prognostic variable and age at presentation, tumor size, stage, grade, and type of adjuvant therapy significantly affect median survival and overall survival probabilities.

Purpose: Unresectable hepatocellular carcinoma (HCC) is often treated with sorafenib or transarterial chemoembolization (TACE) for palliation. Cancer patients on aspirin or clopidogrel see improved survival. Addition of antiplatelet therapy can improve outcomes as seen in this case series of patients with liver cancer.

HCC develops from platelet mediated cytotoxic T lymphocyte liver damage. Sorafenib, aspirin and clopidogrel act via depletion of platelets and also reduce carcinogenic intrahepatic cytotoxic T lymphocytes. Mean progression free survival on treatment is dismal; sorafenib (5.5 mo), TACE (3.9 mo). and TACE plus sorafenib (6.3 mo.). Median overall survival on sorafenib, TACE, and TACE + sorafenib are 10.7, 19-20 mo, and 12 mo, respectively.

Background: 5 male HCC patients were treated with sorafenib and/or TACE and aspirin, clopidogrel, or both. They all underwent triphasic CT scans. Case 1: Age 55 years, male, 2x2 cm lesion; received sorafenib 200 mg twice daily, 81 mg aspirin, and 75 mg clopidogrel. The patient achieved complete remission twice and was alive at 7 years 2 mo. Case 2: Age 69 years, male, 5x5 cm HCC; received TACE once and took 81 mg aspirin daily. He achieved radiographic complete remission and was alive at 43 mo 9 days. Case 3: Age 67 years, male, 6 x 6 cm HCC; had TACE once and 81 mg aspirin daily. Patient had complete remission at 32 mo and 16 days. Case 4: Age 72, male, 2 x 2 cm HCC; had TACE and 81 mg aspirin. He achieved complete remission at 14 months. Case 5: Age 68 years, male, 8 x 5 cm HCC; previously failed TACE and sorafenib. The patient presented with weight loss, class Child C cirrhosis, large volume ascites; alpha-fetoprotein (AFP) 208,960 ng/mL. He started on baby aspirin, diuretics and hospice care. A month later, his ascites decreased and he began sorafenib 200 mg twice daily. 3 months later the AFP dropped to 83,000 ng/mL. 5 months later, AFP 5950 ng/mL, tumor 3x2 cm; no ascites. 13 mo later: AFP 34,620 ng/mL, alive, asymptomatic.

Conclusion: These cases achieved progression free survival and overall survival significantly better (3-4x) than historical controls. Childs C cases might also benefit from adding aspirin or clopidogrel to sorafenib. Antiplatelet medication merits further study in hepatocellular cancer treated with sorafenib or TACE.

Purpose: Unresectable hepatocellular carcinoma (HCC) is often treated with sorafenib or transarterial chemoembolization (TACE) for palliation. Cancer patients on aspirin or clopidogrel see improved survival. Addition of antiplatelet therapy can improve outcomes as seen in this case series of patients with liver cancer.

HCC develops from platelet mediated cytotoxic T lymphocyte liver damage. Sorafenib, aspirin and clopidogrel act via depletion of platelets and also reduce carcinogenic intrahepatic cytotoxic T lymphocytes. Mean progression free survival on treatment is dismal; sorafenib (5.5 mo), TACE (3.9 mo). and TACE plus sorafenib (6.3 mo.). Median overall survival on sorafenib, TACE, and TACE + sorafenib are 10.7, 19-20 mo, and 12 mo, respectively.

Background: 5 male HCC patients were treated with sorafenib and/or TACE and aspirin, clopidogrel, or both. They all underwent triphasic CT scans. Case 1: Age 55 years, male, 2x2 cm lesion; received sorafenib 200 mg twice daily, 81 mg aspirin, and 75 mg clopidogrel. The patient achieved complete remission twice and was alive at 7 years 2 mo. Case 2: Age 69 years, male, 5x5 cm HCC; received TACE once and took 81 mg aspirin daily. He achieved radiographic complete remission and was alive at 43 mo 9 days. Case 3: Age 67 years, male, 6 x 6 cm HCC; had TACE once and 81 mg aspirin daily. Patient had complete remission at 32 mo and 16 days. Case 4: Age 72, male, 2 x 2 cm HCC; had TACE and 81 mg aspirin. He achieved complete remission at 14 months. Case 5: Age 68 years, male, 8 x 5 cm HCC; previously failed TACE and sorafenib. The patient presented with weight loss, class Child C cirrhosis, large volume ascites; alpha-fetoprotein (AFP) 208,960 ng/mL. He started on baby aspirin, diuretics and hospice care. A month later, his ascites decreased and he began sorafenib 200 mg twice daily. 3 months later the AFP dropped to 83,000 ng/mL. 5 months later, AFP 5950 ng/mL, tumor 3x2 cm; no ascites. 13 mo later: AFP 34,620 ng/mL, alive, asymptomatic.

Conclusion: These cases achieved progression free survival and overall survival significantly better (3-4x) than historical controls. Childs C cases might also benefit from adding aspirin or clopidogrel to sorafenib. Antiplatelet medication merits further study in hepatocellular cancer treated with sorafenib or TACE.

Purpose: Unresectable hepatocellular carcinoma (HCC) is often treated with sorafenib or transarterial chemoembolization (TACE) for palliation. Cancer patients on aspirin or clopidogrel see improved survival. Addition of antiplatelet therapy can improve outcomes as seen in this case series of patients with liver cancer.

HCC develops from platelet mediated cytotoxic T lymphocyte liver damage. Sorafenib, aspirin and clopidogrel act via depletion of platelets and also reduce carcinogenic intrahepatic cytotoxic T lymphocytes. Mean progression free survival on treatment is dismal; sorafenib (5.5 mo), TACE (3.9 mo). and TACE plus sorafenib (6.3 mo.). Median overall survival on sorafenib, TACE, and TACE + sorafenib are 10.7, 19-20 mo, and 12 mo, respectively.

Background: 5 male HCC patients were treated with sorafenib and/or TACE and aspirin, clopidogrel, or both. They all underwent triphasic CT scans. Case 1: Age 55 years, male, 2x2 cm lesion; received sorafenib 200 mg twice daily, 81 mg aspirin, and 75 mg clopidogrel. The patient achieved complete remission twice and was alive at 7 years 2 mo. Case 2: Age 69 years, male, 5x5 cm HCC; received TACE once and took 81 mg aspirin daily. He achieved radiographic complete remission and was alive at 43 mo 9 days. Case 3: Age 67 years, male, 6 x 6 cm HCC; had TACE once and 81 mg aspirin daily. Patient had complete remission at 32 mo and 16 days. Case 4: Age 72, male, 2 x 2 cm HCC; had TACE and 81 mg aspirin. He achieved complete remission at 14 months. Case 5: Age 68 years, male, 8 x 5 cm HCC; previously failed TACE and sorafenib. The patient presented with weight loss, class Child C cirrhosis, large volume ascites; alpha-fetoprotein (AFP) 208,960 ng/mL. He started on baby aspirin, diuretics and hospice care. A month later, his ascites decreased and he began sorafenib 200 mg twice daily. 3 months later the AFP dropped to 83,000 ng/mL. 5 months later, AFP 5950 ng/mL, tumor 3x2 cm; no ascites. 13 mo later: AFP 34,620 ng/mL, alive, asymptomatic.

Conclusion: These cases achieved progression free survival and overall survival significantly better (3-4x) than historical controls. Childs C cases might also benefit from adding aspirin or clopidogrel to sorafenib. Antiplatelet medication merits further study in hepatocellular cancer treated with sorafenib or TACE.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Background: Undertreated symptoms are common among patients with lung cancer and lead to increased use of acute care facilities. Studies show that better symptom management can improve patient quality of life. It is unknown, however, whether provider knowledge and documentation of patients’ symptoms results in improved symptom management. Therefore, we conducted a randomized study to evaluate whether patient-reported symptoms improved provider documentation and symptom management among Veterans diagnosed with lung cancer.

Methods: All Veterans with lung cancer receiving ongoing treatment with chemotherapy or immunotherapy were randomized to either usual care or usual care enhanced with a lay health worker-led weekly telephonic symptom assessment. Symptoms rated at a 4 or greater on a scale from 0 to 10 with 10 being the worst possible were documented in the patient’s chart and their provider notified. The patients’ charts were reviewed retrospectively to determine if symptoms were documented and managed at the patient’s next clinic visit.

Results: Between July 01, 2017 and May 01, 2018, 37 Veterans consented and were enrolled in the study. Retrospective chart review was performed for 30 participants (usual care n = 15, intervention n = 15). Across both groups, median age was 68 years, majority were non-Hispanic white (67%), male (99%), and diagnosed with stage IV disease. Provider documentation and management of symptoms did not improve in the intervention group when compared to the usual care group at baseline, 3 months, and 6 months (P = .41, P = .50, P = .51, respectively).

Conclusions: Patient-reported symptoms are important to ensuring timely interventions to decrease symptom burden. However, challenges remain in ensuring that symptoms that are reported result in a timely intervention by clinical providers. Weekly symptom assessment holds promise in reducing symptom severity but more research is needed to ensure that providers document and intervene on symptoms reported by patients.

Background: Undertreated symptoms are common among patients with lung cancer and lead to increased use of acute care facilities. Studies show that better symptom management can improve patient quality of life. It is unknown, however, whether provider knowledge and documentation of patients’ symptoms results in improved symptom management. Therefore, we conducted a randomized study to evaluate whether patient-reported symptoms improved provider documentation and symptom management among Veterans diagnosed with lung cancer.

Methods: All Veterans with lung cancer receiving ongoing treatment with chemotherapy or immunotherapy were randomized to either usual care or usual care enhanced with a lay health worker-led weekly telephonic symptom assessment. Symptoms rated at a 4 or greater on a scale from 0 to 10 with 10 being the worst possible were documented in the patient’s chart and their provider notified. The patients’ charts were reviewed retrospectively to determine if symptoms were documented and managed at the patient’s next clinic visit.

Results: Between July 01, 2017 and May 01, 2018, 37 Veterans consented and were enrolled in the study. Retrospective chart review was performed for 30 participants (usual care n = 15, intervention n = 15). Across both groups, median age was 68 years, majority were non-Hispanic white (67%), male (99%), and diagnosed with stage IV disease. Provider documentation and management of symptoms did not improve in the intervention group when compared to the usual care group at baseline, 3 months, and 6 months (P = .41, P = .50, P = .51, respectively).

Conclusions: Patient-reported symptoms are important to ensuring timely interventions to decrease symptom burden. However, challenges remain in ensuring that symptoms that are reported result in a timely intervention by clinical providers. Weekly symptom assessment holds promise in reducing symptom severity but more research is needed to ensure that providers document and intervene on symptoms reported by patients.

Background: Undertreated symptoms are common among patients with lung cancer and lead to increased use of acute care facilities. Studies show that better symptom management can improve patient quality of life. It is unknown, however, whether provider knowledge and documentation of patients’ symptoms results in improved symptom management. Therefore, we conducted a randomized study to evaluate whether patient-reported symptoms improved provider documentation and symptom management among Veterans diagnosed with lung cancer.

Methods: All Veterans with lung cancer receiving ongoing treatment with chemotherapy or immunotherapy were randomized to either usual care or usual care enhanced with a lay health worker-led weekly telephonic symptom assessment. Symptoms rated at a 4 or greater on a scale from 0 to 10 with 10 being the worst possible were documented in the patient’s chart and their provider notified. The patients’ charts were reviewed retrospectively to determine if symptoms were documented and managed at the patient’s next clinic visit.

Results: Between July 01, 2017 and May 01, 2018, 37 Veterans consented and were enrolled in the study. Retrospective chart review was performed for 30 participants (usual care n = 15, intervention n = 15). Across both groups, median age was 68 years, majority were non-Hispanic white (67%), male (99%), and diagnosed with stage IV disease. Provider documentation and management of symptoms did not improve in the intervention group when compared to the usual care group at baseline, 3 months, and 6 months (P = .41, P = .50, P = .51, respectively).

Conclusions: Patient-reported symptoms are important to ensuring timely interventions to decrease symptom burden. However, challenges remain in ensuring that symptoms that are reported result in a timely intervention by clinical providers. Weekly symptom assessment holds promise in reducing symptom severity but more research is needed to ensure that providers document and intervene on symptoms reported by patients.

Background: Colorectal cancer (CRC) surveillance guidelines suggest that timing of a 3rd colonoscopy should be based on results of two prior exams. However, data are limited on whether baseline screening colonoscopy can inform the risk of advanced neoplasia (AN) at 3rd exam.

Methods: This study describes the risk of AN at 3rd colonoscopy stratified by findings on two previous exams in a prospective screening cohort and compares this risk over time from a negative 2nd exam between those with differing 1st exam findings.

The CSP #380 cohort included 3,121 Veterans aged 50-75 years who underwent screening colonoscopy from 1994-1997 and were followed for at least 10 years. Exclusion criteria included not having three colonoscopies more than one year apart, or having CRC at 1st or 2nd exam. The primary outcome was the proportion of AN at 3rd exam. Findings at 1st and 2nd exam were classified as high-risk adenoma (HRA), low-risk adenoma (LRA), or no adenoma. Chi-square tests compared proportions of AN on the 3rd exam between those with different baseline screening results but similar 2nd exam findings.

Results: This analysis included 891 participants: 58 (6.5%) had AN at 3rd exam. The proportion of AN at 3rd exam ranged from 3.2% to 21.4% when stratified by results of two previous exams. In participants with HRA or LRA on the 2nd exam, baseline screening colonoscopy was not associated with risk of AN at 3rd exam. However, for participants with no adenomas on the 2nd exam, baseline screening colonoscopy was associated with risk of AN at 3rd exam (P =.04). Furthermore, all AN was identified within about 5 years of the negative 2nd exam in those with HRA on the 1st exam.

Conclusions: Results of the 1st exam remain a risk factor for AN at 3rd exam in those with no adenomas at 2nd exam. This supports current guidelines which recommend a shortened surveillance interval in those with no adenomas at 2nd exam but HRA at 1st. Future work will combine CRC risk factors with genomic risk and colonoscopy outcomes over time to better identify individuals who might benefit from continued surveillance and to help inform appropriate surveillance intervals.

Background: Colorectal cancer (CRC) surveillance guidelines suggest that timing of a 3rd colonoscopy should be based on results of two prior exams. However, data are limited on whether baseline screening colonoscopy can inform the risk of advanced neoplasia (AN) at 3rd exam.

Methods: This study describes the risk of AN at 3rd colonoscopy stratified by findings on two previous exams in a prospective screening cohort and compares this risk over time from a negative 2nd exam between those with differing 1st exam findings.

The CSP #380 cohort included 3,121 Veterans aged 50-75 years who underwent screening colonoscopy from 1994-1997 and were followed for at least 10 years. Exclusion criteria included not having three colonoscopies more than one year apart, or having CRC at 1st or 2nd exam. The primary outcome was the proportion of AN at 3rd exam. Findings at 1st and 2nd exam were classified as high-risk adenoma (HRA), low-risk adenoma (LRA), or no adenoma. Chi-square tests compared proportions of AN on the 3rd exam between those with different baseline screening results but similar 2nd exam findings.

Results: This analysis included 891 participants: 58 (6.5%) had AN at 3rd exam. The proportion of AN at 3rd exam ranged from 3.2% to 21.4% when stratified by results of two previous exams. In participants with HRA or LRA on the 2nd exam, baseline screening colonoscopy was not associated with risk of AN at 3rd exam. However, for participants with no adenomas on the 2nd exam, baseline screening colonoscopy was associated with risk of AN at 3rd exam (P =.04). Furthermore, all AN was identified within about 5 years of the negative 2nd exam in those with HRA on the 1st exam.

Conclusions: Results of the 1st exam remain a risk factor for AN at 3rd exam in those with no adenomas at 2nd exam. This supports current guidelines which recommend a shortened surveillance interval in those with no adenomas at 2nd exam but HRA at 1st. Future work will combine CRC risk factors with genomic risk and colonoscopy outcomes over time to better identify individuals who might benefit from continued surveillance and to help inform appropriate surveillance intervals.

Background: Colorectal cancer (CRC) surveillance guidelines suggest that timing of a 3rd colonoscopy should be based on results of two prior exams. However, data are limited on whether baseline screening colonoscopy can inform the risk of advanced neoplasia (AN) at 3rd exam.

Methods: This study describes the risk of AN at 3rd colonoscopy stratified by findings on two previous exams in a prospective screening cohort and compares this risk over time from a negative 2nd exam between those with differing 1st exam findings.

The CSP #380 cohort included 3,121 Veterans aged 50-75 years who underwent screening colonoscopy from 1994-1997 and were followed for at least 10 years. Exclusion criteria included not having three colonoscopies more than one year apart, or having CRC at 1st or 2nd exam. The primary outcome was the proportion of AN at 3rd exam. Findings at 1st and 2nd exam were classified as high-risk adenoma (HRA), low-risk adenoma (LRA), or no adenoma. Chi-square tests compared proportions of AN on the 3rd exam between those with different baseline screening results but similar 2nd exam findings.

Results: This analysis included 891 participants: 58 (6.5%) had AN at 3rd exam. The proportion of AN at 3rd exam ranged from 3.2% to 21.4% when stratified by results of two previous exams. In participants with HRA or LRA on the 2nd exam, baseline screening colonoscopy was not associated with risk of AN at 3rd exam. However, for participants with no adenomas on the 2nd exam, baseline screening colonoscopy was associated with risk of AN at 3rd exam (P =.04). Furthermore, all AN was identified within about 5 years of the negative 2nd exam in those with HRA on the 1st exam.

Conclusions: Results of the 1st exam remain a risk factor for AN at 3rd exam in those with no adenomas at 2nd exam. This supports current guidelines which recommend a shortened surveillance interval in those with no adenomas at 2nd exam but HRA at 1st. Future work will combine CRC risk factors with genomic risk and colonoscopy outcomes over time to better identify individuals who might benefit from continued surveillance and to help inform appropriate surveillance intervals.

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Purpose: Improve patient access, turnaround times and customized results notification while improving mammography program’s ability to detect and follow high-risk patients.

Background: Barriers to care is of high concern when outsourcing services into the community. Therefore, having a tracking system to ensure clinicians and patients are aware of results is of vital importance. A committee was formed to review mammogram barriers and processes. The desire was to achieve a faster turnaround time for patients from consult placement to appointment time and the ability to follow abnormal results along with high-risk detection.

Methods: A mammogram committee was formed to review general work processes and identify barriers which existed. Implementation of high-risk patient assessment and turnaround time from consult to appointment was also reviewed. Initial data showed that from consult placement to completion could range up to 220 days with the average of 158 days. There were multiple steps involved from placement of the consult until the patient was scheduled. High-risk patient screening was not utilized and it was recognized as a significant weakness in the work process.

Results: The review of the current process revealed many steps involved in obtaining an appointment and test results. An algorithm was developed to decrease the steps necessary from consult to appointment and a process was started where all mammogram orders/results were associated with one VA provider and fax number. Consult turnaround time was decreased from an average of 158 days to 35 days. Implementation of a women’s health navigator position enabled the process of detecting high-risk patients for breast cancer through a phone interview with new enrollees.

Implications: New women Veteran enrollees are receiving personalized phone appointments to assess them for risk factors in many areas of women’s health, including breast cancer screening. This has improved our ability to provide earlier detection through genetic testing, screening procedures, and prophylactic treatments. Decreasing average turnaround time by 167 days has improved patient satisfaction and decreased time in treatment for abnormalities that are found in screening. Centralizing all mammogram ordering and results received have enabled process streamlining and now allow customized patient result notification.

Purpose: Improve patient access, turnaround times and customized results notification while improving mammography program’s ability to detect and follow high-risk patients.

Background: Barriers to care is of high concern when outsourcing services into the community. Therefore, having a tracking system to ensure clinicians and patients are aware of results is of vital importance. A committee was formed to review mammogram barriers and processes. The desire was to achieve a faster turnaround time for patients from consult placement to appointment time and the ability to follow abnormal results along with high-risk detection.

Methods: A mammogram committee was formed to review general work processes and identify barriers which existed. Implementation of high-risk patient assessment and turnaround time from consult to appointment was also reviewed. Initial data showed that from consult placement to completion could range up to 220 days with the average of 158 days. There were multiple steps involved from placement of the consult until the patient was scheduled. High-risk patient screening was not utilized and it was recognized as a significant weakness in the work process.

Results: The review of the current process revealed many steps involved in obtaining an appointment and test results. An algorithm was developed to decrease the steps necessary from consult to appointment and a process was started where all mammogram orders/results were associated with one VA provider and fax number. Consult turnaround time was decreased from an average of 158 days to 35 days. Implementation of a women’s health navigator position enabled the process of detecting high-risk patients for breast cancer through a phone interview with new enrollees.

Implications: New women Veteran enrollees are receiving personalized phone appointments to assess them for risk factors in many areas of women’s health, including breast cancer screening. This has improved our ability to provide earlier detection through genetic testing, screening procedures, and prophylactic treatments. Decreasing average turnaround time by 167 days has improved patient satisfaction and decreased time in treatment for abnormalities that are found in screening. Centralizing all mammogram ordering and results received have enabled process streamlining and now allow customized patient result notification.

Purpose: Improve patient access, turnaround times and customized results notification while improving mammography program’s ability to detect and follow high-risk patients.

Background: Barriers to care is of high concern when outsourcing services into the community. Therefore, having a tracking system to ensure clinicians and patients are aware of results is of vital importance. A committee was formed to review mammogram barriers and processes. The desire was to achieve a faster turnaround time for patients from consult placement to appointment time and the ability to follow abnormal results along with high-risk detection.

Methods: A mammogram committee was formed to review general work processes and identify barriers which existed. Implementation of high-risk patient assessment and turnaround time from consult to appointment was also reviewed. Initial data showed that from consult placement to completion could range up to 220 days with the average of 158 days. There were multiple steps involved from placement of the consult until the patient was scheduled. High-risk patient screening was not utilized and it was recognized as a significant weakness in the work process.

Results: The review of the current process revealed many steps involved in obtaining an appointment and test results. An algorithm was developed to decrease the steps necessary from consult to appointment and a process was started where all mammogram orders/results were associated with one VA provider and fax number. Consult turnaround time was decreased from an average of 158 days to 35 days. Implementation of a women’s health navigator position enabled the process of detecting high-risk patients for breast cancer through a phone interview with new enrollees.

Implications: New women Veteran enrollees are receiving personalized phone appointments to assess them for risk factors in many areas of women’s health, including breast cancer screening. This has improved our ability to provide earlier detection through genetic testing, screening procedures, and prophylactic treatments. Decreasing average turnaround time by 167 days has improved patient satisfaction and decreased time in treatment for abnormalities that are found in screening. Centralizing all mammogram ordering and results received have enabled process streamlining and now allow customized patient result notification.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

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.

Purpose/Rationale: In order to improve cancer care coordination (CCC) a quality improvement pilot study was performed using a novel tracking tool for Veterans at the VA North Texas Health Care System (VANTHCS) located in Dallas, Texas.

Background: The VANTHCS is the second largest VA health care system in the country, serving over 113,000 Veterans and delivering one million outpatient episodes of care each year. Cancer is one of the leading causes of these episodes of care. This specific population faces unique needs due to the complexity of cancer care. Particularly, newly diagnosed cancer patients are at risk for being lost to follow up, receiving timeliness of care as well as having interruptions in communication among providers and Veterans. Cancer care coordination has been shown to augment the quality of cancer care. Prior to the initiation of this study, there was no cancer care tracking tool in place and no comprehensive CCC across the continuum at VANTHCS.

Methods: In April 2017, discussion was initiated among the key cancer care providing stakeholders to formulate a plan to identify all Veteran patients newly diagnosed with cancer at VANTHCS. Utilizing histopathology and cytology reports from VistA, we developed an interface that displayed Veterans with new cancer diagnoses. This system was put in place to capture initial date of diagnosis and
monitor scheduled patient appointments through the date of initial treatments. A plan-do-study-act (PDSA) was conducted to assess for any changes.

Results: From May 2017 through May 2018, data were collected and analyzed in the Cancer Care Tracking Tool by a designated registered nurse (RN); approximately 1,400 newly diagnosed cancer cases were tracked. Fifty-three cases were identified requiring an intervention. This tracking prompted discussion with key cancer stakeholders for the need of a cancer program clinical coordinator (CPCC). A full-time CPCC was appointed in February 2018.

Conclusions/Implications: This innovative study presented an original approach to improve the quality of cancer care for Veterans. Through the Cancer Care Tracking Tool the RN and CPCC actively identified and addressed barriers to cancer care. This may have numerous implications for future studies including, patient satisfaction and enhanced patient outcomes.

Purpose/Rationale: In order to improve cancer care coordination (CCC) a quality improvement pilot study was performed using a novel tracking tool for Veterans at the VA North Texas Health Care System (VANTHCS) located in Dallas, Texas.

Background: The VANTHCS is the second largest VA health care system in the country, serving over 113,000 Veterans and delivering one million outpatient episodes of care each year. Cancer is one of the leading causes of these episodes of care. This specific population faces unique needs due to the complexity of cancer care. Particularly, newly diagnosed cancer patients are at risk for being lost to follow up, receiving timeliness of care as well as having interruptions in communication among providers and Veterans. Cancer care coordination has been shown to augment the quality of cancer care. Prior to the initiation of this study, there was no cancer care tracking tool in place and no comprehensive CCC across the continuum at VANTHCS.

Methods: In April 2017, discussion was initiated among the key cancer care providing stakeholders to formulate a plan to identify all Veteran patients newly diagnosed with cancer at VANTHCS. Utilizing histopathology and cytology reports from VistA, we developed an interface that displayed Veterans with new cancer diagnoses. This system was put in place to capture initial date of diagnosis and
monitor scheduled patient appointments through the date of initial treatments. A plan-do-study-act (PDSA) was conducted to assess for any changes.

Results: From May 2017 through May 2018, data were collected and analyzed in the Cancer Care Tracking Tool by a designated registered nurse (RN); approximately 1,400 newly diagnosed cancer cases were tracked. Fifty-three cases were identified requiring an intervention. This tracking prompted discussion with key cancer stakeholders for the need of a cancer program clinical coordinator (CPCC). A full-time CPCC was appointed in February 2018.

Conclusions/Implications: This innovative study presented an original approach to improve the quality of cancer care for Veterans. Through the Cancer Care Tracking Tool the RN and CPCC actively identified and addressed barriers to cancer care. This may have numerous implications for future studies including, patient satisfaction and enhanced patient outcomes.

Purpose/Rationale: In order to improve cancer care coordination (CCC) a quality improvement pilot study was performed using a novel tracking tool for Veterans at the VA North Texas Health Care System (VANTHCS) located in Dallas, Texas.

Background: The VANTHCS is the second largest VA health care system in the country, serving over 113,000 Veterans and delivering one million outpatient episodes of care each year. Cancer is one of the leading causes of these episodes of care. This specific population faces unique needs due to the complexity of cancer care. Particularly, newly diagnosed cancer patients are at risk for being lost to follow up, receiving timeliness of care as well as having interruptions in communication among providers and Veterans. Cancer care coordination has been shown to augment the quality of cancer care. Prior to the initiation of this study, there was no cancer care tracking tool in place and no comprehensive CCC across the continuum at VANTHCS.

Methods: In April 2017, discussion was initiated among the key cancer care providing stakeholders to formulate a plan to identify all Veteran patients newly diagnosed with cancer at VANTHCS. Utilizing histopathology and cytology reports from VistA, we developed an interface that displayed Veterans with new cancer diagnoses. This system was put in place to capture initial date of diagnosis and
monitor scheduled patient appointments through the date of initial treatments. A plan-do-study-act (PDSA) was conducted to assess for any changes.

Results: From May 2017 through May 2018, data were collected and analyzed in the Cancer Care Tracking Tool by a designated registered nurse (RN); approximately 1,400 newly diagnosed cancer cases were tracked. Fifty-three cases were identified requiring an intervention. This tracking prompted discussion with key cancer stakeholders for the need of a cancer program clinical coordinator (CPCC). A full-time CPCC was appointed in February 2018.

Conclusions/Implications: This innovative study presented an original approach to improve the quality of cancer care for Veterans. Through the Cancer Care Tracking Tool the RN and CPCC actively identified and addressed barriers to cancer care. This may have numerous implications for future studies including, patient satisfaction and enhanced patient outcomes.