AVAHO

Background: Compared to the general population, colorectal cancer (CRC) survivors are at higher risk for developing additional malignancies, with up to 11.5% of male CRC survivors diagnosed with a second distinct malignancy.

Methods: To determine if this trend is similar in CRC survivor veterans, a retrospective analysis of all veterans diagnosed with colorectal cancer (CRC) between 1995 and 2011 within a single Veterans Affairs Medical Center was performed.

Results: Of 1,496 veterans diagnosed with sporadic CRC, 22.6% had developed a second primary malignancy and 2.7% had a third primary malignancy. The most frequently diagnosed second primary malignancies within this cohort included cancer of the prostate (38.5%), lung and bronchus (15.3%), urinary bladder (11.5%), oral cavity and pharynx (6.3%), and kidney and renal pelvis (6.1%). Incidences of second primary malignancies were 24.8%, 27.3%, and 15.9% for veterans of World War II, the Korean War and Vietnam War, respectively.

Conclusions: Our findings indicated that cancer survivor veterans carried even a higher risk of developing a second primary malignancy regardless of their service eras as compared to the general population. Healthcare providers should remain vigilant regarding surveillance for the development of additional, distinct malignancy in this particular patient population.

Background: Compared to the general population, colorectal cancer (CRC) survivors are at higher risk for developing additional malignancies, with up to 11.5% of male CRC survivors diagnosed with a second distinct malignancy.

Methods: To determine if this trend is similar in CRC survivor veterans, a retrospective analysis of all veterans diagnosed with colorectal cancer (CRC) between 1995 and 2011 within a single Veterans Affairs Medical Center was performed.

Results: Of 1,496 veterans diagnosed with sporadic CRC, 22.6% had developed a second primary malignancy and 2.7% had a third primary malignancy. The most frequently diagnosed second primary malignancies within this cohort included cancer of the prostate (38.5%), lung and bronchus (15.3%), urinary bladder (11.5%), oral cavity and pharynx (6.3%), and kidney and renal pelvis (6.1%). Incidences of second primary malignancies were 24.8%, 27.3%, and 15.9% for veterans of World War II, the Korean War and Vietnam War, respectively.

Conclusions: Our findings indicated that cancer survivor veterans carried even a higher risk of developing a second primary malignancy regardless of their service eras as compared to the general population. Healthcare providers should remain vigilant regarding surveillance for the development of additional, distinct malignancy in this particular patient population.

Background: Compared to the general population, colorectal cancer (CRC) survivors are at higher risk for developing additional malignancies, with up to 11.5% of male CRC survivors diagnosed with a second distinct malignancy.

Methods: To determine if this trend is similar in CRC survivor veterans, a retrospective analysis of all veterans diagnosed with colorectal cancer (CRC) between 1995 and 2011 within a single Veterans Affairs Medical Center was performed.

Results: Of 1,496 veterans diagnosed with sporadic CRC, 22.6% had developed a second primary malignancy and 2.7% had a third primary malignancy. The most frequently diagnosed second primary malignancies within this cohort included cancer of the prostate (38.5%), lung and bronchus (15.3%), urinary bladder (11.5%), oral cavity and pharynx (6.3%), and kidney and renal pelvis (6.1%). Incidences of second primary malignancies were 24.8%, 27.3%, and 15.9% for veterans of World War II, the Korean War and Vietnam War, respectively.

Conclusions: Our findings indicated that cancer survivor veterans carried even a higher risk of developing a second primary malignancy regardless of their service eras as compared to the general population. Healthcare providers should remain vigilant regarding surveillance for the development of additional, distinct malignancy in this particular patient population.

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Background: CONCORD is a global program for worldwide surveillance of cancer survival. A recent analysis of the CONCORD-2 study shows a 9-10% lower survival rates for blacks affected by colon cancer (CC) as compared to whites in the US between 2001 and 2009.

Methods: We aim to investigate the differences in the survival of blacks and whites affected by CC in the National VA Cancer Cube Database in the same time-period. Overall, 30,196 CC cases between 2001 and 2009 were examined.

Results: 66.12% (19,967) of CC patients identified as white and 16.32% (4929) identified as black. The distribution of stages in blacks was the following: Stage 0: 10.49% (517), I: 25.10% (1237), II: 18.58% (916), III: 17.73% (874) and IV: 17.91% (883). By comparison, CC cases in whites presented as Stage 0: 8.92% (1781), I: 26.62% (5316), II: 22.29% (4450), III 18.75% (3744) and IV 13.71% (2738) (P value for X2 trend test = .021). Interestingly, in contrast to the results of the CONCORD study, the overall 5-year survival for all stages of CC in blacks and whites was similar [blacks: 2,854 (57.90%); whites 11,897 (59.58%); P = .2750]. The same holds true for the 5-year survival for Stage 0 [blacks: 423 (81.82%) whites: 1391 (78.10%); P = .5338], Stage I [blacks: 932 (75.34%) whites: 3973 (74.74%); P = .8667], Stage II [blacks: 605(66.05%) whites:2927 (65.78%); P = .9427], Stage III [blacks:509 (58.24%) whites:2138 (57.10%); P = .7513], Stage IV blacks:101 (11.44%) whites:364 (13.29%); P = .2058].

Conclusions: The racial disparity in survival highlighted in CONCORD-2 (9-10% lower 5-year survival for blacks) is not replicable in the VA system. This difference is likely due to the uniformity of the VA in providing screening and treatment services and in leveling the playing field in terms of access to care. We believe these results should be taken into consideration in the current discussion of the shape of the healthcare system the US should adopt.

Background: CONCORD is a global program for worldwide surveillance of cancer survival. A recent analysis of the CONCORD-2 study shows a 9-10% lower survival rates for blacks affected by colon cancer (CC) as compared to whites in the US between 2001 and 2009.

Methods: We aim to investigate the differences in the survival of blacks and whites affected by CC in the National VA Cancer Cube Database in the same time-period. Overall, 30,196 CC cases between 2001 and 2009 were examined.

Results: 66.12% (19,967) of CC patients identified as white and 16.32% (4929) identified as black. The distribution of stages in blacks was the following: Stage 0: 10.49% (517), I: 25.10% (1237), II: 18.58% (916), III: 17.73% (874) and IV: 17.91% (883). By comparison, CC cases in whites presented as Stage 0: 8.92% (1781), I: 26.62% (5316), II: 22.29% (4450), III 18.75% (3744) and IV 13.71% (2738) (P value for X2 trend test = .021). Interestingly, in contrast to the results of the CONCORD study, the overall 5-year survival for all stages of CC in blacks and whites was similar [blacks: 2,854 (57.90%); whites 11,897 (59.58%); P = .2750]. The same holds true for the 5-year survival for Stage 0 [blacks: 423 (81.82%) whites: 1391 (78.10%); P = .5338], Stage I [blacks: 932 (75.34%) whites: 3973 (74.74%); P = .8667], Stage II [blacks: 605(66.05%) whites:2927 (65.78%); P = .9427], Stage III [blacks:509 (58.24%) whites:2138 (57.10%); P = .7513], Stage IV blacks:101 (11.44%) whites:364 (13.29%); P = .2058].

Conclusions: The racial disparity in survival highlighted in CONCORD-2 (9-10% lower 5-year survival for blacks) is not replicable in the VA system. This difference is likely due to the uniformity of the VA in providing screening and treatment services and in leveling the playing field in terms of access to care. We believe these results should be taken into consideration in the current discussion of the shape of the healthcare system the US should adopt.

Background: CONCORD is a global program for worldwide surveillance of cancer survival. A recent analysis of the CONCORD-2 study shows a 9-10% lower survival rates for blacks affected by colon cancer (CC) as compared to whites in the US between 2001 and 2009.

Methods: We aim to investigate the differences in the survival of blacks and whites affected by CC in the National VA Cancer Cube Database in the same time-period. Overall, 30,196 CC cases between 2001 and 2009 were examined.

Results: 66.12% (19,967) of CC patients identified as white and 16.32% (4929) identified as black. The distribution of stages in blacks was the following: Stage 0: 10.49% (517), I: 25.10% (1237), II: 18.58% (916), III: 17.73% (874) and IV: 17.91% (883). By comparison, CC cases in whites presented as Stage 0: 8.92% (1781), I: 26.62% (5316), II: 22.29% (4450), III 18.75% (3744) and IV 13.71% (2738) (P value for X2 trend test = .021). Interestingly, in contrast to the results of the CONCORD study, the overall 5-year survival for all stages of CC in blacks and whites was similar [blacks: 2,854 (57.90%); whites 11,897 (59.58%); P = .2750]. The same holds true for the 5-year survival for Stage 0 [blacks: 423 (81.82%) whites: 1391 (78.10%); P = .5338], Stage I [blacks: 932 (75.34%) whites: 3973 (74.74%); P = .8667], Stage II [blacks: 605(66.05%) whites:2927 (65.78%); P = .9427], Stage III [blacks:509 (58.24%) whites:2138 (57.10%); P = .7513], Stage IV blacks:101 (11.44%) whites:364 (13.29%); P = .2058].

Conclusions: The racial disparity in survival highlighted in CONCORD-2 (9-10% lower 5-year survival for blacks) is not replicable in the VA system. This difference is likely due to the uniformity of the VA in providing screening and treatment services and in leveling the playing field in terms of access to care. We believe these results should be taken into consideration in the current discussion of the shape of the healthcare system the US should adopt.

Purpose/Rationale: Lack of access to a hematology specialist is a barrier to care for veterans in rural and underserved areas. In light of the increasingly short supply of sub-specialists, there is a need to provide hematology education and outreach to primary care providers within the VA system.

Background: The ECHO program (Extension for Community Healthcare Outcomes) is a well-established and successful platform that audibly and visually links an area specialist to primary care providers and interdisciplinary team members, allowing for two-way specialty consultation combined with continuing education. Overall, our service network (VISN 20) has provided specialty education to more than 10 specialties and 171 clinical sites (26% rural or highly rural) through the VA-ECHO program. In fiscal year 2016, VISN 20 estimated that over 280,000 potential patient travel miles saved as a result of VA-ECHO.

Methods/Approach: As we could not identify an existing Hematology VA-ECHO program within VISN 20, nor to our knowledge nationally, we sought to develop and implement a Hematology VA-ECHO program based at the Puget Sound VA (Seattle, WA).

Results: We delivered an introductory 3-part VA-ECHO series to assess demand and solicit feedback about Hematology VA-ECHO. Session topics were iron deficiency anemia, polycythemia, and deep vein thrombosis/pulmonary embolism. We had participation from 17 sites in 9 states; 10 sites within VISN 20. Attendees included pharmacists, MDs, APRNs and RNs. We averaged 20 participants per session and welcomed 43 unique participants over 3 sessions. The vast majority (94%) of respondents (n=34) agreed or strongly agreed that the content in the sessions were relevant to their practice and 80% anticipated changing their practice as a result of session participation

Conclusion/Implications: A successful Hematology VA-ECHO program stands to de-monopolize specialty knowledge and help primary providers evaluate and manage common hematologic abnormalities, especially in underserved areas. We aim to expand Hematology VA-ECHO to include 8-9 sessions over the next calendar year. Uptake of Hematology VA-ECHO at additional VA sites in different geographical areas would help further increase hematology access for primary providers.

Purpose/Rationale: Lack of access to a hematology specialist is a barrier to care for veterans in rural and underserved areas. In light of the increasingly short supply of sub-specialists, there is a need to provide hematology education and outreach to primary care providers within the VA system.

Background: The ECHO program (Extension for Community Healthcare Outcomes) is a well-established and successful platform that audibly and visually links an area specialist to primary care providers and interdisciplinary team members, allowing for two-way specialty consultation combined with continuing education. Overall, our service network (VISN 20) has provided specialty education to more than 10 specialties and 171 clinical sites (26% rural or highly rural) through the VA-ECHO program. In fiscal year 2016, VISN 20 estimated that over 280,000 potential patient travel miles saved as a result of VA-ECHO.

Methods/Approach: As we could not identify an existing Hematology VA-ECHO program within VISN 20, nor to our knowledge nationally, we sought to develop and implement a Hematology VA-ECHO program based at the Puget Sound VA (Seattle, WA).

Results: We delivered an introductory 3-part VA-ECHO series to assess demand and solicit feedback about Hematology VA-ECHO. Session topics were iron deficiency anemia, polycythemia, and deep vein thrombosis/pulmonary embolism. We had participation from 17 sites in 9 states; 10 sites within VISN 20. Attendees included pharmacists, MDs, APRNs and RNs. We averaged 20 participants per session and welcomed 43 unique participants over 3 sessions. The vast majority (94%) of respondents (n=34) agreed or strongly agreed that the content in the sessions were relevant to their practice and 80% anticipated changing their practice as a result of session participation

Conclusion/Implications: A successful Hematology VA-ECHO program stands to de-monopolize specialty knowledge and help primary providers evaluate and manage common hematologic abnormalities, especially in underserved areas. We aim to expand Hematology VA-ECHO to include 8-9 sessions over the next calendar year. Uptake of Hematology VA-ECHO at additional VA sites in different geographical areas would help further increase hematology access for primary providers.

Purpose/Rationale: Lack of access to a hematology specialist is a barrier to care for veterans in rural and underserved areas. In light of the increasingly short supply of sub-specialists, there is a need to provide hematology education and outreach to primary care providers within the VA system.

Background: The ECHO program (Extension for Community Healthcare Outcomes) is a well-established and successful platform that audibly and visually links an area specialist to primary care providers and interdisciplinary team members, allowing for two-way specialty consultation combined with continuing education. Overall, our service network (VISN 20) has provided specialty education to more than 10 specialties and 171 clinical sites (26% rural or highly rural) through the VA-ECHO program. In fiscal year 2016, VISN 20 estimated that over 280,000 potential patient travel miles saved as a result of VA-ECHO.

Methods/Approach: As we could not identify an existing Hematology VA-ECHO program within VISN 20, nor to our knowledge nationally, we sought to develop and implement a Hematology VA-ECHO program based at the Puget Sound VA (Seattle, WA).

Results: We delivered an introductory 3-part VA-ECHO series to assess demand and solicit feedback about Hematology VA-ECHO. Session topics were iron deficiency anemia, polycythemia, and deep vein thrombosis/pulmonary embolism. We had participation from 17 sites in 9 states; 10 sites within VISN 20. Attendees included pharmacists, MDs, APRNs and RNs. We averaged 20 participants per session and welcomed 43 unique participants over 3 sessions. The vast majority (94%) of respondents (n=34) agreed or strongly agreed that the content in the sessions were relevant to their practice and 80% anticipated changing their practice as a result of session participation

Conclusion/Implications: A successful Hematology VA-ECHO program stands to de-monopolize specialty knowledge and help primary providers evaluate and manage common hematologic abnormalities, especially in underserved areas. We aim to expand Hematology VA-ECHO to include 8-9 sessions over the next calendar year. Uptake of Hematology VA-ECHO at additional VA sites in different geographical areas would help further increase hematology access for primary providers.

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

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

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

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

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

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

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

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

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

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

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

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

Background: Small cell lung cancer (SCLC) carries a dismal prognosis with a 5-year survival of about 10%. Progress in treatment of SCLC has been poor and overall survival of SCLC has remained stagnant since the late 1970s. Limited-stage SCLC (LS-SCLC) is defined as a tumor confined into one hemithorax with or without lymphadenopathies included in a single radiation field. LS-SCLC frequently metastasizes to the brain. The administration of preventive radiation to the brain, a process known as prophylactic cranial irradiation (PCI) has been the major change in the management of SCLC. There is currently a paucity of data on sites of metastasis of SCLC after PCI has been performed. We aim to describe the pattern of recurrence post-PCI in SCLC.

Methods: A retrospective chart review of all LS-SCLC (stages IA to IIIB) patients who presented to the Stratton Veteran Affairs Medical Center (SVAMC) between January 2006 and January 2017 was performed. Exclusion criteria included other types of lung cancer and stage IV SCLC.

Results: Of the 31 LS-SCLC patients, 12 received PCI. Reasons for not receiving PCI included rapid progression of the disease/metastasis to the brain (8), patient refusal (5), loss to follow-up (4) and existing co-morbidities/poor performance status (2). Of the 12 that received PCI, 8 patients had recurrences, with most recurrences affecting more than one organ. Sites of recurrences included: lung (6), liver (4), lymph nodes (3), bone (2), soft tissue (1).

Conclusions: Post-PCI, LS-SCLC is likely to recur at the site of the tumor itself or metastasize to the liver and lymph nodes. Given the rarity of SCLC presenting at the limited stage, larger scale studies are needed to further delineate the pattern of metastasis of SCLC.

Background: Small cell lung cancer (SCLC) carries a dismal prognosis with a 5-year survival of about 10%. Progress in treatment of SCLC has been poor and overall survival of SCLC has remained stagnant since the late 1970s. Limited-stage SCLC (LS-SCLC) is defined as a tumor confined into one hemithorax with or without lymphadenopathies included in a single radiation field. LS-SCLC frequently metastasizes to the brain. The administration of preventive radiation to the brain, a process known as prophylactic cranial irradiation (PCI) has been the major change in the management of SCLC. There is currently a paucity of data on sites of metastasis of SCLC after PCI has been performed. We aim to describe the pattern of recurrence post-PCI in SCLC.

Methods: A retrospective chart review of all LS-SCLC (stages IA to IIIB) patients who presented to the Stratton Veteran Affairs Medical Center (SVAMC) between January 2006 and January 2017 was performed. Exclusion criteria included other types of lung cancer and stage IV SCLC.

Results: Of the 31 LS-SCLC patients, 12 received PCI. Reasons for not receiving PCI included rapid progression of the disease/metastasis to the brain (8), patient refusal (5), loss to follow-up (4) and existing co-morbidities/poor performance status (2). Of the 12 that received PCI, 8 patients had recurrences, with most recurrences affecting more than one organ. Sites of recurrences included: lung (6), liver (4), lymph nodes (3), bone (2), soft tissue (1).

Conclusions: Post-PCI, LS-SCLC is likely to recur at the site of the tumor itself or metastasize to the liver and lymph nodes. Given the rarity of SCLC presenting at the limited stage, larger scale studies are needed to further delineate the pattern of metastasis of SCLC.

Background: Small cell lung cancer (SCLC) carries a dismal prognosis with a 5-year survival of about 10%. Progress in treatment of SCLC has been poor and overall survival of SCLC has remained stagnant since the late 1970s. Limited-stage SCLC (LS-SCLC) is defined as a tumor confined into one hemithorax with or without lymphadenopathies included in a single radiation field. LS-SCLC frequently metastasizes to the brain. The administration of preventive radiation to the brain, a process known as prophylactic cranial irradiation (PCI) has been the major change in the management of SCLC. There is currently a paucity of data on sites of metastasis of SCLC after PCI has been performed. We aim to describe the pattern of recurrence post-PCI in SCLC.

Methods: A retrospective chart review of all LS-SCLC (stages IA to IIIB) patients who presented to the Stratton Veteran Affairs Medical Center (SVAMC) between January 2006 and January 2017 was performed. Exclusion criteria included other types of lung cancer and stage IV SCLC.

Results: Of the 31 LS-SCLC patients, 12 received PCI. Reasons for not receiving PCI included rapid progression of the disease/metastasis to the brain (8), patient refusal (5), loss to follow-up (4) and existing co-morbidities/poor performance status (2). Of the 12 that received PCI, 8 patients had recurrences, with most recurrences affecting more than one organ. Sites of recurrences included: lung (6), liver (4), lymph nodes (3), bone (2), soft tissue (1).

Conclusions: Post-PCI, LS-SCLC is likely to recur at the site of the tumor itself or metastasize to the liver and lymph nodes. Given the rarity of SCLC presenting at the limited stage, larger scale studies are needed to further delineate the pattern of metastasis of SCLC.

Background: We present a case of a 69-year-old male with a past medical history of RA, Afib, COPD, and DVT with pulmonary embolism. He presented to the emergency department with encephalopathy and severe abdominal pain. On exam the patient was septic with a diffusely tender abdominal exam with peritoneal signs. The CT scan showed pneumoperitoneum. The patient underwent emergent laparotomy which revealed fecal peritonitis from a cecal perforation. After washout, patient had bowel resection of the involved intestine with a primary anastomosis. Biopsy of his resected small bowel and cecum showed submucosal blood vessels with numerous lymphoid cells. Immunohistochemical staining showed aberrant expression for CD43 and CD30 with an increased proliferation index (Ki67 80-90%). Molecular studies of both the lymphoid aggregates
and the atypical intravascular cells were negative for Ig heavy chain, t(11:18) & t(14,19). A diagnosis of intravascular lymphoma was still made. Patient underwent four further abdominal washouts with reconstruction of anterior abdominal wall with Permacol™ biological mesh. The patient condition continued to deteriorate, and he was transitioned to palliative care. He died a month after. An autopsy was not performed.

Discussion: Intravascular lymphoma is a rare and very aggressive malignancy characterized by proliferation of atypical B cell confined mostly to the vascular lumen. Its presentation is protean depending on the organs involved. It has been referred to as “the oncologists great imitator.” In a series of 38 patients by Ferreri et al, the most common symptoms were fever, cutaneous symptoms, neurological symptoms followed by abdominal pain. Most patients present in an advanced state, one series of 96 patients by Murase et al, 91% of the patient presenting with clinical stage III or stage IV disease.

There remain no standard diagnostic criteria for intravascular lymphoma. First step is demonstration of lymphoma cells in small- and medium-sized blood vessels with characteristic sparing of surrounding tissue. B cell clones are most common, but T and NK cells have also been reported. Molecular, immune histochemical and flow cytometry techniques may aid in establishing diagnosis. Prognosis remains poor even with aggressive treatment, the largest series by Murase et al, with mean survival of just 13 months with treatment.

Background: We present a case of a 69-year-old male with a past medical history of RA, Afib, COPD, and DVT with pulmonary embolism. He presented to the emergency department with encephalopathy and severe abdominal pain. On exam the patient was septic with a diffusely tender abdominal exam with peritoneal signs. The CT scan showed pneumoperitoneum. The patient underwent emergent laparotomy which revealed fecal peritonitis from a cecal perforation. After washout, patient had bowel resection of the involved intestine with a primary anastomosis. Biopsy of his resected small bowel and cecum showed submucosal blood vessels with numerous lymphoid cells. Immunohistochemical staining showed aberrant expression for CD43 and CD30 with an increased proliferation index (Ki67 80-90%). Molecular studies of both the lymphoid aggregates
and the atypical intravascular cells were negative for Ig heavy chain, t(11:18) & t(14,19). A diagnosis of intravascular lymphoma was still made. Patient underwent four further abdominal washouts with reconstruction of anterior abdominal wall with Permacol™ biological mesh. The patient condition continued to deteriorate, and he was transitioned to palliative care. He died a month after. An autopsy was not performed.

Discussion: Intravascular lymphoma is a rare and very aggressive malignancy characterized by proliferation of atypical B cell confined mostly to the vascular lumen. Its presentation is protean depending on the organs involved. It has been referred to as “the oncologists great imitator.” In a series of 38 patients by Ferreri et al, the most common symptoms were fever, cutaneous symptoms, neurological symptoms followed by abdominal pain. Most patients present in an advanced state, one series of 96 patients by Murase et al, 91% of the patient presenting with clinical stage III or stage IV disease.

There remain no standard diagnostic criteria for intravascular lymphoma. First step is demonstration of lymphoma cells in small- and medium-sized blood vessels with characteristic sparing of surrounding tissue. B cell clones are most common, but T and NK cells have also been reported. Molecular, immune histochemical and flow cytometry techniques may aid in establishing diagnosis. Prognosis remains poor even with aggressive treatment, the largest series by Murase et al, with mean survival of just 13 months with treatment.

Background: We present a case of a 69-year-old male with a past medical history of RA, Afib, COPD, and DVT with pulmonary embolism. He presented to the emergency department with encephalopathy and severe abdominal pain. On exam the patient was septic with a diffusely tender abdominal exam with peritoneal signs. The CT scan showed pneumoperitoneum. The patient underwent emergent laparotomy which revealed fecal peritonitis from a cecal perforation. After washout, patient had bowel resection of the involved intestine with a primary anastomosis. Biopsy of his resected small bowel and cecum showed submucosal blood vessels with numerous lymphoid cells. Immunohistochemical staining showed aberrant expression for CD43 and CD30 with an increased proliferation index (Ki67 80-90%). Molecular studies of both the lymphoid aggregates
and the atypical intravascular cells were negative for Ig heavy chain, t(11:18) & t(14,19). A diagnosis of intravascular lymphoma was still made. Patient underwent four further abdominal washouts with reconstruction of anterior abdominal wall with Permacol™ biological mesh. The patient condition continued to deteriorate, and he was transitioned to palliative care. He died a month after. An autopsy was not performed.

Discussion: Intravascular lymphoma is a rare and very aggressive malignancy characterized by proliferation of atypical B cell confined mostly to the vascular lumen. Its presentation is protean depending on the organs involved. It has been referred to as “the oncologists great imitator.” In a series of 38 patients by Ferreri et al, the most common symptoms were fever, cutaneous symptoms, neurological symptoms followed by abdominal pain. Most patients present in an advanced state, one series of 96 patients by Murase et al, 91% of the patient presenting with clinical stage III or stage IV disease.

There remain no standard diagnostic criteria for intravascular lymphoma. First step is demonstration of lymphoma cells in small- and medium-sized blood vessels with characteristic sparing of surrounding tissue. B cell clones are most common, but T and NK cells have also been reported. Molecular, immune histochemical and flow cytometry techniques may aid in establishing diagnosis. Prognosis remains poor even with aggressive treatment, the largest series by Murase et al, with mean survival of just 13 months with treatment.

Purpose: A VISN initiative in 2015 led to development of hematology/oncology medication order sets to improve the translation of medication orders from CPRS provider order entry program to pharmacy verification program in VistA. Our purpose is to report the incidence of averted errors due to hematology/oncology medication order translation issues prior to order set initiative as compared to incidence post-order set initiative.

Background: Hematology/oncology medication orders at this outpatient VA oncology clinic are prescribed via provider order entry within CPRS. Safety concerns existed due to inefficient communication between CPRS order entry and pharmacy verification within VistA. A pharmacist verifying orders within VistA was required to re-enter critical medication order information such as drug dose into VistA. In order to find the dose ordered by a provider, the verification pharmacist
advanced at least one screen in VistA then returned to the original VistA verification screen to enter drug dose.

Methods: Incidence of averted errors related to hematology/oncology medication order translation issues between CPRS and VistA are reported for the 2-year time period (October 2013 through September 2015) prior to order set initiative and for the 2-year time period (October 2015 through September 2017) after beginning the order set initiative. Additional information includes facility resources, such as: treatment area, providers, staffing, oncology pharmacy, pharmacy ADPAC, and CACs; mechanisms of orders and notes entering/recording; dosing and safety checks;
and available order sets.

Results: The incidence rate of averted errors related to hematology/oncology medication order translation issues prior to order set initiative was 0.379% as compared to 0.128% rate of averted errors in the two years post order set initiative. Results showed hematology/oncology medication order sets used at this facility positively impacted the incidence of averted errors attributed to translation issues from CPRS to VistA. With fewer averted errors, patient safety increased.

Implications: Using limited VA resources, order sets were implemented for use at this VA outpatient oncology clinic. The hematology/oncology health care team worked together to provide vigilant oversight of order sets and to incorporate necessary revisions, updates, and additions. With fewer averted errors, the effectiveness of this initiative is quantified with improved patient care, safety and efficiency.

Purpose: A VISN initiative in 2015 led to development of hematology/oncology medication order sets to improve the translation of medication orders from CPRS provider order entry program to pharmacy verification program in VistA. Our purpose is to report the incidence of averted errors due to hematology/oncology medication order translation issues prior to order set initiative as compared to incidence post-order set initiative.

Background: Hematology/oncology medication orders at this outpatient VA oncology clinic are prescribed via provider order entry within CPRS. Safety concerns existed due to inefficient communication between CPRS order entry and pharmacy verification within VistA. A pharmacist verifying orders within VistA was required to re-enter critical medication order information such as drug dose into VistA. In order to find the dose ordered by a provider, the verification pharmacist
advanced at least one screen in VistA then returned to the original VistA verification screen to enter drug dose.

Methods: Incidence of averted errors related to hematology/oncology medication order translation issues between CPRS and VistA are reported for the 2-year time period (October 2013 through September 2015) prior to order set initiative and for the 2-year time period (October 2015 through September 2017) after beginning the order set initiative. Additional information includes facility resources, such as: treatment area, providers, staffing, oncology pharmacy, pharmacy ADPAC, and CACs; mechanisms of orders and notes entering/recording; dosing and safety checks;
and available order sets.

Results: The incidence rate of averted errors related to hematology/oncology medication order translation issues prior to order set initiative was 0.379% as compared to 0.128% rate of averted errors in the two years post order set initiative. Results showed hematology/oncology medication order sets used at this facility positively impacted the incidence of averted errors attributed to translation issues from CPRS to VistA. With fewer averted errors, patient safety increased.

Implications: Using limited VA resources, order sets were implemented for use at this VA outpatient oncology clinic. The hematology/oncology health care team worked together to provide vigilant oversight of order sets and to incorporate necessary revisions, updates, and additions. With fewer averted errors, the effectiveness of this initiative is quantified with improved patient care, safety and efficiency.

Purpose: A VISN initiative in 2015 led to development of hematology/oncology medication order sets to improve the translation of medication orders from CPRS provider order entry program to pharmacy verification program in VistA. Our purpose is to report the incidence of averted errors due to hematology/oncology medication order translation issues prior to order set initiative as compared to incidence post-order set initiative.

Background: Hematology/oncology medication orders at this outpatient VA oncology clinic are prescribed via provider order entry within CPRS. Safety concerns existed due to inefficient communication between CPRS order entry and pharmacy verification within VistA. A pharmacist verifying orders within VistA was required to re-enter critical medication order information such as drug dose into VistA. In order to find the dose ordered by a provider, the verification pharmacist
advanced at least one screen in VistA then returned to the original VistA verification screen to enter drug dose.

Methods: Incidence of averted errors related to hematology/oncology medication order translation issues between CPRS and VistA are reported for the 2-year time period (October 2013 through September 2015) prior to order set initiative and for the 2-year time period (October 2015 through September 2017) after beginning the order set initiative. Additional information includes facility resources, such as: treatment area, providers, staffing, oncology pharmacy, pharmacy ADPAC, and CACs; mechanisms of orders and notes entering/recording; dosing and safety checks;
and available order sets.

Results: The incidence rate of averted errors related to hematology/oncology medication order translation issues prior to order set initiative was 0.379% as compared to 0.128% rate of averted errors in the two years post order set initiative. Results showed hematology/oncology medication order sets used at this facility positively impacted the incidence of averted errors attributed to translation issues from CPRS to VistA. With fewer averted errors, patient safety increased.

Implications: Using limited VA resources, order sets were implemented for use at this VA outpatient oncology clinic. The hematology/oncology health care team worked together to provide vigilant oversight of order sets and to incorporate necessary revisions, updates, and additions. With fewer averted errors, the effectiveness of this initiative is quantified with improved patient care, safety and efficiency.

Purpose: The purpose of this study was to characterize the incidence of cardiovascular events and time to first cardiovascular event due to tyrosine kinase inhibitors (TKIs) in patients with advanced RCC at VASDHS. Additional aims were to describe the current clinical practice management of cardiac monitoring via EKG or ECHO in this patient population.

Background: Over the past 12 years, the US Food and Drug Administration has approved six multitargeted TKIs for the treatment of RCC: axitinib, cabozantinib, lenvatinib, pazopanib, sorafenib and sunitinib. Other than hypertension, most studies of these therapies did not report the incidence of cardiovascular events that occurred during early clinical trials.

Methodology: This was a retrospective study that evaluated the incidence of cardiovascular events in patients diagnosed with advanced RCC who received oral TKI therapy for at least 30 days. The incidence of cardiovascular events was collected in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) grading at predetermined time points from the start of each TKI therapy. Cardiovascular events were defined as hypertension, QT prolongation, congestive heart failure (CHF), stroke, myocardial infarction (MI) and pulmonary hypertension.

Results: Fifty-four patients were included in this study with a median age of 66 years. There were no cardiac events in patients without a history of cardiovascular disease. Eleven patients with a history of cardiovascular disease experienced an adverse cardiac event while taking pazopanib, sorafenib, or sunitinib. The most common adverse events were hypertension (n=6) and MI (n=2). The remaining three patients experienced a stroke, QT prolongation, or CHF. Seventy-three percent of events occurred within four months of starting therapy. Baseline EKG or ECHO were not available for most patients started on TKI therapy and obtained only when patients were symptomatic.

Conclusions: The results of this study indicate a need for baseline and routine monitoring in patients started on oral TKIs with a history of cardiovascular disease to align with the current recommendations as listed in the medication package inserts. Based on the results of this study, baseline and routine monitoring should be considered during the first four months of therapy in patients with a history of cardiovascular disease.

Purpose: The purpose of this study was to characterize the incidence of cardiovascular events and time to first cardiovascular event due to tyrosine kinase inhibitors (TKIs) in patients with advanced RCC at VASDHS. Additional aims were to describe the current clinical practice management of cardiac monitoring via EKG or ECHO in this patient population.

Background: Over the past 12 years, the US Food and Drug Administration has approved six multitargeted TKIs for the treatment of RCC: axitinib, cabozantinib, lenvatinib, pazopanib, sorafenib and sunitinib. Other than hypertension, most studies of these therapies did not report the incidence of cardiovascular events that occurred during early clinical trials.

Methodology: This was a retrospective study that evaluated the incidence of cardiovascular events in patients diagnosed with advanced RCC who received oral TKI therapy for at least 30 days. The incidence of cardiovascular events was collected in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) grading at predetermined time points from the start of each TKI therapy. Cardiovascular events were defined as hypertension, QT prolongation, congestive heart failure (CHF), stroke, myocardial infarction (MI) and pulmonary hypertension.

Results: Fifty-four patients were included in this study with a median age of 66 years. There were no cardiac events in patients without a history of cardiovascular disease. Eleven patients with a history of cardiovascular disease experienced an adverse cardiac event while taking pazopanib, sorafenib, or sunitinib. The most common adverse events were hypertension (n=6) and MI (n=2). The remaining three patients experienced a stroke, QT prolongation, or CHF. Seventy-three percent of events occurred within four months of starting therapy. Baseline EKG or ECHO were not available for most patients started on TKI therapy and obtained only when patients were symptomatic.

Conclusions: The results of this study indicate a need for baseline and routine monitoring in patients started on oral TKIs with a history of cardiovascular disease to align with the current recommendations as listed in the medication package inserts. Based on the results of this study, baseline and routine monitoring should be considered during the first four months of therapy in patients with a history of cardiovascular disease.

Purpose: The purpose of this study was to characterize the incidence of cardiovascular events and time to first cardiovascular event due to tyrosine kinase inhibitors (TKIs) in patients with advanced RCC at VASDHS. Additional aims were to describe the current clinical practice management of cardiac monitoring via EKG or ECHO in this patient population.

Background: Over the past 12 years, the US Food and Drug Administration has approved six multitargeted TKIs for the treatment of RCC: axitinib, cabozantinib, lenvatinib, pazopanib, sorafenib and sunitinib. Other than hypertension, most studies of these therapies did not report the incidence of cardiovascular events that occurred during early clinical trials.

Methodology: This was a retrospective study that evaluated the incidence of cardiovascular events in patients diagnosed with advanced RCC who received oral TKI therapy for at least 30 days. The incidence of cardiovascular events was collected in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) grading at predetermined time points from the start of each TKI therapy. Cardiovascular events were defined as hypertension, QT prolongation, congestive heart failure (CHF), stroke, myocardial infarction (MI) and pulmonary hypertension.

Results: Fifty-four patients were included in this study with a median age of 66 years. There were no cardiac events in patients without a history of cardiovascular disease. Eleven patients with a history of cardiovascular disease experienced an adverse cardiac event while taking pazopanib, sorafenib, or sunitinib. The most common adverse events were hypertension (n=6) and MI (n=2). The remaining three patients experienced a stroke, QT prolongation, or CHF. Seventy-three percent of events occurred within four months of starting therapy. Baseline EKG or ECHO were not available for most patients started on TKI therapy and obtained only when patients were symptomatic.

Conclusions: The results of this study indicate a need for baseline and routine monitoring in patients started on oral TKIs with a history of cardiovascular disease to align with the current recommendations as listed in the medication package inserts. Based on the results of this study, baseline and routine monitoring should be considered during the first four months of therapy in patients with a history of cardiovascular disease.