AVAHO

Background

The care of veterans with head and neck cancers requires a team approach among multiple disciplines throughout the entire trajectory of their cancer treatment course. Veterans with head and neck cancer have complicated treatments including surgery, radiation, chemotherapy and reconstructive surgery which can affect swallow function, speech, taste and physical appearance. Many patients who get treated for head and neck cancer will have lasting side effects of treatment. Veterans with cancer are more likely than the general population to have mental health comorbidities such as anxiety, depression and PTSD. Many head and neck cancer patients have used tobacco and/or alcohol as coping mechanisms for these issues. A new diagnosis of cancer may exacerbate their mental illness. Tobacco cessation may exacerbate anxiety for patients who have used tobacco as a coping mechanism. Ongoing alcohol use can complicate treatment. All of these issues can create delays in care.

Methods

In August 2019, a task force (“the ENT Multidisciplinary Workgroup”) was formed at VA Connecticut Healthcare System (“VACHS”) including representatives from ENT, Speech Pathology, Nutrition, Palliative Care and Oncology with the specific goal of improved coordination of care for head and neck cancer patients. Regular weekly meetings began in September 2019 to identify and track patients and to make referrals for appropriate diagnostic testing, treatment and supportive care.

Discussion

Weekly meeting among the core members of the ENT workgroup led to identification of patient needs earlier in the illness course than was observed prior to this workgroup initiative. Each week several opportunities are identified to improve patient care. This is a dynamic, ongoing process that has improved communication among key members of the interdisciplinary team that cares for these very complex patients and has led to the development of quality improvement initiatives that are reproducible at other VA sites.

Background

The care of veterans with head and neck cancers requires a team approach among multiple disciplines throughout the entire trajectory of their cancer treatment course. Veterans with head and neck cancer have complicated treatments including surgery, radiation, chemotherapy and reconstructive surgery which can affect swallow function, speech, taste and physical appearance. Many patients who get treated for head and neck cancer will have lasting side effects of treatment. Veterans with cancer are more likely than the general population to have mental health comorbidities such as anxiety, depression and PTSD. Many head and neck cancer patients have used tobacco and/or alcohol as coping mechanisms for these issues. A new diagnosis of cancer may exacerbate their mental illness. Tobacco cessation may exacerbate anxiety for patients who have used tobacco as a coping mechanism. Ongoing alcohol use can complicate treatment. All of these issues can create delays in care.

Methods

In August 2019, a task force (“the ENT Multidisciplinary Workgroup”) was formed at VA Connecticut Healthcare System (“VACHS”) including representatives from ENT, Speech Pathology, Nutrition, Palliative Care and Oncology with the specific goal of improved coordination of care for head and neck cancer patients. Regular weekly meetings began in September 2019 to identify and track patients and to make referrals for appropriate diagnostic testing, treatment and supportive care.

Discussion

Weekly meeting among the core members of the ENT workgroup led to identification of patient needs earlier in the illness course than was observed prior to this workgroup initiative. Each week several opportunities are identified to improve patient care. This is a dynamic, ongoing process that has improved communication among key members of the interdisciplinary team that cares for these very complex patients and has led to the development of quality improvement initiatives that are reproducible at other VA sites.

Background

The care of veterans with head and neck cancers requires a team approach among multiple disciplines throughout the entire trajectory of their cancer treatment course. Veterans with head and neck cancer have complicated treatments including surgery, radiation, chemotherapy and reconstructive surgery which can affect swallow function, speech, taste and physical appearance. Many patients who get treated for head and neck cancer will have lasting side effects of treatment. Veterans with cancer are more likely than the general population to have mental health comorbidities such as anxiety, depression and PTSD. Many head and neck cancer patients have used tobacco and/or alcohol as coping mechanisms for these issues. A new diagnosis of cancer may exacerbate their mental illness. Tobacco cessation may exacerbate anxiety for patients who have used tobacco as a coping mechanism. Ongoing alcohol use can complicate treatment. All of these issues can create delays in care.

Methods

In August 2019, a task force (“the ENT Multidisciplinary Workgroup”) was formed at VA Connecticut Healthcare System (“VACHS”) including representatives from ENT, Speech Pathology, Nutrition, Palliative Care and Oncology with the specific goal of improved coordination of care for head and neck cancer patients. Regular weekly meetings began in September 2019 to identify and track patients and to make referrals for appropriate diagnostic testing, treatment and supportive care.

Discussion

Weekly meeting among the core members of the ENT workgroup led to identification of patient needs earlier in the illness course than was observed prior to this workgroup initiative. Each week several opportunities are identified to improve patient care. This is a dynamic, ongoing process that has improved communication among key members of the interdisciplinary team that cares for these very complex patients and has led to the development of quality improvement initiatives that are reproducible at other VA sites.

Background

Basaloid squamous cell carcinoma (BSCC) is an aggressive laryngeal cancer with high recurrence and metastasis rates. Its rarity complicates diagnosis and optimal treatment selection, underscoring the significance of comprehensive data collection through national cancer registries. Historically, surgical intervention has been the primary approach to management.The RTOG 91-11 randomized trial catalyzed a paradigm shift, prioritizing laryngealpreserving treatments. The study provided evidence for radiotherapy in early-stage disease (stages 1-2) and combined chemoradiotherapy in advanced disease (stages 3-4). Consequently, organ preservation protocols gained traction, maintaining laryngeal anatomy while achieving comparable oncologic outcomes to total laryngectomy. This shift emphasizes exploring multimodal, laryngeal-sparing regimens to optimize quality of life without compromising disease control. However, further research utilizing large databases is needed to elucidate survival outcomes associated with these approaches.

Methods

We used the National Cancer Database to identify patients diagnosed with BSCC of the larynx (ICD-O-3 histology code 8083) between 2004-2019 (Nf1487). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p< 0.05.

Results

For early-stage patients, the estimated survival was 93.179 months. Surgery demonstrated the most favorable outcome with a median survival of 100.957 months, significantly higher than non-surgical patients (85.895 months, p=0.028). Survival did not differ between patients who received only chemotherapy (p=0.281), radiation (p=0.326), or chemoradiation (p=0.919) and those received other treatment modalities. In late-stage patients, the estimated survival was 61.993 months. Surgery yielded the most favorable outcome with a median survival of 70.484 months, significantly higher than non-surgical patients (54.153 months, p< 0.001). Patients who received only chemotherapy (p< 0.001), radiation (p< 0.001) and chemoradiation (p=0.24) had a worse survival outcome compared to those who received other treatment modalities.

Conclusions

The study results indicate that surgical resection could potentially improve survival outcomes for patients diagnosed with advanced-stage laryngeal BSCC. Conversely, for those with earlystage BSCC, larynx-preserving treatment modalities such as radiation, chemotherapy or concurrent chemoradiation appear to achieve comparable survival rates to primary surgical management. These results highlight the importance of careful consideration of treatment modalities based on disease staging at initial presentation.

Background

Basaloid squamous cell carcinoma (BSCC) is an aggressive laryngeal cancer with high recurrence and metastasis rates. Its rarity complicates diagnosis and optimal treatment selection, underscoring the significance of comprehensive data collection through national cancer registries. Historically, surgical intervention has been the primary approach to management.The RTOG 91-11 randomized trial catalyzed a paradigm shift, prioritizing laryngealpreserving treatments. The study provided evidence for radiotherapy in early-stage disease (stages 1-2) and combined chemoradiotherapy in advanced disease (stages 3-4). Consequently, organ preservation protocols gained traction, maintaining laryngeal anatomy while achieving comparable oncologic outcomes to total laryngectomy. This shift emphasizes exploring multimodal, laryngeal-sparing regimens to optimize quality of life without compromising disease control. However, further research utilizing large databases is needed to elucidate survival outcomes associated with these approaches.

Methods

We used the National Cancer Database to identify patients diagnosed with BSCC of the larynx (ICD-O-3 histology code 8083) between 2004-2019 (Nf1487). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p< 0.05.

Results

For early-stage patients, the estimated survival was 93.179 months. Surgery demonstrated the most favorable outcome with a median survival of 100.957 months, significantly higher than non-surgical patients (85.895 months, p=0.028). Survival did not differ between patients who received only chemotherapy (p=0.281), radiation (p=0.326), or chemoradiation (p=0.919) and those received other treatment modalities. In late-stage patients, the estimated survival was 61.993 months. Surgery yielded the most favorable outcome with a median survival of 70.484 months, significantly higher than non-surgical patients (54.153 months, p< 0.001). Patients who received only chemotherapy (p< 0.001), radiation (p< 0.001) and chemoradiation (p=0.24) had a worse survival outcome compared to those who received other treatment modalities.

Conclusions

The study results indicate that surgical resection could potentially improve survival outcomes for patients diagnosed with advanced-stage laryngeal BSCC. Conversely, for those with earlystage BSCC, larynx-preserving treatment modalities such as radiation, chemotherapy or concurrent chemoradiation appear to achieve comparable survival rates to primary surgical management. These results highlight the importance of careful consideration of treatment modalities based on disease staging at initial presentation.

Background

Basaloid squamous cell carcinoma (BSCC) is an aggressive laryngeal cancer with high recurrence and metastasis rates. Its rarity complicates diagnosis and optimal treatment selection, underscoring the significance of comprehensive data collection through national cancer registries. Historically, surgical intervention has been the primary approach to management.The RTOG 91-11 randomized trial catalyzed a paradigm shift, prioritizing laryngealpreserving treatments. The study provided evidence for radiotherapy in early-stage disease (stages 1-2) and combined chemoradiotherapy in advanced disease (stages 3-4). Consequently, organ preservation protocols gained traction, maintaining laryngeal anatomy while achieving comparable oncologic outcomes to total laryngectomy. This shift emphasizes exploring multimodal, laryngeal-sparing regimens to optimize quality of life without compromising disease control. However, further research utilizing large databases is needed to elucidate survival outcomes associated with these approaches.

Methods

We used the National Cancer Database to identify patients diagnosed with BSCC of the larynx (ICD-O-3 histology code 8083) between 2004-2019 (Nf1487). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p< 0.05.

Results

For early-stage patients, the estimated survival was 93.179 months. Surgery demonstrated the most favorable outcome with a median survival of 100.957 months, significantly higher than non-surgical patients (85.895 months, p=0.028). Survival did not differ between patients who received only chemotherapy (p=0.281), radiation (p=0.326), or chemoradiation (p=0.919) and those received other treatment modalities. In late-stage patients, the estimated survival was 61.993 months. Surgery yielded the most favorable outcome with a median survival of 70.484 months, significantly higher than non-surgical patients (54.153 months, p< 0.001). Patients who received only chemotherapy (p< 0.001), radiation (p< 0.001) and chemoradiation (p=0.24) had a worse survival outcome compared to those who received other treatment modalities.

Conclusions

The study results indicate that surgical resection could potentially improve survival outcomes for patients diagnosed with advanced-stage laryngeal BSCC. Conversely, for those with earlystage BSCC, larynx-preserving treatment modalities such as radiation, chemotherapy or concurrent chemoradiation appear to achieve comparable survival rates to primary surgical management. These results highlight the importance of careful consideration of treatment modalities based on disease staging at initial presentation.

Background

Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.

Methods

We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.

Results

There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.

Conclusions

We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.

Background

Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.

Methods

We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.

Results

There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.

Conclusions

We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.

Background

Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.

Methods

We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.

Results

There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.

Conclusions

We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Discussion

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. For example, the Very Low Risk flow map has seven unique Veterans entered, whereas the Molecular Testing flow map has over 3,900 unique Veterans entered. One clear reason for this disparity in pathway documentation use is that local prostate cancer is managed by urology and their documentation of the PCCP is not as widespread as the medical oncologists. The National Oncology Program developed clinical note templates to document PCCP that medical oncologist use which has increased utilization. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator. The UPCN will function as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. The UPCN is in the testing phase at three pilot test sites and is scheduled to be deployed summer 2024. The collaborative effort is aligned with the VHA directives outlined in the Cleland Dole Act.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Discussion

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. For example, the Very Low Risk flow map has seven unique Veterans entered, whereas the Molecular Testing flow map has over 3,900 unique Veterans entered. One clear reason for this disparity in pathway documentation use is that local prostate cancer is managed by urology and their documentation of the PCCP is not as widespread as the medical oncologists. The National Oncology Program developed clinical note templates to document PCCP that medical oncologist use which has increased utilization. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator. The UPCN will function as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. The UPCN is in the testing phase at three pilot test sites and is scheduled to be deployed summer 2024. The collaborative effort is aligned with the VHA directives outlined in the Cleland Dole Act.

Background

Prostate cancer is the most common non-cutaneous malignancy diagnosis within the Department of Veterans Affairs (VA). The Prostate Cancer Clinical Pathways (PCCP) were developed to enable providers to treat all Veterans with prostate cancer at subject matter expert level.

Discussion

The PCCP was launched in February 2021; however, provider documentation of PCCP is variable across the VA healthcare system and within the PCCP, specific flow maps have differential use. For example, the Very Low Risk flow map has seven unique Veterans entered, whereas the Molecular Testing flow map has over 3,900 unique Veterans entered. One clear reason for this disparity in pathway documentation use is that local prostate cancer is managed by urology and their documentation of the PCCP is not as widespread as the medical oncologists. The National Oncology Program developed clinical note templates to document PCCP that medical oncologist use which has increased utilization. To increase urology specific flow map use, a collaboration between the National Surgery Office and National Oncology Program was established to develop a Urology Prostate Cancer Note (UPCN). The UPCN was designed by urologists with assistance from a medical oncologist and a clinical applications coordinator. The UPCN will function as a working clinical note for urologists and has the PCCPs embedded into reminder dialog templates, which when completed generate health factors. The health factors that are generated from the UPCN are data mined to record PCCP use and to perform data analytics. The UPCN is in the testing phase at three pilot test sites and is scheduled to be deployed summer 2024. The collaborative effort is aligned with the VHA directives outlined in the Cleland Dole Act.

TOPLINE:

The number of cancer cases in men is estimated to increase by 84% from 2022 to 2050 — reaching 19 million globally — and deaths are expected to rise by more than 93% — reaching 10.5 million globally — with substantial disparities in cancer cases and deaths by age and region of the world, a recent analysis found.

METHODOLOGY:

• Overall, men have higher cancer incidence and mortality rates, which can be largely attributed to a higher prevalence of modifiable risk factors such as smoking, alcohol consumption, and occupational carcinogens, as well as the underuse of cancer prevention, screening, and treatment services.
• To assess the burden of cancer in men of different ages and from different regions of the world, researchers analyzed data from the 2022 Global Cancer Observatory (GLOBOCAN), which provides national-level estimates for cancer cases and deaths.
• Study outcomes included the incidence, mortality, and prevalence of cancer among men in 2022, along with projections for 2050. Estimates were stratified by several factors, including age; region; and Human Development Index (HDI), a composite score for health, education, and standard of living.
• Researchers also calculated mortality-to-incidence ratios (MIRs) for various cancer types, where higher values indicate worse survival.

TAKEAWAY:

• The researchers reported an estimated 10.3 million cancer cases and 5.4 million deaths globally in 2022, with almost two thirds of cases and deaths occurring in men aged 65 years or older.
• By 2050, cancer cases and deaths were projected to increase by 84.3% (to 19 million) and 93.2% (to 10.5 million), respectively. The increase from 2022 to 2050 was more than twofold higher for older men and countries with low and medium HDI.
• In 2022, the estimated global cancer MIR among men was nearly 55%, with variations by cancer types, age, and HDI. The MIR was lowest for thyroid cancer (7.6%) and highest for pancreatic cancer (90.9%); among World Health Organization regions, Africa had the highest MIR (72.6%), while the Americas had the lowest MIR (39.1%); countries with the lowest HDI had the highest MIR (73.5% vs 41.1% for very high HDI).
• Lung cancer was the leading cause for cases and deaths in 2022 and was projected to remain the leading cause in 2050.

IN PRACTICE:

“Disparities in cancer incidence and mortality among men were observed across age groups, countries/territories, and HDI in 2022, with these disparities projected to widen further by 2050,” according to the authors, who called for efforts to “reduce disparities in cancer burden and ensure equity in cancer prevention and care for men across the globe.”

SOURCE:

The study, led by Habtamu Mellie Bizuayehu, PhD, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia, was published online in Cancer.

LIMITATIONS:

The findings may be influenced by the quality of GLOBOCAN data. Interpretation should be cautious as MIR may not fully reflect cancer outcome inequalities. The study did not include other measures of cancer burden, such as years of life lost or years lived with disability, which were unavailable from the data source.

DISCLOSURES:

The authors did not disclose any funding information. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

TOPLINE:

The number of cancer cases in men is estimated to increase by 84% from 2022 to 2050 — reaching 19 million globally — and deaths are expected to rise by more than 93% — reaching 10.5 million globally — with substantial disparities in cancer cases and deaths by age and region of the world, a recent analysis found.

METHODOLOGY:

• Overall, men have higher cancer incidence and mortality rates, which can be largely attributed to a higher prevalence of modifiable risk factors such as smoking, alcohol consumption, and occupational carcinogens, as well as the underuse of cancer prevention, screening, and treatment services.
• To assess the burden of cancer in men of different ages and from different regions of the world, researchers analyzed data from the 2022 Global Cancer Observatory (GLOBOCAN), which provides national-level estimates for cancer cases and deaths.
• Study outcomes included the incidence, mortality, and prevalence of cancer among men in 2022, along with projections for 2050. Estimates were stratified by several factors, including age; region; and Human Development Index (HDI), a composite score for health, education, and standard of living.
• Researchers also calculated mortality-to-incidence ratios (MIRs) for various cancer types, where higher values indicate worse survival.

TAKEAWAY:

• The researchers reported an estimated 10.3 million cancer cases and 5.4 million deaths globally in 2022, with almost two thirds of cases and deaths occurring in men aged 65 years or older.
• By 2050, cancer cases and deaths were projected to increase by 84.3% (to 19 million) and 93.2% (to 10.5 million), respectively. The increase from 2022 to 2050 was more than twofold higher for older men and countries with low and medium HDI.
• In 2022, the estimated global cancer MIR among men was nearly 55%, with variations by cancer types, age, and HDI. The MIR was lowest for thyroid cancer (7.6%) and highest for pancreatic cancer (90.9%); among World Health Organization regions, Africa had the highest MIR (72.6%), while the Americas had the lowest MIR (39.1%); countries with the lowest HDI had the highest MIR (73.5% vs 41.1% for very high HDI).
• Lung cancer was the leading cause for cases and deaths in 2022 and was projected to remain the leading cause in 2050.

IN PRACTICE:

“Disparities in cancer incidence and mortality among men were observed across age groups, countries/territories, and HDI in 2022, with these disparities projected to widen further by 2050,” according to the authors, who called for efforts to “reduce disparities in cancer burden and ensure equity in cancer prevention and care for men across the globe.”

SOURCE:

The study, led by Habtamu Mellie Bizuayehu, PhD, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia, was published online in Cancer.

LIMITATIONS:

The findings may be influenced by the quality of GLOBOCAN data. Interpretation should be cautious as MIR may not fully reflect cancer outcome inequalities. The study did not include other measures of cancer burden, such as years of life lost or years lived with disability, which were unavailable from the data source.

DISCLOSURES:

The authors did not disclose any funding information. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

TOPLINE:

The number of cancer cases in men is estimated to increase by 84% from 2022 to 2050 — reaching 19 million globally — and deaths are expected to rise by more than 93% — reaching 10.5 million globally — with substantial disparities in cancer cases and deaths by age and region of the world, a recent analysis found.

METHODOLOGY:

• Overall, men have higher cancer incidence and mortality rates, which can be largely attributed to a higher prevalence of modifiable risk factors such as smoking, alcohol consumption, and occupational carcinogens, as well as the underuse of cancer prevention, screening, and treatment services.
• To assess the burden of cancer in men of different ages and from different regions of the world, researchers analyzed data from the 2022 Global Cancer Observatory (GLOBOCAN), which provides national-level estimates for cancer cases and deaths.
• Study outcomes included the incidence, mortality, and prevalence of cancer among men in 2022, along with projections for 2050. Estimates were stratified by several factors, including age; region; and Human Development Index (HDI), a composite score for health, education, and standard of living.
• Researchers also calculated mortality-to-incidence ratios (MIRs) for various cancer types, where higher values indicate worse survival.

TAKEAWAY:

• The researchers reported an estimated 10.3 million cancer cases and 5.4 million deaths globally in 2022, with almost two thirds of cases and deaths occurring in men aged 65 years or older.
• By 2050, cancer cases and deaths were projected to increase by 84.3% (to 19 million) and 93.2% (to 10.5 million), respectively. The increase from 2022 to 2050 was more than twofold higher for older men and countries with low and medium HDI.
• In 2022, the estimated global cancer MIR among men was nearly 55%, with variations by cancer types, age, and HDI. The MIR was lowest for thyroid cancer (7.6%) and highest for pancreatic cancer (90.9%); among World Health Organization regions, Africa had the highest MIR (72.6%), while the Americas had the lowest MIR (39.1%); countries with the lowest HDI had the highest MIR (73.5% vs 41.1% for very high HDI).
• Lung cancer was the leading cause for cases and deaths in 2022 and was projected to remain the leading cause in 2050.

IN PRACTICE:

“Disparities in cancer incidence and mortality among men were observed across age groups, countries/territories, and HDI in 2022, with these disparities projected to widen further by 2050,” according to the authors, who called for efforts to “reduce disparities in cancer burden and ensure equity in cancer prevention and care for men across the globe.”

SOURCE:

The study, led by Habtamu Mellie Bizuayehu, PhD, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia, was published online in Cancer.

LIMITATIONS:

The findings may be influenced by the quality of GLOBOCAN data. Interpretation should be cautious as MIR may not fully reflect cancer outcome inequalities. The study did not include other measures of cancer burden, such as years of life lost or years lived with disability, which were unavailable from the data source.

DISCLOSURES:

The authors did not disclose any funding information. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

Background

The Jesse Brown Veterans Affairs Medical Center (JBVAMC) serves predominantly Black American veterans, many with significant psychosocial needs, who live in Chicago’s South and West sides and Northwest Indiana. The JBVAMC hematology/oncology clinic is adopting the 4R Oncology Model (Right Info/ Care/Patient/Time) for patient-facing care planning and self-management, to enhance supportive and health maintenance care delivery. In order to guide the integration of the 4R model, baseline data were collected regarding patients’ understanding of their disease, social determinants of health, and use of services offered by JBVAMC.

Methods

Patients at JBVAMC were surveyed from February 2023 to September 2023. As a small incentive, these veterans received a $25 gift card for their participation. Analysis was conducted using descriptive statistics.

Results

Survey response rate was 67% (30/45). Median age was 66 (range 38-80). The population was 93% male, 83% black, 57% with highest level of education being high school or less, 59% with annual income less than $30k, and 47% living alone. Less than half (43%) of respondents knew their stage of cancer at diagnosis, and only 63% were aware of their treatment goals. Furthermore, only 17% remember receiving recommendations for support services that may be available through JBVAMC such as transportation assistance and home care. Information regarding “emotional distress or worry support recommendations” was acquired by 24% of veteran respondents. More than half, 57%, of veterans were encouraged to talk to their primary care provider about routine health maintenance during cancer treatment. Just over a quarter, 27%, were referred to a dietician.

Conclusions

This survey uncovered gaps in care planning, supportive services, and health maintenance care. These data will serve as a baseline to assess the effectiveness of the 4R care plan model. The implementation of the 4R Oncology Model is designed to address these gaps by providing a personalized care sequence that establishes a clear roadmap through the patient’s care trajectory, ultimately enhancing patient-centered care. Post-intervention survey results will be shared when available.

Background

The Jesse Brown Veterans Affairs Medical Center (JBVAMC) serves predominantly Black American veterans, many with significant psychosocial needs, who live in Chicago’s South and West sides and Northwest Indiana. The JBVAMC hematology/oncology clinic is adopting the 4R Oncology Model (Right Info/ Care/Patient/Time) for patient-facing care planning and self-management, to enhance supportive and health maintenance care delivery. In order to guide the integration of the 4R model, baseline data were collected regarding patients’ understanding of their disease, social determinants of health, and use of services offered by JBVAMC.

Methods

Patients at JBVAMC were surveyed from February 2023 to September 2023. As a small incentive, these veterans received a $25 gift card for their participation. Analysis was conducted using descriptive statistics.

Results

Survey response rate was 67% (30/45). Median age was 66 (range 38-80). The population was 93% male, 83% black, 57% with highest level of education being high school or less, 59% with annual income less than $30k, and 47% living alone. Less than half (43%) of respondents knew their stage of cancer at diagnosis, and only 63% were aware of their treatment goals. Furthermore, only 17% remember receiving recommendations for support services that may be available through JBVAMC such as transportation assistance and home care. Information regarding “emotional distress or worry support recommendations” was acquired by 24% of veteran respondents. More than half, 57%, of veterans were encouraged to talk to their primary care provider about routine health maintenance during cancer treatment. Just over a quarter, 27%, were referred to a dietician.

Conclusions

This survey uncovered gaps in care planning, supportive services, and health maintenance care. These data will serve as a baseline to assess the effectiveness of the 4R care plan model. The implementation of the 4R Oncology Model is designed to address these gaps by providing a personalized care sequence that establishes a clear roadmap through the patient’s care trajectory, ultimately enhancing patient-centered care. Post-intervention survey results will be shared when available.

Background

The Jesse Brown Veterans Affairs Medical Center (JBVAMC) serves predominantly Black American veterans, many with significant psychosocial needs, who live in Chicago’s South and West sides and Northwest Indiana. The JBVAMC hematology/oncology clinic is adopting the 4R Oncology Model (Right Info/ Care/Patient/Time) for patient-facing care planning and self-management, to enhance supportive and health maintenance care delivery. In order to guide the integration of the 4R model, baseline data were collected regarding patients’ understanding of their disease, social determinants of health, and use of services offered by JBVAMC.

Methods

Patients at JBVAMC were surveyed from February 2023 to September 2023. As a small incentive, these veterans received a $25 gift card for their participation. Analysis was conducted using descriptive statistics.

Results

Survey response rate was 67% (30/45). Median age was 66 (range 38-80). The population was 93% male, 83% black, 57% with highest level of education being high school or less, 59% with annual income less than $30k, and 47% living alone. Less than half (43%) of respondents knew their stage of cancer at diagnosis, and only 63% were aware of their treatment goals. Furthermore, only 17% remember receiving recommendations for support services that may be available through JBVAMC such as transportation assistance and home care. Information regarding “emotional distress or worry support recommendations” was acquired by 24% of veteran respondents. More than half, 57%, of veterans were encouraged to talk to their primary care provider about routine health maintenance during cancer treatment. Just over a quarter, 27%, were referred to a dietician.

Conclusions

This survey uncovered gaps in care planning, supportive services, and health maintenance care. These data will serve as a baseline to assess the effectiveness of the 4R care plan model. The implementation of the 4R Oncology Model is designed to address these gaps by providing a personalized care sequence that establishes a clear roadmap through the patient’s care trajectory, ultimately enhancing patient-centered care. Post-intervention survey results will be shared when available.

Background

Given the poor prognosis of patients with metastatic castration-resistant prostate cancer (mCRPC), interventions aimed at increasing adherence to oral treatments have the potential to improve patient outcomes. This study evaluates the impact of a patient stewardship assistance pilot program (stewardship program) on the adherence and persistence to oral treatments among patients with mCRPC at VA medical centers (VAMCs).

Methods

A non-randomized controlled study design and data from the VA Corporate Data Warehouse were used. The study included patients treated with an oral mCRPC therapy (i.e., abiraterone acetate or enzalutamide) between 08/2018 and 12/2019. Patients participating in the stewardship program formed the intervention arm and patients not participating the controls. Control patients were selected and matched 1:3 based on age, race and index year. The index date was the date of initiation of abiraterone acetate or enzalutamide. Outcomes included persistence (no gap >60 days of supply) and adherence (proportion of days covered [PDC] ≥80%) to oral mCRPC treatment post-index. Persistence and adherence were compared between the two arms using a Cox proportional hazard model and logistic regression model, respectively, adjusted for baseline characteristics.

Results

The study included 108 intervention patients (mean age: 74.6, 19.4% Black or African American, 44.4% from South, mean Quan-CCI: 6.7) and 324 control patients (mean age: 74.6, 19.4% Black or African American, 31.5% from South, mean Quan-CCI: 6.2). There was no statistically significant difference in persistence between the intervention and control arms (hazard ratio [95% confidence interval]: 0.84 [0.66-1.10], p-value: 0.211), with respective median times to discontinuation of 18 and 19 months. Over the first 12 months post-index, the proportion of adherent patients was not significantly different between the intervention arm and the control arm (50.6% vs. 50.9%; odds ratio [95% confidence interval]: 1.05 [0.80-1.38], p-value: 0.729).

Conclusions

In this racially diverse study of patients treated at VAMCs, high levels of persistence and adherence to oral mCRPC therapy were observed. The absence of any significant difference in adherence and persistence from the study intervention suggests that a stewardship assistance program aimed at improving adherence and persistence of patients with mCRPC may not be required at VAMCs.

Background

Given the poor prognosis of patients with metastatic castration-resistant prostate cancer (mCRPC), interventions aimed at increasing adherence to oral treatments have the potential to improve patient outcomes. This study evaluates the impact of a patient stewardship assistance pilot program (stewardship program) on the adherence and persistence to oral treatments among patients with mCRPC at VA medical centers (VAMCs).

Methods

A non-randomized controlled study design and data from the VA Corporate Data Warehouse were used. The study included patients treated with an oral mCRPC therapy (i.e., abiraterone acetate or enzalutamide) between 08/2018 and 12/2019. Patients participating in the stewardship program formed the intervention arm and patients not participating the controls. Control patients were selected and matched 1:3 based on age, race and index year. The index date was the date of initiation of abiraterone acetate or enzalutamide. Outcomes included persistence (no gap >60 days of supply) and adherence (proportion of days covered [PDC] ≥80%) to oral mCRPC treatment post-index. Persistence and adherence were compared between the two arms using a Cox proportional hazard model and logistic regression model, respectively, adjusted for baseline characteristics.

Results

The study included 108 intervention patients (mean age: 74.6, 19.4% Black or African American, 44.4% from South, mean Quan-CCI: 6.7) and 324 control patients (mean age: 74.6, 19.4% Black or African American, 31.5% from South, mean Quan-CCI: 6.2). There was no statistically significant difference in persistence between the intervention and control arms (hazard ratio [95% confidence interval]: 0.84 [0.66-1.10], p-value: 0.211), with respective median times to discontinuation of 18 and 19 months. Over the first 12 months post-index, the proportion of adherent patients was not significantly different between the intervention arm and the control arm (50.6% vs. 50.9%; odds ratio [95% confidence interval]: 1.05 [0.80-1.38], p-value: 0.729).

Conclusions

In this racially diverse study of patients treated at VAMCs, high levels of persistence and adherence to oral mCRPC therapy were observed. The absence of any significant difference in adherence and persistence from the study intervention suggests that a stewardship assistance program aimed at improving adherence and persistence of patients with mCRPC may not be required at VAMCs.

Background

Given the poor prognosis of patients with metastatic castration-resistant prostate cancer (mCRPC), interventions aimed at increasing adherence to oral treatments have the potential to improve patient outcomes. This study evaluates the impact of a patient stewardship assistance pilot program (stewardship program) on the adherence and persistence to oral treatments among patients with mCRPC at VA medical centers (VAMCs).

Methods

A non-randomized controlled study design and data from the VA Corporate Data Warehouse were used. The study included patients treated with an oral mCRPC therapy (i.e., abiraterone acetate or enzalutamide) between 08/2018 and 12/2019. Patients participating in the stewardship program formed the intervention arm and patients not participating the controls. Control patients were selected and matched 1:3 based on age, race and index year. The index date was the date of initiation of abiraterone acetate or enzalutamide. Outcomes included persistence (no gap >60 days of supply) and adherence (proportion of days covered [PDC] ≥80%) to oral mCRPC treatment post-index. Persistence and adherence were compared between the two arms using a Cox proportional hazard model and logistic regression model, respectively, adjusted for baseline characteristics.

Results

The study included 108 intervention patients (mean age: 74.6, 19.4% Black or African American, 44.4% from South, mean Quan-CCI: 6.7) and 324 control patients (mean age: 74.6, 19.4% Black or African American, 31.5% from South, mean Quan-CCI: 6.2). There was no statistically significant difference in persistence between the intervention and control arms (hazard ratio [95% confidence interval]: 0.84 [0.66-1.10], p-value: 0.211), with respective median times to discontinuation of 18 and 19 months. Over the first 12 months post-index, the proportion of adherent patients was not significantly different between the intervention arm and the control arm (50.6% vs. 50.9%; odds ratio [95% confidence interval]: 1.05 [0.80-1.38], p-value: 0.729).

Conclusions

In this racially diverse study of patients treated at VAMCs, high levels of persistence and adherence to oral mCRPC therapy were observed. The absence of any significant difference in adherence and persistence from the study intervention suggests that a stewardship assistance program aimed at improving adherence and persistence of patients with mCRPC may not be required at VAMCs.

Introduction

Signet ring cell carcinoma (SRCC) of the small intestine is very rare. It is characterized by the presence of malignant cells that contain mucin that push nuclei to the periphery. It is more aggressive compared to other adenocarcinomas due to early metastasis and poorer prognosis.

Case Presentation

A 59-year-old male with a history of HIV/AIDS, presented with complaints of anorexia, vomiting and weight loss. Initial abdominal CT showed a retroperitoneal mass causing gastric outlet obstruction. The patient elected to go home after supportive treatment and follow up as an outpatient, however, he presented 10 days later with worsening symptoms. Evaluation with CT abdomen and pelvis showed enlarging soft tissue density in the retrocrural space extending into the retroperitoneum around the aorta, as well as a 1.5 cm intraluminal cystic lesion in the duodenum. Endoscopic ultrasound revealed lymphadenopathy of celiac and porta hepatis regions, along with duodenal stenosis, stent placement for decompression was not feasible and biopsies were inconclusive. The decision was made to proceed with laparotomy for decompression and additional biopsies from the retroperitoneal mass and omental lymph nodes, which confirmed poorly differentiated adenocarcinoma with signet ring cells. The presence of a mass in the duodenum strongly suggested adenocarcinoma of small intestine origin. As the patient’s symptoms worsened, imaging revealed progression with lung metastases. The patient continued to deteriorate rapidly requiring dialysis and gangrenous cholecystitis. Given his complex medical history, patient decided to transition to comfort care.

Discussion

SRCC can present with any GI symptoms. Most important step in diagnosing SRCC is biopsy. Current treatment options for small intestinal malignancies include wide resection that includes the mesentery and corresponding lymph nodes. The use of adjuvant chemotherapy has been described only in small retrospective studies. Due to its scarcity, there isn’t sufficient data for optimal treatment strategies compared to gastric SRCC.

Conclusions

This case report highlights the importance of how rare and aggressive signet ring cell adenocarcinoma of the small intestine. There are only a few cases documented in the literature, which is why we lack data on how to manage the disease. 

Introduction

Signet ring cell carcinoma (SRCC) of the small intestine is very rare. It is characterized by the presence of malignant cells that contain mucin that push nuclei to the periphery. It is more aggressive compared to other adenocarcinomas due to early metastasis and poorer prognosis.

Case Presentation

A 59-year-old male with a history of HIV/AIDS, presented with complaints of anorexia, vomiting and weight loss. Initial abdominal CT showed a retroperitoneal mass causing gastric outlet obstruction. The patient elected to go home after supportive treatment and follow up as an outpatient, however, he presented 10 days later with worsening symptoms. Evaluation with CT abdomen and pelvis showed enlarging soft tissue density in the retrocrural space extending into the retroperitoneum around the aorta, as well as a 1.5 cm intraluminal cystic lesion in the duodenum. Endoscopic ultrasound revealed lymphadenopathy of celiac and porta hepatis regions, along with duodenal stenosis, stent placement for decompression was not feasible and biopsies were inconclusive. The decision was made to proceed with laparotomy for decompression and additional biopsies from the retroperitoneal mass and omental lymph nodes, which confirmed poorly differentiated adenocarcinoma with signet ring cells. The presence of a mass in the duodenum strongly suggested adenocarcinoma of small intestine origin. As the patient’s symptoms worsened, imaging revealed progression with lung metastases. The patient continued to deteriorate rapidly requiring dialysis and gangrenous cholecystitis. Given his complex medical history, patient decided to transition to comfort care.

Discussion

SRCC can present with any GI symptoms. Most important step in diagnosing SRCC is biopsy. Current treatment options for small intestinal malignancies include wide resection that includes the mesentery and corresponding lymph nodes. The use of adjuvant chemotherapy has been described only in small retrospective studies. Due to its scarcity, there isn’t sufficient data for optimal treatment strategies compared to gastric SRCC.

Conclusions

This case report highlights the importance of how rare and aggressive signet ring cell adenocarcinoma of the small intestine. There are only a few cases documented in the literature, which is why we lack data on how to manage the disease. 

Introduction

Signet ring cell carcinoma (SRCC) of the small intestine is very rare. It is characterized by the presence of malignant cells that contain mucin that push nuclei to the periphery. It is more aggressive compared to other adenocarcinomas due to early metastasis and poorer prognosis.

Case Presentation

A 59-year-old male with a history of HIV/AIDS, presented with complaints of anorexia, vomiting and weight loss. Initial abdominal CT showed a retroperitoneal mass causing gastric outlet obstruction. The patient elected to go home after supportive treatment and follow up as an outpatient, however, he presented 10 days later with worsening symptoms. Evaluation with CT abdomen and pelvis showed enlarging soft tissue density in the retrocrural space extending into the retroperitoneum around the aorta, as well as a 1.5 cm intraluminal cystic lesion in the duodenum. Endoscopic ultrasound revealed lymphadenopathy of celiac and porta hepatis regions, along with duodenal stenosis, stent placement for decompression was not feasible and biopsies were inconclusive. The decision was made to proceed with laparotomy for decompression and additional biopsies from the retroperitoneal mass and omental lymph nodes, which confirmed poorly differentiated adenocarcinoma with signet ring cells. The presence of a mass in the duodenum strongly suggested adenocarcinoma of small intestine origin. As the patient’s symptoms worsened, imaging revealed progression with lung metastases. The patient continued to deteriorate rapidly requiring dialysis and gangrenous cholecystitis. Given his complex medical history, patient decided to transition to comfort care.

Discussion

SRCC can present with any GI symptoms. Most important step in diagnosing SRCC is biopsy. Current treatment options for small intestinal malignancies include wide resection that includes the mesentery and corresponding lymph nodes. The use of adjuvant chemotherapy has been described only in small retrospective studies. Due to its scarcity, there isn’t sufficient data for optimal treatment strategies compared to gastric SRCC.

Conclusions

This case report highlights the importance of how rare and aggressive signet ring cell adenocarcinoma of the small intestine. There are only a few cases documented in the literature, which is why we lack data on how to manage the disease. 

Background

Nutrition disorders, such as sarcopenia, malnutrition, and cachexia are prevalent in cancer patients and correlated with negative outcomes, increased costs, and reduced quality of life (QOL). Registered dietitians (RDs) effectively diagnose and treat nutrition disorders. RD staffing guidelines in outpatient cancer centers are non-specific and unvalidated. This study explored RD staffing ratios to determine trends which may indicate best practices.

Methods

Facility-level measures including full time equivalents (FTE), referral practices, RD participation interdisciplinary round participation, and nutrition referral practices were obtained from survey data of RDs working in oncology clinics and from cancer registries across VHA between 2016-2017. A proactive score was calculated based on interdisciplinary meeting attendances, use of validated screening tools, and standardized protocols for nutrition referrals. Chart review was conducted for 681 Veterans from 13 VHA cancer centers and 207 oncology providers (OPs) to determine weight change, malnutrition, oral nutrition supplement (ONS) use, time to RD referral, and survival. Logistic regression was used for statistical analysis.

Results

Mean and median RD FTE assigned to oncology clinics was 0.5. The total RD:OP ratio ranged from 1:4 to 1:850 with an average of 1 RD to 48.5 OP. An increase in RD:OP ratio from 0:1 to 1:1 was associated with a 16-fold increased odds of weight maintenance during cancer treatment (95% CI: 2.01, 127.53). A 10% increase in the RD:OP ratio increased probability of weight maintenance by 32%. Being seen by an RD was associated with 2.87 times odds of being diagnosed with malnutrition (95% CI: 1.62, 5.08). Each unit increase in a facility’s proactive score was associated with 38% increased odds of a patient being seen by an RD (95% CI: 1.08, 1.76), and 21% reduced odds of being prescribed an ONS (95% CI: 0.63, 0.98).

Conclusions

Few cancer centers employ dedicated fulltime RDs and nutrition practices vary across cancer centers. Improved RD:OP ratios may contribute to improved nutrition outcomes for this population. When RDs are active in interdisciplinary cancer teams, nutrition treatment improves. These efforts support patient complexity, facility funding, and QOL. These data may be used to support cancer care guidelines across VHA.

Background

Nutrition disorders, such as sarcopenia, malnutrition, and cachexia are prevalent in cancer patients and correlated with negative outcomes, increased costs, and reduced quality of life (QOL). Registered dietitians (RDs) effectively diagnose and treat nutrition disorders. RD staffing guidelines in outpatient cancer centers are non-specific and unvalidated. This study explored RD staffing ratios to determine trends which may indicate best practices.

Methods

Facility-level measures including full time equivalents (FTE), referral practices, RD participation interdisciplinary round participation, and nutrition referral practices were obtained from survey data of RDs working in oncology clinics and from cancer registries across VHA between 2016-2017. A proactive score was calculated based on interdisciplinary meeting attendances, use of validated screening tools, and standardized protocols for nutrition referrals. Chart review was conducted for 681 Veterans from 13 VHA cancer centers and 207 oncology providers (OPs) to determine weight change, malnutrition, oral nutrition supplement (ONS) use, time to RD referral, and survival. Logistic regression was used for statistical analysis.

Results

Mean and median RD FTE assigned to oncology clinics was 0.5. The total RD:OP ratio ranged from 1:4 to 1:850 with an average of 1 RD to 48.5 OP. An increase in RD:OP ratio from 0:1 to 1:1 was associated with a 16-fold increased odds of weight maintenance during cancer treatment (95% CI: 2.01, 127.53). A 10% increase in the RD:OP ratio increased probability of weight maintenance by 32%. Being seen by an RD was associated with 2.87 times odds of being diagnosed with malnutrition (95% CI: 1.62, 5.08). Each unit increase in a facility’s proactive score was associated with 38% increased odds of a patient being seen by an RD (95% CI: 1.08, 1.76), and 21% reduced odds of being prescribed an ONS (95% CI: 0.63, 0.98).

Conclusions

Few cancer centers employ dedicated fulltime RDs and nutrition practices vary across cancer centers. Improved RD:OP ratios may contribute to improved nutrition outcomes for this population. When RDs are active in interdisciplinary cancer teams, nutrition treatment improves. These efforts support patient complexity, facility funding, and QOL. These data may be used to support cancer care guidelines across VHA.

Background

Nutrition disorders, such as sarcopenia, malnutrition, and cachexia are prevalent in cancer patients and correlated with negative outcomes, increased costs, and reduced quality of life (QOL). Registered dietitians (RDs) effectively diagnose and treat nutrition disorders. RD staffing guidelines in outpatient cancer centers are non-specific and unvalidated. This study explored RD staffing ratios to determine trends which may indicate best practices.

Methods

Facility-level measures including full time equivalents (FTE), referral practices, RD participation interdisciplinary round participation, and nutrition referral practices were obtained from survey data of RDs working in oncology clinics and from cancer registries across VHA between 2016-2017. A proactive score was calculated based on interdisciplinary meeting attendances, use of validated screening tools, and standardized protocols for nutrition referrals. Chart review was conducted for 681 Veterans from 13 VHA cancer centers and 207 oncology providers (OPs) to determine weight change, malnutrition, oral nutrition supplement (ONS) use, time to RD referral, and survival. Logistic regression was used for statistical analysis.

Results

Mean and median RD FTE assigned to oncology clinics was 0.5. The total RD:OP ratio ranged from 1:4 to 1:850 with an average of 1 RD to 48.5 OP. An increase in RD:OP ratio from 0:1 to 1:1 was associated with a 16-fold increased odds of weight maintenance during cancer treatment (95% CI: 2.01, 127.53). A 10% increase in the RD:OP ratio increased probability of weight maintenance by 32%. Being seen by an RD was associated with 2.87 times odds of being diagnosed with malnutrition (95% CI: 1.62, 5.08). Each unit increase in a facility’s proactive score was associated with 38% increased odds of a patient being seen by an RD (95% CI: 1.08, 1.76), and 21% reduced odds of being prescribed an ONS (95% CI: 0.63, 0.98).

Conclusions

Few cancer centers employ dedicated fulltime RDs and nutrition practices vary across cancer centers. Improved RD:OP ratios may contribute to improved nutrition outcomes for this population. When RDs are active in interdisciplinary cancer teams, nutrition treatment improves. These efforts support patient complexity, facility funding, and QOL. These data may be used to support cancer care guidelines across VHA.

Background

Currently within the Veterans Health Administration, nearly 38% of VA users reside in rural areas. Approximately 70% of rural areas do not have an oncologist, resulting in a high proportion of Veterans who lack access to specialized cancer services. The National TeleOncology Service (NTO) was designed to increase access to specialty and subspecialty cancer care for Veterans regardless of geographical location, and for those who may experience additional barriers to in-person care due to medical complexity or other social determinants of health. Purpose: THRIVE focuses on health equity for telehealth-delivered cancer care. We are specifically interested in the intersection of poverty, rurality, and race. As part of this inquiry, we examined provider experiences of the NTO to better understand the benefits, drawbacks, facilitators and barriers to implementing NTO care.

Methods

We conducted two focus groups with NTO providers. We developed guides using the Consolidated Framework for Implementation Research (CFIR 2.0) and utilized rapid qualitative analysis. We arrayed data in matrices based on CFIR 2.0-based guide for analysis.

Results

The focus groups included NTO physicians (n=4) and non-physicians (n=19). Providers agreed that NTO provides valuable cancer care to Veterans facing in-person access issues. The technology is easy to use for many patients, but those in rural areas experiencing poverty struggle most. NTO’s technical support resources reduce technical skill and equipment barriers and facilitate connection for both patients and providers. Providers enjoyed the team-based approach of NTO and believed it increases care quality through access to multiple providers and resources within the clinical encounter. The NTO’s work could be strengthened by standardizing technology to facilitate records transfer and enable sharing of documentation and education between NTO and patients. Implications: This study examined providers’ perceived acceptability, feasibility, barriers, and facilitators of NTO-delivered cancer care within VA, demonstrating that NTO service is well-liked and a valuable emerging resource of VA care.

Conclusions

In an era when CMMS shifts away from reimbursing telehealth, VA has committed to continue such care providing a variety of patient-centered approaches. NTO may serve as a model for expanding telehealth-delivered care for other serious and chronic diseases and conditions.

Background

Currently within the Veterans Health Administration, nearly 38% of VA users reside in rural areas. Approximately 70% of rural areas do not have an oncologist, resulting in a high proportion of Veterans who lack access to specialized cancer services. The National TeleOncology Service (NTO) was designed to increase access to specialty and subspecialty cancer care for Veterans regardless of geographical location, and for those who may experience additional barriers to in-person care due to medical complexity or other social determinants of health. Purpose: THRIVE focuses on health equity for telehealth-delivered cancer care. We are specifically interested in the intersection of poverty, rurality, and race. As part of this inquiry, we examined provider experiences of the NTO to better understand the benefits, drawbacks, facilitators and barriers to implementing NTO care.

Methods

We conducted two focus groups with NTO providers. We developed guides using the Consolidated Framework for Implementation Research (CFIR 2.0) and utilized rapid qualitative analysis. We arrayed data in matrices based on CFIR 2.0-based guide for analysis.

Results

The focus groups included NTO physicians (n=4) and non-physicians (n=19). Providers agreed that NTO provides valuable cancer care to Veterans facing in-person access issues. The technology is easy to use for many patients, but those in rural areas experiencing poverty struggle most. NTO’s technical support resources reduce technical skill and equipment barriers and facilitate connection for both patients and providers. Providers enjoyed the team-based approach of NTO and believed it increases care quality through access to multiple providers and resources within the clinical encounter. The NTO’s work could be strengthened by standardizing technology to facilitate records transfer and enable sharing of documentation and education between NTO and patients. Implications: This study examined providers’ perceived acceptability, feasibility, barriers, and facilitators of NTO-delivered cancer care within VA, demonstrating that NTO service is well-liked and a valuable emerging resource of VA care.

Conclusions

In an era when CMMS shifts away from reimbursing telehealth, VA has committed to continue such care providing a variety of patient-centered approaches. NTO may serve as a model for expanding telehealth-delivered care for other serious and chronic diseases and conditions.

Background

Currently within the Veterans Health Administration, nearly 38% of VA users reside in rural areas. Approximately 70% of rural areas do not have an oncologist, resulting in a high proportion of Veterans who lack access to specialized cancer services. The National TeleOncology Service (NTO) was designed to increase access to specialty and subspecialty cancer care for Veterans regardless of geographical location, and for those who may experience additional barriers to in-person care due to medical complexity or other social determinants of health. Purpose: THRIVE focuses on health equity for telehealth-delivered cancer care. We are specifically interested in the intersection of poverty, rurality, and race. As part of this inquiry, we examined provider experiences of the NTO to better understand the benefits, drawbacks, facilitators and barriers to implementing NTO care.

Methods

We conducted two focus groups with NTO providers. We developed guides using the Consolidated Framework for Implementation Research (CFIR 2.0) and utilized rapid qualitative analysis. We arrayed data in matrices based on CFIR 2.0-based guide for analysis.

Results

The focus groups included NTO physicians (n=4) and non-physicians (n=19). Providers agreed that NTO provides valuable cancer care to Veterans facing in-person access issues. The technology is easy to use for many patients, but those in rural areas experiencing poverty struggle most. NTO’s technical support resources reduce technical skill and equipment barriers and facilitate connection for both patients and providers. Providers enjoyed the team-based approach of NTO and believed it increases care quality through access to multiple providers and resources within the clinical encounter. The NTO’s work could be strengthened by standardizing technology to facilitate records transfer and enable sharing of documentation and education between NTO and patients. Implications: This study examined providers’ perceived acceptability, feasibility, barriers, and facilitators of NTO-delivered cancer care within VA, demonstrating that NTO service is well-liked and a valuable emerging resource of VA care.

Conclusions

In an era when CMMS shifts away from reimbursing telehealth, VA has committed to continue such care providing a variety of patient-centered approaches. NTO may serve as a model for expanding telehealth-delivered care for other serious and chronic diseases and conditions.