Conference Coverage

The Current State of VHA’s National Precision Oncology Program

Abstract: 2018 AVAHO Meeting


 

Purpose: To inform VA stakeholders of the availability of Precision Oncology (PO) services for Veterans with advanced cancer.

Background: PO offers the promise of effective, lowtoxicity targeted therapies tailored to individual tumor genomics but is unequally available within VHA. A system-wide National PO Program (NPOP) including patients in rural areas launched in July 2016.

Methods: Patients tested with multigene next generation sequencing (NGS) tumor testing through 2 contracted vendors were identified from NPOP records and cancer characteristics were extracted from NPOP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from NPOP records.

Results: In all, 3,981 samples have been sent for NGS sequencing via NPOP. 3,036 samples were sequenced successfully and 597 failed (83.57% successful). Of the successful samples, 99 are liquid biopsies and 2,880 have Watson for Genomics treatment recommendations. Utilization of NPOP services has increased across VHA since the national rollout, from 4 participating facilities in NPOP’s first quarter (Q4 2016) to 51 facilities last quarter (Q3 2018). Average samples sent per month in 2018 is 182, up from 105 in 2017. Despite these increases, NGS testing is not yet systematically utilized at all participating facilities and 79 facilities did not participate last quarter. NPOP is servicing a large rural population (34% rural), which is similar to that of all VHA patients (33%) and more than twice the national rate (14%). The top diagnoses were lung (1,333: 917 adeno, 283 squamous, 133 non-small cell), colorectal (307), prostate (297), skin (154) and head and neck (75). 158 patients have been prescribed 225 of the recommended treatments before (130) and after (95) the NGS results date.

Conclusions: Utilization of NGS testing in the VHA population has grown significantly over the past year throughout most of the country. The higher volume has been facilitated through improvements in NPOP’s data infrastructure. Additional VHA patients can benefit from NGS gene panel testing to guide therapeutic decisionmaking.

Recommended Reading

Use of Mobile Messaging System for Self-Management of Chemotherapy Symptoms in Patients With Advanced Cancer
AVAHO
Cancer Among Women Treated in the Veterans Affairs Health Care System
AVAHO
Antiplatelet Therapies in Combination With Sorafenib and/or Transarterial Chemoembolization Improve Hepatocellular Carcinoma Treatment Outcomes
AVAHO
Primary Anatomical Site and Other Prognostic Variables for Dedifferentiated Liposarcoma
AVAHO
VA Symptom Assessment Scale (VSAS): Symptom Prevalence, Reliability and Internal Consistency
AVAHO
Screening Cancer Survivors for Bone Density Loss: An Analysis of Prevalence and Risk Factors in the Veteran Population
AVAHO
Development of A New Hematology Oncology (H/O) Fellowship Role to Improve Consult Wait Times and Reduce ER Visits
AVAHO
Prognostic Factors, Treatment and Survival in Primary Cardiac Sarcoma
AVAHO
Evaluation of Implementation of Tumor Next-Generation Sequencing Within the Veterans Health Administration (VHA)
AVAHO
Use and Toxicity of Checkpoint Inhibitors for Solid Tumor Treatment in a Veteran Population
AVAHO