Williams CD

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Purpose: Approximately 10% of patients with stage I non-small cell lung cancer (NSCLC) are managed without definitive therapy. We therefore investigated whether this rate is similar among veterans cared for by the Veterans Health Administration (VHA), and explored the outcomes and factors associated with under- utilization of these standard of care management strategies.

Methods: The Veterans Affairs (VA) Corporate Data Warehouse (CDW) was queried for all patients diagnosed with NSCLC between 2003 and 2016. Receipt of definitive therapy was determined using VHA cancer registry data, CPT codes and ICD-9/ICD-10 procedure codes within a year after diagnosis. We also captured receipt of chemotherapy as the primary course of treatment, whenever this was the case. Vital status data were assessed using the Kaplan-Meier method.

Results: A total of 19,971 veterans were diagnosed with biopsy-proven clinical stage I NSCLC. The primary treatment for 13,080 (65.5%), 4,889 (24.5%), and 2,002 (10.0%) patients was surgery, RT, or no documented surgery or RT, respectively. The 5-year overall survival for these 3 groups was 53.1%, 19.7%, and 8.9%, respectively. The proportion of patients without documentation of definitive therapy was highest in 2004 at 16.9%, decreasing to 6.3% by 2016. Patients treated at a VA medical center with an on-site radiation oncology service were more likely to receive definitive therapy (chi-square P<0.01). However, this difference was driven by higher utilization of surgery instead of radiation therapy. Among patients without documentation of definitive therapy, 17.4% received systemic chemotherapy as their first reported treatment course.

Conclusion: The proportion of patients without documentation of definitive surgery or RT was similar to previous publications. The rate of no definitive therapy has declined by more than 50% over the past decade, and is coincident with the increased availability of onsite radiotherapy services, as well as minimally invasive thoracic surgery and stereotactic radiotherapy within and outside the VHA. Future investigations of this dataset are likely to increase our understanding about the reasons for treatment delay or avoidance, and its consequences for patients with a highly curable stage I NSCLC.

Purpose: Approximately 10% of patients with stage I non-small cell lung cancer (NSCLC) are managed without definitive therapy. We therefore investigated whether this rate is similar among veterans cared for by the Veterans Health Administration (VHA), and explored the outcomes and factors associated with under- utilization of these standard of care management strategies.

Methods: The Veterans Affairs (VA) Corporate Data Warehouse (CDW) was queried for all patients diagnosed with NSCLC between 2003 and 2016. Receipt of definitive therapy was determined using VHA cancer registry data, CPT codes and ICD-9/ICD-10 procedure codes within a year after diagnosis. We also captured receipt of chemotherapy as the primary course of treatment, whenever this was the case. Vital status data were assessed using the Kaplan-Meier method.

Results: A total of 19,971 veterans were diagnosed with biopsy-proven clinical stage I NSCLC. The primary treatment for 13,080 (65.5%), 4,889 (24.5%), and 2,002 (10.0%) patients was surgery, RT, or no documented surgery or RT, respectively. The 5-year overall survival for these 3 groups was 53.1%, 19.7%, and 8.9%, respectively. The proportion of patients without documentation of definitive therapy was highest in 2004 at 16.9%, decreasing to 6.3% by 2016. Patients treated at a VA medical center with an on-site radiation oncology service were more likely to receive definitive therapy (chi-square P<0.01). However, this difference was driven by higher utilization of surgery instead of radiation therapy. Among patients without documentation of definitive therapy, 17.4% received systemic chemotherapy as their first reported treatment course.

Conclusion: The proportion of patients without documentation of definitive surgery or RT was similar to previous publications. The rate of no definitive therapy has declined by more than 50% over the past decade, and is coincident with the increased availability of onsite radiotherapy services, as well as minimally invasive thoracic surgery and stereotactic radiotherapy within and outside the VHA. Future investigations of this dataset are likely to increase our understanding about the reasons for treatment delay or avoidance, and its consequences for patients with a highly curable stage I NSCLC.

Purpose: Approximately 10% of patients with stage I non-small cell lung cancer (NSCLC) are managed without definitive therapy. We therefore investigated whether this rate is similar among veterans cared for by the Veterans Health Administration (VHA), and explored the outcomes and factors associated with under- utilization of these standard of care management strategies.

Methods: The Veterans Affairs (VA) Corporate Data Warehouse (CDW) was queried for all patients diagnosed with NSCLC between 2003 and 2016. Receipt of definitive therapy was determined using VHA cancer registry data, CPT codes and ICD-9/ICD-10 procedure codes within a year after diagnosis. We also captured receipt of chemotherapy as the primary course of treatment, whenever this was the case. Vital status data were assessed using the Kaplan-Meier method.

Results: A total of 19,971 veterans were diagnosed with biopsy-proven clinical stage I NSCLC. The primary treatment for 13,080 (65.5%), 4,889 (24.5%), and 2,002 (10.0%) patients was surgery, RT, or no documented surgery or RT, respectively. The 5-year overall survival for these 3 groups was 53.1%, 19.7%, and 8.9%, respectively. The proportion of patients without documentation of definitive therapy was highest in 2004 at 16.9%, decreasing to 6.3% by 2016. Patients treated at a VA medical center with an on-site radiation oncology service were more likely to receive definitive therapy (chi-square P<0.01). However, this difference was driven by higher utilization of surgery instead of radiation therapy. Among patients without documentation of definitive therapy, 17.4% received systemic chemotherapy as their first reported treatment course.

Conclusion: The proportion of patients without documentation of definitive surgery or RT was similar to previous publications. The rate of no definitive therapy has declined by more than 50% over the past decade, and is coincident with the increased availability of onsite radiotherapy services, as well as minimally invasive thoracic surgery and stereotactic radiotherapy within and outside the VHA. Future investigations of this dataset are likely to increase our understanding about the reasons for treatment delay or avoidance, and its consequences for patients with a highly curable stage I NSCLC.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.

Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.

Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.

Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).

Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Purpose: We sought to: (1) determine the odds of colorectal cancer (CRC) survivors being diagnosed with hypertension 2 years post-CRC diagnosis; (2) assess differences in blood pressure (BP) control one year post-CRC diagnosis; and (3) assess differences in antihypertensive medication adherence one year post-CRC diagnosis, all relative to matched non-cancer controls.

Background: CRC and hypertension share common risk factors. Because CRC survivors often transition from oncology-led care to primary care, it is important to know whether they have differential prevalence of hypertension for chronic disease management.

Methods: We used the national VA Central Cancer Registry to identify patients diagnosed with non-metastatic CRC from 10/1/2008 to 12/31/2012 who had ≥ 1 primary care or oncology visit in the previous year. Up to 3 non-cancer controls were identified for each CRC survivor through electronic health records matched on age, race, sex, copayment status, geographic region, distance to VA healthcare, body mass index, number of outpatient visits (≥ 3 vs. fewer), and pre-existing hypertension, hyperlipidemia, and diabetes. We used logistic regression to calculate odds ratios (OR) and confidence intervals (CI) for being diagnosed with, and control of, hypertension between CRC survivors and controls. We calculated Medication Possession Ratio (MPR), a pharmacy refill-based adherence measure, for patients prescribed metoprolol tartrate.

Results: 9,758 patients with CRC were matched to 29,066 controls. The cohort was predominantly white (79.5%) men (97.8%), mean age of 66.8 years. Compared to matched controls, CRC survivors had 60% higher odds of being diagnosed with hypertension (OR = 1.59, 95% CI, = 1.51-1.67) one year post-diagnosis (69.4% CRC survivors have hypertension). CRC survivors experienced lower odds of BP control (OR = 0.89, 95% CI, 0.85-0.94); antihypertensive medication adherence was lower (relative MPR difference 7%) compared with matched non-cancer controls.

Implications: Compared to patients without a history of cancer, CRC survivors have higher odds of being diagnosed with hypertension, worse BP control, and worse antihypertension medication adherence. A critical component of survivorship care for CRC patients is management of hypertension to reduce CVD risk.

Purpose: We sought to: (1) determine the odds of colorectal cancer (CRC) survivors being diagnosed with hypertension 2 years post-CRC diagnosis; (2) assess differences in blood pressure (BP) control one year post-CRC diagnosis; and (3) assess differences in antihypertensive medication adherence one year post-CRC diagnosis, all relative to matched non-cancer controls.

Background: CRC and hypertension share common risk factors. Because CRC survivors often transition from oncology-led care to primary care, it is important to know whether they have differential prevalence of hypertension for chronic disease management.

Methods: We used the national VA Central Cancer Registry to identify patients diagnosed with non-metastatic CRC from 10/1/2008 to 12/31/2012 who had ≥ 1 primary care or oncology visit in the previous year. Up to 3 non-cancer controls were identified for each CRC survivor through electronic health records matched on age, race, sex, copayment status, geographic region, distance to VA healthcare, body mass index, number of outpatient visits (≥ 3 vs. fewer), and pre-existing hypertension, hyperlipidemia, and diabetes. We used logistic regression to calculate odds ratios (OR) and confidence intervals (CI) for being diagnosed with, and control of, hypertension between CRC survivors and controls. We calculated Medication Possession Ratio (MPR), a pharmacy refill-based adherence measure, for patients prescribed metoprolol tartrate.

Results: 9,758 patients with CRC were matched to 29,066 controls. The cohort was predominantly white (79.5%) men (97.8%), mean age of 66.8 years. Compared to matched controls, CRC survivors had 60% higher odds of being diagnosed with hypertension (OR = 1.59, 95% CI, = 1.51-1.67) one year post-diagnosis (69.4% CRC survivors have hypertension). CRC survivors experienced lower odds of BP control (OR = 0.89, 95% CI, 0.85-0.94); antihypertensive medication adherence was lower (relative MPR difference 7%) compared with matched non-cancer controls.

Implications: Compared to patients without a history of cancer, CRC survivors have higher odds of being diagnosed with hypertension, worse BP control, and worse antihypertension medication adherence. A critical component of survivorship care for CRC patients is management of hypertension to reduce CVD risk.

Purpose: We sought to: (1) determine the odds of colorectal cancer (CRC) survivors being diagnosed with hypertension 2 years post-CRC diagnosis; (2) assess differences in blood pressure (BP) control one year post-CRC diagnosis; and (3) assess differences in antihypertensive medication adherence one year post-CRC diagnosis, all relative to matched non-cancer controls.

Background: CRC and hypertension share common risk factors. Because CRC survivors often transition from oncology-led care to primary care, it is important to know whether they have differential prevalence of hypertension for chronic disease management.

Methods: We used the national VA Central Cancer Registry to identify patients diagnosed with non-metastatic CRC from 10/1/2008 to 12/31/2012 who had ≥ 1 primary care or oncology visit in the previous year. Up to 3 non-cancer controls were identified for each CRC survivor through electronic health records matched on age, race, sex, copayment status, geographic region, distance to VA healthcare, body mass index, number of outpatient visits (≥ 3 vs. fewer), and pre-existing hypertension, hyperlipidemia, and diabetes. We used logistic regression to calculate odds ratios (OR) and confidence intervals (CI) for being diagnosed with, and control of, hypertension between CRC survivors and controls. We calculated Medication Possession Ratio (MPR), a pharmacy refill-based adherence measure, for patients prescribed metoprolol tartrate.

Results: 9,758 patients with CRC were matched to 29,066 controls. The cohort was predominantly white (79.5%) men (97.8%), mean age of 66.8 years. Compared to matched controls, CRC survivors had 60% higher odds of being diagnosed with hypertension (OR = 1.59, 95% CI, = 1.51-1.67) one year post-diagnosis (69.4% CRC survivors have hypertension). CRC survivors experienced lower odds of BP control (OR = 0.89, 95% CI, 0.85-0.94); antihypertensive medication adherence was lower (relative MPR difference 7%) compared with matched non-cancer controls.

Implications: Compared to patients without a history of cancer, CRC survivors have higher odds of being diagnosed with hypertension, worse BP control, and worse antihypertension medication adherence. A critical component of survivorship care for CRC patients is management of hypertension to reduce CVD risk.