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Successful and Sustainable Implementation of a VA Cancer Survivorship Clinic
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.
Background
There are an estimated 18 million cancer survivors in the US with unique needs including specific surveillance imaging, testing for recurrence, monitoring for and managing late effects of cancer treatments, and for second malignancies. Survivorship care is an unmet need in most VAHC. Purpose: Assess implementation outcomes of a Survivorship Clinic.
Methods
A Survivorship Clinic was initiated comprising of a Survivorship APRN and Nurse Navigator. A referral process and workflow were created. Medical and Radiation Oncology providers were educated regarding availability of survivorship services. We describe the results of the Survivorship Clinic 2021-2025 including demographics, diagnoses and referral patterns.
Results
1,332 visits were completed for 424 patients. 2021 (Oct-Dec): 21, 2022: 219, 2023: 424, 2024: 508, 2025 (Jan-Mar): 160. 364 men and 60 women. Cancer diagnoses seen: lung: 108, lymphoma: 62, colorectal: 52, breast: 45, head and neck: 40, melanoma: 28, NET: 23, testicular: 13, bladder: 13, esophageal: 10, renal: 7, sarcomas: 7, anal: 6, HCC: 6, hepatobiliary: 6, gastric/GIST: 5, leukemia: 5, pancreatic: 5, prostate: 5, Merkel cell: 3, SCC: 3, thymus: 3, uterine: 2, 1 each appendix, anaplastic astrocytoma, periosteal carcinoma, poorly differentiated basaloid chest wall carcinoma, and small intestine. For symptom management the following referrals were placed: Rehab (all departments) : 71, Psychology/Whole Health/THRIVE: 52, Gastroenterology: 43, Nutrition: 24, Dermatology: 20, Urology, ED: 16, Pulmonology: 15, Plastic Surgery: 15, ENT: 12, LIVESTRONG YMCA: 10, Genetics: 9, General Surgery: 4, Neurology: 4, Breast Clinic: 3, Dental: 3, Neurosurgery: 2, Ophthalmology: 2, Pain Management: 2, Radiation Oncology: 2, Wound Care: 2, Pharmacy: 1, and Rheumatology: 1. Survivorship care plans were created and provided to all patients.
Conclusions
Since 2021, the Cancer Survivorship Clinic, operated by an APRN, has successfully served 424 cancer survivors encompassing a wide range of cancers. The disproportionately low number of prostate cancer survivors referred may be reflective of their care being managed by Urology, and presents an opportunity for future growth.
Implications for VA
Having a Survivorship Clinic provides cancer survivors specialized services and meets their unique needs; at the same allowing for improved capacity for new active cancer referrals for the Oncology Clinics.
National Tele-Oncology High-Risk Breast Clinic Program
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.