Health Care Disparities Dominate at AVAHO Meeting

More than 500 VA hematologists, oncologists, pharmacists, nurses, social workers, and cancer registrars came to the 14th annual Association of VA Hematology/Oncology meeting held outside of Chicago, September 28 through September 30. Mark Klein, MD, succeeded Rusty Crawford, BPharm, as president and William Wachsman, MD, PhD, was named president-elect.

A key focus of the meeting was health care disparities and providing cancer care to underserved populations. An entire track of the meeting was devoted to patients with serious mental illness (SMI), including discussions of the risk of suicide Also a focus was the challenge of providing optimal treatments for patients who may not be adherent because they do not have access to support networks or steady housing.

According to Jessica B. Geller, PhD, MS, and Jessica L. Brand, PhD, a patient with a SMI diagnosis should not preclude considering aggressive treatment but requires a close level of care. Cancer care of patients with SMI requires close collaboration with mental health and pharmacy providers to manage these complex patients. According to Elizabeth Holyman, PsyD, care providers should give serious attention to complaints despite difficult behavior, treat pain, use active listening and provide interpersonal supports, and assume people with SMI have similar needs to the non-SMI.

For both patients with SMI and the entire veteran population, a cancer diagnosis can raise the risk of suicide, explained Catherine Rotolo, LISW-S. Suicidal ideation occurs in nearly 9% of people with cancer, most frequently in the first 3 months after diagnosis, and remains a significant cause of mortality for cancer patients. For patients with cancer, the rate of suicide—already elevated for veterans—is twice that of the baseline rate.

In a keynote address, Lisa Margolies, executive director of the LGBT Cancer Network, cautioned care providers not only to provide a welcoming environment, but also  avoid making any assumptions about sexual behavior. “Do ask, we want to tell,” she told attendees, “Make it a part of your regular questions.” According to Margolies, there are more than 1 million LGBT veterans; they use the VA at higher rates, and the best estimate is that there are about 150,000 transgender veterans. According to Margolies, many do not tell their health care providers about their identity; 24% of lesbian, gay, bisexual, and transgender (LGBT) adults withheld information about sexual practices; 9.4% of men who identified as straight had sex with another man within the previous year. In another survey, more than 77% of lesbians had at least 1 sexual experience with a man—8% in the previous year. Margolies’ key point: avoid assumptions about a patient’s identity and simply take a comprehensive medical history so that you better understand the individual in front of you.

Another track of sessions focused on the challenges women face receiving care in the VA. Many female veterans, especially survivors of military sexual trauma (MST), are not comfortable going to the VA for care or being around groups of male veterans. Col (ret) Mona Pearl Treyball, PhD, RN, pointed out that up to 70% of women veterans experienced MST; most never reported it. That point was reinforced by Chad Hamilton, MD, who noted that among veteran women “Significantly higher proportion of users, compared to nonusers reported avoiding VA because of past sexual trauma (19% of users vs 8% of nonusers).

Yeun-hee Anna Park reported on the High Risk Breast Cancer Screening Program, a 10-site pilot project to assess breast cancer risk. The quality improvement program sought to enhance screening for high-risk breast cancer and increase use of chemoprevention and genetic counseling in accordance with national guidelines. In the pilot, women veterans were at increased risk of breast cancer compared with that of the general population (46% vs 13%, respectively), based on a high rate of prior breast biopsies or positive family history. Moreover, posttraumatic stress disorder rates were nearly 3 times the national average. In the program, use of chemoprevention was nearly 2 times the national average.

Female patients undergoing treatment for cancer also face distinct risks related to fertility, bone health, and vasomotor symptoms of menopause. According to Tyler Fenton, PharmD, some cancer treatment approaches involving chemotherapy, radiation, and/or surgery carry a risk of ovarian failure and the accompanying symptoms of premature menopause. Dr. Fenton noted, that menopausal symptoms such as hot flashes are reported to occur in as many as 73% of breast cancer survivors, and 42% of female patients with cancer of reproductive age may develop premature ovarian failure as a result of their chemotherapy.

More than 500 VA hematologists, oncologists, pharmacists, nurses, social workers, and cancer registrars came to the 14th annual Association of VA Hematology/Oncology meeting held outside of Chicago, September 28 through September 30. Mark Klein, MD, succeeded Rusty Crawford, BPharm, as president and William Wachsman, MD, PhD, was named president-elect.

A key focus of the meeting was health care disparities and providing cancer care to underserved populations. An entire track of the meeting was devoted to patients with serious mental illness (SMI), including discussions of the risk of suicide Also a focus was the challenge of providing optimal treatments for patients who may not be adherent because they do not have access to support networks or steady housing.

According to Jessica B. Geller, PhD, MS, and Jessica L. Brand, PhD, a patient with a SMI diagnosis should not preclude considering aggressive treatment but requires a close level of care. Cancer care of patients with SMI requires close collaboration with mental health and pharmacy providers to manage these complex patients. According to Elizabeth Holyman, PsyD, care providers should give serious attention to complaints despite difficult behavior, treat pain, use active listening and provide interpersonal supports, and assume people with SMI have similar needs to the non-SMI.

For both patients with SMI and the entire veteran population, a cancer diagnosis can raise the risk of suicide, explained Catherine Rotolo, LISW-S. Suicidal ideation occurs in nearly 9% of people with cancer, most frequently in the first 3 months after diagnosis, and remains a significant cause of mortality for cancer patients. For patients with cancer, the rate of suicide—already elevated for veterans—is twice that of the baseline rate.

In a keynote address, Lisa Margolies, executive director of the LGBT Cancer Network, cautioned care providers not only to provide a welcoming environment, but also  avoid making any assumptions about sexual behavior. “Do ask, we want to tell,” she told attendees, “Make it a part of your regular questions.” According to Margolies, there are more than 1 million LGBT veterans; they use the VA at higher rates, and the best estimate is that there are about 150,000 transgender veterans. According to Margolies, many do not tell their health care providers about their identity; 24% of lesbian, gay, bisexual, and transgender (LGBT) adults withheld information about sexual practices; 9.4% of men who identified as straight had sex with another man within the previous year. In another survey, more than 77% of lesbians had at least 1 sexual experience with a man—8% in the previous year. Margolies’ key point: avoid assumptions about a patient’s identity and simply take a comprehensive medical history so that you better understand the individual in front of you.

Another track of sessions focused on the challenges women face receiving care in the VA. Many female veterans, especially survivors of military sexual trauma (MST), are not comfortable going to the VA for care or being around groups of male veterans. Col (ret) Mona Pearl Treyball, PhD, RN, pointed out that up to 70% of women veterans experienced MST; most never reported it. That point was reinforced by Chad Hamilton, MD, who noted that among veteran women “Significantly higher proportion of users, compared to nonusers reported avoiding VA because of past sexual trauma (19% of users vs 8% of nonusers).

Yeun-hee Anna Park reported on the High Risk Breast Cancer Screening Program, a 10-site pilot project to assess breast cancer risk. The quality improvement program sought to enhance screening for high-risk breast cancer and increase use of chemoprevention and genetic counseling in accordance with national guidelines. In the pilot, women veterans were at increased risk of breast cancer compared with that of the general population (46% vs 13%, respectively), based on a high rate of prior breast biopsies or positive family history. Moreover, posttraumatic stress disorder rates were nearly 3 times the national average. In the program, use of chemoprevention was nearly 2 times the national average.

Female patients undergoing treatment for cancer also face distinct risks related to fertility, bone health, and vasomotor symptoms of menopause. According to Tyler Fenton, PharmD, some cancer treatment approaches involving chemotherapy, radiation, and/or surgery carry a risk of ovarian failure and the accompanying symptoms of premature menopause. Dr. Fenton noted, that menopausal symptoms such as hot flashes are reported to occur in as many as 73% of breast cancer survivors, and 42% of female patients with cancer of reproductive age may develop premature ovarian failure as a result of their chemotherapy.

More than 500 VA hematologists, oncologists, pharmacists, nurses, social workers, and cancer registrars came to the 14th annual Association of VA Hematology/Oncology meeting held outside of Chicago, September 28 through September 30. Mark Klein, MD, succeeded Rusty Crawford, BPharm, as president and William Wachsman, MD, PhD, was named president-elect.

A key focus of the meeting was health care disparities and providing cancer care to underserved populations. An entire track of the meeting was devoted to patients with serious mental illness (SMI), including discussions of the risk of suicide Also a focus was the challenge of providing optimal treatments for patients who may not be adherent because they do not have access to support networks or steady housing.

According to Jessica B. Geller, PhD, MS, and Jessica L. Brand, PhD, a patient with a SMI diagnosis should not preclude considering aggressive treatment but requires a close level of care. Cancer care of patients with SMI requires close collaboration with mental health and pharmacy providers to manage these complex patients. According to Elizabeth Holyman, PsyD, care providers should give serious attention to complaints despite difficult behavior, treat pain, use active listening and provide interpersonal supports, and assume people with SMI have similar needs to the non-SMI.

For both patients with SMI and the entire veteran population, a cancer diagnosis can raise the risk of suicide, explained Catherine Rotolo, LISW-S. Suicidal ideation occurs in nearly 9% of people with cancer, most frequently in the first 3 months after diagnosis, and remains a significant cause of mortality for cancer patients. For patients with cancer, the rate of suicide—already elevated for veterans—is twice that of the baseline rate.

In a keynote address, Lisa Margolies, executive director of the LGBT Cancer Network, cautioned care providers not only to provide a welcoming environment, but also  avoid making any assumptions about sexual behavior. “Do ask, we want to tell,” she told attendees, “Make it a part of your regular questions.” According to Margolies, there are more than 1 million LGBT veterans; they use the VA at higher rates, and the best estimate is that there are about 150,000 transgender veterans. According to Margolies, many do not tell their health care providers about their identity; 24% of lesbian, gay, bisexual, and transgender (LGBT) adults withheld information about sexual practices; 9.4% of men who identified as straight had sex with another man within the previous year. In another survey, more than 77% of lesbians had at least 1 sexual experience with a man—8% in the previous year. Margolies’ key point: avoid assumptions about a patient’s identity and simply take a comprehensive medical history so that you better understand the individual in front of you.

Another track of sessions focused on the challenges women face receiving care in the VA. Many female veterans, especially survivors of military sexual trauma (MST), are not comfortable going to the VA for care or being around groups of male veterans. Col (ret) Mona Pearl Treyball, PhD, RN, pointed out that up to 70% of women veterans experienced MST; most never reported it. That point was reinforced by Chad Hamilton, MD, who noted that among veteran women “Significantly higher proportion of users, compared to nonusers reported avoiding VA because of past sexual trauma (19% of users vs 8% of nonusers).

Yeun-hee Anna Park reported on the High Risk Breast Cancer Screening Program, a 10-site pilot project to assess breast cancer risk. The quality improvement program sought to enhance screening for high-risk breast cancer and increase use of chemoprevention and genetic counseling in accordance with national guidelines. In the pilot, women veterans were at increased risk of breast cancer compared with that of the general population (46% vs 13%, respectively), based on a high rate of prior breast biopsies or positive family history. Moreover, posttraumatic stress disorder rates were nearly 3 times the national average. In the program, use of chemoprevention was nearly 2 times the national average.

Female patients undergoing treatment for cancer also face distinct risks related to fertility, bone health, and vasomotor symptoms of menopause. According to Tyler Fenton, PharmD, some cancer treatment approaches involving chemotherapy, radiation, and/or surgery carry a risk of ovarian failure and the accompanying symptoms of premature menopause. Dr. Fenton noted, that menopausal symptoms such as hot flashes are reported to occur in as many as 73% of breast cancer survivors, and 42% of female patients with cancer of reproductive age may develop premature ovarian failure as a result of their chemotherapy.