Heightened ambition seems to be an important aspect of increased creativity in people with bipolar disorder, according to results of two studies by Sheri L. Johnson, Ph.D., and her associates.

In Study One, 22 bipolar patients who identified as highly creative took the WASSUP (Willingly Approached Set of Statistically Unlikely Pursuits) test, an assessment to determine ambition. WASSUP scores were elevated in the group, and a higher score was related to lifetime creative accomplishment in artistic bipolar patients.

In Study Two, 221 undergraduates completed the WASSUP, the Hypomanic Personality Scale (to measure mania risk), and a measure to assess creativity in business projects. Both increased ambition and creativity were linked to increased mania risk, and ambition was related to creativity outside of a bipolar setting as well.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.02.021).

[email protected]

Heightened ambition seems to be an important aspect of increased creativity in people with bipolar disorder, according to results of two studies by Sheri L. Johnson, Ph.D., and her associates.

In Study One, 22 bipolar patients who identified as highly creative took the WASSUP (Willingly Approached Set of Statistically Unlikely Pursuits) test, an assessment to determine ambition. WASSUP scores were elevated in the group, and a higher score was related to lifetime creative accomplishment in artistic bipolar patients.

In Study Two, 221 undergraduates completed the WASSUP, the Hypomanic Personality Scale (to measure mania risk), and a measure to assess creativity in business projects. Both increased ambition and creativity were linked to increased mania risk, and ambition was related to creativity outside of a bipolar setting as well.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.02.021).

[email protected]

Heightened ambition seems to be an important aspect of increased creativity in people with bipolar disorder, according to results of two studies by Sheri L. Johnson, Ph.D., and her associates.

In Study One, 22 bipolar patients who identified as highly creative took the WASSUP (Willingly Approached Set of Statistically Unlikely Pursuits) test, an assessment to determine ambition. WASSUP scores were elevated in the group, and a higher score was related to lifetime creative accomplishment in artistic bipolar patients.

In Study Two, 221 undergraduates completed the WASSUP, the Hypomanic Personality Scale (to measure mania risk), and a measure to assess creativity in business projects. Both increased ambition and creativity were linked to increased mania risk, and ambition was related to creativity outside of a bipolar setting as well.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.02.021).

[email protected]

Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

Click on the PDF icon at the top of this introduction to read the full article.

Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

Click on the PDF icon at the top of this introduction to read the full article.

Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

Click on the PDF icon at the top of this introduction to read the full article.

I recently went to a local salon for a manicure, and when I asked the manicurist not to cut my cuticles, she looked at me as though I was offending her. Shortly thereafter, I took a phone call that swayed my attention, and she secretly dove in and quickly started cutting my cuticles thinking I would not notice. Why is cuticle-cutting a necessary part of nail care ... and almost a rampant ritual?

The cuticle is the protective barrier surrounding the nail plate and nail folds. Biting, pulling, or improper cutting of the cuticle over time can cause long-term damage to the nail plate, such as ridging of the nail, median nail dystrophy, or permanent destruction of the nail plate. Trimming the cuticles can also break the seal that protects the surrounding skin and nails. Not only can the removal of the cuticle introduce infection, but it can also cause deformities in the nail plate itself. Infections to consider around the nail include acute or chronic paronychia, herpetic whitlow, onychomycosis, and warts. These infections can be the direct result of entry from the removal of the cuticle barrier or improperly cleaned and sterilized instruments.

Tools used to remove cuticles can transfer infections. In addition to skin infections, viruses that cause systemic infections, such as hepatitis C, can live in dry blood for up to 3 days and can be transferred on tools that have not been cleaned properly. Sterilized tools must first be cleaned and submerged in antiseptic solutions, then sterilized in an autoclave or a Food and Drug Administration–registered dry-heat sterilizer, not a UV box. UV boxes are commonly used and do not actually sterilize tools; they keep tools clean only if they have been previously sterilized.

The best way to ensure proper sterilization is to check the indicator tape or indicator color on the packaging. Autoclave tape and dry heat sterilizer strips work by changing colors when exposed to a certain temperature (and pressure for the autoclave tape) for a certain amount of time. I routinely check the sterilizing packets and immediately look up the indicator color on the Internet to ensure the color change was correct. I ask about what sterilization techniques the salon uses, and I often require salons to use my own nail care tools (which should be cleaned after every use).

Trimming or cutting cuticles is a bad habit and can be a dangerous salon ritual. Many states, such as New York and Massachusetts, do not allow manicurists to cut the cuticles given blood-borne pathogen risks and improper sanitation; however, this regulation is often loosely enforced. It also creates an endless cycle of cuticle trimming as the growing cuticle can often look frayed – and thus creates the need for them to be cut over and over again. Pushing the cuticle back may be a better option for those who prefer the cosmetic appearance of trimmed cuticles, but it still poses a portal of entry for pathogens.

Let’s educate our patients, the salons, and the regulatory boards to prevent the spread of infection and ensure safe nail care techniques.

Dr. Wesley and Dr. Talakoub are co-contributors to a monthly Aesthetic Dermatology column in Dermatology News. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub.

I recently went to a local salon for a manicure, and when I asked the manicurist not to cut my cuticles, she looked at me as though I was offending her. Shortly thereafter, I took a phone call that swayed my attention, and she secretly dove in and quickly started cutting my cuticles thinking I would not notice. Why is cuticle-cutting a necessary part of nail care ... and almost a rampant ritual?

The cuticle is the protective barrier surrounding the nail plate and nail folds. Biting, pulling, or improper cutting of the cuticle over time can cause long-term damage to the nail plate, such as ridging of the nail, median nail dystrophy, or permanent destruction of the nail plate. Trimming the cuticles can also break the seal that protects the surrounding skin and nails. Not only can the removal of the cuticle introduce infection, but it can also cause deformities in the nail plate itself. Infections to consider around the nail include acute or chronic paronychia, herpetic whitlow, onychomycosis, and warts. These infections can be the direct result of entry from the removal of the cuticle barrier or improperly cleaned and sterilized instruments.

Tools used to remove cuticles can transfer infections. In addition to skin infections, viruses that cause systemic infections, such as hepatitis C, can live in dry blood for up to 3 days and can be transferred on tools that have not been cleaned properly. Sterilized tools must first be cleaned and submerged in antiseptic solutions, then sterilized in an autoclave or a Food and Drug Administration–registered dry-heat sterilizer, not a UV box. UV boxes are commonly used and do not actually sterilize tools; they keep tools clean only if they have been previously sterilized.

The best way to ensure proper sterilization is to check the indicator tape or indicator color on the packaging. Autoclave tape and dry heat sterilizer strips work by changing colors when exposed to a certain temperature (and pressure for the autoclave tape) for a certain amount of time. I routinely check the sterilizing packets and immediately look up the indicator color on the Internet to ensure the color change was correct. I ask about what sterilization techniques the salon uses, and I often require salons to use my own nail care tools (which should be cleaned after every use).

Trimming or cutting cuticles is a bad habit and can be a dangerous salon ritual. Many states, such as New York and Massachusetts, do not allow manicurists to cut the cuticles given blood-borne pathogen risks and improper sanitation; however, this regulation is often loosely enforced. It also creates an endless cycle of cuticle trimming as the growing cuticle can often look frayed – and thus creates the need for them to be cut over and over again. Pushing the cuticle back may be a better option for those who prefer the cosmetic appearance of trimmed cuticles, but it still poses a portal of entry for pathogens.

Let’s educate our patients, the salons, and the regulatory boards to prevent the spread of infection and ensure safe nail care techniques.

Dr. Wesley and Dr. Talakoub are co-contributors to a monthly Aesthetic Dermatology column in Dermatology News. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub.

I recently went to a local salon for a manicure, and when I asked the manicurist not to cut my cuticles, she looked at me as though I was offending her. Shortly thereafter, I took a phone call that swayed my attention, and she secretly dove in and quickly started cutting my cuticles thinking I would not notice. Why is cuticle-cutting a necessary part of nail care ... and almost a rampant ritual?

The cuticle is the protective barrier surrounding the nail plate and nail folds. Biting, pulling, or improper cutting of the cuticle over time can cause long-term damage to the nail plate, such as ridging of the nail, median nail dystrophy, or permanent destruction of the nail plate. Trimming the cuticles can also break the seal that protects the surrounding skin and nails. Not only can the removal of the cuticle introduce infection, but it can also cause deformities in the nail plate itself. Infections to consider around the nail include acute or chronic paronychia, herpetic whitlow, onychomycosis, and warts. These infections can be the direct result of entry from the removal of the cuticle barrier or improperly cleaned and sterilized instruments.

Tools used to remove cuticles can transfer infections. In addition to skin infections, viruses that cause systemic infections, such as hepatitis C, can live in dry blood for up to 3 days and can be transferred on tools that have not been cleaned properly. Sterilized tools must first be cleaned and submerged in antiseptic solutions, then sterilized in an autoclave or a Food and Drug Administration–registered dry-heat sterilizer, not a UV box. UV boxes are commonly used and do not actually sterilize tools; they keep tools clean only if they have been previously sterilized.

The best way to ensure proper sterilization is to check the indicator tape or indicator color on the packaging. Autoclave tape and dry heat sterilizer strips work by changing colors when exposed to a certain temperature (and pressure for the autoclave tape) for a certain amount of time. I routinely check the sterilizing packets and immediately look up the indicator color on the Internet to ensure the color change was correct. I ask about what sterilization techniques the salon uses, and I often require salons to use my own nail care tools (which should be cleaned after every use).

Trimming or cutting cuticles is a bad habit and can be a dangerous salon ritual. Many states, such as New York and Massachusetts, do not allow manicurists to cut the cuticles given blood-borne pathogen risks and improper sanitation; however, this regulation is often loosely enforced. It also creates an endless cycle of cuticle trimming as the growing cuticle can often look frayed – and thus creates the need for them to be cut over and over again. Pushing the cuticle back may be a better option for those who prefer the cosmetic appearance of trimmed cuticles, but it still poses a portal of entry for pathogens.

Let’s educate our patients, the salons, and the regulatory boards to prevent the spread of infection and ensure safe nail care techniques.

Dr. Wesley and Dr. Talakoub are co-contributors to a monthly Aesthetic Dermatology column in Dermatology News. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub.

Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.

Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.

Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).

Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.

Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.

Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.

Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).

Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.

Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.

Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.

Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).

Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.

Background: Natalizumab is an effective immunosuppressive therapy for multiple sclerosis (MS) that received its initial FDA approval in 2004. Its most notable toxicity is progressive multifocal leukoencephalopathy (PML), an opportunistic infection that is the focus of an FDA-mandated registry, TOUCH. The Southern Network on Adverse Reactions identified a fatal case of natalizumab-associated urethral melanoma and undertook an extensive evaluation of all cases of natalizumab-associated melanoma included in the FDA’s Adverse Event Reporting System (FAERS) (between 2005 and 2014).

Methods: Patient characteristics were determined from the FAERS reports and put into a comprehensive dataset. The quality of these reports was assessed based on a 15-point scale of various clinical, demographic, and pharmacy components. Cases were identified as being reported through the TOUCH system, using TOUCH information but reporting outside the system, not using TOUCH at all in the U.S. or not U.S. Quality scores and their components within the 4 Touch groups were statistically compared across all attributes using the mathematical programming-based statistical methodology univariate optimal discriminant analysis.

Results: The mean patient age at the time of diagnosis of melanoma was 46 years (SD 11). Seventeen patients were diagnosed with cutaneous melanoma developing in nonsun-exposed areas. We found that cases reported through the TOUCH registry were of lower quality (mean score 7.7) compared with others that reported outside of the U.S. (mean score 8.5, P < .008). Those cases reported through the TOUCH system were less likely to report the site of melanoma (P < .019) and have overall lower clinical scores (P < .04) compared with reports using TOUCH information but reporting outside of the system.

Conclusions: Our findings suggest that in the U.S., the TOUCH Registry should be expanded to require clinicians to report details of natalizumab-associated melanoma, an opportunistic illness that frequently develops in immunocompromised persons. Also, the FDA-approved product label for natalizumab should be revised to include information on occurrences of melanoma among natalizumab-treated MS patients, particularly those who have cutaneous nevi prior to natalizumab initiation. Natalizumab-treated MS patients and their physicians should be vigilant for changes in nevi appearances and development of new cutaneous lesions (particularly in nonsun-exposed cutaneous areas).

Background: Natalizumab is an effective immunosuppressive therapy for multiple sclerosis (MS) that received its initial FDA approval in 2004. Its most notable toxicity is progressive multifocal leukoencephalopathy (PML), an opportunistic infection that is the focus of an FDA-mandated registry, TOUCH. The Southern Network on Adverse Reactions identified a fatal case of natalizumab-associated urethral melanoma and undertook an extensive evaluation of all cases of natalizumab-associated melanoma included in the FDA’s Adverse Event Reporting System (FAERS) (between 2005 and 2014).

Methods: Patient characteristics were determined from the FAERS reports and put into a comprehensive dataset. The quality of these reports was assessed based on a 15-point scale of various clinical, demographic, and pharmacy components. Cases were identified as being reported through the TOUCH system, using TOUCH information but reporting outside the system, not using TOUCH at all in the U.S. or not U.S. Quality scores and their components within the 4 Touch groups were statistically compared across all attributes using the mathematical programming-based statistical methodology univariate optimal discriminant analysis.

Results: The mean patient age at the time of diagnosis of melanoma was 46 years (SD 11). Seventeen patients were diagnosed with cutaneous melanoma developing in nonsun-exposed areas. We found that cases reported through the TOUCH registry were of lower quality (mean score 7.7) compared with others that reported outside of the U.S. (mean score 8.5, P < .008). Those cases reported through the TOUCH system were less likely to report the site of melanoma (P < .019) and have overall lower clinical scores (P < .04) compared with reports using TOUCH information but reporting outside of the system.

Conclusions: Our findings suggest that in the U.S., the TOUCH Registry should be expanded to require clinicians to report details of natalizumab-associated melanoma, an opportunistic illness that frequently develops in immunocompromised persons. Also, the FDA-approved product label for natalizumab should be revised to include information on occurrences of melanoma among natalizumab-treated MS patients, particularly those who have cutaneous nevi prior to natalizumab initiation. Natalizumab-treated MS patients and their physicians should be vigilant for changes in nevi appearances and development of new cutaneous lesions (particularly in nonsun-exposed cutaneous areas).

Background: Natalizumab is an effective immunosuppressive therapy for multiple sclerosis (MS) that received its initial FDA approval in 2004. Its most notable toxicity is progressive multifocal leukoencephalopathy (PML), an opportunistic infection that is the focus of an FDA-mandated registry, TOUCH. The Southern Network on Adverse Reactions identified a fatal case of natalizumab-associated urethral melanoma and undertook an extensive evaluation of all cases of natalizumab-associated melanoma included in the FDA’s Adverse Event Reporting System (FAERS) (between 2005 and 2014).

Methods: Patient characteristics were determined from the FAERS reports and put into a comprehensive dataset. The quality of these reports was assessed based on a 15-point scale of various clinical, demographic, and pharmacy components. Cases were identified as being reported through the TOUCH system, using TOUCH information but reporting outside the system, not using TOUCH at all in the U.S. or not U.S. Quality scores and their components within the 4 Touch groups were statistically compared across all attributes using the mathematical programming-based statistical methodology univariate optimal discriminant analysis.

Results: The mean patient age at the time of diagnosis of melanoma was 46 years (SD 11). Seventeen patients were diagnosed with cutaneous melanoma developing in nonsun-exposed areas. We found that cases reported through the TOUCH registry were of lower quality (mean score 7.7) compared with others that reported outside of the U.S. (mean score 8.5, P < .008). Those cases reported through the TOUCH system were less likely to report the site of melanoma (P < .019) and have overall lower clinical scores (P < .04) compared with reports using TOUCH information but reporting outside of the system.

Conclusions: Our findings suggest that in the U.S., the TOUCH Registry should be expanded to require clinicians to report details of natalizumab-associated melanoma, an opportunistic illness that frequently develops in immunocompromised persons. Also, the FDA-approved product label for natalizumab should be revised to include information on occurrences of melanoma among natalizumab-treated MS patients, particularly those who have cutaneous nevi prior to natalizumab initiation. Natalizumab-treated MS patients and their physicians should be vigilant for changes in nevi appearances and development of new cutaneous lesions (particularly in nonsun-exposed cutaneous areas).

Background: A 2004 German study found preoperative chemoradiotherapy followed by postoperative chemotherapy provided increased local control and reduced toxicity over postoperative chemoradiotherapy in stage II/III rectal cancer, though a statistically significant advantage in overall survival was not observed. We examined similar survival differences and the utilization of appropriate therapy on a larger scale.

Methods: This study retrospectively examined patients diagnosed with stage II/III rectal cancer from 2006 to 2011 using a participant user file from the National Cancer Database, a data registry jointly sponsored by the American College of Surgeons and the American Cancer Society capturing approximately 70% of newly diagnosed cancer cases nationwide. Overall survival differences between treatment modalities were assessed using life tables and pairwise comparisons, and changes in the utilization of these treatments were examined.

Results: Of 40,546 patients diagnosed with stage II/III rectal cancer, 27,014 (66.6%) received therapy consisting of surgery, chemotherapy, and radiation. Those administered preoperative chemoradiotherapy followed by postoperative chemotherapy had the highest 5-year survival rate (stage II 81.4%, stage III 71.2%), but the difference was not significant against postoperative chemoradiotherapy in stage III disease (69.9%) after the Bonferroni correction was applied. Five-year survival was higher in postoperative (stage II 76.0%, stage III 69.9%) than that in preoperative (stage II 72.5%, stage III: 65.8%) chemoradiotherapy in both stages. Preoperative chemoradiotherapy remains the most commonly administered (60.6% in stage II and 46.0% in stage III), but preoperative chemoradio-therapy followed by postoperative chemotherapy has been steadily rising (2006: 12.2% in stage II, 16.5% in stage III vs 2011: 22.8% in stage II, 28.0% in stage III).

Conclusions: A survival benefit of preoperative chemoradiotherapy followed by postoperative chemotherapy in stage II disease was observed, along with a nonsignificant advantage in stage III disease. The utilization of preoperative chemoradiotherapy followed by postoperative chemotherapy increased, but preoperative chemoradiotherapy remained most prevalent despite its lesser overall survival. Cox regression will be performed prior to the AVAHO annual meeting to evaluate the impact of other characteristics such as age, insurance, income, and comorbidities on survival.

Background: A 2004 German study found preoperative chemoradiotherapy followed by postoperative chemotherapy provided increased local control and reduced toxicity over postoperative chemoradiotherapy in stage II/III rectal cancer, though a statistically significant advantage in overall survival was not observed. We examined similar survival differences and the utilization of appropriate therapy on a larger scale.

Methods: This study retrospectively examined patients diagnosed with stage II/III rectal cancer from 2006 to 2011 using a participant user file from the National Cancer Database, a data registry jointly sponsored by the American College of Surgeons and the American Cancer Society capturing approximately 70% of newly diagnosed cancer cases nationwide. Overall survival differences between treatment modalities were assessed using life tables and pairwise comparisons, and changes in the utilization of these treatments were examined.

Results: Of 40,546 patients diagnosed with stage II/III rectal cancer, 27,014 (66.6%) received therapy consisting of surgery, chemotherapy, and radiation. Those administered preoperative chemoradiotherapy followed by postoperative chemotherapy had the highest 5-year survival rate (stage II 81.4%, stage III 71.2%), but the difference was not significant against postoperative chemoradiotherapy in stage III disease (69.9%) after the Bonferroni correction was applied. Five-year survival was higher in postoperative (stage II 76.0%, stage III 69.9%) than that in preoperative (stage II 72.5%, stage III: 65.8%) chemoradiotherapy in both stages. Preoperative chemoradiotherapy remains the most commonly administered (60.6% in stage II and 46.0% in stage III), but preoperative chemoradio-therapy followed by postoperative chemotherapy has been steadily rising (2006: 12.2% in stage II, 16.5% in stage III vs 2011: 22.8% in stage II, 28.0% in stage III).

Conclusions: A survival benefit of preoperative chemoradiotherapy followed by postoperative chemotherapy in stage II disease was observed, along with a nonsignificant advantage in stage III disease. The utilization of preoperative chemoradiotherapy followed by postoperative chemotherapy increased, but preoperative chemoradiotherapy remained most prevalent despite its lesser overall survival. Cox regression will be performed prior to the AVAHO annual meeting to evaluate the impact of other characteristics such as age, insurance, income, and comorbidities on survival.

Background: A 2004 German study found preoperative chemoradiotherapy followed by postoperative chemotherapy provided increased local control and reduced toxicity over postoperative chemoradiotherapy in stage II/III rectal cancer, though a statistically significant advantage in overall survival was not observed. We examined similar survival differences and the utilization of appropriate therapy on a larger scale.

Methods: This study retrospectively examined patients diagnosed with stage II/III rectal cancer from 2006 to 2011 using a participant user file from the National Cancer Database, a data registry jointly sponsored by the American College of Surgeons and the American Cancer Society capturing approximately 70% of newly diagnosed cancer cases nationwide. Overall survival differences between treatment modalities were assessed using life tables and pairwise comparisons, and changes in the utilization of these treatments were examined.

Results: Of 40,546 patients diagnosed with stage II/III rectal cancer, 27,014 (66.6%) received therapy consisting of surgery, chemotherapy, and radiation. Those administered preoperative chemoradiotherapy followed by postoperative chemotherapy had the highest 5-year survival rate (stage II 81.4%, stage III 71.2%), but the difference was not significant against postoperative chemoradiotherapy in stage III disease (69.9%) after the Bonferroni correction was applied. Five-year survival was higher in postoperative (stage II 76.0%, stage III 69.9%) than that in preoperative (stage II 72.5%, stage III: 65.8%) chemoradiotherapy in both stages. Preoperative chemoradiotherapy remains the most commonly administered (60.6% in stage II and 46.0% in stage III), but preoperative chemoradio-therapy followed by postoperative chemotherapy has been steadily rising (2006: 12.2% in stage II, 16.5% in stage III vs 2011: 22.8% in stage II, 28.0% in stage III).

Conclusions: A survival benefit of preoperative chemoradiotherapy followed by postoperative chemotherapy in stage II disease was observed, along with a nonsignificant advantage in stage III disease. The utilization of preoperative chemoradiotherapy followed by postoperative chemotherapy increased, but preoperative chemoradiotherapy remained most prevalent despite its lesser overall survival. Cox regression will be performed prior to the AVAHO annual meeting to evaluate the impact of other characteristics such as age, insurance, income, and comorbidities on survival.

Background: The arrival of novel surgical techniques and chemotherapeutic agents has changed the range of available treatments and improved outcomes for stage IV rectal cancers. This is the largest study on stage IV rectal cancer to evaluate the change in treatment strategy and corresponding mortality from 1998 to 2009.

Methods: A population-based study was conducted using the National Cancer Database (1998-2009), which contains 70% of all cancer diagnoses in the U.S. After exclusion criteria were met, 25,046 stage IV rectal cancer patients were analyzed. Treatment modalities were compared by year of diagnosis between 1998 and 2009. Life tables were used to determine mortality by year. All statistics were run on SPSS Version 22 (IBM, Armonk, NY).

Results: Overall survival in stage IV rectal cancer has increased from 1998 to 2009 for 1-year survival (50% vs 61%) and 5-year survival (7% vs 12%). Analysis by treatment revealed that chemotherapy with radiation was most prevalent (20.6%) in 1998, but chemotherapy alone became the predominant treatment (25%) in 2009. Surgery as a planned first course of treatment decreased from 51.5% in 1998 to 27.2% in 2009, with a concordant increase in chemotherapy from 8.4% to 25% in that time frame. The largest 5-year survival increase across these years included surgery only (6% to 15%), surgery and chemotherapy (8% to 23%), and trimodal therapy (15% to 27%).

Conclusions: The outcomes for stage IV rectal cancer have meaningfully improved from 1998 to 2009, as evidenced by the significant improvement in 1- and 5-year survival. There has been a general trend to treat with chemotherapy and avoid surgery as a planned first course of treatment, despite improvement in mortality for both. Survival rates remain highest with trimodal therapy, but 5-year survival for surgery with chemotherapy and surgery only has also significantly improved from 1998 to 2009. Prior to the AVAHO annual meeting, we will conduct a multivariate analysis to evaluate other influences on survival such as age, comorbidities, insurance, education, and income.

Background: The arrival of novel surgical techniques and chemotherapeutic agents has changed the range of available treatments and improved outcomes for stage IV rectal cancers. This is the largest study on stage IV rectal cancer to evaluate the change in treatment strategy and corresponding mortality from 1998 to 2009.

Methods: A population-based study was conducted using the National Cancer Database (1998-2009), which contains 70% of all cancer diagnoses in the U.S. After exclusion criteria were met, 25,046 stage IV rectal cancer patients were analyzed. Treatment modalities were compared by year of diagnosis between 1998 and 2009. Life tables were used to determine mortality by year. All statistics were run on SPSS Version 22 (IBM, Armonk, NY).

Results: Overall survival in stage IV rectal cancer has increased from 1998 to 2009 for 1-year survival (50% vs 61%) and 5-year survival (7% vs 12%). Analysis by treatment revealed that chemotherapy with radiation was most prevalent (20.6%) in 1998, but chemotherapy alone became the predominant treatment (25%) in 2009. Surgery as a planned first course of treatment decreased from 51.5% in 1998 to 27.2% in 2009, with a concordant increase in chemotherapy from 8.4% to 25% in that time frame. The largest 5-year survival increase across these years included surgery only (6% to 15%), surgery and chemotherapy (8% to 23%), and trimodal therapy (15% to 27%).

Conclusions: The outcomes for stage IV rectal cancer have meaningfully improved from 1998 to 2009, as evidenced by the significant improvement in 1- and 5-year survival. There has been a general trend to treat with chemotherapy and avoid surgery as a planned first course of treatment, despite improvement in mortality for both. Survival rates remain highest with trimodal therapy, but 5-year survival for surgery with chemotherapy and surgery only has also significantly improved from 1998 to 2009. Prior to the AVAHO annual meeting, we will conduct a multivariate analysis to evaluate other influences on survival such as age, comorbidities, insurance, education, and income.

Background: The arrival of novel surgical techniques and chemotherapeutic agents has changed the range of available treatments and improved outcomes for stage IV rectal cancers. This is the largest study on stage IV rectal cancer to evaluate the change in treatment strategy and corresponding mortality from 1998 to 2009.

Methods: A population-based study was conducted using the National Cancer Database (1998-2009), which contains 70% of all cancer diagnoses in the U.S. After exclusion criteria were met, 25,046 stage IV rectal cancer patients were analyzed. Treatment modalities were compared by year of diagnosis between 1998 and 2009. Life tables were used to determine mortality by year. All statistics were run on SPSS Version 22 (IBM, Armonk, NY).

Results: Overall survival in stage IV rectal cancer has increased from 1998 to 2009 for 1-year survival (50% vs 61%) and 5-year survival (7% vs 12%). Analysis by treatment revealed that chemotherapy with radiation was most prevalent (20.6%) in 1998, but chemotherapy alone became the predominant treatment (25%) in 2009. Surgery as a planned first course of treatment decreased from 51.5% in 1998 to 27.2% in 2009, with a concordant increase in chemotherapy from 8.4% to 25% in that time frame. The largest 5-year survival increase across these years included surgery only (6% to 15%), surgery and chemotherapy (8% to 23%), and trimodal therapy (15% to 27%).

Conclusions: The outcomes for stage IV rectal cancer have meaningfully improved from 1998 to 2009, as evidenced by the significant improvement in 1- and 5-year survival. There has been a general trend to treat with chemotherapy and avoid surgery as a planned first course of treatment, despite improvement in mortality for both. Survival rates remain highest with trimodal therapy, but 5-year survival for surgery with chemotherapy and surgery only has also significantly improved from 1998 to 2009. Prior to the AVAHO annual meeting, we will conduct a multivariate analysis to evaluate other influences on survival such as age, comorbidities, insurance, education, and income.

Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.

Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.

Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.

Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.

Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.

Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.

Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.

Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.

Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.

Purpose: To assess feasibility of open access and state-of-the-art in-network care for veterans diagnosed with malignant pleural mesothelioma (MPM) in the framework of the VA health care system and according to the patient-centered international mesothelioma program (IMP) care model.

Background: Malignant pleural mesothelioma is a rare disease that disproportionately affects veterans. According to the latest guidelines established by the International Mesothelioma Interest Group, maximal cytoreductive surgery has been shown to be superior to chemotherapy alone in patients with loco-regional MPM. Access to state-of-the-art mesothelioma care for veterans is limited to a handful of VA medical centers, and the West Roxbury VA Campus (WRVA) is uniquely positioned to routinely perform surgery for MPM.

Methods: We welcome all in-network, veteran referrals nationally. After initial phone triage or e-consult, qualified veterans are advised to register at the WRVA. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists, and radiologists, reviews each case and tailors an individual treatment plan. Controversial cases are further reviewed at the IMP. After thorough evaluation, veterans are advised by the surgeon to send additional documents if needed, come to Boston for an onsite consultation, or to continue local treatment.

Results: Between 2011 and 2015, we phone-triaged 55 veter-ans with suspected MPM. Forty-two patients had confirmed MPM, while 9 (4 unknown) had other thoracic pathology, including desmoplastic mesothelioma, sclerosing pleuritis, poorly differentiated non-small cell lung cancer, and peritoneal mesothelioma. We recommended surgical consultation at our VA for 46 veterans, of which 35 travelled to the WRVA from 21 states, with a median age of 63 years (all male), travelling an average distance of 961 miles. Seventeen veterans flew, 16 drove, and 2 came by train. Ultimately, 29 had MPM and 6 were found to have other diseases or the pathologic diagnosis is pending. The average time from initial contact to arrival at Boston was 15.4 days. Therapeutic recommendations were changed in 22 cases.

Conclusions: A national open-access program for suspected MPM is initially feasible at the WRVA. Treatment choices were altered in 63% of cases. This provides specialty in-network care, which is not locally available, regardless of distance traveled and cost required.

Purpose: To assess feasibility of open access and state-of-the-art in-network care for veterans diagnosed with malignant pleural mesothelioma (MPM) in the framework of the VA health care system and according to the patient-centered international mesothelioma program (IMP) care model.

Background: Malignant pleural mesothelioma is a rare disease that disproportionately affects veterans. According to the latest guidelines established by the International Mesothelioma Interest Group, maximal cytoreductive surgery has been shown to be superior to chemotherapy alone in patients with loco-regional MPM. Access to state-of-the-art mesothelioma care for veterans is limited to a handful of VA medical centers, and the West Roxbury VA Campus (WRVA) is uniquely positioned to routinely perform surgery for MPM.

Methods: We welcome all in-network, veteran referrals nationally. After initial phone triage or e-consult, qualified veterans are advised to register at the WRVA. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists, and radiologists, reviews each case and tailors an individual treatment plan. Controversial cases are further reviewed at the IMP. After thorough evaluation, veterans are advised by the surgeon to send additional documents if needed, come to Boston for an onsite consultation, or to continue local treatment.

Results: Between 2011 and 2015, we phone-triaged 55 veter-ans with suspected MPM. Forty-two patients had confirmed MPM, while 9 (4 unknown) had other thoracic pathology, including desmoplastic mesothelioma, sclerosing pleuritis, poorly differentiated non-small cell lung cancer, and peritoneal mesothelioma. We recommended surgical consultation at our VA for 46 veterans, of which 35 travelled to the WRVA from 21 states, with a median age of 63 years (all male), travelling an average distance of 961 miles. Seventeen veterans flew, 16 drove, and 2 came by train. Ultimately, 29 had MPM and 6 were found to have other diseases or the pathologic diagnosis is pending. The average time from initial contact to arrival at Boston was 15.4 days. Therapeutic recommendations were changed in 22 cases.

Conclusions: A national open-access program for suspected MPM is initially feasible at the WRVA. Treatment choices were altered in 63% of cases. This provides specialty in-network care, which is not locally available, regardless of distance traveled and cost required.

Purpose: To assess feasibility of open access and state-of-the-art in-network care for veterans diagnosed with malignant pleural mesothelioma (MPM) in the framework of the VA health care system and according to the patient-centered international mesothelioma program (IMP) care model.

Background: Malignant pleural mesothelioma is a rare disease that disproportionately affects veterans. According to the latest guidelines established by the International Mesothelioma Interest Group, maximal cytoreductive surgery has been shown to be superior to chemotherapy alone in patients with loco-regional MPM. Access to state-of-the-art mesothelioma care for veterans is limited to a handful of VA medical centers, and the West Roxbury VA Campus (WRVA) is uniquely positioned to routinely perform surgery for MPM.

Methods: We welcome all in-network, veteran referrals nationally. After initial phone triage or e-consult, qualified veterans are advised to register at the WRVA. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists, and radiologists, reviews each case and tailors an individual treatment plan. Controversial cases are further reviewed at the IMP. After thorough evaluation, veterans are advised by the surgeon to send additional documents if needed, come to Boston for an onsite consultation, or to continue local treatment.

Results: Between 2011 and 2015, we phone-triaged 55 veter-ans with suspected MPM. Forty-two patients had confirmed MPM, while 9 (4 unknown) had other thoracic pathology, including desmoplastic mesothelioma, sclerosing pleuritis, poorly differentiated non-small cell lung cancer, and peritoneal mesothelioma. We recommended surgical consultation at our VA for 46 veterans, of which 35 travelled to the WRVA from 21 states, with a median age of 63 years (all male), travelling an average distance of 961 miles. Seventeen veterans flew, 16 drove, and 2 came by train. Ultimately, 29 had MPM and 6 were found to have other diseases or the pathologic diagnosis is pending. The average time from initial contact to arrival at Boston was 15.4 days. Therapeutic recommendations were changed in 22 cases.

Conclusions: A national open-access program for suspected MPM is initially feasible at the WRVA. Treatment choices were altered in 63% of cases. This provides specialty in-network care, which is not locally available, regardless of distance traveled and cost required.

Background: Lung cancer is the most common cause of cancer deaths in the U.S. The burden is even more pronounced in veterans due to higher prevalence of smoking in this subset of the population. Since the 1980s, adenocarcinoma has become more common than squamous cell carcinoma (SCC). Some data show that this is not the case among veterans. In this study, we compare the distribution of lung adenocarcinoma and SCC in the veteran population with that of the general population. We also looked at the survival of patients with different histologies in the VA population.

Methods: The electronic charts of 649 patients diagnosed with non-small cell lung cancer (NSCLC) from January 2000 until December 2010 at the Albany Stratton VA Medical Center were retrospectively reviewed. Patient demographics, clinical characteristics, and survival data were collected. Data were entered and analyzed using SPSS (IBM, Armonk, NY). Survival was estimated using Kaplan Meier method. A value of P < .05 was considered statistically significant. Data were compared with data from the Surveillance, Epidemiology, and End Results database. The study was approved by the VA IRB.

Results: A total of 649 patients with NSCLC were included.The proportion of adenocarcinoma was significantly higher in the general population, while that of SCC was significantly higher in the VA population. There were no differences in chemotherapy, radiation therapy, surgery rates, and age at diagnosis among the different histologies in the VA population. Patients with adenocarcinoma presented more frequently with metastatic disease than did patients with SCC (45.4% vs 29.5%, P < .001). The 5-year survival rate tended to be higher in SCC than in adenocarcinoma (15.7% vs 13.0%, P = .325).

Conclusions: Our study showed a significant difference in histologic subtypes of NSCLC between veterans and the general population, with SCC having a higher incidence rate compared with that of adenocarcinoma among veterans. Adenocarcinoma tended to present at a more advanced stage than did SCC. However, this did not translate into a significant survival difference.

Background: Lung cancer is the most common cause of cancer deaths in the U.S. The burden is even more pronounced in veterans due to higher prevalence of smoking in this subset of the population. Since the 1980s, adenocarcinoma has become more common than squamous cell carcinoma (SCC). Some data show that this is not the case among veterans. In this study, we compare the distribution of lung adenocarcinoma and SCC in the veteran population with that of the general population. We also looked at the survival of patients with different histologies in the VA population.

Methods: The electronic charts of 649 patients diagnosed with non-small cell lung cancer (NSCLC) from January 2000 until December 2010 at the Albany Stratton VA Medical Center were retrospectively reviewed. Patient demographics, clinical characteristics, and survival data were collected. Data were entered and analyzed using SPSS (IBM, Armonk, NY). Survival was estimated using Kaplan Meier method. A value of P < .05 was considered statistically significant. Data were compared with data from the Surveillance, Epidemiology, and End Results database. The study was approved by the VA IRB.

Results: A total of 649 patients with NSCLC were included.The proportion of adenocarcinoma was significantly higher in the general population, while that of SCC was significantly higher in the VA population. There were no differences in chemotherapy, radiation therapy, surgery rates, and age at diagnosis among the different histologies in the VA population. Patients with adenocarcinoma presented more frequently with metastatic disease than did patients with SCC (45.4% vs 29.5%, P < .001). The 5-year survival rate tended to be higher in SCC than in adenocarcinoma (15.7% vs 13.0%, P = .325).

Conclusions: Our study showed a significant difference in histologic subtypes of NSCLC between veterans and the general population, with SCC having a higher incidence rate compared with that of adenocarcinoma among veterans. Adenocarcinoma tended to present at a more advanced stage than did SCC. However, this did not translate into a significant survival difference.

Background: Lung cancer is the most common cause of cancer deaths in the U.S. The burden is even more pronounced in veterans due to higher prevalence of smoking in this subset of the population. Since the 1980s, adenocarcinoma has become more common than squamous cell carcinoma (SCC). Some data show that this is not the case among veterans. In this study, we compare the distribution of lung adenocarcinoma and SCC in the veteran population with that of the general population. We also looked at the survival of patients with different histologies in the VA population.

Methods: The electronic charts of 649 patients diagnosed with non-small cell lung cancer (NSCLC) from January 2000 until December 2010 at the Albany Stratton VA Medical Center were retrospectively reviewed. Patient demographics, clinical characteristics, and survival data were collected. Data were entered and analyzed using SPSS (IBM, Armonk, NY). Survival was estimated using Kaplan Meier method. A value of P < .05 was considered statistically significant. Data were compared with data from the Surveillance, Epidemiology, and End Results database. The study was approved by the VA IRB.

Results: A total of 649 patients with NSCLC were included.The proportion of adenocarcinoma was significantly higher in the general population, while that of SCC was significantly higher in the VA population. There were no differences in chemotherapy, radiation therapy, surgery rates, and age at diagnosis among the different histologies in the VA population. Patients with adenocarcinoma presented more frequently with metastatic disease than did patients with SCC (45.4% vs 29.5%, P < .001). The 5-year survival rate tended to be higher in SCC than in adenocarcinoma (15.7% vs 13.0%, P = .325).

Conclusions: Our study showed a significant difference in histologic subtypes of NSCLC between veterans and the general population, with SCC having a higher incidence rate compared with that of adenocarcinoma among veterans. Adenocarcinoma tended to present at a more advanced stage than did SCC. However, this did not translate into a significant survival difference.