Improving Cancer Care for Women Seeking Services in the Veterans Health Administration Through the Breast and Gynecological Oncology System of Excellence

Megan Shepherd-Banigan; Leah L Zullig; Theodore S Z Berkowitz; Graham Cummin; Karen M Goldstein; Michael J Kelley; Neetu Chawla; Hollis J Weidenbacher; Aditi Hazra; Ahmad S Halwani; Vikas Patil; Kelli M Rasmussen; Rachel Pace; Sarah Colonna; Haley Moss

doi:10.1093/milmed/usae447

Improving Cancer Care for Women Seeking Services in the Veterans Health Administration Through the Breast and Gynecological Oncology System of Excellence

Mil Med. 2024 Sep 23:usae447. doi: 10.1093/milmed/usae447. Online ahead of print.

Authors

Megan Shepherd-Banigan^{1

2

3

4}, Leah L Zullig^{1

2}, Theodore S Z Berkowitz¹, Graham Cummin¹, Karen M Goldstein^{1

5}, Michael J Kelley^{6

7

8}, Neetu Chawla⁹, Hollis J Weidenbacher¹, Aditi Hazra^{10

11}, Ahmad S Halwani^{6

12

13

14}, Vikas Patil^{12

13}, Kelli M Rasmussen^{12

13}, Rachel Pace¹, Sarah Colonna^{6

12

13

14}, Haley Moss^{7

8}

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC 27705, USA.
² Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA.
³ Mid-Atlantic MIRECC, Durham VA Health Care System, Durham, NC 27705, USA.
⁴ Duke-Margolis Health Policy Institute, Duke University, Durham, NC 27708, USA.
⁵ Division of General Internal Medicine, Duke, Duke University School of Medicine, Durham, NC 27701, USA.
⁶ Department of Veterans Affairs, National Oncology Program, Washington, DC 27705, USA.
⁷ Hematology-Oncology, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA.
⁸ Duke Cancer Institute, Durham, NC 27701, USA.
⁹ VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
¹⁰ Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
¹¹ Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA.
¹² George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA.
¹³ University of Utah School of Medicine, Salt Lake City, UT 84113, USA.
¹⁴ Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.

PMID: 39312402
DOI: 10.1093/milmed/usae447

Abstract

Women are the fastest growing population among Veterans and have substantial risk factors that increase their likelihood for developing cancer. To ensure that the Department of Veterans Affairs Veterans Health Administration (VHA) offers the best possible cancer care to women Veterans, it established the Breast and Gynecologic Oncology System of Excellence (BGSoE) in 2021. The BGSoE offers telehealth oncology services and a comprehensive cancer navigation program. Veterans are identified through physician referral or through the BGSoE dashboard which integrates ICD-10 codes and text mining from VA electronic health records to identify eligible Veterans with breast or gynecological cancers. Descriptive statistics, including Veteran demographics and geographical location, were derived from BGSoE dashboard data. From January 1, 2021 to March 15, 2024, the BGSoE identified a total of 7,187 incident cases of breast or gynecological cancer among living Veterans. Most cancers were breast (78%) versus gynecological cancers (22%) and 10% of Veterans with breast cancer were identified as male. The average age at diagnosis was 59 for Veterans with breast cancer and 56 for those Veterans with gynecological cancers. Among Veterans in the BGSoE, 28% identified as Black and 6% identified as Hispanic. As the prevalence of women Veterans requiring cancer-related care continues to rise, it will be essential for VHA to evaluate the equitable reach, quality, and acceptability of women-focused cancer health services. The BGSoE focuses on providing high-quality and coordinated clinical cancer care. Veterans Health Administration also established the Center for Oncology Outcomes Review and Gender (COURAGE) to evaluate the BGSoE and continue to strengthen cancer care services in VHA. Initial evaluation objectives include establishing an evidence base regarding Veterans with breast and gynecological cancers, including their experiences with cancer care in the VHA. Eventually, COURAGE will provide ongoing monitoring and evaluation to continue to grow and improve cancer care in the VHA.

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.