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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3048 — Access to Genomic Health Services for Veterans Diagnosed with Colorectal Cancer

Ho CK, San Francisco VA Medical Center, University of California, San Francisco; Green GLHamilton N, and Kaniu-Mwaniki P, San Francisco VA Medical Center; Rongey C, and Walter LC, San Francisco VA Medical Center, University of California, San Francisco; Provenzale DT, Durham VA Medical Center, Duke University; Knight SJ, San Francisco VA Medical Center, University of California, San Francisco;

Objectives:
Widely disseminated guidelines recommend documentation of family history, analysis of tumor tissue, and genetic testing for patients <50 years old diagnosed with colorectal cancer (CRC) to determine presence of hereditary nonpolyposis colorectal cancer (HNPCC), the most common hereditary CRC. While the Veterans Health Administration (VHA) has recently implemented a nationwide HNPCC testing program within the VHA, little is known about current practice. We sought to examine current access to these services among Veterans cared for in the VHA.

Methods:
Cross-sectional record review of Veterans younger than age 50 with a primary diagnosis of CRC identified using VHA administrative data. Of those cases diagnosed in the VHA between 2003 and 2009 (n = 2,000), 1,000 were randomly selected for chart review. In this analysis, we examined charts from VHA Regions 1 and 4 for CRC cases where full text and Central Cancer Registry data were available from one month prior to diagnosis to one year after diagnosis (n = 70).

Results:
Most patients included were male (93%) between the ages of 30 and 50 years of age at the time of CRC diagnosis. Family history was documented in most charts (87%), with a positive family history of CRC in a first or second degree relative in 31%. Possible HNPCC and genetic testing referral were mentioned in only 21% and 23% of the charts, respectively. Molecular analysis of tumor tissue for microsatellite instability (MSI) was noted in only 17% of the cases. Germline testing was conducted in 7% of the patients in the cohort; 6% were positive for HNPCC. Homelessness, substance use, and psychiatric diagnoses were not associated with presence of genomic health services. However, patients who were diagnosed with metastatic CRC were less likely to have documentation of possible HNPCC in their medical records than those diagnosed with localized disease (LR Chi-Square = 7.67; p = 0.02).

Implications:
We found little evidence for difference in access to genomic services according to social factors. While documentation of family history approached guideline recommendations for patients diagnosed with CRC, a gap exists between recent MSI analysis and genetic testing rates and what will be expected in new VHA policy.

Impacts:
These data provide a benchmark for evaluation of the implementation of VHA policy on genomic health services for Veterans diagnosed with CRC.


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