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. 2014 Aug;31(8):10-17.

Prostate cancer survivorship care in the Veterans Health Administration

Ted A Skolarus  1   2   3 , Sarah T Hawley  3   4
Affiliations

Prostate cancer survivorship care in the Veterans Health Administration

Ted A Skolarus et al. Fed Pract. 2014 Aug.

Abstract

The burden of prostate cancer among Veterans is substantial with over 200,000 survivors and 12,000 new diagnoses annually. Most men live with rather than die from this common and expensive disease making prostate cancer survivorship care especially important. In addition, the symptom burden after prostate cancer treatment can be substantial, last well into survivorship and lead to reduced quality of life and greater use of services. For these reasons, it is increasingly recognized that cancer survivorship care is similar to chronic disease management in requiring a combination of primary care providers and cancer specialists to deliver care over long periods of time. Because of its leadership in chronic disease care and the proportion of older men served, the Veterans Health Administration (VHA) is well positioned to become one of the national leaders in prostate cancer survivorship care. However, best practices and portfolios of quality indicators for prostate cancer survivorship care remain underdeveloped. More broadly, there is a limited consensus about who (primary care providers or prostate cancer specialists - urologists, radiation and medical oncologists) has primary responsibility for prostate cancer surveillance, and who manages the often substantial and lingering treatment-related side effects. Unclear roles and regional variation in the VHA cancer specialist workforce also complicate delivery of quality survivorship care. Ultimately, the design and implementation of tools to facilitate the delivery of optimal cancer survivorship care in VHA rests upon understanding how responsibility for survivorship care is managed and the barriers to quality survivorship care. Due to the expanding population of Veteran prostate cancer survivors, improving their quality of survivorship care through effective use of the VHA's provider workforce and latest telemedicine initiatives has potential to transform the national efficiency and effectiveness of cancer specialty care delivery.

Keywords: Prostate cancer; implementation; quality improvement; survivorship; symptoms; veteran.

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Figures

Figure
Figure. Distribution of the national VHA Urologist workforce in 2011
The urologist workforce per 100,000 facility patients varied from 0.94 to 9.95 FTEE.
See this image and copyright information in PMC

References

    1. Veterans Affairs Central Cancer Registry (VACCR)
    1. U.S. Census Bureau. American Community Survey Public Use MicrodataSample, 2009. [Accessed 6/1/2012];National Center for Veterans Analysis and Statistics. http://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2009_F....
    1. [Accessed 6/1/2012];Surveillance, Epidemiology, and End Results (SEER) Program. http://www.seer.cancer.gov/
    1. Uchio EM, Aslan M, Wells CK, Calderone J, Concato J. Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med. 2010 Aug 9;170(15):1390–1395. - PubMed
    1. VHA DIRECTIVE 2003-034. Department of Veterans Affairs, Veterans Health Administration; [Accessed 6/1/2012]. http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=261.

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