Incorporating genomics into routine clinical care for Veterans with colon cancer Project Summary Anticipated impacts for VA Health Care: Genomics to inform early detection of and care for colon cancer is among the first applications of personalized medicine to have accumulated substantial evidence of clinical utility and validity. The findings from our proposed work will inform the Veterans Health Administration (VHA) about the current level of integration of genomics in routine clinical practice for Veterans with colon cancer cared for in the VHA. Our project will provide new insights about improving the delivery of these services in the VHA. Background: While the VHA has recognized its potential to serve the nation at the forefront of genomic medicine and has selected hereditary nonpolyposis colon cancer (HNPCC) as the initial focus for clinical trials, there is little information available on the delivery of genomic services to Veterans diagnosed with colon cancer who are cared for in the VHA. Current evidence supports the use of genomic services for all Veterans diagnosed with colon cancer who are under age 50 and for many who are diagnosed between the ages of 50 and 60. Information is needed on current patterns of delivery of genomic services to these Veterans cared for in the VHA (i.e., family history assessment, genetic counseling, molecular analysis, and genetic testing) and on the barriers encountered by clinicians to providing these services when appropriate to Veterans. Objectives: Our ultimate goal is to inform the VHA about the best models for the delivery of genomic health services in the colon cancer clinical setting. Accordingly, our specific aims are: 1) to characterize the current patterns of colon cancer care for Veterans that are informed by genomic information, and 2) to examine the barriers to and facilitators of incorporating genomic information and services into routine care for Veterans diagnosed with colon cancer. Methods: We will use mixed methods including quantitative and qualitative approaches to accomplish our specific aims. To address specific aim one, we will triangulate three main data sources to characterize current patterns of service delivery. These will include VHA and other administrative data, the VHA Cancer Registry, and medical record abstraction data. To address specific aim two, we will interview key informants from a national sample of VHA facilities about barriers and facilitators of genomic service delivery in the colon cancer clinical setting. Key informants will be VHA clinicians and administrators involved in colon cancer screening, diagnosis, and treatment, including gastroenterologists, oncologists, pathologists, tumor board members, nurses, cancer registry staff, and laboratory administrators.
Genomics-specifically, targeted health care interventions based on the characteristics of individual patients, including their genetics-is likely to transform American health care in the next decade. The Veterans Health Administration (VHA) has great potential to serve Veterans and the nation at the forefront of genomic medicine. The use of genetic information to inform the diagnosis and treatment of colon cancer is one of the first genomic applications to have sufficient scientific evidence to support its incorporation in clinical practice. Genomic health services in colon cancer care include family history assessment, genetic counseling, analysis of tumor tissue, and genetic testing. Our study will be among the first to examine how genomic information is being used in the VHA to inform the care of Veterans diagnosed with colon cancer and their related family members. Our findings will inform the VHA about the best methods for efficient delivery of genomic health services to Veterans who are cared for in the VHA.