Poster #77 - Effects of the Veterans Health Administration’s National Oncology Program on Treatment Initiation and PSA Screening

• In Event: Friday Poster Reception

Abstract

Introduction/Background: Prostate cancer is a major public health burden in the United States, with rising incidence rates, and remains the second leading cause of cancer-related death among men. Veterans may face nearly twice the risk due to military-related carcinogenic exposures. To improve cancer prevention, detection, treatment, and care quality, the Veterans Health Administration (VHA) implemented National Oncology Program (NOP) through VHA Directive 1415 in 2020. The program emphasized multidisciplinary care, patient navigation, clinical pathways, precision medicine, and expanded prostate cancer services, including prostate-specific antigen (PSA) screening and molecular testing, to support individualized screening decisions and provide effective treatment. However, evidence remains limited on whether the NOP improved prostate cancer care delivery.

Purpose/Research Question: This study evaluates whether implementation of the VHA’s National Oncology Program improved timely treatment initiation and pre-diagnosis PSA screening among Veterans with prostate cancer.

Data: This study uses VA electronic health record (EHR) data from 2015 to 2025. As the largest integrated health care system in the United States, the VHA serves approximately 9 million veterans annually across about 1,700 care sites. The EHR data include patient-level information on diagnoses, laboratory results, medications, and healthcare encounters, which were aggregated to the facility-year level for analysis.

 
Research Design and Methods: This retrospective cohort study included men aged 18 years or older who received a new cancer diagnosis between 2016 and 2024. Patients with prostate cancer were designated as the treatment group, while patients with head and neck cancer served as the control group. Outcomes included the proportion of patients initiating treatment following diagnosis and receiving PSA screening prior to diagnosis, both measured at intervals of 30, 60, 90, and 180 days. Program effects were estimated using two-way fixed effects difference-in-differences models with facility and year fixed effects. Event studies were conducted to assess the parallel trends assumption.

Results/Findings: We identified 116 VA facilities contributing 192,853 patients to the prostate cancer treatment group and 94 VA facilities contributing 30,888 patients to the head and neck cancer control group. The NOP was associated with significant increases in treatment initiation across all evaluated intervals: 2.97 percentage points at 30 days (p=0.035), 3.55 percentage points at 60 days (p=0.013), 3.72 percentage points at 90 days (p=0.009), and 3.80 percentage points at 180 days (p=0.010). For PSA screening, the NOP was associated with significant increases within 30 days (4.45 percentage points; p<0.0001) and 60 days before diagnosis (2.33 percentage points; p=0.016).

Conclusion/Implications: These findings suggest that the VHA’s National Oncology Program may have improved timely treatment initiation and increased pre-diagnosis PSA screening among Veterans with prostate cancer. Overall, this study provides policy-relevant evidence that a coordinated, system-level oncology care program may improve timely access to cancer care and potentially support earlier detection.

Author

• Yun Lee, Tulane University
  Presenting Author