The VA Precision Oncology Program

Precision Oncology is the practice of biologically directed cancer care. For example, the mutations in a cancer's genome (the cancer's DNA), can significantly impact the treatment options available to treat that cancer and the likely outcomes after treatment. By knowing the cancer genome, Oncologists and patients are able to choose therapies that specifically target the patient's cancer.

In the new standard of care, patients and doctors request access to a range of ‘omic’ tools, such as whole-exome sequencing, which is most compelling for patients with few remaining treatment options. With the rapid pace of discoveries and recent national focus from the White House and the NIH, the Precision Medicine domain, including Precision Oncology, will continue to grow and affect major changes in healthcare.

The Department of Veteran Affairs (DVA) recognized the need to balance patient-centered and compassionate care with responsible creation of generalizable knowledge on safety and effectiveness of molecular medicine tools. Embracing the principles of the rapid, learning healthcare system (rLHS) espoused by the Institute of Medicine and others, we* created a new clinical program in the Veterans Integrated Service Network 1 (VISN 1) called the Precision Oncology Program (POP), with an initial focus on lung cancer. Though the POP is started in VISN 1, we plan to roll-out across the VA nationally.

The POP system, described in detail here, assures access to modern oncology genomic practice in the VA, strives to remove disparities of access to cutting-edge therapeutics, and improves quality outcomes across the VA network of clinical centers. The functions of the POP are as follows:

  • Facilitates identification of Veterans diagnosed with cancer who may benefit from cancer genomic testing
  • Establish a "virtual" molecular tumor board to provide the interpretation of the ever-increasing number of clinically-relevant cancer genomic features
  • Establish a learning healthcare system that delivers actionable insights for an individual Veteran to the treating Oncologist and tumor board by combining and "learning" from:
    • Generalized knowledge from external sources about molecular medicine in cancer
    • Experiences of other veterans in the program
    • The patient’s own tumor genomic information and history with prior therapies
  • Systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics, regardless of Veteran location.

The knowledge and data generated by the POP ongoing operations will be a unique, continually growing, and vertically integrated repository. This repository will include clinical data (text progress notes, procedures, laboratory data, imaging reports, pathology reports, hospitalizations, clinic visits, medications), cancer genomic data (mutation panel and whole exome), and raw imaging data. POP is seeking many interdisciplinary collaborators to make the most effective and innovative use of this unique repository and ultimately return value to the Veterans under the care of the DVA.