It is estimated that 40,000 Veterans are diagnosed each year with cancer and of that number, 12,000 are diagnosed with prostate cancer. Because of those staggering prostate cancer numbers, the VA joined with the Prostate Cancer Foundation (PCF) to co-host a one-day summit, Launch Pad: Pathways to Cancer InnoVAtion. The event brings together world-class oncology experts, corporate and nonprofit partners to discuss research, big data, technology and clinical solutions to advance screening, diagnostics and care coordination for cancer and to promote the implementation of best practices across the VA healthcare system.
“Fighting and treating cancer among our Veterans is a team effort, which is why this Launch Pad event and this partnership with PCF are so important,” said VA Secretary Bob McDonald. “To effectively serve our Veterans and to keep VA on the cutting edge of medical research, we need government, corporate, and non-profit organizations working together. We are truly grateful to the Prostate Cancer Foundation for this important show of support. Our work together will save Veterans’ lives.”
As part of the summit, PCF announced a $50-million precision oncology initiative to expand prostate cancer clinical research among Veterans to speed the development of new treatment options and cures. The agreement is the first partnership between PCF and VA. Of the thousands of Veterans diagnosed each year with prostate cancer, African-Americans, in particular, are 64 percent more likely to develop prostate cancer compared to any other race or ethnicity and 2.4 times more likely to die from the disease.
The goals of the PCF partnership are to increase the number of Veterans Health Administration (VHA) investigators applying to PCF for funding; increase the number of VHA facilities involved in precision medicine/prostate cancer clinical trials; increase the number of Veterans enrolled in studies, providing veteran specimens or data used in studies as well as increase the number of minorities enrolled in PCF studies; and increase the number of early career scientists working on prostate cancer research.
“Our goal is to increase our scientific understanding of prostate cancer among Veterans and to kick-start the development of precision medicine treatments for them, as well as the general population,” said Jonathan W. Simons, MD, President and Chief Executive Officer, PCF. “This agreement will open new doors for the research community to work with Veterans facing a life threatening disease and ultimately reduce the disease burden on America’s Veterans.”
VA has a long history in cancer prevention and research. Currently, VA’s cancer research portfolio supported 262 active projects with $53.5 million in fiscal year 2016, toward understanding and preventing cancers prevalent in the Veteran population. In addition, VA research also has ongoing collaborations and data-sharing with other public agencies, and profit and non-profit corporations to enhance cancer research, including studies that support the national Precision Medicine Initiative.
VA CANCER PORTFOLIO
The VA cancer research portfolio supported 262 active projects with $53.5 million in fiscal year 2016, toward understanding and preventing cancers prevalent in the Veteran population. VA researchers conduct laboratory experiments aimed at discovering the molecular and genetic mechanisms involved in cancer; studies looking at the causes of disease; clinical trials to evaluate new or existing treatments; and studies focused on improving end-of-life care. The work is conducted through the biomedical, clinical, rehabilitation, and health services research services of the Office of Research and Development (ORD), as well as through ORD’s Cooperative Studies Program. VA Research also has ongoing collaborations and data-sharing with other public agencies, and profit and non-profit corporations to enhance cancer research, including studies that support the national Precision Medicine Initiative.
Below are highlights of VA’s efforts in cancer research:
- Million Veteran Program (MVP): This innovative and ambitious VA program has become the world’s largest database of health, lifestyle, military exposure and genetic data, hitting the half-million enrollment mark in summer 2016. MVP continues to enroll Veterans at more than 50 VA medical centers and clinics nationwide. With nearly a third of participants reporting a history of cancer, MVP is a rich resource for genetic explorations relating to cancer therapy. Researchers in MVP are also working closely with the Department of Defense (DoD) and the National Institutes of Health (NIH) to develop collaborations and data-sharing through interagency agreements. The agreement with DoD will enable enrollment of active-duty members from the Millennium Cohort Study into MVP. The agreement with NIH will enable enrollment of Veterans into NIH’s Precision Medicine Initiative Cohort Program (PMI-CP).
- Informatics infrastructure: Sharing and analysis of “big data” is enhanced by resources such as the Veterans Informatics and Computing Infrastructure (VINCI), a VA data-sharing platform; and the Genomic Information System for Integrated Science (GenISIS), which supports enrollment and secure computing for MVP. VA also has data-use agreements in place with a number of federal research partners.
- VA Precision Oncology Program: VA’s Precision Oncology Program (POP) is an innovative approach to provide standardized state-of-the-art practices in precision oncology care and research for VA cancer care specialists and Veterans. The program is based at VA’s Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) in Boston. It facilitates genomic analysis, tissue repository and molecular oncology support to enhance clinical care and future participation in clinical trials. The program has laid the foundation for VA’s participation in the Applied Proteogenomics Organizational Learning and Outcomes consortium, a partnership with the Department of Defense and the National Cancer Institute to tailor cancer care for patients based on the genes and proteins associated with their tumors.
- VA Cooperative Studies Program: The VA Cooperative Studies Program (CSP) is an efficient platform for multicenter clinical trials involving thousands of Veterans. One past study (CSP #380) set the standard for early colorectal cancer screening by showing the effectiveness of colonoscopy over sigmoidoscopy. A CSP study now underway to compare colonoscopy with fecal immunochemical testing for colorectal cancer screening aims to enroll 50,000 Veterans in all. It has already become the largest single VA clinical trial in history.
- VA Cancer Registries: There are two components of the registry system: (1) facility registries and (2) the VA Central Cancer Registry. In VA, there are over 50,000 new cancer cases among Veterans each year. These account for about 3.5 percent of all cancer cases in the U.S. Data from VA cancer registries are shared with:
- State central cancer registries supported by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program and the Centers for Disease Control and Prevention’s National Program of Cancer Registries.Together, these data contribute to an annual national accounting of cancer.
- Commission on Cancer’s National Cancer Database (NCDB). VA facilities that are certified by the Commission on Cancer provide cancer registry data to the Commission on Cancer’s NCDB, which includes about 70 percent of cancers in the U.S.
- The VA cancer registry is a useful research tool because of VA’s extensive clinical record systems. The registry has been linked (e.g., in VINCI) with other VA datasets for new knowledge discovery and operational needs to improve the lives of patients with cancer. The Clinical Case Registry package assists local VA practitioners in monitoring and managing populations of Veterans with specific conditions.
Cancer Moonshot-related Efforts
- Harnessing Big Data to Transform Veteran Health through Precision Medicine: VA and the Department of Energy are collaborating to apply the most powerful computational assets at DoE’s National Labs to Veterans’ records from the Million Veteran Program, a cornerstone of the Precision Medicine Initiative. This is a five-year, renewable commitment with $3.5 million allocated in fiscal year 2016. The first phase of the partnership will focus on cancer, cardiovascular disease, and mental health issues, and the resulting platform will accelerate our understanding of disease detection, progression, prevention, and treatment by combing MVP’s rich clinical, environmental, and genomic data to enable cutting-edge science.
- Tri-Agency Coalition to Advance Proteogenomics Cancer Care: VA, the Department of Defense and the National Cancer Institute are collaborating to create the nation’s first integrated proteogenomics cancer discovery-to-clinical care implementation system. The system will use state-of-the-art methods in proteogenomics to collectively analyze data from up to 8,000 patients to develop a deeper understanding of cancer biology. The researchers will use this information to identify potential targets for cancer detection and intervention. Efforts will initially focus on lung cancer, but will expand to incorporate multiple cancer types, and aim to enable better testing of clinical questions on toxicity and response, sequencing and proteomics, analysis of samples and use of data science and analysis tools within the framework of two national health care systems.
- IBM’s Watson: IBM is collaborating with VA to provide Watson-powered genome analysis technology to help clinicians develop personalized treatment plans for thousands of Veterans with cancer. IBM will provide Watson’s cognitive computing capabilities, which have been specifically trained for genomic analysis, to scientists and pathologists who have sequenced DNA for VA cancer patients, to help them pinpoint the likely cancer-causing mutations and identify treatments that target those specific mutations. This is a data-intensive process that has been difficult to scale in the past. As America’s largest integrated health system, VA provides care to 3 percent of the nation’s cancer patients – the largest cohort of cancer patients in the country. Watson is expected to give Veterans faster access to personalized care, particularly for patients with advanced cancer. The collaboration with VA is also expected to advance genomic research.
- OneSource: The University of California Office of the President, University of California Health, the Athena Breast Health Network, Quantum Leap Healthcare Collaborative, and Salesforce commit to establishing a new transformative model for health care delivery that evolves the point of care into a patient-centric data hub. By introducing the use of standard “OneSource” checklists for cancer care documentation, and enabling feedback, and multiple connections to registries, trials, and research, VA will create a patient centric data hub. The systems of care and research can be integrated, accelerating learning and driving efficiency and healthcare value. This new model has evolved from our experience personalizing screening and prevention for over 100,000 breast cancer patients in the Athena Breast Health Network and the launch of the PCORI funded Wisdom study; seamless connection to real-time clinical trial registries (CT match/Veterans Affairs and breastcancertrials.org) and adapting care through trials (I-SPY, 20 clinical sites). In the same way data aggregation has transformed such industries as communications, retail, and financial services, the intelligent application of patient clinical trial data will be a disruptive technology that drives the personalization of cancer medicine.
- Stanford University: VA Hadron Radiation Therapy Partnership. The goal of this collaboration would be to establish a Hadron Center on VA’s Palo Alto VA Medical Center campus. The facility would consist of proton beam radiation therapy, research, and the first carbon beam radiation therapy established in the United States, designed to enhance healthcare delivery services for our nation’s Veterans, and Stanford Medicine patients.
- American Cancer Society: VA is partnering with the American Cancer Society (ACS) to develop Veteran-centric initiatives and activities around cancer screening, diagnosis and survivorship. ACS has always had a strong commitment to serving Veterans, demonstrated by their dedication to providing support resources to Veterans and their families struggling with cancer as well as engaging VA leaders and providers in discussing important issues such as colon cancer screening, lung cancer screening and others. A new initiative announced today expands the partnership by setting a long-term plan to collaborate and coordinate efforts to improve the lives of Veterans living with cancer or at risk for cancer.
About the author: Matthew S. Collier is senior advisor to the secretary for strategic partnerships.