Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

{"title":"Potential Tyrosine Kinase Inhibitor Therapy Discontinuation for Patients With Chronic Myeloid Leukemia in a VA Regional Network.","authors":"Kirsten Werner, Jenna Carmichael, Steve Flynn, David Huberman, Robert Malmstrom, Diana T Higgins, Janice M Taylor","doi":"10.12788/fp.0714","DOIUrl":"10.12788/fp.0714","url":null,"abstract":"<p><strong>Background: </strong>Some patients with chronic myeloid leukemia (CML) are eligible for tyrosine kinase inhibitor (TKI) discontinuation, which can reduce health system costs and may result in fewer adverse effects (AEs). This project sought to evaluate the potential cost avoidance and health outcomes associated with TKI discontinuation, including CML relapse, changes in reported AEs, long-term remission, and TKI withdrawal syndrome.</p><p><strong>Observations: </strong>Patients with chronic phase CML who had an active order for a TKI were eligible for discontinuation. Patients needed to be on TKI therapy for ≥ 3 years and have a stable molecular response. Patients were excluded if they had a history of advanced accelerated phase CML, a previous TKI discontinuation trial, nonadherence, or if they did not want to discontinue TKI. Oncology clinical pharmacy practitioners at each Veterans Integrated Services Network (VISN) 21 facility were notified of eligible patients. Fifteen VISN 21 patients were eligible for discontinuation as of October 2024, with a potential annual cost avoidance of $1.2 million if discontinued. A dashboard was developed to allow for ongoing TKI discontinuation in eligible patients.</p><p><strong>Conclusions: </strong>Discussions of TKI discontinuation with patients with CML led to collaboration with the patient care team and potential for significant cost avoidance without negatively impacting patient outcomes. Barriers to therapy discontinuation included patient concern for relapse, risk of discontinuation syndrome, the need for close monitoring, and required clinician buy-in.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S14-S17"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capturing Pathology Workload Associated With Precision Oncology.","authors":"Daniel J Mettman, Karsten R Evans, Linlin Gao, Amy B Frey, Maren T Scheuner, J Stacey Klutts, M Carmen Frias-Kletecka, Jessica Wang-Rodriguez, Daniel J Becker, Sharad C Mathur, Michael M Goodman","doi":"10.12788/fp.0694","DOIUrl":"10.12788/fp.0694","url":null,"abstract":"<p><strong>Background: </strong>Molecular testing for precision oncology (PO) is important in anatomic pathology (AP). As indications expand, there will be further increases in pathology workload. Research associated with AP molecular testing is significant and must be completed.</p><p><strong>Methods: </strong>This study mapped the AP molecular testing consultation process at the Kansas City Veterans Affairs Medical Center and the average time measured for each step. AP records for 2021 through 2023 were reviewed to determine the number of AP molecular send-out tests. Cumulative time investment was collected and a theoretical number of relative value units (RVUs) was calculated using the new pathology clinical consultation <i>Current Procedural Terminology</i> codes (80503-80506). The theoretical number of RVUs was compared to the total AP RVUs generated.</p><p><strong>Results: </strong>Of the 21,021 AP cases, 1338 generated AP molecular send-out test consultations. A total of 2040 hours of pathology staff time were required to complete the associated consultations. If this time were billed, it would have generated 14.8% (3847/25,920) more RVUs.</p><p><strong>Conclusions: </strong>A significant amount of work is necessary for the pathology staff to fulfill its PO responsibilities. This is likely to increase as indications for testing expand. Additional research of pathology processes is necessary to manage increasing workload and maintain the highest quality of cancer care.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S59-S62"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Opportunity to Provide High-Quality Training and Care: Use of Telesupervision and Reflection on Practices.","authors":"Shiloh E Jordan, Margaret-Anne Mackintosh","doi":"10.12788/fp.0692","DOIUrl":"10.12788/fp.0692","url":null,"abstract":"<p><strong>Background: </strong>Rural populations experience more health care disparities than urban populations, including higher rates of chronic conditions and limited access to health care practitioners and facilities. Because health care professional (HCP) training programs are largely based in urban areas and often shape where early-career clinicians practice, rural communities have fewer opportunities to attract individuals to build sustainable local workforces. As the largest provider of health professions training, the US Department of Veterans Affairs (VA) is well positioned to leverage telesupervision- clinical supervision delivered via synchronous audio and video-to strengthen rural training, support high-quality care, and enhance workforce retention.</p><p><strong>Observations: </strong>This 3-year quality improvement project analyzed 11 rural VA psychology training programs. A total of 3197 monthly questionnaires from supervisors and trainees showed that telesupervision upheld patient safety and supervision quality while increasing trainees' comfort with telehealth care. These findings illustrate how telesupervision can create new opportunities to maintain high-quality training and care by connecting geographically dispersed health care practitioners. The evolving use of telesupervision underscores that clinical supervision is a distinct competency requiring intentional relationship building, direct observation, and structured feedback.</p><p><strong>Conclusions: </strong>Thoughtfully implemented telesupervision can support safe, high-quality supervision while broadening access to rural training experiences and specialty expertise. For rural VA sites, telesupervision may strengthen supervisors' professional connection, increase trainees' engagement with veterans living in rural communities, and contribute to rural workforce sustainability and improved population health.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 5","pages":"176-179"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Droperidol Use in the VA Greater Los Angeles Healthcare System Emergency Department.","authors":"Emily Minoda, Shogo Kono, My-Phuong Pham, Hemang Acharya, Jonathan Balakumar","doi":"10.12788/fp.0699","DOIUrl":"10.12788/fp.0699","url":null,"abstract":"<p><strong>Background: </strong>Droperidol, a butyrophenone antipsychotic, is used for postoperative nausea and vomiting and as a sedative, anxiolytic, and analgesic. Concerns about potential QTc (corrected QT interval) prolongation led the US Food and Drug Administration (FDA) to issue a boxed warning and halt manufacturing. However, recent studies have supported droperidol's safety and it was reintroduced in 2019. Given the limited available options for managing acute agitation at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), there has been interest in re-evaluating the risks associated with droperidol use for sedation, anxiolysis, analgesia, and as an antiemetic.</p><p><strong>Methods: </strong>This retrospective chart review examined patients who received droperidol in the VAGLAHS emergency department (ED) from February 2021 to April 2023. The primary outcome was all-cause mortality after droperidol administration within 24 hours. Secondary outcomes included the efficacy of droperidol, incidence of QT prolongation, incidence of extrapyramidal symptoms (EPS) such as akathisia, dystonia, parkinsonism or tardive dyskinesia, and incidence of respiratory depression.</p><p><strong>Results: </strong>Of 207 patients receiving droperidol, 38 (18.4%) were adults aged ≥ 65 years. Droperidol was used for acute agitation in 183 patients (88.4%) and as an antiemetic in 24 (11.6%) patients. No deaths were observed following droperidol administration in a 24-hour period. The need for rescue medication occurred in 15 patients (7.3%). EPS such as tardive dyskinesia and dystonia occurred in 2 (1.0%) patients. No arrhythmias or respiratory depression were observed within 24 hours of administration. No clinically relevant QTc prolongation was observed.</p><p><strong>Conclusions: </strong>No fatalities were seen among patients who received droperidol in the VAGLAHS ED. Despite the boxed warning issued by the FDA, these findings suggest droperidol is safe and effective in managing agitation and as an antiemetic.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 5","pages":"180-185"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Outcomes of Stereotactic Body Radiotherapy for Localized Prostate Cancer: A Retrospective Analysis.","authors":"Eashwer Reddy, Inamul Haque, John Park, Dunia T Khaled","doi":"10.12788/fp.0706","DOIUrl":"10.12788/fp.0706","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer is the most common cancer in US males. While conventional beam radiotherapy has been commonly used, there has been a shift toward hypofractionation, which involves using fewer higher-dose fractions over a shorter treatment course. Stereotactic body radiotherapy (SBRT) further condenses treatment to 5 fractions in < 2 weeks.</p><p><strong>Methods: </strong>This was a retrospective chart review of a veteran population with localized prostate cancer who received SBRT between November 2014 and October 2024 at the Kansas City Veterans Affairs Medical Center. Androgen deprivation therapy (ADT) or pelvic nodal irradiation with ADT was administered where indicated. Patients were included and followed for at least 24 months to assess efficacy and genitourinary (GU) and gastrointestinal (GI) toxicity using Radiation Therapy Oncology Group (RTOG) criteria. Cone-beam computed tomography was exclusively used for image-guided radiotherapy without the use of fiducials or hydrogel spacers.</p><p><strong>Results: </strong>A total of 174 patients met the inclusion criteria. The median age was 74 years, and the median prostate-specific antigen level was 11.9 ng/mL. Twenty-six patients had a Gleason score (GS) of 1, 77 had GS 2, 41 had GS 3, 18 had GS 4, and 12 had GS 5. Patients had a median follow-up of 45 months, and the disease-free survival and overall survival rates were 96.6% and 99.4%, respectively. There were 6 biochemical failures (3.4%), with 1 patient dying from metastatic cancer. The cumulative RTOG grade II and higher GU toxicity was 28.2% (26.4% grade II, 1.2% grade III, and 0.6% grade IV toxicity with rectovesical fistula requiring surgery). The cumulative RTOG grade II or higher GI toxicity rate was 3.4% with no grade III or IV complications.</p><p><strong>Conclusions: </strong>This retrospective analysis indicates that a short course of SBRT for localized prostate cancer demonstrates acceptable toxicity and promising early efficacy, even without the use of fiducials or hydrogel spacers. Longer follow-up is warranted to confirm these findings.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S36-S42"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Challenge of Immune Checkpoint Inhibitor-Induced Hypophysitis in Patient With Melanoma.","authors":"Alexandra Rusz, Melanie Kirk, Woo Jin Seog, Imran Baig, Viraj Modi","doi":"10.12788/fp.0711","DOIUrl":"10.12788/fp.0711","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have emerged as immunotherapy treatment modalities for several advanced malignancies. Although effective in cancer treatment, inhibition of cellular checkpoints can result in the loss of immunologic tolerance with consequent autoimmune disorders. Clinicians must be aware of immune-related adverse events (irAEs), such as hypophysitis, to ensure prompt treatment.</p><p><strong>Case presentation: </strong>A 73-year-old male with a history of metastatic melanoma who had received 5 cycles of pembrolizumab (anti-PD-1) and 2 cycles of combination ICI therapy with ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) presented to a US Department of Veterans Affairs medical center 3 weeks after completing his second cycle of therapy with fatigue, headache, and hyponatremia. Laboratory evaluation revealed a low thyroid hormone level with suppressed thyrotropin, consistent with central hypothyroidism. Magnetic resonance imaging of the brain demonstrated pituitary enlargement suggestive of hypophysitis. The patient was treated with intravenous hydrocortisone for suspected central adrenal insufficiency. A subsequent cosyntropin stimulation test confirmed secondary adrenal insufficiency with low adrenocorticotropic hormone levels and a blunted cortisol response. Computed tomography and positron emission tomography showed normal adrenal glands without metastases. The patient's symptoms improved with glucocorticoid replacement, though he later experienced complications of steroid therapy.</p><p><strong>Conclusions: </strong>Patients presenting with evidence of new autoimmune disorders who have undergone ICI therapy should be immediately evaluated for irAEs. ICI-induced hypophysitis is irreversible, can impact quality of life, and requires maintenance replacement therapy. As ICI therapies become more prevalent in the treatment of solid cancers, it is expected that clinicians will see more cases of ICI-related irAEs, such as hypophysitis, and must become comfortable with diagnosis, treatment, and management.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S63-S67"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypochlorous Acid: A Multipurpose New Addition to the Military Med Bag?","authors":"Adrianna Campo","doi":"10.12788/fp.0702","DOIUrl":"10.12788/fp.0702","url":null,"abstract":"<p><strong>Background: </strong>A medical bag (med bag) in the military medical community contains medical supplies and equipment used to provide care on the battlefield or in noncombat field conditions. Though its contents are situation-dependent (eg, deployment, field exercise, physical fitness event), it generally contains items such as intravenous supplies, airway management tools, pain medications, bandages, tourniquets, splints, suture materials, and antiseptics.</p><p><strong>Observations: </strong>Hypochlorous acid (HOCl) is approved by the US Food and Drug Administration for disinfecting surfaces and wound care. In the military, long foreign deployments and training exercises can last 6 months to 1 year. Short-term field exercises and outdoor physical fitness or training events are also common. Even at a duty station, conditions in a medical facility may be austere, and access to care may be limited. Some clinics may even have limited general medical staff, without nearby military specialists to consult. In these settings, HOCl may be beneficial not only as a disinfectant for field injuries but also off-label management of skin conditions.</p><p><strong>Conclusions: </strong>HOCl may be a potent addition to military medicine in various settings, especially in austere environments or during long deployments.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 5","pages":"172-175"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Care for Veterans at Risk of Cancer From Camp Lejeune Water Exposure.","authors":"Christi A Blake, Kirsten N Brondstater","doi":"10.12788/fp.0696","DOIUrl":"10.12788/fp.0696","url":null,"abstract":"<p><strong>Background: </strong>From 1953 to 1985, as many as 1 million Marines, Navy personnel, civilian workers, and their families stationed at Camp Lejeune were exposed to volatile organic compounds (VOCs) through contaminated drinking and bathing water. Epidemiologic studies link VOC exposure to ≥ 10 cancers. Cohort studies have shown higher cancer incidence and mortality among Camp Lejeune personnel, with up to a 3- to 6-fold increase for some cancers compared with Camp Pendleton controls. Clinical awareness of cancers associated with Camp Lejeune water contamination remains limited. Federal primary care and internal medicine clinicians are uniquely positioned to address this gap.</p><p><strong>Observations: </strong>Camp Lejeune VOC exposure is associated with solid tumor and hematologic cancers, which present with various symptoms, examination findings, and diagnostic considerations. Primary care and internal medicine clinicians can improve outcomes by recognizing symptom patterns, conducting thorough physical examinations, and implementing a targeted diagnostic screening panel for identified veterans who were stationed at Camp Lejeune. A proposed panel includes complete blood count with differential and peripheral smear, comprehensive metabolic panel, lactate dehydrogenase, urinalysis, low-dose chest computed tomography (CT), and CT of the abdomen and pelvis. Educating veterans and clinicians on symptom recognition, relevant physical examination findings, and the value of initial screening may help close this critical gap and reduce costs associated with advanced-stage cancer treatment.</p><p><strong>Conclusion: </strong>Clinicians caring for veterans exposed to Camp Lejeune VOCs can improve outcomes and quality of life through increased awareness of exposure-associated symptoms, targeted physical examination, and timely use of cost-effective screening to support earlier cancer detection and reduce diagnostic delays and costs. Clinicians are central to early recognition, physical assessment, appropriate screening tools, and ongoing care for this high-risk veteran cohort.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S43-S51"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divine Calling and Human Rank: The Locus of Authority for Military Chaplains.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0733","DOIUrl":"10.12788/fp.0733","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 5","pages":"170-171"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating Real-World Tolerance and Dose Reductions of Oncology Multikinase Inhibitors in a VA Population.","authors":"Trey Hon, Katherine Kelly, Hannah Spencer, Kevin C Kelly","doi":"10.12788/fp.0710","DOIUrl":"10.12788/fp.0710","url":null,"abstract":"<p><strong>Background: </strong>Oral multikinase inhibitors (MKIs) are widely used and effective targeted therapies for patients with cancer. These agents can have substantial drug-drug interactions and adverse effects (AEs), which can make them difficult to tolerate. This study sought to evaluate the real-world tolerance of MKIs prescribed by the hematology/oncology clinic at the Veterans Affairs North Texas Health Care System (VANTHCS) to guide clinicians in the selection of starting doses and in setting expectations for the management of dose titrations.</p><p><strong>Methods: </strong>A retrospective chart review of veterans managed by the VANTHCS hematology/oncology clinic with a prescription for axitinib, cabozantinib, lenvatinib, pazopanib, regorafenib, sorafenib, or sunitinib was conducted for patients treated from January 1, 2014, to October 31, 2024. The primary outcome was the evaluation of MKI tolerance through determining the relative dose intensity (RDI) and mean and median time on therapy. Secondary outcomes included rates of AEs and adjustments in doses.</p><p><strong>Results: </strong>One hundred seventy veterans with 208 MKI prescriptions met the study inclusion criteria. The overall combined mean MKI RDI was 67.5%. Individual mean RDIs were 71.0% for axitinib, 59.6% for cabozantinib, 63.7% for lenvatinib, 82.3% for pazopanib, 61.2% for regorafenib, 49.0% for sorafenib, and 85.5% for sunitinib. The mean and median time on therapy for all MKIs (excluding days of therapy that were held) was 155 and 95 days, respectively. There were 376 AEs. Eighty-one prescriptions (38.9%) started at the indicated dose and 127 prescriptions (61.1%) were initiated at a reduced dose because of baseline concerns. Across both groups, 90 prescriptions (43.3%) required further dose reduction during therapy.</p><p><strong>Conclusions: </strong>Oncology MKI therapies used at VANTHCS were difficult for veterans to tolerate and ultimately led to suboptimal dosing. Clinicians may use these data to guide decision-making when initiating and managing MKI agents in this population.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 suppl2","pages":"S18-S23"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}