-Well, thank you very much.
I appreciate it, and I appreciate all you've done.
I want to spend just a few minutes
helping to place in context what VA is.
VA is the largest provider of oncology services in the nation,
50,000 veterans with cancer, 200 new diagnoses a day.
With large numbers of prostate cancer and lung cancer
and really our whole concept is to recognize the fact
that the 19 million veterans,
of which 9 1/2 million of them are enrolled in VA healthcare,
have taken an extraordinary toll for this nation.
Some of that toll, a price of their service,
has been increased risk of cancers.
Prostate cancer especially affects
13,000 new veterans a year, 7,700 new lung cancer patients,
and we can debate all the reasons these things happen,
and what the exposures were, and what the smoking rate is,
whether it was Agent Orange exposed,
but the work that we've done with you, Lou,
really has been to try and place veterans
at the front of the line in seeking care
as well as being provided
the most advanced care in the nation,
but precision oncology and the reason
I'm so impressed with it is that it gives us a chance
to do the genetic markers on the tumor
and then really tune therapy
into the generic mutations that we've found.
Very large numbers of our prostate
and lung cancer patients have mutations
that are potentially treatable.
Unfortunately today in America,
there's very few FDA-approved drugs
for those genetic mutations,
and the whole effort here if we are to be successful
is to drive the number of FDA-approved agents
upwards so that when a veteran
or frankly any American finds out
that their tumor has some sort of genetic mutation
that is potentially treatable, that there's a drug for that,
and that's the whole effort here,
and I'm so proud of the ability of our team
to really get behind this, and I'm going to introduce you
to one of those great researchers and clinicians,
Dr. Ken Myrie, who's leading this effort.
Ken?
-Hi.
I'm Dr. Ken Myrie.
Precision oncology has revolutionized cancer care
by tailoring it to the characteristics of the patient
and of the cancer.
VA cares for many veterans with cancer,
and many of those men and women live in rural areas.
Part of our commitment of creating
a system of excellence for precision oncology care
is to ensure that every veteran, no matter where she or he lives,
can get access to the best possible care.
The difference between VA and other cancer researchers is,
that we can research on a much larger scale
with 170 medical centers
and over 1,000 commuter-based outpatient clinics
as well as the strength of our affiliations
with top medical centers,
many of which are NCI-designated cancer centers.
Our oncology program office has democratized access
to both advanced molecular testing
and to expert care through the teleoncology program.
We are working to fully leverage
that scale by building networks to advance research.
For example, the Prostate Cancer Analysis
for Therapy Choice Network, or PATCH,
is bringing together a number of VA medical centers
to take an umbrella approach to trials,
focus on targetable genetic mutations in prostate cancer.
One of those trials, called Brace,
is evaluating the efficacy of carboplatin versus olaparib.
In veterans with resistant prostate cancer,
containing an mologous recombination repair deficiency.
In addition to clinical trials,
we're using artificial intelligence
to identify predictive markers for diagnosis,
prognosis, therapeutic response and patient stratification.
Together, active collaborations
among investigators across the entire research enterprise
are leveraging all of VA's strengths to transform VA
into a system of excellence and precision oncology care.
Thank you, and now back to Dr. Stone.
-So, Ken, thank you very much.
I appreciate it, and, you know, I think one of the things
that we're most unique in at the VA is the fact
that we have a lifetime responsibility to our parents,
and I'm not denigrating in any way the relationship
that you all have with your patients,
but when veterans are assigned to us coming out of uniform,
we have them for the rest of their lives.
It's not like they go to another insurance plan
or to something else, so we might have 40, 50, 60,
70 years of care with them and as such,
our ability to really do what we call integrated medicine
where we are able to take that patient's comorbidity
and control it makes huge differences
in the outcomes of patients' cancers.
Let me give you an example of that.
We did a study on black males with prostate cancer,
and as you all are well aware, black males with prostate cancer
have a higher mortality rate from their prostate cancer
than other ethnic groups in the nation
except in one subpopulation, and that's the VA.
The VA actually erases that ethnic disparity
and that higher mortality rate,
and it's not because we know how to do prostate cancer therapy
better than anybody else.
It's because we control the comorbidities.
It's because we control the diabetes,
the hypertension better than a nonintegrated healthcare system,
and it's one of the things that we're most proud of
is this erasure of a lot of the ethnic disparities
that we see in the nation
in other parts of our delivery system,
and all of this work would not be possible if it wasn't
for the Secretary's Center for Strategic Partnerships.
That Center for Strategic Partnerships
has brought an integration with the Prostate Cancer Foundation,
who has committed $50 million
to helping us build prostate cancer centers of excellence.
Also, IBM Watson and its use with artificial intelligence
has allowed us to really develop a great amount of information
regarding more than 2,700 veterans
that we've taken a look at with various problems,
including advanced lung cancer.
What I'd like to show you now is a very powerful video,
and that video really tells the unique,
intimate story of a veteran with advanced lung cancer.
♪♪
-It was less than a year when I retired out of the army
until I got diagnosed with cancer.
It was stage IV lung cancer.
It had metastasized to pretty much everywhere -- bone, brain,
spine, lymph nodes, pretty much, you know, everywhere.
-It was off-the-shelf chemotherapy
not designed specifically for him,
and, you know, he was doing okay,
but he was having significant side effects from that.
-You get the intravenous chemo treatment,
and so you just feel like someone beat you up
and stepped all over you for about a week,
and then you start to recover, and then you get to normal,
and then it happens all over again.
-Turned out that he had a cancer mutation
that we had a drug for that was able to be tailored
specifically to the type of mutation that he has,
and we were able to stop his chemotherapy
and start him on that drug.
That, I think, is what resulted in his both improvement
in his tumor and reduction in his side effects,
so this is, you know, targeted therapy.
-The medicine is a lot less harsh, much less side effects,
so it allows me to spend more time with my family,
support my family, spend time with my kids.
-The VA is a national healthcare system.
To be able to take care of patients at that scale,
you need to do something that is more facile and robust
to be able to provide the same level of excellence
to so many patients all at the same time.
The interpretation is the hard part,
actually, in my opinion,
and what we use IBM Watson to help us do
is to bring knowledge focused on this patient's results,
to interpret it in the best way that we can based
on the patient's tumor type
and what drugs might be useful to treat that patient's tumor.
To be able to interpret the results of those genetic tests,
we need different technologies,
and we need those technologies to work very quickly.
-It's patient-physician relationship
and the implementation of all that tremendous information
that's gathered by programs like Watson that help to,
you know, provide the information to the clinician.
-When faced with very difficult discussions about the bad news
that I had to deliver to them,
would look me in the face and say,
"What can I do to help someone else?"
That's really powerful to have them say, you know,
"This is something that I know is going to be bad for me,
but I want to make the best of it,
and I want to think about other people doing it."
That's really powerful.
-What you've just seen is a very powerful video,
and there's none of us that are not moved in watching it.
You'll hear more from Dr. Kelley later in this program,
and I appreciate the leadership role
that Dr. Kelley has had for us,
and now I want to turn to another relationship
that we have, another partnership.
Through an extraordinary gift from Sanford Health,
we have been able to leverage care
and testing in an extraordinary manner,
and I want to introduce you to another veteran, Pat McGuire,
whose extraordinary story you'll see next.
-I was the head miller for House-Autry.
They sell breaders and stuff like that,
and I milled the corn.
I was the head miller.
I had gotten a bad cough one day
from just some dust that was flying around,
and I went home and just coughed real bad,
and it hurt, and I coughed up some blood,
and that was the red flag for me,
and so I go and get this PET scan.
I was driving home.
My doctor called me,
and that's when he told me I had stage IV lung cancer,
which metastasized in my head, my brain.
I had five tumors in my brain, four in my lungs,
one on my adrenal gland,
which is the one I still have left,
but that's about the size of what the cancer was.
I served in the navy for 4 years, from 1992 to '96,
and I was on board the USS Phoenix, SSN-702
out of Norfolk for 3 years.
-Mr. McGuire has been through a lot.
As we now look out beyond his cancer
and think about how to support him,
that's where I think this type of testing
is really going to make a big impact,
so a patient would go to their local VA
where the blood would get drawn,
would get handled in a facility like the one that's behind us,
packaged us and shipped to Sioux Falls, South Dakota,
where the Sanford Imagenetics laboratories
will analyze that data
and then report back to that facility the genetic information
for that individual patient,
where then would get incorporated
into the patient's electronic health record
and made available to each of their providers
so that genetic test results are available
before they start a prescription
so that we can make those better decisions in real time.
-And when I was deployed to Afghanistan as part of the army,
we were working with the British.
The British knew that there was percentages of their population
that would respond to Tylenol at the same rate
as would respond to morphine.
Imagine the ability to predict in advance
what a solider might respond to with a catastrophic injury.
When we think about the relationship
of our healthcare system
and the VA to the American veteran
for their entire lifetime,
the ability to sustain that genomic work
and then predict for them something
that could have in chronic disease
a lifetime of effect is very, very exciting.
-I Believe that this is going to help a lot of people all
because they're doing this testing.
I think I've still got so much left to give.
-My hope that at the conclusion of this program,
we'll be able to expand testing to even more veterans
so that even more of them can get the benefits of the testing,
and we can give back to them in the way that they gave to us.
-More than 1,000 veterans have now been tested
through this great partnership with Stanford Health,
but now I want to turn to our relationship
with the Bristol Myers Squibb Foundation,
who through a gracious grant have provided
$4.5 million dollars to the VA
to expand our teleoncology program.
You know, more than half of veterans in America
live in rural communities or highly rural communities
that getting to a specialist,
especially an oncology specialist,
can take up to 3 hours of drive time.
It's just an untenable situation,
and because VA is an extraordinary leader
in telemedicine,
providing more than 2 million telemedicine visits a year,
we have developed through this grant
a number of oncology hubs
that we are expanding across the nation
in order to allow even a highly rural veteran
to receive exactly the same care planning and care execution
that does a veteran who might live next door
to one of America's premier academic medical centers.
It's an extraordinary story,
and we're incredibly thankful of this partnership.
We're very, very proud of what we've put together at VA
to really serve America's veterans,
and we invite you to think about how you might be part of that.
Catherine has two of our great clinicians
that will talk further on this,
and we look forward to the next time we're together.
Thank you.