The Department of Veterans Affairs' $243.3 billion budget request for next fiscal year includes a $75 million increase for cancer treatment so the VA can "deliver the most up-to-date care as close to the patient's residence as possible."
The investment would go toward the VA's precision oncology program, which moves away from one-size-fits-all cancer treatments to personalized care that focuses on the patient's and cancer's DNA mutations to figure out the best treatment.
Retired 1st Sgt. Jeremy Kitzhaber, 49, considers it a great improvement.
"I'm all for it because I had to go outside of the VA to get it," he said.
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Kitzhaber spent 22 years in the Air Force, where he worked in civil engineering. Before retiring in 2012, he deployed several times, including Incirlik Air Base, Turkey, for earthquake relief and Al Dhafra Air Base, United Arab Emirates, in support of Operation Iraqi Freedom.
While he prefers to receive care from the VA, it wasn't possible in 2014 when he was diagnosed with Pseudomyxoma Peritonei, or appendix cancer, which "leaks everywhere."
It was caused by exposure during his duties to radiation and chemical and biological hazards, he said.
Since there were no VA oncology physicians who specialized in his cancer, Kitzhaber went to a private provider in Omaha, Nebraska. The surgeon lifted Kitzhaber's organs out of a 13-inch incision in his abdomen and "washed his inner belly with chemo," he said.
When he returned to the VA, his medical team started him on traditional chemotherapy that was so severe he almost died. The cancer returned a few months later.
"Cancer care is changing rapidly and becoming increasingly complex," a VA spokeswoman said via email Thursday. "The overall mission of the Precision Oncology initiative is to improve the lives of Veterans with cancer through Precision Medicine by implementing a learning health care model to quickly transition new knowledge into clinical practice and to maximize learning from clinical practice."
Precision medicine is what ultimately saved Kitzhaber's life. The first genetic test he received from the Omaha physician showed nothing more could be done for his stage 4 cancer. But a second opinion and blood test from an oncologist in San Diego proved a breast cancer drug would drastically slow the cancer's progress.
"I tell people it was 60 miles an hour with no treatment; now it's 1 mile an hour," he said, adding that the drug has had few side effects: a little fatigue, slightly thinner hair and more brittle nails.
That's compared to 20 rounds of chemotherapy, which caused him to black out four times due to his heart going into atrial fibrillation.
Among the initiatives to be funded by the VA's budget request will be the National Precision Oncology Program (NPOP), which gives access to a tumor DNA sequencing database and a national molecular oncology tumor board. It will also fund "TeleOncology," a service to let patients access oncology specialists remotely through the internet.
There are about 40,000 cancer cases reported to the VA's Central Cancer Registry annually, according to a 2012 study. Though the database is not available to the public, the VA reports that the five most frequently diagnosed cancers among veterans are prostate; lung and bronchial; urinary and bladder; colon; and skin.
Terrence Hayes from Veterans of Foreign Wars said in an email that his organization has heard from several vets who have struggled to find the right care for their specific need and have had to undergo "rigorous" cancer treatments like Kitzhaber.
"It is encouraging to see VA institute this program and focus more on a personalized approach to cancer treatment for our veterans," he said. "A one-size-fits-all approach to cancer treatment cannot be the way we look at treating our veterans, especially many who developed these cancers due to the environmental hazards they have come in contact with during their service."
Hayes added the VFW hopes this means the VA will have quicker diagnoses and more thorough treatment measures to extend veterans' lives.
William Goeren, CancerCare director of clinical programs, said he's found that, while precision oncology has fragmented care, it gives a lot more hope for patients.
"I will say that precision medicine does provide a patient with a greater sense of hope and individualized attention versus a one size fits all," he said. "[But] there are often so many [medical doctors] involved in a case that patients often don't know who is leading their treatment, especially if a patient has co-morbidities."
CancerCare is a national organization that provides free counseling and emotional support services to cancer patients. It's been studying how to work with veterans with cancer as it tries to create a support group for them.
Goeren said he's found that, while veterans have similar challenges as other cancer patients -- including financial strain and transportation difficulties, they have trust issues when it comes to getting care.
"In some ways, they feel betrayed by their own government. It was through their work that they have now come down with cancer," he said. "There's a sense of 'I've been burned once -- by an organization, the federal government -- so I'm not trusting of anything.'"
Goeren said this is similar to what black or LGBT patients feel when it comes to receiving health care treatment when they have historically been shunned.
Currently, the VA's options for cancer treatment include surgery, chemotherapy, immunotherapy, targeted therapy and hormonal therapy, among others, the VA spokeswoman said. A VA patient is tested for cancer when he or she has symptoms or abnormal test results. If the test shows cancer, the treatment approach will vary based on the patient and cancer.
"Cancer diagnosed at any age is scary," Kitzhaber said. "We have these life plans all that kind of go away."
Before his diagnosis at 43, he said he had his life planned out until the age of 80, looking forward to celebrating his 50th wedding anniversary and taking care of grandchildren. Now, his outlook is much shorter.
"It's not always easy to go outside the system," he said. "Seventy-five million dollars, to me, for people to have a better quality of life, live longer, is money well spent."
-- Dorothy Mills-Gregg can be reached at dorothy.mills-gregg@military.com. Follow her on Twitter at @DMillsGregg.
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