title: The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine.
abstract: The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning health-care system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans. The program assures access to modern genomic oncology practice in the veterans affairs (VA), removes disparities of access across the VA network of clinical centers, disseminates the products of learning that are generalizable to non-VA settings, and systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics.
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Louis D
authors.initials: LD
authors.lastname: Fiore
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Brophy
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Turek
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Valmeek
authors.initials: V
authors.lastname: Kudesia
authors.affiliation: VA Ann Arbor Healthcare System, the University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
authors.forename: Nithya
authors.initials: N
authors.lastname: Ramnath
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Shannon
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferguson
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Saiju
authors.initials: S
authors.lastname: Pyarajan
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fiore
authors.affiliation: Cedar Associates, Menlo Park, CA, USA.; Department of Health Research and Policy, Stanford University, Stanford, CA, USA.; Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.affiliation: Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.; Department of Statistics, Stanford University, Stanford, CA, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Lavori
keywords: Bayesian; learning health-care system; lung cancer; precision oncology; veterans