Federal Practitioner

Beth Cavanaugh, 79, was starting a new medication when she ran into a modern hurdle: Her doctor’s office required all follow–up questions, even those about side effects of the drug, to go through the patient portal.

Cavanaugh said she did not know how to set up or use the system.

“I tried to explain that, but the receptionist said that was the only way to contact the doctor. I felt lost,” said Cavanaugh, a retired psychotherapist near Albany, New York.

Cavanaugh is far from alone. Many older people balk at the idea of communicating with their physicians over the internet. They may have limited digital skills, have physical challenges, or simply prefer human connection.

As medicine leans harder on electronic portals and telehealth, these patients are finding themselves shut out of their own care. Experts warn this approach deepens inequities in access to care and can worsen health outcomes.

Clinicians should “offer options for various types of communication, such as phone calls or texts, because whenever an older adult — or anyone, for that matter — is given a choice, they feel more empowered and more committed to their care,” said Susan Wehry, MD, associate clinical professor at the University of New England College of Osteopathic Medicine in Biddeford, Maine.
 

Tech Support

Use of medical communication tools varies among older adults. One study in JAMA Network Open found nearly two thirds of those older than 65 years who filled out surveys via phone or internet had used a patient portal, while a little under half used telehealth, and only 44% used a medical health application.

Older patients tend to fall into two camps, said Neela Patel, MD, MPH, CMD, chief of the Division of Geriatrics and Supportive Care at the UT Health San Antonio.

Her patients “are at two extremes of the spectrum — some technologically savvy and others with limited digital literacy or limited or no access to the Internet,” Patel, who is also the vice chair of the Health Systems Innovations and Technology Committee of the American Geriatric Society, said.

Patel’s practice has dedicated staff to help patients master certain technologies. For example, a pharmacist teaches patients how to use a glucometer and a blood pressure cuff. Other staff teach them how to use smartphone apps that track blood pressure or glucose.

She usually sees patients in person before offering telehealth as an option, ensuring the person has “enough digital literacy to utilize them and that the patient can see and hear the visit.”

If technological limitations impede a telehealth appointment, clinicians can help patients navigate their computer screen. Patel recounted the story of an older woman who was unable to come to the clinic in person, so had a telehealth visit instead.

“She had trouble hearing me, so I asked her to share her screen with me. I walked her through how to do that. Then I showed her where the ‘volume’ button was located. It turns out her volume was at zero,” Patel said. “Once that was adjusted, we were able to proceed with the appointment.”

Educating older adults on how to use health technology does not have to fall upon clinicians and their staff, according to Wehry. She routinely refers her patients to community resources to help them develop digital skills.

Local libraries and community centers often offer digital education. Some retirement communities and assisted living facilities also have tech support personnel or classes available to residents.

Wehry refers some of her patients to the National Digital Equity Center which teaches older adults how to hold a telehealth visit.

Roughly 90% of Patel’s patients are signed up for the patient portal, but they may not be operating the technology, she said. She advises these patients to ask their children or caregivers for help as appropriate. 

Teaching patients to use the communication technology early on can also be helpful in other ways. If patients who have been technologically proficient start having difficulty, “it’s a clue there may be cognitive changes, and we follow up on those,” Patel said.

Additional resources to help older adults develop digital competence include Cyber Seniors, Older Adults Technology Services, AARP, AARP Find Digital Courses, Area Agencies on Aging, and Senior Navigator.
 

Human Touch

Some older adults may simply want a more traditional means of communicating with their clinician. A review of 29 papers, encompassing over 6200 adults older than 60 years, identified several domains affecting the adoption of healthcare technology, two of which were resistance to new technology and having family or friends that could help with.

Wehry said many older adults “don’t resist this technology because they’re unable to figure out how to use it. Instead, they see the technology as too impersonal.”

One study found many older adults fear technologies may end up replacing face-to-face contact.

“I’m beginning to encourage primary care providers to take a step back and refocus on the doctor-patient relationship. When communication is limited to the technological approach, it can erode trust in that relationship,” Wehry said.

The American Medical Association recommends clinicians “provide a method other than electronic communication for patients who are without technological proficiency or access.”

Some busy clinicians might be concerned phone calls will be too time-consuming, Wehry said. Patients should be informed of hours of phone availability, how much time is allotted to calls, and how many days or hours a response may take. Clinicians might also use tools that allow patients to use their cell phone to text their practice with medical questions.

Cavanaugh ended up finding technological help from a professional organizer whom she hired to help rearrange her closets.

“She’s knowledgeable and patient, and she’s helping me with the portal,” she said. “If I hadn’t serendipitously found the organizer, I’d still be struggling and unable to access proper medical care.”

Wehry and Patel disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Beth Cavanaugh, 79, was starting a new medication when she ran into a modern hurdle: Her doctor’s office required all follow–up questions, even those about side effects of the drug, to go through the patient portal.

Cavanaugh said she did not know how to set up or use the system.

“I tried to explain that, but the receptionist said that was the only way to contact the doctor. I felt lost,” said Cavanaugh, a retired psychotherapist near Albany, New York.

Cavanaugh is far from alone. Many older people balk at the idea of communicating with their physicians over the internet. They may have limited digital skills, have physical challenges, or simply prefer human connection.

As medicine leans harder on electronic portals and telehealth, these patients are finding themselves shut out of their own care. Experts warn this approach deepens inequities in access to care and can worsen health outcomes.

Clinicians should “offer options for various types of communication, such as phone calls or texts, because whenever an older adult — or anyone, for that matter — is given a choice, they feel more empowered and more committed to their care,” said Susan Wehry, MD, associate clinical professor at the University of New England College of Osteopathic Medicine in Biddeford, Maine.
 

Tech Support

Use of medical communication tools varies among older adults. One study in JAMA Network Open found nearly two thirds of those older than 65 years who filled out surveys via phone or internet had used a patient portal, while a little under half used telehealth, and only 44% used a medical health application.

Older patients tend to fall into two camps, said Neela Patel, MD, MPH, CMD, chief of the Division of Geriatrics and Supportive Care at the UT Health San Antonio.

Her patients “are at two extremes of the spectrum — some technologically savvy and others with limited digital literacy or limited or no access to the Internet,” Patel, who is also the vice chair of the Health Systems Innovations and Technology Committee of the American Geriatric Society, said.

Patel’s practice has dedicated staff to help patients master certain technologies. For example, a pharmacist teaches patients how to use a glucometer and a blood pressure cuff. Other staff teach them how to use smartphone apps that track blood pressure or glucose.

She usually sees patients in person before offering telehealth as an option, ensuring the person has “enough digital literacy to utilize them and that the patient can see and hear the visit.”

If technological limitations impede a telehealth appointment, clinicians can help patients navigate their computer screen. Patel recounted the story of an older woman who was unable to come to the clinic in person, so had a telehealth visit instead.

“She had trouble hearing me, so I asked her to share her screen with me. I walked her through how to do that. Then I showed her where the ‘volume’ button was located. It turns out her volume was at zero,” Patel said. “Once that was adjusted, we were able to proceed with the appointment.”

Educating older adults on how to use health technology does not have to fall upon clinicians and their staff, according to Wehry. She routinely refers her patients to community resources to help them develop digital skills.

Local libraries and community centers often offer digital education. Some retirement communities and assisted living facilities also have tech support personnel or classes available to residents.

Wehry refers some of her patients to the National Digital Equity Center which teaches older adults how to hold a telehealth visit.

Roughly 90% of Patel’s patients are signed up for the patient portal, but they may not be operating the technology, she said. She advises these patients to ask their children or caregivers for help as appropriate. 

Teaching patients to use the communication technology early on can also be helpful in other ways. If patients who have been technologically proficient start having difficulty, “it’s a clue there may be cognitive changes, and we follow up on those,” Patel said.

Additional resources to help older adults develop digital competence include Cyber Seniors, Older Adults Technology Services, AARP, AARP Find Digital Courses, Area Agencies on Aging, and Senior Navigator.
 

Human Touch

Some older adults may simply want a more traditional means of communicating with their clinician. A review of 29 papers, encompassing over 6200 adults older than 60 years, identified several domains affecting the adoption of healthcare technology, two of which were resistance to new technology and having family or friends that could help with.

Wehry said many older adults “don’t resist this technology because they’re unable to figure out how to use it. Instead, they see the technology as too impersonal.”

One study found many older adults fear technologies may end up replacing face-to-face contact.

“I’m beginning to encourage primary care providers to take a step back and refocus on the doctor-patient relationship. When communication is limited to the technological approach, it can erode trust in that relationship,” Wehry said.

The American Medical Association recommends clinicians “provide a method other than electronic communication for patients who are without technological proficiency or access.”

Some busy clinicians might be concerned phone calls will be too time-consuming, Wehry said. Patients should be informed of hours of phone availability, how much time is allotted to calls, and how many days or hours a response may take. Clinicians might also use tools that allow patients to use their cell phone to text their practice with medical questions.

Cavanaugh ended up finding technological help from a professional organizer whom she hired to help rearrange her closets.

“She’s knowledgeable and patient, and she’s helping me with the portal,” she said. “If I hadn’t serendipitously found the organizer, I’d still be struggling and unable to access proper medical care.”

Wehry and Patel disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Beth Cavanaugh, 79, was starting a new medication when she ran into a modern hurdle: Her doctor’s office required all follow–up questions, even those about side effects of the drug, to go through the patient portal.

Cavanaugh said she did not know how to set up or use the system.

“I tried to explain that, but the receptionist said that was the only way to contact the doctor. I felt lost,” said Cavanaugh, a retired psychotherapist near Albany, New York.

Cavanaugh is far from alone. Many older people balk at the idea of communicating with their physicians over the internet. They may have limited digital skills, have physical challenges, or simply prefer human connection.

As medicine leans harder on electronic portals and telehealth, these patients are finding themselves shut out of their own care. Experts warn this approach deepens inequities in access to care and can worsen health outcomes.

Clinicians should “offer options for various types of communication, such as phone calls or texts, because whenever an older adult — or anyone, for that matter — is given a choice, they feel more empowered and more committed to their care,” said Susan Wehry, MD, associate clinical professor at the University of New England College of Osteopathic Medicine in Biddeford, Maine.
 

Tech Support

Use of medical communication tools varies among older adults. One study in JAMA Network Open found nearly two thirds of those older than 65 years who filled out surveys via phone or internet had used a patient portal, while a little under half used telehealth, and only 44% used a medical health application.

Older patients tend to fall into two camps, said Neela Patel, MD, MPH, CMD, chief of the Division of Geriatrics and Supportive Care at the UT Health San Antonio.

Her patients “are at two extremes of the spectrum — some technologically savvy and others with limited digital literacy or limited or no access to the Internet,” Patel, who is also the vice chair of the Health Systems Innovations and Technology Committee of the American Geriatric Society, said.

Patel’s practice has dedicated staff to help patients master certain technologies. For example, a pharmacist teaches patients how to use a glucometer and a blood pressure cuff. Other staff teach them how to use smartphone apps that track blood pressure or glucose.

She usually sees patients in person before offering telehealth as an option, ensuring the person has “enough digital literacy to utilize them and that the patient can see and hear the visit.”

If technological limitations impede a telehealth appointment, clinicians can help patients navigate their computer screen. Patel recounted the story of an older woman who was unable to come to the clinic in person, so had a telehealth visit instead.

“She had trouble hearing me, so I asked her to share her screen with me. I walked her through how to do that. Then I showed her where the ‘volume’ button was located. It turns out her volume was at zero,” Patel said. “Once that was adjusted, we were able to proceed with the appointment.”

Educating older adults on how to use health technology does not have to fall upon clinicians and their staff, according to Wehry. She routinely refers her patients to community resources to help them develop digital skills.

Local libraries and community centers often offer digital education. Some retirement communities and assisted living facilities also have tech support personnel or classes available to residents.

Wehry refers some of her patients to the National Digital Equity Center which teaches older adults how to hold a telehealth visit.

Roughly 90% of Patel’s patients are signed up for the patient portal, but they may not be operating the technology, she said. She advises these patients to ask their children or caregivers for help as appropriate. 

Teaching patients to use the communication technology early on can also be helpful in other ways. If patients who have been technologically proficient start having difficulty, “it’s a clue there may be cognitive changes, and we follow up on those,” Patel said.

Additional resources to help older adults develop digital competence include Cyber Seniors, Older Adults Technology Services, AARP, AARP Find Digital Courses, Area Agencies on Aging, and Senior Navigator.
 

Human Touch

Some older adults may simply want a more traditional means of communicating with their clinician. A review of 29 papers, encompassing over 6200 adults older than 60 years, identified several domains affecting the adoption of healthcare technology, two of which were resistance to new technology and having family or friends that could help with.

Wehry said many older adults “don’t resist this technology because they’re unable to figure out how to use it. Instead, they see the technology as too impersonal.”

One study found many older adults fear technologies may end up replacing face-to-face contact.

“I’m beginning to encourage primary care providers to take a step back and refocus on the doctor-patient relationship. When communication is limited to the technological approach, it can erode trust in that relationship,” Wehry said.

The American Medical Association recommends clinicians “provide a method other than electronic communication for patients who are without technological proficiency or access.”

Some busy clinicians might be concerned phone calls will be too time-consuming, Wehry said. Patients should be informed of hours of phone availability, how much time is allotted to calls, and how many days or hours a response may take. Clinicians might also use tools that allow patients to use their cell phone to text their practice with medical questions.

Cavanaugh ended up finding technological help from a professional organizer whom she hired to help rearrange her closets.

“She’s knowledgeable and patient, and she’s helping me with the portal,” she said. “If I hadn’t serendipitously found the organizer, I’d still be struggling and unable to access proper medical care.”

Wehry and Patel disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs) with remote providers delivering virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program value extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach incorporated templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, and Chief Mental Health Officers overseeing facility-based services.

• Regional leaders interacted through executive meetings to ensure appropriate mental health practitioner assignment and service delivery to facilities in need.

TAKEAWAY:

• The Clinical Resource Hub program demonstrated 3 key values: enhanced integration compared to community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioner could work virtually across multiple healthcare systems, with options for hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives of CRH value suggest the program is more than a contingency staffing solution to MH care access problems, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

 LIMITATIONS: The researchers identified lower productivity among Clinical Resource Hub staff compared to facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs) with remote providers delivering virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program value extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach incorporated templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, and Chief Mental Health Officers overseeing facility-based services.

• Regional leaders interacted through executive meetings to ensure appropriate mental health practitioner assignment and service delivery to facilities in need.

TAKEAWAY:

• The Clinical Resource Hub program demonstrated 3 key values: enhanced integration compared to community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioner could work virtually across multiple healthcare systems, with options for hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives of CRH value suggest the program is more than a contingency staffing solution to MH care access problems, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

 LIMITATIONS: The researchers identified lower productivity among Clinical Resource Hub staff compared to facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs) with remote providers delivering virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program value extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach incorporated templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, and Chief Mental Health Officers overseeing facility-based services.

• Regional leaders interacted through executive meetings to ensure appropriate mental health practitioner assignment and service delivery to facilities in need.

TAKEAWAY:

• The Clinical Resource Hub program demonstrated 3 key values: enhanced integration compared to community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioner could work virtually across multiple healthcare systems, with options for hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives of CRH value suggest the program is more than a contingency staffing solution to MH care access problems, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

 LIMITATIONS: The researchers identified lower productivity among Clinical Resource Hub staff compared to facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Psychiatric disorders affect 37.8% of veteran vs 37.3% of nonveteran in a study of > 42,000 women aged ≥ 65 years. Most differences between veterans and nonveterans were statistically insignificant after removing confounders.

METHODOLOGY: 

• Researchers analyzed 42,031 Women's Health Initiative (WHI) participants aged > 65 years at enrollment (1993-1998), including 1,512 veterans and 40,519 non-veterans, through linked WHI-Medicare databases with approximately 15 years of follow-up.

• Analysis included multivariable logistic and Cox regression models to evaluate characteristics associated with prevalent and incident psychiatric disorders, respectively.

• Participants were followed from WHI enrollment until first psychiatric diagnosis, with censoring at death, end of follow-up, or December 31, 2013.

• Investigators examined relationships between individual-level and neighborhood-level socioeconomic status indicators with psychiatric disorders before and after stratification by veteran status.

TAKEAWAY:

• The overall prevalence of psychiatric disorders was 37.3%, with an incidence rate of 25.5 per 1,000 person-years, showing no significant differences between veterans and non-veterans (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.85-0.06).

• There was a higher prevalence of psychiatric disorders for women veterans with technical, sales, or administrative occupations (adjusted OR [aOR], 1.72; 95 % CI, 1.02, 2.89) and those with “other” occupations (aOR, 2.09; 95 % CI, 1.13, 3.88) when compared with women veterans with managerial or professional occupations.

• Mood and anxiety disorders emerged as the leading types of psychiatric conditions among both veteran and nonveteran women.

IN PRACTICE: "Although interaction effects by veteran status were nonsignificant,” the authors of the study explained, “lower education, household income, and neighborhood socioeconomic status were associated with higher frequencies of psychiatric disorders only among women non-veterans.”

SOURCE: The study was led by Jack Tsai and the US Department of Veterans Affairs National Center on Homelessness Among Veterans in Washington, DC. It was published online in Journal of Affective Disorders.

LIMITATIONS: The study faced several limitations including potential selection and survival biases, as findings correspond only to Women's Health Initiative participants who survived until age 65 or later. Information bias likely occurred due to self-reported measures and sole reliance on International Classification of Disease, 9th revision, Clinical Modification diagnostic codes from Medicare claims. Additionally, socioeconomic status indicators assessed at enrollment may not reflect early life or midlife exposures that could influence psychiatric diagnoses.

 DISCLOSURES: The Women’s Health Initiative program received funding from the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through grants 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Psychiatric disorders affect 37.8% of veteran vs 37.3% of nonveteran in a study of > 42,000 women aged ≥ 65 years. Most differences between veterans and nonveterans were statistically insignificant after removing confounders.

METHODOLOGY: 

• Researchers analyzed 42,031 Women's Health Initiative (WHI) participants aged > 65 years at enrollment (1993-1998), including 1,512 veterans and 40,519 non-veterans, through linked WHI-Medicare databases with approximately 15 years of follow-up.

• Analysis included multivariable logistic and Cox regression models to evaluate characteristics associated with prevalent and incident psychiatric disorders, respectively.

• Participants were followed from WHI enrollment until first psychiatric diagnosis, with censoring at death, end of follow-up, or December 31, 2013.

• Investigators examined relationships between individual-level and neighborhood-level socioeconomic status indicators with psychiatric disorders before and after stratification by veteran status.

TAKEAWAY:

• The overall prevalence of psychiatric disorders was 37.3%, with an incidence rate of 25.5 per 1,000 person-years, showing no significant differences between veterans and non-veterans (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.85-0.06).

• There was a higher prevalence of psychiatric disorders for women veterans with technical, sales, or administrative occupations (adjusted OR [aOR], 1.72; 95 % CI, 1.02, 2.89) and those with “other” occupations (aOR, 2.09; 95 % CI, 1.13, 3.88) when compared with women veterans with managerial or professional occupations.

• Mood and anxiety disorders emerged as the leading types of psychiatric conditions among both veteran and nonveteran women.

IN PRACTICE: "Although interaction effects by veteran status were nonsignificant,” the authors of the study explained, “lower education, household income, and neighborhood socioeconomic status were associated with higher frequencies of psychiatric disorders only among women non-veterans.”

SOURCE: The study was led by Jack Tsai and the US Department of Veterans Affairs National Center on Homelessness Among Veterans in Washington, DC. It was published online in Journal of Affective Disorders.

LIMITATIONS: The study faced several limitations including potential selection and survival biases, as findings correspond only to Women's Health Initiative participants who survived until age 65 or later. Information bias likely occurred due to self-reported measures and sole reliance on International Classification of Disease, 9th revision, Clinical Modification diagnostic codes from Medicare claims. Additionally, socioeconomic status indicators assessed at enrollment may not reflect early life or midlife exposures that could influence psychiatric diagnoses.

 DISCLOSURES: The Women’s Health Initiative program received funding from the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through grants 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Psychiatric disorders affect 37.8% of veteran vs 37.3% of nonveteran in a study of > 42,000 women aged ≥ 65 years. Most differences between veterans and nonveterans were statistically insignificant after removing confounders.

METHODOLOGY: 

• Researchers analyzed 42,031 Women's Health Initiative (WHI) participants aged > 65 years at enrollment (1993-1998), including 1,512 veterans and 40,519 non-veterans, through linked WHI-Medicare databases with approximately 15 years of follow-up.

• Analysis included multivariable logistic and Cox regression models to evaluate characteristics associated with prevalent and incident psychiatric disorders, respectively.

• Participants were followed from WHI enrollment until first psychiatric diagnosis, with censoring at death, end of follow-up, or December 31, 2013.

• Investigators examined relationships between individual-level and neighborhood-level socioeconomic status indicators with psychiatric disorders before and after stratification by veteran status.

TAKEAWAY:

• The overall prevalence of psychiatric disorders was 37.3%, with an incidence rate of 25.5 per 1,000 person-years, showing no significant differences between veterans and non-veterans (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.85-0.06).

• There was a higher prevalence of psychiatric disorders for women veterans with technical, sales, or administrative occupations (adjusted OR [aOR], 1.72; 95 % CI, 1.02, 2.89) and those with “other” occupations (aOR, 2.09; 95 % CI, 1.13, 3.88) when compared with women veterans with managerial or professional occupations.

• Mood and anxiety disorders emerged as the leading types of psychiatric conditions among both veteran and nonveteran women.

IN PRACTICE: "Although interaction effects by veteran status were nonsignificant,” the authors of the study explained, “lower education, household income, and neighborhood socioeconomic status were associated with higher frequencies of psychiatric disorders only among women non-veterans.”

SOURCE: The study was led by Jack Tsai and the US Department of Veterans Affairs National Center on Homelessness Among Veterans in Washington, DC. It was published online in Journal of Affective Disorders.

LIMITATIONS: The study faced several limitations including potential selection and survival biases, as findings correspond only to Women's Health Initiative participants who survived until age 65 or later. Information bias likely occurred due to self-reported measures and sole reliance on International Classification of Disease, 9th revision, Clinical Modification diagnostic codes from Medicare claims. Additionally, socioeconomic status indicators assessed at enrollment may not reflect early life or midlife exposures that could influence psychiatric diagnoses.

 DISCLOSURES: The Women’s Health Initiative program received funding from the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through grants 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.

After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”

Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”

And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders. 

Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.

In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds. 

Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.

The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.

Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said. 

Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”

On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.

After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”

Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”

And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders. 

Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.

In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds. 

Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.

The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.

Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said. 

Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”

On Nov. 22, 2014, 8 years after he came back from Iraq with “crippling” posttraumatic stress disorder (PTSD), Jonathan Lubecky took his first dose of the psychedelic compound methylenedioxymethamphetamine (MDMA). Lubecky, a Marine, Army, and National Guard veteran, described his path to MDMA therapy in in the New Horizons in Health podcast.

After 5 suicide attempts and “the hundreds of times I thought about it or stood on a bridge or had a plan,” he felt he had run out of options. Then, in a counseling session, a psychiatric intern slid a piece of paper across the table to him. It read “Google MDMA PTSD.”

Luckily for Lubecky, a space in a clinical trial opened up, in which he had 8 hours of talk therapy with specially trained therapists, combined with MDMA. “MDMA is a tool that opens up the mind, body and spirit,” he said, “so you can heal and process all those memories and traumas that are causing yourissues. It puts you in a middle place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.” said he added, “It’s like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.” In 2023, 9 years after that first dose, Lubecky said, “I’ve been PTSD free longer than I had it.”

And now, in 2025, the research into psychedelic therapy for veterans like Lubecky is taking another step forward according to a report by Military.com. Nine VA facilities, in the Bronx, Los Angeles, Omaha, Palo Alto, Portland (Oregon), San Diego, San Francisco, West Haven, and White River Junction, are participating in long-term studies to test the safety and clinical impact of psychedelic compounds for PTSD, treatment-resistant depression, and anxiety disorders. 

Early trials from Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and others found significant symptom reductions for some participants with chronic PTSD. MAPP2, the multisite phase 3 study that extended the findings of MAPP1, found that MDMA-assisted therapy significantly improved PTSD symptoms and functional impairment, compared with placebo-assisted therapy. Notably, of the 52 participants (including 16 veterans) 45 (86%) achieved a clinically meaningful benefit, and 37 (71%) no longer met criteria for PTSD by study end. Despite the promising findings, a US Food and Drug Administration (FDA) advisory panel recommended against approving the treatment.

In 2024 the VA issued a request for applications for proposals from its network of VA researchers and academic institutions to gather “definitive scientific evidence” on the potential efficacy and safety of psychedelic compounds, such as MDMA and psilocybin, when used in conjunction with psychotherapy. It would be the first time since the 1960s that the VA had funded research on such compounds. 

Funding proposals for such research have cycled in and out of Congress for years, but have gathered more steam in the last few years. The 2024 National Defense Authorization Act directed the US Department of Defense to establish a process for funding clinical research into the use of certain psychedelic substances to treat PTSD and traumatic brain injury. In April 2024, Representatives Lou Correa (D-CA) and Jack Bergman (R-MI), cochairs of the Psychedelics Advancing Therapies (PATH) caucus, introduced the Innovative Therapies Centers of Excellence Act of 2025, bipartisan legislation that would increase federally funded research on innovative therapies to treat veterans with PTSD, substance use disorder, and depression. It would also, if enacted, direct the VA to create ≥ 5 dedicated centers of excellence to study the therapeutic uses of psychedelic substances. The bill has also been endorsed by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, and the Wounded Warrior Project.

The current administration has two strong high-level supporters of psychedelics research: VA Secretary Doug Collins and US Department of Health and Human Service Secretary Robert F. Kennedy Jr. Sec. Kennedy has castigated the FDA for what he calls “aggressive suppression” of alternative and complementary treatments, including psychedelics. This, although the FDA granted breakthrough therapy status for MDMA for treating PTSD and psilocybin for treating depression in 2018 and 2019, respectively, as well a pivotal draft guidance in 2023 for the development of psychedelic drugs for psychiatric disorders, substance use disorders, and various medical conditions.

Collins, citing an “eye-opening” discussion with Kennedy, enthusiastically backs the research into psychedelics. In a May 2025 hearing that was mainly a series of testy exchanges about his proposed budget slashing, he emphasized the importance of keeping and expanding VA programs and studies on psychedelic treatments, something he has been advocating for since the beginning of his appointment. “We want to make sure we’re not closing off any outlet for a veteran who could be helped by these programs,” he said. 

Taking the intern’s advice to look into MDMA, Jonathan Lubecky said, was one of the best decisions he’d ever made. But “it’s not the MDMA that fixes you,” he said. “It’s the therapy. It’s the therapist working with you and you doing the hard work.”

TOPLINE: Agent Orange exposure was associated with a 26% to 71% increased risk for multiple lymphoid cancers in veterans enrolled in the US Department of Veterans Affairs (VA) Million Veterans Program (MVP), while genetic predisposition independently raised risk by 12% to 81% across different lymphoma subtypes. A case-controlled analysis of 255,155 veterans found no significant interaction between genetic risk scores and Agent Orange exposure.

METHODOLOGY:

• A case-control study included 255,155 non-Hispanic White veterans (median age 67 years, 92.5% male) enrolled in the VA MVP with genotype and Agent Orange exposure data.

• Researchers analyzed five lymphoid malignant neoplasm subtypes: chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma diagnosed from January 1965 through June 2024.

• Agent Orange exposure was determined through self-reported survey responses, while polygenic risk scores were derived from genome-wide association studies of lymphoid malignant neoplasms.

• Analysis included adjustments for age at enrollment, sex, and the first 10 genetic principal components in logistic regression models evaluating Agent Orange exposure, polygenic risk scores, and their potential interaction.

TAKEAWAY:

• Agent Orange exposure significantly increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% CI, 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).

• Polygenic risk scores were independently associated with all lymphoma subtypes, with strongest associations for chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93) and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).

• Analysis in African American participants showed similar associations for multiple myeloma with both Agent Orange exposure (OR, 1.56; 95% CI, 1.18-2.07) and polygenic risk scores (OR, 1.31; 95% CI, 1.15-1.49).

• According to the researchers, no significant polygenic risk score and Agent Orange exposure interactions were observed for any lymphoma subtype.

IN PRACTICE: "Our study addressed the public health concerns surrounding Agent Orange exposure and lymphoid malignant neoplasms, finding that both Agent Orange exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, Irvine and the Tibor Rubin Veterans Affairs Medical Center, Long Beach, Californiaand was published online on August 13 in JAMA Network Open.

LIMITATIONS: According to the authors, while this represents the largest case-control study of Agent Orange exposure and lymphoid malignant neoplasm risk, the power to detect interaction associations in specific subtypes might be limited. Self-reported Agent Orange exposure data may have introduced survival bias, particularly in aggressive subtypes, as patients with aggressive tumors may have died before joining the MVP. Additionally, about half of the patients were diagnosed with lymphoid malignant neoplasms before self-reporting Agent Orange exposure, potentially introducing recall bias.

DISCLOSURES: The research was supported by a Veterans Affairs Career Development Award Xueyi Teng, PhD, received grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Agent Orange exposure was associated with a 26% to 71% increased risk for multiple lymphoid cancers in veterans enrolled in the US Department of Veterans Affairs (VA) Million Veterans Program (MVP), while genetic predisposition independently raised risk by 12% to 81% across different lymphoma subtypes. A case-controlled analysis of 255,155 veterans found no significant interaction between genetic risk scores and Agent Orange exposure.

METHODOLOGY:

• A case-control study included 255,155 non-Hispanic White veterans (median age 67 years, 92.5% male) enrolled in the VA MVP with genotype and Agent Orange exposure data.

• Researchers analyzed five lymphoid malignant neoplasm subtypes: chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma diagnosed from January 1965 through June 2024.

• Agent Orange exposure was determined through self-reported survey responses, while polygenic risk scores were derived from genome-wide association studies of lymphoid malignant neoplasms.

• Analysis included adjustments for age at enrollment, sex, and the first 10 genetic principal components in logistic regression models evaluating Agent Orange exposure, polygenic risk scores, and their potential interaction.

TAKEAWAY:

• Agent Orange exposure significantly increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% CI, 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).

• Polygenic risk scores were independently associated with all lymphoma subtypes, with strongest associations for chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93) and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).

• Analysis in African American participants showed similar associations for multiple myeloma with both Agent Orange exposure (OR, 1.56; 95% CI, 1.18-2.07) and polygenic risk scores (OR, 1.31; 95% CI, 1.15-1.49).

• According to the researchers, no significant polygenic risk score and Agent Orange exposure interactions were observed for any lymphoma subtype.

IN PRACTICE: "Our study addressed the public health concerns surrounding Agent Orange exposure and lymphoid malignant neoplasms, finding that both Agent Orange exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, Irvine and the Tibor Rubin Veterans Affairs Medical Center, Long Beach, Californiaand was published online on August 13 in JAMA Network Open.

LIMITATIONS: According to the authors, while this represents the largest case-control study of Agent Orange exposure and lymphoid malignant neoplasm risk, the power to detect interaction associations in specific subtypes might be limited. Self-reported Agent Orange exposure data may have introduced survival bias, particularly in aggressive subtypes, as patients with aggressive tumors may have died before joining the MVP. Additionally, about half of the patients were diagnosed with lymphoid malignant neoplasms before self-reporting Agent Orange exposure, potentially introducing recall bias.

DISCLOSURES: The research was supported by a Veterans Affairs Career Development Award Xueyi Teng, PhD, received grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Agent Orange exposure was associated with a 26% to 71% increased risk for multiple lymphoid cancers in veterans enrolled in the US Department of Veterans Affairs (VA) Million Veterans Program (MVP), while genetic predisposition independently raised risk by 12% to 81% across different lymphoma subtypes. A case-controlled analysis of 255,155 veterans found no significant interaction between genetic risk scores and Agent Orange exposure.

METHODOLOGY:

• A case-control study included 255,155 non-Hispanic White veterans (median age 67 years, 92.5% male) enrolled in the VA MVP with genotype and Agent Orange exposure data.

• Researchers analyzed five lymphoid malignant neoplasm subtypes: chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma diagnosed from January 1965 through June 2024.

• Agent Orange exposure was determined through self-reported survey responses, while polygenic risk scores were derived from genome-wide association studies of lymphoid malignant neoplasms.

• Analysis included adjustments for age at enrollment, sex, and the first 10 genetic principal components in logistic regression models evaluating Agent Orange exposure, polygenic risk scores, and their potential interaction.

TAKEAWAY:

• Agent Orange exposure significantly increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% CI, 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).

• Polygenic risk scores were independently associated with all lymphoma subtypes, with strongest associations for chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93) and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).

• Analysis in African American participants showed similar associations for multiple myeloma with both Agent Orange exposure (OR, 1.56; 95% CI, 1.18-2.07) and polygenic risk scores (OR, 1.31; 95% CI, 1.15-1.49).

• According to the researchers, no significant polygenic risk score and Agent Orange exposure interactions were observed for any lymphoma subtype.

IN PRACTICE: "Our study addressed the public health concerns surrounding Agent Orange exposure and lymphoid malignant neoplasms, finding that both Agent Orange exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, Irvine and the Tibor Rubin Veterans Affairs Medical Center, Long Beach, Californiaand was published online on August 13 in JAMA Network Open.

LIMITATIONS: According to the authors, while this represents the largest case-control study of Agent Orange exposure and lymphoid malignant neoplasm risk, the power to detect interaction associations in specific subtypes might be limited. Self-reported Agent Orange exposure data may have introduced survival bias, particularly in aggressive subtypes, as patients with aggressive tumors may have died before joining the MVP. Additionally, about half of the patients were diagnosed with lymphoid malignant neoplasms before self-reporting Agent Orange exposure, potentially introducing recall bias.

DISCLOSURES: The research was supported by a Veterans Affairs Career Development Award Xueyi Teng, PhD, received grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Abiraterone and enzalutamide showed identical survival outcomes when used as first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC), according to a new study using US Department of Veterans Affairs (VA) data. The report represents the first head-to-head clinical analysis of these commonly used androgen receptor inhibitors.

Among 1258 veterans treated with abiraterone and 311 treated with enzalutamide, median overall survival was 36.2 months for both drugs. Patients were followed for a mean of 28.7 months (abiraterone) and 30.8 months (enzalutamide), reported by Martin W. Schoen, MD, MPH, from Saint Louis University School of Medicine and the St. Louis VA Medical Center, in JAMA Network Open. 

Notably, there was no significant difference in outcomes among Black veterans, who often have poorer outcomes in prostate cancer, and in patients with cardiovascular disease.

“This is the first direct comparison of abiraterone and enzalutamide for mHSPC in a clinical practice setting,” Schoen told Federal Practitioner. “At the population level, there are no differences based on initial treatment choice.”

Abiraterone Is Preferred in the VA Due to Cost

According to Schoen, abiraterone and enzalutamide are the most commonly used androgen receptor inhibitors to treat mHSPC within the VA. A 2025 study by Schoen and colleagues found that 53.7% of veterans with mHSPC in 2022 received androgen receptor inhibitor therapy, up from 16.9% in 2017. 

“In the VA, the preference for most patients is abiraterone since it is the least expensive agent,” he said. A generic version has been available for several years.

Additionally, abiraterone “has been on the market for the longest, and therefore clinicians are familiar with its use,” Schoen said. However, “clinicians have little idea of the comparative efficacy between these 2 agents,” he added.

The authors suggest that the cost and toxicities of the medications should guide clinician decisions, Schoen said. “There is data that abiraterone may worsen diabetes, since it is given with prednisone and could increase the risk of cardiovascular events,” he said.

He added that 2 newer drugs, apalutamide and darolutamide, are also “viable options.” Chemotherapies and certain targeted drugs are also available, “but they are only used in a select group of patients.”

Outside Specialist: Diverse Study Population Is a Plus

Hematologist-oncologist Natalie Reizine, MD, of the University of Illinois College of Medicine, Chicago, who was not involved in the study, told Federal Practitioner that the real-world data are valuable given the limitations of clinical trial populations.

“It’s difficult to compare clinical trials because they enroll different groups of patients,” she said. And, she said, they often exclude patients with significant comorbidities. “If they have bad cardiovascular disease, for instance, or poorly controlled diabetes, they're excluded from the clinical trial. But in real life, many of our patients have other medical problems that we have to manage.”

Reizine also emphasized the significance of the study’s diverse patient population. “Black men are very underrepresented in clinical trials. Many clinical trials that lead to drug approval will have only few or no Black men at all, yet these drugs go on to be widely prescribed to all men with prostate cancer.”

Results Are ‘Reassuring’

Reizine described the overall study findings as “reassuring,” especially in light of “studies that show that abiraterone and prednisone may be associated with worse cardiovascular outcomes. This study showed that in this VA population, even for patients who had cardiovascular disease, there was not a difference in how they did.”

As for choosing between agents, she recommended considering comorbidities and potential drug-drug interactions. “One of the big reasons that you may not be able to safely prescribe enzalutamide, for instance, is if a patient is on an anticoagulant, which is incredibly common in cancer patients. Enzalutamide has more drug-drug interactions than abiraterone and prednisone.” 

Study Demographics and Findings

The study included all patients with mHSPC who initiated abiraterone or enzalutamide between July 2017 and April 2023.

Median ages were 73 (abiraterone) and 74 years (enzalutamide, P = .29). Racial distribution was similar between groups: abiraterone (68.1% White, 25.0% Black, 6.9% other/unknown) and enzalutamide (66.6% White, 27.0% Black, 6.4% other/unknown; P = .74). Ethnicity was 89.2% non-Hispanic, 4.4% Hispanic, and 6.4% unknown in the abiraterone group vs 88.4% non-Hispanic, 3.5% Hispanic, and 8.0% unknown in the enzalutamide group (P = .50).

The groups had similar rates of the most common comorbidities: diabetes (40.5% vs 46.3%, respectively, P = .07), peripheral vascular disease (40.2% vs 37.6%, respectively, P = .44), and chronic pulmonary disease (37.0% vs 40.5%, P = .29).

In an inverse probability weighting analysis with abiraterone as reference, weighted median overall survival was comparable across the entire cohort (36.2 months, P = .32), Black veterans (39.7 months, P = .90), and those with cardiovascular disease (31.5 months, P = .30).

The authors noted limitations such as the observational cohort design and data constraints. 

The study was supported by the American Society of Clinical Oncology Conquer Cancer Foundation, the Prostate Cancer Foundation, and the Blavatnik Family Foundation.

Schoen discloses relationships with the Prostate Cancer Foundation, Astellas, and US Department of Defense. Other authors disclose relationships with the American Society of Clinical Oncology, Pfizer, Exelixis, Eli Lilly, Sanofi, Merck, Seagen, Bellicum, and BMS.

Outside the submitted work. Reizine discloses relationships with the US Department of Defense, Sanofi, Exelexis, Janssen, AstraZeneca, EMD Serono, Janssen, Merck, and Tempus.

Abiraterone and enzalutamide showed identical survival outcomes when used as first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC), according to a new study using US Department of Veterans Affairs (VA) data. The report represents the first head-to-head clinical analysis of these commonly used androgen receptor inhibitors.

Among 1258 veterans treated with abiraterone and 311 treated with enzalutamide, median overall survival was 36.2 months for both drugs. Patients were followed for a mean of 28.7 months (abiraterone) and 30.8 months (enzalutamide), reported by Martin W. Schoen, MD, MPH, from Saint Louis University School of Medicine and the St. Louis VA Medical Center, in JAMA Network Open. 

Notably, there was no significant difference in outcomes among Black veterans, who often have poorer outcomes in prostate cancer, and in patients with cardiovascular disease.

“This is the first direct comparison of abiraterone and enzalutamide for mHSPC in a clinical practice setting,” Schoen told Federal Practitioner. “At the population level, there are no differences based on initial treatment choice.”

Abiraterone Is Preferred in the VA Due to Cost

According to Schoen, abiraterone and enzalutamide are the most commonly used androgen receptor inhibitors to treat mHSPC within the VA. A 2025 study by Schoen and colleagues found that 53.7% of veterans with mHSPC in 2022 received androgen receptor inhibitor therapy, up from 16.9% in 2017. 

“In the VA, the preference for most patients is abiraterone since it is the least expensive agent,” he said. A generic version has been available for several years.

Additionally, abiraterone “has been on the market for the longest, and therefore clinicians are familiar with its use,” Schoen said. However, “clinicians have little idea of the comparative efficacy between these 2 agents,” he added.

The authors suggest that the cost and toxicities of the medications should guide clinician decisions, Schoen said. “There is data that abiraterone may worsen diabetes, since it is given with prednisone and could increase the risk of cardiovascular events,” he said.

He added that 2 newer drugs, apalutamide and darolutamide, are also “viable options.” Chemotherapies and certain targeted drugs are also available, “but they are only used in a select group of patients.”

Outside Specialist: Diverse Study Population Is a Plus

Hematologist-oncologist Natalie Reizine, MD, of the University of Illinois College of Medicine, Chicago, who was not involved in the study, told Federal Practitioner that the real-world data are valuable given the limitations of clinical trial populations.

“It’s difficult to compare clinical trials because they enroll different groups of patients,” she said. And, she said, they often exclude patients with significant comorbidities. “If they have bad cardiovascular disease, for instance, or poorly controlled diabetes, they're excluded from the clinical trial. But in real life, many of our patients have other medical problems that we have to manage.”

Reizine also emphasized the significance of the study’s diverse patient population. “Black men are very underrepresented in clinical trials. Many clinical trials that lead to drug approval will have only few or no Black men at all, yet these drugs go on to be widely prescribed to all men with prostate cancer.”

Results Are ‘Reassuring’

Reizine described the overall study findings as “reassuring,” especially in light of “studies that show that abiraterone and prednisone may be associated with worse cardiovascular outcomes. This study showed that in this VA population, even for patients who had cardiovascular disease, there was not a difference in how they did.”

As for choosing between agents, she recommended considering comorbidities and potential drug-drug interactions. “One of the big reasons that you may not be able to safely prescribe enzalutamide, for instance, is if a patient is on an anticoagulant, which is incredibly common in cancer patients. Enzalutamide has more drug-drug interactions than abiraterone and prednisone.” 

Study Demographics and Findings

The study included all patients with mHSPC who initiated abiraterone or enzalutamide between July 2017 and April 2023.

Median ages were 73 (abiraterone) and 74 years (enzalutamide, P = .29). Racial distribution was similar between groups: abiraterone (68.1% White, 25.0% Black, 6.9% other/unknown) and enzalutamide (66.6% White, 27.0% Black, 6.4% other/unknown; P = .74). Ethnicity was 89.2% non-Hispanic, 4.4% Hispanic, and 6.4% unknown in the abiraterone group vs 88.4% non-Hispanic, 3.5% Hispanic, and 8.0% unknown in the enzalutamide group (P = .50).

The groups had similar rates of the most common comorbidities: diabetes (40.5% vs 46.3%, respectively, P = .07), peripheral vascular disease (40.2% vs 37.6%, respectively, P = .44), and chronic pulmonary disease (37.0% vs 40.5%, P = .29).

In an inverse probability weighting analysis with abiraterone as reference, weighted median overall survival was comparable across the entire cohort (36.2 months, P = .32), Black veterans (39.7 months, P = .90), and those with cardiovascular disease (31.5 months, P = .30).

The authors noted limitations such as the observational cohort design and data constraints. 

The study was supported by the American Society of Clinical Oncology Conquer Cancer Foundation, the Prostate Cancer Foundation, and the Blavatnik Family Foundation.

Schoen discloses relationships with the Prostate Cancer Foundation, Astellas, and US Department of Defense. Other authors disclose relationships with the American Society of Clinical Oncology, Pfizer, Exelixis, Eli Lilly, Sanofi, Merck, Seagen, Bellicum, and BMS.

Outside the submitted work. Reizine discloses relationships with the US Department of Defense, Sanofi, Exelexis, Janssen, AstraZeneca, EMD Serono, Janssen, Merck, and Tempus.

Abiraterone and enzalutamide showed identical survival outcomes when used as first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC), according to a new study using US Department of Veterans Affairs (VA) data. The report represents the first head-to-head clinical analysis of these commonly used androgen receptor inhibitors.

Among 1258 veterans treated with abiraterone and 311 treated with enzalutamide, median overall survival was 36.2 months for both drugs. Patients were followed for a mean of 28.7 months (abiraterone) and 30.8 months (enzalutamide), reported by Martin W. Schoen, MD, MPH, from Saint Louis University School of Medicine and the St. Louis VA Medical Center, in JAMA Network Open. 

Notably, there was no significant difference in outcomes among Black veterans, who often have poorer outcomes in prostate cancer, and in patients with cardiovascular disease.

“This is the first direct comparison of abiraterone and enzalutamide for mHSPC in a clinical practice setting,” Schoen told Federal Practitioner. “At the population level, there are no differences based on initial treatment choice.”

Abiraterone Is Preferred in the VA Due to Cost

According to Schoen, abiraterone and enzalutamide are the most commonly used androgen receptor inhibitors to treat mHSPC within the VA. A 2025 study by Schoen and colleagues found that 53.7% of veterans with mHSPC in 2022 received androgen receptor inhibitor therapy, up from 16.9% in 2017. 

“In the VA, the preference for most patients is abiraterone since it is the least expensive agent,” he said. A generic version has been available for several years.

Additionally, abiraterone “has been on the market for the longest, and therefore clinicians are familiar with its use,” Schoen said. However, “clinicians have little idea of the comparative efficacy between these 2 agents,” he added.

The authors suggest that the cost and toxicities of the medications should guide clinician decisions, Schoen said. “There is data that abiraterone may worsen diabetes, since it is given with prednisone and could increase the risk of cardiovascular events,” he said.

He added that 2 newer drugs, apalutamide and darolutamide, are also “viable options.” Chemotherapies and certain targeted drugs are also available, “but they are only used in a select group of patients.”

Outside Specialist: Diverse Study Population Is a Plus

Hematologist-oncologist Natalie Reizine, MD, of the University of Illinois College of Medicine, Chicago, who was not involved in the study, told Federal Practitioner that the real-world data are valuable given the limitations of clinical trial populations.

“It’s difficult to compare clinical trials because they enroll different groups of patients,” she said. And, she said, they often exclude patients with significant comorbidities. “If they have bad cardiovascular disease, for instance, or poorly controlled diabetes, they're excluded from the clinical trial. But in real life, many of our patients have other medical problems that we have to manage.”

Reizine also emphasized the significance of the study’s diverse patient population. “Black men are very underrepresented in clinical trials. Many clinical trials that lead to drug approval will have only few or no Black men at all, yet these drugs go on to be widely prescribed to all men with prostate cancer.”

Results Are ‘Reassuring’

Reizine described the overall study findings as “reassuring,” especially in light of “studies that show that abiraterone and prednisone may be associated with worse cardiovascular outcomes. This study showed that in this VA population, even for patients who had cardiovascular disease, there was not a difference in how they did.”

As for choosing between agents, she recommended considering comorbidities and potential drug-drug interactions. “One of the big reasons that you may not be able to safely prescribe enzalutamide, for instance, is if a patient is on an anticoagulant, which is incredibly common in cancer patients. Enzalutamide has more drug-drug interactions than abiraterone and prednisone.” 

Study Demographics and Findings

The study included all patients with mHSPC who initiated abiraterone or enzalutamide between July 2017 and April 2023.

Median ages were 73 (abiraterone) and 74 years (enzalutamide, P = .29). Racial distribution was similar between groups: abiraterone (68.1% White, 25.0% Black, 6.9% other/unknown) and enzalutamide (66.6% White, 27.0% Black, 6.4% other/unknown; P = .74). Ethnicity was 89.2% non-Hispanic, 4.4% Hispanic, and 6.4% unknown in the abiraterone group vs 88.4% non-Hispanic, 3.5% Hispanic, and 8.0% unknown in the enzalutamide group (P = .50).

The groups had similar rates of the most common comorbidities: diabetes (40.5% vs 46.3%, respectively, P = .07), peripheral vascular disease (40.2% vs 37.6%, respectively, P = .44), and chronic pulmonary disease (37.0% vs 40.5%, P = .29).

In an inverse probability weighting analysis with abiraterone as reference, weighted median overall survival was comparable across the entire cohort (36.2 months, P = .32), Black veterans (39.7 months, P = .90), and those with cardiovascular disease (31.5 months, P = .30).

The authors noted limitations such as the observational cohort design and data constraints. 

The study was supported by the American Society of Clinical Oncology Conquer Cancer Foundation, the Prostate Cancer Foundation, and the Blavatnik Family Foundation.

Schoen discloses relationships with the Prostate Cancer Foundation, Astellas, and US Department of Defense. Other authors disclose relationships with the American Society of Clinical Oncology, Pfizer, Exelixis, Eli Lilly, Sanofi, Merck, Seagen, Bellicum, and BMS.

Outside the submitted work. Reizine discloses relationships with the US Department of Defense, Sanofi, Exelexis, Janssen, AstraZeneca, EMD Serono, Janssen, Merck, and Tempus.

TOPLINE: COVID-19 infection is associated with a 25% reduction in cancer risk over 3 years among veterans who survived the initial infection. This protective effect was observed across sexes and racial groups, with stronger benefits seen in older patients and those with mild disease.

METHODOLOGY: 

• Researchers conducted a retrospective cohort study comparing Veterans who tested positive for COVID-19 between March 15, 2020, and November 30, 2020, to those who tested negative.

• Analysis included 499,396 veterans, with 88,590 (17.2%) COVID-19 positive and 427,566 (82.8%) COVID-19 negative patients, with mean (SD) ages of 57.9 (16.4) and 59.5 (15.8) years, respectively.

• Investigators utilized Cox proportional hazard regression models to determine the hazard ratio of new cancer diagnosis within a three-year follow-up period.

• Patient characteristics included age, race, ethnicity, sex, BMI, smoking status, and various comorbidities as covariates in the analysis.

TAKEAWAY:

• For patients surviving ≥ 30 days after COVID-19 testing, infection was associated with a 25% reduction in cancer hazard (hazard ratio [HR], 0.75; 95% CI, 0.73-0.77).

• The reduction in cancer risk was similar across sexes and races, with the exception of Asians, and showed greater decreases with advancing age above 45 years.

• Patients with mild COVID-19 showed the strongest reduction in cancer risk (adjusted HR, 0.72; 95% CI, 0.70-0.74), while those with moderate COVID-19 showed an 11% reduction (adjusted HR, 0.89; 95% CI, 0.83-0.93), and severe COVID-19 showed no significant reduction in cancer risk.

IN PRACTICE: "Regarding age, the incidence of cancer appeared to decrease with each decade of life in the COVID-19 group com­pared to that in the non-exposed group,” the authors noted. “This is surprising, given that cancer diagnoses typically increase with age.” 

SOURCE: The study was led by researchers at the Miami Veterans Affairs (VA) Healthcare System Geriatric Research, Education, and Clinical Center and was published online on August 25 in PLoS One.

LIMITATIONS: The findings of this retrospective and observational study should be interpreted with caution. Results may not be generalizable beyond the predominantly male, older veteran population. The 3-year follow-up period may be insufficient to fully understand long-term cancer incidence patterns. Researchers could not capture all COVID-19 reinfection cases due to testing occurring outside the Veterans Affairs system, including at-home testing. The impact of vaccination status and reinfection on cancer risk could not be fully assessed, as the initial study cohort was grouped prior to vaccine availability.

DISCLOSURES: The authors report no financial support was received for this study and declare no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: COVID-19 infection is associated with a 25% reduction in cancer risk over 3 years among veterans who survived the initial infection. This protective effect was observed across sexes and racial groups, with stronger benefits seen in older patients and those with mild disease.

METHODOLOGY: 

• Researchers conducted a retrospective cohort study comparing Veterans who tested positive for COVID-19 between March 15, 2020, and November 30, 2020, to those who tested negative.

• Analysis included 499,396 veterans, with 88,590 (17.2%) COVID-19 positive and 427,566 (82.8%) COVID-19 negative patients, with mean (SD) ages of 57.9 (16.4) and 59.5 (15.8) years, respectively.

• Investigators utilized Cox proportional hazard regression models to determine the hazard ratio of new cancer diagnosis within a three-year follow-up period.

• Patient characteristics included age, race, ethnicity, sex, BMI, smoking status, and various comorbidities as covariates in the analysis.

TAKEAWAY:

• For patients surviving ≥ 30 days after COVID-19 testing, infection was associated with a 25% reduction in cancer hazard (hazard ratio [HR], 0.75; 95% CI, 0.73-0.77).

• The reduction in cancer risk was similar across sexes and races, with the exception of Asians, and showed greater decreases with advancing age above 45 years.

• Patients with mild COVID-19 showed the strongest reduction in cancer risk (adjusted HR, 0.72; 95% CI, 0.70-0.74), while those with moderate COVID-19 showed an 11% reduction (adjusted HR, 0.89; 95% CI, 0.83-0.93), and severe COVID-19 showed no significant reduction in cancer risk.

IN PRACTICE: "Regarding age, the incidence of cancer appeared to decrease with each decade of life in the COVID-19 group com­pared to that in the non-exposed group,” the authors noted. “This is surprising, given that cancer diagnoses typically increase with age.” 

SOURCE: The study was led by researchers at the Miami Veterans Affairs (VA) Healthcare System Geriatric Research, Education, and Clinical Center and was published online on August 25 in PLoS One.

LIMITATIONS: The findings of this retrospective and observational study should be interpreted with caution. Results may not be generalizable beyond the predominantly male, older veteran population. The 3-year follow-up period may be insufficient to fully understand long-term cancer incidence patterns. Researchers could not capture all COVID-19 reinfection cases due to testing occurring outside the Veterans Affairs system, including at-home testing. The impact of vaccination status and reinfection on cancer risk could not be fully assessed, as the initial study cohort was grouped prior to vaccine availability.

DISCLOSURES: The authors report no financial support was received for this study and declare no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: COVID-19 infection is associated with a 25% reduction in cancer risk over 3 years among veterans who survived the initial infection. This protective effect was observed across sexes and racial groups, with stronger benefits seen in older patients and those with mild disease.

METHODOLOGY: 

• Researchers conducted a retrospective cohort study comparing Veterans who tested positive for COVID-19 between March 15, 2020, and November 30, 2020, to those who tested negative.

• Analysis included 499,396 veterans, with 88,590 (17.2%) COVID-19 positive and 427,566 (82.8%) COVID-19 negative patients, with mean (SD) ages of 57.9 (16.4) and 59.5 (15.8) years, respectively.

• Investigators utilized Cox proportional hazard regression models to determine the hazard ratio of new cancer diagnosis within a three-year follow-up period.

• Patient characteristics included age, race, ethnicity, sex, BMI, smoking status, and various comorbidities as covariates in the analysis.

TAKEAWAY:

• For patients surviving ≥ 30 days after COVID-19 testing, infection was associated with a 25% reduction in cancer hazard (hazard ratio [HR], 0.75; 95% CI, 0.73-0.77).

• The reduction in cancer risk was similar across sexes and races, with the exception of Asians, and showed greater decreases with advancing age above 45 years.

• Patients with mild COVID-19 showed the strongest reduction in cancer risk (adjusted HR, 0.72; 95% CI, 0.70-0.74), while those with moderate COVID-19 showed an 11% reduction (adjusted HR, 0.89; 95% CI, 0.83-0.93), and severe COVID-19 showed no significant reduction in cancer risk.

IN PRACTICE: "Regarding age, the incidence of cancer appeared to decrease with each decade of life in the COVID-19 group com­pared to that in the non-exposed group,” the authors noted. “This is surprising, given that cancer diagnoses typically increase with age.” 

SOURCE: The study was led by researchers at the Miami Veterans Affairs (VA) Healthcare System Geriatric Research, Education, and Clinical Center and was published online on August 25 in PLoS One.

LIMITATIONS: The findings of this retrospective and observational study should be interpreted with caution. Results may not be generalizable beyond the predominantly male, older veteran population. The 3-year follow-up period may be insufficient to fully understand long-term cancer incidence patterns. Researchers could not capture all COVID-19 reinfection cases due to testing occurring outside the Veterans Affairs system, including at-home testing. The impact of vaccination status and reinfection on cancer risk could not be fully assessed, as the initial study cohort was grouped prior to vaccine availability.

DISCLOSURES: The authors report no financial support was received for this study and declare no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”