Letter to Dr. Steven L. Lieberman, Deputy Under Secretary for Health - Klobuchar, Boozman Request Update from Department of Veterans Affairs on Oncology Care Programs for Female Veterans

Letter

Dear Dr. Lieberman,

We are writing to seek additional information about the outreach and structure of your comprehensive oncology care programs, specifically the Breast and Gynecological Cancers System of Excellence. The Department of Veterans Affairs (VA) has recognized the need to provide further outreach and stability, noting that the department "must position itself to address the potential access needs for rural cancer care, ensuring that rural veterans receive the same state-of-the-art care as their urban counterparts."

For too long, access to oncology care for our nation's two million female veterans has been overlooked. This problem has been particularly acute for women suffering from the after-effects of toxic exposure during their military service. The VA has noted that veterans are nearly 2.5 times more likely to live in rural areas, but only 11.6 percent of oncologists practice in those parts of the country. In states such as Minnesota and Arkansas, over two million residents live in underpopulated areas.

In previous reports and briefings to Congress, the VA noted that a recently-established TeleOncology will help serve cancer patients across the country. This TeleOncology program received $4.5 million in grant funding and works in conjunction with the Breast and Gynecological Cancers System of Excellence and other VA cancer centers.

Additionally, legislation like the Dr. Kate Hendricks Thomas Supporting Expanded Review for Veterans in Combat Environments (SERVICE) Act and the Making Advances in Mammography and Medical Options for Veterans (MAMMO) Act which were signed into law on June 7, 2022, directs the VA to expand mammography screening to veterans who served in locations with increased exposure to toxic substances and improve screening and early detection of breast cancer.

We are encouraged that the Department has continued to transform cancer research, treatment, prevention, and outcomes for female veterans with the establishment of the Breast and Gynecological Cancers System of Excellence. As such, we request answers to the following questions:

The VA estimates there are 4.7 million rural and highly rural veterans, with 2.7 million enrolled in VA programs. What is the VA's plan in using TeleOncology to provide outreach to the 2 million rural veterans not currently enrolled in services?
a. Similarly, how will the Breast and Gynecologic Systems of Excellence provide specific outreach to female veterans in rural areas?

The TeleOncology program was established with funding from grant money. How long will this grant money sustain the TeleOncology and the Breast and Gynecological Cancer System of Excellence programs?
We understand that TeleOncology systems are in use at more than 10 Veterans Health Administration (VHA) sites and are expected to expand to over 20 sites soon. What effort will VHA make to ensure the telehealth services are available across the country, including in the Upper Midwest region and other rural regions?
a. What is the percentage of oncology care that can be accomplished in-home versus care that must be conducted within a VA facility?

We commend the VA for being proactive in its effort to care for our nation's two million female veterans. As your partner in Congress, we hope to continue to be able to assist the development of these vital health programs. Our veterans deserve the best.

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