b'Racial Disparity Found in VA CareWhen Novel CLL Treatments IntroducedIn a new study, researchers said they were surprised when a review of first-line chronic lymphocytic leukemia treatment showed racial disparities within the VA healthcare system, which is known for providing equitable care. Black veterans were found to be less likely to receive early novel agents to treat CLL compared to white ones.The situation has improved over time, however.By Brenda L. MooneySANANTONIOBlackpatientsdiagnosedwithResults indicated that, overall, Black patients were chroniclymphocyticleukemia(CLL)intheVAless likely to receive NAs than white patients (14% healthcare system were less likely to receive earlyvs. 26%; P = 0.02), although the gap narrowed over novel agents (NAs) to treat their cancer, compared tothe study period: white patients, according to a new study. 4% vs. 17% (2014), ThereportintheJournalofManagedCare 13% vs. 25% (2015), Specialty Pharmacy pointed out that ibrutinib, ide-17% vs. 33% (2016), and lalisib and venetoclax were first introduced in 2013 31% vs. 33% (2017). as therapeutic options to treat CLL. A study teamBlack race (P = 0.02) and fiscal year (P 0.01) led by researchers from the South Texas Veteranswere the only variables significantly associated with HealthcareSystemandtheUniversityofTexasNA use in the multivariable model, the research-Health, both in San Antonio, sought to determineers pointed out. Health outcomes and most com-whether the uptake of NAs for first-line treatmentplications were similar for Black and white patients was similar across races. 1 despite the difference in prescribing patterns.Among Black patients, the higher prevalence ofCLL, the most common leukemia in adults, also high-risk features for which NAs are recommendedhas a significant impact on the health of many U.S. might predict a higher rate of novel treatment receiptveterans.Since1993,morethan27,000veterans compared with white patients, the authors wrote.have received care for CLL through the VA, at least TheVeteransAffairs(VA)isthelargestequal- partly because the U.S. veteran population has a high access healthcare system in the United States, so it isproportion of CLL risk factors. expected that VA patients should have equal accessIn a 2002 report, the Health and Medicine Division to these NAs. We hypothesized that the uptake of(HMD) (formally known as the Institute of Medicine) NAs for first-line treatment of CLL would be similarof the National Academy of Sciences, Engineering, in Black and white patients managed in the VA. and Medicine concluded there is sufficient evidence The study team conducted a retrospective cohortofanassociationbetweenexposuretoherbicides studyincludingadultswithCLLmanagedintheand CLL. In 2003, VA recognized CLL as related to VA from Oct. 1, 2013, to Sept. 30, 2017. Includedexposure to Agent Orange or other herbicides during inthestudywere565patients86%whiteandmilitary service, according to the VA.14% Black. Black patients were younger than whiteInanupdated2008report,HMDwrotethereis patients (median age [66 vs. 69 years; P 0.01]) butsufficient evidence of an association between expo-had similar median baseline Charlson comorbiditysure to Agent Orange and CLL, including hairy cell scores (4 vs. 5).leukemiaandotherchronicB-cellleukemias.As Continued on Page 90 u82'