2014 CANCER CONTROL ANNUAL REPORT

Transcription

1 2014 CANCER CONTROL ANNUAL REPORT Academic Comprehensive Cancer Program Accredited by the American College of Surgeons Commission on Cancer

2 ACADEMIC COMPREHENSIVE CANCER PROGRAM UMC TREATMENT AND DIAGNOSTIC PROGRAMS The American College of Surgeons has designated University Medical Center of Southern Nevada as an Academic Comprehensive Cancer Program and is currently the only program of its kind in the state of Nevada. This designation indicates that the hospital program has met very stringent requirements for the care of cancer patients. UMC Medical Staff Cancer Control Committee supervises the program. The UMC Academic Comprehensive Cancer Program offers a full range of diagnostic and treatment capabilities for the patients who have been found to have one of the many forms of cancer. The staff of the Academic Comprehensive Cancer Program includes physicians with special interest, training, and abilities in the care of the cancer patient. Members of the UMC medical staff with special interests in oncology include internal medicine, obstetrics/gynecology, thoracic and cardiovascular surgery, general surgery, colorectal surgery, genitourinary surgery, neurosurgery, pediatrics, plastic surgery, radiology, and pathology. The specially trained and experienced nursing staff is of vital importance in the management of the patient. The separate oncology nursing unit assures continuity of care for our patients to include rehabilitation, home health care and hospice care. Resource Center. A full-time Social Worker is available to oncology patients related to psychosocial needs and patient navigation. An enterostomal therapist is available to provide specialized care and treatment for patients with ostomies, skin problems, decubitus ulcers and draining wounds. Patients receive preand-post operative counseling, treatment and education. Registered Dieticians are available to provide adequate nutritional support to patients receiving supplements, such as TPN or tube feedings, and to assist with planning special menus. The Cancer Control Committee supervises the Academic Comprehensive Cancer Program. Professional educational programs include CME activity and the UMC Tumor Board, which reviews cases and furnishes an annual review of cancer diagnosis and therapy. The committee is responsible for supervision of the cancer registry, participation in studies of the American College of Surgeons and the publishing of the Cancer Control Annual Report Treatment may require surgical care, radiation and/or chemotherapy/biotherapy administration for adults and pediatric patients. Radiation treatment is provided by an affiliation with the 21st Century Oncology Radiation Center. The Nevada Cancer Research Foundation one of 34 designated sites for the NCI Community Oncology Research Program (NCORP) which provides cancer patients with participation in clinical trials and supports the physicians in their care of the patient. The Pharmacy Department plays an active role in the preparation of chemotherapy/biotherapy, pain control and assistance with research protocols. With their expertise, the pharmaceutical services ensure safe and accurate distribution of medications. Pharmacists are responsible for compliance with the American Society of Hospital Pharmacists and OSHA guidelines for chemotherapy/biotherapy preparation, handling, and dispensing of chemotherapeutic and biological agents. Rehabilitation of patients is done with the assistance of the UMC Rehabilitation Center, the HOPE Chaplains and counseling programs at UMC and the American Cancer Society. University Medical Center partners with the American Cancer Society (ACS) in providing the Look Good Feel Better (LGFB) Program. The LGFB program is free and teaches beauty techniques to women in active treatment to help them with appearancerelated side effects of cancer treatment. A general Cancer Survivor Support Group is facilitated onsite at the UMC Family

3 2014 Cancer Control Committee Members: John Ellerton, M.D., C.M., Medical Oncology/Hematology Chairperson Quality Improvement Coordinator Wydell Willilams, M.D., Surgery Cancer Liaison Physician, Surgical Oncologist Brody Winn, M.D., Pathologist Cancer Conference Coordinator Ian Haycock, M.D., Diagnostic Radiologist Daniel Kirgan, M.D. Oncology Surgeon Brian Lawenda, M.D. Radiation Oncologist Paul Treadwell, M.D., Radiation Oncologist -ALT Dianne Mazzu, M.D., Diagnostic Radiologist - ALT Lindsey Vandersteen, PharmD, Hematology/Oncology Brandi Miller, PharmD, Hematology/Oncology Scott Leader, PharmD, Hematology/Oncology Gregg Fusto, RN, Chief Nursing Officer Cancer Program Administrator Melody Talbott, RN, Assistant Chief Nursing Officer Cancer Program Administrator - ALT Lorraine Noonan, RN, Nursing Administration, Performance Improvement Elena Hardy, RN, Oncology Clinical Manager Dave Tyrell, RN, Director of Medical-Surgical Services Doris Cowell, RN, BSN, OCN, Oncology Program Coordinator Community Outreach Coordinator Cheryl Alvarez, RN PICU Cynthia Jones, RN, PICU Nurse Manager Karen Sartell, RN, M.A., Nevada Cancer Research Foundation Program Coordinator Clinical Research Representative Shannon Yule, CRA, Nevada Cancer Research Foundation Clinical Research Representative - ALT Robyn Simon, CTR, Cancer Registrar Cancer Registry Quality Coordinator Palliative Care Team Vidya Ramanan, LCSW, Director of Social Services Lorraine Goodwin, FNP-C Stephanie Seybold, RD, Oncology Registered Dietician Tammy Luttrell, PT, MOMT, OCS, Director of Rehabilitation Services Rehabilitation Services Representative Maria Zenquis, LCSW Oncology Social Worker Psychosocial Services Coordinator Erika Gurnee, American Cancer Society Representative

4 2014 Program Activities Professional Education Medical CME program entitled Individualizing Treatment of Mulitple Myeloma Across the Disease Continuum: A Look at the Latest Data was held on Friday, December 12, Educational objectives included: Discuss how to individualize treatment selection in MM based on patient and treatment-related factors. Describe how to assess clinical trial data outlining the use of stem cell transplantation, chemotherapy, and targeted approaches for the management of MM in treatment-naïve patients. Explain how to evaluate current and emerging treatment options for patients with relapsed/ refractory MM. Accreditation and Credit Designation Statements: Quintiles Medical Education, Inc. is accredited by the American Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. Quintiles Medical Education, Inc. designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit. Thomas Martin, M.D., Clinical Professor of Medicine, UCSF Medical Center, San Francisco, CA presented the information. Nursing Greater Las Vegas Chapter ONS Oncology Nursing Symposium April 5, 2014 included: An Integrative Radiation Oncologist s Approach to Cancer Care; Genomics: Ethical Decision-Making For Nurses; Nursing Strategies For Management of Myelofibrosis; Difficult Patients, Difficult Families; Identifying, Preventing and Treating Serious Side-Effects Leading to Termination of Therapy in Lymphoma; From Evidence to Practice: Evidence- Based Medicine in Clinical Practice CNE contact hours were awarded through this program. Annual Nursing Chemotherapy/Biotherapy Certification Competency August 2014 CNE Home Studies to include the following: Labs & Tests Pertinent to Cancer Patients; Oncology Nursing Overview; Oncologic Emergencies; Pain Management in the Cancer Patient; Oral Medications in the Treatment of Cancer and Non-Oncology Diagnoses Acronym Glossary ACS American Cancer Society AJCC American Joint Commission on Cancer NCORP NCI Community Oncology Research Program CME Continuing Medical Education CNE Continuing Nursing Education ONS Oncology Nursing Society OSHA Occupational Safety and Health Association UMC University Medical Center

5 UMC Bladder Cancer Report John Ellerton, M.D., F.A.C.S. UMC Medical Staff Bladder cancer is the sixth most common cancer in the United States after lung cancer, prostate cancer, breast cancer, colon cancer, and lymphoma. It is the third most common cancer in men but only the eleventh most common cancer in women. Of the roughly 70,000 new cases annually, about 53,000 are in men and about 18,000 are in women. Of the roughly 15,000 annual deaths, over 10,000 are in men and fewer than 5,000 are in women. The reasons for this disparity between the sexes are not well understood. According to the SEER data the incidence has remained stable over several years. The SEER data also shows that incidence does not vary by race but white males are more likely to die from bladder cancer. This data also indicates an overall 5 year survival rate of 77 percent UMC Analytic Bladder Malignancies By Gender Female 18% Male 82% Recent studies have confirmed that half of all bladder 12 cancers in men and women are directly related 10 to smoking. Approximately 8 70% to 80% of patients with newly diagnosed 6 bladder cancer will present 4 with superficial bladder tumors. 2 A review of the UMC data tells very much the 0 same story. Eighty-two percent of the patients are male. Sixty five percent of the patients are over 60 and eighty eight percent are over 50. A majority of the patients presented with superficial cancer (55-60%0; in keeping with the SEER results. The 5 year all stage survival at UMC is 63%. Many factors may contribute to the lower survival rate. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 UMC Analytic Bladder Malignancies By Insurance n=10 n=9 n=8 n=7 No Insurance HMO/PPO Private Insurance MDCR 2009 UMC ANALYTIC BLADDER MALIGNANCIES - ALL STAGES by 5-YEAR SURVIVAL 88% 75% 75% 66% 63% 1 Year 2 Years 3 Years 4 Years 5 Years

6 2013 UMC Analytic Bladder Malignancies By Treatment Surgery with Other 21% 2013 UMC Analytic Bladder Malignancies By Age Range % % % Surgery Alone 44% % Surgery with Chemotherapy 35% % The numbers are small so one must be cautious. In addition, one third were uninsured and would not have had reliable follow up care. With the ACA and the Medicaid expansion one would expect these percentages to improve N= UMC Analytic Bladder Malignancies By AJCC Stage In summary, the bladder cancer patient at UMC is similar to the average US patient. In the future we will look again at this disease and analyze any trends that we find N=6 N=3 N=3 N=3 Stage 0 Stage I Stage II Stage IV N/A 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 UMC Analytic Bladder Malignancies By Ethnicity White Hispanic Black Filipino

7 UMC CANCER REGISTRY The Cancer Registry at UMC is just one of the important parts of an American College of Surgeons approved Teaching Hospital Cancer Program. The registry collects, manages, and analyzes data on patients who are diagnosed with a malignancy or treated for a malignancy at UMC. The Cancer Registry at UMC was established in 1979 and its reference year is There are approximately 15,950 cases in its database with 938 new cases accessioned into the registry in 2013 and approximately 6,000 patients followed annually. The registry s primary goal is to assist the hospital in providing optimal care to the cancer patients. To ensure a credible database, the registry performs ongoing quality control checks through IOP (Improving Organizational Performance) improvement procedures on case finding for both pathology and Disease Index List sources of cases and also maintains the quality of registry data with a review of ten percent of analytical cases by Cancer Control Committee Member. These findings are reported to the Cancer Control Committee quarterly. The Registry also participates in Special Studies required by the Commission on Cancer. They work closely with the Cancer Committee Chair, Cancer Liaison Physician and the Cancer Program Coordinator to assure the hospital maintains its approval with the American College of Surgeons. The Registrar anually attends the yearly Education Conference sponsored by the National Cancer Registrars Assocation and keeps all members of the 70% Cancer Control Committee advised of changes to the CoC Standards that will 60% impact the facility. 50% 40% Female 52% 61% 2013 UMC Analytic Cases All Sites By Gender Male 48% 2013 UMC Analytic Cases All Sites By Ethnicity 35% 2013 UMC Analytic Cases All Sites By Age 30% 30% 29% 25% 20% 26% 20% 16% 14% 15% 12% 15% 10% 6% 3% 10% 5% 4% 7% 6% 0% White Hispanic Black Asian Other 0% % 2013 UMC Analytic Cases All Sites By Pay Source Other Leukemia Lymphoma 3% 5% 6% 2013 UMC Analytic Cases All Sites By System MDCR/Federal 20% Endocrine System Brain & Nervous System Urinary System 2% 5% 6% Medicaid 7% Not Insured 34% 2013 UMC Analytic Cases All Sites By Age Male Genital System 3% Female Genital System 10% Breast 9% Skin Bones, Joints & Soft Tissue 1% 7% HMO/PPO 19% Respiratory System Digestive System 13% 27% Insured, NOS 20% Oral Cavity & Pharynx 3%

8 The Nevada Cancer Research Foundation NCI Community Oncology Research Program Shannon Yule, CCRP Program Administrator The Nevada Cancer Research Foundation NCI Community Oncology Research Program (NCRF NCORP) is a non-profit, clinical trials oncology program that has been funded since 1983 by various grants from the Division of Cancer Prevention, National Cancer Institute (NCI). The mission of the NCI-supported NCORP Network is to develop and conduct state-of-the-art cancer prevention, control, and treatment clinical trials with significant involvement of community oncologists and populations they serve. The NCORP Network mission includes: (1) accelerating development of interventions to prevent and treat cancer and its symptoms by increasing accrual to trials; (2) fostering quality care in the community through adoption of results from clinical trials; and (3) increasing the involvement of minority and underserved patient/participant populations in cancer clinical trails. The NCRF NCORP is fortunate that the University Medical Center of Southern Nevada (UMCSN) has been affiliated with the NCRF since To assist the NCRF, UMCSN provides a regulatory umbrella for studies that are conducted at UMCSN. In addition, the UMCSN Institutional Review Board reviews phase II and cancer control studies so that these studies are available for patients being treated in local oncologists and radiation oncologists offices. This affiliation allows patients in the Las Vegas area to participate in national clinical trials that would otherwise not be available to them. These clinical trials are available to the patients because UMCSN is a member of NCI Clinical Trials Networks through its affiliation with the NCRF NCORP. These networks serve as research bases for the NCRF NCORP and provide a portfolio of clinical trials from which the NCRF NCORP and UMCSN are able to choose studies that best fit the patient population. The national Networks which UMCSN is affiliated with via the NCRF NCORP include: Alliance, COG, ECOG-ACRIN, NRG, SWOG and the University of Rochester Cancer Center. There are approximately 60 studies that are active currently and many more studies that are closed to new patient enrollment but the NCRF NCORP and UMCSN continue to collect data on these patients. This collaboration will continue for many years as each study has a unique period of time where the patient is followed after active treatment. This may range from a few months to the lifetime of the patient. In 2008, UMCSN became a member of the Children s Oncology Group (COG). The UMCSN now has about 40 pediatric oncology studies available for children with leukemia and renal cancers as well as correlative science and quality of life studies. UMCSN has been instrumental in the success of the NCRF NCORP program due to the support and commitment of the UMC administration, as well as the medical and nursing staff of the Pediatric and Oncology Units. For more information on the Nevada Cancer Research Foundation NCI Community Oncology Research Program, telephone (702) Psychosocial Distress Maria Zenquis, LSW, Social Services Department The social worker is an integral part of the team that is involved in the patient navigation process which refers to individualized assistance offered to patients/families/caregivers to help overcome health care system barriers and facilitate timely access to quality medical and psychosocial care that can encompass care prior to a cancer diagnosis as well as through all the phases of the cancer experience. One of the barriers is lack of knowledge of the AHCA (Affordable Health Care Act) and the social worker can provide the patient/family, information about how to obtain and access medical coverage that they are now eligible for the first time in their lives. With this coverage, they can now access inpatient medical care, medications and follow up outpatient visits that they did not have access to previously. The social worker can also collaborate with the EFS (Eligibility Financial Services) worker to ensure that applications are completed and submitted for those individuals eligible for medical coverage under the new AHCA. that patients may experience. In collaboration with nursing, once the patient s psycho-social health is screened and documented in the EHR, a referral may be triggered to the social worker to address the patient s concerns. The social worker can provide emotional support and reassurance as well as information, education on community resources as well as make referrals, where necessary. For instance, patients who need counseling services could be provided with printed information on available community counseling services. Another example would be patients with substance abuse issues, where the social worker can counsel the patient to recognize that they have a problem which can benefit from substance abuse rehab programs offered in the community and link them with these programs. Since cancer is a serious and complex disease that can affect the patient in a variety of ways, the social worker can assist with addressing any psycho-social, financial and behavioral issues

9 Community Outreach 2014 Doris Cowell, BSN, RN, OCN Community Outreach Coordinator In 2014, the UMC Cancer Control Committee set community outreach goals in prevention (CoC Standard 4.1) and screening (CoC Standard 4.2). Prevention goals included education in breast, skin, cervical, prostate, and colon cancer awareness for the local community. As part of community outreach in cancer awareness education, the UMC Employee Health Fair was held on April 9, 2014 at Delta Point. There were approximately 300 in attendance. Information was provided at the Oncology Department booth: effects of cigarette smoke and secondhand smoke, smoking cessation information, national guidelines related to screening for breast, cervical, prostate, and colon cancers. Information on melanoma/skin cancers and how to prevent skin cancer was provided through information according to ACS on sun safety measures. Since the month of April is head and neck cancer awareness month, information was provided on oral, head and neck cancer according to the Head and Neck Cancer Alliance. Information included risk factors, signs/symptoms of head and neck cancer, and screening. The targeted cancer-related information presented in the UMC employee health fair is reflective of the top five cancer sites seen at UMC to include lung, breast, and melanoma/skin cancers. This year, the Las Vegas Valley Water District invited UMC to participate in the annual employee Safety Stand Down Day that was held on October 1, A one-hour sun safety program was held all day for employees. The program was entitled Beautiful, but Dangerous. What you need to know about skin cancer and sun safety. Objectives included the following: Define Ultraviolet (UV) Radiation to including forms of UV radiation. Statistics related to skin cancer. Health issues related to sun damage. What is skin, skin cancer and the different types of skin cancer? Skin cancer prevention and screening. There were 265 in attendance and the program was received well. Sunscreen and Sun safety information was provided as handouts to all attendees. Education during lung cancer awareness month included the effects of cigarette smoke and second-hand smoke. Smoking cessation program information is available as well as on the UMC Intranet. basal and squamous cell carcinoma) in Nevada for 2014, will be 470 out of 14, 450 cases of cancer diagnoses for all sites. In addition, in July 2014, the Surgeon General s Call to Action to Prevent Skin Cancer had been a focus of discussion as skin cancer has been reported to be the most commonly diagnosed cancer in the United States and in most cases is preventable. The UMC skin cancer screening was held on August 9, 2014 with 50 people being screened. Out of the 50 people who were screened for skin cancer, 9 of them needed follow up care. Out of the 9 follow up cases from the skin cancer screening program, only one was found to have basal cell carcinoma. After hearing about the skin cancer screening event, more employees took advantage of having a full body skin check and one early stage melanoma was found. The UMC Cancer Survivor Support Group serves as a cancer support program in the community and meets on the first Tuesday of the month. Informative topics for discussion at the monthly meetings included dental health, breast health during Breast Cancer Awareness Month, Diabetes and Cancer Awareness, Healing Touch, Colon Cancer Awareness, and American Cancer Society program resources.. The annual cancer survivor spring celebration took place in May 2014 with presentations in Integrative Oncology presented by Brian Lawenda, M.D. Radiation Oncologist, Integrative Oncology Essentials Program Director and Specialized Massage therapy for post-surgical healing from lumpectomies and mastectomies presented by Sally Spurgeon, LMT, Director of Therapie, A Healing Place. Healing Touch was offered to cancer survivors as well. In addition, the annual Cancer Survivor Holiday Party took place in December 2014 with Stacy Escalante, Melanoma Cancer Survivor presenting what it is like to be a cancer survivor from Stage III melanoma. Her inspiring story gave hope to those who were newly diagnosed with cancer. A cancer survivorship needs assessments was completed for The cancer survivor needs assessment data revealed cancer survivors preferred to hear information regarding all health-related topics for cancer survivorship. Also, during the month of November, the Clark County Health Fair was held over 2 days and over 600 Clark County employees attended the event. Education on cancer awareness included skin cancer, effects of cigarette smoke to include second-hand smoke, breast, cervical, colon and prostate cancer screening guidelines (American Cancer Society), and head and neck cancer screening for oral health. This year, skin cancer was set as a screening goal in 2014 as skin cancer continues to be one of the top five sites at UMC. The estimated number of skin cancer diagnoses (excluding

10 2014 Preventative Activities UMC Employee Health Fair April 2014 Las Vegas Valley Water District Safety Stand Down Day: Skin Cancer Prevention October Screening Activities Beautiful, But Dangerous Skin Cancer Awareness and Screening Program for UMC Employees August Community Outreach Activities UMC Cancer Survivor Support Group Survivorship Celebration May 2014 UMC Cancer Survivor Holiday Party December 2014 Support Groups UMC Cancer Survivor Support Groups First Tuesday Evening of the Month 2014 CanCer Survivor Support Group First tuesday of every Month 6:00 PM to 7:00 PM schedule of meetings/ events FebRuaRy 4th march 4th april 1st may 6th CanCer survivor CeLebration 5:30 p.m. 7:30 p.m. June 3Rd July 1st august 5th september 2nd october 7th breast cancer awareness november 4th lung cancer awareness december 2nd CanCer survivor holiday Party 5:30 p.m. 7:30 p.m. Family ResouRce center 1120 shadow lane (2 driveways behind del taco) RSVP for meetings: doris cowell, Rn at rancho W. Charleston shadow Lane

11 CANCER SURVIVOR HOLIDAY PARTY CANCER SURVIVORS, FAMILIES AND FRIENDS WELCOMED Tuesday, December 2 5:30 p.m. - 7:30 p.m. Special Guest: Stacey Escalante, former news anchor and cancer survivor, will present Cancer Survivorship Light refreshments and door prizes. RSVP with Doris Cowell at no later than November 26, 2014

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