2004 Cancer Program Annual Report

Transcription

1 Cape Canaveral Hospital 2004 Cancer Program Annual Report Published October 2005 Together, we re better.

2 options, and clinical trials, which enables them to make informed decisions regarding their care Cancer Committee Chairman s Report Our interdisciplinary Tumor Board includes participation from all required specialties, including Medical Oncology, Radiation Therapy, Surgery, Radiology, and Pathology. In addition, we have had 100 percent attendance from the hospital s administrators and allied health professionals who are involved in our cancer care program. Most cancer sites are presented in a prospective manner, including the five most common cancer diagnoses at Cape Canaveral Hospital: breast, lung, colon, bladder, and prostate cancer. As part of our Tumor Board, the physicians and surgeons refer to the National Comprehensive Cancer Network Guidelines to facilitate education to the committee participants. By Richard M. Levine, MD Al Pecoraro, MD, a general surgeon who s a member of the medical staff at Cape Canaveral Hospital, is our Physician Liaison for the American College of Surgeons (ACoS). Dr. Pecoraro attended the ACoS Clinical Congress meeting this past year and provides communication and leadership from the ACoS to our cancer care program. Also serving as our community outreach coordinator, Dr. Pecoraro monitors our many community education and fund-raising outreach events and programs at Cape Canaveral Hospital, which in 2004 included: BMW Drive for the Susan G. Komen Foundation, led by Janet Rooks, CCH social worker Cattle Baron s fund-raiser for the American Cancer Society (Dr. Al Pecoraro served as Chairman for this event.) Wheelchair Paced Rally Cape Canaveral Hospital Foundation Grand Prix to benefit the Cancer Care Unit Annual Christmas party for children of patients with endstage cancer The Cancer Committee at Cape Canaveral Hospital has been very active this past year. The high quality of cancer care provided at Cape Canaveral Hospital continues to be enhanced by strengthening existing programs as well as a number of successful new initiatives. We are very proud that 17 of our chemotherapy nurses are nationally certified as Oncology Certified Nurses (OCNs). This is illustrative of the dedication, commitment, and skill provided by the nurses who care for cancer patients and their families at Cape Canaveral Hospital. Additionally, all cancer patients are seen within 24 hours after admission by the Oncology Social Workers, who are part of our cancer care team. Patients are also registered and visited by an American Cancer Society (ACS) representative within 48 hours of admission. They also receive a packet from ACS, which includes information pertinent to their diagnosis, treatment 1

3 Chairman s Report continued Sale of ACS Hope bracelets at the Cape Canaveral Hospital gift shop Leukemia/Lymphoma Light the Night event Hospice House Brick Paver gift program Lee Denim Day (local co-sponsor for ACS) Making Strides Against Breast Cancer (local co-sponsor for ACS) Relay For Life (local co-sponsor for ACS) Cape Canaveral Hospital is committed to reaching out to patients and their families touched by cancer with education, information, and support for families of cancer patients. We have implemented several programs and support groups, including: Look Good, Feel Better program Central Florida Leukemia/Lymphoma Society Annual Survivorship Balloon Walk Cape Canaveral Cancer Support Group Active for Life program ALL Caregiver support group Camp Bright Star (for grieving children) Hospice teenage volunteer program Man to Man (prostate cancer support group) Ovarian Cancer Support Group Smoking cessation patient education programs Reach for Recovery (with ACS) Space Coast Nu-Voice Club for post-laryngectomy patients Sunflower House support group for hospice care givers SWAT (school-based adolescent anti-smoking program) To help diagnose cancer early and improve survival, Cape Canaveral Hospital sponsors and participates with many cancer screening and community lecture series. These include the: Women s Health Fair Freedom from Smoking program GI Awareness Lectures on colon cancer prevention and treatment and Open House Day Grand Prix mini-race car event (provide sunscreen packets and ACS educational material on skin cancer to the community) Our Healthy Attitude lectures focus on smoking, diet, alcohol, and exercise, as well as prostate and breast cancer screening. Cancer prevention videos are available to all patients in their rooms on the patient education channel. The Health First Marketing Department collaborated with the NAACP in sponsoring the Men s Health Summit, an annual prostate screening event. The Cape Canaveral Hospital Resource Center presented a one-day workshop on women s health issues called The Potpourri of Women s Health, which included lectures on cancer, obesity, and heart disease. Our affiliation with Shands Cancer Center remains active, with the highlight being the quarterly Grand Rounds, which are conducted onsite for staff and the community. This past year we hosted the following experts who presented topics covering a wide range of cancer-related topics: Dr. Robert de Marsh presented New Therapies in Cancer Dr. Barbara Shea presented An Update on Breast Cancer Treatment Dr. John Wingard presented Treatment Strategies for Chronic Myelogenous Leukemia Dr. Michelle Bishop spoke on Emotional Support for Caregivers and Staff Additional education to the staff and community is provided through our Lunch and Learn seminars. Lectures have covered topics involving end-of-life issues, fundamentals of pain, innovative cancer treatment, cancer genetic risk assessment, palliative care, and new treatment options for neoplastic meningitis. The Cancer Registry at Cape Canaveral Hospital employs two certified tumor registrars and a cancer data assistant, all of whom attended the Florida Cancer Data Systems meeting and the National Cancer Registrars Association 2

4 Chairman s Report continued annual meeting. The inpatient Oncology nurses attended the National Nurse Practitioner Conference as well as the Oncology Nursing Society (ONS) Advanced Practice conference at Vanderbilt University. Many new quality initiatives and performance improvement studies were initiated and completed this past year. These included: A meperidine-usage analysis New nursing assessment sheets added to the patients charts to assess their spiritual needs A new pathology procedure to identify lymph nodes in colon cancer surgical specimens. CAP protocols for Pathology reports Enhancements to the Cancer Care Unit, including a quiet room and two computers equipped with Internet access for patients and families to facilitate their personal needs Bi-weekly interdisciplinary team rounds, which includes the staff, physicians, case management, social workers, and the hospital s chaplain. This team has enhanced coordination of care for cancer patients along the continuum of their disease process. In spite of three hurricanes, which resulted in two hospital evacuations in 2004, our nationally accredited cancer care program is an example of the strength and leadership that Cape Canaveral Hospital provides in meeting the needs of the patients and families in our community. We continue to strive to meet the needs of our patients, as well as create new opportunities to improve the service and medical care we are proud to offer our cancer patients. If you have any questions regarding our cancer care program or any cancer-related services available at Cape Canaveral Hospital, please contact our cancer registrar, Sue Finn, at Respectfully submitted, Richard M. Levine, MD 3

5 About Cape Canaveral Hospital s Cancer Registry Requests for data as described below* are welcomed and should be directed to: Cape Canaveral Hospital Cancer Registry PO Box Cocoa Beach, FL Tele: Fax: *The Cape Canaveral Hospital Cancer Registry has general information on cancer diagnosis, treatment, and clinical trials for the community. Clinicians may request information on our hospital s cancer trends and statistics by contacting the cancer registrar at Cape Canaveral Hospital s Cancer Registry under the direction of Susan Gruno, CTR, utilizes Medical Registry Services System, a computerized cancer registry system designed for collecting, following, managing, and analyzing cancer data. The cancer registrar analyzes data based on the patient s medical record and enters the information into the cancer registry database. All cancer case reports must be completed within six months from their diagnosis date. Cancer patients are given accession numbers based on the year in which they were diagnosed. Since January of 1994, our Cancer Registry has accessioned approximately 6,329 cases in its database. Our Cancer Registry develops a detailed cancer-focused record for every patient with active cancer at our hospital. We re required to report our cancer cases to the Florida Cancer Data System (FCDS), the state s cancer registry. In addition, our Cancer Registry is required to report any historical primary cancers. Analytic cases are reported annually to the National Cancer Data Base (NCDB), a joint project of the American College of Surgeons (ACoS) and the American Cancer Society. Data reported to these state and national organizations are used to support research, track trends, initiate epidemiological studies, generate articles and information in medical literature and journals, and provide data for allocation of services. Our Cancer Registry s certified tumor registrar coordinates our hospital s monthly multi-disciplinary Tumor Board meetings. These meetings cover all major cancer sites for patients diagnosed and/or treated at Cape Canaveral Hospital, and focus on pre-treatment evaluation, staging, treatment strategy, and rehabilitation. There were 77 cases presented at our Tumor Board in These cases included patients with cancer of the breast, lung, colon, bladder, prostate, head and neck, as well as with lymphoma and melanoma. Our Cancer Registry conducts annual follow-up on all patients treated at Cape Canaveral Hospital. We re required to maintain a 90 percent follow-up rate to be in compliance with the ACoS Cancer Program Standards. Regular followup visits for a cancer patient are important not only for our Cancer Registry to be able to maintain accurate follow-up, but more importantly for the patient, since early detection is linked to longer survival for most cancers. The Cancer Registry currently maintains a follow-up rate of 95 percent, which exceeds our target rate of 90 percent. Respectfully submitted, Susan Gruno, CTR 2004 American Cancer Society Support Services* Freedom from Smoking program Look Good, Feel Better program Man to Man (prostate cancer support group) Reach for Recovery *Cape Canaveral Hospital also provides leadership to the ACS Community Board. 4

6 Summary of Cancer Registry Data for 2004 In 2004 there were 444 new cancer cases accessioned into the Cancer Registry at Cape Canaveral Hospital (see the Primary Site Table on the next page). Of these cases, 397 were analytic cases (initially diagnosed and/or treated at this hospital). The remaining 47 were non-analytic cases (receiving subsequent treatment only at our hospital). The Cancer Registry has a total number of 6,329 cases entered since the initial reference date of January The other charts in this section show how our cancer cases are distributed by gender (see Chart I below); race (see Chart II on page 7); age (see Chart III on page 7). Additionally, Chart IV on page 8 compares our hospital s top five cancer sites to percentage of patients in Florida (state) and the United States (national).* The Primary Site Table on the next page gives a breakdown of all sites by gender, type, and stage. CHART I: 2004 CAPE CANAVERAL HOSPITAL CANCER DIAGNOSIS BY GENDER Female 57% 254 Cases 190 Cases Male 43% 5

7 2004 Primary Cancer Sites at Cape Canaveral Hospital The Primary Site Table below reveals anatomical sites for all cancers that were either diagnosed and/ or treated at Cape Canaveral Hospital (analytic cases) or cancer sites diagnosed and treated elsewhere (non-analytic cases) but seen here for subsequent treatment or recurrence of the original cancer. PRIMARY SITE TOTAL SEX NON- AJCC MALE FEMALE ANALYTIC ANALYTIC UNKNOWN N/A BREAST BRONCHUS AND LUNG COLON BLADDER PROSTATE GLAND SKIN HEMATOPOIETIC/RETICULOEN CORPUS UTERI LYMPH NODES PANCREAS RECTUM ESOPHAGUS STOMACH TESTIS THYROID GLAND BRAIN LARYNX OVARY RECTOSIGMOID JUNCTION UNKNOWN PRIMARY SITE ANUS AND ANAL CANAL KIDNEY RENAL PELVIS SMALL INTESTINE LIVER-INTRAHEP BILE DUCTS OTHER PARTS BILIARY TRACT OTHER URINARY ORGANS PALATE VULVA BASE OF TONGUE BONES, JOINTS, CARTILAGE CERVIX UTERI CONNECTIVE/SOFT TISSUE EYE AND ADNEXA MENINGES OTHER & ILL-DEFINED DIGEST OTHER PARTS OF TONGUE RETROPERITONEUM AND PERITONEUM UTERUS, NOS TOTAL

8 CHART II: 2004 CAPE CANAVERAL HOSPITAL CANCER DIAGNOSIS BY RACE White 369 Black 17 Chinese 1 Other CHART III: 2004 CAPE CANAVERAL HOSPITAL AGE AT CANCER DIAGNOSIS Patients Age 7

9 CHART IV: 2004 CAPE CANAVERAL HOSPITAL TOP FIVE CANCER SITES COMPARED WITH STATE AND NATIONAL CASES* 35% 30% 30% 25% % Patients 20% 15% 10% 14% 16% 13% 14% 13% 9% 10% 11% 7% 18% 17% 5% 5% 4% 4% 0% Breast Lung Colon Cape Canaveral Hospital Site Bladder Prostate Florida United States *Cape Canaveral Hospital s analytic cancer cases have been compared to expected cases in the state of Florida and the United States according to the American Cancer Society s Cancer Facts & Figures

10 Definitions and Abbreviations American College of Surgeons (ACoS): The ACoS Commission on Cancer (CoC) is referenced throughout this report and in some tables, charts, or graphs. The ACoS CoC surveys and approves cancer programs nationally. AJCC TNM Stage: A staging system developed by the American Joint Committee on Cancer (AJCC). The size and/or depth of invasion of a tumor determines the tumor (T) stage. The (N) is determined by lymph node involvement. Distant metastasis (M) is the spreading of the cancer to distant sites. For applicable sites, the T, N, and M determine whether the stage is I, II, III, IV, or Unknown Stage. Higher staged cancers usually have a poorer prognosis. Analytic case: Cancer cases diagnosed and/or treated for all or part of the first course of therapy at Cape Canaveral Hospital. Florida Cancer Data System (FCDS): FCDS is an incidence registry for the State of Florida and is a cancer registry administered by the Florida Department of Health operated and maintained by the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine. Non-analytic case: Cancer cases diagnosed and treated elsewhere for the first course of therapy. Reference date: The date in which a cancer registry began collecting cases. The date is usually January 1 of a given year. 9

11 Cape Canaveral Hospital 2004 Site-Specific Report: Lung Cancer Approximately 570,000 Americans were diagnosed with cancer in 2004, which is more than 1,500 persons a day. In the United States, one of every four deaths is caused by cancer. Unfortunately, lung cancer remains the leading cause of cancer deaths in both males and females in the United States. In 2004 approximately 184,000 new cases were diagnosed (102,000 males and 82,000 females), with 167,000 deaths (93,000 males and 74,000 females). The vast majority of individuals who develop lung cancer could have avoided the disease by not consuming tobacco or tobacco-related products. Smoking awareness is extremely important in lung cancer prevention. At Cape Canaveral Hospital there were a total of 65 new cases of lung cancer identified in 2004 by our Cancer Registry. Thirty-eight of these cases were a non-small cell subtype of lung cancer and were diagnosed and treated here at Cape Canaveral in This report will analyze this specific type of large cell lung cancer. Of the 38 analytic cases, there were 18 males (47%) and 20 females (53%). (See Table I.) At Cape Canaveral the age at time of diagnosis ranged from 44 to 90 years of age with a medial age of 71. In Table II age at diagnosis at our hospital is compared to data from the National Cancer Data Base (NCDB). TABLE I: NON-SMALL CELL LUNG CANCER 2004 Cape Canaveral Patients Distribution by Gender Females 53% Males 47% Total Cases = 38 Males = 18 Females = 20 TABLE II: NON-SMALL CELL LUNG CANCER AGE AT DIAGNOSIS 2004 Cape Canaveral Patients Compared with NCDB Data 50% 45% 45% Percentage of Patients 40% 35% 30% 25% 20% 15% 10% 5% 3% 5% 13% 18% 26% 30% 33% 13% 14% Cape Canaveral Hospital NCDB 0% Age Commission on Cancer, American College of Surgeons. NCDB Benchmark reports, Chicago, IL, The content reproduced from its applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based on the original Text, Tables, or Figures. 10

12 The diagnostic procedures utilized most frequently to obtain pathologic confirmation of suspected lung cancer included bronchoscopy and CT scan-guided needle biopsy. The breakdown according to stage is as follows: Eight patients (21%) presented with early Stage I disease, four patients (10%) were diagnosed with Stage II disease, three patients (8%) were diagnosed with Stage III disease, and 22 patients (58%) presented with Stage IV disease. Stage at diagnosis for one patient (3%) could not be determined. (See Table III.) TABLE III: NON-SMALL CELL LUNG CANCER 2004 Cape Canaveral Hospital Patients Stage at Diagnosis 22 The pathologic subtypes of our 38 analytic, non-small cell cancer patients included: adenocarcinoma, squamous cell, large cell, and adenosquamous carcinomas. Other analytic subtypes not analyzed in this report included: small cell, and carcinoma NOS. The most common treatment for non-small cell lung cancer patients at Cape Canaveral Hospital was chemotherapy (13 patients). Seven patients received radiation therapy, with only three patients undergoing surgery. Three patients diagnosed with lung cancer in 2004 expired prior to initiation of recommended treatment due to the extent of their disease. Patients Five-year survival continues to be low for all stages, which also follows the national trend. (See Tables V & VI on page 12) I II III IV Stage at Diagnosis Unknown The patients medical histories indicate that a 25 patients had a documented history of smoking, two patients never smoked, and 11 patients had unknown smoking history. (See Table IV.) TABLE IV: NON-SMALL CELL LUNG CANCER 2004 Cape Canaveral Hospital Smoking History 3 1 Conclusions: 1. Lung cancer remains a common cancer diagnosed at Cape Canaveral Hospital, second only to breast cancer. 2. More females were diagnosed than males in The majority of patients presented with advanced Stage IV disease. 4. Non-small cell lung cancer remains more common than small cell lung cancer, which is similar to the national trend. Respectfully submitted, Richard M. Levine, MD Patients Unknown Never Current Smoking Previous 11

13 TABLE V: CAPE CANAVERAL HOSPITAL LUNG CANCER FIVE-YEAR SURVIVAL BY STAGE % of Survivors Stage I Stage II Stage III Stage IV Years TABLE VI: COMPARISON OF SURVIVAL DATA CAPE CANAVERAL HOSPITAL TO NATIONAL AND STATE OF FLORIDA Stage at Diagnosis Stage I Stage II Stage III Stage IV 1% 1% 7% 8% 6% 22% 23% 21% 34% 39% 39% 58% Cape Canaveral Hospital State United States 0% 10% 20% 30% 40% 50% 60% 70% Percentage of Patients Surviving Five Years After Diagnosis Commission on Cancer, American College of Surgeons. NCDB Benchmark reports, Chicago, IL, The content reproduced from its applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based on the original Text, Tables, or Figures. 12

14 2004 Cancer Committee Members PHYSICIANS: CHAIRMAN Richard M. Levine, MD Medical Oncology PHYSICIAN LIAISON OUTREACH COORDINATOR Alphonse Pecoraro, MD General Surgery CANCER CONFERENCE COORDINATOR Jonathan Charles, MD Pathology Diane Bergau, MD Radiology Ashish Dalal, MD Medical Oncology James Giebink, MD Radiation Oncology Cynthia Halcin, MD Dermatology Karen Levy, MD Radiology Rodney Moore, MD VP Medical Affairs Fe Pancito, MD Radiation Oncology Michael P. Widick, MD Otolaryngology, ENT PROFESSIONAL STAFF MEMBERS: Lisa Acosta Corporate Wellness Coordinator Cyndi Ayres, RN Oncology Unit Loretta Beorlegui, RN Nursing Donna Crossland, WOCN Wound/Ostomy Care Vicki Crosswell Director, Radiology Linda Donohoe, RN Oncology Unit Denise Gangraw Center for Learning Susan Gruno, CTR Cancer Registry Kelly Haskins American Cancer Society Debbie Helton Director, Health First Marketing and Public Relations Debra Hemphill Rehabilitative Services Sandra Ingle, RN Director, Med./Surg. Oncology Unit Darlene Kerby American Cancer Society Sharon Labbate, CTR Cancer Registry Robin Litman Respiratory Therapy Janice McCoy, RN, MS VP, Patient Care Services Susan McDonough- Stackpoole, MSN, RN Director, Nursing Operations Carol Ann Muir Cancer Registry Cape Canaveral Hospital 701 W. Cocoa Beach Causeway Cocoa Beach, Florida Scott Neel, PhD Pharmacy Lori Roche, RD, LD Food & Nutrition Michelle Rogers Director, Private Duty Home Health Janet Rooks, MSW Case Management Social Worker Judy Simpson, RN Community Education Manager Rev. Jerald Smith Pastoral Care Roberta VanDusen Executive Director, Hospice of Health First Kathy Wilderotter, RN Clinical Quality Performance Improvement Coordinator 13