CANCER INSTITUTE. Outcomes Report. Presenting 2017 Statistics. Learn more at

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1 CANCER INSTITUTE 2018 Outcomes Report Presenting 2017 Statistics Learn more at

2 Contents Chairman s Letter Through the Patient s Eyes Community Outreach Education and Support Statistical Analysis 2017 Data

3 On behalf of the Flagler Hospital Cancer Committee, I am happy to share the 2018 annual report. The Flagler Cancer Institute is accredited by the American College of Surgeons Commission on Cancer. The cancer program at Flagler Hospital was formally organized in 1999 and received initial accreditation by the Commission on Cancer in The breast cancer program at Flagler Hospital received accreditation from the National Accreditation Program for Breast Centers (NAPBC) in Both the Cancer Committee and the Breast Program Leadership Team have worked diligently to expand and improve upon our programs. Included in this letter are a few highlights of our services. Flagler s new radiation treatment center has been open for approximately one year with many patients successfully treated. The new center features the most sophisticated radiation technology currently available. Radiation treatments can be delivered with the highest degree of precision while minimizing side effects. It is located in a newly constructed center with a warm and inviting atmosphere. CHAIRMAN S LETTER Marc A Warmuth, MD Cancer Committee Chairman The field of immunotherapy for cancer continues to expand. We offer an array of treatments which are designed to harness one s own immune system to battle cancer. These treatments offer the potential for dramatically improved results while typically having fewer side effects than traditional chemotherapy. Our team stays abreast of the latest developments in this ever changing field. Another rapidly emerging technology involves the use of genomic testing of cancer cells. Through this technology, the DNA of a cancer cell can be analyzed to determine which factors cause it to be malignant. At that point, a treatment is chosen to directly inhibit the cancer. This so called targeted therapy is often highly effective. Our cancer team utilizes these innovative techniques to create a treatment plan customized to the individual patient. Because of the expanding role of heredity in cancer diagnosis and treatment, we have added the services of a genetic counselor. The counselor is able to advise patients and health care professionals about the most appropriate tests and to help them decide whether genetic testing is the right option. Her role also includes counseling patients and families who have tested positive for a cancer gene. Whether it is radiation, immunotherapy, targeted therapy or other more traditional approaches, our goal is provide a highly individualized cancer treatment specific to each patient s needs. On behalf of the Cancer Committee at Flagler Hospital and all of the hard working individuals dedicated to cancer care, I present the 2018 Annual Report. Respectfully submitted, Marc A Warmuth, MD CANCER COMMITTEE CHAIRMAN 1

4 THROUGH THE PATIENT S EYES A Radiation Oncology Journey Helen does not consider herself a fighter. When she was first diagnosed with breast cancer many months ago, she felt afraid, devastated and most concerned about how her diagnosis would affect her family, especially her husband of 54 years. For someone from my generation, hearing the word cancer feels like a death sentence. I struggled with that. Then I thought, I owe it to my family to step up, Helen remarks. I have never really been a fighter; I m more the type of person who just goes along with things, so I had to wrap my head around how to process this situation and move forward with a plan. I like to say that I m not fighting with cancer; I am dancing with it -and hopefully at some point I will take the lead. Helen is finished with her chemotherapy treatment and started radiation therapy two weeks ago. Her course includes daily radiation, 5 days-a -week, for seven weeks. She has already developed a close bond with the staff at Flagler Radiation Oncology and the Medical Director Dr. Emily Tanzler. When I first met Dr. Tanzler, I felt at ease right away. She is a very caring, compassionate person and took the time to explain to me in great detail about the technology she would use to treat my cancer, said Helen. It s been a couple weeks now and I am feeling pretty good. The staff takes great care of me and the technology in the center is truly amazing. I am so grateful to have what I understand to be some of the most advanced radiation technology in the Southeast right here, near my home and family. Helen s journey continues and she feels positive about the future. Most importantly, she encourages all women to pay attention to their bodies, schedule their annual screenings and express support for others in need. If you see someone who looks like they might be going through cancer treatment, don t hesitate to reach out, give them a big smile, a pat, or a hug, she says. This dance with cancer isn t easy, and we are all in it together. ABOUT FLAGLER RADIATION ONCOLOGY At Flagler Hospital, we understand the impact a cancer diagnosis can have on you, your loved ones and your daily life. That s why we ve assembled a team of recognized experts and invested in advanced technology to deliver seamless, quality cancer care right here, close to home. Flagler Hospital and Cancer Specialists of North Florida are pleased to introduce our new Flagler Radiation Oncology Center. Located on the hospital s main campus, adjacent to Flagler Imaging, the Radiation Oncology center offers cancer treatment with Versa HD by Elekta. This revolutionary technology delivers highly precise treatment in a shorter amount of time, minimizing the impact of treatment on your quality of life - because family matters; life matters; you matter. 2

5 Local Dancer and Theatre Performer Tackles Lung Cancer with a Positive Attitude and the LOVE OF DANCE by JENNIFER JAMACK I guess what makes me different is that I look at myself as a woman who has cancer, not a cancer patient. Anne Kraft Anne is not your average 80-year-old woman. She is incredibly vibrant and her positive personality shines through the room the moment she walks in the door. When I first sat down with Anne, she spoke about her love of dance, and the moment that she noticed something wasn t right with her body during a competition. All of a sudden, I felt a shortness of breath that I hadn t experienced before. I couldn t breathe deeply, she shared. The discomfort lingered on well after the dance competition, so Anne decided to see a pulmonologist and run some tests. After multitude of tests, a PET scan showed positive uptake in a 1.8cm nodule of her left lower lung. She then had a bronchoscopy which led to a CT guided biopsy. Flagler Hospital s lung cancer nurse navigator Susan Hession reached out to Anne and helped her schedule surgery immediately. The pathology results from the biopsy revealed invasive adenocarcinoma, a form of lung cancer. The cancer was diagnosed in stage ll B and indicated that one lymph node had the presence of cancer. Anne was told that she would need to have chemotherapy during her treatment plan. She has successfully responded to four chemotherapy treatments and is being closely monitored by her medical oncologist and pulmonologist. While talking with Anne, she mentioned how well her clinical team at Flagler treated her, especially the navigational assistance she received from Susan. She also mentioned how quickly she has recovered from the surgery due to her love of dance. The show must go on, she said. During all of my chemo treatments, I still found a way to do the things I love and put a smile on my face when I would wake up in the morning. I made sure I put on makeup and still worked on days I felt good and even danced on days I felt my best. Anne even participated in a local play at the theater and continued to work at her day job during her treatments. It was really important for me not to dwell on anything and I tried my best to continue to show up. I kept looking forward to dancing again, and enjoyed the days I did get to rest on the weekends and recover. Anne spends her days volunteering at A Classic Theater (ACT) and working at a Law office. She is incredibly inspiring, and has recently competed in a dance competition with her instructor, Felix Solis where they received extremely high scores. Anne attributes her smooth recovery to her positive outlook. Instead of allowing this cancer to knock her down, she continued to participate in the things that she loves. One thing that Anne mentioned before our conversation ended, really stuck with me. She said: It s really important to have something for yourself, and feel needed. That s why I decided to show up every day, even when it was hard. I may be eighty years old, but I don t feel eighty at all. Luckily, for Anne, she immediately noticed something was wrong when she had trouble breathing and because of that, and the quick attention she received from the Flagler Hospital s team of doctors, the cancer was caught at an earlier stage. Anne also stressed the importance of knowing your body, and if something feels wrong, to go get it checked out. We were honored to be able to speak to this amazing woman who continues to smile, even during difficult times. She really is the epitome of the phrase: The Show Must Go On. 3

6 National Cancer Survivors Day COMMUNITY OUTREACH More than 80 survivors, friends, and families gathered together at Flagler Hospital on June 3rd, 2018 to celebrate National Cancer Survivors Day. National Cancer Survivors Day is an annual, treasured Celebration of Life that is held in hundreds of communities nationwide, and around the world, on the first Sunday in June. It is a celebration for those who have survived, an inspiration for those recently diagnosed, a gathering of support for families, and an outreach to the community. On National Cancer Survivors Day, thousands gather across the globe to honor cancer survivors and to show the world that life after a cancer diagnosis can be fruitful, rewarding, and even inspiring. Guests at Flagler Hospital s event had an opportunity to hear messages of hope and inspiration from Flagler s Chief Quality Officer Christopher Schmidt, and Dr. Tanzler. This day provides an opportunity for all people living with cancer to connect with one another, and recognize those who have supported them along the way. It is also a day to draw attention to the ongoing challenges of cancer survivorship in order to promote more resources, research, and survivor-friendly legislation to improve cancer survivor s quality of life. Each year, the Flagler Cancer Institute facilitates prevention and screening programs targeted to meet the needs of the community. Flagler Hospital s Cancer Committee planned and implemented numerous prevention and screening programs throughout focused on breast, colon, lung cancer which are consistently ranked as top cancer sites at Flagler Hospital and within St. Johns County. Flagler Cancer Institute also partners with other community organizations such as Good Samaritan Wildflower Clinic, American Cancer Society, Lung Cancer Alliance, and Pink up the Pace to promote cancer awareness and early detection. 4

7 Pink Up the Pace- Flagler Hospital sponsors local 5k for Breast Cancer Awareness On Saturday, October 6th, the Flagler Hospital team was out in full force to support the 10th annual Pink Up the Pace walk/run. The Pink Up the Pace organization aims to have a positive impact on the lives of those affected by breast cancer in St. Augustine, and the surrounding areas. Their mission is to raise money to assist the uninsured and underinsured in the early detection of breast cancer, while also increasing public awareness of the importance of early detection. PUTP has funded over 250,000 in breast imaging services in St. Johns and Putnam County. Approximately one in eight women will be diagnosed with breast cancer in her lifetime. For most affected, the cause is multifactorial. Prevention strategies for high risk women focus on decreasing the breast s exposure to estrogens-- ranging from dietary modifications to surgical risk reduction procedures. Prevention, however, is often not possible. What is possible, in the vast majority of cases, is early detection. Focusing on Breast Cancer In October, for insured women whose schedule may not permit them to get a mammogram during normal business hours, we opened the imaging center on a Thursday evening and a Saturday morning; a combined total of 29 mammograms were completed. On October 18, 2018 we conducted 25 mammograms, for a Free Mammo Day. Flagler Hospital also participated in the PUTP Expo and the Flagler College Employee Health Fair. At both of these events, community members were given information pertaining to breast cancer awareness. We also raised $775 for Pink Up the Pace by raffling off an Apple watch and pink Yeti at the expo. Over 2,700 community members attended this event, and received information on breast cancer screening and treatment options. The gold standard of early detection for breast cancer is the screening mammogram. In general, screening for any disease helps physicians identify a subset of people who are likely to have the disease. The test will identify some as possibly having the disease who actually do not, and conversely will fail to identify some who do. The sensitivity of screening mammogram varies. Ideally, a screening mammogram will detect cancer when small and at an early stage. The earlier the stage of cancer at the time of diagnosis, the higher the survival rate will be. If you or a loved one is in need of these screening services, please contact Flagler Imaging Center at (904) To learn more about the Pink Up the Pace organization, please visit: We are proud to be a partner of PUTP and look forward to next year s race. Genetic Counseling Program Next year, an estimated 16,000 women will be diagnosed with breast cancer in the St. Augustine and surrounding area. Between 10-15% of these women will have an underlying genetic cause to explain their personal history. Depending on the genetic cause, these women might be at higher risk for contralateral or triple negative breast cancer, earlier-onset cancer, or other types of cancers such as ovarian, pancreatic, or skin cancer. The program s mission is to increase patient access to genetic counseling services so that patients at highest risk for a genetic predisposition to cancer are identified earlier. Earlier diagnosis allows for anticipatory guidance and shared decisionmaking of surgical options. Knowledge of status can also help direct management and screening and determine risk for relatives. The Genetic Counseling Program at Flagler Hospital offers patients who are determined to have a high risk for harboring a genetic mutation the opportunity to speak with a counselor who will take a medical and family history, provide a risk assessment, provide educational counseling and anticipatory guidance, and when appropriate, coordinate genetic testing. So far this year, the program has received over 70 referrals from providers in the CSNF and St. Augustine Surgical networks. 5

8 CANCER EDUCATION AND SUPPORT EDUCATION AND SUPPORT Next year, an estimated 16,000 women will be diagnosed with breast cancer in the St. Augustine and surrounding area. Between 10-15% of these women will have an underlying genetic cause to explain their personal history. Depending on the genetic cause, these women might be at higher risk for contralateral or triple negative breast cancer, earlier-onset cancer, or other types of cancers such as ovarian, pancreatic, or skin cancer. The program s mission is to increase patient access to genetic counseling services so that patients at highest risk for a genetic predisposition to cancer are identified earlier. Earlier diagnosis allows for anticipatory guidance and shared decisionmaking of surgical options. Knowledge of status can also help direct management and screening and determine risk for relatives. The Genetic Counseling Program at Flagler Hospital offers patients who are determined to have a high risk for harboring a genetic mutation the opportunity to speak with a counselor who will take a medical and family history, provide a risk assessment, provide educational counseling and anticipatory guidance, and when appropriate, coordinate genetic testing. So far this year, the program has received over 70 referrals from providers in the CSNF and St. Augustine Surgical networks. The Flagler Hospital Education and Support Center (CESC) provides patients and their families with access to the latest information about their specific types of cancer, and connects them with others who can help them through their cancer journey. In addition to the patient library, the CESC coordinates a variety of classes and support groups. This year, Flagler hospital implemented new education classes that encouraged patients to participate in activities that relax the mind, body, and spirit. For patients living with cancer, this year they were able to attend restorative yoga classes, Breast Cancer support groups (about 21 attendees each week), a new Art Well Class,(10 attendees max) in partnership with the St. Augustine ArtWell Association, and a one-time nutrition class that had over 30 participants. There is also an adult coloring class offered bi-weekly to cancer patients and survivors, free of charge. The Wellness Program at the Wellness Center is offered on an ongoing basis, based on referrals. The goal is to continue to welcome cancer survivors, caregivers, and family members to participate in these educational support groups and increase awareness within our community, that resources are readily available during their journey. 6

9 SHINING A LIGHT ON LUNG CANCER In November, Shine A Light on Lung Cancer events are hosted by health care facilities across the country as part of Lung Cancer Awareness Month. These events bring together those living with lung cancer, their families, and the healthcare teams. Shine a Light events are also intended to honor all of those who are living with lung cancer and those we have lost to the disease. Lights are provided and each event has a moment of remembrance as we shine a light on those touched by lung cancer. More than 30 area residents attended Flagler Hospital s event on November 15th in the Cancer Education Support Center. The guest speakers were Dr. Husain and Dr. Deegan. The cancer educational piece of the program was covered by Dr. Husain in regard to how lung cancer is detected, what types of treatment options are available, and the survival rates of this disease. Dr. Deegan reviewed the radiation oncology segment, and new technologies and medications that are now used within treatment depending on the severity of the cancer. Around 7:00pm the Cancer Education Center and its attendees took out their flashlights and had a moment of silence for those who have lost their lives to lung cancer and a moment of remembrance. SMOKING CESSATION Quit Smoking Now is a smoking cessation program developed by ex-smokers for smokers. The group sessions are facilitated by the Community Health Improvement and Cardiopulmonary departments at Flagler Hospital once a week for one hour, over a six-week period. The group sessions cover different topics such as nicotine replacement therapy, stress reduction and relaxation techniques and identifying smoking triggers. Written material is provided, a toll free Quit Line is available, and people can re-enter the program as many times as necessary. Nicotine replacement therapy is provided at no cost to the participants. In addition to the Quit Smoking Now smoking cessation program, The Great American Smokeout was held at Flagler Hospital on November 15, This is a national event held at different locations across the nation. The goal is to encourage smokers to make a plan to quit or pledge to help someone they know quit. Over 100 community members visited and received information on how to quit smoking or help someone quit smoking. 7

10 STATISTICAL ANALYSIS 2017 DATA 2017 ONCOLOGY REGISTRY SUMMARY The Oncology Registry at Flagler Hospital was organized in 1999 for the purpose of collecting, managing and analyzing data on persons with cancer, as well as those with benign and borderline central nervous system brain tumors. To date, the registry database contains approximately 12,562 patients records; of those, 3,466 patients are currently being followed. In 2017, the American Cancer Society Facts and Figures reported an estimated 1,688,780 new cancer diagnosis. The national estimate by gender was reported at 49.5% for male and 50.5% for female. The actual figures seen at the Flagler Cancer Institute were 45.3% among men; the female incidence was 54.7%. Additional Registry Facts are reported as follows: In 2017, 878 cases were reviewed and entered into the registry database, an increase of 6.9% from the previous year. As seen in the incidence table Fig 1a, 625 are the newly diagnosed patients. These figures include those individuals who received all, or part of their first course treatment at Flagler Hospital. The non-analytic cases totaled 253. These are patients who were initially diagnosed elsewhere and seen at Flagler Hospital for part of their diagnostic work-up, or patients seen for care due to recurrent or persistent cancer. The five most frequently diagnosed malignancies in 2017 were as follows: breast, bronchus and lung, colorectal, prostate and urinary bladder. Collectively, the five sites made up 67% of the total analytic caseload. Displayed in Fig 1b are the five most prevalent sites in comparison to state and national figures. Patient quality care is evaluated through submission and data analysis to the Commission on Cancer, National Cancer Database with feedback from quality programs such as the Rapid Quality Reporting System (RQRS), Cancer Program Practice Profile Reports (CP3R) and Cancer Quality Improvement Program (CQUIP), to name a few. Patient specific information is closely monitored and continuously updated to reflect the most complete and accurate information regarding diagnosis, treatment, lifetime follow-up and outcomes. Registry staff adheres to strict state and national reporting guidelines as outlined by various national organizations to include the Florida statewide cancer registry (FCDS) and the Commission on Cancer/American College of Surgeons (CoC/ACoS). Registry staff are continuously recognized by the statewide registry for excellence in cancer reporting. 8

11 FIG. 1A: 2017 NEW CANCER CASES Site Name Total Male Female Number (%) Number (%) Number (%) Base Of Tongue 3 0% 2 67% 1 33% Other Parts Of Tongue 1 0% 1 100% 0 0% Parotid Gland 1 0% 0 0% 1 100% Tonsil 1 0% 1 100% 0 0% Oropharynx 1 0% 1 100% 0 0% Hypopharynx 2 0% 2 100% 0 0% Other Oral Cavity 1 0% 0 0% 1 100% Esophagus 4 1% 3 75% 1 25% Stomach 4 1% 3 75% 1 25% Small Intestine 3 0% 2 67% 1 33% Colon 65 10% 34 52% 31 48% Rectosigmoid Junction 5 1% 1 20% 4 80% Rectum 7 1% 3 43% 4 57% Anus & Anal Canal 1 0% 1 100% 0 0% Liver & Bile Ducts 7 1% 6 86% 1 14% Pancreas 13 2% 8 62% 5 38% Other Digestive Organs 1 0% 0 0% 1 100% Larynx 3 0% 3 100% 0 0% Bronchus & Lung % 60 57% 46 43% Heart Mediastinum Pleura 1 0% 1 100% 0 0% Blood & Bone Marrow 15 2% 9 60% 6 40% Skin 19 3% 11 58% 8 42% Retroperitoneum & Peritoneum 2 0% 1 50% 1 50% Breast % 2 1% % Corpus Uteri 11 2% 0 0% % Ovary 2 0% 0 0% 2 100% Prostate Gland 54 9% % 0 0% Testis 2 0% 2 100% 0 0% Kidney 21 3% 12 57% 9 43% Kidney, Renal Pelvis 1 0% 0 0% 1 100% Ureter 2 0% 2 100% 0 0% Urinary Bladder 34 5% 23 68% 11 32% Other & Unspecified Urinary Organs 1 0% 1 100% 0 0% Meninges 19 3% 5 26% 14 74% Brain 9 1% 5 56% 4 44% Other Nervous System 1 0% 0 0% 1 100% Thyroid Gland 5 1% 1 20% 4 80% Other Endocrine Glands 4 1% 2 50% 2 50% Lymph Nodes 25 4% 14 56% 11 44% Unk Primary 13 2% 7 54% 6 46% Overall Totals % % % 9

12 FIG. 1B: FLAGLER HOSPITAL CANCER CASES DIAGNOSED 2017 * NATIONAL COMPARISON OF THE FIVE MOST PREVALENT CANCER SITES * Estimated Cancer Cases from: The American Cancer Society Cancer Facts and figures 2017 Fig 1b Flagler Cancer Institute Actual *Florida ACS 2017 Projections *National ACS 2017 Projections Fig 1b Flagler Cancer Institute Actual *Florida ACS 2017 Projections *National ACS 2017 Projections 10

13 5 TOP SITES COMPARISON Primary Site Flagler Cancer Institute Actual *Florida ACS 2017 Projections *National ACS 2017 Projections Lung 17% 15% 13% Breast 25% 15% 15% Colorectal 12% 8% 8% Prostate 9% 10% 10% Bladder 5% 5% 5% All Others 33% 28% 32% 2017 CANCER EDUCATION The Flagler Cancer Institute in collaboration with Continuing Medical Education, provided the following cancer related educational programs to physicians and allied health professionals 1/19/2017 Webcast: Utilization of Fluorescence Imaging in Colorectal Cancer 6/15/2017 Live Presentation: An Update on Cervical Cancer 8/24/2017 Webcast: Rectal Cancer- 3 different ways why one technique is beter than another. Modern Approaches to surgery while adapting techniques, importance and utilization of TME in rectal cancer. 10/5/2017 Webcast: Rectal Cancer- 3 different ways why one technique is beter than another. Modern Approaches to surgery while adapting techniques, importance and utilization of TME in rectal cancer. 11

14 2017 HOSPITAL WIDE MULTIDISCIPLINARY ONCOLOGY CONFERENCES Patient specific case reviews during the tumor board sessions are an integral part of cancer care delivery and patient centered approach at Flagler Hospital. The conferences are multidisciplinary in nature whereby initial work up, diagnosis, and treatment are reviewed and discussed. Cases may also be re-presented to discuss changes in treatment management or issues affecting quality of life. In addition, the tumor conferences are approved for continuing medical education and CEU credits. The meetings are held twice a month, typically on the second and fourth Wednesday. For the reporting period, a total of 91 cases were reviewed. Of these, 93% were prospectively reviewed. All required disciplines (medical oncology, radiation oncology, radiology and pathology) were in attendance and the average turnout was 20. The multidisciplinary team of physicians reviews patient specific information to include prognostic factors and evaluation of radiological as well as pathological findings; the clinical and pathologic stage is reviewed and assigned when applicable, which enables the team to devise the most appropriate treatment recommendations according to nationally established guidelines. In addition, options for clinical trial participation are discussed. As seen below, during the 2017 hospitalwide oncology conference presentations, the most frequent diagnosed cancers were discussed, in addition to a variety of other sites. Colorectal 15 Lung 28 Lymph Nodes 8 Blood & BM 6 GU 7 Other Sites* 27 * Three breast cases were included in the other sites category. All other breast cases were presented at the specific breast conference 30% OTHER SITES 8% OTHER SITES 6% BLOOD AND BM 9% LYMPH NODES 16% COLORECTAL 31% LUNG 12

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16 Caring for Our Community since 1889 Cancer Institute Health Park Blvd., St. Augustine, FL,