COMMUNITY CANCER PROGRAM ACCREDITATION WITH COMMENDATION BY THE COMMISION ON CANCER

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1 2014 COMMUNITY CANCER PROGRAM ACCREDITATION WITH COMMENDATION BY THE COMMISION ON CANCER

2 CANCER COMMITTEE Lowndes Harrison, MD, Radiation Oncology, Cancer Committee Chairman, Cancer Conference Coordinator Alberto Echeverri, MD, General Surgery, Cancer Liaison Physician Elquis Castillo, MD, Medical Oncology John B. Priest, MD, Pathology Calvin Herring, MD, Diagnostic Radiology Ramie Anderson BSRT, (R) (T) Director of Imaging and Radiation Oncology, Community Outreach Coordinator Lora Ramsey, RHIA, Director of Health Information Management, Quality Improvement Coordinator Paula Wyatt, CTR, Cancer Registry Coordinator Kelly Evers, CTR, Quality of Cancer Registry Data Coordinator Sherri Bryant, RN, Clinical Trials Coordinator Doris Davis, RN, Quality Management Taylor Krueger, Administrative Specialist Kelly Bullock, RN, BSN Director of Oncology Floor Amy Burns, RN, Case Management Megan Cox, Dietary Alison Shirley, American Cancer Society Norris Hilton, Pastoral Care Table of Contents Chairman s Report...3 Cancer Liaison Report...3 Cancer Registry Data Site Specific Analysis-PANCREAS Community Outreach...12 National Cancer Survivor s Dinner...13

3 Chairman s Report The American College of Surgeons Commission on Cancer provides a useful organization mode for local cancer programs. Currently only 1,500 hospitals nationwide are approved cancer programs. Gadsden Regional Medical Center belongs to the Community Cancer Program Category and is surveyed every three years for continuation of approval. As a result of the 2014 survey, the program s continues to be an accredited facility with commendation in six areas: Clinical Trial Accrual, Cancer Registrar Education, Public Reporting of Outcomes, College of American Pathologist Protocols, Nursing Care, Data submissions and Accuracy of Data. The approval status are the results of the efforts of numerous individuals-the administrators, cancer committee members and health care professionals who take care of cancer patients are all to be commended! Through their efforts and knowledge, cancer patients in this region are able to rely on comprehensive and compassionate care close to home. Lowndes Harrison, MD Radiation Oncologist Cancer Conference Coordinator Cancer Liaison s Report At Gadsden Regional Medical Center we strive to emphasize comprehensive cancer care to our community. We will continue to provide it in an ever-expanding role for cancer patients and their families. The Gadsden Regional Medical Center s cancer program provides support groups and information for cancer patients and families. A number of community outreach programs, such as physician lectures and special events for cancer awareness were offered at Gadsden Regional Medical Center. There are currently 436 Community Cancer Programs across the United States. At the Gadsden Regional Cancer, we offer quality cancer care. Our vision is to provide the best cancer care in a personalized, comfortable, close to home setting. Alberto Echeverri, MD General Surgeon

4 Cancer Registry The Cancer Registry is an essential component of the Gadsden Regional Medical Center s Cancer Program. The registry s primary duty is collecting and reporting information to the Alabama Statewide Cancer Registry (ADPH) and National Cancer Data Base (NCDB). Long term follow up of patient outcomes is sought on ALL cases reported. Other duties include organizing Cancer Committee meetings and Cancer Conferences and documenting compliance with the CoC standards to maintain the cancer programs accreditation from the American College of Surgeons Commission on Cancer. The registry has responsibilities including the accurate and timely collection of information on cancer diagnosed and/or treated at GRMC and it s Cancer Center, as well as management and analysis of this data. The information collected such as demographics, anatomic site, test, treatment and extent of disease, has multiple uses, which include outcome reporting, patient care reviews, physician education and clinical trials. The Cancer Registry has two fulltime employees and a part-time abstractor, all are certified tumor registrars (CTR), which ensures quality and accurate data. Cancer Registry Staff (left to right) Barbara Robert, CTR Paula Wyatt, CTR, Cancer Registry Coordinator Kelly Evers, CTR, Medical Secretary The data collected by the Cancer Registry is electronically submitted to the ADPH and NCDB for further comparative analysis with other hospitals and databases. Data analysis for specific sites can be done to compare site, demographics, histology, stage of disease, treatment modalities and survival to other published state, regional or nation data. This information can be used to benchmark opportunities on patterns of patient care and survival. The registry staff participated in ongoing cancer-related education at the local, state and national levels to maintain abstracting skills and to maintain credentials in their field. The registry staff also participate in community outreach programs and provides support group information. Physicians and other healthcare professionals are encouraged to utilize data collected. The Cancer Registry staff can be reached at (256) (Paula Wyatt) or (Kelly Evers).

5 Cancer Committee The Cancer Committee meet quarterly throughout the year and is responsible for the cancer programs operations and establishes specific goals early in the year. The cancer committee monitors the goals and objectives for endeavors relating to the cancer care in clinical areas, community outreach, programmatic endeavors and quality improvement. Four coordinators are assigned to specified areas within the committee to help monitor key elements, Lowndes Harrison MD, Cancer Committee Chairman and Cancer Conference Coordinator, Ramie Anderson, as Community Outreach Coordinator, Lora Ramsey, RHIA, as Quality Improvement coordinator and Kelly Evers, CTR as Quality of Cancer Registry Data Coordinator. Cancer Conferences Cancer Conferences are integral to improving the care of cancer patients by encouraging multidisciplinary discussions of cancer diagnosis and treatment planning. All members of the medical staff at Gadsden Regional Medical Center are welcome to attend the cancer conferences. During 2013, 25 cancer conferences were conducted on Wednesday afternoons. A total of 98 cases were presented, of which 100 percent were prospective cases. The 98 cases presented at cancer conference represent approximately 19 percent of all newly diagnosed cancer cases seen in Several education activities were held throughout the year. The purpose of these activities is to provide the cancer care providers with current information about cancer prevents, early detection, diagnosis, stage (extent) of disease, treatment guidelines, prognostic indicators, treatment and follow up care. Cancer specific educational topics and speakers in 2013 included: Lung Cancer Treatment Options by Drs. Arianne Bennett-Venner, Christopher Clark and Elquis Castillo Malignant Mesothelioma by Dr. Alejandro Garcia-Hernandez Oncology Unit The oncology unit at Gadsden Regional Medical Center is located on the 7th floor and has 51 rooms available for use. The unit is staffed with a combination of oncology trained nurses and oncology certified nurses. All experienced nurses who care for patient on the oncology unit, complete annual competency evaluations. Chemotherapy policies are reviewed and updated regularly to reflect current evidence based practices. Services provided on the inpatient oncology unit include, but are not limited to: antineoplastic chemotherapy administration, blood product transfusions, brachytherapy, I131 administration and bone marrow biopsy.

6 2013 Statistical Summary of Registry Data During 2013, the Cancer Registry accessioned 511 analytic cases for the year. Analytic cases are patients that were diagnosed and/or received part or all of first course therapy at Gadsden Regional Medical Center and/or Cancer Center. Top five sites for 2013 are (1) Prostate (2) Lung (3) Breast (4) Colon/Rectum and (5) Bladder. Sixty one percent of the analytic cases accessioned were male and thirty nine percent were female (Graph 1). Over half of the analytic patients diagnosed in 2013 were over the age of 60 (Graph 2) and the overall median age range was years old. Female 39% Male 61% Graph 1 GRMC Sex Distribution Graph 2 GRMC Age at Diagnosis Analytic 2013 Cases Other Age Group

7 350 Graph 3-County at Diagnosis Etowah Calhoun De Kalb Cherokee Other Graph 3 Shows the county in which patients lived in at the time of diagnosis. GRMC provides care not only to Etowah county, but the surrounding counties as well. Graph 4 Shows distribution of patient race Graph 4-Race Black 13% Other 1% Graph 5 Shows the distribution of GRMC s top five sites vs. race White 86% Lung Breast Prostate Gland Bladder Colon/Rectum White Black Other Graph 5-Race vs. Top 5 Sites

8 2013 Statistical Summary of Registry Data continued Tables 1 and 2 below reflects the distribution of Gadsden Regional Medical Center s 2013 analytic cancer cases based on gender. Table New Male Cancer Case Comparisons Table New Female Cancer Case Comparisons Oral Cavity and Pharynx 15 5 Thyroid Lung & Bronchus Breast Lung & Bronchus Pancreas Kidney & Renal Pelvis 3 9 Urinary Bladder 26 Colon/Rectum 26 4 Kidney & Renal Pelvis 2 Ovary 12 Uterine Corpus 11 Colon & Rectum Prostate 101 Lymphoma 12 Melanoma of Skin 5 Leukemia 7 Other Sites 61 3 Lymphoma 2 Melanoma of Skin 3 Leukemia 46 Other Sites Total 311 Total 200

9 Oral Cavity & Male Female Pharynx Lip 1 2 Tongue 4 0 Oropharnx 1 0 Hypopharynx 1 0 Other 8 3 Digestive System Male Female Esophagus 6 0 Stomach 3 3 Colon Excluding 14 8 Rectum Rectum & 12 3 Rectosigmoid Liver 1 2 Pancreas 3 3 Other Respiratory System Male Female Larynx 6 3 Lung Female Genital System Male Female 0 17 Male Genital System Male Female Prostate Testis 4 0 Penis 1 0 Brain & Other Male Female Nervous System Brain 4 4 Breast Male Female 2 73 Urinary System Male Female Bladder 26 9 Kidney/Pelvis 9 4 other 2 1 Lymphoma Male Female Hodgkin 1 1 Non-Hodgkin 12 3 Soft Tissue including Heart Male Female 2 1 Myeloma Male Female 6 2 Endocrine System Male Female Thyroid 1 5 Other 0 1 Skinincluding Melanoma Male Female 12 3 Mesothelioma Male Female 1 0 Miscellaneous Male Female 10 4 Leukemia Male Female 7 3 GRMC 2013 Primary Site Distribution

10 Gadsden Regional Medical Center Standard 4.6 Monitoring Compliance with Evidence Based Guidelines Pancreatic Cancer 2014

11 Site Analysis-Pancreas Each year, the cancer program analyzes a specific site. This analysis is used to assess whether patients within the program are evaluated and treated according to evidence based national treatment guidelines. This allows for any possible performance improvements within the facility. National Comprehensive Cancer Network (NCCN) guidelines state diagnostic imaging evaluation, blood testing and tissue sampling are all necessary for treatment planning. Diagnostic imaging consist of either CT, MRI, PET, Endoscopic ultrasound or by laparoscopy, followed by blood tests; specifically, CA19-9. High levels of CA19-9 can be caused by pancreatic cancer but does not confirm pancreatic cancer. Pancreatic cancer can be divided into four main groups: resectable, borderline resectable, locally advanced unresectable and metastatic. Resectable - Cancer has not spread outside of the pancreas and appears to be easily treated with surgery. Borderline Resectable - Cancer that is confined to the pancreas, but the tumor approaches nearby structures and may not be resectable with clear margins (tumor gets left behind). Locally advanced unresectable - Cancer has spread beyond the pancreas to nearby structures (blood vessels or other tissue) Metastatic - Cancer has spread to other organs and tissues outside of the pancreas There are more than one treatment available for pancreatic cancer. Most patients with pancreatic cancer will receive more than one type of treatment. Neo-adjuvant Treatment given to shrink the tumor BEFORE surgery. Adjuvant Treatment given after primary treatment to kill any remaining cancer cells. Primary Main treatment given to rid the body of cancer First line treatment The first set of treatments given. Second line treatment The next set of treatments given after the first or previous treatments have failed.

12 Not every person with pancreatic cancer will receive every treatment listed. Cancer treatment for pancreatic cancer can consist of the following: -Surgery -Radiation therapy -Chemotherapy -Targeted therapy -Clinical Trials Six new pancreatic cancer cases were diagnosed and/or treated at Gadsden Regional Medical Center in These six cases were analyzed following the NCCN guidelines ensuring our patients were evaluated and treated accordingly. Our analysis showed the following: All six cases received appropriate diagnostic testing - 100% All six cases had CA19-9 blood testing performed - 100% Five cases had tissue sample testing (biopsy) performed prior to surgery, chemotherapy and/or radiation therapy - 83% (One patient denied treatment) All six cases received appropriate 1st course treatment recommended - 100% (Chemotherapy was the primary treatment administered or recommended in all six cases) In 2013, Gadsden Regional Medical Center treated a small number of pancreatic cancer cases and followed the best practice guidelines for diagnosis and treatment. The multi-disciplinary team is committed to the comprehensive care and exceptional treatment of patients with pancreatic cancer. ** Radiation only patient-chemo was recommended as primary treatment but patient refused, radiation treatment to metastatic site for palliative care

13 NCCN guidelines for Pancreatic Adenocarcinoma Chemotherapy General Principles: Systemic therapy is used in all stages of pancreatic cancer, including neoadjuvant (resectable or borderline resectable), adjuvant, locally advanced unresectable, and metastatic disease Goals of systemic therapy should be discussed with patients prior to initiation of therapy, and enrollment in a clinical trial is strongly encouraged. Close follow up of patients undergoing chemotherapy is indicated. Neoadjuvant Therapy There is limited evidence to recommend specific neoadjuvant regimens off-study, and practices vary with regard to the use of chemotherapy and radiation. Subsequent chemo-radiation is sometimes included. When considering neoadjuvant therapy, consultation at a high-volume center is preferred. When feasible, treatment with neoadjuvant therapy at or coordinated through a high-volume center is preferred. Participation in clinical trial is encouraged. Adjuvant Therapy Recommended adjuvant therapy options apply to patients who did not receive prior neoadjuvant therapy. For those who received prior neoadjuvant therapy, the adjuvant therapy options are dependent on the response to neoadjuvant therapy and other clinical considerations. In our six case studies, chemotherapy was offered and administered to all but one. Patient choice must be respected. Was chemotherapy offered Was chemotherapy administered No Alberto Echeverri, M.D.

14 Community Outreach Gadsden Regional Medical Center and Gadsden Regional Cancer Center have presented and/or participated in several screening, prevention and education activities in Etowah County. Some of these events include: Look Good Feel Better sessions for female cancer patients (bi-monthly) Relay for Life of Etowah County National Cancer Survivor s Day-Dinner Celebration 2nd Annual GRMC mammogram-athon during the month of October Free skin cancer screening by Dr. Wren Assisted several patients with medication and trips to and from treatment T.O.U.C.H. Today Our Understanding of Cancer is Hope.-Monthly meeting Attend Health Fairs and provide prevention pamphlets to the community

15 2013 National Cancer Survivors Day Dinner Celebration

16 Gadsden Regional Medical Center Best in Bama Resource Directory Gadsden Regional Medical Center (256) Axillary and Volunteers (256) Cancer Registry (256) or (256) Pastoral Care (256) Health Information Management (Medical Records) (256) Cancer Center (Dr. Lowndes Harrison) (256) Hematology and Oncology Associates of Alabama- (Drs. Castillo and Garcia-Hernandez) (256) Surgical Associates of Gadsden (256)