2016 CANCER PROGRAM REPORT. Bay Medical Sacred Heart Health System 615 North Bonita Avenue Panama City, FL

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1 2016 CANCER PROGRAM REPORT Bay Medical Sacred Heart Health System 615 North Bonita Avenue Panama City, FL

2 2016 Cancer Program Report Bay Medical Sacred Heart provides comprehensive services and equipment specializing in the prevention, diagnosis, treatment and management of patients with cancer. The cancer program at Bay Medical Sacred Heart is designated as a Comprehensive Community Cancer Program by the American College of Surgeons Commission on Cancer. As an accredited cancer program, we remain committed to providing outstanding care and meeting the rigorous standards of quality annually. This program is directed by the leadership of a multidisciplinary Cancer Committee, and members work diligently to help provide the best cancer treatment available. Throughout the year a range of educational events and screenings are also offered to the community. Multiple platforms are utilized to share information about cancer, including programs on the air, social and printed media, health fairs, and other public venues. In 2016, Bay Medical Sacred Heart provided and collaborated with others to offer a variety of programs including the following: Colon Cancer Educational Seminar Skin Cancer Screenings Mammogram Awareness Campaign Making Strides against Breast Cancer Tobacco Cessation Classes Look Good Feel Better Bay Medical Sacred Heart Health System 2016 Cancer Program Report 1

3 Bay Medical Sacred Heart Health System 2016 Cancer Program Report 2

4 Cancer Registry At Bay Medical Sacred Heart, the Cancer Registry plays an integral role in the Comprehensive Community Cancer Program. With a Registry Reference year of 1999, the Registry is responsible for collecting and maintaining data for newly diagnosed cancers and / or those receiving treatment at this facility. This data assists in determining incidence, monitoring outcomes, and evaluating cancer care. The information is collected according to Cancer Program Standards established by the American College of Surgeons Commission on Cancer, as well as the Florida Cancer Data System (FCDS), which is the state s central registry. All analytic 1 cases are reported annually to the American College of Surgeons Commission on Cancer as is stipulated of an accredited program. Additionally, cases are submitted to FCDS as required by state law. The data collected is disease specific and standardized to ensure accurate comparisons with national and state outcomes for all cancer types. Cancer Registry Data - Summary of 2015 Statistics The top five cancer sites most frequently diagnosed and / or treated at Bay Medical Sacred Heart in 2015 were, in order of most to least, Lung, Colorectal, Breast, Bladder, and Thyroid. For 2015, the Cancer Registry accessioned 700 new cases into the database, and of those 489 were analytic 1 cases and 211 were non-analytic cases. The following data and graphs reflect the distribution of analytic primary sites seen in 2015 at Bay Medical Sacred Heart (BMSH). 1 Cases diagnosed and / or received all or part of first course treatment at Bay Medical Sacred Heart Gender Distribution Bay Medical Sacred Heart 2015 Male 49.9% Female 50.1% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 3

5 2015 Analytic Cases TOTAL MALE FEMALE ORAL CAVITY & PHARYNX DIGESTIVE SYSTEM RESPIRATORY SYSTEM BONE & JOINTS SOFT TISSUE SKIN, EXCLUDING BASAL & SQUAMOUS BREAST FEMALE GENITAL SYSTEM MALE GENITAL SYSTEM URINARY SYSTEM BRAIN & OTHER NERVOUS SYSTEM ENDOCRINE SYSTEM LYMPHOMA MYELOMA LEUKEMIA MESOTHELIOMA MISCELLANEOUS Bay Medical Sacred Heart Health System 2016 Cancer Program Report 4

6 Age at Diagnosis Bay Medical Sacred Heart 2015 OTHER 6% AGE % AGE % AGE % AGE % AGE % Top Five Cancer Sites by Gender Bay Medical Sacred Heart % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Lung Colorectal Breast Bladder Thyroid Male 54.2% 58.5% 0.0% 80.0% 26.3% Female 45.8% 41.5% 100.0% 20.0% 73.7% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 5

7 Cancer Incidence Bay Medical Sacred Heart 2015 This chart shows the frequency of the top five primary sites seen at Bay Medical Sacred Heart in Lung cancer remains the leading primary site, representing 26.8% of cancer cases. Lung 26.8% Colorectal 13.3% Breast 12.9% Bladder 4.1% Thyroid 3.9% Other Cancers 39.0% 30% 25% 20% Cancer Frequency Comparison National, State and Bay Medical Sacred Heart 2015 This graph displays the comparison of Bay Medical Sacred Heart's 2015 cases to Florida and national estimates. State and national figures are taken from the American Cancer Society's Facts and Figures BMSH has a higher occurrence rate of lung and colorectal cancer when compared to the national and state data. BMSH has implemented lung cancer education and screenings and has provided colorectal cancer seminars and community educational offerings in response to this. 15% 10% 5% 0% Lung Colorectal Breast Bladder Thyroid BMSH 26.8% 13.3% 12.9% 4.1% 3.9% FL 14.7% 8.2% 13.6% 5.0% NA USA 13.3% 8.0% 14.1% 4.5% 3.8% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 6

8 Triple Negative Breast Cancer 2016 Study It is estimated that in 2016 there will be approximately 246,660 women and 2,600 men diagnosed with invasive breast cancer, and 61,000 additional women will be diagnosed with in-situ breast cancer. Breast cancer remains the most commonly diagnosed cancer in women and the second leading cause of death in women in the United States. From , breast cancer was the most commonly diagnosed cancer in the state of Florida. When the diagnosis of breast cancer has been confirmed, the samples of cancer tissue are evaluated by lab tests to determine the presence or absence of receptors (proteins), specifically estrogen, progesterone and HER2/neu (human epidermal growth factor receptor 2) receptors. The results of these tests assist in determining which treatments are likely to be more effective. If the tumor tests positive, this indicates that there are many receptors. If the tumor tests negative, then this means that there are few or no receptors. The presence of these receptors is known to support the growth of most breast cancers. There are more treatment options for tumors that test positive. Hormonal therapies and the HER2- targeted therapies interfere with the effects of hormones and the HER2 receptors on the breast cancer cells. When all three of these receptors test negative it is known as triple negative breast cancer (TNBC). In the United States, about 10-20% of all breast cancers are triple negative cancers. Of the reviewed breast cancer cases at Bay Medical Sacred Heart from 2011 through 2015, 10 percent were triple negative breast cancers. Most breast cancers are diagnosed after the age of 55, and although TNBC can occur in anyone, it is more likely to occur in those who are younger, African American and Hispanic women, or those who have the BRCA 1 gene mutations. The graph below reflects the TNBC age distribution at Bay Medical Sacred Heart for the same time period of 2011 through Bay Medical Sacred Heart Health System 2016 Cancer Program Report 7

9 Age Distribution Bay Medical Sacred Heart > 60 yo = 46% < 60 yo = 54% Additionally, when testing the tumor tissue, the pathologist determines the grade of the cancer tissue on a scale of 1 to 3. The higher the grade, the less the cancer cells resemble normal cells in their appearance and growth pattern. The triple negative breast cancers tend to be a higher grade than other types of breast cancer. Of the reviewed triple negative breast cancer cases at Bay Medical Sacred Heart, 75% were Grade 3. Tumor Grade Distribution Bay Medical Sacred Heart Grade 2: 25% Grade 3: 75% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 8

10 Triple negative breast cancer is typically treated with a combination of surgery, chemotherapy, and radiation. The chemotherapy with radiation is often adjuvant therapy, being given after surgery. According to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines, surgery with or without chemotherapy and radiation is the standard for locoregional triple negative breast cancer. Although TNBC is not treated with hormone or targeted therapy, some studies have shown that TNBC may respond better to chemotherapy than the breast cancers that are hormone-receptor positive. Bay Medical Sacred Heart manages triple negative breast cancer in concordance with current NCCN guidelines. For the cases reviewed with TNBC diagnosed from 2011 through 2015, in those with small tumor size AJCC Stage I disease, surgery alone was the treatment option for a very few patients. One patient with Stage I disease refused chemotherapy, and surgery and radiation alone was the treatment in this case. Chemotherapy was administered appropriately and withheld only upon refusal by the patient. Surgery with chemotherapy and radiation therapy were the treatment modalities for all those with Stage III disease. As per guidelines, anti-hormone therapy was not prescribed for these patients. Trastuzumab (Herceptin), an immunotherapy that targets the HER2 receptor / protein, was not utilized in any of these cases. Bay Medical Sacred Heart Health System 2016 Cancer Program Report 9

11 AJCC Staging Triple Negative Breast Cancer 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Stage I Stage II Stage III Triple Negative Cases 33% 50% 17% Treatment for BMSH TNBC Surgery, Chemotherapy, & Radiation Therapy 50.0% Surgery and Chemotherapy 37.5% Surgery Alone 8.3% Surgery and Radiation Therapy (Refused Chemotherapy) 4.2% References: The American Cancer Society The American Cancer Society Facts and Figures 2016 Breastcancer.org Susan G. Komen Foundation Bay Medical Sacred Heart Health System 2016 Cancer Program Report 10

12 Accountability and Quality Improvement Measures Bay Medical Sacred Heart continues to participate in the Rapid Quality Reporting System (RQRS) of the American College of Surgeons. RQRS is a reporting and quality tool used to provide real time assessment of the program s adherence to quality cancer measures for various types of cancer. This allows physicians to track clinical performance on national quality indicators. Participating in this activity on a monthly basis provides a method to evaluate care in a timely manner and develop appropriate quality improvements. Another way care is evaluated is by reviewing the performance rates of care received by patients with breast, colon, gastric, lung, and rectal cancer who have documentation of treatment according to standard of care. The goals for the standards are established by the American College of Surgeons Commission on Cancer (CoC). Bay Medical Sacred Heart Performance: All measures with applicable cases were compliant for the most recent year evaluated, being either above the established standard (goal) percentage or with an upper limit of the 95% confidence interval above the set benchmark. Breast Standard: Radiation is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conservation surgery for breast cancer. CoC Standard: 90% Standard: Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1c, or Stage IB-III hormone receptor positive breast cancer. CoC Standard: 90% Standard: Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with > = 4 positive regional lymph nodes. CoC Standard: 90% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 11

13 Standard: Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer. CoC Standard: 80% Colon Standard: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. CoC Standard: 85% Gastric Standard: At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer. CoC Standard: 80% Lung Standard: Systemic chemotherapy is administered within 4 months to day pre-operatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pn1) and (pn2) NSCLC. CoC Standard: 85% Standard: Surgery is not the first course of treatment for cn2, M0 lung cases. CoC Standard: 85% Rectum Standard: Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is recommended; for patients under the age of 80 receiving resection for rectal cancer. CoC Standard: 85% Bay Medical Sacred Heart Health System 2016 Cancer Program Report 12

14 The Healing Garden 615 North Bonita Avenue Panama City, FL Bay Medical Sacred Heart Health System 2016 Cancer Program Report 13