2015 Annual Report Cancer Services

Transcription

1 2015 Annual Report Cancer Services St. Joseph Mercy Oakland Alice Gustafson Center Cancer Resource and Support Center

2 Introduction Dr. Judie Goodman, Oncology Program Medical Director The Oncology Program at St. Joseph Mercy Oakland (SJMO) strives to continue growing in a rapidly evolving world. Our access to national clinical trials keeps our patients abreast of the newest developments. Multidisciplinary tumor boards provide thoughtful and rapid prospective case evaluation involving numerous subspecialists. Our screening programs bring the best technologies to our patients, in arenas such as lung cancer, breast cancer and head and neck cancer. Our support services for patients is exemplary: providing nurse navigation, image enhancement, genetics counseling, alternative and complementary medicines, survivorship assessment, distress screening and support groups. We provide both outpatient and inpatient palliative care and hospice services. In short, our program encompasses the full spectrum of services from screening and prevention to treatment and supportive care throughout a patient s cancer journey. Message from John C. Stout, MBA, FACHE, Regional Director, Oncology Services St. Joseph Mercy Cancer Network Finding hope. Finding options. Finding results. Over the past year Saint Joseph Mercy Health System continued to regionalize Oncology services, with an emphasis on improving care coordination and identifying efficiencies. Our mission is to provide patients and families value-add services, including culture of safety, clinical outcomes, access/ appropriate care setting and value-based services. This approach aligns well with Trinity Health s People Centered 2020 strategic plan. Oncology s regionalization in Southeast Michigan has achieved a variety of positive outcomes that improve the patient experience and program development, while yielding a stronger network of physician and program leadership. Our expert team will continue to strive in these areas as we move toward population health for our patients and families. Outcomes Prevention and Screening Programs and Supportive Care Clinic Prevention & Screening BREAST: Eight free mammogram clinics were held this year. Services include additional imaging and ultrasounds. Clinical breast exam by a surgeon specializing in diseases of the breast is offered at four of the clinics. Persons needing a biopsy are referred to the Breast and Cervical Cancer Screening program (Title 15) and, if found to have a positive diagnosis, are assisted with obtaining a payer source. Eight clinics, to date, have been held: 135 persons served. One positive diagnosis has been found. LUNG: Low dose CT screenings for lung cancer are offered at SJMO for those persons who meet criteria. Approximately 260 persons served to date. Free Smoking Cessation classes were offered during the months of March, June, and October: 45 persons served. ORAL, HEAD AND NECK March 2015 free Head and Neck Cancer screening: 84 persons served. Supportive Care Clinic St. Joseph Mercy Oakland (SJMO) has expanded its award-winning Palliative Care Program and taken it outside the hospital walls by opening a Supportive Care Clinic for outpatients with serious illnesses. The new outpatient clinic is designed to improve a patient s quality of life by preventing, relieving, and reducing the symptoms of a disease. It helps both the patient and family members cope with serious illness and end-stage disease by providing support. St. Joe s clinic is one of the first Supportive Care/Palliative Care outpatient clinics offered in southeast Michigan. Housed in the Cancer Resource and Support Center in the Alice Gustafson Center on the hospital campus, the Supportive Care Clinic is directed by advanced certified nurse practitioners Peg Nelson, RN-BC, MSN, NP, ACHPN, and Suzanne Jermstad, MSN, FNP-BC, AOCNP, ACHPN. They work closely with each patient s physician and other health professionals to address the physical, emotional and spiritual needs of patients and their families. A multidisciplinary group of health professionals meets monthly to review all cases. The group is made up of physicians, nurse practitioners, dietitians, financial and cancer nurse navigators, rehabilitation specialists, case managers, social workers and home care/hospice staff. Patients continue to see their regular physician, who continues to direct the overall plan of care. The primary goal of the outpatient supportive care clinic is to provide support for the whole patient; mind, body and spirit throughout an extremely difficult process. The Supportive Care Clinic strives to prevent problems from occurring by helping patients and families understand and cope with their illness, as well as symptom management as appropriate. Studies have shown an increase in both quality and length of life when palliative services are provided along with traditional medical care.

3 MEET OUR CANCER SUPPORT SERVICES TEAM NURSE NAVIGATORS Andrea Briefs-Ferris, RN, MHSA, CN-BN, Breast Cancer Nurse Navigator, Andrea serves as an advocate for breast cancer patients and assists both patients and families with various resource needs. She assists in coordinating care, provides emotional support, provides education, coordinates counseling when indicated and partners with physicians and their office staff members. She also leads two support groups: Breast Cancer Support Group and Look Good Feel Better, offered in cooperation with the American Cancer Society. Patti Moore, RN, BSN, Lung Cancer Nurse Navigator, Patti serves as an advocate for lung cancer patients and assists both patients and families with various resource needs. She coordinates care, provides emotional support, provides education, coordinates counseling when indicated and partners with physicians and their office staff members. GENETIC COUNSELING Kelly Kennelly, MS, CGC, Genetic Counselor, Our genetic couselor evaluates and communicates the risk of an inherited disease to individuals who are identified as abeing at higher risk of developing cancer during their lifetime. Testing to identify these individuals means that they can take steps to reduce their risk of cancer by pursuing vital screening and risk reduction strategies. Patients can access our service through their physician or self-referrals or by requesting the MammoPlus risk assessment at the time of their digital mammogram at SJMO and then opting to participate in the RiskPlus program. SURVIVORSHIP ISSUES Suzanne Jermstad MSN, FNP-BC, AOCNP, ACHPN, Advanced Oncology Certified Nurse Practitioner, Suzanne is a board-certified, advanced oncology nurse practitioner who has cared for SJMO cancer patients for more than 15 years. She provides chemotherapy teaching, helps to manage treatment side effects, and assists with pain and palliative care. She also serves as the clinical practitioner for the RiskPlus program, making recommendations to primary care physicians for patients found to be at greater risk for developing breast cancer. In her role as the survivorship nurse practitioner, Suzanne formulates a post-treatment care plan and offers continued management of side effects and issues related to cancer diagnosis and treatment; including referrals for therapy, psychosocial support, and rehabilitation. FINANCIAL NEEDS Debra Averill, CPC, Oncology Financial Navigator, Debra assesses financial needs of new and established cancer patients with the intent of removing financial barriers to care and improving coverage for care. She provides patients and the cancer care team with financial education and advises on the most optimal insurance coverage. NUTRITION Lisa Lewis, RD, CDE, Outpatient Registered Dietitian, Lisa in an outpatient registered dietitian who partners with patients on an appointment basis to offer individualized nutritional counseling, helping patients identify their nutrition goals and planning ways to meet those goals. She advises patients on the nutrients they need to help fight cancer and heal. Lisa helps them manage side effects to keep up strength and energy.

4 St. Joseph Mercy Oakland 2014 Primary Site Table Primary Site Total Male Female Analy NA ORAL CAVITY & PHARYNX 13 (1.3%) % Tongue 3 (0.3%) Salivary Glands 3 (0.3%) Gum & Other Mouth 1 (0.1%) Tonsil 5 (0.5%) Hypopharynx 1 (0.1%) DIGESTIVE SYSTEM 166 (17.2%) U.S. % % Esophagus 10 (1.0%) Stomach 19 (2.0%) Small Intestine 2 (0.2%) Colon Excluding Rectum 56 (5.8%) Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid 28 (2.9%) Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct 3 (0.3%) (1.3%) Gallbladder 2 (0.2%) Other Biliary 4 (0.4%) Pancreas 23 (2.4%) Retroperitoneum 1 (0.1%) Peritoneum, Omentum & Mesentery 3 (0.3%) Other Digestive Organs 2 (0.2%) RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear 153 (15.8%) % 1 (0.1%) Larynx 6 (0.6%) Lung & Bronchus 146 (15.1%) BONES & JOINTS 1 (0.1%) % SOFT TISSUE 10 (1.0%) % MELANOMA -- Skin 14 (1.4%) % BREAST 185 (19.1%) % FEMALE GENITAL SYSTEM 87 (9.0%) % Cervix Uteri 15 (1.6%) Corpus & Uterus, NOS 43 (4.4%) Ovary 17 (1.8%) Primary Site Total Male Female Analy NA Vagina 1 (0.1%) Vulva 10 (1.0%) Other Female Genital Organs MALE GENITAL SYSTEM Prostate 1 (0.1%) (10.9%) 102 (10.5%) U.S. % % Testis 3 (0.3%) URINARY SYSTEM 78 (8.1%) % Urinary Bladder 48 (5.0%) Kidney & Renal Pelvis 23 (2.4%) Ureter 6 (0.6%) Other Urinary Organs 1 (0.1%) BRAIN & OTHER NERVOUS SYSTEM 26 (2.7%) % Brain 13 (1.3%) Cranial Nerves Other Nervous System 13 (1.3%) ENDOCRINE SYSTEM 9 (0.9%) % Thyroid 8 (0.8%) Other Endocrine including Thymus 1 (0.1%) LYMPHOMA 42 (4.3%) % Hodgkin Lymphoma 8 (0.8%) Non-Hodgkin Lymphoma 34 (3.5%) NHL - Nodal NHL - Extranodal MYELOMA 13 (1.3%) % LEUKEMIA 24 (2.5%) % Lymphocytic 12 (1.2%) Acute Lymphocytic Chronic Lymphocytic Myeloid & Monocytic (1.2%) Acute Myeloid Chronic Myeloid MESOTHELIOMA 3 (0.3%) % MISCELLANEOUS 38 (3.9%) % Total %

5 2014 Lung Cancer Programs at St. Joseph Mercy Oakland St. Joseph Mercy Oakland's (SJMO) Lung Cancer program continued to develop new and improve existing lung cancer-related services. The Mercy Cancer Network chose Lung Cancer as the focus for the next five years for the Trinity Health system hospitals throughout the state. Lung CT Screenings became one of the main initiatives in 2014 with the anticipated Medicare and third party payor coverage of lung cancer low dose screening CT scans starting in The screening program experienced considerable growth in 2014 compared to 2013 with the total number of screenings jumping from 53 in 2013 to 78 in SJMO's Lung CT Screening program was modeled on the National Lung Screening Trial for early detection and treatment of lung cancer (NLST published in NEJM 2011). We offered one of the lowest prices ($99) for out-of-pocket expense for the screening scan in the metro-detroit area. A physician outreach program was developed and launched in 2014, with the focus being primary care and internal medicine education on lung cancer screening CT scans. Lung Nurse Navigator Patti Moore and Salik Jahania, MD made monthly visits to physician practices. The multidisciplinary lung cancer conference continued to meet every other Wednesday of every month. Overall in 2014 : 122 newly diagnosed lung cancer cases The Lung Steering Committee met quarterly to guide the direction of our lung cancer program. As a performance improvement project, we undertook the evaluation of the sensitivity and specificity of EBUS and mediastinal evaluation as performed at our institution. Outlier performance was evaluated and steps were taken to help outliers meet performance expectations. Other performance measure evaluated were: 1. Timeliness of lung cancer treatment 2. Documentation of pre- treatment clinical staging in consultation notes 3. Documentation of pathologic staging 4. Documentation of EGOG performance status during pre-op evaluation Free Smoking Cessation Classes were held throughout the year. Participants register by calling participants completed the month-long program. The participants made an action/quit plan and were offered ongoing smoking counseling. On Nov. 4, 2014 a multidisciplinary Grand Rounds Lung Cancer Presentation was held at the hospital. 120 physicians, medical residents and nurses attended. They were educated about smoking cessation, lung CT screenings, lung cancer staging and treatments. On Nov. 11, 2014, Dr. Salik Jahania did a presentation on Lung CT Screenings for the Great Lakes Crossing Mall Walkers. The event was held at the Rain Forest Café and over 50 people attended. MIDAS database was developed to assist in tracking the low dose lung CT screening participants in anticipation of using that as a base registry for CMS reimbursement purposes in Radiology adds Breast Tomosynthesis (3D Mammograms) St. Joseph Mercy Oakland has added Breast Tomosynthesis (also known as 3D Mammography), a revolutionary new screening and diagnostic tool for the early detection of breast cancer. This new FDAapproved technology has been shown in clinical studies to be superior to traditional digital mammography alone and is performed in conjunction with traditional 2D digital mammography. During the 3D portion of the mammogram, the X-ray arm sweeps in an arc over the breast, taking images. A computer then generates a 3D image of the breast tissue in one millimeter slices, with fine details more clearly visible. This increased level of detail allows the radiologist to more easily differentiate between normal and abnormal tissue, increasing cancer detection and reducing the need for additional imaging.

6 Oncology Research Program 2014 showed continued progress in the St. Joseph Mercy Oakland (SJMO) Research program. We continue to meet the American College of Surgeons (ACS) commendations benchmark for an academic teaching hospital with 8% of the analytical cases diagnosed in 2014 enrolled in clinical trials. During 2014, 73 patient consents were obtained for a variety of oncology clinical trials at SJMO (e.g. NCORP Treatment and Quality of Life Trials, nursing research through the MSU Reflexology Study, SEER Studies through Wayne State University which focus on the Epidemiology of Cancer, etc.). SJMO s Oncology Program continues its affiliation with the Michigan Cancer Research Consortium s NCORP (NCI Community Oncology Research Program). The format for doing research in the NCORP organization continues to evolve. Patients now have access to multiple research studies with a new design that is based on entry into a main study which then sub-divides into multiple sub-studies or treatment arms based on the results of each tumor s genetic profile. This is a brief outline of some of the newly designed studies: The S1400 Lung MAP Trial is specific for squamous cell lung cancer patients, currently offers four possible sub-studies based on the match of the tissue s genetic profile. If there is not a genetic match made, there is a fifth sub-arm using a non-match drug which is offered to the patient. The Alliance (the ALCHEMIST) Trial focusses specifically on Non-Small Cell Lung Cancer. Patients and currently offered two possible treatment arms based on the results of the lung tissue s genetic profile. The ECOG EAY131 Study (the MATCH Trial) is the first NCI study to focus solely on the genetic characteristics of any type of cancer. This study currently involves an entry study with ten sub-studies which are based on the genetic profile of whatever type of cancer a patient has. The study is directed towards patients with advanced cancers who meet the study entry criteria. New arms are planned to be added as additional drug options are identified. This study is truly a leap forward in the concept of cancer research design. This is definitely an exciting time for cancer research in general, as well as for the Cancer Research Department at St. Joseph Mercy Oakland. Bringing national trials to a community hospital setting continues to be an honor and a privilege Cancer Committee Members Physician Members: Judie Goodman, DO, Chair - Medical Oncology Richard Bennett, MD - Urology James Caralis, DO Thoracic Surgery Mohammad Chisti, MD Medical Oncology Matthew Cotant, MD Medical Oncology Ahmed Ezz, MD, CLP Radiation Oncology John Fischer, MD Pathology Jeff Forman, MD Radiation Oncology Amy Kirby, MD Breast Surgical Services Allan Silbergleit, MD, PhD CLP State Chairman Babu Vemuri, MD Radiology Non-Physician Members: Lisa Anderson Lymphedema/Rehabilitation Becky Bell, CTR Regional Registry Manager Linda Borucki-Urban 4G Nurse Educator Andrea Briefs Ferris Breast Navigator Kathy Courtney Operations Manager Deborah Dixson Faith Community Nursing Suzanne Jermstad Survivorship Program Kelly Kennelly Genetic Counseling Resra Krull Mercy Hospice Donna Moir Director, Oncology and Radiology Jennifer Nagy ACS Representative Peg Nelson Palliative Care Morris Pajewski Director of Organizational Quality Mandy Schroeder Social Work Susan Stempky Oncology Research Linda Thompson Pastoral Care Scott Woik 4G Manager Susan Yun Psychosocial Coordinator Accredited by: Advanced Certification in Palliative Care by The Joint Commission; American College of Surgeons, Commission on Cancer; American College of Radiology (Designated Lung Cancer Screening Center, Breast Imaging Center of Excellence, Breast MRI, Breast Ultrasound, Stereotactic Breast Biopsy, CT, Mammography, MRI, Nuclear Medicine, Ultrasound); American College of Radiation Oncology 21st Century Oncology; Lung Cancer Alliance Screening Center of Excellence; National Accreditation Program for Breast Centers