Cancer Center Cancer Program Annual Report

Transcription

1 Cancer Center 2008 Cancer Program Annual Report

2 Greetings Chairman s Letter Rene Gonzalez, MD Chair, Cancer Committee University of Colorado Hospital The University of Colorado Cancer Center s clinical enterprise continues to grow year by year. Outpatient visits to the Cancer Center grew by over 29 percent during 2008, and the inpatient oncology service on the 11th floor of the Anschutz Inpatient Pavilion maintained a very high census. The program areas with significant growth in clinic visits over the prior year included: lung cancer, 53 percent hematologic malignancies/bmt, 42 percent breast cancer, 26 percent urologic cancer, 20 percent head and neck cancer, 19 percent In order to meet the demand for chemotherapy treatment, we expanded the hours of the Cancer Center infusion service during the week and added regular hours on Saturday. Infusion services for bone marrow transplant patients grew as well. We also continued to expand our clinical outreach program. During the fiscal year, on average, nine physicians traveled to three rural and mountain locations to consult with local physicians and 174 cancer patients, on a regular basis. We had active contracts with Shaw Cancer Center in Vail, Valley View Hospital in Glenwood Springs, and the San Juan Cancer Center in Montrose, and negotiations were underway to expand the outreach services to Alamosa, Colorado Springs and Aspen. The oncology specialties covered include: prostate and renal cancer, breast cancer, hematologic malignancies, lung cancer, GI cancer, melanoma and benign hematology. However, the physicians, who are all medical oncologists or hematologists, are able to treat all cancer sites. Physicians participating in outreach included Drs. Paul Bunn, Michael Glodé, Fred Kolhouse, Anthony Elias, Karl Lewis, Kathryn Hassel, Virginia Borges, William Robinson, and Madeleine Kane. In addition to seeing patients our physicians referred many patients back to UCH for surgery, radiation treatments and other procedures that their home hospitals could not do. UCH and UCCC collaborated on hiring a full-time patient coordinator, Shelly Gregory, to help patients and their primary physicians navigate the clinical Cancer Center and provide better service to physicians. Dr. Glodé was appointed associate director for outreach at UCCC, and he is coordinating the growth of our outreach efforts. UCCC added four outstanding physicians to its clinical staff during : Robert Doebele, MD, PhD, assistant professor of Medical Oncology, UC Denver, was recruited to UC Denver from the University of Chicago. He is a lung cancer specialist and lung cancer translational researcher. Antonio Jimeno, MD, PhD, is assistant professor of Medical Oncology and director of the UC

3 Denver Developmental Therapeutics/Pharmacodynamic Laboratory. Dr. Jimeno has clinical interest in head and neck squamous cell cancer. He is part of the Phase I team, bringing cutting-edge treatments to UCCC patients. Allen Waziri, MD, is assistant professor of Neurosurgery, UC Denver. He is a neurosurgeon whose career focuses on brain tumors. William Tse, MD, is associate professor of Medical Oncology at UC Denver. His clinical and research focus is leukemia--specifically acute myeoloid leukemia--and he has more than a decade of work in the field. He has been PI in numerous multicenter clinical trials. The Hematologic Malignancies/Bone Marrow Transplant Program, directed by Dr. Han Myint, continued its growth in the fiscal year. Now, the program includes specialists in leukemia, lymphoma and myeloma. The program underwent successful accreditation by FACT, the Foundation for the Accreditation of Cellular Therapy. FACT only accredits organizations that demonstrate outstanding patient care and medical and laboratory practices. In , UCCC began offering the Schwartz Center Rounds, a meeting of cancer caregivers that allows them to explore the emotional side of taking care of cancer patients. Initiated under the leadership of Dr. Virginia Borges and led by oncology social worker Cheryl Volmert, the meetings focus on a single topic and give caregivers a safe place to discuss the issues that come with caring for people who are in pain, have side effects, and perhaps do not survive their disease. The series has been successful, drawing several dozen participants at each meeting. The series will continue in , held every other month. As part of our effort to be a community resource, UCCC completed a complete revamp of its web presence. The new website draws visitors in by condition treated, then provides comprehensive information about services, physicians, facilities, tests and treatments, and clinical trials. A new clinical trials database is being developed and will go live in the next fiscal year. Looking ahead, the fiscal year should bring more of the same, despite the difficult economic conditions. We will continue to recruit excellent new faculty, see more patients, offer more clinical trials and expand our reach into the communities that do not have ready access to world-class oncology care. Finally, although this report looks back on the previous fiscal year, I would like to take this opportunity to recognize the immense contributions of Dr Paul Bunn who stepped down Jan. 1, 2009, as director of the Cancer Center after 21 years of outstanding achievements. He has been an inspirational leader and we wish him the best in his new endeavors. Sincerely, Rene Gonzalez, MD

4 Technical Highlights Tumor Registry - University of Colorado Hospital Established originally in 1975, the University of Colorado Hospital Tumor Registry has 41,703 cases to date. This does not include another 1,009 cervix in situ cases. To optimize consistency in follow up, our reference date is January 1, We are currently following 15,816 cases. In 1993, the registry went to paperless abstracts, meaning the entire abstract can be retrieved from the software. With the year 2001 data, the registry went to abstracting off of the electronical Medical Record chart. This has improved the productivity of the registry. In 2007, the registry staff incorporated the Multiple Histology and Primary coding rules book to help identify if a case is a new diagnosis or a recurrence of a case already in the registry. The registry is currently staffed by three full time registrars, two of whom are Certified Tumor Registrars. The staff attends two state meeting per year, and the national meeting is attended by the certified registry staff. For 2007, the Registry was awarded the gold award by the State of Colorado for timeliness and completeness of data submission. Our software capabilities are being upgraded continually to allow us to run different statistical analyses on our data. For 2007, the registrars abstracted 2,224 cases with 80 of these being non-analytic. There were 47 requests for data from the registry for the year. Most of these studies include in depth requests including survival. The follow up rate at the time of this publication is at 93.9% with the goal being above 90%. The registry has seen a significant increase of cases accessioned into the registry on a yearly basis. The primary duties of the tumor registrars are to abstract cancer data (including site, histology, stage and treatment) on all reportable tumors, and to provide lifetime of follow-up of patients. Survival information enables the medical staff to address quality of care of UCH s cancer patients. The hospital tumor registry population is reported to the Colorado Central Cancer Registry (CCCR), Rocky Mountain Cancer Data Systems (RMCDS) in Utah, and the National Cancer Database. The tumor registrars attend weekly general tumor conferences, and they frequently attend other sitespecific hospital cancer conferences. The registrars are participating members of quarterly Cancer Committee meetings. Quality Improvement Studies, required by ACOS, are completed by the tumor registrars and the Quality Improvement Department working with attending physicians and are presented to the Cancer Committee. The medical staff completes quality review of approximately 10 percent of analytic abstracts. Case-finding is conducted monthly for inpatient and outpatient contacts, including Radiation Oncology, Hematology and Oncology Clinic, Breast Clinic, Surgical Oncology Clinic, pathology and cytology reports, inpatient and outpatient disease indexes. Requests by UCH physicians and researchers for analysis of data are encouraged. To request data from the registry, please call Amy Kendall, CTR at (303)

5 Analytic Cancer Cases The analytic cancer cases for the University of Colorado Hospital have grown continually in recent years. In 2002 the Registry enrolled 1,328 cases and in 2007 that number reached 2,137, an increase of more than sixty percent. The top five sites vary somewhat from year to year. In 2007 the top five sites were prostate, lung and bronchus, breast, melanoma and the combination of all GYN cancers. These selected cancer sites represent the strong multi-disciplinary approach taken in the care delivery at UCH, led by physicians specializing in each type of disease. The state ranking of cases varies from the UCCC experience with breast, prostate, lung, melanoma and brain cancers representing the top five sites for the year.

6 Local Cases Cases by Counties ALL Cases UCH Distribution by County at Diagnosis County County County Adams 1267 Alamosa 52 Arapahoe 2598 Archuleta 30 Baca 12 Bent 17 Boulder 1174 Broomfield 74 Chaffee 50 Cheyenne 16 Clear Creek 27 Conejos 22 Costilla 20 Crowley 22 Custer 9 Delta 58 Denver 3855 Dolores 4 Douglas 540 Eagle 147 El Paso 77 Elbert 1197 Fremont 119 Garfield 146 Gilpin 15 Grand 62 Gunnison 44 Hinsdale 3 Huerfano 17 Jackson 6 Jefferson 1561 Kiowa 4 Kit Carson 27 Lake 26 La Plata 106 Larimer 734 Las Animas 44 Lincoln 13 Logan 62 Mesa 151 Mineral 1 Moffat 27 Montezuma 51 Montrose 78 Morgan 100 Otero 70 Ouray 16 Out of State 2281 Park 55 Phillips 17 Pitkin 81 Prowers 55 Pueblo 399 Rio Blanco 13 Rio Grande 54 Routt 98 Saguache 24 San Miguel 13 Sedgwick 14 Summitt 104 Teller 46 Unknown 72 Washington 17 Weld 530 Yuma 42 Total 18666

7 Survival Rates Five-Year Survival Rates The UCH five-year survival experience for selected types is shown on the accompanying graphs for cases enrolled from 1998 through For all five sites the UCH experience is compared to the State of Colorado, the eight-state Mountain Zone Region, as well as national experience data from the National Cancer Data Base. For all sites, including prostate, non-small cell lung cancer, breast cancer, melanoma and liver cancers the experience of patients at UCH is very favorable compared to the care rendered on the state, regional and national level.

8 Research Research at University of Colordo Cancer Center The Prognostic Role of Sentinel Lymph Node Biopsy in Patients with High-Risk Melanoma University of Colorado Cancer Center- Denver Ragini Kudchadkar 1, Rene Gonzalez 1, William Robinson 1, Nathan Pearlman 2, Ricardo Gonzalez 2, Martin McCarter 2, Anna Baron 3, Dexiang Gao 3, Maude Becker 1, Krista Treichel 1, Cindy Braden 1, and Karl Lewis 1 1 Department of Medical Oncology 2 Department of Surgical Oncology 3 Department of Biostatistics Background There is limited data on the prognostic use of sentinel lymph node (SLN) biopsies in patients with high-risk melanomas. Patients with primary melanomas greater than 4 mm and melanomas greater than 2 mm with ulceration have a 50% survival at five years. The question remains as to whether having a negative SLN at the time of diagnosis predicts a better prognosis for these high-risk patients. The data is strong supporting that intermediate risk patients have a significantly decreased risk of development of systemic disease at five years if the SLN is negative for metastatic disease. The routine use of adjuvant therapy in patients with tumors with tumors greater than 4mm remains controversial, especially in patients with a negative SLN. The goal of this retrospective evaluation is to assess the relapse-free survival as well as overall survival for patients with tumors greater than 4 mm or greater than 2 mm with ulceration with a negative SLN as compared to those patients with a positive SLN. Methods Via the tumor registrar at the University of Colorado, records of patients with melanoma from 1998 to 2008 were reviewed. 68 patients were identified with primary tumors greater than 4 mm (n=57) or had > 2 mm with ulceration (n=11) who had a successful SLN biopsy performed. Data was collected regarding sex, age, location of tumor, histologic subtype, presence of ulceration, adjuvant therapy, relapse-free and overall survival. Results 46 males, 21 females 40 (58.8%) negative SLN, 28 (41.1%) positive SLN Median Event-free survival 35 months vs. 12 months Median overall survival 71 months vs months Primarily systemic recurrence Conclusions SLN provides prognostic information for the high-risk patients with SNL negative patients having better overall and relapse-free survival. SNL negative patients are still at high-risk of recurrence with 35% developing systemic disease. High-risk melanoma patients should be considered for adjuvant therapy despite the negative SLN.

9 People Members of the Cancer Committee Cancer Committee Members 2007 Cancer Center Chairman: Rene Gonzalez, MD, Medical Oncology Julie Cantlon, Quality and Outcomes Susan Davidson, MD, GYN Oncology Deb DeVine, RN, 8E Oncology Nursing Allison Faust Jones, Program Director, Cancer Survivorship Melissa Feig, Administration Radiation Oncology Colleen Gill, Food and Nutrition Services Jeanette Gremmels, ACS Navigator Jan Hagman, Rehabilitation Ollie Hensley, Cancer Registry Madeline Kane, MD, Medical Oncology Amy Kendall, CTR, Cancer Registry Fred Kolhouse, MD, Medical Director, Cancer Center Anne Makowski, BMT Program Amy Malcolm, Social Services Leo Martinez, Social Services Martin McCarter, MD ACoS liaison, Surgery Alice Medrano, Cancer Registry Cindy Milazo, RN, Cancer Center Nursing Nathan Pearlman, MD, Surgery David Raben, MD, Radiation Oncology Charles Ray, MD, Interventional Radiology William Robinson, MD, Medical Oncology Ken Shroyer, MD, Pathology Meenakshi Singh, MD, Pathology Cheryl Volmert, LCSW, Social Services E. Strode Weaver, FACHE, Executive Director, Oncology Services Jennifer Zwink, RN, Nurse Manager, IP Unit

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