Geaton and JoAnn DeCesaris Cancer Institute Cancer Registry 2013 Annual Report

Transcription

1 Geaton and JoAnn DeCesaris Cancer Institute Cancer Registry 13 Annual Report Using Cancer Registry Data

2 Cancer Committee Members REQUIRED Barry Meisenberg, MD Medical Director, DeCesaris Cancer Institute Chair, Cancer Committee, Hematology-Oncology Stephen Cattaneo, MD Thoracic Surgeon Cancer Liaison Physician Joanne Ebner, RN, BSN, TTS Cancer Prevention Nurse Coordinator Cancer Prevention Coordinator Commission on Cancer Samir Shah, BS, CTR Manager Cancer Registry and Commission on Cancer Coordinator PHYSICIAN MEMBERS Carol Pressey, MD Primary Care Physician, Family Practice Stephen Proshan, MD General and Colorectal Surgeon Sanford Robbins, MD Director, Pathology Loraine Tafra, MD Medical Director and Breast Surgeon, The Breast Center Stanley Watkins, MD Hematology-Oncology 1 NON-PHYSICIAN MEMBERS Catherine Copertino, BSN, MS, OCN Executive Director, DeCesaris Cancer Institute Bonnie Bresnahan, RT (R) (T) Director, Radiation Oncology and Cancer Registry Justus Burkhardt, BA, MA Digital Marketing/Web Strategist, Marketing Jamie Caldwell, Ph.D. Director, Pharmacy Jan Clemons, RN, MSN, OCN Clinical Director, Nursing Inpatient Oncology Maria Geronimo, RN, MSN, MBA Program Coordinator, Thoracic Oncology Evelyn Graze, RN, MSN, OCN Director, Infusion Center Shirley Knelly, MS, CPAQ, LCADC Corporate Compliance Officer Vice President Patient Safety President, Pathways Teresa Putscher, RN, BSN, OCN Nurse Navigator Erika Siegrist, MS, RN, OCN Director, Research Office Amy Tissiere, LCSW-C Patient and Family Services Ashley Varner, MSW, MBA, OSW-C Counselor, The Breast Center American Cancer Society Representative PARTICIPANTS Arun Bhandari, MD Hematology-Oncology Deborah K Daugherty Director of Advancement, AAMC Foundation Brian Hasson, PhD Chief Medical Physicist Michael LaPenta, MD, FAAFP Hospice Care and Palliative Services Susan Schult Supervisor, AAMC Thoracic Surgery Surgical Oncology Jason Taksey, MD Hematology-Oncology Susanne Tameris Practice Manager, Annapolis Oncology and Hematology Kathy Whittaker, RN, BSN Manager, Patient Advocacy Elizabeth Wiley, MS, CGC Counselor, Genetics Table of Contents Cancer Committee Members Letter from Catherine Copertino and Barry Meisenberg, MD Geaton and JoAnn DeCesaris Cancer Institute Delivering Excellence with a Team Approach The Breast Center Inpatient Oncology Thoracic Oncology Program Outpatient Infusion Center Radiation Oncology Program The Research Institute Patient and Family Services.... Committed to the Health of the Community... 22

3 A Message from Catherine Copertino and Barry Meisenberg, MD The Geaton and Joann DeCesaris Cancer Institute continues to provide the most current evidenced-based care in cancer prevention, screening, diagnosis, treatment, and survivorship. We bring many engaged specialists together in a multidisciplinary approach that puts the patient first each step of the way. Our tumor boards meet to review cancer cases prospectively with follow-up exceeding benchmarks. With representatives from all cancer disciplines, these boards are compromised of dedicated individuals working together to make sure each patient is receiving evidence-based, appropriate and compassionate care. We have been recognized regionally and nationally for our commitment to quality. Our accomplishments include: Our Cancer Program received three-year accreditation and the Outstanding Achievement Award in 11 from the American College of Surgeons Commission on Cancer. This accreditation recognizes our dedication to providing care that meets the highest standards. Our Cancer Program continues to exceed national benchmarks in patient, nursing and staff satisfaction. The Cancer Survivorship Program was launched and received the Meritorious Abstract Award at the Cancer Survivorship Research Translating Science to Care Conference. The Breast Center, accredited in by the National Accreditation Program for Breast Centers (NAPBC), was reaccredited in 13. Our inpatient Oncology Unit focused on quality measures that have resulted in decreased falls, improved treatment of febrile neutropenia, and prevention of hospital-acquired pressure ulcers, just to name a few. We continue to educate oncology nurses throughout the state through our Oncology Nursing Education Program in chemotherapy and biotherapy. Our Thoracic Oncology Program developed a lung screening program that targets individuals at high risk for developing lung cancer, as well as a Rapid Access Chest and Lung Assessment Program to expedite care to individuals with a suspicious finding. The Rapid Access Chest and Lung Assessment Program received the Association of Community Cancer Centers Innovator Award for exhibiting forward-thinking strategic planning and developing pioneering programs and replicable models to improve cancer care. Our Medical Oncology and our Infusion Center received the American Society of Clinical Oncology s Quality Oncology Practice Initiative (QOPI) certification, demonstrating our commitment to delivering the highest standard of oncology care. Underlying each of these programs is our partnership with patients and their families and our commitment to elevating the experience through our focus on the whole patient. We consider ourselves more than a cancer center. We are a community partner dedicated to the health and well-being of each individual we serve. Catherine Copertino, BSN, MS, OCN Executive Director, DeCesaris Cancer Institute Medical Director, DeCesaris Cancer Institute Chair, Cancer Committee, Hematology-Oncology Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 2

4 Geaton and JoAnn DeCesaris Cancer Institute Delivering Excellence with a Team Approach Anne Arundel Medical Center (AAMC) is home to the Geaton and JoAnn DeCesaris Cancer Institute, a comprehensive, regional leader in cancer care that provides the latest in prevention, screening, diagnosis, treatment and survivorship. The DeCesaris Cancer Institute recruits and retains the highest-caliber physicians, nurses and staff. These highly skilled individuals come together with the patient to form a team where each perspective is honored and explored to ensure we have the most comprehensive, holistic view of each patient, along with his or her unique health status and how we can best restore health. Comprehensive Services The DeCesaris Cancer Institute continues to expand and increase the services available to our cancer patients and their families. We provide services across the continuum of cancer care, including prevention, highly specialized diagnostic and treatment services, community support, survivorship resources and end-of-life care. Each month, multiple disease-specific tumor boards teams of providers and staff whose experience spans all cancer disciplines meet to review the majority of cancer cases at AAMC. This multidisciplinary review ensures that we continue to deliver the best, most appropriate care to each patient. In, 1,452 patients were identified for tumor board review. 3

5 DeCesaris Cancer Registry The DeCesaris Cancer Institute Cancer Registry systematically tracks the diagnosis, treatment, and follow-up of patients diagnosed with cancer. The data we collect provides researchers, physicians and healthcare providers information needed to improve the outcome of cancer treatment. The American College of Surgeons Commission on Cancer (CoC) requires that cancer programs maintain an 80 percent tracking rate of all eligible cancer patients starting from the reference year (00) and a 90 percent follow-up rate on all cancer patients diagnosed with cancer within the last five years. In 08 and 11, the AAMC Cancer Registry received commendation from the CoC for meeting and exceeding these standards. Standard 5.3 = Follow-up since registry reference date 00 Standard 5.3 Follow-up of Patients Since 00 Total number of cases since 00: 15,519 Required follow-up rate: 80% Current follow-up rate: 86.99% 1% analytic cases = 155 patients Standard 5.4 = Follow-up within last 5 years; 08- Standard 5.4 Follow-up of Patients DIAGNOSED WITHIN last 5 years Total number of cases within last 5 years: 7,619 Required follow-up rate: 90% Current follow-up rate: 92.39% 1% analytic cases = 76 patients All Tumor Boards for Jan.-Dec. 79% of Cases Discussed Prospectively Conference Total Tumor Med Onc. Rad Onc. Surgeon Pathologist Radiologist Cases Prospective Board Conf. Presented Cases 1 Brain/CNS Not Required GU-ONCOLOGY Not Required Not Required GYNOCOLOGY Not Required THORACIC BREAST GENERAL HEMATOLOGY Not Required Not Required 11 Not Required Total Average % Average % Average % Average % Average % Total Cases Total Cases Attendance Attendance Attendance Attendance Attendance % 0% 98% 0% 98% 1,452 1,300 Total Reportable Cases Identified Jan.-Dec. = 1,647 Cases Presented Prospectively as Per Standard 1.7 = 1,300 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 4

6 Measuring Performance Commission on Cancer s Rapid Quality Reporting System (RQRS) PRESENTING CANCER REGISTRY DATA The DeCesaris Cancer Institute voluntarily participates in the CoC s Rapid Quality Reporting System (RQRS). This reporting and quality improvement tool provides real clinical-time assessment of hospital-level adherence to National Quality Forum (NQF)-endorsed quality of cancer care measures for breast and colorectal cancers. The six rating dials, one for each of the measures monitored and reported through RQRS, show the year-to-date facility performance rate achieved in. Reading the Dials The year-to-date (YTD) performance rate is based on the total number of cases for which chemotherapy has or was expected to be administered within the past year (365 days). For this measure, this includes all cases of patients diagnosed within the past 24 months. 3 Shaded areas represent the range of performance rates for other participating programs: Green: Top quartile, 75 th 0 th Yellow: 50 th 75 th percentile Red: 25 th 50 th percentile % n=14 2 Red needle points to the current YTD performance rate. Breast Measures % n=133 0% n=15 98% n=195 Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer. Combination chemotherapy is considered or administered within four months (1 days) of diagnosis for women under age 70 with AJCC T1cN0M0 or stage II or III hormone receptor-negative breast cancer. Tamoxifen or third-generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1cN0M0 or stage II or III hormone receptor-positive breast cancer. COLON Measures* RECTAL Measures % n= At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. 87.5% n=8 Adjuvant chemotherapy is considered or administered within four months (1 days) of diagnosis for patients under age 80 with AJCC stage III (lymph node positive) colon cancer. 87.5% n=8 Radiation therapy is considered or administered within six months (180 days) of diagnosis for patients under age 80 with clinical or pathologic AJCC T4N0M0 or stage III receiving surgical resection for rectal cancer. * The colon cancer measure for the number of nodes removed and pathologically examined reflects the proportion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. The rates shown in these dials indicate the proportion of patients for whom adjuvant chemotherapy was expected to be started within the last 365 days. Exceeding National Averages Comparison with National Cancer Data Base (NCDB) The National Cancer Data Base (NCDB), a joint program of the CoC and American Cancer Society (ACS), is a nationwide oncology outcomes database for more than 1,500 Commission-accredited cancer programs in the United States and Puerto Rico. Some 70 percent of all newly diagnosed cases of cancer in the United States are captured at the institutional level and reported to the NCDB. Launched in 1989, NCDB now contains approximately 29 million records from hospital cancer registries across the United States. Data on all types of cancer are tracked and analyzed. This data is used to explore trends in cancer care, create regional and state benchmarks for participating hospitals, and serve as the basis for quality improvement. 5

7 Measuring Performance Commission on Cancer s Rapid Quality Reporting System (RQRS) The DeCesaris Cancer Institute strives to meet and exceed national averages. The following graphs demonstrate our efforts to continually improve the delivery of quality cancer care. Breast MAC Breast HT Breast BCS 0% 0% 0% 90% 90% 90% 80% 80% 80% 70% 70% 70% 60% 60% 60% 50% % % MAC AAMC MAC Maryland State HT AAMC HT Maryland State BCS AAMC BCS Maryland State MAC-combination chemotherapy is considered or administered within four months (1 days) of diagnosis for women under age 70 with AJCC T1cN0M0, or stage II or III hormone receptornegative breast cancer. Performance Rate>=90% HT-tamoxifen or third-generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1c N0 M0, or stage II or III hormone receptor-positive breast cancer. BCS-radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer. Performance Rate>=90% Colon ACT Colon 12RLN Rectal AdjRT 0% 0% 0% 90% 90% 90% 80% 80% 80% 70% 70% 70% 60% 60% 60% 50% 50% 50% ACT AAMC ACT Maryland State 12RLN AAMC 12RLN Maryland State AdjRT AAMC AdjRT Maryland State ACT-adjuvant chemotherapy is considered or administered within four months (1 days) of diagnosis for patients under age 80 with AJCC stage III (lymph node positive) colon cancer. Performance Rate >=90% 12RLN-The colon cancer measure for the number of nodes removed and pathologically examined reflects the proportion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. Performance rate>=80% AdjRT-radiation therapy is considered or administered within six months (180 days) of diagnosis for patients under age 80 with clinical or pathologic (AJCC T4N0m) or stage III receiving surgical resection for rectal cancer. Performance Rate>=90% Quality Improvement A quality improvement project was initiated after we reviewed AAMC colon ACT cases. A protocol was instituted where any case with an initial node harvest falling below the standards will have the remaining specimen placed back into acetic formalin for additional fixation and re-examined for additional nodes. As a result of meticulous dissection and selected repeat dissection, our node count now averages 18 nodes per case, with many cases having 40 or more nodes. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 6

8 DCI Cancer by Body System and Sex Oral Cavity & Pharynx (3%) Lung & Bronchus 99 (15%) Thyroid 33 (3%) Lung & Bronchus 123 (12%) Pancreas 24 (4%) Kidney & Renal Pelvis 17 (3%) Breast 473 (47%) Kidney & Renal Pelvis (1%) Urinary Bladder 37 (6%) Ovary 25 (2%) Males Females Colon & Rectum 56 (9%) Uterine Corpus 45 (4%) Prostate 157 (25%) Colon & Rectum 52 (5%) Non-Hodgkin Lymphoma 40 (6%) Non-Hodgkin Lymphoma 22 (2%) Melanoma of the Skin 33 (5%) Melanoma of the Skin 21 (2%) Leukemia (3%) All Other Sites 137 (21%) All Other Sites 188 (9%) Leukemia (3%) 7

9 Summary by Body System, Sex, Class, Status and Best AJCC Stage Report Sex Class of Case Status Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Analy NA Alive Exp Stg. 0 Stg. I Stg. II Stg. III Stg. IV Not Staged Unk. ORAL CAVITY & PHARYNX %) Tongue 13 (0.8%) Salivary Glands 2 (0.1%) Gum & Other Mouth 2 (0.1%) Nasopharynx 2 (0.1%) Tonsil 6 (0.4%) Hypopharynx 3 (0.2%) DIGESTIVE SYSTEM 222 (13.5%) Esophagus 15 (0.9%) Stomach 13 (0.8%) Small Intestine 9 (0.5%) Colon (Excluding Rectum) 84 (5.1%) Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid 25 (1.5%) Rectosigmoid Junction Rectum Anus, Anal Canal & Anorectum 8 (0.5%) Liver & Intrahepatic Bile Duct 11 (0.7%) Liver Intrahepatic Bile Duct Other Biliary 7 (0.4%) Pancreas 48 (2.9%) Retroperitoneum 2 (0.1%) RESPIRATORY SYSTEM 232 (14.1%) Nose, Nasal Cavity & Middle Ear 3 (0.2%) Larynx 5 (0.3%) Lung & Bronchus 223 (13.5%) Trachea, Mediastinum & Other Respiratory Organs 1 (0.1%) BONES & JOINTS 3 (0.2%) Bones & Joints 3 (0.2%) SOFT TISSUE 11 (0.7%) Soft Tissue (Including Heart) 11 (0.7%) SKIN EXCLUDING BASAL & SQUAMOUS 63 (3.8%) Melanoma Skin 57 (3.5%) Other Non-Epithelial Skin 6 (0.4%) BREAST 477 (29.0%) FEMALE GENITAL SYSTEM 86 (5.2%) Cervix Uteri 8 (0.5%) Corpus & Uterus, NOS 46 (2.8%) Corpus Uteri Uterus, NOS Ovary 23 (1.4%) Vagina 1 (0.1%) Vulva 6 (0.4%) Other Female Genital Organs 2 (0.1%) MALE GENITAL SYSTEM 152 (9.2%) Prostate 144 (8.7%) Testis 8 (0.5%) URINARY SYSTEM 82 (5.0%) Urinary Bladder 52 (3.2%) Kidney & Renal Pelvis 27 (1.6%) Ureter 1 (0.1%) Other Urinary Organs 2 (0.1%) BRAIN & OTHER NERVOUS SYSTEM 57 (3.5%) Brain 17 (1.0%) Cranial Nerves Other Nervous System 40 (2.4%) ENDOCRINE SYSTEM 45 (2.7%) Thyroid 39 (2.4%) Other Endocrine including Thymus 6 (0.4%) LYMPHOMA 66 (4.0%) Hodgkin Lymphoma 5 (0.3%) Non-Hodgkin Lymphoma 61 (3.7%) NHL Nodal NHL Extranodal MYELOMA 17 (1.0%) LEUKEMIA 42 (2.6%) Lymphocytic Leukemia 27 (1.6%) Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia 12 (0.7%) Acute Myeloid Leukemia Chronic Myeloid Leukemia Other Myeloid/Monocytic Leukemia Other Leukemia 3 (0.2%) MESOTHELIOMA 4 (0.2%) Mesothelioma 4 (0.2%) MISCELLANEOUS 60 (3.6%) Total 1, ,015 1, ,

10 Caseload by Diagnosis Brain/CNS 2% SKIN 4% Breast 31% Respiratory 15% Hematopoietic 9% Digestive Systems 31% Genitourinary 31% GYN 5% Head & Neck 2% Endocrine 3% 5-Year Analytic Caseload Comparison SITE Head & Neck Respiratory Digestive System GYN Genitourinary Skin Breast Brain/CNS Hematopoietic Endocrine Miscellaneous

11 Cancer by Race Key Breast n White n Black n Filipino n Korean n Pakistani n Other Asian, including Asian/Oriental, NOS n Other n Unknown Vietnamese 82.60% 14.68% 2.73% 0.84% 0.21% 0.21% 0.42% 0.84% 0.21% 0.00% Caucasion 390 African American 70 Filipino 4 Korean 1 Pakistani 1 Other Asian, Including Asian/ Oriental, NOS 0 Other 4 Unknown 1 Lung Prostate Gland 0.44% 9.73% 18.06% Caucasion 3 Caucasion 118 African American 22 African American % Other % Other 0 Hematopoietic & Reticubenlothelial System Skin 3.17% 13.68% Caucasion 82 Caucasion 61 African American 13 African American % Other % Other 0 Anne Anne Arundel Arundel Medical Medical Center Center DeCesaris DeCesaris Cancer Cancer Institute Institute Cancer Cancer Registry Registry Annual Annual Report Report

12 Recognition for Dedication to Quality The DeCesaris Cancer Institute received the American College of Surgeons CoC Outstanding Achievement Award in 08 and 11. This prestigious award demonstrates our dedication to providing quality care to cancer patients. Other accreditations, awards, and grants that we have received include: Recognition for Quality and Safety of Patient Care In, the DeCesaris Cancer Institute s Radiation Oncology Department and Outpatient Infusion Center were recognized for improving the quality and safety of patient care based on HealthStream scores. In 11, Radiation Oncology received HealthStream s national Excellence through Insight Award for Overall Satisfaction Outpatient-Oncology and was ranked first by HealthStream for improving quality and safety of patient care. Meritorious Abstract Award, Biennial Cancer Survivorship Research Conference Members of our cancer survivorship initiative Ashley Varner; Amy Vance; Monique Willingham, MS, NP; and Catherine Copertino presented an award-winning poster at the June Survivorship Research Conference sponsored by the National Cancer Institute, the American Cancer Society, Livestrong, and Centers for Disease Control and Prevention. The poster detailed the development of the DeCesaris Cancer Institute s innovative Cancer Survivorship Program. NIH Funding Through Cognitive Behavior Therapy Training for Cancer Clinicians In April 13, Ashley Varner, oncology social worker at The Breast Center, received a training grant from City of Hope for a six-month program focusing on evidence-based practices to treat anxiety in those affected by cancer. NIH Funding Through Building Supportive Care Programs In March 13, Catherine Copertino, Amy Vance, and Ashley Varner represented the DeCesaris Cancer Institute at an NIHfunded program offered at City of Hope where they participated in a discussion of best practices for building supportive care programs. NIH Funding Through ExCEL in Social Work: Excellence in Cancer Education & Leadership In June 13, Ashley Varner received a grant for a one-year training project to improve psychosocial oncology services for patients with advanced disease and their family caregivers. LIVESTRONG Community Impact Grant In July, the DeCesaris Cancer Institute received a grant to fund Pillars4Life, an online coping skills program for cancer patients and their caregivers. AAMC is one of hospitals nationwide that provide this program. Anne Arundel, Kent and Queen Anne s Counties Departments of Health Grants In July, the DeCesaris Cancer Institute received three grants for early detection and diagnosis of colon, rectal, breast and cervical cancers for low-income Maryland residents. Nursing Bedside Scientist Grant AAMC s Nursing Evidence-Based Practice/Research Council established a grant program, Nursing Bedside Scientist, to fund and recognize evidence-based quality improvement and nursing research projects. Up to $1,000 in funding is available for each proposal accepted. In the following proposals were funded: Inpatient Oncology Unit Promoting Patient and Family Involvement in Hand Hygiene Compliance Outpatient Infusion Center Use of Art Therapy in Infusion Patients In 13 the following proposal was funded: Outpatient Infusion Center and Inpatient Oncology Unit Hand Washing 11 HealthStream Scorecard: Oncology Department Patient Experience H30 Overall rating of facility Your Top Box 7/1/-6/30/11 Your Top Box 7/1/11-6/30/12 Your Top Box 7/1/12-6/30/13 Clinic Outpatient IV Therapy 84.6% 83.2% 90.0% Outpatient Breast Center* 89.9% 90.0% 88.9% Outpatient Radiation Oncology Services 83.9% 90.6% 94.1% Oncology Inpatient 63.4% 79.6% 77.2% *The Breast Center discontinued using HealthStream for surveys as of April 1, 13; the FY13 score includes The Breast Center data for July 1, March 3, 13.

13 The Breast Center The Breast Center at AAMC is accredited by the National Accreditation Program for Breast Centers (NAPBC). The center received a three-year full accreditation in and again in 13. The Center provides comprehensive care in prevention, screening, diagnosis, treatment and survivorship of breast cancer and breast disease. Our facilities give patients a safe haven of kind and compassionate care that is focused on maintaining the patient s dignity and improving his or her quality of life. We use the least invasive methods for diagnosis and treatment that have the greatest chance for cure. Our specialists work as a team to provide individualized treatments and services. We are able to meet the unique needs of each patient, delivering the highest standard of care. Our Multidisciplinary Team The Breast Center s team of professionals delivers excellence with a multidisciplinary approach. Our board-certified physicians work closely with researchers, genetics counselors, nurse navigators, nurse practitioners, physician assistants and our oncology social worker to provide care that matches or exceeds current best practices in breast care. The Breast Center also sponsors a oneyear breast surgery fellowship program through the Society of Surgical Oncology (SSO), making it one of only 35 such facilities nationwide to offer such a comprehensive program. Breast Cancer Conferences The Breast Cancer Conference convenes weekly to review cases of newly diagnosed patients, patients under treatment, and patients who have completed treatment. The team includes representatives from medical oncology, radiation oncology, breast and reconstruction surgery, radiology, pathology, rehabilitation, clinical trials, tumor registry, psychiatry, oncology nursing, and social work. The discussion follows AJCC staging guidelines and nationally accepted breast cancer patient care guidelines established by the National Comprehensive Care Network and the Choosing Wisely Initiative. With a comprehensive view of the patient, we are able to recommend the most appropriate treatment plan. In, AAMC held 51 Breast Cancer Conferences. Of the 232 cases presented, 228 were reviewed prospectively. (See All Tumor Boards on page 4.) Admissions Related to Pain & Weakness The Breast Cancer Care Quality Measures Pilot Project: Catalyst for Symptom Management Clinic The Breast Cancer Care Quality Measures Pilot Project, funded through the Oncology Nursing Society Foundation (ONS) and The Joint Commission (TJC), developed quality measures for breast cancer patients receiving chemotherapy. In, 39 sites, including AAMC, participated in the pilot program. Data was collected and reported in and again in, demonstrating a need for assessment, intervention, and documentation. In response to this identified need, 15 of the original 39 sites, including AAMC, came together to form the Oncology Quality Collaborative (OQC) to network and work collectively to improve their practices on selected quality measures. Educational programs are being developed to address the gaps in practice and learning needs based on the results of the Breast Cancer Care Quality Measures Pilot Project. The OQC has been the catalyst for a national campaign, sponsored by ONS, to promote exercise as an intervention to improve health for cancer patients. The DeCesaris Cancer Institute is using the data and networking from the OQC to improve patient care through the implementation of evidence-based practices. An important outcome of the collaboration was the development of the symptom management clinic. Total Admissions Related to Symptoms of Pain & Weakness Oncology Unit 0 Nov Dec Jan. 26 Feb. 25 March 22 Intervention: June Symptom Management Clinic Opening April 28 May 29 June n/a July 22 Aug. Sept. 18 Oct. 12 Nov. 17 Dec. 12 Jan. 16 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 12

14 Inpatient Oncology AAMC s 30-bed Medical-Surgical Unit provides acute inpatient care to cancer patients as well as inpatient palliative and hospice care. Our care model is that of patient- and family-based, and we allow families to visit around the clock. Daily bedside nursing and patient shift reports, along with daily interdisciplinary rounds play a key role in each patient s care. We care for patients receiving continuous chemotherapy/biotherapy, those undergoing symptom management of the cancer disease process, newly diagnosed patients, and end-of-life patients. All of our nurses are competent in chemotherapy and trained on end-of-life care. We encourage our staff to pursue professional and scholastic growth, and many are in continuing education programs and working toward or have obtained certification in oncology as a specialty. Inpatient oncology is integrated with the DeCesaris Cancer Institute, oncology providers, nurse navigators, treatment services, ancillary counselors and consultants to ensure each patient receives the care he or she needs. To support our focus on outcomes, we use National Database of Nursing Quality Indicators (NDNQI ) standards for measuring and maintaining quality. Using NDNQI measures, we benchmark our care with peer hospitals to gain actionable insights into our quality of care. In, we improved nursing satisfaction in all ten survey areas. We have also developed many internal programs that recognize and promote achievements in delivering quality care. Measures of Excellence Our inpatient quality measures are trended on a monthly and quarterly basis using both AAMC and NDNQI data. The following quality measures are collected and reviewed on unit and cancer center leadership levels: Inpatient Falls: Our inpatient unit developed an aggressive program to reduce inpatient falls. In the past year we have seen the number of falls reduced by 32 percent. Febrile Neutropenia Admissions Receiving Antibiotics Within Two Hours: We developed a multidisciplinary approach to successfully identify and treat febrile neutropenia patients. Adopting current practice recommendations, patients are treated with recommended antibiotics within two hours of neutropenia diagnosis. Prevention of Hospital-Acquired Pressure Ulcers (HAPUs): We have reduced the occurrence of HAPUs over the past year to virtually zero. Catheter-Associated Urinary Tract Infections (CAUTIs): We initiated daily interdisciplinary rounding to review the status of all patients with Foley catheters and proactively work to remove catheters as soon as the patient s health status indicates they are no longer necessary. This practice of prudent discontinuation of Foley catheters reduces the incidence of CAUTIs. Pain Reassessment: Each patient is reassessed within one hour of pain intervention. Our goal is 90 percent compliance for patient reassessment and documentation. Within the past year, we have achieved and often exceeded this goal. Leading Nursing Education in Chemotherapy Since February 09, AAMC has sponsored and led a quarterly oncology nursing society chemotherapy/ biotherapy course for nurses and pharmacists interested in oncology patient care. The two days of instruction provide a comprehensive overview of basic cancer education and updates on recent therapeutic cytotoxic drugs. The goal of the course is to further prepare oncology nurses to understand chemotherapy/biotherapy modalities, factors that affect treatment response, ethical and legal issues in cancer care, cytoxic and biologic agents, side effects from agents, patient and family education, and safe administration of agents. Approximately 494 nurses representing more than six states have enrolled in this course since 09. Nurses Enrolled in Oncology Nursing Society Chemotherapy Biotherapy Certificate Course total since

15 Thoracic Oncology Program Focusing on early detection of lung cancer, the Thoracic Oncology Program of the DeCesaris Cancer Institute developed a lung screening program that targets individuals most likely to develop lung cancer. Employing criteria from the National Lung Cancer Screening Trial, we reach out to individuals who are current or former smokers, between the ages of 55 and 74, and who have or have had a 30 pack-year history of smoking. These individuals are eligible for a chest CT scan at a reduced rate. Taking it a step further, AAMC s award-winning Rapid Access Chest and Lung Assessment Program (RACLAP) ensures patients quickly receive the information needed to decide on a course of action. If a suspicious finding shows up on a patient s lung CT scan or X-ray, he or she is able to see our multidisciplinary team, which includes a pulmonologist, thoracic surgeon, thoracic radiologist, and nurse navigator, within a few days. Providers in the community as well as those within the hospital and the emergency department can contact the program coordinator directly to refer any patient with any abnormal chest finding. Patients and referring providers appreciate the timely feedback and expedited management. From September 17, to September 30,, 195 patients were referred to RACLAP. Almost a third of those referred were diagnosed with lung cancer. From the day of referral they averaged 7.8 days to see a physician and 15 days to receive a diagnosis. Eighty percent of the doctors who referred patients to the program were highly satisfied and more than 90 percent would refer future patients. N=71 Patients Needing Invasive Procedure for Diagnosis Recognized for Innovation In, AAMC s DeCesaris Cancer Institute received the Association of Community Cancer Centers (ACCC) Innovator Award for RACLAP. The award is sponsored by GE Healthcare and recognized our innovative, coordinated and multidisciplinary approach for patients with abnormal chest findings that leads to expedited referrals and better management. RACLAP Referrals 23% Currently in Follow-Up=43 31% Lung Cancer= Call to Appointment Mean # of Days 7 Median # of Days 6 16% Follow-Up with Films Only=30 7% Elected to follow-up elsewhere=14 % Other Diagnosis= 13% Did Not Follow Up= Call to Diagnosis * Even though the patient can be evaluated in one to two days, many do not come in that quickly due to work schedules or other commitments. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 14

16 Thoracic Oncology Program STS National DatabaseTM Participant 13 Measuring Excellence Using the Society of Thoracic Surgeons Database AAMC s participation in the Society of Thoracic Surgeons (STS) National Database shows the ability of our thoracic surgeons to provide the highest-quality patient care through education, research and advocacy. Every six months we are able to examine our performance against national benchmarks and established best practices. The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among thoracic surgeons and focuses on three areas of thoracic surgery: adult cardiac, general thoracic, and congenital heart surgery. Our inpatient Oncology Unit works collaboratively with the thoracic surgeons to provide acute postoperative care to all thoracic surgical patients. Excellent postoperative care includes a thorough assessment and care of chest tubes; continuous respiratory and telemetry monitoring; interdisciplinary services such as physical therapy, nutrition, and social work; and management of pain and cardiac status. Based on the post-operative complications data, we made a change to our standard of care for 13. Since postoperative complications were low, rather than admit patients to the Intensive Care Unit after surgery, thereby utilizing valuable but unnecessary resources, patients are now admitted safely to a regular floor bed in the Oncology Unit. Working to Eliminate the Most Potent Cancer Risk Eliminating nicotine dependence and tobacco use is integrated into many of the programs at the DeCesaris Cancer Institute. AAMC not only provides services on our campus but also take our expertise out into the community to reach high-risk individuals and groups. Through our community partnerships and our commitment to promoting health within communities, we participated in more than 50 community events in through 13. At these events we reached almost 5,000 individuals in one year s time with our tobacco avoidance/tobacco cessation programs. We continue to work to eliminate this potent health problem and are active in professional organizations, policy development and legislative efforts to address this health issue. Our staff includes a registered nurse and a health educator, both of whom are certified Tobacco Treatment Specialists. From April 1 through 5, 13, AAMC hosted the Mayo Clinic Nicotine Dependence Center Certification Training Program for Tobacco Treatment Specialists. Three of the 15 attendees who received certification are AAMC employees. Become Smoke Free AAMC provides smoking cessation assistance through the seven-week Become Smoke Free program. Individual quit rates are documented upon the end of class and at one month, three months, six months and one year. The Percent of Patients Who Quit Smoking per Month graph on the next page represents the percentage of class participants who quit smoking (based on monthly tracking). Quit rates vary widely based on time elapsed since class completion and a number of other factors (e.g. number of classes attended, medication compliance, etc.). The average quit rate for the data represented is 46.6 percent. 15

17 Thoracic Oncology Program Inpatient Tobacco Cessation AAMC is committed to improving the health of our patients and ensuring optimum recovery for hospitalized patients. Our tobacco cessation counseling service provides bedside counseling to patients who use or have used tobacco products in the year prior to admission. In, more than 3,700 patients received individual counseling, information and resources for quitting tobacco. Working with Community Health Centers AAMC provides individual counseling sessions onsite and at our community health centers. Individual counseling for tobacco cessation provides a more intense and tailored treatment for quitting tobacco. It also allows flexibility for the client with regard to scheduling and accessibility. Our counselors work closely with the client s primary care physician to optimally treat individuals struggling with tobacco addiction. Clients are followed diligently and develop a rapport with counselors as they work through the process of quitting for good. In, we conducted 279 counseling sessions, and in 13 we conducted 409 sessions. Working with Youth AAMC s Nicotine Dependence Program reaches out to youth and young adults, recognizing that tobacco avoidance is ideal. Our Teen Tobacco Road Show is an educational, interactive program developed by AAMC Tobacco Treatment Specialists with evidence-based strategies for educating and counseling youth. It is geared toward deterring middle and high school students from initiating tobacco use. The program is incorporated into health classes within county schools. Hundreds of students have had the opportunity to participate in the tobacco avoidance education program Inpatient Tobacco Cessation Number of Patients Counseled Tobacco Cessation Year-End Totals Projected Total Percent of Patients Who Quit Smoking per Month 0 Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. FY 114 people registered for the tobacco cessation class; 50 completed all 7 sessions; 49 of those 50 quit upon completion of the course (98% quit rate) One year out from classes 43% remained smoke free. FY people registered for the tobacco cessation class; 59 completed all 7 sessions; 43 of those 59 quit upon completion of the course (73% quit rate) One year out from classes 34% remained smoke free. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 16

18 Outpatient Infusion Center AAMC s Outpatient Infusion Center provides a comfortable, supportive atmosphere for cancer patients requiring both cancer treatments and supportive infusion therapies. A multidisciplinary team including physicians, oncology certified nurses, pharmacists, laboratory technicians, nutritionists, and social workers work to provide these treatments and create the best possible experience for the patient. Our outpatient infusion services include: Chemotherapy Hydration Antibiotic, antifungal and antiviral therapies Management of peripherally inserted central catheters, peripheral access catheters, mid-line catheters, and the repair of Hickman catheters Specialized infusions, including intravenous gamma globulin, deferoxamine, pamidronate, Zometa, prolastin, infliximab and other monoclonal antibody therapies Score QOPI Certification Overall Quality Score Trend Fall 09 Fall Fall 11 Round Spring Spring 13 Color by Site n AAMC n Target Score: Fall 09 (72.62%) n Target Score: Spring 13 beyond (75%) Quality Oncology Practice Initiative (QOPI) Certification In, AAMC was the third hospital in the Maryland to receive Quality Oncology Practice Initiative (QOPI) certification. The Association of Clinical Oncology s QOPI program is an oncologistled, practice-based quality assessment and improvement program integrated within hospital services. The goal is to promote excellence in cancer care by helping hematology-oncology practices create a culture of self-examination and improvement. The process employed for improving cancer care includes measurement, feedback and improvement tools. Our participation ensures that we continue to keep current with nationally recognized practice guidelines. Annapolis Oncology and Hematology, an outpatient practice owned by AAMC, has participated every year since receiving initial certification in. In 13, we received recertification and have exceeded target scores every year of participation. QOPI Certification Adjuvant Treatment Measures Score Trend Score Fall 09 Fall Spring Round Spring 13 Color by Site n AAMC n Target Score (80%)

19 Radiation Oncology Program Quality Improvement Conebeam Imaging AAMC s Radiation Oncology Program is accredited by the American College of Radiology and provides a variety of therapies for cancer care. Accreditation is received through a comprehensive review of the program s quality and best practices. Our team consists of physicians, physicists, dosimetrists, nurses, radiation therapists, social workers and nutritionists, all of whom are specialty-trained in radiation therapy. Focusing on delivering quality patient and family-centered care, we regularly assess patient pain and fatigue. In, we exceeded our goal of 95 percent for each quarter. Radiation Oncology Nursing Quality 0% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% 1st Quarter 2nd Quarter 3rd Quarter Fatigue Assessment Pain Assessment 4th Quarter To document precision of therapist adjustments and minimize physician interruptions, the Radiation Oncology Program conducted a 90-day study on conebeam imaging corrections. A physician will request a readjustment prior to treatment delivery if more than 0.3 cm correction is needed. The study examined conebeam images over a 90-day period, from April 1 through July 31, 11. Of the 792 conebeam images, 111 (14 percent) required readjustments with a shift of less than 1 cm prior to treatment delivery. Of the 111 images, 86 images were aligned using the patient s anatomy versus 24 images that were aligned using implanted fudicial markers. The results set a benchmark for how adjustments influence outcomes and inform process improvements. Conebeam CT Study Results Required Did Not Require Total Images Readjustment Adjustment Acquired Aligned Using Fudicial Markers Aligned Using Patient s Anatomy Results using Fisher s exact test: The two-tailed P value is less than ; extremely statistically significant. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report 18

20 The Research Institute AAMC s Research Institute brings together a team of professional research nurses, research coordinators, data managers and physicians. All research efforts carefully safeguard the rights and safety of clinical trial patients, ensuring regulatory compliance and promoting excellence in clinical practices. Our dedication to research excellence ensures we are contributing to generalizable knowledge. Our goals for the research program are: To maintain a comprehensive menu of clinical trials so that many patients have the opportunity to participate in research studies To maintain a sensitive and compassionate approach that meets all regulatory standards for discussing clinical trial options with patients To search out and develop basic science liaisons and relationships to improve translational research in cancer To provide opportunities to our faculty and staff for research project development, funding and support Clinical Trials AAMC evaluates cancer patients for clinical trial eligibility at the time of diagnosis and following surgery. Patients are also evaluated at each of their initial appointments in the specialty practices (medical and radiation oncology). Potential clinical trials for patients are also discussed at monthly tumor board meetings. At each step of the patient s journey, we want to make the most appropriate and thoughtful treatment options available to him or her, including participation in suitable clinical trials. When a patient expresses interest in participating in a clinical trial, our research staff guides him or her through each step of the process AAMC Oncology Patients Enrolled in Clinical Trials Treatment Biomarker Screening Registry Total Over the years, the number and type of trials that a patient can participate in has grown. We have access to research studies in which patients can donate their blood or biopsy tissue for tumor biology research studies to learn more about how cancer develops and grows. We also participate in clinical trials that evaluate how well a new medical device or a new drug treatment works. AAMC has exceeded the CoC standard of six percent enrollment in clinical trials. Of the 1,647 cancer cases in, 571 (38 percent) were enrolled in clinical trials. The breakdown of patient enrollments by study type is shown in the figures below: Cancer Prevention Study In June, AAMC was proud to serve as an enrollment site for the American Cancer Society s Cancer Prevention Study-3. This historic, nationwide study will help researchers better understand the genetic, environmental, and lifestyle factors that cause or prevent cancer. More than 300 members of the community volunteered to join this study. Oncology Research Enrollments 46% Biomarker & Registry=264 Screening Trials=38 7% 8% Treatment Trials=47 Clinical Breast Care Project Since 06, breast cancer patients at AAMC have donated more than,000 blood and tissue samples for research. This work is part of the Clinical Breast Care Project in which AAMC partners with the Walter Reed Army Medical Center and Windber Research Institute. Network of Collaboration AAMC has helped connect patients with cutting-edge treatment options through our collaborations with the National Cancer Institute (NCI), pharmaceutical companies, and the Johns Hopkins Clinical Research Network (JHCRN). JHCRN gives AAMC patients expanded access to clinical trials by facilitating a partnership between physicians at AAMC and Johns Hopkins to open clinical trials. Patients can receive the same treatment they would receive in a university setting right here in their community. Publications A list of publications for research supported by AAMC Research Institute can be found at: 39% Prevention Trials=222 19

21 Patient and Family Services To achieve the best possible outcomes in cancer care, we pay special attention to the psychosocial health needs of each patient. Our interdisciplinary approach involves a variety of support professionals who understand the day-to-day challenges of living with cancer. Valuable support includes patient navigation, supportive counseling, genetic counseling, and survivorship resources. Psychosocial Care The oncology social workers at the DeCesaris Cancer Institute provide state-of-the-art psychosocial care to our patients, their friends and family members. Our masters-prepared oncology social workers support patients and their loved ones through all phases of the cancer experience and provide access to crisis intervention and short-term counseling. We build and maintain relationships with community organizations and help patients access a network of resources to address common challenges including transportation, prosthetic and financial assistance. Support is offered in multiple settings to meet the needs of each individual, such as online and face-to-face support groups as well as individual, couples and family counseling. Currently, the DeCesaris Cancer Institute offers more than ten different support and education groups facilitated by our professional oncology staff. All patients are screened for psychosocial distress using the National Coalition for Cancer Network (NCCN) Survivorship Distress Thermometer and Problem Checklist at pivotal moments in therapy (newly diagnosed, beginning of chemotherapy, beginning of radiation, survivorship consult visit), and oncology social workers followup with patients as needed. Our oncology social workers speak to community groups about issues important to patients and caregivers and have also been asked to speak and teach internationally on topics such as cancer survivorship and end-of-life care as well as effective care for family caregivers. Nutrition Counseling Our dietitians and nutritionists provide counseling to patients receiving cancer treatment. We give patients and their families practical strategies to handle the emotional and physical stresses of cancer. Our nutritionists administer the Patient-Generated Subjective Global Assessment (PG-SGA) tool to assess patients for nutrition risk. A care plan is then devised to provide strategies to minimize nutrition impact symptoms and optimize nutrition throughout treatment into survivorship. Patients are educated about dietary requirements, and agreed-upon goals are set to meet each patient s needs. Dietitians assist with meal planning, alternative food choices and nutrition supplements to reach these goals. Patients may request a nutrition consultation at any time. These patients are followed throughout the continuum of care, including survivorship. 40 Cancer Patients Screened for Distress Patients are Screened for Distress at Pivotal Points During Their Cancer Journey # of Patients Total Patients who Screened as Possibly Distressed (six or greater on the NCCN Distress Thermometer) Total Patients who Screened as Possibly Distressed Who Were Contacted by Oncology Social Work 0 Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 13 Annual Report