Goshen Center for Cancer Care 2016 Annual Report

Transcription

1 2016 Annual Report

2 Table of Contents Chairman s Report... 3 The Cancer Committee facts & figures... 6 Annette s second chance Living well on a cancer journey Crystal Breast cancer study They saved my life twice. And they made it possible for me to enjoy this little one.

3 Chairman s Report A note from our Goshen center for Cancer Care Committee Chairman. In 2016, the Goshen Center for Cancer Care delivered outstanding, comprehensive, patient-centered care to the communities it serves. The American College of Surgeons Commission on Cancer (COC) recently completed its triennial survey of our program. We expect to maintain our current level of commendations and awards, highlighting the commitment that we have made to provide excellent care to those we serve. Specifically, we expect commendations in the following areas: Clinical trials accrual Cancer registrar education Public reporting of outcomes CAP compliance Oncology nursing certification RQRS NCDB data collection In addition, the following areas were identified as possible best practices: Monitoring effectiveness Pathology Oncology nursing Palliative care Patient navigation Psychosocial distress screening Quality improvement (RIE) Registry follow-up Registry credentials & education We also received accreditation by the National Accreditation Program for Breast Centers (NAPBC). As our #1 tumor site, management of breast cancer patients requires a highly coordinated approach to care. We have once again the necessary proficiency to achieve such recognition. Our interdisciplinary oncology program continues to grow as we seek the highest quality providers to deliver care in the areas of surgical oncology, radiation oncology, medical oncology and supportive services. Our tumor boards and conferences are functioning at a high level with full representation of all the specialties required. We expect to continue expanding as we add services and providers to our program. With the rapidly changing treatment options for many cancer patients, our DOTs (Disease Oriented Teams) meets weekly to address the current guidelines and state of the art management practices to ensure that our patients are properly treated. We are as dedicated as ever to providing patients with a holistic experience, as evidenced by the integration of our dietary, naturopathic and mind-body counseling services in the routine care of our patients. We continue to place special emphasis on clinical research. This provides patients with unique opportunities to access innovative, potentially groundbreaking therapies without having to leave their community. Finally, it was extremely rewarding to be told during our recent accreditation survey that areas for improvement or growth were hard to find! As gratifying as this may be, it also creates a very high standard for us to meet. The program looks forward to the challenge. Daniel Bruetman MD, MMM Director of Medical Oncology, Dr. Bruetman Here at Goshen, our cancer program is unique in many ways. 3

4 Roderich Schwarz, MD, PhD, FACS Susan Franger, MHA Rita Gingrich, LSCW, OSW-C James Wheeler, MD, PhD Tracy Paulus, CTR Michael Brendle, MD Min Yan, MD, PhD Medical Director, Vice President of Cancer Services, PNI Counselor, Director of Radiation Oncology, Cancer Registry, Radiologist, Radiology Inc. Director of Pathology, Goshen Hospital Surgical Oncologist Cancer Program Administrator Social Worker & Psychosocial Services Coordinator Radiation Oncologist Certified Tumor Registrar & Cancer Registry Quality Coordinator Diagnostic Radiologist Pathologist Cancer Committee Committee Responsibilities Develop and evaluate the annual goals and objectives for the clinical, educational and programmatic activities related to cancer. Promote a coordinated, multidisciplinary approach to patient management. Ensure that educational and consultative cancer conferences cover all major sites and related issues. Ensure that an active, supportive care system is in place for patients, families and Colleagues. 4

5 Beth Otto, CMA Daniel Bruetman, MD, MMM Daniel Diener, MD, FACS Ebenezer Kio, MD, PhD Hollie Carlson, Ms. Ed. Juliet Leamon, BSN, RN, NE-BC Rhonda Griffin, RN, BSN Cancer Registry, Director of Medical Oncology, General Surgeon, Gerig Surgical Services Medical Oncologist, Health Education Coordinator, Oncology Unit Director, Goshen Hospital Clinical Quality and Data Manager, Cancer Conference Coordinator Cancer Committee Chairman & Palliative Care Cancer Liaison Physician Medical Oncologist & Clinical Research Coordinator Community Outreach Coordinator Oncology Nurse Quality Improvement Coordinator Promote clinical research. Monitor quality management and improvement through completion of quality management studies that focus on quality, access to care and outcomes. Supervise the cancer registry and ensure accurate and timely abstracting, staging and follow-up reporting. Perform quality control of registry data. Encourage data usage and regular reporting. Ensure content of the annual report meets requirements. Publish the annual report. Uphold medical ethical standards. 5

6 2015 Facts and Figures Cancer Registry Report Roger I was hoping that I could go back to fooling with my tractors. I can do anything I did before. Cancer Registry department is a hospital-based cancer information center. Certified tumor registrars collect, interpret and record a wide range of demographic, diagnostic and treatment information on all cancer patients who are diagnosed and/or treated at this facility. Since 2004, has been designated as a Community Hospital Comprehensive Cancer Center through the American College of Surgeons/ Commission on Cancer. In September of 2013, this program received a three-year Accreditation with Commendation at the Gold level. This indicates the program performs at the highest level possible and achieved all eight out of eight possible commendations for exceptional achievement. is mandated by Indiana Code to provide Indiana State Department of Health a detailed abstract for each case of malignant disease that is diagnosed and/or treated at this facility, as well as benign brain and related CNS tumors. Cancer data is also submitted to the National Cancer Data Base (NCDB), and comparisons are frequently performed to analyze state and national trends and benchmarking statistics. Quality of registry data is paramount. For this reason, quality assurance procedures, periodic audits from the Indiana State Department of Health and internal quality assurance practices are performed to ensure that Cancer Registry data are complete and correct. In 2015, a total of 809 cases were accessioned by the Cancer Registry: 682 were analytic (new cancer cases) and 127 were non-analytic. During 2015, the Cancer Registry followed 4,275 patients and maintained a follow-up rate of 89.41% on patients diagnosed since the Registry reference year (80% required by the Commission on Cancer) and a follow-up rate of 94.51% for patients diagnosed within the last five years (90% required by the Commission on Cancer). is staffed by certified tumor registrars and cancer registry specialists who work under the guidance of Rhonda Griffin, BSN, manager,. 6

7 T T Top Five Sites 15% 25% 9% NATIONAL ** Breast 231,840 Lung 221,200 Prostate 220,800 Colon 132,700 Urinary 74,000 Bladder 26% 25% State and County Distribution 15% 22% 8% STATE ** Lung 5,510 Breast 4,600 Prostate 4,040 Colon 2,890 Urinary 1,590 Bladder 25% 30% St. Joseph Elkhart 52% LaGrange 5.56% 4.42% T 11% 12% GCCC * 16% Breast 166 Lung 103 Colon 71 Prostate 52 Pancreas 47 23% 38% Steuben 1% Marshall 1% Out-of-State 6.85% Kosciusko 16.26% Noble 3.14% Other IN Counties 6.13% Allen 1% * Registry total patients ** Cancer Facts & Figures 2015, Estimated Numbers of New Cases for Selected Cancers by State, US, 2015* (American Cancer Society, 2015) most frequent diagnoses (analytic patients only) Number of patients Dr. Schwarz We embrace treatment so our patients have a chance for a fulfilled and active life. Breast Lung Prostate Colon Melanoma Non-Hodgkin Pancreas Lymphoma 7

8 Primary site table GENDER CLASS OF CASE AJCC STAGING Primary Site Total Male Female Analytic Non Analytic 0 I II III IV NA UNK ORAL CAVITY, PHARYNX Lip Tongue Salivary Gland Floor of Mouth Gum, Other Mouth Tonsil Nasopharynx Oropharynx Hypopharynx DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon, Rectum, Anus Liver Gallbladder Intrahepatic Bile Duct Other Biliary Pancreas Retroperitoneum Peritoneum, Omentum, Mesentery Kathy Other Digestive Organs RESPIRATORY SYSTEM Nose, Nasal Cavity, Middle Ear Larynx Lung and Bronchus SOFT TISSUE INCLUDING HEART SKIN It is important to me to get back to quality of life. I have a lot to do. Skin: Melanoma Skin: Other Non-Epithelial BREAST Female Breast Male Breast

9 GENDER CLASS OF CASE AJCC STAGING Primary Site Total Male Female Analytic Non Analytic 0 I II III IV NA UNK FEMALE GENITAL SYSTEM Cervix Uteri Corpus, Uterus: NOS Ovary Other Female Genital Organs MALE GENITAL SYSTEM Prostate Testis Penis URINARY SYSTEM Urinary Bladder Kidney Renal Pelvis Ureter Other Urinary Organs EYE, ORBIT Eye, Orbit: Non-Melanoma Eye, Orbit: Melanoma BRAIN, OTHER NERVOUS SYSTEM Brain: Malignant Brain-CNS: Benign, Borderline ENDOCRINE SYSTEM Thyroid Thymus Endocrine: Benign, Borderline LYMPHOMA Hodgkin Lymphoma Dr. Moore Non-Hodgkin Lymphoma MYELOMA LEUKEMIA Lymphocytic Leukemia Non-Lymphocytic Leukemia Other Leukemia MESOTHELIOMA MISCELLANEOUS We realized we were both on the same page with how we approach wellness and overall strategies for life. TOTALS

10 AnnetteD

11 r. Fornalik

12 Annette s Second Chance When doctors told Annette there was nothing left that they could do for her, she turned to Dr. Fornalik and the experts at. There, she received a second opinion, and a second chance. After being diagnosed with stage four ovarian cancer, Annette received extensive treatment at another cancer center. She endured invasive surgery, followed by six rounds of chemotherapy, with each round eroding her quality of life. After everything she had already been through, there was still residual cancer. The surgeons at that other cancer center decided that going back in was too risky and in October of 2015, gave Annette a devastating terminal diagnosis. Christmas in July Christmas is Annette s favorite holiday. So much so that she puts a Christmas tree in every room of her house. Even though Annette had found the team of experts she had been praying for, her new course of treatment kept her from celebrating with her friends and family that year. So she made a promise. If I make it through this, and I m still here in July, we re going to have a great big party to celebrate Christmas with everyone. Restoring quality of life The integrated, multidisciplinary team at focused on restoring Annette s quality of life. With minimally invasive surgery, she was back in the comfort of her own home in days rather than weeks, and had practically no scaring. The nutritionists at Goshen restored I knew I was in the right place with Dr. Fornalik. I felt his kindness and more importantly, his confidence. Annette gave me her trust and willingness to try options to improve her quality of life. Despite a terminal diagnosis, Annette wasn t ready to give up hope. She decided to go to for a second opinion. From the very moment when Dr. Hubert Fornalik took Annette s hands in his and asked her to trust him, she knew her life had been truly touched for the better. Dr. Fornalik, a recognized expert in advanced minimally invasive surgery, wasn t afraid to go back in to deal with the residual cancer. Annette s strength, helping her return to an active life. Most importantly to Annette, Goshen also treated her mind and soul. At Goshen, everyone felt like family, offering their love and support every step of the way. Thankful for every day Thanks to Dr. Fonalik and the team at, Annette was able to have that party in July. And in celebration of every new day they spend together, Annette decided to leave the Christmas tree up all year long. 12

13 Living Well on a Cancer Journey It s how patients with cancer live that makes the difference for Rita Gingrich. She believes each one has the inner power to help with their own healing process and improve their overall quality of life. Rita joins patients on their journey to wellness as a mind-body counselor and certified oncology social worker for Goshen Health Center for Cancer Care. She brings an innovative, patient-centered approach to help patients strengthen their sense of well-being and feel more in control. By supporting patients every step of the way, Rita helps them define how they live and enjoy their lives. In acknowledgment of Rita s devotion to supporting patients with cancer and their families, she received the Innovation Recognition during the 2016 Coaches vs. Cancer Night of the Stars. The honor recognizes her tireless efforts to help patients connect the mind and body throughout their treatment. Rita Gingrich When a family member is diagnosed with cancer, it affects everyone who loves and cares for that person. I m so grateful for the successes our team has had with developing and implementing support programs for children, families, and couples. I m also grateful for many who have supported these endeavors in a variety of ways, including the cancer center s administration, the hospital auxiliary board, many colleagues and volunteers, and also cancer survivors. Rita was among five area cancer care providers honored during Night of the Stars. The annual event brings together community leaders, the American Cancer Society and the National Association of Basketball Coaches to spotlight advocacy programs that increase cancer awareness. Notre Dame Head Basketball Coach Mike Brey served as honorary chair and host of the 2016 event. Rita holds certification in oncology social work and is a licensed clinical social worker. She has been a part of the Cancer Care Integrative Therapies team since

14 Ben Goshen took excellent care of me through the whole process. James A. Wheeler, MD, PhD Director of Radiation Oncology, Radiation Oncologist Prostate Cancer Study Although 80 to 90% of men who are diagnosed with early stage prostate cancer are cured, many men will not discover they have cancer until it is more advanced. The initial treatment for men whose prostate cancer has spread to the bones is hormonal therapy, either with removal of the testes or medicines to reduce the testosterone levels in the blood. Most men have a good initial response to hormonal management, but eventually the cancer cells overcome this treatment. Cancer growing in the bones can cause pain and can even cause bones to break. If the prostate cancer only involves a few bones, radiation therapy can be given in one to ten treatment sessions to relieve pain and/or prevent a fracture. Sometimes the cancer spreads to so many bones that treating with radiation beams from the outside either is impractical or too toxic. In this situation, treatment with radiopharmaceuticals is a better choice. The radioactive drugs Strontium-89 (Metastron) and Samarium-153 (Quadramet) have been available for many years. These drugs biochemically look like calcium phosphate, which the normal bone uses to repair the damage caused by the cancer. Once taken up into the bone, both drugs undergo radioactive decay by emitting a powerful electron which kills the nearby cancer cells. The emitted electrons have so much energy they can travel into the bone marrow, where the blood elements (red cells, white cells, and platelets) are produced, and it can take months for the bone marrow to recover from this damage. Radium-223 (Xofigo) also looks like calcium phosphate to the bone which the body is trying to repair, and it too is taken up where the bone is undergoing repair. Ra- 223 decays by emitting an alpha particle, which is several thousand times larger than an electron. The alpha particle can travel far enough to kill the cancer cells in the bone, but not far enough to injure the normal bone marrow. The ALSYMPCA (Alpharadin in Symptomatic Prostate Cancer) trial was a phase 3, placebo-controlled, randomized trial in which 920 men with painful bone metastasis from hormone refractory prostate cancer (HRPC) were randomly assigned to receive radium-223 (Ra-223) or placebo. The study enrolled patients from 136 centers in 19 countries between June 12, 2008 and February 1, The Goshen Center for Cancer Care was selected to be one of the participating sites. The ALSYMPCA trial showed that Ra-223 produced a 30% survival benefit, with a median survival of 14.9 months compared to 11.3 months for patients treated with a placebo. This result led to the FDA approval in

15 The committee sought to determine how our patients fared in terms of survival and treatment toxicity with the published data of the patients treated on the ALSYMPCA trial. The Goshen Center for Cancer Care IRB approved our conducting this retrospective analysis. We identified 11 patients who started treatment with Ra-223 between March 15, 2013 and December 10, After collecting the data from the relevant medical records, in order to safeguard our patient s privacy, a spreadsheet was constructed with all of the patients identifying information removed. The data were then independently analyzed by members of the Department of Applied and Computational Mathematics and Statistics at the University of Notre Dame. The median age for the ALSYMPCA patients was 71 years, with a range from By contrast, the median age of our 11 patients was 82 years with a range from years. The ALSYMPCA patients treated with Ra-223 had a median survival of 14.9 months compared to an estimated survival of our patients of 7.8 months. Our patients did statistically significantly worse than the ALSYMPCA patients treated with RA-223. Our patient survival was not statistically different than the ALSYMPCA patients treated with the placebo. Only 27.3% of our patients completed all six planned Ra-223 infusions, which was significantly less than the 63% completion rate for the ALSYMPCA patients who received Ra-223. Our completion rate was not significantly different than the ALSYMPCA patients who received the placebo. The median survival from the last Ra-223 infusion for our patients was 3.5 months. After starting treatment with Ra-223, our patients did not develop statistically significant worse rates of anemia (fewer red cells to carry oxygen to the cells), neutropenia (fewer white cells to fight infection), or thrombocytopenia (fewer platelets to help stop bleeding) compared to the ALSYMPCA patients. Almost two-thirds of our patients had various other treatments prior to starting Ra-223, and nearly half of our patients received a variety of treatments after they stopped receiving Ra-223. We used three measures of treatment effectiveness: 1) reduction in the pain scores, 2) reduction in the serum PSA, and 3) reduction in the serum alkaline phosphatase. Compared to the pre-treatment values, numerical reductions were seen at the last follow-up evaluation for both the pain scores and the alkaline phosphatase levels, but the reductions were not statistically significant. Considering that our patients were older, received a variety of other treatments, and were not required to meet the strict enrollment criteria required of the patients on the ALSYMPCA trial, our patients fared reasonably well. The fact that two thirds of our patients were not able to complete the planned six cycles of Ra-223 and lived only a few months after stopping this treatment underscores that, as a whole, this group of patients had very advanced cancer. Rather than offering Ra-223 as a treatment of last resort, when all other options have failed, it is better to offer this new and unique therapy to patients when they still have sufficient life expectancy to fully enjoy the benefits of improved survival and less bone marrow toxicity than is obtained with the two alternative radiopharmaceuticals. Dr. Agarwal I put a very strong premium on maintaining quality of life for my patients. 9

16 Northern Indiana s first comprehensive cancer center 200 High Park Ave. Goshen, Indiana (574) (866) 775-HOPE