COMMITTEE MEMBERS Brian Mathews, MD Matt Eckley, PharmD Janet Elledge-Nauman, RN Harry James McCarty, MD

Transcription

1 2015 Cancer Report

2 COMMITTEE MEMBERS Brian Mathews, MD Hematology/Oncology Cancer Committee Chair Harry James McCarty, MD Radiation Oncology Cancer Liaison Physician Rachel Kruspe, MD Hematology/Oncology Cancer Liaison Physician Elizabeth Falkenberg, MD Radiation Oncology Marshall Schreeder, MD Hematology/Oncology Noel Estopinal, MD Radiation Oncology Frank Honkanen, MD. Aimee League, MD Pathology Richard Richardson, MD General Surgeon Tyler Kirkby, MD GYN Oncology Jeff Walker, MD Critical Care/Trauma/General Surgery Joseph Pettus, MD Urology Mohamad Younes, MD Hematology/Oncology John Gleason, MD Radiation Oncology Douglas Downey, MD General Surgeon Christian Scales, MD Radiology Libby Shadinger, MD Radiology Michael Brown, MD Urology John Roberts, MD Pain Managment Karen Adams, RN, BSN Cancer Program Manager Matt Eckley, PharmD Oncology Pharmacy Janet Elledge-Nauman, RN Quality Management Coordinator Kristina Johnson Marsha Farrell, BSN, RN-BC, CHPN Lee Shaw Hospice Family Care Jennifer Vann, DNP, CRNO Akashai Janak, MD Palliative Care Emily Pauli, BMS, PharmD, RPh Clinical Research Coordinator Karen Hislop James Kelly Therapy Services Sandra Cross, RN Breast Center Lennox Marr, RN, BSN, MSN Oncology Inpatient Unit Director Allison Shirley Justin Thomas American Cancer Society Ruth Smith, MSN, RN, AOCNS Inpatient Clinical Nurse Specialist Patty Stutts, LCSW Social Services Crystal McVey, RDLD Vilmali Demerin Clinical Nutrition Pranteek Patnaik Community Health Initiative/Mobile Medical Unit Cindy Johnson, CTR Connie Jensen, CTR Carol Spahn Judy Crawford Katherine Wolfson Cancer Registry Rod Crutcher Chaplain 2

3 CANCER CONFERENCE Huntsville Hospital continues to offer weekly multidisciplinary cancer conferences to provide consultative services to identified cancer patients. Physician representatives from surgery, medical oncology, radiation oncology, diagnostic radiology, pathology and a variety of other medical specialists can attend and participate in cancer conferences. The number of annual cases presented is to be proportional to the annual analytic caseload and should represent the case mix. All major cancer sites are discussed each year. The American College of Surgeons Commission on Cancer requires that 15% of the annual analytic caseload be presented at cancer conference. In 2014, Huntsville Hospital, the Center for Cancer Care and Clearview Cancer Institute presented 305 cases CANCER CONFERENCE CASES Urinary System 15 Breast 42 Brain/CNS 3 Colon 6 Gastric 2 GYN 8 Head & Neck 29 Hematopoietic 31 Liver 2 Lung 68 Lymphoma 24 Pancreas 3 Prostate 9 Rectum 17 Skin/Melanoma 21 Thymus 2 Thyroid 4 Other 19 TOTAL 305 CANCER REGISTRY ACTIVITIES The Huntsville Hospital Cancer Registry is an information data base system for the collection, management and analysis of cancer patient data. The cancer registry participates in a nationwide effort to compile data on the diagnosis and treatment of all types of cancers. The American College of Surgeons Commission on Cancer requires a minimum 80% follow-up rate be maintained for all analytic cases from the cancer registry reference date of l987, and a minimum 90% follow-up rate for all analytic cases diagnosed within the last five years. At present, the cancer registry operates with a 93.12% and 93.98% follow-up rate, respectively. The cancer registry has collected more than 36,000 cases since its reference date. In 2014, 2,064 new analytic cases were abstracted and entered into the registry CANCER REGISTRY DATA AJCC Stage by Sex at Diagnosis I II III IV UNK N/A Age by Sex at Diagnosis

4 PRIMARY SITE TABLE PRIMARY SITE MALE FEMALE Oral Cavity Lip 2 3 Tongue 5 3 Oropharynx 2 0 Hypopharynx 2 0 Other 19 8 Digestive System Esophagus 17 5 Stomach 19 9 Colon Rectum Anus/Anal Canal 2 4 Liver 6 3 Pancreas Other Respiratory System Nasal/Sinus 3 1 Larynx 6 3 Lung/Bronchus Other 1 3 Blood & Bone Marrow Leukemia Multiple Myeloma Other 8 9 Bone 0 0 Connective/Soft Tissue 8 1 Skin Melanoma Other 4 2 Breast Female Genital Cervix Uteri 0 24 Corpus Uteri 0 85 Ovary 0 48 Vulva 0 14 Other 0 6 Male Genital Prostate Testis 7 0 Other 4 0 Urinary System Bladder Kidney/Renal Other 3 4 Brain & CNS Brain (benign) 0 0 Brain (malignant) Other Endocrine Thyroid Other 7 2 Lymphatic System Hodgkin s Disease 6 5 Non Hodgkin s Unknown Primary 10 5 Other/Ill-defined 2 6 TOTAL 872 1,192 Race at Diagnosis Race Number of Cases White 1718 Black 276 Other 70 TOTAL 2,064 Alabama County of Residence at Diagnosis County Number of Cases Baldwin 1 Blount 3 Calhoun 0 Colbert 15 Cullman 13 Dekalb 33 Etowah 2 Franklin 5 Jackson 114 Jefferson 1 Lamar 0 Lauderdale 46 Lawrence 40 Lee 1 Limestone 215 Lowdes 0 Madison 1203 Marion 3 Marshall 152 Montgomery 0 Morgan 137 Walker 1 Wintson 4 Total

5 Out of State Residence at Diagnosis State Number of Cases Florida 1 Georgia 3 Illinois 1 Indiana 1 Marylan 1 Tennessee 69 Utah 1 TOTAL Estimated US Cancer Cases* Primary Site Males Number of Cases Prostate 233,000 Lung/Bronchus 116,000 Colon & Rectum 71,830 Urinary Bladder 56,390 Non-Hodgkin s Lymphoma 38,270 Melanoma 43,890 Kidney and Renal Pelvis 39,140 Oral Cavity & Pharynx 30,220 Leukemia 30,100 Pancreas 23,530 All Sites 855,220 Primary Site Females Number of Cases Breast 232,670 Lung/Bronchus 109,210 Colon & Rectum 65,000 Non-Hodgkin s Lymphoma 32,530 Melanoma 32,210 Kidney and Renal Pelvis 24,780 Ovary 21,980 Leukemia 22,280 Urinary Bladder 18,300 All Sites 810,320 * Excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder. Source: American Cancer Society Facts & Figures Treatment Distribution Treatment Modality Number of Cases Surgery 745 Chemo 216 None 168 Surgery/Chemo 165 Chemo/Radiation 133 Surgery/Chemo/Radiation 106 Surgery/Radiation/Hormones 88 Surgery/Hormones 75 Surgery/Radiation 71 Radiation 65 Surgery/Chemo/Radation/Hormones 36 Surgery/Chemo/Radation 35 Chemo/Immu 31 Surgery/Chemo/Immu 21 Surgery/Chemo/Radation/Immu 13 Chemo/Hormones 12 Hormones 11 Chemo/Radiation/Immu 9 Chemo/Hormones/Immu 9 Surgery/Chemo/Hormones/Immu 7 Surgery/Immu 7 Immu 7 Surgery/Hormones/Immu 6 Chemo/Tram 6 Surgery/Chemo/Hormones/Immu 4 Surgery/Rad/Hormones/Immu 3 Radiation/Hormones 3 Surgery/Radation/Immu 3 Chemo/Radation/Hormones 2 Other 2 Chemo/Immu/Tran 2 Chemo/Rad/Hormones/Immu 1 Surgery/Other 1 Radiation/Tran 1 TOTAL 2,064 5

6 2014 HUNTSVILLE HOSPITAL CANCER CASES DIAGNOSED *NATIONAL COMPARISON OF SELECTED CANCER SITES *Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2014 HUNTSVILLE HOSPITAL ALABAMA NATIONAL PRIMARY SITE CASES PERCENT CASES PERCENT CASES PERCENT BREAST % 3, % 235, % LUNG % 4, % 224, % COLORECTAL % 2, % 136, % Prostate % 3, % 233, % BLADDER % % 74, % NH LYMPHOMA % % 70, % CORPUS UTERI % % 52, % MELANOMA % 1, % 76, % LEUKEMIA % % 52, % CERVIX % % 12, % ALL OTHERS % 7, % 497, % TOTAL CASES 2, % 26, % 1,658, % MISMATCH REPAIR TESTING FOR LYNCH SYNDROME MMR testing as a screening tool for detection of Lynch Syndrome was started in 2014 at Huntsville Hospital as a as requested test for patients with colorectal carcinoma, endometrial carcinoma, and clear cell and endometrioid carcinomas of the ovary. Starting in 2015 the testing shifted from requested to automatic based on NCCN Guidelines. Criteria for testing are: Colorectal, age 70 meeting Bethesda guidelines (as requested). Endometrial: age 60 or younger or as requested over age 60. Ovary: age 60 or younger with endometrioid or clear cell morphology or as requested. MMR TESTING Four immunostains, performed in house with 24 hour turnaround. MLH1, MSH2, MSH6, PMS2 If all are normal, low risk of Lynch Syndrome If MLH1 alone or MLH1 and PMS2 are not expressed, reflex BRAF testing is performed. Other combinations will require genetic counseling for determination of appropriate additional (expensive) testing. BRAF does not work on endometrial carcinomas, if MLH1 is absent, reflex to MLH1 promoter methylation assay. INITIAL REVIEW Our initial look back was to determine the baseline levels of testing PRIOR to universal testing for CRC only. A total of 162 patients had colorectal tumor resections performed at Huntsville Hospital in were age 71 or greater. 15 had tumor histology inappropriate for testing (neuroendocrine or metastatic tumors), 2 of these were also over age patients were eligible for testing 25 were actually tested 29% of eligible patients were tested when the test had to be requested by the clinician. Next steps: Follow up with 2015/2016 data Include endometrial and ovarian carcinoma

7 NCCN Guidelines Version Lynch Syndrome ROUTINE TUMOR TESTING CRITERIA FOR LYNCH SYNDROME g All CRC patients or CRC patients diagnosed at <70 y and also those 70 y who meet the Bethesda Guidelines (See LS-8) RISK STATUS TESTING STRATEGY Tumor available No tumor available or insufficient tumor Tumor testing (See LS-A) with IHC or MSI Criteria met (See LS-B) Consider testing all 4 MMR genes and EPCAM c,d See tumor testing results and additional testing strategies (LS-A 2 of 3) h Positive mutation found in MLH1, MSH2, MSH6, PMS2 or EPCAM Not tested a or no deleterious mutation or mutation of unknown significance found See Lynch Syndrome Surveillance (LS-3) and (LS-4) and Genetic testing for at-risk family members c,f Tailored surveillance based on individual and family risk assessment No criteria met (See LS-B) Individual management CRC screening/surveillance based on individual risk assessment See NCCN Guidelines for Colorectal Cancer Screening for average risk and for increased risk a Testing of unaffected family members when no affected member is available should be considered. Significant limitations of interpreting test results should be discussed. c proper pretest counseling should be done by an individual with expertise in genetics. d The decision to test all 4 MMR genes and EPCAM concurrently versus sequentially (stepwise) is left to the discretion of the clinician. fan at-risk family member can be defined as a first-degree relative of an affected individual and/or proband. If a first-degree relative is unavailable or unwilling to be tested, more distant relatives should be offered testing for the known mutation in the family. g 1HC and/or MSI screening of all colorectal and endometrial cancers (usually from surgical resection but may be performed on biopsies), regardless of age at diagnosis or family history, has been implemented at some centers to identify individuals at risk for LS. This approach was recently endorsed for colorectal cancer by the Evaluation of Genomic Applications in Practice and Prevention Working Group from the CDC and shown to be cost-effective (EGAPP Recommendation Statement. Genet Med-2009; 11 :35-41). Counseling by an individual with expertise in genetics is not required prior to routine tumor testing. An infrastructure needs to be in place to handle the screening results. h For individuals found to have a deleterious LS mutation, see LS surveillance recommendations (LS-3 and LS-4 ). Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation In clinical trials is especially encouraged. 7

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