CANCER REGISTRY REPORT

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1 CANCER REGISTRY REPORT

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3 Overview Oncology Volumes St. Francis Medical Center St. Mary s Hospital Memorial Regional Medical Center Colon Cancer Study St. Francis Medical Center St. Mary s Hospital Memorial Regional Medical Center Bon Secours Cancer Institute Cancer Registrars 3

4 On behalf of Bon Secours Virginia Health System, we are pleased to present Cancer Registry Report The primary purpose of our Cancer Registry Report is to promote quality improvement at Bon Secours Virginia facilities, optimizing the care we provide our patients. Measuring and reporting outcomes reflects our organizational commitment to accountability, transparency and results. Bell tower at St. Francis Medical Center 4

5 The mission of the Bon Secours Cancer Institute is to provide seamless, comprehensive, interdisciplinary, evidence-based cancer treatment, as well as support and survivorship programs for oncology patients. We are recognized for our compassionate and world-class staff, extraordinary care experiences, convenient, state-of-the-art diagnostic and treatment facilities, and accreditation by prestigious oncology organizations. Bon Secours Cancer Institute is comprised of highly skilled and specialized health care professionals who live the Bon Secours values every day. We employ a full spectrum of cancer specialists including surgical oncologists, medical oncologists and radiation oncologists. Our compassion sets us apart, but it s our leading-edge, scientifically based cancer treatments delivered by expert clinicians that drive patient success. Oncology Specialists/ Departments Support Programs Diagnostic Imaging Interventional Radiology Surgical Oncology Surgical Thoracic, colorectal Breast, Urologic, Dermatologic, Plastics and ENT Specialists Medical Oncology Radiation Oncology Outpatient Infusion Dedicated oncology inpatient nursing units Centers of Excellence Liver Institute of Virginia Bon Secours Cancer Institute Oncology Nurse Navigators Social Workers, Support Groups Palliative Care Hospice Psychiatry Breast Cancer Survivorship Clinic Every Woman s Life Cullather Brain Tumor Quality of Life Center Healing Vibrations (Yoga, Art Therapy) Cancer Resource Centers Survivorship 5

6 Bon Secours Cancer Institute maintains an extensive tumor registry, which is the source for much of the outcomes and volume data presented in this report. Data included in the outcomes graphs, derived from the tumor registry, are from patients receiving initial treatment at Bon Secours in The volume data in this section is presented for St. Mary s Hospital, St. Francis Medical Center, and Memorial Regional Medical Center, although photos of all our cancer facilities are shown. Overall oncology volumes are presented by year. In addition to total volume, the top five types of cancer and their percentage of total cases is presented. 6

7 New Cancer Cases per Year The top five types of cancer cases and their percentage of total cancer cases 7

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10 New Cancer Cases per Year The top five types of cancer cases and their percentage of total cancer cases 10

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13 New Cancer Cases per Year The top five types of cancer cases and their percentage of total cancer cases 13

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16 Colon Cancer Study 2013 Quality Improvement ACoS Standard 4.6 Monitoring compliance with evidence-based treatment guidelines Each year, a physician member of the cancer committee performs a study to assess whether patients within the program are evaluated and treated according to evidence-based national treatment guidelines. Study results are presented to the cancer committee and documented in the minutes 16

17 St. Francis Medical Center Colon Cancer Study 2013 STUDY TOPIC: Adherence to Nation Comprehensive Cancer Network (NCCN) guidelines for Stage I-III colon cancer OBJECTIVE: To ensure cancer patients are evaluated and treated in accordance with evidence based national guidelines METHOD: Retrospective review of all stage I-III analytic colon cancer cases RESULTS: 30 patients were identified, one with synchronous diagnosis of extensive stage small cell lung cancer excluded. Of the remaining 29 patients, 2 had large sessile polyps that could not be completely resected via colonoscopy and cancer diagnosis made after colectomy. These 2 patients are thus not included in the denominator in the analysis of pre-surgical evaluation but are in the denominator for appropriate first course of treatment. Guideline Checklist MET TOTAL PERCENT Colonoscopy % CEA % CBC % Chemistry % CT abdomen % CT pelvis % CT chest % Stage I no chemo recommended % Stage III chemo recommended % CONCLUSION: Retrospective chart review revealed the following: 1) 100% compliance with chemotherapy recommendations and CBC and chemistry panels 2) 93% compliance with colonoscopy, CT abdomen, and CT pelvis 3) 67 % compliance with CEA 4) 33% compliance with CT chest 17

18 St. Mary s Hospital Colon Cancer Study 2013 Cancer Program Standards 2012 Colon cancer was selected by the cancer committee for the 2013 study. There were a total of 80 first contact colon cases for 2012 in the registry data base. These cases were evaluated using a tool provided by the CoC standards resource repository. The tool presented elements of NCCN guidelines for pre-op evaluation, and treatment. Review of 25 cases was discussed at cancer committee on November 13, It was noted that chest CTs were almost never done preoperatively, although recommended in NCCN guidelines. The committee suggested reviewing presence of CT of abdomen and pelvis for compliance. There was discussion about impact on cost to patients and reimbursement with chest CTs for this indication. Review: All eighty cases were reviewed. Cases were evaluated for conformity with NCCN guidelines for pre op evaluation and treatment. Concordance with NCCN pre op evaluation guidelines: Cases were excluded if elements of evaluation were at an outside institution and timing of scans or labs could not be determined. Cases were not counted in the evaluation measure if they were managed as gynecologic, and discovered to be colon cancer at time of surgery or by pathologic diagnosis. Sixty cases were evaluable. Fifty eight percent had a preoperative evaluation per NCCN guidelines. Forty two percent either did not have a pre op CEA and/or CT of abdomen/pelvis. Concordance with treatment guidelines: Fifty eight cases were evaluable. Of the 58 evaluable cases 88% were concordant with NCCN guidelines. Eight cases (14%) did not receive chemotherapy, when indicated by stage. Reasons were comorbities, refusal, referral to hospice or palliative care. NCCN guidelines do not address these situations. There was one treatment delay due to problems with coordination of care. 18

19 St. Mary s Hospital Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Case Acc # Stage CT Chest/ ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Evaluation Treatment Concordant with NCCN Guidelines Remarks / I No No No Part colectomy Fragmented polypectomy spec / IV NA NA Neoad FOLFOX sig colectomy Scans not at SMH / IIa No No No Part. colectomy / IV No No Surgery colon Chemo FOLFOX /00036 I No hemicolectomy / I No No No hemicolectomy / IIIB No Rt colectomy No chemo 87 year old with cirrhosis / I No No hemicolectomy IIIb No Hemicolectomy Chemo folfox / I NA NA No hemicolectomy Appendix only (outside institution) / IIIb No No Part colectomy No chemo Group home schizophrenia / IVB No Hemicolectomy Chemo FOLFOX / IIA No Hemicolectomy / IV synchron?? Chemo rad Hemicolectomy Not evaluable Labs not in connect care / IV No (PET done) FOLFOX / Tis NA NA NA NA Endoscopic polypectomy 19

20 St. Mary s Hospital Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Case Acc # Stage CT Chest/ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Evaluation Treatment Concordant with NCCN Guidelines Remarks / IV NA NA NA Hemicol TAH folfox Found during GYN surgery for pelvic mass / IIA No Hemicolectomy / IIIB No Partial colecto folfox / IIIB? outside Out- Side? No Partial col Recurrence No Oncologist documented patient not chemo candidate / IIa No Tr colectomy / IVa Palliative No / IVb No Surg for obstru hospice No / IVb No NA NA NA Radiation bone mets only No No chemo- oncologist notes fractured care / IVb No Surg for obstr chemo / IIa No No Part colectomy / I No No Hemi colectomy / I No No Not on record Hemicolectomy / IV No No Mass resect, Part collect, No Hospice (no chemo) Thought GYN pre-op / IIa Hemi or > 20

21 St. Mary s Hospital Colon Cancer Study 2013 Case Acc # Stage/ colonscopy Diagnostic evaluation per NCCN Guidelines CT Chest/ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Evaluation Treatment Concordant with NCCN Guidelines Remarks / Incomplete information No info No info No info No info No information Not evaluable Biopsy at SMH treated at outside institutions / IIIb No Rt colectomy folfox / I No No No Hemi or > / IIa No No Hemi or > / IVa No No Hemi or > Not evaluable / Tis NA NA NA NA polypectomy / IIa No Part colectomy / IIa No No Not in CC Hemi colectomy / IIIc No No Hemi excision huge mass Folfox 11/7/12 Appendiceal mass eroding into muscle / I also with I 3 yrs prior No No yes Elective total colectomy HNPCC / unknown NA NA NA NA NA Exclude Staging + tx outside / IIa No Hemicolectomy 21

22 St. Mary s Hospital Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Evaluation Case Acc # Stage/ colonscopy CT Chest/ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Treatment Concordant with NCCN Guidelines Remarks / I No No Hemicolectomy / IIb?? No Debulking Hemicolectomy Not evaluable Abd mass ascites, thought GYN / I No No No Hemicolectomy / I NA NA NA NA NA Exclude Staging + tx outside / I No No No No Partial colectomy / IVb No (PET/CT for potentially resectable dz) Subtotal colec, rt lobe hepatic Chemo- XELOX / IVb No Partial colec FOLFOX avastin / IIIc No Partial colec Not evaluable Carcinomatosis at presentation / IVb No Lt colec for obs Liver biopsy, FOLFOX / IV NA NA NA NA Tran colostomy Liver bx Not resectable Pre op labs scans outside, Chemo South Hill / Tis NA NA NA NA polypectomy / IV Chemo- FOLFOX avastin anemic mult liver mets not resected 22

23 St. Mary s Hospital Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Evaluation Case Acc # Stage/ colonscopy CT Chest/ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Treatment Concordant with NCCN Guidelines Remarks / IV No FOLFOX Liver biopsy / IV Partial colec Liver biopsy ECOG stage 4 hospice referral / IV No (had PET) No Had PET YEs Planned FOL- FOX Had stroke before chemo could be given / I No No Hemicolectomy / IIa No Hemicolectomy / IIa No No No No Partial colec xeloda / IIa No No Hemicolectomy / IIIb No No Partial colect Refused chemo No Chemo offered, patient refused / IIa No NA hemi NA Carcinoid in appendix then reoperation / IIIb No Surgery delayed One year Not evaluable No information re chemo Patient is 91 yrs / I No No No Polypectomy / IIa No Hemi or > / IIIb No No Hemi or > XELOX 23

24 St. Mary s Hospital Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Evaluation Case Acc # Stage/ colonscopy CT Chest/ ABD/ CT ABD/ Pre op CEA CBC Plats Chem 1 st course treatment Treatment Concordant with NCCN Guidelines Remarks / IVa No No Not in CC Partial colec Lt lobe liver FOLFOX Not evaluable Part colec 11/15/12 Lt lobe hepatectomy 2/14/ / IIa No Hemicolectomy / IVb No Part col 11/12 HIPEC+ wedge resect 12/12 FOLFOX 1/13 Not evaluable OR x / IIIb NA NA NA NA NA NA Diagnosis only at SMH treatment out of BSR / Tis NA NA NA NA Polypectomy / I No No Part colectomy / I No No Sig colec Not evaluable SP polypect outside No residual ca in surg specimen. No surg path report in cc / IV No No Subtotal colec + folfox yes Managed as GYN pre-op / I No No or outside No hemicolectomy yes / Tis NA NA NA NA polypectomy yes / IIA No No No hemicolectomy yes 91 yr old hx elevated creatinine / Tis NA NA NA NA polypectomy yes / NA NA NA NA NA Biopsy only at SMH NA Treatment outside neuroendocrine tumor 24

25 Memorial Regional Medical Center Colon Cancer Study 2013 During the year 2013, 19 new cases of stage III colon cancer were diagnosed. The 2013 case distribution by race was 68% Caucasian, 30% African-Americans. A majority of the cases were diagnosed in patients over 60 years of age (71%). Patients with stage III disease comprised of about 22% of all cases. Most patients who were diagnosed at MRMC also received their initial treatment at this hospital (71%). The pathological examination confirmed the histology to be Adenocarcinoma in 70% of all cases and mucinous histology was noted in less than 10% of cases. 67% of all stage III patients received colon resection as the first step in their treatment of their disease in confirmation with the national standards (61% in the NCDB benchmark). About 5% of patients did not undergo any active treatment due to various reasons. Overall survival for patients with stage III disease has steadily improved in the last 5 years, from 80% in 2008 to 91% in the year year survival for patient with stage III colon cancer who are diagnosed and treated at MRMC mirrors the national benchmark set by NCDB (~ 52% ). All but 1 patient underwent CT scan of the abdomen and pelvis prior to colon surgery. All patients had routine laboratory investigation including blood counts and metabolic panel prior to surgery. 25

26 Memorial Regional Medical Center Colon Cancer Study 2013 Diagnostic evaluation per NCCN Guidelines Evaluation Case Acc # Stage Colonoscop y T3N2b 3C Clinical T3N1M0 2a T3N1 3b T3N2b 3C Clinical 3b 3a T4N2b 3C T4bN1a 3c T3N1b 3b T4aN1a 3b Clinical T3N1M0 3b T3N1 3b Clinical T4bN1M0 3c T4bN1 3c Clinical T1N1M0 3a T1N1 3a Clinical T3N0M0 2A T2N2b 3b Clinical T1N1M0 I T1N1a 3A Clinical T3N1bM0 3b T3N1b 3b Clinical T4aN2aM1 4a T4aN2a 3c Clinical T4aN1aM1a T4aN1a 3c Clinical T3N2aM0 3b T3N2a 3b T3N1b 3b T3N1b 3b CT Chest/ ABD/ CT ABD/ Pre op CEA CBC Plats Che m 1 st course treatment No Xeloda, Laparoscopic Hemicolectomy No Laparoscopic Hemicolectomy Treatment Concordant with NCCN Guidelines Hemicolectomy? No Remarks 2 nd Primary, Liver mets Hemicolectomy Age 85 Sigmoid Resection FolFox No No Ileocolectomy Pt expired Colectomy Folfox No No Hemicolectomy Age 81 Colon Obstruction No Hemicolectomy No Right Colectomy Age 80 Colectomy Xeloda Sigmoid Colectomy Xelox Unk Unk Right Colectomy Age 80 Dx 99/99/12 Colon Resection Xeloda No Palliative Colectomy No Palliative Colectomy Physician Appropriate dx eval: (18/19) 94%, (16/19) 84% Appropriate treatment. Rt Hemicolectomy No Pt refused FOLFOX Two primaries Liver mets Two primaries Liver mets No No Rt Hemicolectomy Xeloda, Oxaliplatin Hemicolectomy Age 84 26