2015 Cancer Program Report. Incorporating a statistical summary of the 2014 cancer registry data.

Transcription

1 15 Cancer Program Report Incorporating a statistical summary of the 14 cancer registry data.

2 INDEX Chairman s Message 3 Cancer Committee 4 Screenings, Support & Education 5 Cancer Registry Report 6 Schneck Data 7 Perspective 9 Lung Cancer Analysis Nurse Navigation Update 14 Directory of Terms 14 Palliative Care Program 15 SERVICE DIRECTORY (812) Toll Free (800) Cancer Services Center (812) Cancer Registry (812) Screening Information Line (812) Community Wellness (812) Diagnostic Imaging (X-Ray) (812) Diagnostic Laboratory (Lab) (812) Home Services & Hospice (812) Nutrition Services (812) Pain Center (812) Patient Services (812) (Social Work, Case Management, Discharge Planning) Psychological Services (812) Rehab Services (812) Schneck Foundation (812) Smoking Cessation Classes (812) Wound Care (812) The vision of the Cancer Program at is to be the provider of choice for cancer care in our community. Our mission is to provide excellence in prevention, diagnosis, and treatment throughout the continuum of cancer care. s Community Cancer Program is based on the standards prescribed by the American College of Surgeons, Commission on Cancer (ACoS, CoC). Schneck is accredited with Commendation by the ACoS, CoC. The CoC recommends that this program publish an annual report. A time lag is caused by the length of time which may occur between diagnosis and first course of treatment and the time required for generation of data. Page 2

3 CHAIRMAN S MESSAGE The Cancer Center at again succeeded in providing excellent care to the patients of Jackson and its surrounding counties in 15. This was facilitated by the strong leadership of Dr. Dolores Olivarez, our fulltime medical oncologist. Dr. Higinia Cardenes joined us this year as the cancer center s full-time radiation oncologist, adding her expertise and drive to our talented staff. Dr. Amanda Dick continued to serve as our cancer liaison physician. Dr. LeAnn Stidham also continued as our radiologist and Dr. Whitler as our pathologist. Anita Collins, a nurse practitioner, joined the cancer center this year with dedication to the Palliative Care program. Lynda Richey, an experienced nurse at the cancer center, has continued in the role as our Patient Navigator. This role serves to guide the patient through the emotional and overwhelming terrain on their path to diagnosis and treatment, and we continued to solidify this process with improved treatment plans and communication goals. In conjunction with this process, the cancer center has a more cohesive survivorship care plan that communicates to the patient expectations once treatment is completed. The Schneck Cancer Center continues to flourish in 15 as the incredible staff and innovative technologies aid us in marrying art and science to provide excellent cancer care. As cancer treatment requires the most up-to-date innovations and technology, the Schneck Cancer Center met this challenge by transitioning to electronic medical records. This allowed the vital chemotherapies and other orders to be entered electronically, improving patient safety. We also purchased a new nasopharyngeal scope to visualize and aid in the treatment of head and neck cancers. In addition to these updated technologies, we began a research project involving an enhanced treatment process called photodynamic therapy. These cases are being discussed in the context of our All Things Chest cancer conference which served to augment our continuing breast conferences with the addition of lung cancer cases. Grant J. Olsen, M.D. 14 Distribution by County Total Analytic Cases 2 Schneck serves Jackson County as well as many surrounding counties in Indiana. Jackson 147 Jennings 38 Scott 17 Bartholomew 6 Rush 3 Lawrence 2 Washington 2 Clark, Dubois, Greene, Harrison, and Jefferson 1 each 15 Annual Cancer Program Report Page 3

4 CANCER COMMITTEE The Cancer Committee is comprised of physicians and other healthcare professionals dedicated to providing the community with state-of-the-art cancer control efforts in prevention, early diagnosis, pretreatment evaluation, staging, treatment, rehabilitation, and surveillance. The Committee provides leadership to plan, initiate, stimulate, and assess all cancer-related activities at Schneck. Members include: Sally Acton, RN, BSN, OCN, MSM, Director, Cancer & Palliative Care Services (Cancer Program Administrator) Aaron Banister, PhD, HSPP, Mental Health & Wellness (Psychosocial Services Coordinator) Donna Butler, MSN, ANP-BC, OCN, ACHPN, FAAPM, Palliative Care Higinia Cárdenes, M.D., Ph.D., Radiation Oncologist Vicki Johnson-Poynter, MSN, RN, NE- BC, CSSBB, VP of Nursing Services and Chief Nursing Officer Suzie McDonald, RN, BSN, MHA, Nurse Manager, Hospice Services Dolores Olivarez, M.D., Medical Oncologist (Clinical Research Representative) Grant Olsen, M.D., Hospitalist (Chairman) Debbie Clontz, RN, BSN, OCN, Oncology Nurse, Cancer Services Leighana Crenshaw, MSW, LSW, Case Manager, Patient Services Lynda Richey, RN, BSN, OCN, Oncology Nurse and Nurse Navigator, Cancer Services (Community Outreach Coordinator) LeAnn Stidham, M.D., Diagnostic Radiologist Tammi Covert, OTR, Rehab Coordinator, Rehab Services Ann Wenderoth, Coordinator, Health Initiatives, Great Lakes Division, American Cancer Society Amanda Dick, M.D., General Surgeon (ACoS Cancer Liaison Physician) Sherry Dowling, CTR, Cancer Registrar, Cancer Services (Cancer Conference Coordinator) J. Wesley Whitler, M.D., Pathologist (Quality of Cancer Registry Data Coordinator) Suki Wright, MSM, CSSBB, Director, Organizational Excellence and Innovation (Quality Improvement Coordinator) Page 4

5 COMMUNITY OUTREACH Lynda Richey, Community Outreach Coordinator, monitors outreach activity, assuring that materials and staff are available for screening and educating the community. She reports these events to the Cancer Committee. Screenings Early detection is the key to finding cancer in an early stage, thus providing a better chance for cure. Screenings can detect cancers in early stages, before symptoms would prompt a physician office visit. Schneck Medical Center provided the following screenings: ColoCare, a test for detecting blood in the stool, was distributed for colon cancer screening at numerous health events. Skin cancer screenings were held by a local dermatologist at the Cancer Center. Prostate cancer screenings were held in September by Dr. McAleese at the Cancer Center. Breast health screenings were held in May and September; a cervical screening was included. Oral screening was performed by Dr. Hiester-Stout at the community health fair. CT lung cancer screening is available through Schneck Diagnostic Imaging. Lynda Richey, RN, BSN, OCN Community Outreach Coordinator Public Education Public education is provided through many venues. Professional staff of the Schneck Cancer Center provides information about prevention, detection, and good health habits to various community organizations. In addition, instruction and literature about various cancer topics are provided at community events. Support Psychological services and social workers are available to provide emotional support and assistance with community resources throughout the disease process. Other venues for support include the following: Cancer support group Leukemia & Lymphoma support group Fresh Start Smoking Cessation program Nutritional counseling Genetic testing and counseling through referral Cancer navigation program Grief counseling Free wig bank (ACS) Look Good Feel Better program (ACS) Road to Recovery (ACS) Reach to Recovery (ACS) Palliative Care Team Research Computers with internet access are located in our Resource Center with easy access to the National Cancer Institute and clinical trials. Patient tracking of those participating in clinical trials is being done by the cancer center staff. 15 Annual Cancer Program Report Page 5

6 CANCER REGISTRY REPORT Cancer Registrars monitor, report, and analyze all types of cancer diagnosed or treated in an institution. Maintaining a cancer registry ensures that health officials have accurate and timely data for treatment, research, and educational purposes. Fundamental research on the epidemiology of cancer is initiated using the accumulated data reported to central (state/national) registries. Our Cancer Program is accredited by the American College of Surgeons, Commission of Cancer, CoC, with commendation level of compliance on all required standards, therefore receiving the CoC Outstanding Achievement Award. Our registry has implemented the CoC Rapid Quality Reporting System (RQRS) to actively monitor and assess compliance with several National Quality Forum endorsed measures to support efforts in maintaining a high-level of evidence-based cancer care. Currently, I am honored to serve as treasurer of the Indiana Cancer Registry Association. As a member of the National and State Cancer Registrars Associations, I have the opportunity to interact with registrars across the nation and to stay current with required changes in coding documentation. Please take a few moments to look over the graphs on the following pages. While the cancer registry compiles the data, this is truly a reflection of everyone working together to care for our patients. Sherry L. Dowling, CTR, Cancer Registrar SCHNECK CANCER REGISTRY SUMMARY Total number of cases in registry since 5894 Total number of cases requiring follow-up 4412 Less number of deceased cases 2846 Total number of cases followed 1566 Cases with current follow-up 1289 Total follow up rate 93.7% A follow-up rate of 80% for all analytic patients is required by the ACoS, CoC. SCHNECK CANCER PATIENTS ENTERED IN THE LAST FIVE YEARS SUMMARY Total number of cases in registry last five years 869 Total number of cases requiring follow-up 869 Less number of deceased cases 358 Total number of cases followed 511 Cases with current follow-up 478 Total follow up rate 95.6% A follow-up rate of 90% for analytic patients entered in the last five years is required by the ACoS, CoC. Calculations based on September 15 follow-up. Cancer Registry reference date: January 1, 1986 J. Wesley Whitler, M.D. Quality of Registry Data Coordinator Quality of the Cancer Registry is monitored and reported quarterly to the Cancer Committee. This includes monitoring of case finding, accuracy of data collection and staging, abstracting timeliness (RQRS), follow-up, and data reporting. As a pathologist, Dr. Whitler also oversees the quality of the pathology reporting system. Page 6

7 SCHNECK CANCER CASES BY PRIMARY 14 Frequency by Primary Site 261 Total: Analytic 2, Non-Analytic 41 Lung & Bronchus 35/8 Breast 36/3 Colon Prostate Urinary Bladder Pancreas 12/1 /3 22/0 11/ Analytic Non-Analytic Non-Hodgkin's Lymphoma Pharynx other bucca Corpus Uteri 8/1 8/0 7/1 Thyroid Gland Rectum and Rectosigmoid Stomach Kidney and Renal Pelvis Hodgkin's disease Larynx Multiple Myeloma Cervix Uteri Liver Soft Tissue (incl. head) Melanomas Leukemia Ovary Tongue 4/3 6/0 6/0 5/0 5/0 4/0 4/0 4/0 4/0 3/0 1/2 3/0 2/1 2/1 Other/Ill Defined/Unknown 18/ *Other includes sites with frequency of two or less. Breast cancer is our top analytic site, followed by lung, colon, prostate, and urinary bladder cancers. Lung cancer is highlighted later in this report by Dr. David Wilson. Our top sites coincide with the top sites nationally. 15 Annual Cancer Program Report Page 7

8 SCHNECK CANCER CASES BY PATIENT DISTRIBUTION 14 Age by Gender at Diagnosis 2 Analytic Cases: 2 male, 118 female Male Female Cancer incidence rises with age, with most cases affecting adults in mid-life or older. Females predominated at 118 of the total 2 cases. 14 AJCC Stage by Gender at Diagnosis 2 Analytic Cases: 2 male, 118 female Male Female In Situ I II III IV N/A or Unknown The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Detecting cancer in an earlier stage can often lead to a higher survival rate. The majority of females were diagnosed at Stage II or earlier. Page 8

9 PERSPECTIVE Lung cancer is the leading cause of cancer death in the U.S. and as such presents tremendous challenges. But, the opportunity for improved diagnosis and care is great. With this backdrop of challenges and opportunities, Schneck implemented new technology for lung cancer detection and therapy in late 14. But first, let s detail the lung cancer experience at Schneck for 14. There were 36 cases of Lung cancer in 14. Demographically 25% occurred at less than 60 years of age. The sixth decade of life was the most common for incident lung cancer at 41.7%. 22.2% occurred in the age range of and only 11.1% greater or equal to the age of 80. This roughly mimics the U.S. experience as a whole. Detection strategies with lung cancer screening should improve earlier disease recognition. Presumably, this would lower the age incidence. The National Lung Cancer Screening Trial defined a screening benefit with low dose Chest CT scans that promises to aid in early detection of lung cancer. Many insurers and CMS now cover low dose Chest CT for lung cancer screening. Stage remains the most important predictive factor in lung cancer outcomes, and 26 patients presented at Stage III and IV disease. This is actually better than national data. Stage III and IV disease at Schneck is at 67%, while nationally this number is closer to 85%. cases presented at Stage I and II which carry a much better prognosis. Lung cancer survival remains at only 15% nationally. This is defined as cancer free status at five years from diagnosis. The location of lung cancer has slowly moved further to the periphery and away from the central airways. The 14 Schneck experience shows this to be accurate. Only two cases, or 5.6%, were in main airways (trachea/ Main stem bronchi). Upper lobe predominance was present at 55.5%. This is also nationally and historically the case. Lower lobe disease occurrence was less at 19.4%. Treatment regimens at Schneck were multi-modality with combinations of surgical, chemotherapeutic, and radiation therapy. No one approach predominated. This is very common and expected given the complex nature of lung cancer. Eleven patients in the cohort chose no therapy or were beyond the point of tolerating therapy. Again, this is a tragic malignancy and detection at a late stage often limits therapy options. Challenging diseases also create enormous opportunities. Schneck embraced opportunities to improve lung cancer detection by investing in the Veran Navigational Bronchoscopy/Percutaneous Biopsy System in late 14. Combined with Transthoracic Needle Biopsy with CT guidance, it gives Schneck the ability to have three non-surgical methods to detect earlier stage lung cancer. This has also lead to re-thinking the Cancer Nurse Navigator role to include identification of abnormal chest x-rays and chest CTs. The hope of early detection is promising. Surgery is the most curative therapy. But, surgery is best with early stage disease. Lung cancer surgical case volumes at Schneck began to rise in late 14 largely due to identifying early stage disease. Newer therapy modalities were embraced in 14 as well. Schneck has implemented the only Photodynamic Therapy (PDT) program for lung cancer treatment in the state. Patients with lung cancer have better therapeutic outcomes if tumors occluding airways are destroyed. Many methods exist to eradicate airway tumors, but PDT with Laser excitation of a cytotoxic photophryn drug is reemerging as a preferred method because it is less traumatic to the patient. This PDT program has treated many patients to improve their ability to undergo chemotherapy and radiation therapy. The future of lung cancer detection and treatment remains optimistic. David S. Wilson MD, FCCP 15 Annual Cancer Program Report Page 9

10 SCHNECK NON-SMALL CELL CARCINOMA CANCER DATA Age at Diagnosis 36 Analytic Lung Cases AJCC Stage at Diagnosis 36 Analytic Lung Cases I II III IV The sixth decade of life was the most common for incidence, 41.7%, of lung cancer. Twenty six patients, or 67%, presented at Stage III and IV. This is better than the national data in which closer to 85% of patients present at Stage III or IV. 14 Topography at Diagnosis 36 Analytic Lung Cases 14 Treatment at Diagnosis 36 Analytic Lung Cases Main Bronchus Upper lobe, lung Middle lobe, lung Lower lobe, lung Unknown 1, 3% 7, 19% 6, 17%, 56% 2, 5% No Treatment 1, 3% 2, 6% Surgery alone Chemotherapy alone Radiation alone 2, 5% Radiation / Chemo 9, 25% Surgery / Chemo Surgery / Radiation 5, 14% Surgery / Radiation / Chemo 11, 31% 3, 8% 3, 8% More than half, 55.5%, of our patients presented with cancer in the upper lobe. Treatment at Schneck follows national standards. Unfortunately, due to late stage diagnosis, patients may not be able to tolerate therapy and may opt to forgo treatment due to the progression of cancer. Page

11 NON-SMALL CELL CARCINOMA CANCER NCDB COMPARATIVE ANALYSIS Percentage of Cases, Age at Diagnosis* & NCDB Total Analytic Cases: 247 Schneck, 1,3,025 NCDB SM C NCDB Incidence of cancer increases with age, with most cases affecting adults in mid-life or older. Schneck s age groups at initial diagnosis track national trends closely Percentage of Cases, AJCC Stage at Diagnosis* & NCDB Total Analytic Cases: 247 Schneck, 1,3,025 NCDB SMC NCDB I II III IV Unknown The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Data shows the majority of lung cancers are diagnosed in the later stages of disease. 15 Annual Cancer Program Report Page 11

12 NON-SMALL CELL CARCINOMA CANCER ANALYSIS (CONT.) Percentage of First Course of Treatment* & NCDB Total Analytic Cases: 247 Schneck, 1,3,025 NCDB SMC NCDB Surge ry Only Radiation Only Surgery & Radiation Surgery & Chemo Radiation & Chemo Chemo Only Surgery, Radiation & Chemo Other Specified Therapy No First Course of Treatment Schneck s first course of treatment very closely matches national statistics. Many patients only require surgery. Depending upon the stage of disease, national guidelines recommend additional treatment. * Comparison data provided by 15 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) as of Tuesday, October, 15. RESEARCH Schneck joined Indiana University in a lung cancer screening research study, Measuring Stigma and Health Beliefs about Lung Cancer Screening in Long-Term Smokers. This study should help us better understand factors that may influence screening behavior and help us identify effective recruitment methods. Page 12

13 NON-SMALL CELL CARCINOMA CANCER ANALYSIS (CONT.) is leading the way for improved cancer care for patients in our community. As Dr. Wilson outlined earlier in this report, unique therapies, including photodynamic therapy and navigational bronchoscopy, are now being offered as part of our approach to treating lung cancer. Current treatment guidelines for lung cancer recommend consideration of chemotherapy for lymph node positive (pn1 and pn2) non-small cell lung cancer within 4 months pre-operatively or 6 months post-operatively. In 11, every patient treated at Schneck Cancer Center met that guideline. Additional goals include appropriate selection of patients for surgical treatment. Recommendations are for non-surgical treatment as the first course for node positive non-small cell lung carcinoma. We met that guideline 0% of the time. Surgical treatment of lung cancer here at Schneck is a relatively new occurrence. Optimal outcomes and appropriate surgical therapy will remain a focus as we continue to treat more lung cancer patients here at Schneck. Cancer prevention through education of both patients and providers as well as preventative care measures will help reduce the incidence of cancer. Community outreach and education regarding causes of lung cancer and who is appropriate to seek screening tests will be a big focus for the coming year. Timely diagnoses and nationally recognized care are paramount to potential cure and faster return to their lives and loved ones. Amanda Dick, M.D. Cancer Liaison Physician NCBD, CP 3 R Performance Rate Comparisons* SMC IN NCDB SMC IN NCDB SMC IN NCDB L no Surgery Surgery is not the first course of treatment for cn2, cm0 lung cases. 0% 91.6% 89.9% 0% 91.3% 90.8% 0% 93.8% 91.6% LCT Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively or it is considered for surgically resected (pn1) and (pn2) NSCLC. 0% 89.1% 85.6% N/A 90.9% 90.3% N/A 91.5% 88% National performance measures are used to measure treatment practices. Schneck monitors and compares data in an effort to maintain a high-level of cancer care. Schneck s performance rate exceeds others across the nation. 15 Annual Cancer Program Report Page 13

14 NURSE NAVIGATION OUR NURSE NAVIGATOR HELPS PATIENTS THROUGH A COMPLEX CANCER DIAGNOSIS. DEDICATED TO GIVING PATIENTS MORE CONTROL OF THEIR CANCER As our Cancer Center Nurse Navigator, Lynda Richey, RN, BSN, OCN, focuses on helping each patient after their diagnosis no matter what type of cancer it is. This includes providing education to patients, giving emotional support, and connecting them to crucial resources in the surrounding area. With more than 25 years of experience in cancer care, Lynda helps our cancer patients and their families move through the healthcare process from diagnosis through treatment and into survivorship. Lynda continues to stay in contact with physician offices, providing treatment plans and updates as needed. She focuses on addressing the barriers of cancer patients on an individual level using interdisciplinary resources as appropriate. For referrals, please call DIRECTORY OF TERMS AJCC Stage of Diagnosis: Depending on the TNM classifications or anatomic extent of disease, cases are placed into Stage Groupings or levels of disease. Early disease is classified as Stage 0 with the stage increasing with the amount of disease present. Analytic: Cases diagnosed and/or treated initially at since the Cancer Registry reference date of January 1, Non-Analytic: Cases diagnosed and/or treated elsewhere; cases diagnosed and treated at Schneck Medical Center prior to the Cancer Registry reference date of January 1, 1986, and which have returned with recurrent disease during the current year; cases diagnosed at autopsy; or known cases diagnosed and initially treated in a staff physician s office. Survival: Observed rate is the calculation made without correcting for other types of mortality. Page 14

15 PALLIATIVE CARE PROGRAM Schneck s palliative care team will work with primary care physicians to combine pain and symptom control in all aspects of our patient s care plan. Rev. Stephen Barrett has been a Hospice/Palliative Care Chaplain at Schneck since 11. A pastor for twelve years, he is a member of the Association of Professional Chaplains. Aaron Banister, Ph.D., is a licensed counseling psychologist specializing in health psychology, cognitive behavioral therapy, and anxiety-based disorders. He has been with Schneck since 13. Donna Butler, MSN, ANP- BC, OCN, ACHPN, FAAPM, has been focusing on palliative care since 03. She is certified in oncology, advanced hospice, and palliative care nursing and a fellow of the American Academy of Pain Management. Anita Collins, MSN, FNP-BC, has been a nurse practitioner since 08, focusing on pain management. She recently joined palliative care. She has worked at since Leighana Crenshaw, MSW, LSW, has been a social worker since 1994, joining Schneck in 00. She has been active in the Palliative Care program since 11. David Hartung, DO, is the medical director of the Palliative Care Program. Dr. Hartung joined Schneck s medical staff in 05. He is board certified in family medicine. Colette Mills, RN, BSN, CHPN, has been an RN since With Schneck Hospice since 08, she has served on the Palliative Care team since 11. She is a certified Hospice and Palliative Care nurse. Dana Prieto, RN, BSN, is an experienced nurse with training in pediatrics, medical/surgical, ICU and oncology. She become an RN in 07, joining Schneck in. Dana has served on the Palliative Care team since 12. PALLIATIVE CARE PROGRAM UPDATES Since beginning the program in 11, Donna Butler has expanded Schneck s program to encompass a wide range of patients. The goal of the program is to improve quality of life both for the patient and their family by addressing goals of care, life goals, and advance care planning. Donna has mentored regional programs, helping other organizations initiate or improve their palliative care programs. Performance improvement is continually monitored and demonstrates improved symptom management. Sally Acton, Cancer Center Director, spoke about the program in November at the Center to Advance Palliative Care. In her poster presentation, Sally highlighted Schneck s commitment to advancing the services provided at Schneck by training more nurse practitioners. This strategic initiative allowed for Anita Collins to join the palliative care program in Annual Cancer Program Report Page 15

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