2015 Cancer 2016 Cancer Program Report Program Report. Incorporating a statistical summary of the 2015 cancer registry data.

Transcription

1 215 Cancer 216 Cancer Program Report Program Report Incorporating a statistical summary of the 215 cancer registry data.

2 SERVICE DIRECTORY INDEX Chairman s Message 3 Cancer Committee 4 Toll Free (812) (8) Cancer Services Center (812) Cancer Registry (812) Screening Information Line (812) Screenings, Support & Education 5 Cancer Registry Report 6 Schneck Data 7 Community Wellness (812) Perspective 9 Diagnostic Imaging (X-Ray) (812) Prostate Cancer Analysis Diagnostic Laboratory (Lab) (812) Cancer Liason Report 13 Home Services & Hospice (812) Directory of Terms 14 Nutrition Services (812) Palliative Care Program 15 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 In 216, the Cancer Center at had another incredible year of growth and recognition. Jackson, and its neighboring counties, can be proud of the multiple accolades of their local cancer center, but particularly for achieving an accreditation with commendation from the American College of Surgeons, Commission on Cancer (ACoS, COC). This award exemplified the incredible work and rigorous adherence to standards of treatment as well as demonstrating excellence in patient care. This was facilitated through the strong leadership of Dr. Dolores Olivarez, our fulltime cancer oncologist, and Dr. Higinia Cardenes, our full-time radiation oncologist, as well as Dr. Amanda Dick, our cancer liaison physician, Dr. LeAnn Stidham, our radiologist, and our extremely dedicated staff. In addition to the high honor of receiving the Outstanding Achievement Award (OAA) from the ACoS, COC, the Cancer Center was also able to share in other honors and recognition. The nursing staff at Schneck Medical Center received the Magnet distinction for the third time, a designation indicating a gold standard in hospital-wide nursing care and professional achievement. The Cancer Center also received an accreditation for use of the breast MRI in the detection of breast cancers. Our Palliative Care program achieved The Joint Commission Certification in December 215. Technology and innovation remain an important aspect of providing the best cancer care. Schneck s Cancer Center has demonstrated its dedication to obtaining these technologies through the acquisition of key pieces of equipment this year. Stereotactic radiation equipment has been added to our arsenal. This is a device that uses a high dose beam of radiation to reduce the number of overall treatments used for certain types of cancers. A 4D, 16 slice CT simulator was also purchased. This allows extremely precise imaging that can be used to obtain accurate imaging while the patient is breathing with chest rise and falling. Also, contrast media can be used for head and neck cancers to discover the relationship of blood vessels to the 216 Annual Cancer Program Report cancer. Patient safety and access has also been expanded over this last year. A walker to be used by patients with weakness and debility has been placed in the cancer center to prevent falls. New Philips monitors have been installed within the rooms to more accurately follow vital signs as well as use for heart monitoring. Two additional clinical rooms have been added to improve patient access. Dieticians are now meeting with patients on-site for weekly education. Also, there has been a hard-wiring of safety huddles each morning for staff to discuss mutual patients and the daily plan. The Cancer Center also continues to partner with the community and with surrounding institutions. An action plan was developed to continue community assessments and screenings for prostate, breast, cervical, and skin cancer. A goal of achieving 8% of colon cancer screens by 218 has been set. We are also participating in research studies focusing on lung DNA testing. The Cancer Center at demonstrates an ongoing commitment to meeting and exceeding the standards of cancer care, and we are pleased that our patients can receive such care without having to leave their community. Grant J. Olsen, M.D. 215 Distribution by County Total Analytic Cases 264 Schneck serves Jackson County as well as many surrounding counties in Indiana. Jackson Jennings Scott Bartholomew Ripley Jefferson 3 Washington 3 Brown, Cass, Decatur, Johnson, Monroe, Putnam 1 each Out-of-State 2 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: Page 4 Sherry Dowling, CTR, Cancer Registrar, Cancer Services (Cancer Conference Coordinator) Sally Acton, RN, BSN, OCN, MSM, Director, Cancer & Palliative Care Services (Cancer Program Administrator) Aaron Banister, PhD, HSPP, Mental Health & Wellness (Psychosocial Services Coordinator) Dolores Olivarez, M.D., Medical Oncologist (Clinical Research Representative) Donna Butler, MSN, ANP-BC, OCN, ACHPN, FAAPM, Palliative Care Grant Olsen, M.D., Hospitalist (Chairman) Higinia Cárdenes, M.D., Ph.D., Radiation Oncologist Amy Pettit DNP, RN, NE-BC, CSSBB, VP of Nursing Services and Chief Nursing Officer Debbie Clontz, RN, BSN, OCN, Oncology Nurse, Cancer Services Lynda Richey, RN, BSN, OCN, Oncology Nurse and Nurse Navigator, Cancer Services (Community Outreach Coordinator) Leighana Crenshaw, MSW, LSW, Case Manager, Patient Services LeAnn Stidham, M.D., Diagnostic Radiologist Bridgett Cope, RN, BSN, CMSRN, COS-C, Hospice Ann Wenderoth, Coordinator, Health Initiatives, Great Lakes Division, American Cancer Society Tammi Covert, OTR, Rehab Coordinator, Rehab Services J. Wesley Whitler, M.D., Pathologist (Quality of Cancer Registry Data Coordinator) Amanda Dick, M.D., General Surgeon (ACoS Cancer Liaison Physician) Suki Wright, MSM, CSSBB, Director, Organizational Excellence and Innovation (Quality Improvement Coordinator)

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 Lynda Richey, RN, BSN, OCN stages, before symptoms would prompt a physician office visit. Schneck Community Outreach Coordinator 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. Kartha at the Cancer Center. Breast health and cervical screenings were held in October. CT lung cancer screening is available through Schneck Diagnostic Imaging. 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: Research 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 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. 216 Annual Cancer Program Report Page 5

6 CANCER REGISTRY REPORT The Cancer Registry collects and monitors all types of cancer diagnosed or treated in our institution. We strive to provide accurate and complete cancer information, timely data reporting and strict patient confidentiality. Cancer Registry data is utilized to monitor specific cancer trends. We have implemented the Rapid Quality Reporting System (RQRS) to support our efforts in maintaining a high-level of evidence-based cancer care. Our Cancer Program is accredited by the American College of Surgeons, Commission of Cancer, CoC, with gold level compliance receiving the CoC Outstanding Achievement Award again in 216. Currently, I am serving a second term 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. SCHNECK CANCER REGISTRY SUMMARY Total number of cases in registry since 6227 Total number of cases requiring follow-up 4659 Less number of deceased cases 316 Total number of cases followed 1632 Cases with current follow-up 1167 Total follow up rate 9% A follow-up rate of 8% 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 1223 Total number of cases requiring follow-up 922 Less number of deceased cases 383 Total number of cases followed 539 Cases with current follow-up 468 Total follow up rate A follow-up rate of 9% for analytic patients entered in the last five years is required by the ACoS, CoC. Calculations based on July 216 follow-up. Cancer Registry reference date: January 1, 1986 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 Page % 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. J. Wesley Whitler, M.D. Quality of Registry Data Coordinator As a pathologist, Dr. Whitler also oversees the quality of the pathology reporting system.

7 SCHNECK CANCER CASES BY PRIMARY 215 Frequency by Primary Site 328 Total: Analytic 264, Non-Analytic 64 Lung & Bronchus 58/ 47/7 Breast Colon 22/ Prostate 15/7 Thyroid Gland 9/7 Urinary bladder 11/3 Leukemia /3 Rectum and Rectosigmoid 11/2 Non-Lodgkin's Lymphoma 5/4 Melanomas of the Skin 2/7 Multiple Myeloma 6/2 Corpus Uteri 7/1 Larynx 6/2 Pancreas 7/1 Kidney & Renal Pelvis 6/1 Tongue 5/2 Liver 4/1 Stomach 5/ Pharynx 4/1 Testis 3/ Ovary 1/2 Soft Tissue (inc head/ neck) 2/1 Analytic Non-Analytic 18/ Other/Ill Defined/Unknown *Other includes sites with frequency of two or less. Lung cancer is our top analytic site, followed by breast, colon, prostate, and urinary bladder cancers. Prostate cancer is highlighted later in this report by Dr. Ryan Malone. Our top sites coincide with the top sites nationally. 216 Annual Cancer Program Report Page 7

8 SCHNECK CANCER CASES BY PATIENT DISTRIBUTION 215 Age at Diagnosis 264 Analytic Cases: 127 male, 137 female Male Female Cancer incidence rises with age, with most cases affecting adults in mid-life or older. Females predominated at 137 of the total 264 cases. 215 AJCC Stage at Diagnosis 264 Analytic Cases: 127 male, 137 female 5 45 Male 45 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 After skin cancer, prostate cancer is the leading cancer in men. This data is derived from the National Cancer Institute s Surveillance, Epidemiology and End Results (SEER) program. Per the SEER database, the estimated number of new cases in 216 will be over 18, men. The percentage of new cancer cases will represent over % of the population. Estimated deaths in 216 from prostate cancer will be 26, with an overall percent of cancer specific death of over 4.4%. The risk to a man of developing prostate cancer over his lifetime is 12.9%. At, there were 15 cases of prostate cancer diagnosed and treated in 215. Of 15 cases, the ranges were three cases from ages 5-59, three cases this from 6-69, and nine cases from the ages of The stage breakdown according to these numbers reveals seven cases of stage IIA, four cases of stage IIB, two cases of stage III disease, and two cases of stage IV disease. The treatment associated was radiation for one patient, radiation plus hormonal manipulation for 11 patients, one patient who underwent surgery and chemotherapy, one patient underwent surgery and radiation therapy, and one patient underwent surgery with radiation and hormonal manipulation. As you can see from the national statistics, prostate cancer, while survivable, certainly can be more challenging. Once prostate cancer moves beyond its initial stages it becomes very challenging to treat and manage. While the percentage of death from prostate cancer is not as high as its prevalence, the sheer volume makes this a significant disease. 216 Annual Cancer Program Report Also demonstrated is the multi-modality approach that has to offer patients. These treatments are cutting edge and available without patients needing to travel for state of the art treatment. also supports evidence based medicine. Recent recommendations on PSA testing have made this diagnosis challenging. While recognizing the shortcomings of this test, the medical community has taken this data point among others to help limit the need for unnecessary biopsy and diagnosis. The role of diagnosing and knowing when to intervene with treatment versus surveillance continues to be an active goal of prostate cancer treatment. Dr. Ryan Malone Page 9

10 SCHNECK PROSTATE CANCER DATA 215 Age at Diagnosis 15 Analytic Prostate Cases The seventh decade of life was the most common for incidence of prostate cancer. 215 AJCC Stage at Diagnosis 15 Analytic Prostate Cases A 2B 3 4 Almost half of patients were diagnosed at stage 2A. 215 First Course of Treatment 15 Analytic Prostate Cases Radiation and Diagnostic Radiation, Hormonal Surgery, Chemotherapy, Surgery, Radiation Surgery, Radiation biopsy Therapy, and Diagnostic Hormonal Therapy, and Therapy, and Diagnostic Therapy, and Hormonal Biopsy Diagnostic Biopsy Biopsy Therapy The majority of patients received radiation, hormonal therapy, and diagnostic biopsy as the first course of treatment. Page

11 PROSTATE CANCER NCDB COMPARATIVE ANALYSIS Percentage of Cases, Age at Diagnosis* & NCDB Total Analytic Cases: 117 Schneck, 1,34,47 NCDB SMC NCDB Incidence of cancer increases with age, with most cases affecting men in their 6s and 7s. Schneck s age groups at initial diagnosis tend to be older than national rates. Percentage of Cases, AJCC Stage at Diagnosis* & NCDB Total Analytic Cases: 117 Schneck, 1,34,47 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 prostate cancers are diagnosed in the earlier stages of disease. 216 Annual Cancer Program Report Page 11

12 PROSTATE CANCER ANALYSIS (CONT.) Percentage of First Course of Treatment* & NCDB Total Analytic Cases: 117 Schneck, 1,34,47 NCDB SMC NCDB Surgery Only Radiation Only Surgery & Radiation 2.5 Surgery, Radiation & Hormone Therapy Radiation & Hormone Therapy Hormone Therapy Only Other Specified Therapy 6 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 216 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) as of Wednesday, September 28, 216. 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 COC CANCER LIAISON PHYSICIAN END OF YEAR REPORT Breast cancer remains one of the most common cancers among American women. We can expect 12% of women to develop breast cancer in their lifetime. In 216, an estimated 3,+ women will be diagnosed with breast cancer. The majority of those cancers will be invasive. Over 4, women will die from breast cancer in 216. As terrifying as these numbers seem, it is also important to know that there are currently over 2.8 million breast cancer survivors currently living in the United States alone. Breast cancer rates are decreasing and survival rates are improving thanks to decreasing utilization of hormone replacement therapy and early detection. For women diagnosed with Stage or I breast cancer, survival rates approach %. For those with stage II disease, survival rates are over 93%. Appropriately timed screening and administration of treatments help create good outcomes for those faced with this disease. provide free breast cancer screening clinics as key to early detection in our community. Review of CoC guidelines show % compliance at Schneck Cancer Center for appropriate and timely administration of chemotherapy, radiation and hormone receptor therapy; and for the use of core needle biopsy as gold standard for diagnosis of breast cancer. We also received accreditation for breast MRI. Once again, I am proud to be a part of the cancer committee that has achieved an Outstanding Cancer Center Award again in 216. I look forward to helping more patients find a cancer free future with the help of our amazing staff here at Schneck Cancer Center. Amanda Dick, M.D. Cancer Liaison Physician Here at Schneck, we are fortunate to have an amazing team of doctors and nurses that are highly trained and skilled at the diagnosis and treatment of breast cancer. In 215 we treated 47 new patients with breast cancer. Early detection through screening and fast track to biopsy and consultation are the first steps to successful treatment. We will continue to 216 Annual Cancer Program Report Page 13

14 COC CANCER LIAISON PHYSICIAN END OF YEAR REPORT (CONT) NCBD, CP3R Performance Rate Comparisons** BREAST CARCINOMA NATIONAL MEASURES Our Program (SMC) Our State (IN) Our Census Region Our ACS My CoC All CoC Division Program Programs (Lakeshore) Type (CCP) BCSRT - Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 7 receiving breast conserving surgery for breast cancer % 95% 93% 92.3% 9.2% 91.5% HT - Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1cNM, or stage IB III hormone receptor positive breast cancer. % 94.2% 93% 92% 9.1% 91.2% MASTRT - Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with 4 positive regional lymph nodes % 95.3% 9.4% 9.7% 86.3% 87.6% nbx - Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer. % 91.3% 9.7% 91.8% 88.1% 9.3% 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. ** Comparison data provided by COC, Quality Improvement Program (CQIP) Annual Report 215, updated February 216, and reviewed October 4, 216. 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 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 211. A pastor for twelve years, he is a member of the Association of Professional Chaplains. Brittaney Haynes, RRT, is a Registered Respiratory Therapist. With Schneck since 27, she is the disease management Patient Care Supervisor for the respiratory care department. Brittaney joined the Palliative Care team in 216. 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 213. Colette Mills, RN, BSN, CHPN, has been an RN since With Schneck Hospice since 28, she has served on the Palliative Care team since 211. She is a certified Hospice and Palliative Care nurse. Donna Butler, MSN, ANP- BC, OCN, ACHPN, FAAPM, has been focusing on palliative care since 23. She is certified in oncology, advanced hospice, and palliative care nursing and a fellow of the American Academy of Pain Management. Dana Prieto, RN, BSN, OCN, is an experienced nurse with training in pediatrics, medical/surgical, ICU and oncology. She become an RN in 27, joining Schneck in 2. Dana has served on the Palliative Care team since 212. Anita Collins, MSN, FNP-BC, has been a nurse practitioner since 28, focusing on pain management. She has worked at since PALLIATIVE CARE PROGRAM UPDATES Leighana Crenshaw, MSW, LSW, has been a social worker since 1994, joining Schneck in 2. She has been active in the Palliative Care program since 211. Performance improvement is continually monitored and demonstrates improved symptom management. The program became accredited by The Joint Commission in December of 215. David Hartung, DO, is the medical director of the Palliative Care Program. Dr. Hartung joined Schneck s medical staff in 25. He is board certified in family medicine. Donna Butler and Anita Collins spoke about the program in November at the Center to Advance Palliative Care (CAPC). The poster presentation highlighted the program s commitment to supporting the grieving process by holding memorial services for employees to remember patients lost and to recognize the caregivers. 216 Annual Cancer Program Report The program began in 211 and has since expanded its role with the addition of Anita Collins, who follows chronic illnesses such as COPD and CHF. These illnesses often begin within the inpatient setting. Page 15

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