2011 Cancer Program Annual Report

Transcription

1 2011 Cancer Program Annual Report 2011 I CANCER PROGRAM Annual Report I 1

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3 Message from the Medical Director Bachar Dergham, MD At Marymount Hospital, we deliver exceptional care, without exception. We provide our patients with state-of-the-art cancer care because we are part of an integrated system of care. We partner with the American College of Surgeons Commission on Cancer, American Cancer Society, Cleveland Clinic Taussig Cancer Institute and our local community of primary and specialty care physicians. Our alliance with these programs allows us to deliver safe care, function efficiently, build system accountability, and incorporate innovation into our practice. The collaboration provides the platform to appropriately applied medical advances for our cancer patients. Our annual report highlights lung cancer clinical services and care. Lung cancer affects more than 200,000 Americans each year. Significant discoveries have been made in the past year. Low-dose CT scanning reduces lung cancer death rate in people at high risk for lung cancer. Personalized approaches to treatment by incorporating molecular markers into treatment decisions can provide more effective and better tolerated therapies. Advances in the surgical and radiotherapy management of lung cancer have made potentially curative therapies a reality for more patients. While our treatment advances have increased survival rates, we have additional insight to key areas in which advanced cancer care can be improved. This year, we examined clinical management of lung cancer patients. We explored our practice of including appropriate advance care planning discussions during treatment planning for our patients diagnosed with Stage IV lung cancer. We designed a care coordination process for our cancer patients that includes our strongest community partner, the American Cancer Society. At Marymount Hospital, we continually strive to advance lung cancer care and improve our patients outcomes. I am honored to lead our cancer care team and share progress made to keep patient centered care the bedrock for our cancer program. Bachar Dergham, MD Chairperson, Cancer Committee I CANCER PROGRAM Annual Report I 3

4 Physician Leadership: Lung Cancer Care at Marymount Hospital Physician Leadership Focus: Dr. Donna Waite Dr. Waite s focus as a thoracic surgeon is to build a foundation of careful pre-operative staging and follow it with stage-specific treatment in collaboration with a multidisciplinary cancer care team. Patients with lung cancer are evaluated using a variety of staging techniques, including radiologic imaging, mediastinoscopy and videoassisted thoracic surgery (VATS) exploration. Dr. Waite also offers several procedures to manage symptoms associated with more advanced disease. Procedures are applied that can open a compressed or diseased airway and ease breathing. A compressed lung can be re-expanded using VATS techniques or by insertion of a drainage catheter. Dr. Waite takes care of each patient as if he or she were a member of her own family. She strongly believes that providing prompt and efficient evaluation and clear explanations help patients make good decisions so they can become active and effective partners in their cancer care. 4 I CANCER PROGRAM Annual Report I 2011

5 Quality Focus: Lung Cancer Treatment at Marymount Hospital 2011 Annual Report on Lung Cancer Donna Waite, M.D Byron Coffman, M.D. Study assistants: Tracy Funk, RHIA, CTR Heather Fisher, CTR Rosemary B. Field, MS, RN, AOCNS Overview Lung cancer remains one of the top five cancer sites diagnosed at Marymount Hospital. Despite the lower volume in 2010, lung cancer remained the second most frequently diagnosed cancer at Marymount Hospital. The 2011 Annual Report reviews the following elements for lung cancer cases diagnosed at Marymount Hospital (MMH). Demographic changes for 2010 and 2006 MMH patient population diagnosed with non-small cell and small cell lung cancer. Differences and similarities of treatment used for the most prevalent stage of non-small cell [Stage I, III and IV] and small cell lung [Stage III and IV] cancer patients diagnosed at Marymount Hospital with appropriate populations. Differences and similarities between Marymount Hospital & survival data for patients diagnosed with non-small cell and small cell lung cancer. The report is divided into two sections: Non-small cell cancer [NSCLC] and small cell lung [SCLC] cancer. Section I: Non-small cell lung cancer outcome data In 2010, there was a 10% decrease in the number of NSCLC cases diagnosed at MMH. Two changes were noted: an increase in the number of African-American cases and a change in the predominant age group diagnosed at Marymount Hospital saw a 50% increase [12 total cases] in the number of African- Americans diagnosed at Marymount Hospital and a 33% increase [16 total cases] in the age group diagnosed with NSCLC at Marymount Hospital I CANCER PROGRAM Annual Report I 5

6 Table 1. Demographics Changes: Non-small Cell Lung Cancer Cases Diagnosed at Marymount Hospital Lung Cancer Age at Diagnosis Non-small Cell Carcinoma Age TOTAL Lung Cancer Race Non-small Cell Carcinoma Race Caucasian Africanamerican 8 12 Unknown 1 1 TOTAL In 2010, there was an increase in the number of Stage IA and IIB NSCLC cases diagnosed at Marymount Hospital. There was a decrease in the number of cases diagnosed at Stage III and IV. These changes may be a reflection of: change in staging criteria, improved case finding and diagnostic work-up. Figure 1. A Comparison of Stage at Diagnosis: Non-Small Cell Lung Cancer 6 I CANCER PROGRAM Annual Report I 2011

7 To determine differences and similarities between Marymount Hospital cases and cases seen in reporting hospitals, non-small cell lung cancer cases at Marymount Hospital was combined. Patients diagnosed and/or had initial treatment for Stage I, II, III and IV nonsmall cell lung [NSCL] cancer at MMH in (125 cases) benchmark data on cases reported to the by 478 Community Hospital Cancer Programs in 2008 (124,017 cases ) Table 2: Differences and Similarities: A Comparison of Marymount Hospital and Cases by Stage and Age at Diagnosis STAGE I STAGE II STAGE III STAGE IV NA/UNK TOTALS AGE AT DIAGNOSIS Total Source: 2008 Data and Marymount Oncology Services Data For Marymount Hospital NSCLC cases, there was a similar distribution of stage at diagnosis when compared to data. Patients in the age group diagnosed with NSCLC represent more of the NSCLC cases diagnosed at Marymount Hospital when compared to, regardless of stage. When race was reviewed at diagnosis for Marymount Hospital cases only, there was not a difference in the proportion of African Americans diagnosed at Stage IV when compared to African-Americans diagnosed with Stage I, II or III NSCLC. Decision making regarding initial treatment choice is often shared between clinician and patient, taking into consideration adverse effect profiles of treatment, co-morbid disease and other factors. Life expectancy should be the foremost component of the discussion I CANCER PROGRAM Annual Report I 7

8 Table 4 compares the treatment patterns for the lung cancer cases at Marymount Hospital with data for the all stages of NSCLC cases. Marymount Hospital had a greater number of Stage I cases [7 patients/22.2%] that did not receive treatment. This finding may be explained by a smaller sample size and by the larger number of Marymount cases in the age group when compared to data. A record review of 7 patients provided a better understanding of the findings. Results are listed below: 5/7 patients and/or guardians refused [1 patient (80 years old)/guardian refused chemotherapy, preferring watchful waiting when surgery was contraindicated because of co-morbid pulmonary disease; 2 patients/guardians refused surgery and chemotherapy offered as a course of treatment and 2 patients had medical conditions that made surgery and chemotherapy a contraindication.] 1/7 patient [86 year old] was assessed by oncologist as a poor surgical risk based on age and performance status but deferred to thoracic surgery for treatment planning. Chemo-radiation was recommended to the patient who was eventually discharged to nursing home with follow up planned on an out-patient basis. No information was available to provide an understanding of subsequent treatment after diagnosis. 1/7 patients [69 year old, resident of a skilled nursing facility with multiple co-morbid illness] was to be evaluated and followed up on an out-patient basis for work up and treatment of solitary lesion. No information was available to provide an understanding of subsequent treatment after diagnosis. A closer evaluation of findings for the treatment of Stage I NSCLC is completed in the 2011 patient care evaluation study for lung cancer. 8 I CANCER PROGRAM Annual Report I 2011

9 Table 4. Differences and Similarities Non-small Cell Lung Cancer: A Comparison of Marymount Hospital and Cases by Stage and Treatment at Diagnosis STAGE 1 STAGE 2 STAGE 3 STAGE 4 UNKNOWN CASES % % % % % TREATMENT MM MM MM MM MM MM SURGERY SURGERY & CHEMO SURGERY/ CHEMO & RADIATION RADIATION CHEMO CHEMO/ RADIATION NO 1ST COURSE TX Source: 2008 Data and Marymount Oncology Services Data The populations used for comparison of observed survival were Marymount Hospital NSCLC cancer cases diagnosed in 2004 [85 cases] and 2003 NSCLC cases from 477 Community Hospital Cancer Programs in all states [73506 cases]. At the 5-year survival mark, Marymount NSCL cases had lower rates when compared to data for all stages I CANCER PROGRAM Annual Report I 9

10 Figure 2. Comparison of Marymount Hospital and NSCLC Cases: Survival Rate at 5-Years Table 5. Comparison of Marymount Hospital and NSCLC Cases: Survival Over 5-Year Period STAGE CASES 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 YEAR MM MM MM MM MM MM I % 80.5% 63.2% 66.9% 57.9% 57.4% 42.1% 50.8% 21.1% 44.9% II % 67.1% 33.3% 47.1% 16.7% 36.7% 16.7% 30.5% 0.0% 26.0% III % 45.3% 20.6% 24.8% 14.7% 17.3% 5.9% 12.8% 5.9% 10.3% IV % 21.7% 3.8% 8.6% 0.0% 4.8% 0.0% 3.2% 0.0% 2.4% Source: 2003 Data and 2004 Marymount Oncology Services Data Section II: Small Cell Lung Cancer Outcome Data Small cell lung cancer (SCLC) accounts for approximately 15% of bronchogenic carcinomas. The overall incidence and mortality rates of SCLC in the United States have decreased during the past few decades. Small cell lung cancer continues to account for a smaller portion of lung cancer cases diagnosed at Marymount Hospital. In 2010, there was a 36% decrease in the number of small cell cancer cases when compared to Of the 2010 cases there were more in the 70 + age group. 10 I CANCER PROGRAM Annual Report I 2011

11 Table 6. Demographic Changes: Small Cell Lung Cancer Cases Diagnosed at Marymount Hospital Lung Cancer Age at Diagnosis Non-small Cell Carcinoma Age TOTAL 11 7 Lung Cancer Race small Cell Carcinoma Race Caucasian 11 7 Africanamerican 0 0 Unknown 0 0 TOTAL 11 7 Despite differences in patient volume, Marymount Hospital has seen a consistent distribution of lung cancer stage at diagnosis when 2006 data (11 cases) is compared with 2010 (7 cases) [Figure 3]. To determine differences and similarities between Marymount Hospital cases with reporting hospitals [21678 cases], small cell lung cancer cases diagnosed at Marymount Hospital were combined [17 cases]. At diagnosis of small cell lung cancer, Marymount Hospital cases are similar to community cancer programs included in data base. As with reporting hospital, all patients at Marymount hospital were diagnosed at Stage III and IV small cell lung cancer [Table 7]. Figure 3. A Comparison of Stage at Diagnosis: Small Cell Lung Cancer 2011 I CANCER PROGRAM Annual Report I 11

12 Table 7. Differences and Similarities: A Comparison of Marymount Hospital and cases by Stage and Age at Diagnosis STAGE I STAGE II STAGE III STAGE IV NA/UNK TOTALS AGE AT DIAGNOSIS Total Source: 2008 Data and Marymount Oncology Services Data Decision making regarding initial treatment choice is often shared between clinician and patient, taking into consideration adverse effect profiles of treatment, co-morbid illness and other factors. Life expectancy should be the foremost component of the discussion. At Marymount Hospital, most SCLC cases fall into Stage III and IV by staging definitions. Table 8 compares the treatment patterns for the SCLC cases at Marymount Hospital with data for the Stage III and IV SCLC patients. 12 I CANCER PROGRAM Annual Report I 2011

13 Table 8. Differences and Similarities: A Comparison of Marymount Hospital and SCLC Cases by Stage and Treatment at Diagnosis STAGE 1 STAGE 2 STAGE 3 STAGE 4 UNKNOWN CASES % % % % % TREATMENT MM MM MM MM MM MM SURGERY SURGERY & CHEMO SURGERY/ CHEMO & RADIATION RADIATION CHEMO CHEMO/ RADIATION NO 1ST COURSE TX Source: 2008 Data and Marymount Oncology Services Data The data base and MMH patients diagnosed with stage IV cancer were predominantly between the ages of years old. Marymount Hospital had a greater number of stage IV cancer patients between years old when compared to data. The age difference coupled with a various acceptable treatment approaches and patient preferences may explain the difference in treatment selection at diagnosis for the Marymount Hospital SCLC cancer patient compared to data. [Table 8]. A closer review of the 2 cases that did not receive a first course of treatment revealed that patients had extensive co-morbid diseases, were provided information about chemotherapy/radiation treatment options, but had selected admission to hospice services instead I CANCER PROGRAM Annual Report I 13

14 The populations used for comparison of observed survival were Marymount Hospital SCL cancer cases diagnosed in 2004 [20 cases] and 2003 NSCL cancer cases from 477 Community Hospital Cancer Programs in all states [14302 cases]. Observed survival (Figure 4) is not adjusted for age or other causes of death. We compared survival rates for Stages III [12 cases] and IV [8 cases], which reflect all cases included in survival data review. Overall, the rates for Marymount Hospital are better for Stage III cases when compared to those for the National Cancer Data Base group of Community Hospital Cancer Programs. There were slight differences for Stage IV SCLC cases. Figure 4. Comparison of Marymount Hospital and Small Cell Lung Cancer Cases: Survival Rate at 5-Years Table 9. Comparison of Marymount Hospital and Small Cell Lung Cancer Cases: Survival at 5-Years STAGE CASES 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 YEAR MM MM MM MM MM MM I % 66.1% 0.0% 39.6% 0.0% 30.3% 0.0% 26.0% 0.0% 21.3% II % 65.6% 0.0% 33.7% 0.0% 23.5% 0.0% 16.6% 0.0% 14.7% III % 49.5% 33.3% 23.9% 25.0% 14.9% 16.7% 11.6% 16.7% 9.6% IV % 21.9% 0.0% 5.5% 0.0% 2.8% 0.0% 2.0% 0.0% 1.7% Reference: American Cancer Society.: Cancer Facts and Figures Atlanta, Ga: American Cancer Society. 14 I CANCER PROGRAM Annual Report I 2011

15 Care Coordination for Cancer Patients A diagnosis of cancer changes the lives of patients and their families. Patients and families are challenged to acquire knowledge and skills to manage problems accompanying the disease and its treatment. They also strive to create a safety net made of various support systems as they move through their lives outside the hospital setting. A care coordination model is essential to meet the multidimensional and complex needs arising from a diagnosis of cancer and its subsequent treatment. At Marymount Hospital, we believe care coordination is an integral service and function provided by our oncology clinical nurse specialist, staff nurses, social workers, case managers and community partners, such as the American Cancer Society. Our team intervenes to manage symptoms and address health system, financial, psychosocial and communication issues. Our goal is to establish a person-centered, coordinated approach that enables patients and families to move successfully through their cancer journey. Exploring Palliative Care with Patients and Their Families Treatment advances have increased cancer survival rates. However, for the patient with metastatic cancer, the priority is to provide the most effective treatment for their cancer AND palliative services to maximize the quality of their life. This year, the American Society of Clinical Oncology (ASCO) published a statement recommending steps to ensure that all physicians start the conversation about the seriousness of a patient s illness and prognosis soon after their diagnosis to help patients and their families make decisions about treatment options. The cancer care team at Marymount Hospital believe in having thoughtful and at times, difficult conversations with patients and their families about choices to make when faced with a life-limiting illness. We believe these conversations strengthen the physician-patient relationship, foster collaboration, and permit patients and their families to plan and cope. To determine how our practices compare to the ASCO practice recommendations, we took a look at our practice when delivering news to patients who had metastatic lung cancer. Our physician practices reflect what we believed- physicians included a thorough review of treatment options, including palliative care and/or hospice services, during treatment planning appointments with patients with metastatic cancer I CANCER PROGRAM Annual Report I 15

16 At Marymount Hospital, palliative services are made available to our patients in consultation with out-patient and/or home-care based palliative care programs. We believe our cancer patients timely connection to a palliative care program can make a difference in their quality of life. Community Outreach: Prostate Cancer Screening Makes a Difference for One Man Prostate cancer screening has been a part of Marymount Hospital s Community Outreach program since Prostate Specific Antigen (PSA) testing and digital rectal examinations are provided free of charge. In 2011, there was a 28% increase in over-all participation. For one man, our program made a difference. Jerry, a 70 year old retired AC sales rep from Sagamore Hills, attended a free prostate cancer screening at Marymount Hospital in Garfield Heights faithfully each year. This year was different. Shortly after the screening, Jerry was contacted by the hospital with abnormal test results and referred to a urologist. Tests confirmed he had fullblown cancer and needed surgery. In August, Jerry underwent robotic surgery at Hillcrest Hospital. With robotics, surgeons can perform complex procedures without making large incisions. This type of surgery helps patients return to their normal activities faster. Jerry is doing quite well after surgery and recovered in time for his annual golf trip with his buddies. Prostate cancer is the most frequently diagnosed cancer in men and is a leading cause of cancer death in men, second only to lung cancer. For the years ahead, our outreach program will focus on delivering evidence-based community education about prostate cancer screening guidelines. We believe that armed with the information, men will be able to engage in a dialogue with their health care provider to make informed decisions about prostate cancer screening procedures. 16 I CANCER PROGRAM Annual Report I 2011

17 Marymount Cancer Program Facts and Figures Cancer Cases in Marymount Hospital, 2010 Marymount Hospital Program Growth 2011 I CANCER PROGRAM Annual Report I 17

18 Leadership: 2011 Cancer Committee members B. Dergham, MD. Medical Oncology, Chair L. Rabinowitz, M.D. Pathology, Co-Chair K. Weiss, MD Cancer Liaison Physician B. Coffman, MD Outreach Coordinator A. Thomas, MD Radiology P. Catanzaro, MD Radiation Oncology W. O Brien, MD General Surgery D. Waite, MD Thoracic Surgery L. Bernstein, MD Urology A. Blaha Social Work B. Zinner, RN, MSN Cancer Program Administrator J. Tapocsi, R.Ph. Pharmacy M. Douglas Rehab Services N. Suggs American Cancer Society M. Prizada Laboratory Services A. Almasy Nutrition Care Services B. Gulick Pastoral Care Services R. Bednar Marketing V. Edick Director, Accreditation Quality Improvement Coordinator R. Field, RN, AOCNS Oncology Clinical Nurse Specialist Stephanie Conard-Scott, RN Clinical Nurse Manager 18 I CANCER PROGRAM Annual Report I 2011

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