2016 Public Outcomes Report

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1 2016 Public Outcomes Report

2 The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Hospital and Medical Center is a Compre hensive Community Cancer Program, designated by the Commission on Cancer of the American College of Surgeons. The cancer center diagnoses and treats approximately 1,200 patients each year. A multidisciplinary team of disease management specialists including surgical oncologists, medical oncologists, radiation oncologists, interventional radiologists, pathologists, nurses, patient navigators, genetic counselors, and other specialists work together in one location to provide patients with comprehensive, personalized care plans. The development of an oncology database enables the cancer center to keep accurate patient statistics and to monitor and ensure compliance with Commission on Cancer Guidelines on standards of care to all patients. In addition, the cancer center offers screenings to detect early stage cancers and participates in cancer prevention programs to raise awareness of risks and early intervention approaches. For more information about our cancer program and the information in this report, contact us: The Lefcourt Family Cancer Treatment and Wellness Center Englewood Hospital and Medical Center 350 Engle Street Englewood, NJ cancer.center@englewoodhealth.org

3 Standard 4.1 Cancer Prevention Programs Englewood Hospital and Medical Center is committed to improving the health of the communities it serves through collaborative partnerships, bringing important health education and raising awareness of cancer risk, prevention, and early intervention to patients where they live. Englewood Hospital collaborates with community organizations such as houses of worship, local businesses, municipal organizations, and schools to provide outreach programs designed to address barriers to care and tackle heath needs identified through a community needs assessment. The hospital participates in various health fairs, cancer awareness walks/runs, conferences, national cancer initiatives, media partnerships, and local awareness campaigns. Below is a snapshot of some of the outreach events the hospital participated in throughout Community Outreach Activities Date Activity/Topic Collaborators 3/30/16 Colorectal cancer information table 5/7/16 Bergen Family Health Day 6/5/16 George Washington Bridge Challenge American Cancer Society 6/8/16 Survivors Day 6/13/16 Lilly Oncology on Canvas 6/15/16 Survivors Rock! Concert 9/24/16 NED Concert 10/8/16 Community Health Fair Fort Lee Department of Health 10/9/16 Breast Health and Cancer Awareness JCC on the Palisades 10/16/16 Breast Health and Cancer Awareness and Genetics Englewood Department of Health 10/16/16 Breast Health and Awareness The Gym in Englewood 10/19/16 Saint John s Greek Church 10/20/16 Breast Health, Cancer Risk, and Prevention 10/24/16 Breast Health, Cancer Risk, and Prevention 10/30/16 Annual Walk for Awareness: Honoring Breast Cancer Survivors 11/21/16 Breast Health and Cancer Risk Assessment 12/10/16 K Radio Medical Talk Show at EHMC: Gastrointestinal Cancer Among Asian Americans, inclusive of Hepatitis B screening (an early indicator of liver cancer risk) K Radio AM

4 Standard 4.2 Cancer Screening Programs In 2016, Englewood Hospital and Medical Center specialists conducted screenings for prevalent cancers to address health needs of the uninsured and underinsured. Skin cancer is the most common cancer in the United States, and prostate cancer is the second most common among men and the third leading cause of cancer death in American men, according to the National Cancer Institute, National Institutes of Health. Lung Cancer Screening Program: Low-dose CT Scan Englewood Hospital and Medical Center provided the community with access to a free low-dose CT screening for lung cancer. Mark Shapiro, MD, Chief of Radiology, conducted onsite screenings for patients who met national screening guidelines, including those with a 30 pack-year smoking history. The purpose of conducting onsite screenings for lung cancer is to increase awareness of lung cancer risk factors and provide access to early detection methods for those most at risk, including heavy smokers. This free screening day was part of our larger screening program, which has screened 500+ patients. Onsite Lung Cancer Results Number of Onsite Lung Cancer Screening Events 1 Number of Clinical Lung Cancer Tests Performed 19 Number of Follow-Up Referrals 8 Screened Since Program Inception 646 Cancers Found To Date 6 4

5 Prostate Cancer Screening Program: Two-Part PSA Blood Test and Physical Exam Englewood Hospital and Medical Center provided the community with a two-part free prostate cancer screening. The first part consisted of a PSA blood test performed in the hospital s outpatient lab. The second part entailed a physical exam performed by a urologist. Urologists were onsite to provide information and conduct physical exams, including Eric Margolis, MD, Chief of Urology, and urologists Thomas Chun, MD, George Klafter, MD, Chester Lee, MD, Robert Simon, MD, and Gary Wasserman, MD, among others. The purpose of conducting onsite prostate cancer screenings is to provide access to education and early detection of prostate cancer for men who are most at risk, including those with a family history of prostate cancer, aged 50 or older, and African American a population with a greater prevalence for developing prostate cancer at a younger age. Onsite Prostate Cancer Results Number of Onsite Prostate Cancer Screening Events 1 Number of Clinical Prostate Cancer Exams Performed 109 Number of Referrals After Positive Finding 13 Skin Cancer Screening Program: Clinical Skin Exam Collaborative Effort with the American Academy of Dermatology Englewood Hospital and Medical Center provided the community with access to onsite skin cancer screenings. Gary Brauner, MD, Chief of Dermatology, and colleagues conducted a visual inspection of exposed skin (face, necks, arms, hands, etc.) to identify any abnormalities or rule out skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma. The purpose of conducting onsite skin cancer screenings is to increase awareness of the different types of skin cancer, the importance of regular screenings, as well as provide access to education about risk factors, symptoms, and prevention of skin cancer. Onsite Skin Cancer Results Number of Onsite Skin Cancer Screening Events 1 Number of Clinical Skin Cancer Exams Performed 64 Number of Referrals After Positive Finding 6 5

6 Standard 4.4 and 4.5 Accountability Measures and Quality Improvement Measures: Cancer Program Practice Profile Report (CP3R) The web-based Cancer Program Practice Profile Report (CP3R) offers Englewood Hospital and Medical Center comparative information to assess adherence to and consideration of standard of care therapies for major cancers. This reporting tool provides a platform from which to promote continuous practice improvement to improve quality of patient care at the local level. The aim is to empower clinicians, administrators, and other staff to work cooperatively and collaboratively to identify variations in practice and delivery and to implement best practices that will diminish disparities in care across Commission on Cancer (COC)-accredited cancer programs. The CP3R provides feedback to our program to: Improve the quality of data across several disease sites Foster pre-emptive awareness to the importance of charting and coding accuracy Improve clinical management and coordination of patient care in the multidisciplinary setting The following data reflects four cancer site measures of 2014 Englewood Hospital and Medical Center performance rates shown in comparison to the Commission on Cancer s standard percentage. 6

7 Cancer Program Practice Profile Report Site Measure CoC Std% Breast Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer (Accountability) Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB III hormone receptor positive breast cancer (Accountability) BCSRT HT MASTRT 90% 90% 90% EHMC s EPR% 91.90% 91.10% 100% Radiation therapy is recommended or administered following any partial mastectomy within 1 year (365 days) or diagnosis of breast cancer for women with 4 positive regional lymph nodes (Accountability) nbx 80% 87.30% Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer (Quality Improvement) Colon At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer (Quality Improvement) Stomach At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer (Quality Improvement) Non-Small Cell Lung Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic, lymph node-positive (pn1) and (pn2) NSCLC (Quality Improvement) 12RLN 85% 90.20% G15RLN 80% 80% LCT 85% 100% 7

8 Standard 4.6 Monitoring Compliance with Evidence-Based Guidelines: Invasive Breast Cancer and Breast MRI As The Lefcourt Family Cancer Treatment and Wellness Center s 2016 Evidence Based Guidelines study, the committee reviewed MRI usage in women with newly diagnosed invasive breast cancers. To determine if NCCN guidelines were followed for these patients, the committee reviewed real-time pathology data from all patients diagnosed with invasive breast cancers from July 1, 2016 to December 31, 2016 and to confirm that breast MRIs were performed. The director of the breast cancer center worked closely with the laboratory supervisor to obtain the pathology/ cytology results of all patients diagnosed with newly diagnosed invasive breast cancer. A list of pre-andpost breast cancer surgery patients was provided to ensure that all eligible patients were included. The team determined that NCCN Guidelines for use of MRI in patients with invasive breast cancers was being followed appropriately. Invasive Breast Cancer and Breast MRI # Patients diagnosed with invasive breast cancer between July 1, 2016-December 31, MRI performed 86 (69%) MRI not performed 39 (31%) Reasons MRI not recommended Elderly, renal disease, obesity, claustrophobia, limited mobility due to past/recent surgery, cardiac implant Additional Results: Between July 1, 2016 and Sept 30, 2016, the course of treatment was changed in 22% of the patients due to additional findings identified during breast MRI (e.g., invasive breast cancer in opposite breast, DCIS in opposite breast, high risk lesions in the same/opposite breast) 8

9 Standard 4.7 Study of Quality: MRI vs Endoscopic Ultrasound Englewood Hospital and Medical Center has established a cancer committee dedicated to assessing and comparing rectal MRI and transrectal endoscopic ultrasound (EUS) for patients diagnosed with rectal cancer to identify if one test is superior. The committee reviewed charts of patients diagnosed with stage II and III rectal cancer to determine three factors: Whether patients were referred for transrectal EUS and/or rectal MRI during staging Whether appropriate patients completed both studies After comparison of results, whether one test is superior The Englewood Hospital and Medical Center rectal pathway recommendation for patients with stage II and III rectal cancer is to undergo both tests. If patients were not referred for either or both tests, the committee looked at the reasons behind the decision. Members of the committee reviewed the charts of all patients diagnosed with stage II or III rectal cancer in 2016 to identify which tests patients received and to compare the results to see if one test is superior. The list of patients was shared with the EUS physician champion, chief of medical oncology, and chief of radiology to ensure accuracy and completeness. Pathology reports were pulled four times to determine all newly diagnosed rectal/rectosigmoid cancer patients and their medical records reviewed to confirm which tests they received. Based on that data, the committee created a study to determine the number of patients overall with rectal cancer, those who met the study criteria, and patients who completed and didn t complete the tests. The results are listed below. MRI vs Endoscopic Ultrasound # rectal cancer patients in # patients not fitting criteria 13 # patients completed MRI & EUS 3 (100% of patients meeting criteria) # patients who did not meet protocol for medical/non-medical reasons 1 9

10 Englewood Hospital s chief of radiology subsequently pulled the data of the three patients who met the criteria and completed both MRI and EUS to correlate the findings. The results showed both tests had excellent correlation with exact T stage with minor discrepancies in lymph node N staging. With the limited data available, the committee was not able to determine if one test is superior and plans to extend the study to include patients in 2017 with the goal of understanding the cancer center s institutional strengths and to establish a preference of either MRI or EUS. 10

11 Standard 4.8 Quality Improvement: Breast Center Patient Experience As The Lefcourt Family Cancer Treatment and Wellness Center s 2015 Breast Center Patient Experience study, the committee reviewed the overall patient experience scores within the Leslie Simon Breast Care and Cytodiagnosis Center. Englewood Hospital uses NRC Research to perform patient satisfaction surveys. After reviewing the overall scores from 2014 reflecting a lower percentile than the average, the committee created a plan using various tools and activities to address the numbers, including identifying key drivers, creating a huddle board with patient comments, holding daily huddle meetings, and daily rounding with immediate feedback and coaching. The breast center s director and manager monitor the overall patient experience scores on a routine basis and discuss the scores with the breast care team and the senior vice president of operations. After implementing the plan, the committee saw significant improvements in overall patient experience scores. In November 2015, patients began registering at the breast care center instead of outpatient registration with the goal of positively impacting patient experience scores Breast Center Patient Experience Scores Percentile Rankings Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec CY 2014 Year-to-Year Progress Percentile Rankings 66 CY CY

12 The Lefcourt Family Cancer Treatment and Wellness Center Cancer Registry In an 18-month period between from January 2015 through June 2016, there were 1,641 diagnosed and treated cases recorded to The Lefcourt Family Cancer Treatment and Wellness Center cancer registry. The top eight cancer sites at Englewood Hospital in 2015 and 2016 were breast, lung and bronchus, colon, prostate, uterine, thyroid, kidney and kidney pelvis, and non- Hodgkin lymphoma. Site Group Cancer Registry ORAL CAVITY & PHARYNX 28 Total Cases Tongue 9 Salivary Glands 10 Tonsil 7 Hypopharynx 2 DIGESTIVE SYSTEM 309 Esophagus 11 Stomach 40 Small Intestine 10 Colon Excluding Rectum 119 Rectum & Rectosigmoid 42 Anus, Anal Canal & Anorectum 11 Liver & Intrahepatic Bile Duct 14 Gallbladder 5 Other Biliary 15 Pancreas 38 Peritoneum, Omentum & Mesentery 2 Other Digestive Organs 2 RESPIRATORY SYSTEM 138 Nose, Nasal Cavity & Middle Ear 1 Larynx 16 Lung & Bronchus 121 BONES & JOINTS 1 Bones & Joints 1 table continued on next page 12

13 table continued from previous page SOFT TISSUE 1 Soft Tissue (including Heart) 1 SKIN EXCLUDING BASAL & SQUAMOUS 28 Melanoma - Skin 26 Other Non-Epithelial Skin 2 BREAST 567 Breast 567 FEMALE GENITAL SYSTEM 109 Cervix Uteri 13 Corpus & Uterus, NOS 62 Ovary 24 Vulva 6 Other Female Genital Organs 4 MALE GENITAL SYSTEM 54 Prostate 50 Testis 4 URINARY SYSTEM 86 Urinary Bladder 34 Kidney & Renal Pelvis 48 Ureter 2 Other Urinary Organs 2 EYE & ORBIT 1 Eye & Orbit 1 BRAIN & OTHER NERVOUS SYSTEM 57 Brain 21 Cranial Nerves Other Nervous System 36 ENDOCRINE SYSTEM 109 Thyroid 103 Other Endocrine Including Thymus 6 LYMPHOMA 79 Hodgkin Lymphoma 8 Non-Hodgkin Lymphoma 71 table continued on next page 13

14 table continued from previous page MYELOMA 20 Myeloma 20 LEUKEMIA 25 Lymphocytic Leukemia 6 Myeloid & Monocytic Leukemia 17 Other Leukemia 2 MESOTHELIOMA 1 Mesothelioma 1 MISCELLANEOUS 28 Miscellaneous 28 TOTAL 1641 ALL CASES Mesothelioma, <1% Soft Tissue, <1% Bones and Joints, <1% Eye and Orbit, <1% Leukemia, 2% Myeloma, 1% Lymphoma, 5% Miscellaneous, 2% Oral Cavity, 2% Endocrine System, 7% Brain & other Nervous System, 3% Digestive System, 20% Male Genital System, 3% Urinary System, 5% Respiratory System 9% Female Genital System, 7% Breast 35% Skin (excluding basal and squamous cell) 2% 14

15 SELECT CANCER SITE GROUPS Digestive Cancers Peritoneum, Omentum & Mesentery, 1% Other Digestive Organs, 1% Esophagus, 3% Other Biliary, 5% Gallbladder, 2% Pancreas 12% Stomach 13% Small Intestine, 3% Liver & Intrahepatic Bile Duct, 4% Anus, Anal Canal & Anorectum, 4% Rectum & Rectosigmoid 14% Colon Excluding Rectum 38% Genitourinary Cancers Ureter, 2% Other Urinary Organs, 1% Kidney & Renal Pelvis 34% Prostate 36% Testis, 3% Urinary Bladder 24% 15

16 Other Female Genital Organs, 4% Gynecologic Cancers Vulva 5% Cervix Uteri 12% Ovary 22% Corpus & Uterus, NOS 57% Head and Neck Cancers Tongue 7% Salivary Glands 8% Tonsil 5% Hypopharynx 1% Thyroid 79% 16

17 Blood Cancers Other Leukemia, 2% Hodgkin Lymphoma, 6% Lymphocytic Leukemia, 5% Myeloid & Monocytic Leukemia 14% Myeloma 16% Non-Hodgkin Lymphoma 57% 17

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