Gadsden Regional Medical Center

Transcription

1 Gadsden Regional Medical Center 2012 Cancer Program Annual Report With statistical data from 2011 ACCREDITATION WITH COMMENDATION Gadsden Regional Medical Center 1007 Goodyear Avenue Gadsden, AL Telephone:

2 Cancer Committee Members CHAIRMAN: Lowndes Harrison, MD (Radiation Oncologist) CANCER LIAISON PHYSIAN: Alberto Echeverri, MD (General Surgery COORDINATORS: Lowndes Harrison, MD (Cancer Conference Coordinator) Chris Boatfield (Community Outreach Coordinator) Kelly Evers, CTR (Cancer Registry Quality Coordinator) Lora Ramsey (Quality Improvement Coordinator) Asif Kaleem, MD (Pulmonologist) Ashvini Sengar, MD (Medical Oncologist) Elquis M. Castillo, MD (Medical Oncologist) John B. Priest, MD (Pathologist) Calvin Herring, MD (Diagnostic Radiologist) Jerria Carter, RN (Cancer Center RN) Alison Enochs (American Cancer Society) Lauren Davenport (Department of Dietary) Paula Wyatt (Cancer Registry Coordinator) Daniel McKinney (Administrative Specialist) Norris Hilton (Pastoral Care) Doris Davis, RN (Quality Management) Kelly Bullock, RN (Director of Oncology Floor) Amy Burns, RN (Case Management)

3 CHAIRMAN S REPORT On behalf of our cancer committee, I am pleased to present to you Gadsden Regional Medical Center Cancer Program s 2012 annual report. Our cancer committee is a multidisciplinary group-including physicians, nurses, administrators and social workers-committed to assessing and overseeing the care of cancer patients within our community. Community hospitals voluntarily participate in the approvals program of the American College of Surgeons. The goal of Community Cancer Programs and the American College of Surgeons is to decrease cancer morbidity and mortality through prevention, education and monitoring of cancer patients and their care. The cancer committee monitors cancer conference and oversees and guides the cancer registry (the foundation of our cancer program). The cancer registry provides the data that the Cancer Committee uses to monitor the quality of and improve our cancer program. The subject of this year s report is breast cancer. In this report you will learn a variety of physicians perspectives in the care of patients with breast cancer, as well as strategies for early detection. It is our hope that this information will be useful to our cancer patients and their family and friends who support them. We are also excited to announce the delivery of our new Xoft, electronic brachytherapy system. This equipment will deliver radiation treatment more efficiently to many existing patients as well as provide treatment not previously available in Northeast Alabama. I sincerely thank you for your interest in our cancer program and for your support of our cancer center. I hope you find our annual report helpful and informative. G. Lowndes Harrison, M.D. Chairman, Cancer Committee

4 CANCER REGISTRY What is a Cancer Registry? Most people are unaware that a Cancer Registry exists. A Cancer Registry is an information system designed for the collection, management and analysis of data on persons with a diagnosis of a malignancy. GRMC s Cancer Registry maintains all data on all patients diagnosed and/or treated at our facility and all patients diagnosed elsewhere with active disease upon admission to our hospital. Each record entered into the database contains information on the diagnosis, extent of disease, treatment received, recurrence of disease and lifetime follow-up for each patient. We report cancer cases to the Alabama Statewide Cancer Registry, a division of the Alabama Department of Public Health, as required by state law. The cancer registry at Gadsden Regional Medical Center plays an active role in the cancer program by providing services and support for our Commission on Cancer (CoC) approved program. Data is maintained, analyzed and reported for the purpose of research and quality improvement analysis. In addition to routine cancer registry responsibilities, staff serve as ACoS accreditation coordinators by playing key roles on the Cancer Committee and ensuring GRMC meets and/or exceeds all CoC standards. The Cancer Registry coordinates and supports the quarterly Cancer Committee meetings and bi-weekly Cancer Conferences/Tumor Board. The staff are responsible for: -Identifying and accessioning all reportable cancer cases. -Collecting information on all diagnostic and screening services. -Adhering to the current standards set by the CoC and Alabama Statewide Cancer Registry. -Completing an abstract on each patient in a timely fashion. -Conducting annual follow-up on all analytic cases. -Performing Quality Control of registry data. -Responding to data request for administrative and research purposes. -Submitting data to the National Cancer Data Base (NCDB).

5 CANCER REGISTRY How do Cancer Registries ensure confidentiality? Aggregate data is analyzed and published without patient identifiers to protect the confidentiality of each patient according to Alabama state laws and HIPAA regulations. Our Cancer Registry Staff Cancer Registrars have a unique perspective about the occurrence and management of cancer as the only persons at the facility to review detailed information on every cancer patient diagnosed and/or treated at GRMC. The Certified Tumor Registrar (CTR) report cases by summarizing the patient s medical records and then translating clinical information into standard Oncology coding language. All treatment information is required to be obtained on all patients diagnosed and/or treated at our facility, regardless of where treatment is performed. Registrars are required to have a vast knowledge of medical terminology, oncology disease process, oncology treatments and drugs as well as administrative processes, such as performance improvement and statistics. -Continued GRMC Cancer Registry Cases in 2011 In 2011, the Cancer Registry staff accessioned 575 new cases. Of those cases, 539 were analytic and 36 were non-analytic. Our top 5 sites are (1) Lung, (2) Prostate, (3) Breast, (4) Bladder and (5) Colon/Rectum. Since our new 2003 reference year, the Cancer Registry has accessioned 5,096 cases and completed follow-up for 3,098 patients. Our follow-up rate is 94.60% for patients diagnosed within the last five years. Registry Staff pictured left to right: Barbara Roberts, CTR; Paula Wyatt, Cancer Registry Coordinator; Kelly Evers, CTR

6 CANCER REGISTRY -Continued SITE DISTRIBUTION FOR 2011 ANALYTIC CASES ORAL CAVITY & PHARYNX 19 Liver & Intrahepatic Bile Duct 1 EYE & ORBIT 1 Lip 2 Other Biliary 3 BRAIN & OTHER NERVOUS SYSTEM 11 Tongue 3 Pancreas 6 Brain 9 Salivary Glands 6 Other Digestive Organs 1 Cranial Nerves Other Nervous System 2 Gum & Other Mouth 1 RESPIRATORY SYSTEM 117 ENDOCRINE SYSTEM 12 Tonsil 3 Larynx 13 Thyroid 12 Oropharynx 1 Lung & Bronchus 104 LYMPHOMA 19 DIGESTIVE SYSTEM 78 SKIN 6 Hodgkin Lymphoma 1 Esophagus 7 Melanoma -- Skin 6 Non-Hodgkin Lymphoma 18 Stomach 9 BREAST 74 NHL - Nodal 15 Small Intestine 7 FEMALE GENITAL SYSTEM 21 NHL - Extranodal 3 Colon Excluding Rectum 32 Cervix Uteri 10 MYELOMA 1 Cecum 5 Corpus & Uterus, NOS 4 LEUKEMIA 3 Appendix 3 Ovary 6 Lymphocytic Leukemia 1 Ascending Colon 4 Vulva 1 Myeloid & Monocytic Leukemia 1 Hepatic Flexure 3 MALE GENITAL SYSTEM 99 Other Leukemia 1 Transverse Colon 4 Prostate 96 MESOTHELIOMA 1 Descending Colon 2 Testis 2 MISCELLANEOUS 9 Sigmoid Colon 9 Penis 1 Large Intestine, NOS 2 URINARY SYSTEM 68 TOTAL 539 Rectum & Rectosigmoid 10 Urinary Bladder 51 Rectosigmoid Junction 2 Kidney & Renal Pelvis 14 Rectum 8 Ureter 1 Anus, Anal Canal & Anorectum 2 Other Urinary Organs 2

7 CANCER REGISTRY -Continued GRMC 2011 Top Five Sites Colon/ Rectum 11% Breast 20% GRMC 2011 All Cancer Sites County at Diagnosis Bladder 14% Prostate 26% Lung 29% Etowah Calhoun Cherokee De Kalb Marshall Other

8 N u m b e r of P a t i e n t s Female 43% CANCER REGISTRY GRMC 2011 All Cancer Sites Sex Male 57% -Continued GRMC 2011 All Cancer Sites Race Black 8% Other 1% White 91% GRMC 2011 All Cancer Sites Age at time of Diagnosis Other Age at Diagnosis

9 Number of Patients Number of Patients Number of Patients Colon/Rectum By Stage Lung Cancer By Stage Stage 0 Stage I Stage II Stage III Stage IV Unknown AJCC Stage at Diagnosis Stage 0 Stage I Stage II Stage III Stage IV Unknown AJCC Stage at Diagnosis GRMC Top 5 Sites Breast Cancer By Stage Stage 0 Stage I Stage II Stage III Stage IV Unknown Stage at Diagnosis AJCC Stage at Diagnosis

10 Number of Patients Number of Patients GRMC Top 5 Sites continued Prostate Cancer by Stage Bladder Cancer by Stage Stage 0 Stage I Stage II Stage III Stage IV Unknown Stage 0 Stage I Stage II Stage III Stage IV Unknown AJCC Stage at Diagnosis AJCC Stage at Diagnosis

11 Number of Cases MAJOR SITE ANALYSIS Breast Cancer A retrospective review was performed of all breast cancer cases at Gadsden Regional Medical Center for the year The total number of new diagnosis in that time was 74 cases. Approximately 13.7% of all cancer cases diagnosed in This reflects all patients who received all or part of their treatment at Gadsden Regional Medical Center and/or Gadsden Regional Cancer Center. As shown below, the majority of patients reside in Etowah County Breast Cases County at Diagnosis Etowah Calhoun Cherokee St. Clair De Kalb Marshall Other County

12 MAJOR SITE ANALYSIS Breast Cancer At GRMC and/or Cancer Center, breast cancer is treated through an evidence-based multidisciplinary approach. In 2011, most of the breast cancer patients were diagnosed in their 5 th or 6 th decade of life with the average age of diagnosis between years of age. The data below shows a comparison in age distribution for breast cancer from the National Cancer Data Base 2009 data (most current comparative data available) and 2011 GRMC data. National Cancer Database Age Comparison GRMC NCDB Age at Diagnosis

13 MAJOR SITE ANALYSIS Breast Cancer First course of therapy is the initial treatment or series of treatment usually initiated within four months of diagnosis. The vast majority of patients were treated with a variety of modality combinations, however surgery was the primary treatment. In approximately 84% of patients some form of surgery was performed. Types of First Course Treatment of Breast Cancer 2011 surgeries performed are: Lumpectomy Partial mastectomy Total mastectomy Modified radical mastectomy Radical mastectomy S,H NO TX D,H D,R,C D,S,C 3 D,S,R,H D-Diagnostic (Biopsy or D,S,R,C Fine Needle Aspiration) S-Surgery D,S,R R-Radiation D,S C-Chemotherapy H-Hormones Given S 8 NO TX- No treatment given 9 D

14 A radiation oncology perspective Breast cancer is the most common non-skin cancer in women in the United States. In 2011, an estimated 3,700 new cases and 700 deaths of female breast cancer are expected to occur in Alabama. It remains the second leading cause of cancer related deaths in women (after lung cancer). Death rates from breast cancer have been decreasing over the years, largely due to improved screening techniques and improved forms of treatment. Significant advances in all forms of treatment for breast cancer including chemotherapy, surgery, radiation and hormonal therapy have contributed to these improved outcomes. Radiation has long been a mainstay in the treatment of breast cancer. Within the field of radiation oncology, several advances have been made that have contributed not only to these improved outcomes, but decreasing the side effects of treatment. Routine screening with mammograms and a generally higher screening rate has led to breast cancers being detected much earlier. With the current screening techniques, after treatment, the highest risk are for breast cancer to return after lumpectomy is 1 to 2 centimeters away from the primary tumor site. This has led toward treating a more limited area of the breast in early stage breast cancers. In women with more advanced disease, lymph node involvement and have undergone a mastectomy, improved techniques in radiation delivery have resulted Radiation therapy s purpose is to eradicate residual local disease. The timing of radiation usually depends upon whether or not the patient is receiving chemotherapy; delaying radiation therapy until the completion of chemotherapy is preferred, particularly in patients who are at high risk of distant recurrence. Lowndes Harrison, M.D. Radiation Oncology

15 A medical oncology perspective Each of us likely has personal knowledge of a friend or relative who has been diagnosed with breast cancer. Some people speak of this disease as an epidemic. It is good to know that we are making progress in the battle against all stages of breast cancer. Advanced metastatic cancer (Stage IV) is the most difficult disease to treat. Breast cancer can not be cured at this stage; however, due to the development of a personalized targeted approach the outcomes of this particular group of patients has improved considerably. Our goal in this sub group of patients is to convert an incurable disease into a chronic disease such as Diabetes. We were pleased to find in our 2011 statistic analysis that 45% of patients with stage IV breast cancer had survived 5 years after diagnosis. Actually, our 45% is more than twice the national average of 22%. This impressive survival rate is a result of the early adoption of newer drugs and technologies to treat the disease. This last decade has seen the development of a new personalized approach of breast cancer. Molecular and genetic tests are often used to study this type of cancer. There are also new modalities of treatment in the area of radiation therapy. Early detection allows us to give better outcome for patients with localized disease (Stage I, II, and III).

16 For example, for breast cancer stage I the national 5-year survival average is 92%. This compares well with our rate of 90%. For stage III our 5-year survival is 75% compared to a national average of 66%. These statistics reflect the efforts of our medical community to improve and extend the lives of patients with this disease. This is all possible to a multidisciplinary approach in the management of breast cancer. We have a team of family doctors, pathologist, surgeons, radiologist, radiation oncologist, plastic surgeons and medical oncologist. We work in different locations but work as a team to deliver the best possible outcomes when caring for our patients. Elquis Castillo, M.D. Hematology-Medical Oncology

17 S u r v i v a l R a t e MAJOR SITE ANALYSIS Breast Cancer **Most current comparative data available NCDB Survival For Cases Diagnosed in Stage 0 Stage I Stage II Stage III Stage IV Years NCDB Overall Survival Rate Percentages: *Dx =Diagnosis *Dx 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs Stage0 100% 99% 98% 97% 96% 95% Stage I 100% 99% 97% 96% 94% 92% Stage II 100% 98% 95% 92% 88% 85% Stage III 100% 94% 85% 78% 71% 66% Stage IV 100% 66% 48% 37% 28% 22%

18 S u r v i v a l R a t e MAJOR SITE ANALYSIS Breast Cancer GRMC Survival for Cases Diagnosed in Stage 0 Stage I Stage II Stage III Stage IV 20 0 Dx Years GRMC Overall Survival Rate Percentages: *Dx =Diagnosis *Dx 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs Stage0 100% 100% 98% 97% 95% 93% Stage I 100% 100% 95% 94% 94% 90% Stage II 100% 97% 94% 89% 89% 80% Stage III 100% 93% 90% 81% 81% 75% Stage IV 100% 86% 80% 66% 66% 45%

19 Trends in Breast Cancer Incidence and Mortality Rates, Females, Alabama **Alabama Cancer Facts & Figures 2011

20 A hematology oncology perspective Hormone Positive Breast Cancer The incidence of hormone positive breast cancer has increased slightly over the last 2 decades. Hormone Positive Breast Cancer (ER/ PR positive) is the most common type of breast cancer in women over the age of 40 years. It accounts for about 75% of all breast cancers in that age. In contrast, the incidence of ER/PR positive breast cancer is only about 40% in women less than 40 years. These cancers are treated with anti hormonal therapy with or without other modalities i.e. chemotherapy and radiation therapy. Overall, the chances of response are higher in older post- menopausal women with ER/ PR positive breast cancer. There are two indications for anti hormonal therapy in breast cancer- for adjuvant use (postoperative where the intent is curing the cancer) and for metastatic disease (where the intent is controlling the disease and prolonging survival). Adjuvant Use Ashvini Sengar, M.D. For premenopausal women, drug of choice is Tamoxifen 20mg daily for 5 years. Tamoxifen is an antagonist of the ER/PR receptor on the cancer cell surface (this mechanism is known as selective estrogen receptor modulation). Important side effects include hot flashes, myalgias, arthralgias, mood swings, BP changes, venous and arterial thromboembolism and small but definite risk of endometrial cancer. Risk of thromboembolism is significantly higher in patients > 50 years. For postmenopausal women, the agents of choice are a class of drugs called Aromatase Inhibitors (AI). These block the aromatase enzyme in the peripheral tissues, which is responsible for conversion of androgenic steroids to estrogens. There are three agents in this class- Anastrozole (Arimidex), Letrozole (Femara) and Exemestane (Aromasin).

21 A hematology oncology perspective continued All three are indicated for adjuvant use. Anastrozole as 1mg daily for 5 years, Letrozole as 2.5mg daily for 5 years and Exemestane as 25mg daily for 3 years (after taking Tamoxifen for 2 years). All three are thought to be almost equally effective. Important side effects are myalgias, arthralgias, mood swings, hot flashes, bone loss leading to osteoporosis, small risk of thromboembolism and hepatic dysfunction. All patients going on AI should have a baseline DEXA scan performed. If there is any evidence of osteopenia or osteoporosis, they should be treated aggressively with oral calcium with vitamin D in addition to Denosumab 60mg given once every 6 months for the duration of AI therapy. Metastatic disease In case of metastatic disease all of the agents listed above are indicated for use and are the drugs of choice as first line therapy for ER/ PR positive disease. For premenopausal women, Tamoxifen is indicated. For postmenopausal women, aromatase inhibitors are indicated as first line of therapy. In cases of intolerance to AI, Tamoxifen can be used. Another drug called Fulvestrant (Faslodex) is indicated in cases of failure to respond to AI. It is given as IM injection 500mg every month. Important side effects are hepatic impairment and muscle hematoma in patients who are on anticoagulants. Ashvini Sengar, M.D. Hematology-Medical Oncology

22 A surgeon s perspective Over the past several decades, surgical techniques for the diagnosis and treatment of breast cancer have evolved, leading to the effective treatment of the cancer, while attempting to preserve the tissue, function, and body image of the women. However, that each patient is different, and each new case of breast cancer needs to be evaluated fully in order to make wise, informed choices regarding surgical care. There is tremendous variety of emotional response of any given patient in regards to a new diagnosis of breast cancer. Some patients return for several follow up appointments as they understandably, do not absorb all the information relayed by their physician. Some make rapid decisions to get the cancer our of me as soon as possible. A woman s decision regarding her choice of breast surgery is a very personal one. It is made with the input from her physicians, and, in some cases, can be limited to one choice only. Surgery: Two main types of surgery are used for the primary treatment of breast cancer. A lumpectomy is less invasive than a mastectomy, with removal of only the tumor rather than the entire breast. A mastectomy may be necessary for larger tumors. Women who choose to have a mastectomy may want to have reconstructive surgery. Axillary lymph nodes under the arm are removed so that a pathologist can examine nodes for signs of cancer cells. A procedure known as a sentinel lymph node biopsy has helped minimize the number of lymph nodes removed. Surgeons collaborate closely with their colleagues in the multiple disciplines taking part in the breast cancer management: diagnostic radiologist, pathologist, medical and radiation oncologist and reconstructive (plastic) surgeons. Alberto Echeverri, M.D. Cancer Liaison Physician General Surgery

23 Early Detection According to the American Cancer Society, the most prevalent tool used to detect breast cancer is the simple self-examination. It is a manual examination of the breast using the hands, for the purpose of detecting any significant changes in breast structure. Regular self exams can help you become familiar with the characteristics of your breasts so that you are more aware to the development of abnormalities. Women in their 20s and 30s should have a clinical breast exam as part of their regular health exam, usually (every 3 years) as well as self-exams. Cancer is the second most common cause of death in the U.S.. Exceeded only by heart disease. Regular screening examination by a health care professional can result in the detection and removal of precancerous growths, as well as the diagnosis of cancer at an early stage, when most treatable. Mammography can detect breast cancer at an early stage when treatment is more effective and a cure is more likely. A yearly mammogram should be performed beginning at the age of 40, in addition to self and clinical exams. Digital mammography offered at Gadsden Regional Medical Center.

24 GRMC Healthy Woman Bras for a Cause Our event raised nearly $4,000 for the American Cancer Society! Thank you for your support and donations! Guest Speaker: Brenda Ladun

25 Etowah County: $113, GRMC & Cancer Center: $11,919.50

26 Cancer.One word that changed my life for the better. Survivor.The opportunity to share my story and give others hope as they embark on a journey that words can not explain. If I can raise awareness by my story then my journey was a success. My faith, My dreams, My outlook on life have been renewed. I have been blessed. A quote that I found strength in and it is so true, Put Faith in God and he will show you the way. No one can go back and make a brand new start. Everyone can start from now and make a brand new ending. God doesn t promise days without pain, laughter without sorrow, sun without rain, but He did promise strength for the day, comfort for the tears and light for the way. My thanks to Dr. Castillo and his staff for working with God to make me a survivor and for never losing faith. Marie Hatcher

27 Support Services Case Management The Case Management Department provides care coordination and assistance with referrals. Food and Nutrition Services Registered dieticians provide customized nutrition assessments as well as counseling and education for the patient and family. Therapy is individualized to proved optimal nutritional support for each person. Cancer Support/Education Groups Pastoral Services Supportive pastoral services are available as requested. Information and Internet Resources The Cancer Center has a wide selection of cancer literature. There is an internet resource room in the cancer center for the convenience of patients and their families The support/education groups include: Monthly-Tuesday night T.O.U.C.H. support group Every other month Look Good Feel Better support group. Gadsden Regional Medical Center s cancer program works closely with the American Cancer Society and its various programs. Our patients have access to a supportive staff.

28 The American College of Surgeons Commission on Cancer acknowledged Gadsden Regional Medical Center s commitment to maintaining an Approved Cancer Program during the tri-annual on-site survey in November GRMC was awarded a three year approval with commendation. The survey process is based on objective evaluation of the 36 standards set forth in the 2009 Revised Edition manual.

29 XOFT What s happening in 2012 XOFT-Electronic brachytherapy system. Electronic brachytherapy can be used in place of conventional external radiation therapy. There are four treatment areas where Xoft might be an option 1)Selected Breast Cancer Patients a. Conventional Treatment Time: 35 days of external beam radiation 2) GYN b. Xoft Treatment Time: 10 treatments in 5 days a. Conventional Treatment: Patients must travel to Birmingham for prober treatment b. Xoft Treatment: Now patients can stay in Northeast Alabama to have the same treatment 3) Skin a. Conventional Treatment Time: 30 days of external beam radiation b. Xoft Treatment: 9 days over the course of 3 weeks 4) IORT (Intra Operative Radiation therapy) a. Currently being performed in academic medical centers and leading community hospitals b. Gadsden Regional has the capability to deliver this same treatment option.

30 Gadsden Regional Medical Center Best in Bama Picture taken by Denise Huselton-RN at Hematology and Oncology Associates Resource Directory Gadsden Regional Medical Center (256) Auxiliary and Volunteers (256) Cancer Registry (256) / Pastoral Care (256) Health Information Management (Medical records) (256) Cancer Center (Dr. Lowndes Harrison) (256) Hematology and Oncology Associates (Dr. Elquis Castillo) (256) Alabama Cancer Care (Dr. Ashvini Sengar) (256) Surgical Associates of Gadsden (Dr. Alberto Echeverri) (256)