Cancer Program. Annual Report 2015 (Data from 2014) ST. VINCENT S MEDICAL CENTER RIVERSIDE CANCER COMMITTEE

Transcription

1 ST. VINCENT S MEDICAL CENTER RIVERSIDE CANCER COMMITTEE Cancer Program Annual Report 2015 (Data from 2014) INCLUDES ONLY INCIDENCE DATA FOR SOUTHSIDE AND CLAY COUNTY

2 Table Of Contents Cancer Committee Chairman s Message 1 Oncology Administrator s Message 2 Cancer Committee Members List 3 Overview and Introduction 4-5 Accomplishments and Goals (2014) 4-5 Cancer Conferences and Lectures 5 Cancer Registry Data Summary 6 Cancer Incidences and Analyses: St. Vincent s Riverside 7-10 Primary Cancer Sites: Distribution by Gender and Stage 7-8 Ten Most Cancer Sites: St. Vincent s vs FL vs USA 8 Cancer Diagnoses: Race by Gender Distribution 9 Cancer Diagnoses by FL County 10 Cancer Diagnoses: Age Groups by Gender Distribution 11 Cancer Incidences and Analyses: St. Vincent s Southside Cancer Diagnoses by Florida County 12 Major Cancer Sites 13 Cancer Diagnoses: Race by Gender Distribution 13 Cancer Diagnoses: Age Groups by Gender Distribution 14 Accountability Measures and Quality Improvement Measures Studies of Quality and Improvement - Melanoma (Dr. Fox & Dr. Hunger) Cancer Prevention Programs for Cancer Incidences and Analyses Summary - St. Vincent s Clay County Clinical Trials Research Summary Report 22 Community Outreach Activities Genetic Testing Study References and Definition of Terms 28-29

3 Cancer Committee Chair s Message DEAR FRIENDS, The St. Vincent s Cancer Committee has worked in a collaborative fashion to improve cancer care services for all who might be diagnosed in the greater Jacksonville area. On your behalf, we have accomplished several goals and made improvements in specific programs. We provided education for the community on the topics of lung cancer and colorectal cancer. The importance of a healthy diet, exercise, smoking cessation and knowledge of risk factors was promoted in both of these events. We held our second annual cancer survivorship event which was attended by many patients, families, and healthcare providers was a busy year as we were preparing for the changes in accreditation that were coming in Formalizing survivorship programs was a big part of those changes. We ve always supported our cancer survivors in many different ways and now, with the 2015 standards, we are formalizing and standardizing the information provided to patients after their treatment. These advances provide patients with a greater connection to St. Vincent s for their lifetime. We continue to improve our services to stay at the front of healthcare technology and changing care paradigms. Our long-standing tumor boards allow for collaboration, frequent discussions, and dissemination of new information. We are proud to provide tumor boards for breast cancers, thoracic cancers, spine and brain cancers, and a general tumor board for all other cancers. Reviewing cases in a prospective manner allows the physicians and other providers to adequately review an individual patient s ability to go through certain treatments, but more importantly, allows for sharing of information regarding the patient s opinion. So much of cancer care is a choice and the patient and his/her family are integral to the discussion and decisions made regarding treatment. The specialists at St. Vincent s continue to expand their services and add providers as needed. This is true for surgical services, medical oncology, pulmonology, cardiothoracic surgeons and others. The specialists at St. Vincent s continue to expand their services and add providers as needed. This is true for surgical services, medical oncology, pulmonology, cardiothoracic surgeons and others. St. Vincent s HealthCare operates one of the nation s oldest cancer care programs with more than 55 years of continual accreditation by the American College of Surgeons as a Community Hospital Comprehensive Cancer Program. We are proud to deliver effective and superior cancer care to Jacksonville and the surrounding communities while maintaining the core values of Ascension. William E. Sumner, III, MD Chair, Cancer Committee St. Vincent s Riverside St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

4 Oncology Administrator s Message DEAR JACKSONVILLE COMMUNITY, As the administrative leader of the St. Vincent s Cancer Program, I m proud to let you know that you have a great team working on your behalf. If you ve ever been diagnosed with cancer, you know that your relationship with your physician is critical. The physician leaders at St. Vincent s know that you have a choice and they work hard to make sure you receive the best care possible. This individualized care has been a hallmark of St. Vincent s for many years. You ll probably hear a lot more in the media about individualized medicine. St. Vincent s is already on that same road and has been We appreciate every bit of support, whether large or small because it all makes a difference. for many years. We will use the advances in medicine (genomics, technology, etc.) to better care for you and work with you and your family to make sure you are a big part of the discussions and treatment decisions. The staff at St. Vincent s is diverse and caring. We strive to make sure we all work as a team and not as individual providers, knowing that your care is multifaceted. I am proud to be a witness to the care and compassion provided every day to those in need. Many times, our patients don t have family in town. Sometimes they don t have transportation to treatment. Sometimes, patients are without insurance and a way to pay for treatment. Our patients are regular people just like us and we know that cancer is just one aspect of them as an individual. So when someone is diagnosed with cancer, we work hard to make sure all other barriers to care are addressed. Our patient and nurse navigators are key to this coordination of care. Additionally, our dietitian, social workers, genetic counselor, pharmacists, rehabilitative therapists, imaging technologists, financial counselors and others all work in concert to make sure we know what you need. Information is shared between hospital and private office staff to make sure we don t miss anything. This takes a lot of work but we are committed to doing whatever is best for anyone who is diagnosed with cancer. Thank you for your support of St. Vincent s over the years. Many of the programs we provide are generously funded by you, our community, through the St. Vincent s HealthCare Foundation ( This says a lot about your commitment to improving care in the community. We appreciate every bit of support, whether large or small because it all makes a difference. It is late 2015 as I m writing this report on 2014 successes. This is a normal retrospective review of our work and report to you. As we put together our plans for this coming year, I am proud that we will mark the 100th anniversary in years of providing care to the greater Jacksonville community and many of those with a focus on cancer care. Wishing you health and happiness but know that we are here for you and your family if you need us. Sincerely, Cynthia K. Farah Service Line Director Oncology, Women s, Palliative Care, Research St. Vincent s HealthCare 02

5 Cancer Committee Members PHYSICIAN MEMBERSHIP Anne Bernstein, MD Hudson Berry, MD Brett Cantrell, MD Jennifer Contin, MD Paul Crum, Sr., MD Michael Donohue, MD Michael Fallucco, MD Leann Fox, MD Javier Herrera, MD Cancer Committee Physician Liaison NON-PHYSICIAN MEMBERSHIP Edward Bateh Robin Bettman, RPH, BCOP Kate Bodden, DPT Patty Britton, RN Jamie Buller, LCSW Heather Campbell, BS, MSW Gail Green, RN, CNO Barbara Dearmon, BS, CTR Alanna Eubanks, RD, CSO Cynthia Farah, MS, RT Veena Ganesh, MS, GC, MS Biotech Maria Cabrera Wendy Holt, RN, MSN, OCN Abby Hart, RN, BSN, CPHON Sue Kreichelt, RN, BSN, MSH Cathy Lane, RN, BSN, OCN Ray Miller, PT Elaine Murtha, MBA/HCM, RT(R) (M), CRA Jill Nelson, RT Marlynn Townsend, RT Kathy Rozar, CHSP Scott Speight Hank Hill, MD Kevin Hunger, MD Brian McKibben, MD Ali Lankarani, MD Paul Ossi, MD Donald Smitha, DDS Felicia Snead, MD Timothy Sternberg, DMD, MD William Sumner, MD Cancer Committee Chair Jose Soto-Soto, MD Marketing Oncology-Certified Pharmacist Rehabilitative Services Lung Cancer Nurse Navigator Manager, Palliative Care Social Worker Nursing Manager, Oncology Support Services Oncology-Certified Dietitian Oncology Service Line Director Genetic Counselor ACS Representative Clinical, Manager, Cancer Services Research Manager Nurse Navigator Radiation Oncology Nurse Manager, Rehabilitative Therapy Director, Medical Imaging, Radiation Oncology, Rehab Manager, Medical Imaging Cancer Patient Navigator Performance Improvement Chaplain, Pastoral Care PROGRAM COORDINATORS QI Coordinator Education/Outreach Coordinator Cancer Conference Coordinator Cancer Registry Coordinator Kathy Rozar (Leann Fox, MD - co-coordinator) Vicky Willis (with support from Steven Siegel, MD) Paul Ossi, MD Barbara Dearmon, BS, CTR St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

6 Overview and Introduction Cancer Registry coordinates St. Vincent s Riverside s weekly cancer treatment panels and follows all analytic cases through each patient s lifetime. A total of 729 cases were presented at the weekly cancer panels during 2014 and 98% were prospective case presentations. Cancer Conferences provide multidisciplinary consultations for patients and physicians to develop a plan of care. ST. VINCENT S MEDICAL CENTER RIVERSIDE SUMMARY OF CANCER PANEL (JAN-DEC) 2014 Total number of cases presented 729 Total number of cases prospective 717 (98%) AJCC staging discussed 556 (76%) Breast presentations 292 (40%) National guidelines discussed 212 (29%) Represents 185 (25%) Multidisciplinary representation 99% - 100% Physician attendance (average) 10 FREQUENCY OF MEETINGS General Cancer Panel (7:30am 8:00am) Breast Panel (7:00am 7:30am) Thoracic Panel Spine and Brain Panel Bi-weekly - Tues-Fri Bi-weekly - Tues-Fri 2nd & 4th Thurs 1st & 3rd Thurs St. Vincent s Riverside Accomplishments for 2014 Continued participation in Rapid Quality Reporting System for tracking breast and colorectal national treatment measures Promoted Community Hospice Center for Caring at St. Vincent s Riverside on 4th floor Promoted the Lung Cancer Institute Continued to offer Kids Together Against Cancer, a cancer support group for families who have a parent with cancer Continued to offer Cancer Treatment Panel and Thoracic Panel (tumor board), a treatment planning conference for physicians representing multiple disciplines; continues to meet multiple times per month to discuss prospective treatment plans for cancer patients Promoted St. Vincent s Spine and Brain Institute Implemented dedicated Neuro-Spine and Brain Tumor Board, meeting twice per month Implemented free yoga classes for cancer survivors and caregivers in conjunction with the Christina Phipps Foundation Hosted Candid Conversations about Breast Cancer, a support group for women diagnosed with breast cancer 04

7 Continued membership and participation in Association of Community Cancer Centers (ACCC) Promoted and provided membership to American Cancer Society Board of Directors, Committees and programs such as Road to Recovery Promoted smoking cessation with IQuit program, formalized program of Area Health Education Center (AHEC) Participated in & provided leadership for the American Cancer Society s Making Strides Against Breast Cancer events Hosted the following community outreach activities Free skin cancer screening event Victory in Pink breast cancer awareness community celebration for survivors Breast Reconstruction Awareness Day free community educational event, focusing on options for breast reconstruction Cancer survivorship event celebration of cancer survivorship St. Vincent s HealthCare s Ask The Doctor Radio Show local radio program supported many times during the year by oncology physicians and staff to address a variety of oncology topics Promoted physicians use of the AJCC TNM staging and clinical documentation in pretreatment planning Continued to monitor the NQF estimated performance rate for breast and colorectal cancers Continued to participate in the NCDB Annual Call for Data St. Vincent s Riverside Cancer Committee Goals for 2014 Caring for Nurses Compassion Fatigue 98% of staff on 3 East and 3 Center and several of the Nurse Navigators attended Compassion Fatigue training. Pastor Scott Speight presented at August Cancer Conference Increased GI referral to genetic counseling from 0% to 10% by end of the year based on analytic caseload. A total of 13 cases were referred by end of October Advanced Care Planning Pilot Study - Pilot started in April The goal is to have 100 people screened system-wide by the end of the study. St. Vincent s Riverside Cancer Conferences and Lectures 2014 Promoted several didactic Cancer Conferences with expert speakers on the topics of: Interventional Bronchoscopy at St. Vincent s for Diagnosis and Management of Lung Cancer Breast Reconstruction After Cancer: Flaps, Implants, Stem Cells Breast Cancer: Future Directions in Historical Perspective Myelodysplastic Syndromes: Best Practices in Patient Care Compassion Fatigue St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

8 Cancer Registry Data Summary (2014 Statistics) Barbara J. Dearmon, BS, CTR Cancer Registry Coordinator The Cancer Registry is designed to collect, analyze and manage data on malignant (cancer) diagnosis and other reportable diseases. Information is collected on all patients diagnosed and/or treated for cancer at St. Vincent s HealthCare. A wide range of information and prognostic indicators are collected to provide quality outcome data in the registry. For 2014, the Cancer Registry added 2,453 new cases. There were a total of 256 historical cases captured which accounted for incidence reporting to the state (not included in incidence comparison reports). A total of 1,149 were classified as analytic cases (initially diagnosed and/or received first course of therapy or part of first course therapy at St. Vincent s Riverside). The current follow-up rate is 92% for all living patients and 93% for patients diagnosed within the last five years which exceeds Commission on Cancer requirements. The Cancer Registry is responsible for maintaining compliance with the following regulatory agencies listed below: Florida Cancer Data Systems to maintain reporting of cancer incidence to Florida Department of Health American College of Surgeons Commission on Cancer program for approved comprehensive cancer program Facility Information Profile System (FIPS) National Cancer Database Rapid Quality Reporting System National Accreditation Program for Breast Centers The Cancer Registry had several data requests for the 2014 calendar year from administration, physicians and staff. To ensure the accuracy of collection of data, the Cancer Committee Chair and physician members performed quality review on registry data. In 2014, 10% of all analytical cases were reviewed for accuracy. The cancer registry quality control policy is reviewed annually by the Cancer Registry Coordinator and Cancer Committee to evaluate the quality of data collection. 06

9 Cancer Incidences and Analyses for 2014 CANCER SITE BY GENDER AND STAGE OF DIAGNOSIS ST. VINCENT S RIVERSIDE The top sites seen at St. Vincent s Riverside in 2014 were breast, lung, colorectal, GYN and bladder. The number of cases initially diagnosed and/or treated at our facility declined from NOTE: Only cases that were diagnosed and/or treated at St. Vincent s Riverside were included in this analysis. N/A refers to AJCC stage category for cancer cases that are not eligible for staging. St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

10 Cancer Incidences and Analyses for 2014 TEN MOST PREVALENT CANCER DIAGNOSIS SITES FOR 2014 AT ST. VINCENT S RIVERSIDE IN COMPARISON WITH FLORIDA AND NATIONAL DATABASES 1 NOTE: Florida and national data are based on estimated numbers of new cases from the American Cancer Society s Cancer Facts & Figures. 2 The comparison analysis excludes basal and squamous cell skin cancers and non-invasive carcinomas except urinary bladder. It is estimated that about 62,570 carcinoma-in-situ of the female breast and 63,770 melanoma-in-situ cases will be diagnosed in the U.S in Only cases that were diagnosed and/or treated at St. Vincent s Riverside were included in this analysis. 08

11 Cancer Diagnoses - Race and Gender Distribution AT ST. VINCENT S RIVERSIDE About 75.7% of all diagnoses in 2013 were for whites, whereas blacks accounted for 20.6%. Most cases seen were for women with 58 % of all diagnoses, and only 41% were for men White Black Other Male 20 Female 22 NOTE: Only cases that were diagnosed and/or treated at St. Vincent s Riverside were included in this analysis. St. Vincent s Riverside Cancer Diagnoses by Florida County of diagnosis St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

12 Cancer Cases Diagnosed and/or Treated AT ST. VINCENT S RIVERSIDE IN 2014 BY FLORIDA COUNTY OF DIAGNOSIS AND GENDER In 2014, most patients that were diagnosed and/or treated at St. Vincent s Riverside resided in Duval County, representing about 71.9% of the total cases (see table below). DIAGNOSIS COUNTY FEMALE MALE TOTAL VALUES NBR (%) NBR (%) NBR (%) ALACHUA BAKER BRADFORD BREVARD CLAY COLUMBIA DUVAL JACKSON MARION NASSAU ORANGE PALM BEACH PASCO PUTNAM ST. JOHNS SANTA ROSA SUWANEE OUT OF STATE OVERALL TOTALS

13 Cancer Cases Diagnosed and/or Treated AGE GROUP AT DIAGNOSIS BY GENDER AGE AT DIAGNOSIS FEMALE MALE TOTAL VALUES NBR (%) NBR (%) NBR (%) < = OVERALL TOTALS NOTE: Only cases that were diagnosed and/or treated at St. Vincent s Riverside were included in this analysis. St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

14 Cancer Incidences and Analyses for 2014 AT ST. VINCENT S SOUTHSIDE BY GENDER AND FLORIDA COUNTY OF DIAGNOSIS For 2014, Cancer Registry accessioned a total of 528 cases for St. Vincent s Southside. Of the 528 cases, a total of 321 cases were diagnosed and/or treated at the facility, qualifying them as analytic cases. The top sites seen were breast with 75 cases, which is 23% of the total (see figure on pg. 13). This is followed by lung (13%), colorectal (10%), melanoma (7%) and 6.8% representing CNS tumors. A total of 266 (82.9%) patients diagnosed and/or treated at St. Vincent s Southside in 2014 resided in Duval County, whereas 55 (17%) are from other surrounding communities including Georgia (see table below). In addition, there were a total of 49 historical cases captured which accounted for incidence reporting to the state that was not included in incidence comparison DIAGNOSIS COUNTY FEMALE MALE TOTAL VALUES NBR (%) NBR (%) NBR (%) BAKER CLAY DUVAL HILLSBOROUGH NASSAU PUTNAM ST. JOHNS ST. LUCIE OUT OF STATE OVERALL TOTALS NOTE: Out-of-state includes patients from Georgia. 12

15 Most Frequent Cancer Sites Diagnosed and/or Treated AT ST. VINCENT S SOUTHSIDE IN Breast Bronchus & Lung NUMBER OF Skin 18 CASES DIAGNOSED 42 Colon & Rectum Urinary Bladder Blood & Bone Marrow Prostate Brain Kidney All Other Cancer Diagnoses - Race by Gender Distribution AT ST. VINCENT S SOUTHSIDE White Black Other 0 Male NBR Female NBR St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

16 Age Distribution at diagnosis by Gender AT ST. VINCENT S SOUTHSIDE IN 2014 AGE AT DIAGNOSIS MALE FEMALE TOTAL VALUES NBR (%) NBR (%) NBR (%) < = OVERALL TOTALS

17 Accountability Measures and Quality Improvement Measures AT ST. VINCENT S RIVERSIDE Below are estimated performance rates on proportion of patients concordant with national treatment measures by diagnosis year. This report reflects continuous improvement in quality of care and compliance with national treatment guidelines endorsed by the National Quality Forum. Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer (Surveillance) BREAST SELECT MEASURES MEASURE CoC Std/% BCS Not Applicable Image or palpation-guided needle biopsy core or FNA of the primary site is performed to establish diagnosis of breast cancer (Quality Improvement) nbx 4.5/80% Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-II hormone receptor positive breast cancer (Accountability) HT 4.4/90% Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with > = 4 positive regional lymph nodes (Accountability) MASTRT 4.4/90% Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability) BCSRT 4.4/90% Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB - III hormone receptor negative breast cancer (Accountability) Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC stage III (lymph node positive) colon cancer (Accountability) COLON MAC ACT 4.4/90% 4.4/90% SELECT MEASURES MEASURE CoC Std/% At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer (Quality Improvement) 12RLN 4.5/85% St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

18 Accountability Measures and Quality Improvement Measures AT ST. VINCENT S RIVERSIDE (Continued) Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiationare administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer (Quality Improvement) At least 10 regional lymph nodes are removed and pathologically examined for AJCC stage IA, IB, IIA, and IIB resected NSCLC (Surveillance) RECTUM SELECT MEASURES MEASURE CoC Std/% LUNG REORTCT 10RLN Not Applicable SELECT MEASURES MEASURE CoC Std/% Not Applicable Surgery is not the first course of treatment for cn2, M0 lung cases (Quality Improvement) LNoSurg Not Applicable 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 cases with pathologiclymph node-positive (pn1) and (pn2) NSCLC (Quality Improvement) Radiation therapy completed within 60 days of initiation of radiation among women diagnosed with any stage of cervical cancer (Surveillance) CERVIX LCT OBRRT Not Applicable SELECT MEASURES MEASURE CoC Std/% Not Applicable Use of brachytherapy in patients treated with primary radiation with curative intent in any stage of cervical cancer (Surveillance) OBRRT Not Applicable

19 Quality Study: St. Vincent s Riverside 2014 CANCER COMMITTEE 2014 MELANOMA STUDY Leann L. Fox, MD & Kevin K. Hunger, MD Even though melanoma accounts for only 2% of skin cancers, it will be responsible for almost 10,000 deaths in United States in About 76,000 new cases are expected to be diagnosed and treated in 2014 as well. 3 The incidence of melanoma in the United States is approximately 27/100,000 in men and 17/100,000 in women. This marks an increased incidence of approximately 3% in white males. Some authors believe that the incidence of melanoma is greatly underreported in this country because many cases of melanoma are treated in private practices and are not counted by tumor registries. 4, 5 The major cause of melanoma is ultraviolet radiation with greater threat from UVB wavelengths than UVA. This has been demonstrated in epidemiologic studies that show increasing incidence of melanoma in latitudes closest to the equator. There is a greater incidence of melanoma in individuals who undergo intermittent intense sun exposure resulting in burns as opposed to those who have more frequent low level exposures resulting in tanning. Nelemans and colleagues showed that people who experienced five or more severe sunburns during the teenage years had twice the Organization as carcinogens in In 2014, one study reported a 61% increased risk of melanoma for those who had used tanning booths for greater than a year. 8 People with a Familial Atypical Multiple Mole and Melanoma Syndrome have markedly increased risk of melanoma and should undergo screening by age ten. Other risk factors that have been reported and are awaiting verification include PUVA treatment for psoriasis, endometriosis, Parkinson s, tumor necrosis factor and Viagra. High alcohol intake (greater than 50g or five standard drinks per day) appears to increase the risk of melanoma by 50%. Smoking appears to not increase the risk of melanoma. Other than decreasing exposure, the most important preventive strategy includes diets rich in Vitamin D. Vitamin D appears to reduce the incidence of melanoma and the level of Vitamin D at the time of diagnosis appears to influence prognosis. incidence of melanoma. 6 Tanning beds became popular in the United States in the 1970s because of the glamorization of tans and the claim that tanning treated multiple ailments. These beds, producing UVB, were found to increase the incidence of melanoma and were named by the World Health St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

20 Quality Study: St. Vincent s Riverside 2014 CANCER COMMITTEE 2014 MELANOMA STUDY (Continued) The treatment of melanoma involves the biopsy of a suspicious skin lesion leaving a 1 to 2 mm rim or normal appearing skin. Definitive surgery is a 2 cm margin and a sentinel lymph dissection for lesions between 1 and 4 mm thick or for lesions between.76 and 1 mm that show ulceration or a mitotic rate of greater than or equal to 1 mitosis/ mm2. We reviewed the incidence and surgical treatment of melanoma from 2000 to 2011 compared to the national average. SUMMARY: The median age for diagnosis of melanoma at St. Vincent s Riverside is which is consistent with the national mean for age at diagnosis. Wide excision comprises the majority of curative surgical procedures. The incidence of melanoma is more common in males both at St. Vincent s Riverside and nationally. Non- specific melanoma is the most common sub-type of melanoma which is reflected in data collected. The majority of the melanomas diagnosed at St. Vincent s Riverside are Stage 0, I, II. The most common Stage is I, with an incidence of 43.64% compared to the national average of 40.8%. Quality Study: St. Vincent s Riverside 2014 AGE GROUP OF MELANOMA OF SKIN CANCER DIAGNOSED IN 2000 TO 2011 ST. VINCENT S RIVERSIDE, JACKSONVILLE, FLORIDA COMPARED TO NCDB (ALL STATES) NOTE: The comparative data includes all cases diagnosed and treated at facility (Class of Case 10-14) and diagnosed elsewhere and part of treatment administered at St. Vincent s (Class of Case 20-22). Data from 1637 hospitals 18

21 2014 NCDB Commission on Cancer Benchmark Data FIRST COURSE SURGERY OF MELANOMA OF THE SKIN CANCER DIAGNOSED IN 2000 TO 2011 ST. VINCENT S RIVERSIDE, JACKSONVILLE, FL VS. ALL TYPES IN ALL STATES 2014 NCDB Commission on Cancer Benchmark Data GENDER OF MELANOMA OF THE SKIN CANCER DIAGNOSED IN 2000 TO 2011 ST. VINCENT S RIVERSIDE, JACKSONVILLE, FL VS. ALL TYPES IN ALL STATES St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

22 2014 NCDB Commission on Cancer Benchmark Data HISTOLOGY OF MELANOMA OF THE SKIN CANCER DIAGNOSED IN 2000 TO 2011 ST. VINCENT S RIVERSIDE, JACKSONVILLE, FL VS. ALL TYPES IN ALL STATES 2014 NCDB Commission on Cancer Benchmark Data STAGE OF MELANOMA OF THE SKIN CANCER DIAGNOSED IN 2000 TO 2011 ST. VINCENT S RIVERSIDE, JACKSONVILLE, FL VS. ALL TYPES IN ALL STATES 20

23 Cancer Incidences and Analyses for 2014 AT ST. VINCENT S CLAY COUNTY The Cancer Registry captured 388 new cases in 2014 for St. Vincent s Clay County. The most common sites were breast, colorectal, lung and lymphoma. There were a total of 11 historical cases which accounted for incidence reporting to the state that was not included in incidence comparison. For cases initially diagnosed and/or treated at St. Vincent s Clay County, 156 (78%) reside in Clay County and 31 (15%) in Duval. Another 13 (7%) were from surrounding communities. PRIMARY SITE NBR WHITE BLACK OTHER NBR (%) NBR (%) NBR (%) NBR (%) OTHER PARTS OF TONGUE PAROTID GLAND ESOPHAGUS STOMACH SMALL INTESTINE COLON RECTOSIGMOID JUNCTION RECTUM LIVER & BILE DUCTS GALLBLADDER PANCREAS LARYNX BRONCHUS & LUNG BLOOD & BONE MARROW SKIN CONNECTIVE SUBCUTANEOUS OTHER SOFT TISSUE BREAST CERVIX UTERI CORPUS UTERI OVARY PROSTATE GLAND TESTIS St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

24 Cancer Incidences and Analyses for 2014 AT ST. VINCENT S CLAY COUNTY (Continued) PRIMARY SITE NBR WHITE BLACK OTHER NBR (%) NBR (%) NBR (%) NBR (%) KIDNEY KIDNEY, RENAL PELVIS URETER URINARY BLADDER THYROID GLAND LYMPH NODES UNK PRIMARY OVERALL TOTALS Clinical Trials and Research AT ST. VINCENT S St. Vincent s Riverside participated in clinical trials sponsored by the National Cooperative Groups of the National Cancer Institute. This includes trials in medical oncology, radiation oncology, as well as pharmaceutical trials. Cooperative Group Trials is the majority type of work that is conducted through the hospital and hospital staff. Other trials (Pharma) are conducted through the medical oncology private practices and the hospital is included in these trials as patients may obtain hospital services as part of the trial. In 2014, St. Vincent s Riverside enrolled 8% of their patients into clinical trials. This exceeded the requirement set forth by the American College of Surgeons Commission on Cancer. For information about cancer research studies contact the Cancer Research office at

25 Community Outreach Activities Completed in 2014 AT ST. VINCENT S RIVERSIDE COMMUNITY OUTREACH ACTIVITIES FOR 2014 BASED ON COMMUNITY NEEDS ASSESSMENT FOR DUVAL COUNTY Candid Conversations About Breast Cancer Support Group Breast Reconstruction Awareness Day ACS Making Strides Against Breast Cancer (American Cancer Society) Yoga for Cancer Survivors & Caregivers Victory in Pink a celebration of breast cancer survivors event hosted by St. Vincent s. Clay County School Board Health Fair: Smoking Cessation, Lung Cancer Institute, Breast Cancer Cancer Issues for Men & Women DATE, LOCATION, FREQUENCY Meets monthly in the St. Vincent s Mary Virginia Terry Cancer Center, Riverside Campus From 6-7pm The event was held on 10/15/14 from 6 to 8 pm at Maggiano s Little Italy in the St. Johns Town Center Held on 10/26/14 in downtown Jacksonville from 7 am to noon and on 10/11/14 in Clay County. Classes are every Tuesday 11:30am 12:30pm in the Spirituality Center Held on 10/4/2014 Held on 10/10/2014 at Fleming Island High School from 9am 1pm Held 8/22/14 at St. George Antiochian Orthodox Church from 6:30pm to 7:30pm SUMMARY OF EVENT AND EFFECTIVENESS The breast cancer support group was very effective; offered to the community with various topics discussed throughout the year which included nutrition, genetics, survivorship, coping with cancer, etc. The average attendance was and ACS guidelines were used. The event was a success and open to the general public to promote awareness and increase education regarding breast reconstruction options. The event provided women with information to make informed decisions about treatment. There were 100 participants in attendance. We provided a speaker from North Florida Plastic Surgeons. Feedback from participants felt that the event was informative and helped with making decision. All participants were offered free consultation appointments if needed prior to leaving the event. Participated in community-wide event to promote breast cancer awareness. Over 10,000 participants in attendance between the two events. Implemented in 2014 in conjunction with the Christina Phipps Foundation. Participants can join free yoga classes for cancer survivors and caregivers to restore mind, body and soul. Approximately 1000 participants; community wide event held at the St. Johns Town Center to promote breast cancer awareness, screening, reconstruction, etc. Participated in community-wide function to promote cancer service line information to participants which included information on smoking cessation, lung cancer institute, breast awareness information. Approximately 100 participants Offered to Arabic church community to discuss common health issues (cancer) for men and women NOTE: Please visit for upcoming community outreach events St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

26 2014 Community Skin Screening Summary ST. VINCENT S HEALTHCARE NEEDS ASSESSMENT: Current estimates are that one in five Americans will develop skin cancer. More than 3.5 million new cases of skin cancer will be diagnosed in the United States this year. Of these cases, it is estimated that about 131,810 are melanoma, the deadliest form of skin cancer, which claims an estimated 9,180 lives annually. One American dies of melanoma almost every hour. The fiveyear survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 98%. In Florida, a 2004 survey found that 38% of white adults in Florida had at least one sunburn within the past year and sunburns are a known significant risk factor in the development of skin cancer. An estimated 5,000 Florida residents were diagnosed with melanoma in About 626 people in Florida die of melanoma every year with St. Johns County having the highest melanoma death rate in the state, 96% higher than the national average from OBJECTIVES: Provide a valuable free screening to our local community (Duval, Clay and St John s counties) Increase public understanding about skin cancer Motivate positive behavior change to reduce the incidence of and mortality from skin cancer Fulfill COC requirements as an accredited Cancer Program SITUATION ANALYSIS: St. Vincent s HealthCare hosted a communitywide skin cancer screening on Saturday September 13, 2014 at the Family Medicine Center. Since the event was advertised through various media outlets, there were scheduled appointments, but walk-in availability was allowed. Upon arrival, participants registered by filling out paperwork provided by the American Academy of Dermatology (AAD). Once completed, the participant was directed to an exam room. The participant was given a gown with the option to undress, leaving undergarments on. A volunteer medical professional (physician and/or physician assistant) thoroughly examined the participant for skin lesions including, but not limited to, actinic keratoses, basal cell carcinomas, squamous cell carcinomas, and melanomas. The medical professional then reviewed his/her findings with the participant and recommended appropriate treatment. A copy of the results was given to the participant. Referral information was also provided if they did not have a regular physician or dermatologist. For the uninsured, information was provided about St. Vincent s HealthCare HOPE program. In addition, our medical professionals offered services to those uninsured on an as-needed basis. Prior to leaving, each participant was given AAD contact information and educational materials on the warning signs of skin cancer and prevention. 24

27 Each participant was asked to complete a survey evaluating the event. RESULTS: Number of registrants: 300 No-shows: 88 Walk-ins: 12 Event attendance: 224 Recommended further treatment (biopsies): 32% (72 participants) Referrals: 34% (47 participants) Survey results: 188 (84% of participants) 82% (186) stated the event was excellent 1% (1) stated the event was very good 1% (1) stated the event was good 224 (100%) answered the following: 36% (82) stated they would have been screened with or without the free screening 64% (142) stated they would NOT have been screened without the free screening Some comments from the survey included the following: Everything was great! I have mole to be removed may have saved my life! You guys are amazing! We appreciate the service. Awesome! Everything was well organized. Great job, St Vincent s! FOLLOW-UP PLAN: Participants who were recommended for further follow-up were given physician contact information by the participating physicians. Participants were given contact information for The American Academy of Dermatology for additional support in finding a local dermatologist if needed. The uninsured were given the HOPE Program brochure with contact information for further assistance. The lead dermatologists for the screening received a copy of all of the results. AAD received a copy of all of the results. NATIONAL GUIDELINES: Recommendations by the American Cancer Society: Most skin cancers can be found early with skin exams. Both regular exams by your doctor and examining your own skin frequently can help find cancers early, when they are easier to treat. As part of a routine cancer-related checkup, your doctor should check your skin carefully. They should be willing to discuss any concerns you might have about this exam. AUDIENCES: General public EVENT PROMOTION: Florida Times-Union Ask the Doctor Radio Show The Shannon Miller Show St. Vincent s intranet Printed flyers throughout St. Vincent s Riverside & Southside campuses MESSAGES: Parking is free and handicap accessible To register for this event, please call St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

28 2014 Triple Negative Breast Cancer and Genetic Testing Study AT ST. VINCENT S RIVERSIDE Veena Ganesh, MS, GC, MS Biotech, Genetic Counselor The National Comprehensive Cancer Network guidelines recommend that patients who are diagnosed with triple negative breast cancer at 60 years or younger should be offered genetic testing for hereditary breast and ovarian cancer (HBOC). Our aim is to improve the access to genetic testing for patients who have been diagnosed with triple negative breast cancer between 2010 through CRITERIA FOR EVALUATION: Patients who have been diagnosed with triple negative breast cancer at 60 years or younger between 2010 through 2013 DATA FROM THE FOLLOWING SOURCES WAS UTILIZED IN THIS STUDY: St. Vincent s HealthCare Cancer Registry Data St. Vincent s genetic counseling record GOALS: Identify areas of improvement in the care of this patient population Convey the results of the study along with areas for potential improvement to all departments responsible for the treatment of the patient population Devise a method to ensure patients are receiving the recommended care Monitor the progress of the above goals and report the results to the Cancer Committee in a timely manner for information as well as suggestions BACKGROUND FOR STUDY: Hereditary breast and ovarian cancer (HBOC) is an autosomal dominant inherited cancer syndrome that is characterized by an increased lifetime risk for breast, ovarian, prostate, and pancreatic cancers due to mutations in the BRCA1 and BRCA2 genes. A mutation in the BRCA1 and BRCA2 genes should be suspected in individuals with a personal or family history of any of the following: breast cancer diagnosed at age 50 or younger, ovarian cancer, bilateral breast cancer, male breast cancer, triple negative breast cancer, Ashkenazi Jewish ancestry, two or more relatives with breast cancer with one diagnosed under the age of 50, three of more relatives with breast cancer diagnosed at any age or a previously identified BRCA mutation in the family. The prevalence of germline BRCA1 mutations in women with triple-negative breast cancer is significant, both in women undergoing clinical genetic testing (and thus selected in large part for family history) and in unselected triple-negative patients, with mutations reported in 9% to 35%. The highest rate reported was in a clinic-based series in women younger than 30 years with high-grade triple-negative breast cancer. In this small, highly selected population, 35% had BRCA1 mutations. 9 The NCCN guidelines state that individuals who are diagnosed at 60 years or younger with triple negative breast cancer should be offered genetic testing for hereditary breast and ovarian cancer (HBOC). 10 CRITERIA FOR STUDY: Criteria for this study were developed by the QI Coordinator and a subgroup of the Cancer 26

29 Committee and it was subsequently approved by the Cancer Committee. The data is displayed below. Patient populations were extracted from registry data and included all women within the years of 2010 through 2013 with a diagnosis of triple breast cancer who would likely be candidates for genetic testing for HBOC. recommendations at the November 11, 2014 Cancer Committee meeting. OUTCOMES WITH RESPECT TO THE GOALS OF THIS STUDY 1. Goal - To promote genetic counseling services in patient waiting areas YEAR NUMBER OF TRIPLE NEGATIVE BREAST CANCER CASES NUMBER OF CASES ELIGIBLE FOR GENETIC TESTING FOR HBOC NUMBER OF CASES OFFERED GENETIC TESTING FOR HBOC SUMMARY OF FINDINGS: Of the 49 reported triple negative breast cancer cases abstracted from the Cancer Registry database over a three year period (2010 through 2012), 28 were eligible for genetic testing for HBOC based on their ages of diagnosis and triple negative status. Nine of these 28 cases were offered genetic testing. Of the 29 reported triple negative breast cancer cases abstracted from the Cancer Registry database over a two year period (2012 through 2013), 16 were eligible for genetic testing for HBOC based on their ages of diagnosis and triple negative status. Nine of these 16 cases were offered genetic testing. 2. Goal - To devise a method to continue to educate physicians and their offices on the NCCN recommendations for genetic counseling criteria. Education offered to physicians and other clinicians on April 25, Presentation was on an introduction to hereditary cancer syndromes. Additional educational opportunities will be conducted by May-June Goal - To monitor the progress of the above goals and report the results to the Cancer Committee in a timely manner for information as well as suggestions. Final results were presented to QI subcommittee by Veena Ganesh, GC on October 30, Subcommittee recommends implementing proposed improvements. The quality improvement coordinator with Dr. Fox will present a summary of the findings and implementation of subcommittee St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

30 Comprehensive Cancer Services As part of an accredited cancer program, the physicians and staff at St. Vincent s continually strive to provide premier cancer services to the community in the greater Jacksonville area. Using the latest research data, physicians treat patients in the best way possible as it relates to surgery, radiation, chemotherapy, and other services. We are blessed to have a collaborative team that works with the patient at the center of the equation. The St. Vincent s team is very diverse and includes people across the continuum of care, including, but not limited to: Breast Cancer Nurse Navigator Lung Cancer Nurse Navigator Spine & Brain Cancer Nurse Navigator Cancer Survivorship Care Nurse Navigator General Cancer Nurse Navigators Clinical Patient Navigator Genetic Counselor Cancer Dietitian Social Workers Pharmacists Rehabilitative Therapists Imaging Technologists Radiation Therapists & Nurses In-patient Cancer Nursing teams Out-patient departments and teams Palliative Care team Chaplains Pathologists Surgeons general and specialty Radiation Oncologists Medical Oncologists Pulmonologists Radiologists St. Vincent s Mission and Values keep us on the path of providing the very best possible care for those who are struggling the most. Cancer is a diagnosis that affects not only the patient. It affects the entire family and we recognize this. Through all of our programs and services, we work to provide good information to help families support the person who is diagnosed. It is our honor to continue to provide cancer services to the community. References & Definition of Terms REFERENCES: 1. National Cancer Database (NCDB) Commission on Cancer American Cancer Society, Cancer Facts and Figures Cancer.org, American Cancer Society, What are the key statistics? 4. Cockburn M, Swetter SM, Peng D, et al. Melanoma underreporting: why does it happen, how big is the problem, and how do we fix it? J AM Acad Dermatol 2008;59: Howlader N. Ries LA, Stinchcomb DG, Edwards BK. The impact of underreported Veterans Affairs data on national cancer statistics; analysis using population-based SEER registries. J. Natl Cancer Inst 2009: 101:

31 6. Nelemans PJ, Groenendal H, Kiemeney LA, et al. Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals. Environ Health Perspect 1993; 101:252. DEFINITION OF TERMS: ACS - American Cancer Society AJCC - American Joint Committee on Cancer 7. International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant Melanoma and other skin cancers: A systematic review. Int J Cancer 2007; 120:1116. A - Analytic NA - Non-Analytic NCDB - National Cancer Data Base CoC - Commission on Cancer 8. Colantonio S. Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and metaanalysis. J Am Acad Dermatol 2014; 70:847. NCCN - National Comprehensive Cancer Network ALND - Axillary Lymph Node Dissection 9. Petrucelli, MS, N., B Daly, MD, PhD, M., & L Feldman, MD, PhD, FACMG, G. (2013, September 26). Bookshelf. Retrieved November 8, 2014, from National Comprehensive Cancer Network. (2014, January 1). Retrieved May 18, 2014, from professionals/physician_gls St. Vincent s Medical Center Riverside Cancer Committee Cancer Program Annual Report

32 ST. VINCENT S MEDICAL CENTER ONCOLOGY SUPPORT SERVICES 1 Shircliff Way Jacksonville, FL