2012 Oncology Annual Report

Transcription

1 2012 Oncology Annual Report

2 A New Name, Same Quality Care William G. Sisson President/CEO The year 2012 saw many advances in health care at Central Baptist Hospital, particularly in our oncology services as you will read in this report. We look forward to additional advances in 2013 under our new name, Baptist Health. Central Baptist Hospital and all of the hospitals in our system are now Baptist Health. Baptist Healthcare System has re-branded its family of hospitals across the state to unify them and to help Kentucky residents better identify the unique Baptist brand of care synonymous with exceptional patient experiences. I embrace this name change because I believe it will help our hospital system function more cohesively, which in turn means greater access to more specialized services for more people across Kentucky. The new name also reflects our vision for the future of health care focusing more on preventive health and keeping people well. One thing that has not changed is our dedication to caring for our patients as if we were caring for our own family members. We have always considered it a privilege to care for our friends, loved ones and neighbors, and we always will. On the following pages, you will learn about the new cancer center currently under construction on our campus as well as information about a new lung cancer screening we now offer. There are also details about the implementation of our cancer program s electronic medical record, a significant step in linking our entire family of Baptist hospitals. Our team of highly trained cancer care specialists include medical oncologists, radiation oncologists, breast radiologists and surgical specialists, oncology nurse navigators, oncology clinical nurse specialists, social workers, genetic counselors, chaplains, dietitians and many others who all do their part to treat the whole person. Because of our commitment to quality, our oncology services have been recognized nationally by such respected organizations as the American College of Surgeons Commission on Cancer, the National Accreditation Program for Breast Centers and the American College of Radiology. We want to be held to national best-practice standards because we want our cancer care to be second to none. We appreciate the trust patients have placed in us over the years to help them battle cancer as Central Baptist Hospital. We hope cancer will soon be banished as a threat to our health, but until then we will be here to offer our oncology services as Baptist Health Lexington. 34

3 Contents Introduction 4 All Under One Roof 5-6 Cancer Registry Annual Report 7-19 Implementation of the Mosaiq Oncology Electronic Medical Record Spotlight on New Medical Oncologist 22 Lung Cancer Screening at Central Baptist Hospital Standardizing Practice Patterns in Radiation Oncology 24-25

4 Introduction Russell Eldridge, MD, Medical Oncologist Chairman, Oncology Department Dear Friends and Colleagues, The physicians and staff at Central Baptist Hospital Cancer Center are proud of our progress in Our goal is to provide the community with the highest quality, patient-centered, compassionate care in a community setting. In this issue, you learn about the new endeavors in our program. First is an update on the construction of the new $200 million patient tower expansion project located on the Central Baptist Hospital main campus on Nicholasville Road in Lexington, Kentucky. We look forward to pulling together the entire cancer services program under one roof, which will help in the coordination of patient care. Some of the services located in this new expansion include medical and radiation oncology, infusion services, and patient support services including research, genetics and nurse navigators. There were two other programmatic enhancements in the cancer center during The first project was the implementation of our cancer program s electronic medical record. The EMR now combines a patient s record for all services done in outpatient medical and radiation oncology, as well as gynecologic oncology services and infusion therapy. Not only can a patient s medical record be viewed electronically at Central Baptist Hospital, but if the patient travels to another Baptist hospital in Kentucky with the same EMR, physicians and staff there will be able to view the patient s record. Ultimately, the EMR has given our cancer program leverage to network our entire health system for treatment of cancer patients. Another noteworthy project in 2012 was the start of a Lung Cancer Screening Program. Central Baptist Hospital now offers low-dose CT screening for anyone classified as high risk for lung cancer. We are encouraging patients to talk with their primary care physicians about this program if they feel they are at risk. Finally, we would like to welcome Dr. Mitchell Carl to our medical oncology team. Dr. Carl is working primarily in Richmond but also has a clinic in Paris. Dr. Carl has been with us since November We hope you are as excited about our new programs and projects as we are! We appreciate your trust in us as your oncology providers. 34

5 All Under One Roof Kay Ross, RN, MSN, AOCN Vice President of Oncology, Orthopedics and Clinical Support Services A designated cancer center is a major part of Central Baptist s $200 million expansion project currently underway. The cancer center will occupy more than 53,000 square feet and will bring together all of the components of the hospital s cancer program under one roof. We have been providing state-of-the-art cancer services for a long time, but when we come together we will be able to coordinate our care more efficiently, said CBH cancer program medical director Dr. Elvis Donaldson. The cancer center will be housed on two levels of the new building that will also be home to a women s center, ICU rooms, inpatient imaging services and medical/surgical rooms. Dominating the design will be a three-story atrium that will supply both light and the calming comfort of nature. Patients and visitors on both floors of the cancer center will be able to enjoy comforting courtyard views. Our cancer services have always been patient-centered, putting their needs first as it should be, said Kay Ross, RN, MSN, AOCN, vice president of oncology, orthopedics and clinical support services. We ve put a lot of thought into the design of the new cancer center so that the space will be very patient friendly. 5

6 New Cancer Center Will Offer Many Services The center will have a covered entrance complete with valet parking. Patients will enter a large, light-filled lobby, where they will register. Just a short walk from the registration desk they will find these facilities: Clinic area will have space for as many as nine physicians to provide patient care. Infusion area will offer both semi-private and private space for 30 patients to receive chemotherapy, blood transfusions or other intravenous treatments. Laboratory and pharmacy areas will be centrally located to provide reduced time for patients infusion therapies, as well as for drawing blood and conducting tests needed prior to seeing physicians. Quality-of-Life Center, where patients will be able to see nurse navigators, genetic counselors, nutritionists, social workers and other support staff who play key roles in patient-centered care. Research Center will be convenient to both the clinic and infusion areas so that staff can communicate with patients who are involved in cancer clinical trials. Resource library and patient education area will provide both patients and family members with much-needed information and serve as a new patient orientation location. Retail pharmacy will be convenient for patients who need a prescription filled before returning home. Bistro will provide light refreshments as well as wireless Internet access. Patients coming to the center for radiation or additional services on the lower level may access it via an elevator from the first floor or may enter from an underground garage. Also illuminated by the atrium, the lower level will feature: Radiation and CyberKnife treatment and clinical areas, where patients will see physicians, have treatment planning and receive radiation therapy. Wellness Center, where patients can be introduced to complementary therapies such as music, massage or art therapy that have been shown of benefit to those with cancer. Central Baptist has one of the busiest cancer programs in the state, averaging growth of 100 to 200 patients each year per year over the past decade. In 2011, CBH diagnosed and/or treated an estimated 1,750-1,800 new cases of cancer. Central Baptist has always been known for personalized cancer care from an experienced staff with a passion for what they do, Dr. Donaldson said. Just because we will have a wonderful new facility doesn t mean any of that will change. We will still maintain that close interaction with patients, and it will be easier to do that with all services under one roof. 6

7 Cancer Registry Annual Report The Cancer Registry at Central Baptist Hospital continues to collect and maintain data on all patients diagnosed and/or treated for cancer at our facility. Maintaining our registry assures that health officials have accurate and timely information, while ensuring the availability of data for treatment, research, and educational purposes. Confidentiality of patient identifying information and related medical data is strictly maintained. Aggregate data are analyzed and published without any patient identifiers. Local, state, and national cancer agencies use registry data to make important public health decisions related to public health funds. Registry data is valuable to researchers interested in the etiology, diagnosis, and treatment of cancer. Current lifetime follow-up maintained by the registry provides accurate survival information as well as serves as a reminder to physicians and patients to schedule regular clinical examinations. In 2011, the Cancer Registry at Central Baptist Hospital reported a total of 1,734 cases. Of these cases, 57.21% (992) patients were diagnosed with their disease at CBH and received all or part of their first course treatment here. A total of 31.78% (551) patients were diagnosed elsewhere but received all or part of their first course treatment at CBH. Patients who were initially diagnosed and treated elsewhere but received subsequent treatment at CBH for recurrent disease accounted for 6.92% (120) of our cases. And 4.09% (71) of patients were initially diagnosed at CBH but were treated elsewhere for their disease. 7

8 Newly Diagnosed and/or Treated Cases at CBH The number of newly diagnosed and/or treated (analytic) cases reported at CBH continues to rise, with a significant increase of 6.2% (100) in the number of cases from 2010 to The addition of a new casefinding tool, D-Img, allowed us to identify more CNS cases from radiology reports. Comparison of Top Five Sites Male & Female* According to the 2011 American Cancer Society s Cancer Facts & Figures, approximately 1,596,670 new cancer cases would be diagnosed in the US in 2011, excluding carcinoma in situ of any site except urinary bladder and basal and squamous cell skin cancers. The risk of being diagnosed with cancer increases with age, with most cases occurring in adults; 78% of all cancers are diagnosed in persons 55 years of age or older. About 571,950 Americans were expected to die of cancer in 2011, more than 1,500 people per day. Cancer is the second most common cause of death in the US, exceeded only by heart disease, and cancer accounts for nearly 1 of every 4 deaths. *Data obtained from the 2011 ACS Cancer Facts & Figures, Kentucky Cancer Registry, and CBH Cancer Registry 8

9 Comparative Analysis of Top Ten Sites at CBH As noted in the table above, top three cancer sites for Central Baptist Hospital have remained consistent over the past 5 years, which correlates directly with state and national top cancer sites. These three sites have been the focus of program development for Central Baptist, ensuring the program has the latest technologies, as well as the additional support services needed to elevate the care for these patients. The program has implemented nurse navigators for each of the three top cancer sites, which has helped patients and their families move more efficiently through their care from diagnosis to survivorship. The navigators have helped raise awareness of the Central Baptist Hospital cancer program in the community by participating in cancer screening initiatives, support groups and educational events. There was another notable increase in the prostate cases between 2010 and The number of prostate cases as well as kidney cases more than doubled from 2010 to We can attribute this growth to a urology utilization of robotic surgery, as well as increased use of the CyberKnife. 9

10 2011 Top Five Cancer Sites at CBH by Best Collaborative/AJCC Stage In 2011, CBH continued to diagnose the majority of breast cancer cases at early stages: stage 0 (18.0%), stage I (35.7%), and stage II (31.9%). We can be proud of our early diagnosis of breast cancer and the efforts being made toward education and awareness for screening and early detection. Central Baptist Hospital participates in numerous community events throughout the year focused specifically on educating women about the importance of regular screenings. This education, along with our high quality breast center, is making a difference in earlier diagnosis. In addition to breast education and awareness, we are also targeting screening education for colon cancer. One of our biggest initiatives included educating all patients older than 50 admitted to the hospital who have not had a screening colonoscopy on the importance of this disease. Our goal is to continue emphasizing the importance of colorectal screening and diagnosing colon cancer in the early and more treatable stages. We believe there are opportunities to increase the proportion of early stage diagnoses. With the addition of a GI nurse navigator, we have increased the opportunities to educate patients on the importance of screening and early detection. Because of a surgical oncologist who frequently treats malignant melanoma, and because of his outstanding reputation among the community, melanoma is one of our top 5 tumor sites at Central Baptist Hospital. Fortunately, about 50% of the malignant patients presenting during 2011 were diagnosed as stage 1. We are proud of the efforts being made at Central Baptist Hospital to educate our community on the importance of cancer screenings and offer the highest quality screening services to patients. Additionally, with nurse navigator advocates in 3 of our top 5 cancer sites, we are achieving an even more patientfocused approach to diagnosing and treating our cancer patient population. 10

11 Analysis of Prostate Cancer Care at Central Baptist Hospital Using Cancer Registry Data Goal: Evaluation of Prostate Cancer statistics and analysis of impact of newer robotic surgery and robotic radiosurgery techniques on cases treated at Central Baptist Hospital (CBH). Criteria: Data includes records of newly diagnosed and/or treated patients at CBH. Comparative analyses utilizing National Cancer Data Base data. Sources: CBH Cancer Registry Data, National Cancer Data Base, American Cancer Society 2011 Cancer Facts & Figures Reviewer: Alan Beckman, MD, Radiation Oncology New Cases: According to the ACS Facts & Figures, approximately 240,890 new cases of prostate cancer would be diagnosed in the US in Prostate cancer is the most frequently diagnosed cancer in men. For reasons that remain unclear, incidence rates are significantly higher in African Americans than in Caucasians. Incidence rates for prostate cancer changed substantially between the mid-1980s and mid- 1990s, in large part reflecting changes in prostate cancer screening with the prostate-specific antigen (PSA) blood test. Since 1998 incidence rates have remained relatively stable. At CBH, the number of prostate cases diagnosed and/or treated more than doubled from 2010 and This could be attributed to the fact that Central Baptist Hospital acquired the Da Vinci Robot for surgical cases and our CyberKnife Robotic Radiosurgery program continued to develop. Both treatment modalities have demonstrated excellent long term results for treating prostate cancer. 11

12 CBH Other CBH Other Risk Factors: The only well-established risk factors for prostate cancer are age, race/ethnicity, and family history of the disease. About 62% of all prostate cancer cases are diagnosed in men 65 years of age and older, and 97% occur in men 50 and older. At CBH, 77% of patients were diagnosed at age 60 years of age or older, and 99% of patients were diagnosed at age 50 or older. These findings are consistent with the NCDB data. 12

13 CBH Other CBH Other Early Detection/Stage: At this time, there are insufficient data to recommend for or against routine testing for early prostate cancer detection with the PSA test. The American Cancer Society recommends that beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years receive information about the potential benefits and known limitations of testing for early prostate cancer detection and have an opportunity to make an informed decision about testing. At CBH, 77% of patients are diagnosed at stage II, consistent with the NCDB data. This is a result of PSA screening and early detection. 13

14 CBH Other CBH Other Treatment: Treatment options vary depending on age, stage, and grade of the cancer, as well as other medical conditions, and should be discussed with the individual s physician. Surgery (open, laparoscopic, or robotic-assisted), external beam radiation, or radioactive seed implants (brachytherapy) may be used to treat early stage disease, and hormonal therapy may be added in some cases. At Central Baptist Hospital, more patients were treated with radiation only, in comparison to the NCDB data showing more patients were treated with surgery only. This may be due to the number of radiation treatment options available at CBH, including IMRT, brachytherapy and CyberKnife Stereotactic Radiosurgery. 14

15 First Course Treatment of Prostate Cancer at CBH Prostate Radiation Treatment Modality at CBH

16 Prostate Surgical Approach at CBH

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18 Survival: Comparison of 5-year cumulative survival rates between NCDB data (90.5%) and CBH data (89.9%) for stage II cases are relatively the same. CONCLUSION: Prostate cancer is the most common cancer in men in the United States and the second most common cause of cancer-related mortality in men. Multiple treatment options are available to men with prostate cancer, and there is no statistical difference in cure rates between the modalities. Central Baptist Hospital saw an increase in the number of patients treated surgically with the implementation of the Robotic Da Vinci technique that offers quicker healing compared to conventional open prostatectomy. We are still below the national average for surgery as initial treatment. This may be due to the radiation treatment options available at this institution. Central Baptist Hospital is the regional referral center for 18

19 extra-cranial radiosurgery in Kentucky, with the only CyberKnife in the state during the period reported here. The CyberKnife technique treats prostate cancer in 5 outpatient visits in 1 week, without the need for anesthesia. The 5-year cure rate of 93% is at least as high as other modalities and the risk of side effects is extremely low. The non-invasive nature (compared to surgery or brachytherapy) and the convenience (compared to the prolonged treatment course of 8+ weeks for conventional external beam radiotherapy) make CyberKnife Radiosurgery an attractive option for men with curable prostate cancer and likely accounts for the differences reported here compared to the national average. 19

20 Implementation of the Mosaiq Oncology Electronic Medical Record In the spring of 2012, the CBH Oncology program began a journey toward the implementation of an Electronic Medical Record (EMR) for our cancer patients. With the recent formation of the Baptist Cancer Network project, it was decided that the new EMR would be a valuable component so that a patient s cancer medical record could be accessed if they were to travel from one Baptist Healthcare Oncology facility to another in the state of Kentucky. The Mosaiq product is a comprehensive EMR that includes patient scheduling for all of their appointments in the Oncology settings which includes physician office visits for radiation oncology, medical oncology and GYN Oncology, the complete treatment records for radiation and chemotherapy, office notes, laboratory and radiology results, vital signs, medications and nursing assessments. Other records and test results from outside physicians are scanned into Mosaiq and are available for oncology healthcare providers to review. Our Oncology physicians are able to e-prescribe to the patient s preferred pharmacy via Mosaiq. The patient s demographics are updated with each new visit to ensure up-to-date contact and insurance information. Face photos are taken of the patient as an additional means of identification. Allergies and any special alerts can be viewed each time the patient s electronic chart is opened to ensure the staff is aware of any special needs or patient conditions. Patients on clinical research trials are identified and followed more easily in the EMR. Our Mosaiq EMR project began in the early spring with a goal of completing 6 milestones before the end of calendar year Part of the implementation process included merging the existing Mosaiq EMR at the Baptist East Medical Oncology practice in Louisville, which has been in existence since 2005, with the CBH Mosaiq database. Central Baptist would then incorporate their Radiation Oncology, Medical Oncology, and GYN Oncology departments in the Mosaiq project. The 19-week implementation concluded on November 6, 2012 with the final go-live portion of the system. From the start of this journey there were many other projects being done behind the scenes in preparation for this implementation. Numerous interfaces had to be put in place and tested prior to uses - these included interfaces with the hospital registration and patient billing system to allow the patient demographic and insurance information to flow into Mosaiq, and the charges to be exported daily for the hospital and physician billing systems. There are interfaces that allow laboratory, pathology, and radiology reports ordered by the oncology physicians to flow into Mosaiq and be available for all providers to view. For the Radiation Oncology department, there is an interface that connects Mosaiq with the linear accelerator to capture the daily radiation treatment data, as well as verification of correct radiation dosing and treatment machine parameters. There are more than 170 people using Mosaiq just at CBH alone. We have 3 departments at 6 locations 20

21 utilizing the software, and now 2 hospitals are integrated. In addition to physicians and nurses, users of Mosaiq include nursing assistants, registration, scheduling and medical record staff, support staff including nurse navigators, dietitians, genetic counselors and social workers, cancer registrars, medical record coders, hospital and physician billing staff, pharmacists, cancer research staff, financial counselors, and system support staff. With the growth and development of our Baptist Cancer Network we will be adding more medical and radiation oncology departments at other Baptist Oncology facilities into the Mosaiq database in the future. These advancements will provide easier and more complete access to the oncology patient s medical records if they are in need of oncology care throughout the state. 21

22 Spotlight on New Medical Oncologist Mitchell Carl, MD Mitchell Carl, MD, is Board Certified by the American Boards of Internal Medicine, Infectious Diseases, Medical Oncology and Hematology. Dr. Carl graduated from State University of New York, Downstate College of Medicine, Brooklyn, New York and completed his residency at Montefiore Hospital and Medical Center, Bronx, New York. He completed his fellowship in Infectious Diseases at Channing Laboratory, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts and his fellowship in Hematology and Oncology at Georgetown University Medical Center, Washington, D.C. In 2012, Dr. Carl joined Baptist Lexington Oncology Associates and provides Hematology/Oncology care in the Central Kentucky area with clinics in Richmond and Paris. Lung Cancer Screening at Central Baptist Hospital Lung cancer is the No. 1 cause of cancer-related deaths in the United States and is responsible for more deaths annually than breast, prostate and colorectal cancers combined. Kentucky has the highest lung cancer rates in the nation, and Central Baptist Hospital is striving to improve the survival rates for our patients by detecting cancer at an earlier stage. The National Lung Screening Trial (NLST), a national cancer screening trial sponsored by the NCI, included more than 53,000 heavy smoker adults. Individuals were randomly assigned to standard chest X-ray or low-dose computed tomography. The results of this landmark study conducted by the National Cancer Institute (NCI) provided evidence of a significant benefit for study participants who were screened using a CT scan. CT scans every year for three years reduced lung cancer deaths by 20 percent compared with chest X-rays in the current or former smokers in the study. To meet the needs of our patient population, we responded to the results of the NLST and developed a Lung Cancer Screening service. If a lung abnormality is found on CT scan, pulmonologists at Baptist Pulmonary Associates can provide appropriate recommendations, obtain a diagnosis and expedite referrals for treatments if malignancies are found. In response to the results of the NLST, we developed educational materials, including physician and patient educational brochures. These brochures were sent to primary care physician offices, along with a 22

23 letter outlining the referral and follow-up process for lung screening. The lung nurse navigator role serves as a support for the patient and physician s office ensuring patients are given results in a timely manner. For more information about this service, please contact our lung nurse navigator, Jeanni Thompson, at (859) or (859) 260-HELP. Candidates for Lung Cancer Screening should currently have NO signs/symptoms or history of lung cancer or previous abnormal CT scans of the chest and also meet the following criteria: Age and have a 30-pack-year history of smoking AND are still smoking or have quit less than 15 years ago OR Age 50 or older and have a 20-pack-year history of smoking AND have one additional risk factor for lung cancer; cancer history, lung disease history, family history of lung cancer, radon exposure or occupational exposure. Low-dose lung CT scans are performed at any of the following Central Baptist Hospital locations: Main Campus, Central Baptist Hospital at 1740 Nicholasville Rd, Lexington Central Baptist Diagnostic Center at Southland Drive at 100 Southland Dr, Lexington Central Baptist Outpatient Center at Hamburg at 1775 Alysheba Way, Lexington Central Baptist Medical Plaza at Brannon Crossing, 100 Providence Way, Nicholasville Central Baptist Outpatient Diagnostic Center in Georgetown, 206 Bevins Lane, Georgetown Central Baptist Medical Plaza in Richmond, 107 Meridian Way, Richmond 23

24 Standardizing Practice Patterns in Radiation Oncology In December of 2011, CBH medical physicists completed an annual competency review of variable control settings radiation therapists use on the CyberKnife machine. Based on the competency review, the department established a Parameter Checklist Policy with the intent of standardizing practice patterns among the radiation therapists. The CyberKnife system itself is a computer-controlled robotic arm that directs multiple beams of highdose radiation directly to the affected area. The radiation therapist plays an important role in the treatment delivery of radiation, as well as a key role in monitoring the variable control parameters throughout the treatment. The 2011 Parameter Checklist Policy incorporated a fail-safe requirement for therapists to have physician approval to treat parameters set outside the preferred range. The department analyzed the frequency of each parameter meeting the policy guideline, as well as whether physician approval was obtained when parameters exceeded the policy guideline. From January 2012 June 2012, 74 unique patients received CyberKnife treatment and were reviewed across six different parameters. Four of the six parameters had 100% of all fractions meet the preferred parameter range, and therefore, did not require any additional physician review. The remaining two parameters (n = quantity studied) include: 1. dxab (n= 121 fractions) 2. Rigid Body Error (n= 73 fractions) (Once a radiation oncologist determines the proper dose of radiation for a particular cancer, the dose is divided into smaller doses called fractions.) The first parameter, dxab, used only when treating Xsight Lung and Spine patients, had 11 of the 121 fractions that required a value beyond the preferred range; all 11 fractions successfully gained verbal physician approval prior to adjusting the parameter. The second parameter, Rigid Body Error, used for fiducial tracking, had 4 of the 73 fractions that required a value beyond the preferred range; all 4 fractions successfully gained verbal physician approval prior to adjusting the parameter. Following the results of this study, the Radiation Oncology department made a recommendation to the Cancer Committee to acquire a Report Administration tool through the CyberKnife vendor. This report tool will enable the medical physicists the ability to report robust quality analysis information, and over time, start setting benchmarks through comparative analytics. In December 2012, the department purchased the Report Administration tool and plans to implement it in the spring of

25 Safe delivery of radiation treatment is the No. 1 priority for Central Baptist Hospital s Radiation Oncology department. Our frequent quality checks and analyses are ongoing so that we can continue to exhibit quality improvement in the delivery of care. We are very pleased by the recommendation of the department for a reporting tool which will keep our program ahead of the curve through monitoring and analyzing our quality data. 25