the 2015 Annual Report

Transcription

1 the 2015 Annual Report

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3 Chairman s Report istvan pataki, md, frcp (c) As Chair of the Cancer Committee, I am proud to present our 2015 Annual Report. The Cancer Committee is a group of dedicated health care professionals committed to the treatment and support of cancer patients. Our program continues to offer high-quality cancer care for patients in Cumberland County and surrounding counties including Harnett, Hoke, Bladen, Sampson and others. During this past year, significant expansions have taken place to further improve our ability to offer cancer care in our area. A formerly private practice, the Blood and Cancer Clinic, has joined the hospital, including medical oncologists Shirish Devasthali M.D. and Tariq Nazir M.D. Nay Min Tun M.D. has also joined our cancer center team in medical oncology, seeing patients at our Health Pavilion North location. We also have added a new location where medical oncology services are offered in Dunn, Cape Fear Valley Cancer Center at Harnett. We are also excited about future expansion to other counties in the area. The cancer program remains accredited by the American College of Surgeons Commission on Cancer (ACSCoC) as a Community Hospital Comprehensive Cancer Program. Accreditation can only be obtained and kept if a rigorous set of quality criteria are met and maintained. This accreditation demonstrates that our patients continue to receive quality cancer care closer to home through the Cape Fear Valley Health System. We are proud of the many dedicated and committed people involved at Cape Fear Valley Medical Center in providing the highest quality cancer care possible. This work continues on a daily basis, with one goal in mind: to provide exceptional and comprehensive cancer care to the population that we serve here in Cumberland County and the surrounding area. Sincerely, Istvan Pataki, MD, FRCP (C) Chair, Cancer Committee

4 A change of scenery More patients are turning to Cape Fear Valley s cancer centers for treatment. 4

5 The cancer treatment landscape in southeastern North Carolina is in a state of flux, thanks to two area cancer centers recently closing. The situation has forced patients to seek treatment elsewhere, including at Cape Fear Valley Cancer Centers. The patient shuffling started in the summer of 2014 after The Blood and Cancer Clinic closed to join Cape Fear Valley s cancer treatment program. The Fayetteville practice s two physicians, five staff members and large patient base came with the acquisition. Most of the patients chose to continue their care at Health Pavilion North Cancer Center, where their former physicians ended up. Brenda Hall, Cape Fear Valley s Cancer Director, said the rapid influx of new patients strained Health Pavilion North resources. We literally tripled our patient volumes overnight, Hall said, and we haven t slowed down since. Staff had to be re-arranged to better meet patient needs, while renovations were started to ease patient flow. More rooms were added, a separate blood work area created, and the facility s clinical space and chemotherapy infusion area expanded. Work will soon begin on the facility s second floor to accommodate future growth. Cancer Centers of North Carolina (CCNC) added to the upheaval, when the company closed its Dunn outpatient treatment center soon after The Blood and Cancer Clinic closed. Seeing neighbors in need, Cape Fear Valley Health quickly stepped in and agreed to reopen the Harnett County facility. Located across from Betsy Johnson Hospital, the shuttered cancer clinic was quickly renovated and re-opened as Cape Fear Valley Cancer Center at Harnett. But former patients weren t as quick to return. The facility averaged just 20 patient visits a month at first. We knew there was a need for our services, Hall said. But we weren t sure how long it would take to get patients back from CCNC s multiple Wake County offices, where they were sent after the Dunn office closed. Shirish Devasthali, M.D., volunteered to help reopen the Dunn clinic. The Cape Fear Valley oncologist had experience opening a clinic from the ground up. Cape Fear Valley administrators then put a plan in motion to help him bring patients back. The plan included providing experienced physicians, expert staff and convenient access to several services. They include chemotherapy, an onsite pharmacy, lab, support programs, oncology social workers and dietitians. It worked. Within six months, Dr. Devasthali and his new team were seeing more than 700 patient visits a month. The rapid growth led to another oncologist and mid-level provider being hired. Growth Trends Cancer treatment services have grown nationwide, as more advanced treatment options became available. Even patients with cancers once thought untreatable now have options. Twenty yeas ago, people with advanced cancer would have died within a year, Dr. Devasthali said. Now we re seeing patients live for years with more effective treatments. The growth in cancer treatment led to Cape Fear Valley s decision to build a full-service cancer center at Central Harnett Hospital in Lillington. Slated to open in 2018, the facility will be located behind the main hospital and offer an array of services. They will include diagnostic imaging, radiation therapy, chemotherapy and infusion therapy with onsite pharmacy, social workers and cancer survivor support. It will serve as a one-stop shop for cancer patients. Cape Fear Valley s own Cancer Center in Fayetteville is also seeing a steady increase in patients. Starting last summer, the center s Radiation Oncology department went from treating 80 to 90 patients a day to 130. The surge came after a fire temporarily closed Gibson Cancer Center in Lumberton.

6 Integrating so many patients at once wasn t a simple task, said Margaret Coates, Radiation Oncology Clinical Manager. But our team knew these patients had to be helped. Cape Fear Valley took on most of the Gibson Cancer Center patients within a week of the fire. That allowed patients to resume radiation therapy treatments without disruption. Taking on new patients normally takes weeks, but Cape Fear Valley physicians and staff worked around the clock to make it happen. The health system s Medical Oncology program has also grown in recent years. Since 2012, patients receiving chemotherapy and infusion therapy at Cape Fear Valley s main Fayetteville campus rose from 22 patients per day to 54, more than doubling patient volumes. All the growth has forced Cape Fear Valley to take a hard look at expanding and upgrading equipment at its Cancer Treatment and CyberKnife Center. The in-house pharmacy was already expanded last year. Next on the upgrade list is the Medical Oncology unit s infusion space. Built in 1981, the space will eventually offer eight new infusion chairs. An old linear accelerator used for treatment by the Radiation Oncology department will also be replaced. 6 Twenty yeas ago, people with advanced cancer would have died within a year, now we re seeing patients live for years with more effective treatments. In time, Highsmith-Rainey Specialty Hospital s Lung Nodule Clinic will be relocated closer to the Cancer Treatment and CyberKnife Center. The change is being made for greater patient convenience and coordinated care. The move will be a challenge, because space at the main Cancer Center s Fayetteville campus is already at a premium. But Hall feels it will be well worth it. All the groundwork being laid now, she said, will eventually provide more convenience and greater capacity for growth at the Cancer Center. With cancer incidence rates increasing every year, the Cancer Center will be ready.

7 U.S. cancer incidence rates continue to climb, but so has the survival rate, thanks to a greater emphasis on catching and treating the disease early. Mammograms help detect breast cancer, while colonoscopies can do the same for colon cancer. But detecting early stage lung cancer has traditionally been more difficult. That s because there was no widely accepted screening tool for the disease until recently. The American Society of Clinical Oncologists now recommends smokers and former smokers receive annual low-dose CT scans to check for developing lung problems. These scans are far more accurate at showing small abnormalities, which normal X-rays can miss. With these new guidelines, said Angie Syphrit, we have a screening tool in place that can potentially help us cure a patient s cancer, rather than just offering palliative care once the disease is too far advanced. Syphrit is Cape Fear Valley Health s Lung Nodule Coordinator. It s her job to be the single point of contact between patients and their families and the health system s Lung Nodule Clinic team. The role includes explaining unfamiliar terms and treatments to patients, guiding them through the treatment process and helping them access the various treatment resources available. The goal is to catch possible tumors at their smallest and most curable state. Doing so can save lives. In 2015, roughly 221,000 new lung cancers were diagnosed in the U.S., according to the American Cancer Society. More than 158,000 Americans died from the disease that same year. Active smokers and former longtime smokers, age 55 to 74, are urged to get lung cancer screening. Low-dose CT scans are usually covered by insurance for this age group. Benign nodules require no treatment, other than monitoring for changes over time. Malignant nodules can be treated through radiation therapy, traditional surgery or CyberKnife robotic surgery. Syphrit and her team at Cape Fear Valley s Lung Nodule Clinic provide follow-up care, no matter the screening outcome. Closely monitoring any changes we see in the tumors, helps us stay ahead of the cancer fight, Syphrit said. It s exciting to finally have a tool that gives so many smokers access to treatment options in the cancer s early stages.

8 Non-Small Cell Lung Cancer at Cape Fear Valley Health patient outcome analysis north carolina statistics About 6,800 new cases of non-small cell lung cancer are diagnosed each year in North Carolina. About 3900 of these are in males, with the remaining 2,900 cases are in women. The age-adjusted mortality rate in North Carolina in 2006 was 59.6, which is higher than the national average of 51.5 national statistics In the United States, non-small cell lung cancer (NSCLC) accounts for over 221,000 cases each year, making it the second most commonly diagnosed cancer after breast cancer. However, it is by far the most common cause of death from cancer in both men and women, resulting in 151,000 deaths, more than prostate, breast and colorectal cancer combined. Lung cancer accounts for about 27% of all cancer deaths. Rates for new lung and bronchus cancer cases have been falling on average 1.7% each year over the last 10 years. Death rates have not changed significantly over Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with lung cancer are 65 or older; fewer than 2% of all cases are found in people younger than 45. The average age at the time of diagnosis is about 70. non-small cell lung cancer at cape fear valley health system for 2007 During the study period of 2007, a total of 165 new cases of non-small cell lung cancer were diagnosed at Cape Fear Valley Health System. The cases were split evenly between males and females, with 83 and 82 patients, respectively. Only 1% of patients were younger than 40. Seven percent were between 40 and 49, 17% were between the ages of 50 and 59. The largest single age group was those between 60 and 69, comprising 35% of patients. Those between 70 and 70 made up 30% of the patient population, while those over 80 represented 8% of the group. Eighty-one percent of the above patients were residents of Cumberland County. Robeson County residents accounted for 6 percent while Sampson, Harnett and Lee County residents accounted for four percent, three percent and three percent, respectively. Caucasians accounted for 71 percent of cases, African- Americans made up 25 percent, and American-Indians about one percent. Two percent of patients were listed as unknown ethnicity. Patients diagnosed with Stage I disease accounted for 18% of the patient population, eight percent had Stage II, 31 percent had Stage III, while 39% percent of patients had Stage IV 8

9 NSCLC. In two percent of patients the stage was unknown. This compares with national data reported by the National Cancer Institute (NCI), which reports 16 percent being localized (confined to primary site, which would include stage I and II), 22 percent regional (spread to regional lymph nodes), and 57 percent being metastatic at the time of diagnosis, and 5% with unknown stage. The two most common histologic subtypes found in this patient population were adenocarcinoma which comprised 36% of the group, and non-specified non-small cell histology with also 36 %. Squamous cell carcinomas were 18%, and large cell carcinomas were 2%. treatment trends by stage at cape fear valley health system All stage I patients received definitive (as opposed to palliative) treatment. Surgery was the most common single modality used, with 15 patients in this group. Chemo-radiation was the second most common with 6 patients out of a total of 30 stage I patients. For stage II, surgery and chemotherapy (with or without radiation) was used in 7 of the 14 patients. In the 52 patients diagnosed with stage III NSCLC, chemo-radiation was used in 25 patients, with an additional 8 receiving radiation alone. Thirty of the 64 stage IV patients received chemotherapy as part of their treatment regimen overall survival The overall survival for patients with Stage I disease was 48 percent, for Stage II it was 29 percent, for Stage III it was 12 percent, and for Stage IV it was 3 percent. This compares favorably with national statistics, reported by the American College of Surgeons National Cancer Database, which reports a range of 47 to 48 percent overall survival for Stage I, 28 to 29 percent survival for Stage II, 12 percent for Stage III and 2.6 percent overall survival for Stage IV. Cancer Registry Overview The Cape Fear Valley Health System Cancer Registry is designed for the collection, management, analysis and distribution of information on all reportable malignancies diagnosed or treated at our health system. The registry also helps assess the effectiveness of treatment for cancer by gathering treatment information and lifetime follow-up of our patients. As required by law, newly diagnosed cancer cases are reported to the North Carolina Central Cancer Registry. The data submitted to NCCCR is shared with the American Cancer Society, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Cancer case information is also submitted to the National Cancer Database (NCDB) of the American College of Surgeons Commission on Cancer. The data gathered here is combined with data from our state and across the nation to study patterns of treatment and care. In 2014, 1,426 cases were added to the Cape Fear Valley Health System Cancer Registry database, excluding localized squamous cell and basal cell carcinoma of the skin and carcinoma in situ of the cervix. Of that total 1,311 were newly diagnosed cases. Statistics on recurrence, subsequent treatment and disease status are maintained in the database. The Cancer Registry annually performs lifetime follow-up on all cancer patients diagnosed and or treated at Cape Fear Valley Health System. This directly benefits the patients by reminding the physician and patient of needed regular checkups. Continued surveillance ensures early detection of a possible recurrence or a new malignancy. The Cancer Registry is required to maintain a 5 year follow-up rate of 90 percent. The Cancer Registry appreciates the prompt response to requested follow-up information from area physicians to help us met this required standard from the American College of Surgeons Commission on Cancer.

10 Cancer Statistics Top 5 Sites from Breast 329 Lung 218 Colon 98 Prostate 98 Bladder Breast 278 Lung 212 Prostate 96 Colorectal 85 NHL Breast 296 Lung 248 Prostate 135 Colorectal 109 NHL Breast 285 Lung 215 Prostate 167 Colorectal 131 NHL Breast 275 Lung 210 Colorectal 102 Prostate 86 NHL Diagnosis by County harnett 5% 2014 Cancer Cases by Sex Female 59.65% Male 40.35% hoke 3% robeson 1% cumberland 75% 2014 Cases by Race bladen 4% other 12% 2014 Age at Diagnosis age count percent % % % % % % % % Unknown 0 0% Total 1, % 55.61% 39.13% 2.29% 2.97% 729 cases 513 cases 30 cases 39 cases 10 caucasian african american american indian aleutian or eskimo other

11 2014 Cancer Cases united states* cape fear valley health type # % # % Prostate 233,000 27% 98 18% Lung & Bronchus 116,000 14% % Colon & Rectum 71,830 8% 52 10% Urinary Bladder 56,390 7% 33 6% Melanoma of Skin 43,890 5% 14 3% Men Kidney & Renal Pelvis 39,140 5% 7 1% Non-Hodgkin Lymphoma 38,270 4% 22 4% Oral Cavity 30,220 4% 12 2% Leukemia 30,100 4% 19 4% Liver & Intrahepatic Bile Duct 24,600 3% 10 2% All Other Sites 171,780 19% % Total for Men 855, % % Breast 232,670 29% % Lung & Broncus 108,210 13% % Colon & Rectum 65,000 8% 60 8% Uterine Corpus 52,630 6% 11 1% Thyroid 47,790 6% 31 4% Women Non-Hodgkin Lymphoma 32,530 4% 21 3% Melanoma of Skin 32,210 4% 4 1% Kidney & Renal Pelvis 24,780 3% 6 1% Pancreas 22,890 3% 19 2% Leukemia 22,280 3% 13 2% All Other Sites 169,330 21% % Total for Women 810, % % Excludes basal and squamous cell skin cancers and insite carcinoma except urinary bladder. * American Cancer Society 2014 Facts & Figures. statistics

12 Summary by Body System, Sex, Class, Status and Best AJCC Stage Report sex class primary site total (%) male female analy na ORAL CAVITY & PHARYNX 23 (1.6%) Tongue 9 (0.6%) Salivary Glands 4 (0.3%) Gum & Other Mouth 1 (0.1%) Tonsil 3 (0.2%) Oropharynx 4 (0.3%) Hypopharynx 2 (0.1%) DIGESTIVE SYSTEM 261 (18.3%) Esophagus 16 (1.1%) Stomach 29 (2.0%) Small Intestine 11 (0.8%) Colon Excluding Rectum 75 (5.3%) Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid 43 (3.0%) Rectosigmoid Junction Rectum Anus, Anal Canal & Anorectum 17 (1.2%) Liver & Intrahepatic Bile Duct 15 (1.1%) Liver Intrahepatic Bile Duct Gallbladder 3 (0.2%) Other Biliary 5 (0.4%) Pancreas 45 (3.2%) Retroperitoneum 1 (0.1%) Peritoneum, Omentum & Mesentery 1 (0.1%) RESPIRATORY SYSTEM 250 (17.5%) Nose, Nasal Cavity & Middle Ear 1 (0.1%) Larynx 16 (1.1%) Lung & Bronchus 233 (16.3%) SOFT TISSUE 5 (0.4%) Soft Tissue (including Heart) 5 (0.4%) SKIN EXCLUDING BASAL & SQUAMOUS 19 (1.3%) Melanoma - Skin 19 (1.3%)

13 status stage distribution analytic cases only alive exp stg 0 stg i stg ii stg iii stg iv 88 unknown blank/inv summary

14 sex class primary site total (%) male female analy na BREAST 346 (24.3%) Breast 346 (24.3%) FEMALE GENITAL SYSTEM 69 (4.8%) Cervix Uteri 13 (0.9%) Corpus & Uterus, NOS 38 (2.7%) Ovary 12 (0.8%) Vagina 1 (0.1%) Vulva 2 (0.1%) Other Female Genital Organs 3 (0.2%) MALE GENITAL SYSTEM 130 (9.1%) Prostate 125 (8.8%) Testis 4 (0.3%) Penis 1 (0.1%) URINARY SYSTEM 59 (4.1%) Urinary Bladder 44 (3.1%) Kidney & Renal Pelvis 15 (1.1%) BRAIN & OTHER NERVOUS SYSTEM 20 (1.4%) Brain 16 (1.1%) Cranial Nerves, Other Nervous System 4 (0.3%) ENDOCRINE SYSTEM 38 (2.7%) Thyroid 36 (2.5%) Other Endocrine including Thymus 2 (0.1%) LYMPHOMA 48 (3.4%) Hodgkin Lymphoma 3 (0.2%) Non-Hodgkin Lymphoma 45 (3.2%) Non-Hodgkin Lymphoma - Nodal Non-Hodgkin Lymphoma - Extranodal MYELOMA 46 (3.2%) Myeloma 46 (3.2%) LEUKEMIA 37 (2.6%) Lymphocytic Leukemia 12 (0.8%) Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Myeloid & Monocytic Leukemia 23 (1.6%) Acute Myeloid Leukemia Chronic Myeloid Leukemia Other Leukemia 2 (0.1%) MESOTHELIOMA 2 (0.1%) Mesothelioma 2 (0.1%) MISCELLANEOUS 73 (5.1%) TOTAL 1, ,

15 status stage distribution analytic cases only alive exp stg 0 stg i stg ii stg iii stg iv 88 unknown blank/inv summary

16 cape fear valley cancer treatment and cyberknife center 1638 Owen Drive, Fayetteville, NC Medical Oncology: (910) Radiation Oncology: (910) health pavilion north cancer center 6387 Ramsey Street, Fayetteville, NC Phone: (910) cape fear valley cancer center at harnett 805-C Tilghman Drive, Dunn, NC Phone: (910)