2017 Community Cancer Program Annual Report. Medical oncology provided in collaboration with Dana-Farber Cancer Institute/ Dana-Farber Community Care.

Transcription

1 07 Community Cancer Program Annual Report Medical oncology provided in collaboration with Dana-Farber Cancer Institute/ Dana-Farber Community Care.

2 Table of Contents CHAIRMAN S REPORT... PAGE CANCER REGISTRY DATA...PAGE 4 CANCER BY SITE...PAGE 5 CANCER CASES ACCESSIONED...PAGE 5 CANCER CASES BY GENDER...PAGE 6 SUPPORT SERVICES...PAGE 7 CANCER PROGRAM PRACTICE PROFILE REPORTS (CPR)...PAGE 9 THYROID/PARATHYROID SURGERY IN THE MERRIMACK VALLEY...PAGE 0 HYPOFRACTIONATION FOR BREAST RADIATION THERAPY...PAGE EXPERTS IN EARLY DETECTION...PAGE TOBACCO CESSATION FOR LUNG CANCER PATIENTS...PAGE NUTRITIONAL INTERVENTION FOR GASTROINTESTINAL CANCER PATIENTS...PAGE 4 CANCER PROGRAM SERVICES DIRECTORY...PAGE 5 COMMUNITY OUTREACH HIGHLIGHTS...PAGE 6 Page Lawrence General Hospital 07 Community Cancer Program Annual Report

3 Chairman s Report On behalf of Lawrence General Hospital, the Cancer Committee is proud to present the 07 Annual Community Cancer Program Report.* Our Cancer Program is an accredited program with the American College of Surgeons (ACoS), Commission on Cancer (CoC). Applying for and maintaining CoC approval is a voluntary commitment by a cancer program that ensures its patients will have access to the full scope of services required to diagnose, treat, rehabilitate, and support patients with cancer and their families. Receiving care at a CoC-accredited community cancer program ensures that patients will receive: Comprehensive care including a complete range of state-of-the-art services and equipment A multidisciplinary team approach to coordinate the best available treatment options Information about ongoing cancer clinical trials and new treatment options Access to prevention and early detection programs, cancer education, and support services A cancer registry that gathers data to comply with state and national cancer reporting requirements Ongoing monitoring and improvements in cancer care Quality care that is close to home The Cancer Program at Lawrence General Hospital is dedicated to providing patients with the highest quality care, offering a multidisciplinary approach. Patient care services for our oncology patients are monitored by the Cancer Committee, a group of physicians and other health care professionals involved in the treatment of cancer patients. During 06, over 0 cancer conferences were held, allowing for a prospective, multidisciplinary physician review of cancer cases, which includes the stage of the cancer, and discussion of treatment options to improve patient care. The top cancer sites are discussed at the multidisciplinary conferences with specialized cancer conferences for Breast and Thyroid/Parathyroid cases. The treatment options discussed follow the National Comprehensive Cancer Network (NCCN) treatment guidelines, which are updated regularly to recommend the most recent treatment protocols for specific cancer sites. Multidisciplinary experts work together to achieve the best possible outcomes. Our specialists include dedicated physicians, surgeons, nurses, therapists, dietitians, social workers, pharmacists, and other allied health professionals. Medical Oncology services are provided in collaboration with world-renowned Dana-Farber Community Cancer Care, which provides our cancer patients with cancer treatment that includes blood and platelet transfusion, chemotherapy, genetic consultations, access to clinical trials, and a cancer survivorship program for surveillance of patients who have completed their cancer treatment. With our strong commitment to excellence, we strive to continue to provide the best quality of care for patients within the community. Respectfully submitted, Pedro Sanz-Altamira, MD, PhD Cancer Committee Chair *Based on 05/06 data Lawrence General Hospital 07 Community Cancer Program Annual Report Page

4 Cancer Statistics at Lawrence General Hospital 06 Cancer Registry Data In 06, 99 cancer cases were newly identified and abstracted into the cancer registry database. The tables below identify the cancer sites and gender distribution, focusing on the top five sites. PRIMARY SITE ORAL CAVITY & PHARYNX Tongue Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Other Oral Cavity & Pharynx DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon Excluding Rectum Cecum Appendix Tranverse Colon Ascending Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid Rectosigmoid Junction Rectum Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Other Billary Pancreas Other Digestive Organs TOTAL CASES PRIMARY SITE MALE GENITAL SYSTEM Prostate Testis Penis URINARY SYSTEM Urinary Bladder Kidney & Renal Pelvis BRAIN & OTHER NERVOUS SYSTEM Cranial Nerves ENDOCRINE SYSTEM Thyroid LYMPHOMA Hodgkin Lymphoma Non-Hodgkin Lymphoma NHL - Nodal NHL - Extranodal MYELOMA Myeloma TOTAL CASES RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus SOFT TISSUE Soft Tissue (Including Heart) 9 6 LEUKEMIA Lymphocytic Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Myeloid & Monocytic Leukemia Acute Myeloid Leukemia Chronic Myeloid Leukemia 6 SKIN (Excluding Basal & SQUAMOUS) Melanoma - Skin Other Non-Epithelial Skin BREAST Breast FEMALE GENITAL SYSTEM Corpus & Uterus, NOS Ovary Vulva Other Female Genital Organs MISCELLANEOUS Miscellaneous Page 4 Lawrence General Hospital 07 Community Cancer Program Annual Report TOTAL

5 Cancer Statistics at Lawrence General Hospital 06 Cancer by Site 06 Cancer Cases Accessioned Lawrence General Hospital 07 Community Cancer Program Annual Report Page 5

6 Cancer Statistics at Lawrence General Hospital 06 Cases by Gender Page 6 Lawrence General Hospital 07 Community Cancer Program Annual Report

7 Support Services NUTRITION Food and Nutrition Services are provided to all Lawrence General Hospital cancer patients. They are screened for nutritional risk on admission by a registered nurse and are further evaluated by a registered dietitian. Clinical dietitians offer practical tips for eating healthy during treatment and explore symptom management strategies with patients and their families. For patients in good nutritional status, the dietitian will review the importance of maintaining a balanced diet, which may include protein, whole grains, legumes, vegetables, fruits, and essential fatty acids. If a patient has lost weight and is determined to be at nutritional risk, the dietitian will devise a plan to enhance the patient s oral intake. The dietitian teaches patients how to increase the caloric and protein density of foods and recommends appropriate liquid supplements or multi vitamins as part of a comprehensive diet plan. Meals and between meal nourishment are provided based on each patient s individual needs and preferences. When necessary, nutrition support is administered. Patients may also be referred for continuing nutrition therapy with the outpatient dietitian. SOCIAL SERVICES The integrated care department, which consists of Case Management and Social Service, provides counseling and support for patients and families. Crisis intervention is also provided as necessary. They provide information and referrals to community support groups, and resources for supportive services such as financial and transportation assistance. The department coordinates discharge planning, which includes long-term care placement; hospice and home care services including Visiting Nurse Association, home infusion, and durable medical equipment. Social Services also participate in employee support efforts and services. PHARMACY The Pharmacy Department at Lawrence General Hospital is an integral part of the multidisciplinary team approach to planning, providing, and evaluating the care delivered to cancer patients. The Pharmacy Department provides up-todate chemotherapy treatment modalities for inpatient and outpatient care. Patients are closely monitored from visit to visit to ensure accurate dosing of all agents prescribed. Any significant change in the patient s weight would necessitate a change in their dose of chemotherapeutic agent. Patient leaflets are also provided containing the brand and generic names of the medications, uses, how to use medications, side effects and when to notify your doctor, precautions, and drug interactions. SPIRITUAL SERVICES The chaplains of Lawrence General Hospital provide spiritual, emotional, and sacramental support to cancer patients and their families. The chaplains collaborate with the multidisciplinary team by attending multidisciplinary rounds to provide comprehensive spiritual care. Lawrence General Hospital has a team of chaplains which include an Interfaith, Catholic, Protestant and Latino chaplain. A Rabbi is available when needed. Catholic priests are available on a daily basis to provide sacramental services. Eucharistic Ministers volunteer to bring communion to patients on a daily basis as well. What you can expect from the Chaplains: Prayer/Sacraments Confidentiality Compassionate listening Regular visits Spiritual support for Individuals andfamilies Linking Individuals and families with staff Religious services, sacraments, prayers Information and guidance regarding medical ethics questions, health care proxies, organ donation, end-of-life care decisions, and questions concerning spiritual care Grief ministry in dealing with loss or death Prayer Shawl Ministry Lawrence General Hospital 07 Community Cancer Program Annual Report Page 7

8 Support Services continued. PALLIATIVE CARE Palliative care is the comprehensive care and management of the physical, psychological, emotional and spiritual needs of patients (off all aged) and their families with serious and/or life-threatening illness. Palliative care may be complementary to curative or life-prolonging therapies that are being used to meet patient-defined goals of care. The palliative care team works to: Optimize symptom control Optimize functional statues when appropriate Promote the highest quality of life for patient and family Educate patient and family about understanding in goals of care, underlying disease trajectory, and future course of the illness Assist actively dying patients and their families in preparing and managing life closure Evaluate and alleviate pain, suffering, and other intractable symptoms as high priorities Advocate access to therapies that are reasonable expected to improve patient quality of life and goals of cares Provide access to excellent hospice services transition and end of life care conversations Grief ministry in dealing with loss or death Prayer Shawl Ministry Page 8 Lawrence General Hospital 07 Community Cancer Program Annual Report

9 Cancer Statistics at Lawrence General Hospital General Hospital 05 Cancer Program Practice Profile Reports Primary Site Year Target Score Measure Specifications Breast MAC 05 N/A Surveillance 00% Combination chemotherapy is considered or administered within 4 months (0 days) of diagnosis for women under 70 with AJCC TcN0M0, or stage IB-III hormone receptor negative breast cancer - Accountability MASTRT 05 90% 00% Radiation therapy is considered or administered following any mastectomy within year (65 days) of diagnosis of breast cancer for women with 4 positive regional lymph nodes - Accountability HT 05 90% 94% Systemic therapy 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 pathologic lymph node positive (pn) and (pn) NSCLC - Quality Improvement nbx 05 80% 96.6% Systemic therapy 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 pathologic lymph node positive (pn) and (pn) NSCLC - Quality Improvement Colon ACT 05 N/A Surveillance 00% Adjuvant chemotherapy is considered or administered within 4 months (0 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer - Accountability RLN 05 85% 00% At least regional lymph nodes are removed and pathologically examined for resected colon cancer - Quality Improvement Lung LCT 05 85% 00% Systemic therapy 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 pathologic lymph node positive (pn) and (pn) NSCLC - Quality Improve- Lawrence General Hospital 07 Community Cancer Program Annual Report Page 9

10 Modern Thyroid and Parathyroid Surgical Care in the Merrimack Valley The Thyroid/Parathyroid Committee was formed in the fall of 0 at Lawrence General Hospital and is comprised of thyroid surgeons, endocrinologists, pathologists, radiologists, nuclear medicine physicians, radiation oncologists, and medical oncologists. Meetings provide a review of modern thyroid and parathyroid surgical care and a stimulating exchange of ideas and management strategies that will not only be invaluable for the patients that were discussed, but for future patients as well. Many of the salient points are from recent guidelines established by the American Thyroid Association, as well as various recent peer-reviewed publications on thyroid cancer and parathyroid surgery. The objectives of the meetings include reviewing the most up-to-date outcome data on thyroid cancer and surgical intervention, understanding indications for postoperative radio-iodine treatment in our thyroid cancer patients, and ensuring that all members are following nationally accepted standardized guidelines for thyroid and parathyroid surgical patients. Lawrence General s new state-of-the-art surgical suites, which opened in 07, will complement the Cancer Committee s innovative approach to thyroid and parathyroid surgeries. Some of the recent technological advances in thyroid/parathyroid surgery include: Recurrent laryngeal nerve monitoring to reduce the risk of injury to vocal cord function Harmonic scalpel use to help with the minimally invasive approach to surgery Rapid parathyroid hormone evaluation to definitively determine successful parathyroid adenoma surgery and to help prognosticate for hypocalcemia in patients after total thyroidectomy Suture-less and water proof surgical incisions using dermal adhesives Fully equipped operating room suites with the latest in lighting and audiovisual equipment Page 0 Lawrence General Hospital 07 Community Cancer Program Annual Report

11 Hypofractionation for Breast Radiation Therapy By Claire Fung, MD Breast cancer accounts for about a third of cancer diagnoses at Lawrence General Hospital. Majority of patients have early stage disease at diagnosis and are treated with breast conservation surgery followed by adjuvant breast radiotherapy. Radiotherapy utilizes an X-ray beam directed at the breast tissue and is painless. The goal of radiation is to help reduce the chances of cancer recurrence. Radiotherapy is an outpatient treatment given five days a week. In the past, breast radiotherapy required 0- sessions given over 6 6½ weeks (known as conventional fractionation.) The current practice utilizes evidence-based hypofractionation, which allows treatment to be completed in 0 sessions over 4 weeks, which is significantly shorter. Hypofractionation is proven to provide equal cancer control and cosmetic outcome compared to conventional fractionation, with added benefits of reduced radiation-associated dermatitis and fatigue. Hypofractionation also has socio-economic benefits including less inconvenience due to fewer treatment visits, less time away from family and work, and lower transportation and other logistics-related costs. This patient-centered hypofractionation approach, which is in full compliance with the American Society of Radiation Oncology (ASTRO) and the National Comprehensive Cancer Network (NCCN) practice guidelines, provides our breast cancer patients with up-to-date technologically advanced radiation treatments. Experts in Early Detection By Lawrence General Hospital Staff When it comes to the early detection of breast, lung, and colon cancer, Lawrence General Hospital is counted among the best hospitals in the country. According to the Commission on Cancer of the American College of Surgeons, Lawrence General Hospital exceeds the national average for catching these cancers in the earliest stages, greatly improving the chances for successful treatment. The key to our success is patient education, outreach into the community, and the availability of the most current diagnostic techniques, says oncologist Pedro Sanz-Altamira, MD, from Dana-Farber Community Cancer Care, who also serves as medical director of the Lawrence General Hospital cancer program. Lawrence General is excelling in all of these areas. Primary care physicians in the region play a particularly important role, says Dr. Sanz-Altamira, providing education to patients about cancer prevention and emphasizing the importance of regular screenings. Lawrence General Hospital also hosts regular community events around the Merrimack Valley that provide both education and screening opportunities for the general public. Lawrence General Hospital 07 Community Cancer Program Annual Report Page

12 Tobacco Cessation for Lung Cancer Patients The Community Health Needs Assessment completed by Lawrence General Hospital in 0 found the smoking rate in the city of Lawrence (9.4%) to be higher than the State of Massachusetts (5.8%). Overall, Haverhill holds the highest percentage at %, which is followed by Lawrence, and Methuen (7.8%). As for the percent of the population that speaks a language other than English at home in Massachusetts, Lawrence leads the way at 74.6%. The next service area is Methuen at 6.9% and Haverhill at 9.9%. As a whole, Massachusetts averages.4%. Lawrence General Hospital s data for smokers aligns with the current literature as evidenced by the percentage of the Lawrence General Hospital lung cancer population who use tobacco at the time of diagnosis. Documented continued use of tobacco for nearly half of the Lawrence General Hospital patient population after lung cancer diagnosis suggested an opportunity for active, timely interventions. Causes of Continued Use for Lung Cancer Patients Page Lawrence General Hospital 07 Community Cancer Program Annual Report

13 Tobacco Cessation for Lung Cancer Patients continued. Studies indicate that early tobacco cessation intervention after lung cancer diagnosis increases the success of the outcome of smoking cessation. Studies also conclude that smoking cessation after diagnosis of lung cancer leads to improved patient outcomes. In its study, Lawrence General Hospital found a gap in resources and the lack of standardized patient education related to tobacco cessation for lung cancer patients, and put an action plan in place:. Developed a point of care tobacco cessation intervention for lung cancer patients.. Trained a volunteer tobacco cessation specialist through the ACS/National Lung Association.. Developed bilingual educational items and resources for smoking cessation patient packets to distribute at clinic appointments. 4. Completed a trial for a volunteer to distribute materials regarding tobacco cessation and act as a liasion for patients requesting a referral for tobacco cessation. Lawrence General Hospital 07 Community Cancer Program Annual Report Page

14 Nutritional Intervention for Gastrointestinal Cancer Patients Over 50% of Lawrence General Hospital patients from 0 04 were at a gastrointestinal (GI) cancer stage II or greater, thereby likely experiencing chemotherapy with/without radiation in their treatment plan. In its study, Lawrence General Hospital found the gastrointestinal cancer patient population at Lawrence General Hospital, with its socio-economic status and cultural/linguistic differences, is not specifically targeted for proactive, preventative, nutritional education. Causes of Lack of Nutritional Intervention in Patients with Gastrointestinal Cancers The literature reflects a prevalence range of 50 80% for risk of malnutrition for cancer patients; this statistic aligns with the 65% of Lawrence General Hospital patients identified as moderate/high malnutrition risk. An action plan was developed:. Used evidence-based nutrition materials, created packets of patient education to maximize healthy nutrition during cancer treatment therapies (developed packets in English and Spanish).. Established documentation fields for patient readiness, appropriateness for preventative education, or reason for deferral in electronic patient medical record.. Trained dietician staff regarding proactive, preventative education and documentation. Page 4 Lawrence General Hospital 07 Community Cancer Program Annual Report

15 Lawrence General Cancer Program Services Directory Main Number: Please call during business hours, weekdays 8:00 am to 4:0 pm. TO ASK ABOUT SERVICES OFFERED CONTACT INFORMATION Breast Care Center Bone Density Breast Self-Examination Education Breast Ultrasounds Digital Mammograms Ductograms FNA Mammography Needle Localization Sentine Node Injection Surgeon Consultations Ultrasound Guided Core Biopsy Ultrasound Guided Cyst Aspirations Breast Navigator Women s Health Imaging D Tomosynthesis Mammography at Andover Medical Center Bone Densitometry Ultrasound Diagnostics & Labs Greater Lawrence Family Health Center D Tomosynthesis Mammography Gynecological Surgical ext. 840 Oncology Clinic Methuen Family Health Center D Tomosynthesis Mammography Minimally Invasive Thoracic ext. 850 Surgery Clinic Cancer Registry ext. 84 Hematology/ Oncology at Dana Farber Community Cancer Care Nuclear Medicine Radiology Services New England PET Imaging Systems Rehabilitation Services ext. 06 Support Services Nutritional Services ext. 584 Social Services ext. 550 Palliative Care ext. 0 Wound Clinic ext. 0 Lawrence General Hospital 07 Community Cancer Program Annual Report Page 5

16 06 Community Outreach Highlights Oral, Head and Neck Screening April 4, 06 Dr. Yookyung Selig, Ambulatory Care Center Skin Cancer Prevention and Cancer Awareness Event August, 06 Eisai Corporation, Andover, MA This proved to be a very successful prevention program. Patients were marketed to via printed posters, Spanish radio, hospital website, Facebook and Twitter. 0 walk-in/nonscheduled patients were able to be screened. Educational materials were distributed to all patients. American Cancer Society s Relay for Life Methuen/Merrimack Valley, Lawrence General Hospital Life Gives Hope team May, 06 Methuen High School Community members and participants were given educational material on cancer support services provided at the hospital. The event fostered awareness and support to patients and families in the community battling cancer. Exceeded fundraising goal raising over $,000 and counting. More than 5 team members. Skin Cancer Prevention and Cancer Awareness Event June, 06 Lawrence General Hospital, main lobby This event saw a noticeable increase attendance by patients in the community, compared to years past, due to change in location to hospital main lobby. Onsite American Cancer Society representatives present with skin analyzer. Many attendees indicated they would change their behaviors and/or share this information with a friend/family member. Onsite American Cancer Society representatives present with a skin analyzer. Many attendees indicated they would change their behaviors and/or share this information with a friend/ family member. The Great American Smokeout Smoking Cessation Awareness Prevention and Education November 7, 06 Lawrence General Hospital, main lobby American Cancer Society and Massachusetts Quit Works educational materials given out. Having a trained smoking cessation in attendance was beneficial. Many attendees indicated they would change their behaviors and/or share this information with a friend/family member. Prostate Health Screening November 0, 06 Lawrence General Hospital, main lobby This event was in collaboration with the Community s Mayor s Health Task Force in Lawrence and promoted via local Spanish radio ads, social media, and print advertising. The goal was to educate those in the surrounding community about their risk of prostate cancer through a free cancer screening. Page 6 Lawrence General Hospital 07 Community Cancer Program Annual Report

17 One General Street Lawrence, MA lawrencegeneral.org Lawrence General Hospital has been a vital part of the Merrimack Valley since 875, and is a leader in delivering quality, affordable, patient-centered health care. Lawrence General Hospital is clinically affiliated with Beth Israel Deaconess Medical Center and with Floating Hospital for Children at Tufts Medical Center.