2013 ANNUAL CANCER REPORT

Transcription

1 213 ANNUAL CANCER REPORT

2 CONTENTS EXECUTIVE SUMMARY 1 CANCER PROGRAM OUTCOMES Cancer Volume for the System 1 Cancer Volume by Hospital Location 2 COMMISSION ON CANCER ACCREDITATION AND THE NATIONAL CANCER DATA BASE OUTCOMES 3 National Cancer Data Base Outcomes 3 Survivorship 5 CANCER PROGRAMS, CREATING PERSONALIZED CARE FOR EACH PATIENT 6 Patient Navigation, Helping You Along Your wcancer Journey 6 Thoracic Surgical Services on Kaua i 6 Robotic Assisted Cancer Surgery 7 Survivorship Program Expansion 8 Bone Marrow Transplant; Taking Care of Hawai i s Children 8 Clinical Research, Advancing Cancer Care 9 THE FUTURE OF CANCER CARE AT HAWAI I PACIFIC HEALTH 9

3 EXECUTIVE SUMMARY In 213 Hawai i Pacific Health continued to grow its cancer services for the community, while also investing time and resources into important clinical trial research and quality outcomes. These efforts allow us to provide better clinical care to each cancer patient we serve. Hawai i Pacific Health is an integrated health care system and Hawai i s largest health care provider. The system includes: Kapi olani Medical Center for Women & Children, Pali Momi Medical Center, Straub Clinic & Hospital, and Wilcox Memorial Hospital. As a not-for-profit health care system, Hawai i Pacific Health is committed to providing exceptional service and the highest quality of cancer care. We provide this through our four community-based hospitals, network of outpatient clinics, and over 1, affiliated physicians. What makes cancer care special at Hawai i Pacific Health is the ability to leverage programs, which result in better care to each patient, every time. These services include: specialized clinical knowledge, such as having the only pediatric cancer program (including bone marrow transplant) in the state of Hawai i, cutting edge technology, a shared electronic health record, and an integrated multi-disciplinary approach to cancer care delivery. This year s cancer program report reflects the tremendous growth experienced in programs and services in 213, as well as statistical data from the 212 registry data year. CANCER PROGRAM OUTCOMES Cancer Volume for the System Data from the 212 registry year demonstrates that as a system, Hawai i Pacific Health supported a total analytical case volume (number of cancer cases treated) of 1,778 diagnosed cancer cases. As has been the trend for some time, breast cancer was the most commonly diagnosed cancer type across the system. However, while breast cancer remains the top cancer type at each hospital, each of the four community hospitals have a unique and diverse population base. This is reflected in the differences in the top five analytical case volumes (or most commonly seen cancer types) seen at each hospital. Total Analytical Case Volume 12% 2% Kapi olani Pali Momi Straub Wilcox Top Five Analytical Cases for Hawai i Pacific Health System 2 2 Kapi olani Pali Momi Straub Wilcox % 27% Breast Lung Colon Prostate Uterus The pie chart above reflects the total number of cancer cases diagnosed across Hawai i Pacific Health during calendar year 212. The volume is broken out by hospital location only. Source: 212 Cancer Registry Data. The chart above compares, by hospital location, the top five cancer sites (or types) diagnosed across Hawai i Pacific Health. These are broken out by both hospital location and cancer type. Source: 212 Cancer Registry Data. 213 ANNUAL CANCER REPORT 1

4 Cancer Volume by Hospital Location Cancer types at each hospital within the Hawai i Pacific Health system vary based on patient populations and the location of the hospital. In this section, the top five analytical cases for each hospital is reviewed. These are reflective of the five most common cancer types seen at each hospital and do not reflect all cancer case volume and cancer case types at each location. Kapi olani Top Five Analytical Cases Pali Momi Top Five Analytical Cases Breast Uterus Pediatric (all) Cervix Ovary Breast Lung Colon Thyroid Pancreas Kapi olani Medical Center for Women & Children is home to the State s only Pediatric Cancer Program and Women s Cancer Center. The above chart reflects the top five cancer case types diagnosed at Kapi olani and highlights the focused patient population. The overwhelming cancer type seen is breast, followed by uterine, cervical and ovarian. Additionally, all pediatric cases, regardless of cancer type, are counted together. Source: 212 Cancer Registry Data. Pali Momi Medical Center is a community hospital providing adult cancer care to the West and Central O ahu area. The above chart reflects the top five cancer case types diagnosed at Pali Momi. Source: 212 Cancer Registry Data. Straub Top Five Analytical Cases Wilcox Top Five Analytical Cases Breast Lung Prostate Hematopoietic Colon/ Skin (tie) Breast Lung Prostate Pancreas Hematopoietic Straub Clinic & Hospital is a community hospital in Honolulu providing care for the largest volume of cancer patients at any one hospital location, within the Hawai i Pacific Health system. The above chart reflects the top five cancer case types diagnosed at Straub. The multi-specialty nature of Straub Clinic & Hospital is demonstrated in the diverse tumor types diagnosed and treated. Source: 212 Cancer Registry Data. Wilcox Memorial Hospital cares for the largest volume of adult cancer patients on Kaua i. This allows patients to treat their cancer at home instead of traveling to O ahu or the U.S. mainland for treatment. The above chart reflects the top five cancer case types diagnosed at Wilcox. Source: 212 Cancer Registry Data ANNUAL CANCER REPORT

5 COMMISSION ON CANCER ACCREDITATION AND THE NATIONAL CANCER DATA BASE OUTCOMES Hawai i Pacific Health hospitals are accredited through the American College of Surgeons Commission on Cancer (CoC) Program. Wilcox Memorial Hospital is the most recent of the Hawai i Pacific Health hospitals to earn this status. Applying for and maintaining CoC accreditation is a voluntary commitment by each cancer program that ensures its patients will have access to the full scope of services required to diagnose, treat, rehabilitate and support patients and their families with their cancer care. Accreditation requires a cancer program to continually evaluate its performance, which reaffirms to the community the commitment of the cancer program to provide high-quality cancer care. The Cancer Program category to which each location is assigned is based on the services provided at the facility and the volume of cancer cases accessioned. Hawai i Pacific Health hospitals hold the following levels of accreditation through the CoC: Straub Clinic & Hospital: Comprehensive Community Cancer Program Pali Momi Medical Center: Community Cancer Program Kapi olani Medical Center for Women & Children: Community Cancer Program Wilcox Memorial Hospital: Community Cancer Program As CoC accredited programs, all four Hawai i Pacific Health hospitals submit data to the National Cancer Data Base (NCDB). The NCDB is a nationwide oncology outcomes database for more than 1, CoC accredited cancer programs. The data is used to explore trends in cancer care and to create benchmarks for participating CoC hospitals that serve as the basis for quality improvement by generating Cancer Program Practice Profile Reports (CP 3 R). The CP 3 R reports are accessed and reviewed on a regular basis by cancer program leaders at each of the Hawai i Pacific Health hospitals. This allows the teams to evaluate and assess their hospital performance level with national performance benchmarks, adherence to standard of care, and promote continuous quality improvement. The following quality measures demonstrate performance of the Hawai i Pacific Health hospitals as compared to national performance of CoC programs. National Cancer Data Base Outcomes Needle Biopsy Rate for Breast Cancer Kapi olani Pali Momi Straub CoC Approved Programs To allow for optimal treatment planning, it is preferred that the initial definitive diagnosis of breast cancer be obtained in the least invasive method possible. This typically involves needle biopsy, either by image guidance (stereotactic, ultrasound, or MRI), percutaneous core needle biopsy, or fine needle aspiration. The chart at left shows high utility of these methods, which results in excellent performance as compared to national data. Image or palpation-guided needle biopsy (core or FNA) is performed to establish diagnosis of breast cancer. Source: 211 CP 3R measure. 213 ANNUAL CANCER REPORT 3

6 Combination Chemotherapy for Breast Cancer Straub Wilcox Kapi olani CoC Approved Programs Most patients with hormone receptor breast cancer should receive combination chemotherapy within four months of diagnosis. The National Quality Forum (NQF) has identified this as a quality measure. The chart at left shows excellent performance for Hawai i Pacific Health sites as compared to national data. Combination chemotherapy is considered or administered within four months (12 days) of diagnosis for women under age 7 with AJCC T1cNM, Stage II or III hormone receptor negative breast cancer. Source: 211 CP 3R measure Lymph Node Surgical Excision Rate for Colon Cancer Wilcox Straub CoC Approved Programs The number of lymph nodes removed during surgical treatment of colon cancer has been identified as a quality measure in cancer surgery. The chart at left shows that the percentage of cases containing at least 12 lymph nodes with successful removal and pathological examination reached 1 percent at Wilcox and 96 percent for Straub, both well exceeding the national average of approved programs. At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Source: 211 CP 3R measure Radiation Therapy for Rectal Cancer Pali Momi Straub CoC Approved Programs The addition of radiation therapy to initial surgery in patients with locally advanced rectal cancer is an important part of multidisciplinary cancer care. The chart at left shows that this recommended combination therapy is administered 1 percent of the time for Hawai i Pacific Health programs. This frequency exceeds the national average of approved cancer programs. Radiation therapy is considered or administered within six months (18 days) of diagnosis for patients under age 8 with clinical or pathologic AJCC T4NM or Stage III and who are receiving surgical resection for rectal cancer. Source: 211 CP 3R measure ANNUAL CANCER REPORT

7 Survivorship A national database of cancer treatment outcomes, also known as survivorship, is maintained jointly by the American Cancer Society (ACS) and the American College of Surgeons Commission on Cancer (CoC). Each year, the National Cancer Database (NCDB) provides data to CoC participating hospitals to allow each institution to compare its survivorship with those obtained nationally. The charts below compare survivorship over a fiveyear period for patients seen at Straub Clinic & Hospital and Pali Momi Medical Center. Both Straub and Pali Momi have been collecting survivorship data for the required number of years in order to participate in the comparison reports. As Hawai i Pacific Health s newer CoC cancer programs, both Kapi olani Medical Center for Women & Children and Wilcox Memorial Hospital will be eligible to participate in the next few years. The data reflect patients who have had stage, 1, or 2 breast cancers, stage 3 or 4 lung cancers, and stage 1, 2 or 3 colon cancers. The charts compare outcomes at both Straub and Pali Momi with patients nationally who have had the same treatment for the same stages of their disease. At both Straub and Pali Momi, our survivorship exceeds the survival rate of patients treated at other cancer programs that report their data to the CoC. As seen in the charts below, there are times when there is insufficient data available to track survivorship. This is due to a low case volume of that specific stage for the five-year reporting period. Table 1.1 Breast Cancer Survival Rates for Pali Momi Medical Center and Straub Clinic & Hospital Stage of Disease National Rate Pali Momi Straub Stage 95.6% 97.4% 95.6% Stage % 98.8% 95.6% Stage % 96.4% 86.7% Table 1.1 at left reflects the survivorship rates for breast cancer patients at Pali Momi Medical Center and Straub Clinic & Hospital. For Stage O, 1 and 2, both Pali Momi and Straub are above the national survival rate for breast cancer survivors. Stage 3 and 4 are not listed because Pali Momi and Straub patient volume data were too small to display. Source: NCDB cases diagnosed in Table 1.2 Lung Cancer Survival Rates for Pali Momi Medical Center and Straub Clinic & Hospital Stage of Disease National Rate Pali Momi Straub Stage 3 1.7% insufficient cases to display data 22.4% Stage 4 2.4% 3.3% 3.3% Table 1.3 Colon Cancer Survival Rates for Pali Momi Medical Center and Straub Clinic & Hospital Stage of Disease National Rate Pali Momi Straub Stage % 88.1% insufficient cases to display data Stage % 62.6% 76.2% Stage % 63.6% insufficient cases to display data Table 1.2 at left reflects the survivorship rates for lung cancer patients at Pali Momi Medical Center and Straub Clinic & Hospital. For Stage 3, at a 22.4 percent survival rate, Straub has significantly surpassed the national survival rate of 1.7 percent. For Stage 4, Pali Momi and Straub are above the national survival rate of 2.4 percent. Stage, 1 and 2 are not listed because Pali Momi and Straub patient volume data were too small to display. Source: NCDB cases diagnosed in Table 1.3 at left reflects the survivorship rates for colon cancer patients at Pali Momi Medical Center and Straub Clinic & Hospital. For both Stage 1 and Stage 3, Pali Momi has surpassed the national survival rate. Straub has surpassed the national survival rate for Stage 2 colon cancer. Stage and 4 are not listed because Pali Momi and Straub patient volume data were too small to display. Source: NCDB cases diagnosed in ANNUAL CANCER REPORT 5

8 CANCER PROGRAMS, CREATING PERSONALIZED CARE FOR EACH PATIENT As the second largest provider of oncology care in the state, and the only provider for pediatric oncology, Hawai i Pacific Health continues to develop and advance several key cancer program initiatives to elevate and support patient care services across the system. The following are highlights from various new programs, services and partnerships that had an impact in the care Hawai i Pacific Health provides in the communities it serves. Patient Navigation, Helping You Along Your Cancer Journey Patient navigation refers to individualized assistance offered to patients, families and caregivers to help overcome health care system barriers, and facilitate timely access to quality medical and psychosocial care. Navigation can have a significant impact on the patients experience throughout their cancer treatment journey. Beginning in 215, patient navigation services will be a standard program offering for all CoC accredited cancer programs. However, with cancer patients in Hawai i facing unique geographical, economic, and care coordination factors, Hawai i Pacific Health has moved forward with an initiative to launch navigation services to all locations by 214. At present three of the four Hawai i Pacific Health hospitals have patient navigation programs in place, with the final program in planning and implementation stages for 214. Providing these programs two years prior to the requirement by the CoC ensures Hawai i Pacific Health is offering comprehensive, coordinated care to each cancer patient served, and reflects our commitment to the communities we serve. At Hawai i Pacific Health, patient navigation is modeled after the needs of patients, their family, and their community. The cancer patient navigator s job is to identify and eliminate barriers that prevent individuals from getting the right care, at the right time, and by the right program. Whether that involves educating a patient about the need for timely screening, assisting with access to health insurance, finding transportation to treatment, assistance with access to information about treatment options, or connecting patients to a support group; navigation services help patients and families navigate through their cancer journey. Thoracic Surgical Services on Kaua i In 213, Wilcox Memorial Hospital began offering thoracic surgical services to patients living on Kaua i. With lung cancer being the second most commonly diagnosed cancer on Kaua i, it was important to implement a program at Wilcox to better serve the Kaua i population. This new service brings thoracic surgical services close to home. Made possible by a collaborative partnership between Wilcox, a private practice pulmonologist in the Kauai i community, and the thoracic surgery department at Straub Clinic & Hospital on O ahu. Previous to this partnership, patients were required to fly to O ahu for lung cancer surgical services. This new program has improved access to care for the patients on Kaua i allowing for cancer treatment close to home, where patients have the support from their home-based practitioners, and more importantly, support from their family and friends ANNUAL CANCER REPORT

9 Robotic Assisted Cancer Surgery In 213, Hawai i Pacific Health continued to grow its robot-assisted surgery capabilities at both Kapi olani Medical Center for Women & Children and Pali Momi Medical Center. The addition of the da Vinci robotaided surgical system allows patients the option of a mimimally invasive approach to surgery. This means smaller incision sites, faster healing time, less pain, and lower risk of infection. The following are two examples of the impact robotic-assisted surgery has had on surgical care volumes. Endometrial Adenocarcinoma at Kapi olani Medical Center for Women & Children In the six-month period prior to beginning roboticassisted cancer surgery at Kapi olani, there were 25 new endometrial adenocarcinoma accessions (surgeries). With the increased ability for minimally invasive surgery due to the new robotic surgery capabilities, the first sixmonth period after the da Vinci was implemented, these same surgeries increased to 35, or by 4 percent. The implementation of robotic surgery at Kapi olani has impacted the overall length of stay for our patients requiring a hysterectomy. Those having robotic surgery have had significantly shorter length of stays at the hospital when compared to patients recovering from traditional surgery (.83 days as opposed to 2.77 days for traditional surgery, as well as lower estimated blood loss (55.6 ml as opposed to 38.3 ml for traditional surgery) and less transfusions (/18 cases as opposed to 5/12 cases for traditional surgery). Number of Cases Endometrial Adenocarcinoma at Kapi olani Pre (212) and post (213) addition of Robotic Surgery Prostate Cancer at Pali Momi Medical Center One of the most innovative treatments for prostate cancer is robotic-assisted laparoscopic prostatectomy. Robotic prostatectomy offers similar and often better outcomes than the traditional open surgical approach. In addition, by using the robotic technique there is greater nerve sparing resulting in less chance of erectile dysfunction (ED) and urinary incontinence. With roboticassisted surgery the patient can look forward to a shorter recovery, less chance of infection and less postoperative pain. In the year prior to Pali Momi Medical Center having robot-assisted surgery available, 1 patients received surgical care for their prostate cancer. In the year following the addition of da Vinci, Pali Momi prostate surgery care increased to 18 patients, or by 8 percent. Number of Cases Prostate Cancer Surgical Cases at Pali Momi Pre (212) and post (213) addition of Robotic Surgery 213 ANNUAL CANCER REPORT 7

10 Survivorship Program Expansion Kapi olani Medical Center for Women & Children has long had a successful Pediatric Survivorship Program and in 213, the hospital expanded its service to the Women s Cancer Center to support women on their cancer journey. It is well known that cancer survivors often experience numerous physical and psychological side effects of treatment, and that survivorship care, when integrated at the time of diagnosis, specializes in identifying, treating and coordinating care for this unique patient population. Physical side effects experienced by cancer patients are often caused by the cancer itself, and/ or by the aggressive therapies used during treatment. Typically there are three categories for treatment-related side effects in cancer: short-term, long-term and late effects. Short-term side effects occur during cancer treatment and common symptoms may include nausea, hair loss, pain, fatigue, and weight loss. Generally, these side effects go away after active treatment ends. Long-term side effects are those that begin during treatment and continue after the end of treatment. Common long-term symptoms may include on-going fatigue, higher risk of infection, lymphedema in women who have had a specific type of breast surgery for cancer, infertility in both men and women depending on the type of treatment, or memory loss. Late side effects are symptoms that appear months or years after treatment has ended. These can include issues with cardiac health, osteoporosis, psychological disorders such as posttraumatic stress disorder, and fear of recurrence and even secondary cancers. Psychological and psychosocial side effects of the cancer journey can occur at any point along the treatment spectrum and can include depression, anxiety, sexual dysfunction, financial and employment issues, transportation for treatment, child or adult care concerns, and other issues affecting a patient s emotional health and well-being. Both the Pediatric and Women s Survivorship Programs at the Kapi olani Medical Center are managed by an advanced practice nurse (APRN) who partners with the oncology team (oncologists, surgeons, patient navigator, social worker, behavioral health specialists, chaplin, and related community organizations) to assist patients and their families through their survivorship journey. This integrated patient-centered model will be extended to support all oncology patients across the Hawai i Pacific Health system through all four community-based hospitals over the next 12 months. Bone Marrow Transplant; Taking Care of Hawai i s Children The Hematopoietic Stem Cell Transplant Program at Kapi olani has received independent approval as an affiliate member of the National Marrow Donor Program network. This means that even after the closing of the adult transplant program at Hawai i Medical Center, Kapi olani can continue to offer unrelated donor stem cell transplants to children in need of this life-saving therapy. It demonstrates the hospital s continued commitment to providing comprehensive bone marrow transplant care to Hawai i s vulnerable pediatric patient population. Recently, Kapi olani has also been approved as a National Marrow Donor Program Collection Center, allowing the hospital to support adult donations of bone marrow, not only from related family donors, but from unrelated adult donors belonging to the Hawai i Bone Marrow Donor Registry. These Registry volunteers are now able to remain in Hawai i for their marrow donations instead of having to travel to the Mainland for the procedure. Thanks to a collaborative effort between Kapi olani Medical Center for Women & Children, the Hawai i State Legislature, Governor Neil Abercrombie and philanthropic donors that included UHA, Kapi olani was able to acquire machines and train staff to collect peripheral blood stem cells from both children and related adult donors. Peripheral blood stem cells are an alternative to using bone marrow, and this capability will also halt the need for these donors to travel away from home. Together, these initiatives demonstrate the hospital s continued commitment to supporting bone marrow transplant in Hawai i, and providing comprehensive care to the State s vulnerable pediatric population ANNUAL CANCER REPORT

11 Clinical Research, Advancing Cancer Care Many of today s standard cancer treatments those that are accepted and widely used by medical experts are based on the results of clinical trials. It is through clinical trials that researchers can determine whether new treatments are safe, effective, and work better than current treatments. Hawai i Pacific Health participates in more than 3 clinical trials a year working with more than 7 principal investigators. Many of these trials are done in partnership with the University of Hawai i Cancer Center. Hawai i Pacific Health is a member of the Hawai i Cancer Consortium, a research collaboration between the University of Hawai i Cancer Center, Hawai i Pacific Health, Queen s Medical Center, Kuakini Health System and the John A. Burns School of Medicine. The consortium combines each member s strengths toward a common objective to deliver the best quality and value to patients with cancer. Through this collaboration the persons we serve in the State of Hawai i have access to the latest discoveries in cancer care without having to leave the state. Hawai i Pacific Health brings a uniqueness to this group with the only hospital on Kaui i and many clinics in Maui. THE FUTURE OF CANCER CARE AT HAWAI I PACIFIC HEALTH At Hawai i Pacific Health, we re proud of what we ve accomplished to date, but pursuing excellence means constantly pushing for further improvement. We embrace that challenge, and we re prepared to meet it. Over the next year and beyond, Hawai i Pacific Health is committed to: identifying the evolving health care needs of its patients; fostering strong relationships with referring physicians and communities; further developing integrated service programs; and continually investing in skilled staff and state-of-the-art screening, and treatment technology. These initiatives are essential in helping Hawai i Pacific Health successfully implement the medical home, which provides patient-centered care. Patient-centered care ensures that each patient, every time, is getting care tailored to their specific needs. By providing care tailored to each patient, Hawai i Pacific Health is able to tailor care to the increased aging population. Hawai i Pacific Health will also focus on providing and continually improving its quality measures and providing patient choice in care decisions. Ultimately, though, Hawai i Pacific Health cannot succeed without the support of its communities. It takes its lead from the needs of the communities it serves, and measures success in terms of how well the system has met these goals. Hawai i Pacific Health is honored to care for the families of Hawai i and looks forward to continuing to bring exceptional cancer care to every patient, every time. 213 ANNUAL CANCER REPORT 9

12 hawaiipacifichealth.org Hawai i Pacific Health is a not-for-profit health care network.