Overview...3. Cancer Program.4. Breast Cancer with 5-year Survival Analysis...6. Systemic Therapy.7. Stage of Breast Cancer Diagnosed in

Transcription

1 2011 Annual Report

2 Table Of Contents Overview...3 Cancer Program.4 Breast Cancer with 5-year Survival Analysis...6 Systemic.7 Stage of Breast Cancer Diagnosed in Radiation and Systemic Only...9 Partial Mastectomy Followed by Radiation and Systemic...10 Mastectomy Followed by Radiation or Systemic.11 First Course of Treatment vs. Comprehensive in All States Year Survival Analysis Using NCDB Conclusion..14 2

3 Overview The Bethesda Comprehensive Cancer Center was created in 1985 to serve the special needs of patients with cancer and their families, providing them with innovative treatments, stateof-the-art technology, education and support. The Center offers two convenient locations on the campus of Bethesda Memorial Hospital and on the campus of Bethesda Health City. As part of Bethesda Memorial Hospital, our mission is to provide quality health services in a caring manner to our patients. The Bethesda Comprehensive Cancer Center is proud to be an Affiliate of the H. Lee Moffitt Cancer Center & Research Institute, a National Cancer Institute-designated center. Our Center is accredited by the American College of Surgeons Commission on Cancer and The Joint Commission. We are a proud partner with the American Cancer Society and the Susan G. Komen Foundation. The Bethesda Comprehensive Cancer Center provides various services such as inpatient oncology services. The inpatient oncology unit is staffed by a team of highly skilled, specially trained oncology nurses and other healthcare professionals. The outstanding physicians on the Bethesda Memorial Hospital Medical Staff who specialize in all aspects of cancer care provide individualized care to meet each patient s specific needs. Additional services offered by the Bethesda Comprehensive Cancer Center include: The Center for Radiation Oncology, Bethesda Women s Health Center, The Center for Advanced Imaging, infusion therapy and more. As part of the Bethesda Community Lecture Series, Bethesda Comprehensive Cancer Center physicians present information on advancements in cancer research and technology such as Digestive Cancer Awareness by surgical oncologist/general surgeon Matthew D Alessio, M.D. and High Preventive Screening and by Sonali Pandya, M.D. Our Services The Center for Radiation Oncology Bethesda Women s Health Center Comprehensive Breast Health Services Multimodality Breast Clinic Inpatient Oncology Services Cancer Rebound Rehabilitation Lymphedema Program Cancer Registry The Center for Advanced Imaging Hospice and Palliative Care Unit Infusion Services Research Center Support Groups for our Community 3

4 Cancer Program Cancer Registry In our efforts to continually provide quality healthcare services for cancer patients, the Bethesda Comprehensive Cancer Center has an established Cancer Committee that oversees the hospital s cancer registry operations. The registry operations are a result of all healthcare documentation entered into one abstract. The data that is entered into the abstract starts from day one of diagnosis of a malignancy and presenting to Bethesda, to first course of treatment, whether it be surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, palliative care, hospice, care of mental health and/or survival care. More than 400 pieces of information are collected for research and patient care improvement. The cancer registry submits this information to the states central registry (Florida Cancer Data Systems), and to the National Cancer Data Base (NCDB). The results of the data are then posted on the American Cancer Society (ACS) website for mortality, morbidity, incidence and survival analysis. Bethesda Memorial Hospital followed 33,915 patients since the reference year of January 1, 2001 to obtain disease free, recurrence, metastases, subsequent treatment information, survivorship, quality of life, pain management, and hospice information. Cancer Committee The hospital employs a Cancer Care Coordinator (Consultant), and four Certified Tumor Registrars to abstract approximately 1 to 1250 cancer cases a year and work to keep the cancer program current, while implementing the Commission on Cancers most recent program standards for 2012: Ensuring Patient-Centered Care. There are two Oncology Certified Nurse registered nurses, 29 chemo-certified registered nurses between the Medical/Oncology Unit and the Infusion Department. There are 27 members on the Cancer Committee involved in maintaining the cancer program, that consist of radiation oncology, medical oncology, surgeons, psychiatry, diagnostic radiology, pathology, palliative care, pain management, social service, dietitian, clinical research, clinical management, cancer registrars, patient navigator, rehabilitation, occupational therapy, marketing and hospital administration. The Cancer Care Coordinator oversees the tumor board cancer conference held every Tuesday at the hospital with 30 to 40 medical staff members in attendance offering continuing educational credits to those who attend and evaluate the conference. Those in attendance discuss the clinical stage, treatment, and National Comprehensive Cancer Network guidelines, to properly care for our patients. Continuing Medical Education In conjunction with The H. Lee Moffitt Cancer Center & Research Institute, Bethesda provides educational opportunities for physicians and staff such as Moffitt Grand Rounds where guest physicians from Moffitt present information on the latest advancements in cancer research such as Medical and Surgical Options for Breast Conserving Surgery. 4

5 Cancer Program cont d Support and Rehabilitation Programs Bethesda offers an array of support groups to assist patients, their families and friends in coping with the changes that come with a diagnosis of cancer such as: Breast Cancer Support Coping with Cancer Convivir con el Cancer (Living with Cancer) Look Good Feel Better Man to Man Prostate Cancer Support Moving on After a Diagnosis of Cancer Lung Cancer Support I Can Cope! Cancer Education Seminar Bethesda hosts an annual Cancer Survivor s Day celebration and 134 cancer survivors and guests were in attendance this year. Bethesda also offers rehabilitation programs such as a Lymphedema program for survivors of breast cancer who have undergone lymph node surgery, as well as a Cancer Rebound Rehabilitation program which helps individuals optimize their activities of daily living. Bethesda Women s Health Center As part of the Comprehensive Cancer Center, the Bethesda Women s Health Center provides comprehensive diagnostic services for both women and men with state-of-the-art technology and a caring, compassionate staff. The Center offers all digital mammography with Computer Aided Detection (CAD), one of the best tools in the early detection of breast cancer. Bethesda Women s Health Center offers a Multimodality Breast Clinic that gives breast cancer patients the opportunity to consult with a medical oncologist and radiation oncologist all in one convenient appointment. Bethesda s Breast Health Navigator, a registered nurse, helps patients with any follow-up exams and provides support throughout their course of care. Breast Cancer Bethesda Memorial Hospital s top five sites of cancer are breast, lung, colon, prostate, and bladder. Each year, the hospital releases an annual report of at least one of its top five sites, which includes treatment and survival analysis compared to other Comprehensive Community Cancer Programs using registry information and the NCDB database comparison benchmarks located on the American College of Surgeons, Commission on Cancer website, This year, the focus is on breast cancer as it is the most prevalent form of cancer seen at Bethesda. On behalf of our physicians and staff, the Bethesda Comprehensive Cancer Center remains dedicated to bringing you the best cancer care possible for you and your loved ones. 5

6 Breast Cancer with 5-year Survival Analysis The following observations are based upon data provided by the cancer registry at Bethesda Memorial Hospital concerning breast cancer treatment outcomes: 1. The stages of breast cancer diagnosed in 2008 at Bethesda Memorial Hospital showed comparable results with other comprehensive hospitals in ACS division of Florida, with the exception of stage 2. Additionally, one finding noted that 17% of breast cancers in the database did not have a documented stage, compared to 5% statewide. 2. In 2008, the treatment outcome of only 74 patients is documented in our database. In 2009, the number increased significantly to 295. In 2010, again there were only 74 patients with a documented treatment outcome. Assuming that the statistics for 2010 represent a full calendar year, the variability from year to year has been extreme. While the reason for this discrepant data is unknown, two plausible reasons that could explain this variability include patients receiving treatment elsewhere outside our hospital system and a lack of proper follow-up to determine treatment outcome. Either way, this statistic must improve. 3. In 2008, the majority (55%) of documented patients treated for breast cancer were stage 1. 3 of all breast cancers diagnosed at our facility were treated with surgery alone, compared to 24% statewide. As expected, 66% of stage 1 cancers were treated with surgery or a combination of surgery and radiation. Again, as expected, 10 of stage 0 cancers were treated with surgery or a combination of surgery and radiation. 4. In 2009, the majority (45%) of documented patients treated for breast cancer were stage 1. 21% of patients diagnosed with breast cancer at BMH at all stages did not have a documented treatment outcome in our database. The reason(s) for this lack of documentation are unclear. 58% of all breast cancer diagnosed patients in 2009 received either surgery, a combination of surgery and radiation, a combination of surgery and hormonal therapy, or a combination of surgery, radiation and hormonal therapy. Furthermore, approximately 84% of the patients were diagnosed with early-stage (Stage 0 - Stage 2) breast cancer. These findings represent accurate treatment of early-stage breast cancer. 5. In 2010, the majority (54%) of documented patients treated for breast cancer were stage 1. The total number of documented breast cancer treatment outcomes decreased significantly to 74, but the treatment modality was comparable to the prior years. 6. Bethesda Memorial Hospital does have a certified nurse practitioner, who provides genetic counseling to high-risk patients, or women who qualify for BRCA testing based on NCCN guidelines for genetic testing. This is accomplished if the patients are referred to the nurse practitioner by the treating physician or if the nurse practitioner, who is also certified to do clinical breast examination is involved with the patient from the time of their diagnosis. 6

7 Systemic Systemic of Breast Cancer Diagnosed in 2008 Bethesda Memorial Hospital vs. Comprehensive Hospitals in American Cancer Society Division of Florida Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) 2009 National Cancer Data Base - Generated on November 17, % 48% PERCENT (%) 7% 8% %18% 21% 2 11% 1 Chemotherapy Alone No Systemic Hormone Alone Endocrine Surgery or Radiation Chemotherapy and Immunotherapy Chemotherapy and Hormone Systemic, Not Otherwise Specified SYSTEMIC THERAPY 8% Bethesda Other No Systemic Chemotherapy Alone Hormone Alone Endocrine Surgery or Radiation Chemotherapy and Hormone Chemotherapy and Immunotherapy Systemic, Not Otherwise Specified Bethesda 57% 11% 18% 7% 8% Other 48% 23% 21% 8% 7

8 Stage of Breast Cancer Diagnosed in 2008 Stage of Breast Cancer Diagnosed in 2008 Bethesda Memorial Hospital vs. Comprehensive Hospitals in American Cancer Society Division of Florida Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) 2009 National Cancer Data Base - Generated on November 17, 2011 PERCENT (%) 4 35% 3 25% 2 15% 1 5% 15% 19% 4 38% 16% 25% 9% 7% 4% 3% 17% 0 I II III IV Not Unknown Available STAGE 5% Bethesda Other 0 I II III IV Not Available Unknown Bethesda 15% 4 16% 7% 4% 17% Other 19% 38% 25% 9% 3% 5% Stages of Breast Cancer 0 Abnormal cells in the lining of the ducts or sections of the breast Results in increased risk of developing cancer in both breasts I Cancer in breast tissue tumor less than 2 cm across II Cancer in breast tissue tumor less than 5 cm across Cancer may also spread to axillary (armpit) lymph nodes III Tumor is larger than 5 cm across with extensive spread to axillary or other nearby lymph nodes Possible inflammation of breast tissue, dimpling, thickening and change in color of the skin due to blocked lymphatic drainage IV Spread of cancer beyond the immediate region of the breast 8

9 Radiation and Systemic Only PERCENT (%) Radiation by Systemic of Breast Cancer Diagnosed in 2008 Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) % 93% No Radiation Treatment Beam Radiation Brachytherapy RADIATION THERAPY 9

10 Partial Mastectomy Followed By Radiation and Systemic PERCENT (%) Radiation by Systemic of Breast Cancer Diagnosed in 2008 Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) % 94% No Radiation Treatment 8% 35% 11% 46% 12% 75% 12% 5 5 Beam Radiation Brachytherapy Radiation, Not Otherw ise Specified RADIATION THERAPY Unknow n if Radiation Recommended or Administered 10

11 Mastectomy Followed By Radiation or Systemic Radiation by Systemic of Breast Cancer Diagnosed in 2008 Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) PERCENT (%) % 88% 5 33% 17% 10 No Radiation Treatment Beam Radiation Unknown if Radiation Recommended or Administered RADIATION THERAPY 11

12 First Course of Treatment vs. Comprehensive in All States First Course Treatment of Breast Cancer Diagnosed in 2008 Class of Case 1 (patients treated at Bethesda) and Class of Case 2 (patients diagnosed elsewhere, treated at Bethesda) 2009 National Cancer Data Base - Generated on November 17, 2011 # First Course Treatment BMH (N) National (N) BMH (%) National (%) 1. Surgery Only % 24.24% 2. Surgery & Radiation % 11.91% 3. Surgery & Chemotherapy % 9.64% 4. Surgery, Radiation & Chemotherapy % 8.65% 5. Surgery, Radiation & Hormone % 18.23% 6. Surgery & Hormone % 9.8% 7. Surgery, Radiation, Chemotherapy, & Hormone % 7.79% 8. Surgery, Chemotherapy & Hormone % 9. Other Specified % 3.89% 10. No 1st Course Rx % 1.83% Col. TOTAL Note: American Cancer Society (ACS) data are reported two years retrospectively. Surgery Only Surgery & Radiation Surgery & Chemotherapy Surgery, Radiation & Chemotherapy Surgery Radiation & Hormone Surgery & Hormone Surgery, Radiation, Chemotherapy & Hormone Bethesda 3 13% 4% 6% 16% 1% 7% Surgery, Chemotherapy & Hormone Other 24% 12% 1 9% 18% 1 8% 4% 12

13 5-Year Survival Analysis Using NCDB Cumulative Survival Rate Observed Survival for Breast Sites C500 - Nipple C503 - Lower inner quadrant C506 - Axillary tail or tail of breast C501 - Subareolar C504 - Upper outer quadrant C508 - Central breast C502 - Upper inner quadrant C505 - Lower outer quadrant Cases Diagnosed in Data from 1 Programs (Bethesda Memorial Hospital) WARNING: The information within this graphic is not to be used for clinical decision making Site Codes for Breast Codes from the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) C509 - Breast not otherwise specified (NOS) yr 1.0 yr 2.0 yr 3.0 yr 4.0 yr 5.0 yr Years from Diagnosis 2012 National Cancer Data Base (NCDB), Commission on Cancer (CoC) Stage 0 Stage I Stage II Overall Notice: When comparing survival rates between your cancer program and all other CoC-accredited cancer programs: if the confidence intervals of stage-specific or overall survival rates overlap after five years, then there is no statistical difference between survival rate of patients at your facility with that of other CoC-accredited cancer programs. Stage of Disease Enter 0.0 yr 1.0 yr 2.0 yr 3.0 yr 4.0 yr 5.0 yr 95% Cl Stage Stage I Stage II Stage III 21 Insufficient cases to display survival information Stage IV 5 Insufficient cases to display survival information OVERALL

14 Conclusion Breast cancer is the most prevalent cancer among women in the United States. Breast cancer death rates have decreased nationwide over the years most likely due to early detection and treatment. Currently, there are more than 2.5 million breast cancer survivors in the United States. At Bethesda Memorial Hospital, breast cancer is one of the top five cancer sites treated besides lung, colon, prostate and bladder cancer. This report highlights our observations of breast cancer over the past five years. Based on our observations, the stages of breast cancer diagnosed at Bethesda in 2008 are comparable with other comprehensive hospitals in the American Cancer Society division of Florida, with the exception of stage 2. The majority (55%) of documented patients treated for breast cancer at Bethesda in 2008 were stage 1 compared to 45% in 2009 and 54% in In 2008, 3 of all breast cancers diagnosed at Bethesda were treated with surgery alone compared to 24% statewide. 66% of stage 1 cancers were treated with surgery or a combination of surgery and radiation. 10 of stage 0 cancers were treated with surgery or a combination of surgery and radiation. In 2009, 58% of all breast cancers diagnosed were treated with either surgery, a combination of surgery and radiation, a combination of surgery and hormonal therapy, or a combination of surgery, radiation and hormonal therapy. Approximately 84% of the patients were diagnosed with early stage (Stage 0 - Stage 2) breast cancer. In 2010, the total number of documented breast cancer treatment outcomes decreased significantly to 74, but the treatment modality was comparable to the prior years. Bethesda Comprehensive Cancer Center remains committed to providing the best care possible utilizing state-of-the-art technology. Bethesda s team of experienced specialists are dedicated to enhancing the quality and breadth of cancer care services for cancer patients, their families and the community. 14