Cancer Program Annual Report 2013

Transcription

1 Cancer Program Annual Report 2013 with 2012 Statistics Coping with Tomorrow,Today

2 Letters from 1 Flavio Kruter, M.D. Medical Director of Carroll Hospital Center s Cancer Program and Cancer Committee Chairman I am extremely excited to announce that Carroll Hospital Center s accredited cancer program has completed yet another successful year, with many accomplishments that will put it at the forefront of innovative patient care. Our hospital has recently become a full member of the Alliance for Clinical Trials in Oncology, a national clinical trials network sponsored by the National Cancer Institute that will expand our patients access to clinical trials and research studies, thus broadening their treatment options. We began construction on the new William E. Kahlert Regional Cancer Center, scheduled to open fall of This state-ofthe-art cancer center will offer enhanced cancer services and unparalleled, coordinated care for patients with all types and stages of cancer. To assist breast cancer patients throughout their entire cancer journey, our new Center for Breast Health offers them access to a range of specialists, advanced diagnostic services and a strong social and clinical support team, all in one location. And our ongoing multidisciplinary breast cancer conference which brings together physicians and specialists involved with the treatment of breast cancer to share their expert advice is changing lives by ensuring patients are receiving coordinated, expedited care. Our great achievements would not be possible without the dedication of our exceptional health care providers and Cancer Committee members. Their drive and commitment are unwavering, and our cancer patients will continue to experience the amazing benefits of our staff s hard work throughout our outstanding cancer program. Flavio Kruter, M.D. Medical Oncology/Hematology Chairman, Cancer Committee David J. Salinger, M.D. Cancer Liaison Physician As the cancer liaison physician (CLP) for Carroll Hospital Center s cancer program, I am extremely proud to be a part of the program s many achievements this year. The CLP serves as the physician champion for the cancer program and the Commission on Cancer (CoC). We are continuing to adopt the CoC s quality performance measures for the treatment of breast, colon and rectal cancers. Recently updated specialty recommendations, such as the American Urological Association s prostate cancer screening guidelines, have also been presented to the cancer committee and staff during the past year. Our Cancer Committee has been updated on the hospital s breast, lung and bladder cancer patient rates and treatments, using information from the National Cancer Data Base (NCDB). Our lung cancer experience, in particular, closely matches that of the national experience. The primary role of the CLP is to monitor and interpret this data and to employ this information to evaluate and improve the quality of patient care. Sessions are in place to continually update our clinical staff on the latest information regarding the staging, prognosis and treatments of different cancers, with a particular focus on breast cancer reviewed in an educational session for hospital clinicians this year. The hospital s multidisciplinary cancer conference is also continuing to make great strides in coordinating effective treatment plans for patients. Our cancer program has made significant advances this past year and I look forward to continuing our progress in the years ahead. David Salinger, M.D. Radiation Oncologist, Cancer Liaison Physician & Cancer Conference Coordinator

3 High Quality Cancer Care Where You Live Commission on Cancer Comprehensive Community Hospital Cancer Program Carroll Hospital Center is a proud participant in the Commission on Cancer (CoC) program. The CoC awards accreditation to hospitals and cancer-treating facilities that volunteer to comply with the CoC s established standards. Accreditation by the CoC is recognized in the industry as the gold standard approval, and it ensures that the finest quality of evidenced-based cancer care is available to patients in CoC-accredited facilities. Carroll Hospital Center has held continued CoC accreditation with commendation since 2005 and was awarded the CoC Outstanding Achievement Award during its last survey in 2011 for its exemplary cancer program. Multidisciplinary Cancer Care In 2013, Carroll Hospital Center continued to provide the highest level of clinical and support services for cancer patients. The cancer program s medical staff has been expanded by the additions of experienced surgeons Sarah Lentz, M.D., specializing in general surgery, and Dona Hobart, M.D., who specializes in breast surgery. Dr. Hobart not only brings a wealth of experience in treating breast cancer patients, but also serves as the medical director of the hospital s Center for Breast Health, which opened in Gabriel Del Corral, M.D., a fellowship-trained plastic surgeon specializing in post-mastectomy microsurgical breast reconstruction, also joined the cancer program team. These additions enhanced Carroll Hospital Center s caring and dedicated multidisciplinary physician team, which includes board-certified specialists, cancer diagnostic services, surgical cancer management, systemic cancer treatments (e.g., chemotherapy, hormone therapy and immunotherapy) and radiation therapy. The multidisciplinary team works collaboratively to customize treatment plans for each patient. Experienced certified nurses trained in oncology care also attend to patients and compassionately oversee and guide them through all phases of their journey, from cancer diagnosis and management to survivorship. Patients are counseled and offered access to clinical trials specific to their diagnosis, either on- or off-site, in collaboration with our clinical partners in the region and state. In collaboration with the University of Maryland Marlene and Stewart Greenbaum Cancer Center, we also offer certified genetic counseling services to assist patients at a high risk for genetically related cancer and other diseases. Our palliative care team ensures that patients receive needed therapies for the relief of pain or symptoms resulting from their cancer diagnosis and/or cancer therapy. Further rounding out the team are the professionals that concentrate on the spiritual and emotional well-being of our patients, in keeping with our patient-centered philosophy which recognizes the necessity of treating the whole patient to achieve the very best clinical outcomes. Below is a listing of the full range of services provided at Carroll Hospital Center. Additional services are available outside the hospital s campus, in collaboration with our clinical partners. For more information, please visit CarrollRegionalCancer.org Cancer Services State-of-the-Art Diagnostics: PET/CT CT MRI Digital Mammography Stereotactic Breast Biopsy Ultrasound Nuclear Medicine Digital X-ray Colonoscopy Esophagogastroduodenoscopy (EGD) Endoscopic Retrograde Cholangiopancreatography (ERCP) Therapeutic Services with Personalized Treatment Planning: Surgery, including advanced surgical procedures and minimally invasive techniques Systemic therapies, including chemotherapy, hormone therapy, immunotherapy, blood transfusions, medication management and bone marrow biopsies Radiation therapy, including brachytherapy, a minimally invasive alternative to surgical tumor removal MammoSite 5-day targeted radiation therapy, an outpatient treatment that lets early-stage breast cancer patients get back to their daily lives faster Support Services: Health Navigation Services Genetic Counseling (in partnership with the University of Maryland Greenebaum Cancer Center) The Boutique at The Women s Place (specializing in hats, wigs, breast prostheses and other merchandise for people with cancer) Palliative Care (services designed to optimize quality of life) Lymphedema Treatment Program (featuring a certified lymphedema therapist) Complementary Health Services (massage, acupuncture, integrative reflexology) Oncology Resource Library Transportation Services (in partnership with the American Cancer Society) 2

4 2013 Carroll Hospital Center Cancer Program Activity Moving Forward Carroll Hospital Center continues to merge processes and functions with our recently acquired Carroll Regional Cancer Center to expand and improve the delivery of cancer services across our systems. The hospital also continues to forge partnerships in the community and region to enhance cancer service provisions and improve our patients outcomes. The hospital s Center for Breast Health opened in March 2013 and provides patients with both clinical and support staff to coordinate breast health services and guide patients through education, diagnostics, treatments, complementary health services and patient support groups. A weekly multidisciplinary breast cancer treatment planning conference was added in January 2013, and the general multidisciplinary cancer conference continues to be held bimonthly. At these conferences, hospital physicians and other health care providers confer and create customized individual patient treatment plans. The hospital s cancer program also sponsored three clinical educational programs, Colorectal Cancer Lecture, Post Treatment Care for Cancer Survivors, and The Annual AJCC Staging and National Comprehensive Cancer Network Treatment Guidelines Update. The registered nurse-patient navigation team implemented a standardized patient navigation process within Carroll Hospital Center s system to make the delivery of services more efficient and timely. Additional patient screenings, assessments, services and resources were also added to enhance patients continuity of care through diagnosis, treatment, recovery, survivorship and/ or end of life. Three health navigators are now dedicated to Carroll Regional Cancer Center patients, and three additional health navigators round out the team to provide navigation services to all cancer patients. Lung cancer continues to be one of the leading cancers treated at Carroll Hospital Center. It was the second most common cancer treated in The hospital is exploring the possibility of offering a lung cancer screening program in accordance with The National Comprehensive Cancer Network (NCCN) guidelines for lung cancer screening. Carroll Hospital Center s Community Outreach also continued its skin cancer screenings and sponsored numerous education and cancer prevention programs in Recognizing that palliative care services are often confused with hospice services, and to prevent an under-utilization of those services, the cancer program s palliative care teams continued to educate physicians, patients and the community. Palliative care focuses on providing pain and symptom relief associated with serious illnesses and improving the quality of life for patients at any stage of their disease. Two palliative care teams have been created, one dedicated to inpatients and one dedicated to patients in the outpatient setting. The teams work collaboratively to form the hospital s palliative care program. A patient survivorship packet is in development. The packet will contain customized information pertaining to the patient s individual cancer treatment and status, recommendations for follow-up and healthy living, and information on resources for further education and support. The survivorship packets will be given to each patient at the conclusion of his or her initial treatment plan and will include information for his or her primary care physician as part of the health care team. In endeavoring to expand our cancer clinical trials program, the hospital has been accepted as a full member of the Alliance for Clinical Trials group under the auspices of the National Cancer Institute (NCI). This membership will give the hospital s cancer program access to national cooperative group therapeutic treatment trials to offer cancer patients in our community. Our cancer program has also been accepted as a member of the NCI s Central Institutional Review Board (CIRB) which oversees all NCI-sponsored clinical trials. The hospital s Institutional Review Board (IRB) will continue to review all clinical trials for community and hospital resource impact. The hospital became a voluntary participant in the Commission on Cancer s Rapid Quality Reporting System. The Rapid Quality Reporting System is a quality improvement tool which uses realtime cancer data to assess and improve concordance with National Quality Forum-endorsed quality of care measures for treating breast and colorectal cancers. 3

5 Community Outreach: Cancer Support Services Survey Carroll Hospital Center is dedicated to providing cancer patients with the best care possible. To ensure the hospital continues to meet the needs of cancer patients now and into the future, the hospital conducted a brief cancer survey from February to May A total of 104 cancer patients and survivors throughout the community completed the survey. The following is a summary highlighting key results from the survey and the changes the hospital has implemented to ensure our cancer programs and services continue to meet the community s growing needs: Respondents wanted programs that revolved around their nutritional needs. In response, the hospital is planning to offer additional nutrition education programs and will be hiring a dietitian who will work as a community nutrition educator to provide resources to patients needing nutritional advice. Respondents indicated an interest in having additional speakers attend the hospital s cancer support groups. In response, the hospital has added various cancer experts to discuss cancer-related issues with support group attendees. Respondents requested additional information regarding what they should do following their cancer treatment. To address this what next? feeling among cancer survivors, the hospital created a cancer survivorship lecture series. This series of programs focuses on how cancer survivors can improve their overall health and manage the health issues that they may face during and after treatment. Several programs were held in 2013, and additional lectures are planned for Individualized survivorship care plans also are in development. Caregivers expressed uncertainty with regards to their role and how best to help their loved ones going through and following cancer treatment. To address this concern, the hospital s health navigators and social workers are exploring additional methods to assist patients and their caregivers and supply them with supportive resources and education. Some respondents indicated they would benefit from assistance navigating the medical insurance process, such as filing claims and paying for services. A dedicated part-time social worker has been hired for the cancer program to help patients explore sources of financial support during their cancer treatment. See our additional 2013 outreach efforts on page 5. Cancer Support Services Survey Results Highlights Question: What type of cancer educational programs and/or support services would be helpful to you during your cancer journey? Question: What support services for caregivers of cancer patients do you feel would be helpful? n Educational programs n Prevention n Management of side effects n Navigation services (someone to help coordinate your care and give you resources) n Support groups n Wigs/hats/mastectomy bras and breast prostheses n Other n Support groups n Information n Educational classes n Other Question: What support services would you like to see offered for survivors? Respondents who indicated whether services would be helpful during or after treatment. n During cancer treatment n After cancer treatment n Support groups n Information n Educational classes n Guided retreat opportunities n Other 5 4

6 2013 Community Outreach Prevention, Education & Screening Programs Breast Cancer/Breast Health Education Colorectal Cancer Education Cooking with the Doc Great American Smokeout/ Walk-in Smoking Clinic Health Fairs and Seminars Jump Start to Quitting Tobacco Live Well For Life Lose to Win Wellness Challenge Lymphedema Education and Prevention Program Nutrition Education and Screening Oral Cancer Screening Paint the TownMall Pink Pink Fling Luncheon (Breast Cancer Awareness) Prostate Cancer Education Relay For Life Events Skin Cancer Education and Screening Tobacco Cessation Program Support Groups/Services Bereavement Luncheons The Boutique at The Women s Place Breast Cancer Support Group Camp TR (Bereavement Retreat for Children) Cancer Navigation Services Cancer Support Group Cancer Survivors Day Caregiver Support Group Genetic Counseling Grief Counseling Look Good, Feel Better Lymphedema Support and Treatment Ostomy Support Group Pastoral Care Pathways Support Group Prostate Cancer Education and Support Group Reach for Recovery The Red Devils Road to Recovery Widows/Widowers Support Group 5 Carroll Hospital Center s new Center for Breast Health In March 2013, Carroll Hospital Center opened the Center for Breast Health, a collaboration between the hospital and Advanced Radiology to provide patients with advanced breast care services and specialists in one centralized location. Located in the Charles O. Fisher Medical Building, the center features coordinated, streamlined care. Led by medical director Dona Hobart, M.D., a board-certified surgeon specializing in breast surgery, the Center for Breast Health has a multidisciplinary team of distinguished breast care specialists, including board-certified surgeons, oncologists, radiologists and a breast reconstruction surgeon, who work collaboratively to address a patient s breast health care needs. Breast conditions that are treated include breast cancer, cysts, lumps and breast pain. Advanced reconstructive surgery options, such as microsurgical reconstruction, are also available to appropriate candidates. For specialized breast diagnostic imaging, the Center for Breast Health collaborates with Advanced Radiology, a designated Breast Center of Excellence by the American College of Radiology and led by radiologist Bertan Ozgun, M.D. Diagnostic imaging services include mammography, breast ultrasound, ultrasound-guided biopsy and stereotactic breast biopsy. In addition, the center provides patients with a health navigator to offer them support, education and guidance through their entire journey, beginning before diagnosis and continuing through treatment, recovery and survivorship. It s really about taking the care of breast patients one step further, says Dr. Hobart. At the Center for Breast Health, we are focused not only on treating the disease process or what s wrong with the patient but on treating the entire patient mind, body and spirit. For more information about the Center for Breast Health, please call or visit CarrollHospitalCenter.org/BreastHealth It s really about taking the care of breast patients one step further. - Dona Hobart, M.D. Medical Director of the Center for Breast Health at Carroll Hospital Center

7 Breast Cancer Facts with Dona Hobart, M.D. What is breast cancer? Breast cancer is an abnormal growth of cells in the breast. These cells can invade normal tissue, both in the breast and in distant areas of the body. What are the risk factors for breast cancer? The primary risk factors for breast cancer are being female and age. Approximately five to 10 percent of cancers are related to the BRCA 1 and 2 genes. Other risk factors include having a family member with breast cancer, race, having dense breast tissue and lifestyle decisions such as drinking alcohol and smoking. Nutrition is also believed to impact breast cancer risk. There is a significant increase in breast cancer risk with obesity. When should I be screened for breast cancer? Most women should get screening mammograms starting at the age of 40 and should continue until they are no longer in good health. Younger women should have clinical breast exams yearly. It s important that women know how their breasts feel normally. If they feel a change, they can report it to a medical professional. Some women, because of increased risk, can also be screened with an MRI. This applies to women with a 20 percent greater risk of breast cancer than the normal population. Some women with a family history will need earlier screening. Each woman should check with her medical provider. What are the symptoms of breast cancer? Most breast cancers do not have symptoms. That is why it is so important to get screened. Some rare breast cancers can start with skin changes on the breast or nipple. It is very rare to have pain with a breast cancer diagnosis, but it is possible. I cannot say it too many times, Get your mammogram! Dona Hobart, M.D., Medical Director of the Center for Breast Health at Carroll Hospital Center. How is breast cancer diagnosed? Breast cancer is identified on a mammogram, ultrasound or MRI. Some cancers are able to be felt. The diagnosis in almost all cases is made using a needle to biopsy the tissue. The tissue is viewed under the microscope to make the diagnosis. How is breast cancer treated? There are several types of breast cancer and each has a slightly different treatment. In general, breast cancer is treated using surgery, radiation and medicine or chemotherapy. Sometimes all three are used and sometimes only one or two. The order of treatment differs for each patient. It is very important to have all the doctors from various specialties sit together to discuss the treatment ahead of time. This is called a multidisciplinary conference. The Multidisciplinary Breast Conference led by oncologist Johanna DiMento, M.D., meets every Thursday. There are several types of surgery, and now there are also several types of radiation to use. Some patients can have radiation using a brachytherapy balloon where their radiation is completed in five days rather than the normal six to seven weeks. This is a new procedure we offer at the center. Providing navigation services also is important and we have a health navigator to help patients get through the system with ease, Navigation services are available throughout the diagnostic and treatment process and into survivorship. 6

8 The Carroll Hospital Center Breast Cancer Experience 2012 Data Year Female breast cancer continues to rank near the top of all cancers diagnosed in the United States. In 2012, it was the number one primary cancer diagnosed and/or treated at Carroll Hospital Center, representing 19.9 percent of all analytic* cancer cases for Carroll Hospital Center s breast cancer stage-at-initial-diagnosis rates closely align with the state and national breast cancer experience rates with the exception of stage 0 and stage IV disease. While Carroll Hospital Center reports a higher percentage of stage IV breast cancers at diagnosis than Maryland and national averages, Carroll Hospital Center s stage 0 breast cancer rate is lower than the state and national rates, which are comparable to one another. For the last complete data collection year (2012), Carroll Hospital Center s newly diagnosed breast cancer cases are 14.5 percent for stage 0, 43.6 percent for stage I, 26.4 percent for stage II, 8.2 percent for stage III and 7.2 percent for stage IV. Carroll Hospital Center Breast Cancer Diagnoses by Stage vs. Nation & State of Maryland STAGE IV STAGE III 3.7% 6.7% 7.2% 8.6% 8.3% 8.2% n Maryland n National Cancer Data Base n Carroll Hospital Center STAGE II 25.4% 23.8% 26.4% STAGE I 40.7% 41.4% 43.6% STAGE % 19.9% 20.3% UNKNOWN STAGE 0% 1.6% 1.6% * Analytic data represents patients that were diagnosed and/or received at least a portion of their first course cancer therapy at Carroll Hospital Center. 7

9 The Cancer Registry The cancer registry is an important element of Carroll Hospital Center s American College of Surgeons Commission on Cancer (ACoS-CoC)-approved cancer program. Collecting uniformed clinical data provides us with a valuable tool to measure clinical performance and outcomes. The hospital s cancer registry collects data on all cancer patients who have been diagnosed or have received at least a portion of their first course of therapy at the facility since January 1, Under Carroll Hospital Center s Cancer Committee physician leadership and in accordance with national standardized cancer data collection rules, cancer data management professionals, known as certified tumor registrars (CTRS), create clinical abstracts that include patient demographics, primary tumor site, tumor histology, cancer stage at diagnosis and all first course treatment modalities used to cure or control cancer. Clinical abstracts are also prepared for all central nervous system tumors. Patients receive annual lifetime follow-up to monitor survival and disease status and measure the efficacy of treatments. The cancer registry now contains data on 5,210 cancer cases. The cancer program s medical staff routinely performs quality audits of cancer registry data to ensure that timely and accurate data are available for assessment of treatment outcomes and to monitor cancer trends in the community that assist the hospital in developing crucial clinical cancer services, and cancer screening and prevention programs. In strict compliance with the Health Insurance Portability and Accountability Act (HIPAA), cancer registry data are reported to a variety of entities dedicated to cancer control efforts. Carroll Hospital Center s cancer registry data is reported to the National Cancer Data Base (NCDB), a joint program of the Commission on Cancer and the American Cancer Society. As required by state law, Carroll Hospital Center also contributes cancer registry data to the Maryland Cancer Registry (MCR). The MCR uses this data to measure cancer prevalence and trends statewide. This is necessary to develop effective cancer screening, education and prevention programs to relieve cancer burdens for all Maryland residents. The MCR reports aggregated data to the Centers for Disease Control and Prevention s (CDC) National Program of Cancer Registries. The CDC works collaboratively with state governments in cancer control efforts. The CDC also combines state cancer registry data with cancer data from other sources to produce the United States Cancer Statistics (USCS) reports ( gov/uscs/). In 2013, the cancer registry began reporting prospective data for breast and colorectal cancers to the Commission on Cancer s Rapid Quality Reporting System (RQRS). The Commission on Cancer described the RQRS as a quality improvement tool which provides real clinical-time assessment of hospital-level adherence to the National Quality Forum-endorsed quality of cancer care measures for breast and colorectal cancers. It is a web-based, systematic data collection and reporting system that advances evidenced-based treatment through a prospective alert system for anticipated care which supports care coordination required for breast and colorectal cancer patients at participating cancer programs. It was designed to assist CoC-accredited cancer programs in promoting evidenced-based cancer care at the local level ( 8

10 The Carroll Hospital Center Cancer Experience 2012 Data Year In 2012, certified tumor registrars added an additional 552 analytic* cancer cases to the Carroll Hospital Center cancer registry data base. The top 10 cancer sites diagnosed or treated were breast (19.9%), lung (18.1%), colon (8.0%), prostate (7.1%), melanoma of the skin and urinary bladder (tying at 4.7%), kidney (4.0%), non-leukemia malignancies of the blood and bone marrow (2.9%), non-hodgkin s lymphoma (2.4%), and rectum (2.3%). Carroll Hospital Center s cancer patient demographics closely mirror that of Carroll County by race, but the hospital has a higher rate of female patients and a higher rate of patients 80 years and older. The hospital also had a higher rate of patients presenting with stage IV of the disease when compared to the state and national cancer statistics. See graphs below. Carroll Hospital Center 2012 Analytic Cases* Top 10 Primary Cancer Sites TOP 10 CANCERS COMBINED 74.1% BREAST LUNG 19.9% 18.1% COLON PROSTATE URINARY BLADDER MELANOMA KIDNEY OTHER HEMATOPOIETIC LYMPH NODES RECTUM 8.0% 7.1% 4.7% 4.7% 4.0% 2.9% 2.4% 2.3% Carroll Hospital Center s cancer case prevalence differs slightly from that documented by the American Cancer Society (ACS). Although the top five cancers reported nationally are the top five cancer cases for Carroll Hospital Center, they are listed in different positions. Top 10 Cancer Sites for Carroll Hospital Center 1. Breast 2. Bronchus & Lung 3. Colon 4. Prostate 5. Skin (Melanoma)/Urinary Bladder 6. Kidney 7. Other Hematopoietic 8. Non-Hodgkin s Lymphoma 9. Rectum 10. Pancreas Top 10 Cancer Sites Nationally 1. Prostate 2. Breast 3. Lung 4. Colon 5. Skin (Melanoma) 6. Urinary Bladder 7. Non-Hodgkin s Lymphoma 8. Kidney 9. Thyroid 10. Leukemia * Analytic data represents patients that were diagnosed and/or received at least a portion of their first course of cancer therapy at Carroll Hospital Center. 9

11 Cancer Stage at Diagnosis Commission on Cancer Comprehensive Community Cancer Program Hospitals All Primary Cancer Sites by Stage at Diagnosis 100% 90% 80% 70% 60% 50% 40% 8.4% 8.6% 28.9% 30.1% 19.1% 20.3% 13.0% 13.4% 16.0% 15.3% 6.3% 4.5% 8.4% 7.9% n National n Maryland n Carroll Hospital Center* 30% 20% 10% 6.5% 27.2% 19.6% 13.9% 20.1% 2.0% 10.5% 0% STAGE 0 STAGE I STAGE II STAGE III STAGE IV UNK STAGE AJCC N/A Age at Diagnosis 90 & OVER UNDER 20 Commission on Cancer Comprehensive Community Cancer Programs Age at Diagnosis 2.1% 2.3% 3.4% 2.9% 2.9% 1.3% 1.1% 1.0% 1.1% 0.5% 0.3% 0.2% 5.7% 8.9% 9.4% 13.7% 13.8% 18.2% 23.3% 22.0% 23.9% 19.9% 20.9% 20.8% n National n Maryland n Carroll Hospital Center* 27.8% 27.9% 25.4% 10

12 The Carroll Hospital Center Cancer Experience 2012 Data Year Age at Diagnosis Race/Ethnicity 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 95.1% 92.9% WHITE NON- HISPANIC Carroll Hospital Center 2012 Analytic Cases* by Race/Ethnicity n Carroll Hospital Center n Carroll County Census 3.3% 3.2% 1.3% 1.7% 0.3% 2.6% 0.0% 1.5% 0.0% 0.8% 0.0% 0.2% AFRICAN AMERICAN ASIAN HISPANIC ANY RACE MULTI- RACIAL OTHER RACE NATIVE AMERICAN Gender Carroll Hospital Center 2012 Analytics Cases* by Gender 54.3% n Carroll Hospital Center n Carroll County 50.1% 49.4% 45.7% FEMALE MALE 11 *Analytic cancer cases are cases diagnosed and/or receiving all or part of the first course of treatment at a facility.

13 County/State Carroll Hospital Center 2012 Analytic Cases* by County or State GEORGIA WEST VIRGINIA CHARLES COUNTY MONTGOMERY COUNTY WASHINGTON COUNTY HARFORD COUNTY BALTIMORE CITY ANNE ARUNDEL COUNTY HOWARD COUNTY FREDERICK COUNTY PENNSYLVANIA BALTIMORE COUNTY 0.2% 0.2% 0.2% 0.2% 0.2% 0.2% 0.4% 0.4% 1.1% 1.3% 4.2% 7.9% TOTAL % OF NON-CARROLL COUNTY PATIENTS 16.1% CARROLL COUNTY 83.9% *Analytic cancer cases are cases diagnosed and/or receiving all or part of the first course of treatment at a facility. 12

14 The Carroll Hospital Center Cancer Experience 2012 Data Year CARROLL HOSPITAL CENTER 2012 PRIMARY CANCER SITE TABLE Primary Site Total Cases American Joint Committee on Cancer (AJCC) Stage 0 I II III IV Unknown N/A BREAST BRONCHUS & LUNG COLON PROSTATE GLAND SKIN (MELANOMA) URINARY BLADDER KIDNEY OTHER HEMATOPOIETIC NH LYMPHOMA RECTUM PANCREAS CORPUS UTERI OVARY UNK PRIMARY LEUKEMIA THYROID GLAND RECTOSIGMOID STOMACH ANUS & ANAL CANAL TESTIS MENINGES LIVER & BILE DUCTS OTHER BILIARY TRACT BASE OF TONGUE PERITONEUM BRAIN TONSIL ESOPHAGUS SMALL INTESTINE OTHER DIGESTIVE ORGANS THYMUS PLEURA OTH FM. GENITAL ORGN RENAL PELVIS OTHER SALIVARY GLANDS NASOPHARYNX OTHER ORAL CAVITY GALLBLADDER LARYNX CONNECTIVE/SOFT TISSUE CERVIX UTERI URETER OTHER ENDOCRINE GLANDS Total Details available upon request. 13

15 The six measures below show the year-to-date performance rates for concordance with evidence-based treatment practices for breast, colon and rectal cancers as measured by the Commission on Cancer s Rapid Quality Reporting System (RQRS). These rates are based on cancer registry data that was reported to RQRS on October 15, Standard of Care Measure Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer. [BCS/RT] Commission on Cancer s Minimum Required Concordant Rate Performance Rate > = 90% or Upper Bound of the 95% CI > = 90% Carroll Hospital Center s Concordant Rate 98% Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1c N0 M0, or Stage II or III ERA and PRA negative breast cancer. [MAC] Performance Rate > = 90% or Upper Bound of the 95% CI > = 90% 100% Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c N0 M0, or Stage II or III ERA and/or PRA positive breast cancer. [HT] Performance Rate > = 90% or Upper Bound of the 95% CI > = 90% 95% Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. [ACT] Performance Rate > = 90% or Upper Bound of the 95% CI > = 90% 100% Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or Stage III rectal cancer and receiving surgical resection [AdjRT] Quality Improvement Measures At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. [12RLN] Performance Rate > = 90% or Upper Bound of the 95% CI > = 90% Commission on Cancer s Minimum Required Concordant Rate Performance Rate > = 80% or Upper Bound of the 95% CI > = 80% 100% Carroll Hospital Center s Concordant Rate 93% 14

16 Cancer Committee Members Karen Alban, R.N., B.S.N., O.C.N. (Oncology Nurse Quality Improvement Team Member) Sharon Baker, O.T. (Rehabilitation Representative) Janet Blank, R.N., B.S.N., M.A. (Oncology Nurse Quality Improvement Team Member) Christine Cochran, R.N., B.S.N. (Quality Improvement Coordinator)* Suzi Ford (American Cancer Society Representative) George Grillon, D.M.D. (Other Medical Specialty) Daniel Grove, M.D. (Critical Care Unit Intensivist) Christopher Grove, M.D. (Pathologist CAP Compliance Manager) Dona Hobart, M.D. (Surgeon) Corilynn Hughes, R.N., B.S.N., O.C.N. (Oncology Nurse Clinical Research Coordinator)* Gregory Kirby, P.T. (Rehabilitation Representative) Flavio Kruter, M.D. (Medical Oncologist Cancer Committee Chairman) Terri Mack, L.C.S.W.C. (Social Work Psychosocial Services Coordinator)* Helen O Sullivan, Pharm. D. (Pharmacy) Eileen Overfelt, R.N., B.S.N. (Nurse Navigator Team Member Community Outreach Team Member) Bertan Ozgan, M.D. (Diagnostic Radiologist) Mary Peloquin, R.N., B.S.N. (Community Outreach Coordinator)* Darlene Price, B.S., R.H.I.T., C.T.R. (Cancer Registry Quality Coordinator)* Stephanie Reid, R.N., B.S.N., M.B.A. (Cancer Program Administrator) David Salinger, M.D. (Radiation Oncologist Cancer Liaison Physician & Cancer Conference Coordinator)* Stuart Shindel, M.D. (Surgeon) Dawn Van Der Stuyf, R.N. (Hospice Care Representative) Trisha Wagman, R.N. (Health Educator) Sherry Watts (Cancer Registry Assistant) Julie Wright, R.N., B.S.N. (Palliative Care Team Member) Sherry Morres, R.N. (Oncology Nurse Health Navigator Team Member) 200 Memorial Avenue Westminster, MD CarrollHospitalCenter.org *Required cancer committee coordinators