The Center for Cancer Prevention and Treatment Public Reporting of Outcomes

Transcription

1 The Center for Cancer Prevention and Treatment 2017 Public Reporting of Outcomes

2 Cancer Screening Program - CoC Standard 4.2 Oral Cancer Screening Event Identified Community Need According to the 2014 St. Joseph Hospital Community Needs Assessment Report, one of the top health concerns was the lack of access to preventative care and a high incidence of adult tobacco use in the community. Tobacco use is a risk factor for several cancers, including oral head and neck cancer. Program Description The Center for Cancer Prevention and Treatment s Head and Neck program coordinated and hosted an oral cancer screening event on Oct. 24, The screening team consisted of four physicians who performed the screenings, five registered nurses and four administrative volunteers. The participants were educated and provided handouts on signs and symptoms of oral cancer and the recommendation for oral cancer prevention along with contact information for the head and neck navigator, social worker, financial assistance navigator and the primary care physician referral line. There were a total of 48 registered participants, of which 54% attended and completed screening. All participants completed a questionnaire; 62% reported that they had not previously heard of oral cancer before this event; 88% of participants had never been screened for oral cancer; 100% felt they were better informed on the causes, signs and symptoms of oral cancer after receiving education from the screening team. In addition, 62% indicated they planned to make changes to their lifestyle habits to prevent oral cancer. determined high risk for malignancy. Participants were made aware of the findings and were advised to seek further follow-up with their primary care physician (PCP); they were given a copy of the assessment to ensure proper referral to a specialist was made if determined by their PCP. The Head and Neck Navigator followed up a via phone call to each participant with an abnormal finding to ensure they had follow-up with their primary care physician and provided additional resources as needed. The Head and Neck Navigator also mailed a letter to these participants as an additional reminder regarding their abnormal finding(s), to ensure they seek additional evaluation as recommended by the screening physicians. Evidence-Based Intervention 1. United States Preventative Services Task Force (USPSTF) Recommendations 2. Chuang, Shu-Lin, et al. Population-based Screening Program for Reducing Oral Cancer Mortality in 2,334,299 Taiwanese Cigarette Smokers and/ or Betel Quid Chewers Cancer, Vol. 123, no.9, 1 May.2017, pp Wiley Online Library, doi: /cncr Follow-up Process for Participants with Positive Findings There were eight abnormal findings from which four were 2017 PUBLIC REPORTING OF OUTCOMES 2

3 Cancer Prevention Program - CoC Standard 4.1 Put Yourself in the Driver s Seat: Health Eating, Exercise and Mindfulness Identified Community Need This program served to address the community needs of increased incidents of obesity as well as lack of education and resources on healthy eating and physical activity, which were reported in the 2014 St. Joseph Hospital Community Needs Assessment. Program Description This program was held on March 8, It served to address the needs of increased obesity incidences as well as the lack of education and resources on healthy eating and physical activity, which are known factors that can increase the risks of developing breast cancer. This prevention program provided education to encourage patients and community to make informed choices associated with nutrition and physical activity and its effects on breast cancer prevention and treatment. This educational program consisted of three presentations, which consisted of a cancer wellness navigator who addressed mindfulness and its benefits in reducing stress (1), leading the group in guided imagery; a chef that conducted a healthy meal cooking demonstration (3), while explaining nutritional makeup and health benefits of food grains; and a physical therapist who explained the connection between exercise and maintaining a healthy BMI to lower the risk of developing cancer and decreasing recurrence of breast cancer (2), while leading the group in a light exercise demonstration. breast cancer, 81% reported yes. Participants were also asked if they learned to identify and describe mindfulness and meditation techniques and the benefits as it relates to reducing stress, 81% reported yes. Evidence-Based Intervention 1. Ott, Mary Jane, et al. Mindfulness Meditation for Oncology Patients: A Discussion and Critical Review. Integrative Cancer Therapies, Vol 5, no. 2, 2006, pp , pdf/ / Moore, Steven C., et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Medicine. 2016; 176(6): jamainternalmedicine/fullarticle/ AICR's Foods That Fight Cancer - Whole Grains AICR.org, wholegrains.html Analysis of the Survey Data There were a total of 85 participants. Of the 85 participants, 91% reported that they learned the benefits of healthy food choices and gained strategies to prepare healthy meals. Participants were asked if they understood the importance of exercising as it relates to lowering the risk of developing 2017 PUBLIC REPORTING OF OUTCOMES 3

4 Quality Improvement Study - CoC Standard 4.8 Develop a Physician Notification Process Prior to Initiation of Treatment with Osteoporotic Inducing Anti-hormone Medications in Breast Cancer Patients for the Use of Bone Density Evaluation Completed by Timothy Byun, MD, Lawrence D. Wagman, MD and Lillian Chen Study Topic Develop a physician notification process prior to initiation of treatment with osteoporotic inducing anti-hormone medications in breast cancer patients for the use of bone density evaluation. Background/Reason for Study Aromatase inhibitors are the preferred endocrine therapy for postmenopausal estrogen receptor positive breast cancer patients. However, one of the main long-term side effects is the increased risk of osteoporosis, which increases the risk of fracture. Both ASCO and NCCN guidelines recommend bone mineral density determination at baseline, and periodically thereafter for postmenopausal women who are treated with aromatase inhibitors. The reason for the study was to find out whether baseline bone mineral density evaluation (DEXA scan) is performed in patients who were started on aromatase inhibitor. Study Methodology and Criteria for Evaluation From July 1, 2016 to Sept. 30, 2016, we reviewed patients who were presented at the multidisciplinary breast cancer conference. A total of 60 patients were reviewed. Of these patients, we screened for ER or PR positive cancer and age over 50 as a surrogate for post-menopausal status in women with early stage breast cancer. patients took aromatase inhibitor only, most commonly anastrozole (11), letrozole (10), and exemestane (1). The total adds up to 22 due to two patients taking more than one aromatase inhibitor. Nine of 20 patients (45%) had baseline DEXA scan within six months of aromatase inhibitor therapy initiation. 11 of 20 patients (55%) did not get baseline DEXA scan. Among nine patients with baseline DEXA scan, four patients (44%) were osteopenic at baseline. Four patients had normal bone density. One patient s bone density status was unknown. Summary of Findings In our retrospective review of postmenopausal hormone receptor positive breast cancer patients who were presented at the multidisciplinary Breast Cancer Conference, we found that baseline DEXA scans were not routinely performed prior to aromatase inhibitor therapy initiation as recommended by the guidelines. Only 45% of patients underwent DEXA scan within six months of initiating aromatase inhibitor therapy. In patients who underwent DEXA scan, there was a significant percentage of 44% who were osteopenic at baseline. Data Analysis/Results There were 25 patients who met these criteria. Twenty-four of 25 patients were started on endocrine therapy PUBLIC REPORTING OF OUTCOMES 4

5 Corrective Action Plan (based on evaluation of data) Our plan is to implement a notification system by mail and to treating physicians who present patients who are eligible for aromatase inhibitor therapy at future Breast Cancer Conference. Our objective is to find out if this intervention would result in increased compliance rate of baseline DEXA scan for aromatase inhibitor therapy eligible patients. includes medications that lower sex steroids should be evaluated at baseline and with periodic follow-up DEXA scant to evaluate risk fracture. American Society of Clinical Oncology (ASCO) clinical practice guidelines in breast cancer recommend baseline osteoporotic evaluation for patients with aromatase inhibitors. Methods to ensure patients undergo DEXA scan moving forward: Follow-Up Steps to Monitor the Actions Implemented 1. Recommendation: Identify postmenopausal hormone receptor positive patients at Breast Cancer Conference. The Breast Nurse Navigator will send a letter and/or to Medical Oncologist, Surgical Oncologist, or Radiation Oncologist The Breast Nurse Navigator will track these patients and where the letter was sent. 2. Other Project: Periodic DEXA every 2 years while on aromatase inhibitor therapy. Screen patients previously presented at Breast Cancer Conference that were recommended treatment with AI for baseline osteoporotic evaluation. Physicians who presented newly diagnosed breast cancer cases will receive letter that based on this study, patients treated with AI should be considered for baseline bone density evaluation. A second letter will be sent to physicians whose patient began treatment with AI and did not undergo a bone density test or where documentation or a recommendation from the physician for the patient to have the test done could not be found. Comparison of Data Results with National Benchmark or Guideline NCCN Clinical Practice Guidelines In Oncology: Breast Cancer recommend that patients for whom planned therapy 2017 PUBLIC REPORTING OF OUTCOMES 5

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