2010 Cancer Program Annual Report. Focus on Breast Cancer

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1 2010 Cancer Program Annual Report Focus on Breast Cancer

2 2 About Sophia Gordon Cancer Center The Sophia Gordon Cancer Center at Lahey Clinic offers a full range of comprehensive medical and surgical specialists who are board-certified in medical oncology, radiation oncology and surgical oncology. They work in collaboration to bring personalized, compassionate care to patients. GYN 10% Lahey Clinic 2009 Top Diagnostic Work Groups 88% of 2,616 Analytic Cases RESPIRATORY 10% HEMATO 8% MALE GENITAL 22% Clinicians treating the same patient readily consult one another, review test results and work in partnership on treatment plans. Regular tumor conferences are held to exchange information on complex and common diagnoses, and then together, doctors plan the best therapies for patients. Cancer therapies are designed using the most advanced treatments, research, clinical trials and support resources. Treating the whole patient by understanding the emotional and physical effects of cancer is central to Lahey s model of care. BREAST 15% URINARY 15% DIGESTIVE 20% Lahey has developed teams of cancer care, each headed by a physician director-leader and comprised of at least one hematologist, oncologist, radiation oncologist, surgeon, as well as various allied health care providers. Each team focuses on one specific cancer site. In addition, Lahey s strong support teams augment the cancer team. They are comprised of specialists from pain management, palliative medicine, behavioral medicine, nutrition, physical therapy, social services and nationally certified oncology nurses.

3 3 In 2009, Lahey Clinic s cancer specialists diagnosed and/or treated more than 2,500 unique new patients. Highlights of that activity include the following: There were 2,616 total new primaries diagnosed and treated at Lahey in 2009, representing a decrease of 6% from In 2009, 75% of new cancer patients were diagnosed at Lahey at an early stage. Seventy-four percent of new cancer patients seen were between the ages of 50 and 79. The age range for new cancer patients seen was 18 to 97 years, with a mean of age 65. The cumulative total of cases in Lahey Clinic s cancer database since 1995 grew to 35,354, with 1,154 cases being added in The total of living patients successfully followed during 2009 was 14,354, reflecting an overall follow-up rate of 84%.

4 Cancer Center Activity, By Primary Site Following is more detailed information about the new cancer cases seen, by primary tumor site. PRIMARY SITE TOTAL NEW CASES RECUR/METS MALE FEMALE HEAD AND NECK TONGUE GUM & OTH MOUTH FLOOR OF MOUTH SALIVARY GLANDS TONSIL OROPHARYNX NASOPHARYNX HYPOPHARYNX OTHER ORAL CAVITY DIGESTIVE SYSTEM ESOPHAGUS STOMACH SMALL INTESTINE COLON RECTOSIGMOID JCT RECTUM ANUS AND ANAL CANAL LIVER-INTRAHEPATIC BILE DCTS GALLBLADDER OTHER BILIARY TRACT PANCREAS RETRO & PERITONEUM, MESENT RESPIRATORY SYSTEM NASAL CAVITY LARYNX/TRACHEA BRONCHUS AND LUNG PLEURA SOFT TISSUE AND HEART HEART, MEDIASTINUM SKIN-NON-EPITHELIAL SKIN, MELANOMA SKIN, OTHER BREAST

5 5 FEMALE GENITAL SYSTEM VULVA VAGINA CERVIX UTERI CORPUS UTERI UTERUS NOS OVARY OTH FEMALE GENITAL ORGS MALE GENITAL SYSTEM PENIS PROSTATE GLAND TESTIS OTHER MALE GENITAL ORG URINARY SYSTEM KIDNEY & RENAL PELVIS URETER URINARY BLADDER OTHER URINARY ORGS EYE AND ORBIT BRAIN AND NERVOUS SYSTEM BRAIN OTHER CENTRAL NERVOUS SY THYROID AND ENDOCRINE THYROID GLAND OTH ENDOCRINE GLDS/REL S HEMATOPOIETIC AND LYMPHATIC LEUKEMIAS MYELOMA OTHER HEMATOPOIETIC NON-HODGKIN LYMPHOMA HODGKIN LYMPHOMA UNKNOWN PRIMARY SITE TOTAL

6 6 Cancer Program Year in Review Community Outreach Fifth Annual Lahey Clinic Cancer Walk (June 5, 2010) American Cancer Society/Lahey Clinic collaborative agreement Freedom from Smoking sessions Arms around Arlington Center for Cancer Support and Education Clinical Breast Care Center achieved NAPBC Accreditation Palliative Care Celebration of Life Integrative Medicine Program Programmatic Radiation Oncology awarded full accreditation by the American College of Radiation Oncologists New Clinicians Jonathan Ammen, MEd, MAc, LicAc Integrative Medicine Andrea McKee, MD Radiation Oncology Margaret Seaver, MD Internal Medicine/Palliative Care Gene Wong, MD Radiation Oncology

7 7 Breast Cancer Lahey Clinic s Breast Center Lahey s Breast Center provides diagnosis and expert treatment of noncancerous breast conditions and breast cancer. Lahey offers minimally invasive biopsies, comprehensive treatments for breast cancer and benign breast conditions, genetic counseling and testing services, and risk assessment. After completing a rigorous application process for the National Accreditation Program for Breast Centers (NAPBC), the Breast Center was awarded a three-year full accreditation designation. Only a handful of hospitals in the state of Massachusetts hold this distinction. The Breast Center was rated fully compliant based on the 27 standards and 17 components reviewed. The Breast Center s board-certified surgeons, nurse practitioners and genetic counselor are expertly trained in breast health. They work closely with breast imaging specialists in Lahey s Department of Diagnostic Radiology, as well as colleagues in Radiation Oncology, Medical Oncology, Plastic and Reconstructive Surgery, the Lymphedema Clinic and Social Services. Fully integrated Breast Cancer team Directors: Stephen E. Karp, MD Rebecca Yang, MD (Lahey Clinic North Director) Corinne Zarwan, MD Oncologists: Corrine Zarwan, MD Paola Rode, MD Neela Natarajan, MD Radiation Oncologists: Lyubov Girshovich, MD Andrea McKee, MD Surgeons: Stephen E. Karp, MD Rebecca C. Yang, MD Certified Breast Health Navigator: Rachel Richards, NP Nurse Practitioner: Mary McNeice, NP Pathologist: K. Greg Chang, MD Clinical Research Assistant: Kori Hesse Administrative Liaison: Brenda Hill, RN, BSN, OCN Genetic Counselor: Rebecca Madore

8 8 Diagnosis and Screening As is the case with all cancers, early diagnosis is the key to a successful outcome. For cases diagnosed and/or treated in the Breast Center, 32 percent of all cases were diagnosed at the earliest possible stage, before invasion. This compares with 22 percent of cases diagnosed nationally according to National Cancer Data Base (NCDB) data. Early diagnosis is made possible through the use of state-of-the-art, noninvasive diagnostic tools for breast imaging, including digital mammography, magnetic resonance mammography, and ultrasound. If a biopsy is considered optimum for diagnosis, 98 percent of the time stereotactic prone biopsy is adequate to successfully diagnose suspicious masses without requiring a traditional breast biopsy, which is more invasive and is performed in the operating room. Stage of Breast Cancer at Diagnosis

9 9 Treatment Lahey s team of breast cancer experts including clinicians from General Surgery, Radiation Oncology, Medical Oncology, Pathology and Diagnostic Radiology meets regularly at a multidisciplinary breast cancer conference to review diagnosis and discuss treatment options. The patient s wishes and full medical and social history are carefully considered. In 2010, 34 breast conferences were held, and 204 cases were discussed to plan treatment. Staging was determined in 100 percent of eligible cases. Lahey Clinic s Breast Center adheres to quality guidelines for the treatment of breast cancer that are endorsed by the National Quality Forum (NQF) and the American College of Surgeons National Accreditation Program. Adherence to these guidelines is examined on a regular basis to insure quality. For example, NAP- BC recommends that a proportion of at least 50 percent of all patients diagnosed with early stage breast cancer (Stage 0, I, II) are offered and/or treated with breast conserving surgery. At Lahey s Breast Center, the rate for 2010 was significantly higher, at 81 percent. Overall five-year survival is comparable to the national (NCDB) rate of 85 percent Breast First Course of Treatment Other 7% S 16% S, R, H 30% S,C 5% S, H 15% S, R, C, H 9% S, R, C 6% S, R 12%

10 10 In addition, NQF participants recommend that patients under age 70 who are receiving breast conservation surgery are offered or administered radiation therapy within one year of diagnosis. Review of records from 2004 through 2008 revealed that an average of 96 percent of eligible patients received radiation therapy at Lahey Clinic Breast Conservation Rates

11 11 In 2010, the Breast Center performed a study to determine if patients were receiving timely care following a positive mammogram result. Recognizing that this is an anxious time for patients, the Breast Center team set a goal of 20 business days as the maximum amount of elapsed time between screening mammogram and biopsy. The monthly results for the year are as follows: Clinicians in the Breast Center plan on using the study results to further streamline the flow of care for patients and improve upon the current process. Prevention and Education The Breast Center team provides educational opportunities for the public through the annual Lahey Clinic Cancer Walk, and, in 2010, sponsored a highly successful presentation at the Northshore Mall in Peabody, Mass. Women were offered educational materials; private discussions with a breast surgeon, breast imaging physician, or nurses; and the opportunity to complete a breast cancer risk assessment. In addition, the mammography team answered imaging questions from shoppers, and young shoppers, in particular, were educated in the performance of breast self-examination. As a result of the Northshore Mall Breast Center event, 12 women underwent the risk assessment, 10 screening mammogram appointments were made, and two General Internal Medicine appointments were scheduled.

12 Sophia Gordon Cancer Committee Gregory Chang, MD Pathology Stephen E. Karp, MD Breast Surgery Erika Rosato, RN, OCN, MHA Nurse Manager, Inpatient Oncology Elizabeth Collins, MD Internal Medicine Palliative Care John Cuttino, MD Diagnostic Radiology Jeff Doran Senior Vice President Elizabeth Fayram, RD Nutrition Nellee Fine, RN, MA, AOCN Nursing Education Kameel Garas, MD, FIPP Anesthesiology, Pain Management Lyubov Girshovich, MD Radiation Oncology Karim Hamawy, MD Urological Surgery Benita Handa, MD Behavioral Medicine Brenda Hill, RN, OCN, BSN Clinical Manager, Hematology/ Oncology QI Coordinator Tarun Kewalramani, MD Hematology/Oncology John Libertino, MD Director, Sophia Gordon Cancer Center Chair, Institute of Urology Denise McIntosh, RPT Physical Therapy Herbert Mower, ScD Radiation Therapy Physics Jeffrey O Brien, MHA VP, Cancer Services & Neurosciences Community Outreach Coordinator Deborah Perry Director, Research Administration Gail Reynolds, MS, CTR, RHIA Cancer Program Coordinator Physician QA Coordinator Pam Reznick, MSW, LICSW Social Services Julie Roache, CRA Clinical Research Lawrence Rusin, MD Cancer Liaison Colon & Rectal Surgery Stephanie Saia Communications and Marketing Anne P. Shapter, MD ACoS Cancer Liaison Gynecological Oncology Donna L. Smith, RN Radiation Oncology Mary St. Jean, BS, CTR Cancer Conference Coordinator Keith Stuart, MD Chairman, Cancer Committee Chair, Hematology/Oncology JoAnn Wentworth ACS Cancer Prevention Rebecca C. Yang, MD Lahey Clinic North Surgery Corrine Zarwan, MD Hematology/Oncology For a complete listing of Lahey s cancer specialists, go to

13 13 Lahey Clinic Cancer Services Locations Sophia Gordon Cancer Center Locations Hematology/Oncology and Radiation Oncology Lahey Clinic Medical Center 41 Mall Road Burlington, MA Hematology/Oncology and Radiation Oncology Lahey Clinic Medical Center North Shore One Essex Center Drive Peabody, MA Other Lahey Clinic Oncology Locations Lahey Center for Oncology & Hematology at Parkland Medical Center Overlook Medical Park 6 Tsienneto Road Derry, NH Affiliated Locations Radiation Oncology Associates, P.A.* Massachusetts locations in Burlington and Lowell New Hampshire locations in Concord, Dover, Manchester and Nashua

14 Lahey Clinic Medical Center 41 Mall Road Burlington, MA Lahey Clinic Medical Center, North Shore One Essex Center Drive Peabody, MA