2016 ANNUAL REPORT & 2015 STATISTICAL REVIEW

Transcription

1 CANCER PROGRAM A Body, Mind & Spirit Approach to Healing 2016 ANNUAL REPORT & 2015 STATISTICAL REVIEW

2 CANCER PROGRAM CALL TO ACTION Healthcare That Works Healthcare That Is Safe Healthcare That Leaves No One Behind For Life CORE VALUES Service of the Poor Reverence Integrity Wisdom Creativity Dedication

3 ENABLING STRENGTHS Inspired People Trusted Partnership Empowering Knowledge Vital Presence Stewardship CANCER REPORT 3

4 LOW DOSE SCREENING CT FOR LUNG CANCER Why and How We Are Doing It at St. Vincent s East Cancer Treatment Center LUNG CANCER is the number one cause of cancer related death in men and women. In our patients this is no different from the rest of the U.S. population. In reviewing our trends in diagnosis of lung cancer over the last 5 years it is apparent that 45% of our patients present with Stage 4 disease which has a higher mortality and worse prognosis. Advanced Stage Lung Cancer has a 5 year survival rate of less than 10%. Our Low Dose Screening CT program should help us find lung cancer in our patients at a much earlier stage. The National Lung Screening Trial (NSLT) showed a 20% reduction in lung cancer specific mortality and a stage shift towards early diagnosis with 70% of lung cancer being diagnosed at early stages in the study patient population. It has also been shown that earlier diagnosis and treatment of lung cancer is cost effective for our health care system. Various health organizations including the National Comprehensive Cancer Network (NCCN), American Cancer Society, and American Lung Association all have made recommendations to screen the specific high risk patient population with Low Dose Chest CT. In our system we use the Medicare will cover Low Dose Screening CT in patients who meet the following criteria: 55 to 77 years of age Current smokers or quit smoking in the last 15 years Smoking history of at least 30 pack years (smoking one pack /day for 30 years) Have a written order from a health care provider and have undergone counseling and shared decision making on risks and benefits of Screening CT for Lung Cancer criteria recommended by the Centers for Medicare and Medicaid Services (CMS) which are generally accepted and similar to recommendations made by various organizations. In establishing our Low Dose Screening CT program we felt that it was extremely important to make sure our patients receive appropriate follow up and treatment. All patients are scheduled through our cancer center where they can be tracked by our nurse navigator. Tribute to Dr. Morros It is with great sadness that the associates and physicians of the St. Vincent s East Cancer Treatment Center learned of the passing of Dr. Demetrius Jimmy Morros on November 20, For the past 18 years, Dr. Morros served the patients at St. Vincent s East with great skill and compassion. He was a dedicated father, husband and physician. He had great enthusiasm for the profession of medicine and devoted much time and energy to continually improving the practice of radiology. He was a graduate of Birmingham Southern College and the University of Alabama Medical College. He received his four year residency in Demetrius K. Morros, MD Radiology Radiology at the University of Cincinnati, and completed a year s Interventional Fellowship in Radiology at the University of Alabama, Birmingham. He was a Fellow of the American College of Radiology, and was actively involved in the Alabama Chapter of the American College of Radiology, serving as President of the chapter for two years. 4 ST. VINCENT S EAST

5 Earlier diagnosis and treatment of lung cancer is cost effective for our health care system Our patient data is reported to the American College of Radiology Lung Cancer Screening Registry, and rescreening and follow up is determined by the American College of Radiology Lung-RADS system which assigns findings on Chest CT into categories by imaging criteria and is a standardized system for follow up and additional testing when necessary. When a nodule is detected on a patient s CT based on size and other imaging characteristics we know when it is more likely to be cancer and when it is more likely to be benign. This system allows us to follow nodules that are benign when appropriate and refer patients who have nodules with more worrisome characteristics for earlier biopsy and treatment. We feel that our Low Dose Screening CT program will help our patients and will find more lung cancers sooner when the prognosis is better and the outcomes for our patients are better. Patients who wish to participate in our program should discuss this with their physician and can be scheduled for the test by contacting the St. Vincent s East Cancer Treatment Center. Please contact our Nurse Navigator, Rhonda Reese at for more information. Reference: Christiansen, Jared, Laroia, Archana et al. Lung Cancer Screening Education From Science to Practice, 2015, Kanne, Jeffrey, Online Course, American College of Radiology < Screening-Education> Stage of Lung, Bronchus Non-Small Cell Carcinoma Diagnosed in St. Vincent s East, Birmingham, AL vs. Comprehensive Community Cancer Programs in All States Class of Case / Data from 590 Hospitals St. Vincent s Other NUMBER OF CASES I II III IV UNK STAGE AT DIAGNOSIS 2016 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Wednesday, November 30, 2016 CANCER REPORT 5

6 DIRECTOR S LETTER THE CANCER PROGRAM at St. Vincent s East is committed to the delivery of excellent and compassionate care for all our patients. This Fiscal Year we are excited to announce that the Cancer Treatment Center at East has added the latest cancer-fighting technology with the Varian TrueBeam. The TrueBeam is an advanced radiotherapy system from Varian that dynamically synchronizes imaging, patient positioning, motion management and treatment delivery. This new technology will go a long way to consistently improve patient outcomes and increase our patient satisfaction. Since early detection of cancer saves lives, the Cancer Program continues to focus on community events that promote cancer awareness, screening, early detection and prevention. St. Vincent s East is also designated by the American College of Radiology as a Lung Cancer Screening Site. We appreciate the support of the St. Vincent s Foundation, St. Vincent s East Auxiliary, physicians, and associates who continue to work together to ensure we are able to meet the needs of our patients and their families during their diagnosis, treatment, and recovery. As always we look forward to a very successful year for our patients and for the Cancer Program at St. Vincent s East. Best regards, Johnny Karr BS, (R) ARRT Administrative Director of Clinical Services CANCER COMMITTEE 2017 Dr. James M. Kamplain, MD Radiation/Oncology Chairman Stephen Heinzman, MD General Surgery/Cancer Liaison Physician Dr. Kent Tucker, MD Hematology/Oncology Conference Coordinator Jared Cox, MD Urology Bryan Pruitt, M.D. Obstetrics and Gynecology Patrick Druhan, MD Radiology Maria Johnson, MD Internal/Pulmonary Medicine Jonathan G. Phillips, MD Pathology Shaily Lakhanpal, MD Hematology/Oncology Marc Bloomston, M.D. V.P. Medical Staff Affairs Diana Scalici, MSHA, MBA V.P. Operations Johnny Karr, BS, (R) ARRT Cancer Program Director Rhonda Reese, BSN, RN Navigator Community Outreach Coordinator Carol Kennemur, RHIT, CTR Cancer Registry Coordinator Sharon Cooper Davison, RN, BSN Unit Manager, 5 East, 5 West Linda Adams, RPh., MBA Pharmacy Director Donna Odom, RN, MSN Quality Improvement Coordinator Emily Hopkins, RHIT Health Information Management Barry Bruce, M.Div., BCC Spiritual Care Deidra Bentley, RN, BSN Operating Room Representative Rose Waddell, RN Case Management Karen Willette, MS, CCC-SLP Physician Therapy Erin Adamson, BS, CRC Clinical Research Coordinator Kimberly Wigley, MSHA, LPC, FACHE Psychosocial Services Coordinator Anna Lisa Weigel American Cancer Society Health Systems Manager 6 ST. VINCENT S EAST

7 CHAIRMAN S LETTER ON BEHALF OF the multidisciplinary Cancer Committee of St. Vincent East Hospital, I am pleased to present the 2016 Annual Report. This report reflects our goals, studies of quality and quality improvements, screening and prevention activities and incidence data, for the calendar year Our comprehensive cancer program provides a network of oncology services specializing in the prevention, diagnosis, treatment, and management of patients with cancer. The experienced and caring staff of the Cancer Program offers a multidisciplinary approach to the diagnosis and treatment of each individual cancer patient. This report reflects this approach to patient care including not only physicians but also chaplains, social workers, nurses and other healthcare workers. The goal of the Cancer Program is to provide the highest quality of patient care, exceeding the expectations of patients and their families throughout the course of a cancer illness. In addition, with the help of our Education Department, the Cancer Committee supports a wide range of preventive and educational programs designed to enhance early detection of cancer when the disease is most curable. The Cancer Committee continues to meet quarterly to supervise the activities of the Cancer Program. The multidisciplinary Cancer Conferences which meet twice a month as well as a Chest Cancer Conference which meets once a month provide an excellent forum for a prospective discussion of cancer cases where current treatments available both here at the hospital but also thru national investigational protocols are discussed. To members of our community, our Cancer Program offers quality cancer care that is close to home. St. Vincent East now offers cutting edge screening programs with the development of our lung cancer screening program. By offering low dose CT scans of the lungs for particular individuals at significant risk of developing lung cancer this offers the ability to diagnose the cancer at its earliest stage. Lung cancer continues to be a significant cause of cancer deaths but has an 88 percent survival rate when caught in early stages. The program provides prompt detection and timely care for patients whose test results indicate abnormalities. I am happy to report that with the installation of our new linear accelerator we will be able to offer advanced cancer care, including radiosurgery capabilities to our patients in a community hospital setting. St. Vincent East continues to be involved in its support of community cancer screenings, cancer prevention activities and education. We are truly fortunate to be able to offer such programs as Bosom Buddies, TOUCH, Camp Bluebird, and Look Good Feel Better for emotional support of our patients. The Tumor Registry is involved in collecting data on cancer type, stage of disease, first course of treatments, and offers lifelong patient follow-up. A total of new 606 analytic cancer cases diagnosed in 2015 were added to the Cancer Registry s database. We are truly fortunate to have the particular specialists here at St. Vincent East to manage these challenging cases. The Cancer Committee is also involved in studies that measure the quality of care and outcomes for patients with cancer. This year we have reported on lung cancer. There has been significant progress in the screening, and treatment of this disease with the use of low dose CT scans for screening and in the treatment of the disease with the use of stereotactic radiosurgery and targeted molecular therapies. Both of which are now and will soon be available here. I would also like to congratulate all Cancer Committee members, Cancer Leadership members, medical staff physicians, nurses, ancillary departments and other support personnel for another job well done. It is through these cooperative efforts that make our Cancer Program successful. We will continue to improve and advance the level of care and service we provide to patients and families in our community. James M. Kamplain, M.D. FACR Radiation Oncologist CANCER REPORT 7

8 COMMUNITY OUTREACH ANNUAL REPORT PREVENTION / AWARENESS PROGRAM PROGRAM/ COMMUNITY NEED ADDRESSED ACTIVITIES DATE DISCUSSED DATE PROGRAM HELD # OF PARTICIPANTS GUIDELINE USED SUMMARY OF EFFECTIVENESS SVE hospital auxiliary breast presentation. CNA over ¼ all cancers reported were breast 78% seldom or never perform SBE (avg. age 55-70) Breast Cancer Awareness. Printed educational material: How to check your breast. Breast model to learn how to perform selfbreast examinations. 8/9/2016 at Cancer Committee 9/19/ American College of Obstetricians and Gynecologists American Cancer Society (recommends) 100% reported presentation informative and learned something new. Oktoberfest Trussville Educational presentation based on community needs of knowledge related to cancer Informational booth for breast cancer awareness. Printed material available related to prevention, early detection, and mammograms. A breast model to practice self-exams. 8/9/ /8/ American Cancer Society 59 people took printed material related to breast cancer/mammograms. 79 people practiced on the breast model. 88% stated they were not aware of the amount of pressure needed for breast exams Cross Point women s group Presentation CNA 78% unaware of importance of self-exam to be familiar with their body Breast Cancer Awareness. Supplied printed material: How to check your breast. Breast model to learn how to perform self- breast exams. 8/9/2016 at Cancer Committee 8/31/ American College of Obstetricians and Gynecologists American Cancer Society (recommends) 83% stated they learned something new. 3 women stated they would schedule a mammogram. Follow up all 3 negative. SCREENING PROGRAM PROGRAM/ COMMUNITY NEED ADDRESSED ACTIVITIES DATE DISCUSSED DATE SCREENING HELD # OF PARTICIPANTS GUIDELINE USED SUMMARY OF EFFECTIVENESS LDCT lung screening month Nov. 1-30, 2016 Community Needs Assessment (CNA) to decrease the # late stage lung cancers. NCI lung cancer rate: Al. rate 71.3 / USA rate 62.4 Flyers placed in the community with criteria for screening. Educational materials placed throughout hospital and clinics. 8/9/2016 at cancer committee Month of November 4 American College of Radiology American Cancer Society 3 of 4 were negative. One screen requires a follow up in 3 months. 8 ST. VINCENT S EAST

9 2017 SCHEDULE OF EDUCATIONAL AND CANCER SUPPORT PROGRAMS All Programs are offered at no cost. Please call BOSOM BUDDIES Bosom Buddies is a breast cancer support group that meets once per month to give women the opportunity to talk with others who have been through similar experiences. The group is usually comprised of women, some recently diagnosed and others who are long-term survivors of breast cancer. Bosom Buddies meets on the third Wednesday of every month from 12 1 p.m. Preregistration is required. LOOK GOOD FEEL BETTER This program is for any woman undergoing cancer treatment. A certified professional teaches women how to cope with the appearance-related side effects of cancer treatment which may include hair loss and changes in complexion. Free make-up kits valued at $300 are provided. Look Good Feel Better is scheduled quarterly. Registration is required to ensure availability of make-up kits. For more information call Support Services at or the American Cancer Society at REACH TO RECOVERY Reach to Recovery is an American Cancer Society volunteer visitation program that helps breast cancer survivors meet the emotional, physical and cosmetic needs related to breast cancer. Call the American Cancer Society at for a referral to the Reach to Recovery program. US TOO Us TOO is a prostate cancer survivors support group that meets once per month to give men the opportunity to discuss symptoms and side effects of their diagnosis. The prostate cancer support group meets the second Wednesday of every month from 12 1 p.m. TOUCH (TODAY OUR UNDERSTANDING OF CANCER IS HOPE) TOUCH is a general support group that provides information, understanding, caring and hope for cancer survivors and their families. TOUCH meets the first Wednesday of every month from 12 1 p.m. Cancer screening for 2017, featuring colorectal cancer March is Colorectal Cancer Awareness Month, lets support the American Cancer Society by reaching the goal of 80% screened for colorectal cancer by According to U.S. Preventive Services Task Force (USPSTF), colorectal cancer is the second leading cause of death from cancer. The key to reducing the mortality rate from colorectal cancer is early detection and prevention. While colonoscopy is considered the first choice for screening, the fecal immunochemical tests (FIT) is an alternative method for detecting colorectal cancer. However, there are some advantages and disadvantages to the FIT. ADVANTAGES No cleansing of the colon is necessary No dietary restrictions are needed before FIT Samples can be collected at home Cost is low compared with other screening tests No sedation is needed DISADVANTAGES The test does not detect some polyps and cancers False-positive test results are possible Additional procedures, such as colonoscopy, may be needed if the test result shows blood in the stool CANCER REPORT 9

10 LUNG CANCER FACTS LUNG CANCER is the second most common malignancy diagnosed in both men and women. In the state of Alabama there are expected to be new cases of cancer with 4200 new cases being lung cancer. Although the incidence of lung cancer has decreased in men by 3% and 1.9% in women since 2008 the actual numbers of patients is increasing due to the increased numbers of people who are at risk of developing lung cancer due to advancing age. The median age at diagnosis is 70. Lung cancer accounts for more deaths than any other cancer in men and women accounting for 1 in 4 deaths due to cancer nation-wide. Fortunately the death rates have declined by 38% in men since 1990 and 12% in women due to the drop in smoking prevalence which is the by far the most important risk fact for lung cancer. However, lung cancer is the 4 th most prevalent cancer in the world. Of the various types of lung, nonsmall cell lung cancer is the most prevalent type with adenocarcinoma being the most frequent followed by squamous cell type. These types of lung cancer are felt to be distinct from the small cell or oat cell type of lung cancer which spreads much more rapidly and represent the remaining 15% of lung cancers. Previously there really was no good way to screen for lung cancer. However now with the use of low-dose spiral CT scans lung cancer can be detected at a much earlier stage and has been shown to reduce lung cancer mortality by 20% compared to standard chest x-ray among adults with at least a 30-pack year smoking history. Such a screening program is now available here at St. Vincent East and is actively accepting patients. The fact that untreated early Stage I lung cancer of all non-small cell lung cancer types has an overall mean survival time of only 12 months further confirms the very grim prognosis of having lung cancer. Lung cancer is an extremely heterogeneous family of malignant neoplasms, with well over 50 different histological variants recognized under the 4th revision of the World Health Organization (WHO) typing system with 98% being malignant in nature. The most widely used lung cancer classification scheme separates lung cancer into two basic types, i.e. small cell or oat cell type and non-small cell type. Because these variants have differing genetic, biological, and clinical properties, including response to treatment, correct classification of lung cancer cases are necessary to assure that lung cancer patients receive optimum management. Treatment of lung cancer is based on whether the tumor is the small cell or non-small cell type. This is due to the small cell type spreading so rapidly chemotherapy is the mainstay of therapy. The treatment of nonsmall cell type lung cancer is based on the stage of the disease which determines the type of therapy which can include surgery, radiation, and chemotherapy in various combinations. It is now recognized that even in the specific types of non-small cell lung cancer; there exist specific molecular types which can be identified by special molecular testing procedures done on the original tumor tissue. These tests help to differentiate a particular type which would potentially respond to the newest type of systemic therapy with what are referred to as targeted or biological agents. Targeted therapy of lung cancer refers to using agents specifically designed to selectively target molecular pathways responsible for, or that substantially drive, the growth of lung cancer cells, and as a consequence of this (relative) selectivity, cause fewer toxic effects on normal cells. As noted in our patient population most of the patients who are diagnosed are of advanced age and with advanced Stage III-IV disease. The addition of targeted therapies in these patients with advanced disease has significantly changed the options available to this group of patients. A more optimistic outlook in patient with lung cancer hopefully will result from the use of screening with low-dose CT scanning. This would hopefully significantly change the distribution to earlier stage disease where the results of treatment are significantly better. Another reason for a more optimistic prognosis First Course Treatment of Lung, Bronchus Non-Small Cell Carcinoma Diagnosed in St. Vincent s East, Birmingham, AL vs. Comprehensive Community Cancer Programs in All States Class of Case / Data from 590 Hospitals First Course Treatment SVE (N) Oth. (N) SVE (%) Oth. (%) TOTAL % 100% Radiation & Chemotherapy % 19.69% Surgery Only % 19.40% No 1st Course Rx % 23.90% Chemotherapy Only % 13.66% Radiation Only % 12.95% Surgery & Chemotherapy % 4.55% Surgery, Radiation & Chemotherapy % 2.39% Surgery & Radiation % 0.83% Other Specified Therapy % 1.88% Surgery, Radiation & Hormone Therapy % 10 ST. VINCENT S EAST

11 in early stage lung cancers will be the addition of a new linear accelerator here at St. Vincent East which will make available stereotactic body radiation. This type of therapy also known as stereotactic ablative radiotherapy is a technique of external beam radiation that delivers precisely targeted, ablative doses of radiation. For patients with early stage non-small cell lung cancer, surgical resection is the most established treatment. However, due to many patients having significant lung and heart problems many patients are not felt to be surgical candidates. With the use of stereotactic radiotherapy, this type of therapy has demonstrated that it is just as successful in curing early stage lung cancer as surgery with similar rates of local control and survival, and yet has very low risks of toxicity in terms of lung or heart complications with virtually no mortality from the therapy. I am therefore happy to report that with the newer treatment modalities of targeted therapies and radiosurgery there has been a significant change in the paradigm, (i.e. a distinct set of concepts or thought patterns, including theories, research methods, postulates, and standards for what constitutes legitimate contributions to a field) in the treatment of lung cancer which is now available here at the community hospital setting of St. Vincent East. James M. Kamplain, M.D. FACR Age Group of Lung, Bronchus Non-Small Cell Carcinoma Diagnosed in * St. Vincent s East, Birmingham, AL vs. Comprehensive Community Cancer Programs in All States Class of Case / Data from 590 Hospitals 0.4 St. Vincent s East Other NUMBER OF CASES Under and over AGE AT DIAGNOSIS 1 1 Race Hispanic Race Gender by Race/Ethnicity Lung, Bronchus Non-Small Cell Carcinoma Diagnosed in * Combination: Class of Case Comprehensive Community Cancer Programs in All States Data from 591 Hospitals MALE FEMALE NCDB Race Hispanic Race SVE White White * 2016 National Cancer Database (NCDB)/Commission on Cancer (CoC) CANCER REPORT 11

12 CANCER REGISTRY REPORT THE CANCER REGISTRY at St. Vincent s East has collected valuable data for patients diagnosed with and/or treated for cancer since The collection and analysis of over 25 years of cancer diagnoses, along with annual follow-up of cancer survivors, serves as a valuable resource for physicians and other health professionals. The Cancer Registry is also an integral part of providing cancer support services and educational resources to cancer patients and their families. Under the direction of the St. Vincent s East Cancer Committee, the registry participates in the National Cancer Data Base and Rapid Quality Reporting Systems (RQRS). This reporting system allows the registry to not only report breast, colon, and rectal cases at a time when treatment could be affected, but it also provides a method to monitor approaching treatment deadlines to meet nationally accepted guidelines for quality patient care. The St. Vincent s East Cancer Registry received the Gold Standard for reporting data to the Alabama Statewide Cancer Registry for 2015 data submission, as well as commendation for Annual 2015 NCDB Call for Data. To provide up-to-date treatment and survival information, lifetime patient follow-up is maintained by the registry staff annually. This information provides accurate survival statistics to both state and national agencies. The St. Vincent s East Cancer Registry proudly maintains a 94% follow-up rate for the cases registered within the past five years, and 91% for cases diagnosed since our reference date in This percentage exceeds the standard set forth by the American College of Surgeons and also allows for quality survival analysis. The Cancer Registry facilitates Prospective Cancer Conferences and monthly Chest Cancer Conference. These serve as excellent opportunities Carol Kennemur and Debbie Gray to improve patient care by providing national treatment guidelines based on staging of malignancies during case presentations. Physicians participate in a round table discussion for each diagnosis presented. St. Vincent s East Registry, maintained by Certified Tumor Registrars, serves as the nucleus for documenting cancer program activities, collecting and submitting quality cancer data, facilitating cancer committee meetings, coordinating conference activities that ensure quality patient care, as well as evaluating and promoting the use of ACoS Cancer Program Standards. SVE Top Ten Sites Newly Diagnosed Cases 2015 SVE Newly Diagnosed 2015 Cases Compared with American Cancer Society Estimated New Cases Male Top Ten Sites SVE% ACS% Female Top Ten Sites Breast Lung/Bronchus Prostate Colon Hematopoietic Pancreas Bladder Rectum Kidney Lymphatic Unknown % OF CASES Lung Colon Hematopoietic Kidney Lymph System Pancreas Rectum Bladder Stomach Ovary % OF CASES 12 ST. VINCENT S EAST

13 CANCER REGISTRY REPORT Blount % Etowah % Jefferson % St. Clair % Talladega % Age Comparison All Sites St. Vincent s East, Birmingham, AL vs. Comprehensive Community Cancer Programs in All States Class of Case / Data from 596 Hospitals 30% 25% SVE Other 20% 15% 10% 5% 0 Under and up AGE AT DIAGNOSIS 2016 National Cancer Database (NCDB)/Commission on Cancer (CoC) CANCER REPORT 13

14 PRIMARY SITE TABULATION FOR 2015 ANALYTIC CASES PRIMARY SITE TOTAL SEX STAGE GROUP M F 0 I II III IV UNK ALL SITES ORAL CAVITY Tongue Oropharynx Hypopharynx Other DIGESTIVE SYSTEM Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other RESPIRATORY SYSTEM Larynx Lung/Bronchus Other BLOOD & BONE MARROW Leukemia Multiple Myeloma Other CONNECT/SOFT TISSUE MELANOMA BREAST FEMALE GENITAL Cervix Uteri Corpus Uteri Ovary Other PROSTATE URINARY SYSTEM Bladder Kidney/Renal Other BRAIN & CNS Brain (Malignant) Other ENDOCRINE Thyroid Other LYMPHATIC SYSTEM Hodgkin s Disease Non-Hodgkin s UNKNOWN PRIMARY OTHER/ILL-DEFINED *Green indicates top ten analytic cases treated at St. Vincent s East in ST. VINCENT S EAST

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