Altru Cancer Program 2017 ANNUAL REPORT

Transcription

1 Altru CANCER CENTER Altru Cancer Program 207 ANNUAL REPORT SURGICAL MEDICAL RADIATION RESEARCH CLINICAL TRIALS GENETIC COUNSELING PALLIATIVE CARE DIAGNOSTICS CHEMOTHEARY HEMATOLOGY HOSPICE CARE 960 SOUTH COLUMBIA ROAD GRAND FORKS, ND ALTRU.ORG

2 207 Run for Your Buns Race Colon Cancer Prevention Fundraising Event IVING HOPE. Altru s Promise Every moment of every day, we promise to provide an excellent health care experience. We will be respectful, compassionate and thorough. We know your family and friends are an important part of your care; we will involve them as you wish and extend the same promise of excellence to them.

3 TABLE OF CONTENTS Altru s Promise...inside cover Cancer Committee Membership Message from Cancer Services Manager...2 Message from Cancer Committee Chair...3 Message from Cancer Liaison Physician...4 Clinical Research Trials...5 Prevention and Screening Programs...6 Accountability & Quality Improvement Measures Cancer by Site Patient Demographics...0 Cancer Center Providers... GIVING HOPE. Altru Health System is accredited as a Community Hospital Comprehension Cancer Program and maintains accreditation with the American College of Surgeons Commission on Cancer.

4 CANCER COMMITTEE 207 CANCER COMMITTEE COORDINATORS CANCER CONFERENCE COORDINATOR Kevin Panico, MD CANCER REGISTRY QUALITY CONTROL COORDINATOR Beth Nelson, RN, OCN QUALITY IMPROVEMENT COORDINATOR Shelly Evenson, RN EDUCATION/COMMUNITY OUTREACH COORDINATOR LeAnne Kilzer, RN, OCN RESEARCH COORDINATOR Wanda DeKrey, RN, OCN PSYCHOSOCIAL SERVICES COORDINATOR Vickie Misialek, LSW GENERAL SURGERY CANCER LIAISON PHYSICIAN Stefan Johnson, MD CHAIRMAN PHYSICIAN MEMBERS NON-PHYSICIAN MEMBERS CANCER COMMITTEE Daniel Walsh, MD, Chairman, Medical Oncology Stefan Johnson, MD, General Surgery Grant Seeger, MD, Radiation Oncology Kevin Panico, MD, Medical Oncology Marshall Winchester, MD, Radiation Oncology Muhammad Siddique, MD, Medical Oncology Tim Weiland, MD, Pathology David Chou, MD, Radiology Laura Lizakowski, MD, Internal Medicine, Palliative Care Todor Dentchev, MD, Medical Oncology Tana Setness Hoefs, MD, Obstetrics & Gynecology Henry Caoili, MD, Physiatrist Kelly Hagen, RN Administrative Director of Heart, Vascular and Surgical Procedural Services Beth Nelson, RN, OCN, Cancer Services Manager LeAnne Kilzer, RN, OCN, Oncology Resource Nurse Jodi Savat, RN, OCN, Inpatient Medical Oncology Shelly Evenson, RN, Quality/Utilization Review Rachel Salberg, NP, Palliative Care Denise Becker, RN, Medical Oncology Wanda DeKrey, RN, OCN, Oncology Research Aaron Kempenich, MS, Physicist Vickie Misialek, LSW, Oncology Social Services/Case Manager Anne Nygaard, NP, AOCNP, Medical Oncology Amanda Dudgeon, NP, Medical Oncology Emily Schmiedeberg, RN, Patient Referral Coordinator Annie Berginski, RN, Outpatient Medical Oncology Cassidy Rhondeau, RN, Outpatient Medical Oncology Julie Sundby, RN, Hospice Case Manager Danielle Conrad, LISCW, Grief Center Kim Sheldon, CTR, Cancer Registry Pam Vigen, CHUC, CTR, Cancer Registry Lindsay Carpenter, CTR, Cancer Registry Sara Anderson, American Cancer Society Katilyn Dufault, Recorder 207 Cancer Program Annual Report Altru Health System GIVING HOPE.

5 MESSAGE FROM CANCER SERVICES MANAGER At Altru Cancer Center, we are dedicated to providing an excellent health care experience. The American College of Surgeons (ACoS) Commission on Cancer (CoC) is an accrediting body, which shares our mission to provide patients with excellent care. In this report, we will highlight our work to maintain this highly-sought accreditation status, and to demonstrate how this work impacts our patients' experience. Beth Nelson, RN, OCN Manager, Altru Cancer Center Because of the care provided at the Cancer Center one of our goals included providing education for all staff on stress management. Staff work hard to provide quality care to each patient served and become close to many of our patients as they progress through their treatments. While this is very positive it can also cause increased stress for staff; the education will assist staff in managing this potential stress. A second goal was to increase the number of nursing staff who are oncology certified through the Oncology Nursing Society. Becoming certified is a positive step in demonstrating education, professionalism, and ongoing commitment to growth as a professional. The accreditation standard 2.2 is to have 25% of staff OCN certified. We currently have 33% OCN with three more nurses committing to taking the national test that will qualify them as OCN. We have also been working, along with all Altru Health System, to implement a LEAN system. LEAN is a management method in health care organizations that aims to promote a culture of continuous improvement. This means we have been identifying areas where we can streamline processes, add value for patients, and decrease waste. IVING HOPE. 207 Cancer Program Annual Report Altru Health System 2

6 MESSAGE FROM THE CANCER COMMITTEE CHAIR As Cancer Committee Chair, I am pleased to share with you our 207 Cancer Program Annual Report. Daniel Walsh, MD Cancer Committee Chair This year we want to provide information of what it means to be an accredited cancer program through the American College of Surgeons Commission on Cancer. Altru Health System has maintained continued full accreditation with the American College of Surgeons (ACoS) since 978. To achieve accreditation a cancer program must be compliant with the set standards of the ACoS. One of the standards (.2) requires the reporting of program activities to the public. To fulfill this, we report various cancer program initiatives, quality improvements and screening events in our annual report. Other standards we will focus on in this year s report are:» Standard.9 - Clinical Research Accrual» Standard 4. - Prevention programs» Standard Screening programs» Standard 4.5 Quality Improvement Measures» Standard 4.6 Monitoring compliance with Evidence-Based Guidelines» Standard 4.7 Studies of Quality» Standard 4.8 Quality Improvements We are proud of past accomplishments and what we do every day to provide continued quality care, and we hope that you will be interested in seeing that detailed in this report Cancer Program Annual Report Altru Health System GIVING HOPE.

7 MESSAGE FROM CANCER LIAISON PHYSICIAN Stefan Johnson, MD Cancer Liaison Physician Back in 206 we conducted a quality improvement study (Standard 4.6) to investigate our colorectal cancer cases. We were interested in studying the compliance with national guidelines governing testing for Lynch Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC). Study results revealed some challenges with guideline compliance. Following the 206 study, an effort was made to educate medical staff on patient eligibility requirements and increase awareness of guideline requirements. We then initiated a new quality improvement study (Standard 4.8) in 207 to evaluate trends in testing for microsatellite instability (MSI) and/or mismatch repair (MMR) testing. We are pleased to report that results of the 207 follow-up study do, in fact, show better compliance with the national guideline with more MSI/IHC testing ordered. Another quality study was conducted in 207 to review colon cancer cases and gather data from hospitals within the state of North Dakota to compare rates of open and laparoscopic surgeries. Previous studies have shown a quicker recovery time, earlier hospital discharge, and less pain with laparoscopic surgery. Also, some national studies have shown a lower 30-day mortality rate and fewer complications with laparoscopic approach. Data from this quality study showed that Altru Health System is offering laparoscopic colon resections at a similar rate when compared to the rest of the state. This study fulfilled requirements for Standard 4.7. As Cancer Liaison physician for the Altru Cancer Program, it is also my responsibility to report our cancer program s performance using data from the National Cancer Data Base (NCDB) and Cancer Program Practice Profile Reports (CP3R). CP3R measures are further detailed on page 7. IVING HOPE. 207 Cancer Program Annual Report Altru Health System 4

8 STANDARD.9 CLINICAL RESEARCH TRIALS Clinical trials are an essential component of the cancer program at the Altru Cancer Center (ACC), providing advanced treatment options for adult patients. There are three essential functions of the research program: clinical trial treatment, translational research and procurement of tissue for research. Wanda DeKrey, RN, OCN Altru Cancer Center Research Nurse Clinical trials for our adult population are accessed through membership with the Alliance for Clinical Trials in Oncology. We also utilize the Clinical Trials Support Unit (CTSU), a resource sponsored by the National Cancer Institute (NCI) designed to facilitate access to NCI-funded clinical trials, which gives us access to additional clinical trial cooperative group research. These research groups are the Eastern Cooperative Oncology Group (ECOG) and the American College of Radiology Imaging Network (ACRIN) [ECOG-ACRIN], Canadian Cancer Trials Group/National Cancer Institute of Canada [NCIC], National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group (RTOG), and the Gynecologic Oncology Group (GOG) [NRG], and Southwest Oncology Group [SWOG]. We participate in Screening, Phase II and III studies offering treatment with chemotherapy, targeted and immunotherapy, and/or radiation, Cancer Control/Symptom Management and Quality of Life studies. Clinical trials are an indispensable resource in the ongoing fight against cancer. They provide patients with new discoveries in treatment options that may not be otherwise available. A list of clinical trials currently enrolling at the ACC is accessible at Cancer Program Annual Report Altru Health System GIVING HOPE.

9 STANDARD 4. AND 4.2 PREVENTION & SCREENING PROGRAMS Standard.8 Outreach Programs Standard.8 states: Each calendar year, the Community Outreach Coordinator, under the direction of the cancer committee, monitors the effectiveness of prevention, screening, and outreach activities. In the following outreach events have been held, outcomes and effectiveness have been monitored:» Healthy Living Expo, with information on lung cancer, tobacco cessation and genetics» Relay for Life events» Pretty in Pink» Health Care Horizons» Artful Healing Project LeAnne Kilzer, RN, OCN Education/Community Outreach Coordinator Standard 4. Prevention Programs Standard 4. states: Each year, the cancer committee provides at least one cancer prevention program that is targeted to meet the needs of the community and should be designed to reduce the incidence of a specific cancer type. The Cancer Committee set goals:» Increase HPV vaccinations» Make Tobacco Cessation programs ongoing and available» Distribute sunscreens samples and Sun Safety pamphlets through the Grand Forks Parks Department and also through the skin screening events Standard 4.2 Screening Programs Standard 4.2 states: Each year, the cancer committee provides at least one cancer screening program that is targeted to decreasing the number of patients with late-stage disease. This year, three screening programs are being held. Using 200 to 204 data from our cancer registry and NCDB, stage IV lung cancer incidence was 47% versus national stage IV incidence of 40%. With these results the cancer committee implemented a lung cancer screening. In 206, a total of 40 people went through the lung cancer screening and one case of cancer was found. The lung screening continues and is available throughout the year. Skin cancer screening events are held at various times throughout the year, in 206 a total of 40 participants were screened with findings of one basal cell carcinoma and one squamous cell carcinoma. Prostate cancer screening is held annually in September. In light of new research supporting continued screening we plan to increase efforts to get men to participate, we will increase marketing of program, reach out to men-only organizations and also reach out to large scale employers to put out information in employee newsletters. Cancer screening is important because it helps identify cancer at early stages when a cure is more likely. IVING HOPE. 207 Cancer Program Annual Report Altru Health System 6

10 STANDARD 4.4 AND 4.5 ACCOUNTING AND QUALITY IMPROVEMENT MEASURES Standard 4.4 Accountability Measures Standard 4.4 states: Each calendar year, the expected Estimated Performance Rates (EPR) are met for each accountability measure as defined by the Commission on Cancer. Standard 4.5 Quality Improvement Measures Standard 4.5 states: Each calendar year, the expected Estimated Performance Rates (EPR) is met for each quality improvement measure as defined by the Commission on Cancer. Beth Nelson, RN, OCN Cancer Registry Quality Control Coordinator The Cancer Registry at Altru Health System submits data annually to the National Cancer Data Base (NCDB). The data submitted to NCDB are utilized by the Commission on Cancer in evaluating and assessing quality measures that have been developed to ensure patient-centered treatment outcomes. We use quality improvement measures for internal monitoring of performance so that analyses and remedial actions can be taken, as appropriate. The Cancer Program Practice Profiles Report (CP3R) is generated from data submitted to the NCDB. The ten sites of cancer included in the CP3R measures are: bladder, breast, cervix, colon, endometrium, gastric, kidney, lung, ovary and rectum. Cancer Liaison Physician, Dr. Stefan Johnson, annually presents and reviews the CP3R rates. The cancer committee then develops and action plan to address any accountability or quality improvement measures that drop below the CoC requirement. The following table details the quality measures for lung cancer and corresponding required CoC standard percentage to be met. This is an example of CP3R quality improvement measures and the information available to our facility. Select Measures Measure CoC Std / % Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pn) and (pn2) NSCLC (Quality Improvement) Surgery is not the first course of treatment for cn2, M0 lung cases (Quality Improvement) LCT 4.5 / 85% LNoSurg 4.5 / 85% Cancer Program Annual Report Altru Health System GIVING HOPE.

11 STANDARD 4.7 AND 4.8 STUDIES OF QUALITY AND QUALITY IMPROVEMENT Standard 4.7 Studies of Quality Standard 4.7 states: Each calendar year, the cancer committee, under the guidance of the Quality Improvement Coordinator, develops, analyzes, and documents the required number of studies (based on the program category) that measure the quality of care and outcomes for cancer patients. Shelly Evenson, RN Quality Improvement Coordinator In 205 the Hospice Department at Altru Health Systems brought forward to the cancer committee a concern with the low number of patient referrals to the Hospice Program. A study was conducted in 205 identifying all oncology patients who could benefit from hospice care. Analysis of the data demonstrated that fewer patients were receiving referrals for hospice care than would have benefited from services. After study analysis, the cancer committee recommended the following interventions:» Development of an awareness campaign including scheduled blogs by hospice staff through the Altru public website» Collaboration of case managers, case management teams and cancer center navigators to redesign the referral process for hospice appropriate patients Standard 4.8 Quality Standard 4.8 states: Each calendar year, the cancer committee, under the guidance of the Quality Improvement Coordinator, implements two cancer improvements. One improvement is based on the results of a quality study completed by the cancer program that measures the quality of cancer care and outcomes. One improvement can be based on a completed study from another source. Quality improvements are documented in the cancer committee minutes and shared with medical staff and administration. In 206, after implementation of the cancer committee s recommended improvements, a follow-up study was conducted using the same study criteria as the 205 study. Data analysis showed hospice referrals to have significantly increased an estimated 57%, suggesting these quality improvements had benefited a significant number of patients. The cancer registry continues to capture data on hospice referrals and social work and navigators continue to meet monthly to review opportunities for improvement. IVING HOPE. 207 Cancer Program Annual Report Altru Health System 8

12 206 SITE DISTRIBUTION Primary Site Total Class Sex General Stage A N/A M F INS LOC REG DIST BEN Unk All Sites Oral Cavity Lip Tongue Oropharynx Hypopharynx Other Digestive System Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other Respiratory System Nasal/Sinus Larynx Other Lung/Bronc-Small Cell Lung/Bronc-Non Small Cell Other Bronchus & Lung Blood & Bone Marrow Leukemia Multiple Myeloma Other Bone Connect/Soft Tissue Skin Melanoma Other Breast Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other Male Genital Prostate Testis Other Urinary System Bladder Kidney/Renal Other Brain & CNS Brain (Benign) Brain (Malignant) Other Endocrine Thyroid Other Lymphatic System Unknown Primary Other/Ill-Defined Cancer Program Annual Report Altru Health System GIVING HOPE.

13 206 CASES PER DEMOGRAPHICS GOLDEN VALLEY DIVIDE BURKE WILLIAMS MOUNTRAIL MCKENZIE BILLINGS SLOPE DUNN DIVIDE HETTINGER BOWMAN ADAMS RENVILLE MERCER GRANT WARD MCLEAN OLIVER MORTON SIOUX BOTTNEAU ROLETTE 3 PIERCE MCHENRY 3 SHERIDAN BURLEIGH EMMONDS BENSON 7 WELLS KIDDER LOGAN MCINTOSH TOWNER 9 CAVALIER 6 RAMSEY 6 EDDY - GRIGGS FOSTER - STUTSMAN PEMBINA 42 WALSH 73 GRAND FORKS NELSON LAMOURE DICKEY BARNES STEELE RANSOM SARGENT TRAILL CASS 2 RICHLAND The demographics shown on map reflect that 65% of our cancer patients in 206 North Dakota residents. 34% were from Minnesota and % were from out of state. KITTSON 8 ROSEAU 73 MARSHALL 53 PENNINGTON - 27 RED LAKE - 9 POLK 6 NORMAN MAHNOMEN 3 CLAY WILKIN BECKER LAKE OF THE WOODS 5 BELTRAMI 7 CLEARWATER 5 HUBBARD WADENA KOOCHICHING 2 CASS CROW WING 2 ITASCA AITKIN CARLTON PINE TRAVERSE STEVENS POPE STEARNS BENTON ISANTI SHERBURNE CHISAGO BIG STONE ANOKA WASH- SWIFT KANDIYOHI WRIGHT INGTON HENNEPIN RAMSEY CHIPPEWA MEEKER LAC QUI PARLE MCLEOD CARVER RENVILLE YELLOW MEDICINE SCOTT DAKOTA SIBLEY LA LYON REDWOOD NICOLLETE SUEUR RICE LINCOLN BROWN BLUE PIPESTONE COTTON- WATON- EARTH MURRAY WOOD WAN ROCK OTTER TAIL GRANT NOBLES DOUGLAS JACKSON TODD MORRISON MARTIN MILLE LACS KANNABEC GOODHUE WABASHA STEELE DODGE OLMSTED WASECA FAIRBAULT FREEBORN SAINT LOUIS MOWER LAKE WINONA FILLMORE HOUSTON COOKE Many of our patients travel a great distance to receive care at Altru Cancer Center. Our goal through Patient Navigation and various programs is to ease the burden of that distance and to provide excellent quality of care for our patients and their families. North Dakota (65 Cases 65%) 336 Grand Forks 73 Walsh 6 Ramsey 42 Pembina 25 Nelson 7 Benson 6 Cavalier 3 Rolette Traill 9 Towner 3 Pierce 2 Cass Eddy Bottineau Steele Stutsman Foster Griggs Burleigh Minnesota (323 cases 34%) 6 Polk 73 Roseau 53 Marshall 27 Pennington 8 Kittson 9 Red Lake 7 Beltrami 5 Lake of the Woods 5 Clearwater 2 Koochiching 2 Crow Wing Saint Louis Renville Ramsey Kandiyohi Hennepin Fairbault Out of State ( cases %) IVING HOPE. 207 Cancer Program Annual Report Altru Health System 0

14 CANCER CENTER PROVIDERS Todor Dentchev, MD, is board certified in hematology, medical oncology and internal medicine by the American Board of Internal Medicine and has additional ECG certification by the American College of Cardiology. Dr. Dentchev received his medical degree from Higher Medical Institute, Medical Academy in Bulgaria and has completed an internal medicine residency and hematology/oncology fellowship at the Brooklyn Hospital Center in New York. Laura Lizakowski, MD, received her nursing degree and medical degree from the University of North Dakota. She completed her residency and fellowship at Marshfield Clinic in Marshfield, Wisconsin. She is board certified in internal medicine, hospice and palliative medicine. Ngozi Okoro, MD, is board certified in internal medicine and medical oncology. Dr. Okoro earned her medical degree from the University of Maiduguri, Maiduguri, Nigeria and completed her internal medicine residency and medical oncology fellowship from Howard University, Washingto, D.C. Kevin Panico, MD, received his medical degree from the University of Texas Southwestern Medical Center, and completed an internal medicine residency at SUNY Health Science Center and hematology/oncology fellowship at Ohio State University. Dr. Panico is board certified in internal medicine, hematology, medical oncology and palliative medicine by the American Board of Internal Medicine. Grant Seeger, MD, received his medical degree from the University of North Dakota School of Medicine, and completed his residency internship at the University of Minnesota Internal Medicine program. He completed a four-year radiation oncology residency at the University of Texas Medical Branch. He is board certified in radiation oncology by the American Board of Radiology. Muhammad N. Siddique, MD, received his medical degree from Punjab Medical College in Pakistan. He completed his residency in internal medicine. He completed his residency at Staten Island University in New York, where he also completed his fellowship in hematology and oncology. Dr. Siddique is board certified in internal medicine, hematology and oncology by the American Board of Internal Medicine. 207 Cancer Program Annual Report Altru Health System GIVING Daniel Walsh, MD, received his medical degree from University of Illinois in Chicago. He completed an internal medicine residency and hematology/ oncology fellowship at University of Minnesota Hospitals and Clinics in Minneapolis, MN. Dr. Walsh is board certified in medical oncology by the American Board of Internal Medicine. Marshall Winchester, MD, received his medical degree from Wayne State University in Detroit, Michigan and completed his radiation oncology residency and was chief resident at Henry Ford Hospital in Michigan. He has more than 25 years of radiation oncology experience. Jackie Devine Roberts, DNP, FNP-C, AOCNP, received her master's degree as a family nurse practitioner from the University of North Dakota College of Nursing in 998 and her Doctorate of Nursing Practice from the University of Minnesota in 202. She is certified by the American Nurses Credentialing Center and completed the Advanced Oncology Certification for Nurse Practitioners in Amanda Dudgeon, FNP-C, received her master's degree as a nurse practitioner from the University of North Dakota in 20. She is certified as a family nurse practitioner by the American Association of Nurse Practitioners. Anne Nygaard, FNP-C, AOCNP, received her master's degree from the University of North Dakota College of Nursing in She is certified as a family nurse practitioner by the American Association of Nurse Practitioners and completed the Advanced Oncology Certification for Nurse Practitioners in 203. Bethann Nuelle, FNP-C, received her Master of Science with Family Nurse Practitioner Specialization from the University of North Dakota, Grand Forks, North Dakota. She joined the Altru Cancer Center staff in 207. HOPE.

15 Run For Your Buns 5K raises awareness for colon cancer in a fun (and entertaining) atmosphere. Our generous sponsor support offset the cost of the event, and our net proceeds from the race are donated to the Altru Health Foundation Colon Cancer Initiative to help uninsured or underinsured patients get screening colonoscopies.

16 Improving Health, Enriching Life 960 South Columbia Road Grand Forks, ND 5820 altru.org