Cancer Care Outcomes Report 2017

Transcription

1 Cancer Care Outcomes Report 2017

2 Table of Contents Shady Grove Adventist Aquilino Cancer Center, Cancer Committee Chairman Letter... 1 Adventist HealthCare Washington Adventist Hospital, Cancer Committee Chairman Letter Cancer Committees Community Cancer Outreach Adventist HealthCare... 5 Cancer Care Program at Adventist HealthCare Shady Grove Medical Center... 7 Cancer Cases by Site for 2016 Patients: Adventist HealthCare Shady Grove Medical Center... 8 Clinical Trials Crucial to a Cancer Cure Quality Improvement Implementation: Adventist HealthCare Shady Grove Medical Center Focus On: Colorectal Screening Cancer Care Program at Adventist HealthCare Washington Adventist Hospital Cancer Cases by Site for 2016 Patients: Adventist HealthCare Washington Adventist Hospital Quality Improvement Implementation: Adventist HealthCare Washington Adventist Hospital Focus On: Radiation Therapy for Adverse Pathologic Features on Prostatectomy Breast Cancer Survivors Celebrated at Systemwide Event... 17

3 Dear Colleague, Throughout 2017, the Shady Grove Adventist Aquilino Cancer Center continued to provide comprehensive and coordinated cancer care for patients and families in Montgomery County. Here, our patients and their families were able to find all of their outpatient cancer treatment needs under one roof. The Aquilino Cancer Center gives our patients access to our region s first Integrative Medicine program. Integrative Medicine provides a comprehensive way of looking at total wellness and diseases like cancer. Our program offers therapies that complement traditional cancer treatment methods and address our patients as a whole person body, mind and spirit. The program supports our patient s cancer journey and improves their general health by: Empowering them to take an active role in their treatment and care Treating cancer with state-of-the-art conventional therapies and lifestyle interventions Reducing the side effects of treatment Reducing their risk of recurrence Our brain and spine experts at Shady Grove continue to offer our patients state-of-the-art neurological and neurosurgical care close to home. And with the addition of a new physician to our team in 2017, we now have the ability to perform innovative and minimally invasive brain surgery for our patients. During the past year, we ve also undergone a series of quality improvement processes designed to improve access to care without sacrificing the personal approach that our patients have come to expect from Shady Grove. Our team of specialized staff, including oncologists, surgeons, nurses, technicians, navigators, social workers and integrative medicine experts, allow us to continue to develop and deliver compassionate cancer care for our community into 2018 and beyond. Joseph Haggerty, MD Cancer Committee Chairman Adventist HealthCare Shady Grove Medical Center 1

4 Dear Colleague, The oncology program at Adventist HealthCare Washington Adventist Hospital covers every aspect of cancer treatment from prevention, early detection, pre-treatment evaluation, staging, multi-modality treatment, rehabilitation and post-treatment monitoring. We spent 2017 continuing to offer inpatient and outpatient services to those living with cancer in our community. At Washington Adventist Hospital, our care extends beyond medical and surgical treatment. Our patients benefit from a broad range of support services to help them feel better physically and emotionally. Depending on a patient s personalized care plan, we have radiologists, pathologists, surgeons, radiation oncologists, cancer nurse navigators and dieticians available to be a part of their team. We are excited about the opportunity to extend our cancer care with our new hospital, Adventist HealthCare White Oak Medical Center, which is projected to open its doors in This new facility will allow us to expand access to excellent care and integrate advances in modern medicine. Project highlights and construction progress can be found by visiting As the needs in our community continue to change and evolve, the Cancer Team at Washington Adventist Hospital will continue its commitment to providing the best, most advanced clinical care possible for our patients. Kashif Firozvi, MD Cancer Committee Chairman, Medical Oncology Adventist HealthCare Washington Adventist Hospital 2

5 2017 Cancer Committee Adventist HealthCare Shady Grove Medical Center Donald Bridges, MD Radiation Oncology Cancer Liaison Physician Gregory Dick, MD Plastic & Reconstructive Surgery Shirlana Gabriel, BS, CTR Tumor Registry Consultant Mary Greenberg, MSN, RN Vice President, Service Line Joseph Haggerty, MD Medical Oncology Chairman Dominique Haynes, MHA, RN, OCN, CPHQ Cancer Program Administrator Robert Isaacs, MD Diagnostic Radiology Linda Iovanni, MBA, BSN, RN, CCRP Director, Clinical Research Amir Kende, MD Pathology Natalie Kontakos, MD Medical Director Palliative Care Shannon O Connor, MD Genetics Physician Rachel Serio American Cancer Society Ana Torres Cancer Outreach Coordinator Kendall Traylor, RN Oncology Nurse Manager Lindsey Wise, MSW, LCSW, OSW-C Oncology Social Worker Psychosocial Services Coordinator Ellen Young, CTR Cancer Conference Coordinator Viviane Yusaitis, RN Quality Improvement 3

6 2017 Cancer Committee Adventist HealthCare Washington Adventist Hospital Courtney Ackerman, MD Cancer Liaison Physician Melody Bankert, LGSW Oncology Social Worker, Psychosocial Services Coordinator Senda Beltaifa, MD Pathology Felicia Benjamin, RN Director, Quality Services Alta Berhaneselassie, MBA Cancer Conference Coordinator Paul Davis, PT Director, Rehabilitation Medicine Asante Dickson, MD Radiology Christine Dinh, MD Palliative Care Kashif Firozvi, MD Chairman Kamu Foderingham, MD Radiology Tiebe Green Quality Improvement Coordinator, Quality Management Representative Mary Greenberg, MSN, RN Vice President, Service Lines Rob Jepson Vice President, Business Development Carmen Lezama, MBA Community Outreach Coordinator Dorcas Lwanga, RDN, LDN Oncology Dietitian Brenda Millet, MSN, RN-BC Oncology Nurse Director Ana Torres Community Outreach Zara Necesario Clinical Trials Coordinator Cynthia Plate, MD Surgery Katie Ronca, CTR Cancer Program Manager, Cancer Registry Quality Coordinator Alan Schulsinger, MD Radiation Oncology Sherif Selim, MD Surgery Rachel Serio American Cancer Society Barbara Sweeney Chaplain, Pastoral Care Po Zhao, MD Pathology 4

7 Community Cancer Outreach Adventist HealthCare Adventist HealthCare Provides Screenings for Women in Need For more than two decades, Adventist HealthCare s Breast Screening Program has been serving low income, uninsured women in our community who are 40 years and older to help them detect and fight breast cancer. The purpose of the program is to provide free screening services to underserved women who may otherwise do without these services due to income and insurance limitations. The aim is to make screening, diagnostic and treatment services accessible to all women and reduce the number of deaths related to breast cancer. The Breast Cancer Screening Program is funded by: Avon Foundation Montgomery County Health Department s Women s Cancer Control Program Primary Care Coalition The State of Maryland s Breast and Cervical Cancer Diagnosis and Treatment Program. As of November 2017, 1,010 patients have benefited from the program through breast health education, clinical breast exams, mammograms and treatment, including: 873 screening mammograms 219 diagnostic mammograms 147 breast sonograms 5

8 2017 Adventist HealthCare Prevention Activities and Education Colon Cancer Education Presentation: During Colorectal Cancer Awareness month, dieticians, social workers and members of Adventist HealthCare s cancer team, provided 149 individuals with information about nutrition and digestive health. Sixth Annual Latino Health Fair: The cancer outreach team provided lung cancer educational materials to more than 130 community members at Montgomery College s Rockville Campus. The team also worked with staff from the tobacco cessation program to provide 25 carbon monoxide screenings and tobacco cessation counseling. Susie s Cause Free Outreach Health Festival: The cancer outreach team provided colorectal cancer education and digestive health information to 50 community members in Adventist HealthCare Washington Adventist Hospital s secondary service area. Colorectal Cancer Education and Referrals: Education was provided to women who attended the Breast Screening Program on colon cancer. Adventist HealthCare partnered with the Montgomery County Cancer Crusade, which provides free colonoscopies to eligible Montgomery County residents, to send 65 referrals for free screening. Look Good Feel Better: More than 37 individuals participated in this program led by specially trained cosmetologists and beauticians designed to help women undergoing cancer treatments look and feel their best. 6

9 Cancer Care Program at Adventist HealthCare Shady Grove Medical Center The oncology program at Adventist HealthCare Shady Grove Medical Center provides our patients with a multidisciplinary group of compassionate health care experts who combine their knowledge and expertise to help them get better. At the heart of our cancer care is the Shady Grove Adventist Aquilino Cancer Center, which is the only comprehensive cancer center in Montgomery County. The Aquilino Cancer Center is a community cancer program accredited with commendation by the American College of Surgeons (ACoS) Commission on Cancer (CoC). Only 30 percent of all hospitals in the U.S. are accredited, of which only a minority exceed standards to the degree where commendation is awarded. This distinction signifies the quality care provided to patients in Shady Grove s Cancer Program. Recognition for our cancer care services goes beyond our main campus. Our radiation oncology and imaging services, located in Germantown and Rockville, have earned national accreditation for their commitment to patient care. The Breast Center at Adventist HealthCare Shady Grove Medical Center currently holds a three-year, full accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. The Adventist HealthCare Radiation Oncology Centers in Rockville and Germantown have earned accreditations in radiation oncology from the American College of Radiology. Only 15 percent of U.S. hospitals hold this distinction. Shady Grove Medical Center s Nuclear Medicine Services received the Gold Seal of Accreditation in computed tomography (CT), or CAT scanning, by the American College of Radiology (ACR). The accreditation is given to facilities that provide the highest level of image quality and patient safety. Beyond our notable certifications and accreditations, our Cancer Center also has a wide variety of support services available to patients, including: Nurse Navigators Social Workers Registered Dieticians Rehabilitation/ PT/OT/Speech therapy PET/CT Cancer screenings and education Sophisticated diagnostic tools Patient navigation services, which guide you through diagnosis, treatment and recovery Chemotherapy and other infusion therapies Radiation therapy, including methods that spare healthy tissue A retail shop that provides items to make your daily life easier Support and wellness, including the region s only integrative medicine program 7

10 Cancer Cases by Site for 2016 Patients: Adventist HealthCare Shady Grove Medical Center In 2016, Adventist HealthCare Shady Grove Medical Center saw 1,007 newly diagnosed cancer cases, including those diagnosed at Shady Grove and those who received all or part of their initial course of treatment here. Breast continues to be the No. 1 site of new cancer cases at Shady Grove, accounting for more than 250 cases. Digestive and respiratory were the second and third most often diagnosed and treated cancers at the hospital. Adventist HealthCare Shady Grove Medical Center 2016 Cancer Cases (n=1,007) 8

11 Clinical Trials Crucial to a Cancer Cure Clinical trials involve the study of new, innovative treatments or strategies that may lead to prevention, earlier detection, better treatments or cures for conditions like cancer. These studies are an essential step in ensuring that treatments are safe and effective, as well as gaining regulatory approval. In fact, all of today s advanced cancer treatment options, tests and potential cures are only available because of the participation of clinical trial volunteers. Adventist HealthCare is committed to bringing patients the latest in cancer research through groundbreaking clinical trials. By participating, patients receive access to promising new treatment options. In addition, the Adventist HealthCare team recognizes and appreciates the invaluable contribution of clinical trial participants in cancer research and treatment efforts. In 2017, the cancer team launched 17 clinical trials for cancers that included breast, prostate and solid tumors. Cancer Trials Launched in 2017 Adventist HealthCare s cancer team currently offers access to clinical research for the following types of cancer Breast Colorectal Esophagus/EGJ Gynecology Hematology Lung Lymphoma Prostate Renal Solid Tumors Urothelial Learn more about the clinical trials offered by Adventist HealthCare by visiting 9

12 2017 Process Improvement: Adventist HealthCare Shady Grove Medical Center Focus On: Colorectal Cancer Screening Each calendar year, the Cancer Committee at Adventist HealthCare Shady Grove Medical Center organizes and offers at least one cancer screening program that is designed to decrease the number of patients with latestage disease and is targeted to meet the screening needs of the community. Each screening program is consistent with evidence-based national guidelines and interventions and must have a formal process developed to follow up on all positive findings. The cancer committee focused their efforts on colorectal cancer screening for To reach those at the highest rick of colorectal cancer, the Committee decided to partner with Adventist Medical Group physicians to identify patients age 50-75, who had not received any screening for colorectal cancer. Additionally the Community Health Needs Assessment for the hospital was used to identify patients within high-risk populations, including individuals in the African American and Asian communities, who would benefit from screening. 10

13 Strategy During Colorectal Cancer Awareness month, held in March, the cancer program launched a screening campaign that resulted in 511 completions of the free, online health risk assessments (HRA) hosted on the Adventist HealthCare website. Of those that took the HRA, 77 individuals presented as high risk. s were sent to these patients to remind them to follow up with their primary care physician or to schedule a colonoscopy. Additionally, a nurse navigator served as a liaison to facilitate GI referrals to high risk patients. Testing Methods Patients identified as high-risk were encouraged to undergo additional screening to check for any abnormalities. The two screening options recommended were: InsureFit: A screening test from Quest Diagnostics, which allows patients to take a fecal sample in the privacy of their own home. The test requires no prep or pre-dietary limitations. If abnormalities are detected, a colonoscopy is necessary. Colonoscopy: If required, a patient s primary care physician referred them to a GI practice to undergo a colonoscopy for further screening. Recommendations Based on findings from the testing and research, the Committee determined the need for a patient navigator or community health worker to help patients overcome barriers to screening. Providing this type of individualized assistance to patients is designed to help them navigate the healthcare system and facilitates timely access to quality cancer screening and diagnostic services. With this faster access to care, persons diagnosed with cancer are able to initiate treatment services sooner. Results Using the Committee s recommendations, a Care Coordinator from Adventist HealthCare s Center for Health Equity and Wellness now aides in tracking results to ensure the completion of the FIT screening test and colonoscopy. If a patient has a positive FIT test, they are referred to a GI practice for a colonoscopy. If the colonoscopy results in a malignant result, they are then referred to a nurse navigator for care coordination and oncology navigation team in order to manage care beginning at the time of diagnosis based on the care continuum. 11

14 Cancer Care Program at Adventist HealthCare Washington Adventist Hospital The cancer care specialists at Adventist HealthCare Washington Adventist Hospital are dedicated to providing high-quality, multidisciplinary care for members of our community living with cancer. Our patients have access to the latest advances in diagnosis and treatment, as well as coordinated support services. Washington Adventist Hospital is a community cancer program accredited with commendation by the American College of Surgeons Commission on Cancer. Only 30 percent of all hospitals in the U.S. are accredited, of which only a minority exceed standards to the degree where commendation is awarded. This distinction signifies the quality care provided to patients in Washington Adventist Hospital s Cancer Program. Our cancer team understands the unique demands of cancer and offers a personalized approach with coordinated care from a multidisciplinary team through a patient s cancer journey. Washington Adventist Hospital is part of the Adventist HealthCare system which offers comprehensive, skilled cancer care services including: Inpatient Cancer Treatment Outpatient Cancer Treatment Cancer Related Surgery Radiation Oncology Community Cancer Programs Skilled Home Care Cancer Support Groups Clinical Trials Multi-Disciplinary Clinics Nutrition Services Social Worker Palliative Care Adventist HealthCare cancer care locations in Maryland include: Adventist HealthCare Washington Adventist Hospital in Takoma Park Adventist HealthCare Shady Grove Medical Center in Rockville Shady Grove Adventist Aquilino Cancer Center in Rockville Adventist HealthCare Radiation Oncology Center in Germantown Adventist HealthCare White Oak Breast Center in Silver Spring 12

15 Cancer Cases by Site for 2016 Patients: Adventist HealthCare Washington Adventist Hospital In 2016, Adventist HealthCare Washington Adventist Hospital saw 344 newly diagnosed cancer cases, including those diagnosed at our hospital and those who received all or part of their initial course of treatment here. Breast provided the majority of new cancer cases at Washington Adventist Hospital, accounting for more than a third of cases, followed by male urology, digestive system, including colorectal, respiratory and urinary cancers. Adventist HealthCare Washington Adventist Hospital 2016 Cancer Cases (n=344) 13

16 2017 Quality Improvement Implementation: Adventist HealthCare Washington Adventist Hospital Focus On: Radiation Therapy for Adverse Pathologic Features on Prostatectomy In 2016, the Cancer Committee at Adventist HealthCare Washington Adventist Hospital decided to review its process for prostate cancer patients that had a prostatectomy. Prostate cancer was the second most frequent cancer diagnosed and/or treated at Washington Adventist with 117 patients receiving care with the hospital. As part of the study, the Committee looked at 2015 and 2016 prostate cancer patients who had a prostatectomy with adverse pathologic risk features to determine if these patients were recommended to have adjuvant radiation therapy, per the treatment recommendations from the National Comprehensive Cancer Network (NCCN). Of the 42 patients who received a prostatectomy, 24 percent had adverse pathologic features. NCCN Recommendations NCCN recommends an initial evaluation for prostate cancer to include a DRE, PSA value, family history, and Gleason score. Overall, 69 percent of the patients in this study were found to have a complete initial evaluation for prostate cancer documented in their medical records. NCCN recommends imaging studies for patients who are deemed to be a high or very high risk, including and a bone scan for patients with any of the following: T1 and PSA >20 T2 and PSA >10 Gleason > 8 T3 or T4 Symptomatic Per these recommendations: 31 percent of the patients met the criteria to have a bone scan. 100 percent of those patients had the NCCN recommended bone scan as part of their staging work-up. 31 percent of the patients in the study did not have their initial Gleason scores and/or PSA values documented in their medical records. However, one of those patients did have a bone scan documented. Additionally, NCCN recommends that patients have a Pelvic CT or MRI if they have any of the following: T3 or T4 T1-T2 and nomogram probability of lymph node involvement >10 percent For this study s purposes, 63 percent of patients had a pelvic CT and none were found to have suspicious pelvic lymph nodes. Overall, 69 percent of the patients studied had either a CT or a bone scan and 31 percent did not have any documentation of imaging studies in their medical record. 14

17 Treatment Plan Concordance After diagnostic evaluation was completed, the clinical risk groups for the patients in Washington Adventist s study were determined: 44 percent of patients included in study were classified as high risk due to Gleason 8 or 9 and/or PSA value <20 31 percent of patients included in study were classified as intermediate risk due to Gleason 7 and/or a PSA value percent did not have their risk group documented and these patients also did not have a PSA value or Gleason score documented. It was not possible to determine the risk group for these four patients. However, these four patients are still included in the study based on their adverse pathologic features. 75 percent of patients included in this study had concordant treatment plans based on NCCN recommendations for prostatectomy as initial treatment for their risk group. NCCN outlines further treatment recommendations for adjuvant radiation therapy when adverse pathologic features on prostatectomy are present. Adverse features include: Positive Lymph Nodes Positive Margins Seminal Vesicle Invasion Extracapsular Extension Detectable Post-Op PSA Findings Throughout 2015 and 2016, 36 percent of prostate patients had a prostatectomy and 38 percent of prostatectomy patients had adverse pathologic features. Of the 16 patients who were found to have adverse pathologic features on prostatectomy: 50 percent had a documented recommendation for adjuvant radiation therapy 44 percent of the patients with adverse pathologic features received adjuvant radiation therapy Prostate Cancer at Adventist HealthCare Washington Adventist Hospital Adverse Pathologic Features Source: Washington Adventist Hospital Cancer Registry Database 15

18 Recommendations The study found that 38 percent of all prostatectomy patients at Washington Adventist in 2015 and 2016 had adverse pathologic features, and 88 percent of those patients were black. Also of note, the average age of prostate patients at Washington Adventist in the time period studied, was 66, while the average age of patients with adverse pathologic features was 60 years. The average age of black patients with adverse pathologic features was 55 years, which is considerably younger than the average. The Cancer Committee recommended community outreach efforts that focus on prostate cancer education and PSA screenings in the black community that are targeted toward younger males. The Cancer Committee recommended genetic counseling referrals for patients who have adverse pathologic features and testing for biomarkers on prostatectomy specimens to assist with risk stratification, treatment planning and genetic counseling, especially for young, black patients who appear to be at a higher risk for adverse pathologic features. Finally, the Committee recommended improving access to clinical information, such as allowing the cancer registrar access to physician medical record systems, and documentation of clinical assessment components (PSA, family history, etc.) in history and physical notes or operative notes in the electronic medical record system. This will improve the quality of the data that is collected by the cancer registry and utilized by the hospital, state, and National Cancer Database. 16

19 Breast Cancer Survivors Honored at Systemwide Celebration Adventist HealthCare hosted survivors from Adventist HealthCare Shady Grove Medical Center and Adventist HealthCare Washington Adventist Hospital for the 10th Annual Breast Cancer Survivorship Celebration on Oct. 1 at the RIO Washingtonian Center in Gaithersburg, Maryland. More than 100 survivors who received treatment at our hospitals and their guests enjoyed brunch at the Courtyard Marriott Washingtonian Center, complete with music and a talk by LaShone Wilson. LaShone, who teaches yoga at the Shady Grove Adventist Aquilino Cancer Center, reminded guests to take time to refill their cups, and guests took home mugs filled with chocolates and other treats. The survivors ended their special morning by leading the Pink Walk around the RIO lakefront. Left: Dominique Haynes, Director of Cancer Services, Blessing Sawmmal, Executive Assistant, Dorcas Lwanga, Dietician at Washington Adventist Hospital, and her daughter celebrated with the more than 60 survivors who took part in Adventist HealthCare Shady Grove Medical Center s Breast Cancer Survivorship Celebration brunch on Oct. 1 at the Courtyard Marriott Washingtonian Center. 17

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