2005 Cancer Program Annual Report

Transcription

1 Cape Canaveral Hospital 2005 Cancer Program Annual Report Published October 2006 Together, we re better.

2 2005 Cancer Committee Chairman s Report By Richard M. Levine, MD The Cape Canaveral Hospital Cancer Program is pleased to report the accomplishments we have achieved in Foremost is our continued accreditation by the American College of Surgeons Commission on Cancer (ACoS CoC). Our onsite survey took place on October 26, 2005, and our Cancer Program received the highest approval for three years. Additionally our Cancer Program was awarded the following four Commendations for: 1. Excellent Annual Report publication % compliance with CAP Protocols, and adoption and monitoring of several national guidelines 3. Excellent outreach activities 4. Numerous cancer-related improvements made and documented for each year. Cape Canaveral Hospital continues its affiliation with Shands Cancer Center, providing Shands Grand Rounds lectures for our hospital medical staff and the community. In 2005 we hosted experts presenting lectures on the following cancer-related topics. Dr. Christopher Cogle presented Myelodysplastic Syndromes and Return to Flight Modifications on February 23, 2005; Dr. Jan Moreb spoke on Multiple Myeloma: The Hope for Cure on June 20, 2005 Dr. Veronica Butterweck discussed Herbal Approaches to Malignant Diseases on October 31, Dr. Butterweck also provided a presentation and a questionand-answer session for the community the same afternoon. Other community outreach events in 2005 The Cape Canaveral Hospital Cancer Program also participates in a multitude of community outreach events, which in 2005 included: January 13 Lunch N Learn presentation on Evolution of End of Life April 9 Malabar Spring Fest Provided sunscreen through our Health First team April 9 Big Squeeze Juice Festival provided sunscreen through our Health First team April 29 Presentation on Coping Skills for Cancer Patients May 14 Participated in Doctors Expo, providing cancer screening guidelines May 19 Participated in Pain Conference discussing cancer patient pain management June 6 Participated in Brevard County s Prostate Cancer Education and Support program June 9 Presented Chemotherapy Side Effects Management course June 11 Participated in the Fourth Annual Men s Health Summit, providing free PSA and digital rectal exams June 14 Presented cancer-related cognitive dysfunction lecture June 22 Participated in New Horizons in Women s Care health conference, presenting a lecture on Understanding Hereditary Cancer Risk in Women October 14 & 18 Hosted Oncology Nursing Society s Chemotherapy and Biotherapy Certification Courses Members of the Cape Canaveral Hospital Cancer Program also participated and supported Prostate Cancer Awareness events in September (National Prostate Health Month); Breast Cancer Awareness events in October (National Breast Cancer Awareness Month), including the Making 1

3 Chairman s Report continued Strides Against Breast Cancer Walk, and the Relay For Life American Cancer Society (ACS) event. Members of the Cancer Committee, Janet Rooks and Sandra Jennings-Ingle, as well as Dr. (and Mrs.) Alphonse (Al) Pecoraro were installed as members of ACS s Central/South Brevard Unit Operating Board in September Additionally, our Cancer Program also supported the Leukemia & Lymphoma Foundation s Light the Night Event on September 24 at the Cocoa River Front arena. Dr. Pecoraro, our ACoS COC Liaison Physician, also attended the ACoS Clinical Conference in October Another community event in which our Cancer Committee members and Oncology Unit staff participated the Health First Foundation s Annual Grand Prix Race raised $40,000 to benefit our Cancer Program at Cape Canaveral Hospital. Our Cancer Program collaborates with the ACS in Brevard County, Al Pecoraro, MD and includes ACS New Patient Registration Forms and information in an oncology patient binder given to all cancer patients. We also provide the ACS toll-free number on all our Oncology Unit telephones. ACS programs we co-sponsor include the Man to Man Prostate Cancer Support Group and the Ovarian Cancer Support Group, which meet monthly. We also offer our own cancer support groups, which meet on the fourth Wednesday of each month led by Cape Canaveral Hospital Oncology Social Worker Janet Rooks; as well as the Laryngectomy Support Group, which meets quarterly, led by Debra Hemphill, a Cape Canaveral Hospital Speech Pathologist. Both are members or our Cancer Program Committee. Additionally we continue our ongoing participation in the ACS s Look Good, Feel Better program. Our Cancer Program is also involved in other community education initiatives, including quarterly smoking cessation courses offered by the Cape Canaveral Hospital s Pulmonary Rehabilitation Department in conjunction with the American Lung Association, called the Freedom from Smoking program, and the Free & Clear Tobacco Treatment Program (smoking cessation coaching offered through a toll-free callin number), and have joined the SWAT (Students Working Against Tobacco). We also inform patients about the ACS Quit Line, a telephone-based counseling program that helps individuals who smoke double their chances of successfully kicking the smoking habit. Our Oncology Social Workers also assist children with a parent or relative who s a cancer patient through our annual Putting the Pieces Together Workshop and Sunflower House. Additionally, our Cancer Program also supports the Hospice of Health First bi-annual, two-day workshops for children who have lost loved one s to cancer, called Camp Bright Star, offered by our Hospice program s Bright Star Center for Grieving Children & Families staff and volunteers. On National Skin Cancer Awareness Day, Dr. Cynthia Halcin, a Dermatologist, participated in our annual skin cancer screening event. She screened a total of 40 patients, including nine with basal cell carcinomas and three with squamous cell carcinomas who were identified for followup treatment. Additional community education events supported by our Cancer Program include quarterly public presentations on healthy lifestyles, discussing topics such as smoking, diet, alcohol, cancer, exercise, and annual cancer screening exams. The Resource Center at Cape Canaveral Hospital has posters and brochures that heighten awareness on cervical and ovarian cancer, breast and lung cancer, and colon cancer. Additionally, Oncology Social Worker Janet Rooks, also a member of our Cancer Committee, participated in the Susan G. Komen Breast Cancer Awareness event BMW Ultimate Drive. Other community-targeted events and activities in which our Cancer Program participated included ACS s Breast Cancer Task Force Triple Touch Program promoting clinical 2

4 Chairman s Report continued and self-breast exams as well as annual mammograms; the ACS s Denim Day workplace fund-raiser for breast cancer research on October 7; and the ACS Attitude for Life 10- week program promoting exercise and healthy eating at work; the ACS Cattle Baron s Ball (Dr. and Mrs. Pecoraro were members of the 2005 program committee); the annual Sister Walk, a 5-K walk sponsored by the Space Coast Ovarian Cancer Advocacy Group on November 27; and the Hospice Health Brick Paver Gift Program to benefit the William Childs Hospice House, which is a free-standing, home-like hospice inpatient facility. About the Cape Canaveral Hospital Oncology Unit and Cancer Program The Oncology Unit at Cape Canaveral Hospital is staffed by 14 chemotherapy-certified nurses, four of whom have achieved Oncology Certified Nurse (OCN) designations. The Unit observes standardized policies and procedures for chemotherapy administration. The Oncology Unit participates in bi-weekly unit multidisciplinary Oncology rounds that include the oncology nurses, Pastoral Care, physicians, and Case Management representatives. The Pharmacy Department and Dr. Scott Neel (PharmD), provide updates via the Pharmacy & Therapeutics Committee, as well as in-services to the Oncology Unit staff at quarterly On-the-Go and unit meetings. Cape Canaveral Hospital s Cancer Program continues to offer access to clinical trials for cancer patients. Literature is provided in the cancer binders given to all cancer patients on the Oncology Unit. Patients are also provided with brochures about cancer clinical trial participation and the Website connection for current cancer clinical trial information at Additionally, the Health First Research Institute and Space Coast Medical Associates offer oncology clinical trials involving patients treated in our Cancer Program. Our Cancer Program s Tumor Board meets monthly, presenting a mixed case review of patients diagnosed with cancer at Cape Canaveral Hospital. Multidisciplinary discussions are provided, reviewing the diagnoses, workups, treatments, and prognoses. Additional continued education is offered through Cape Canaveral Hospital s Resource Center s video-conferenced live continuing medical education lectures. Cancer Registrar Sue Finn completed the Quality Improvement Study of the Commission on Cancer on Nasopharyngeal Cancer. The Cancer Program also completed a performance improvement (PI) study on community screening practices with respect to mammography. All breast cancer cases in 2005 were reviewed and compared to national benchmarks. A second PI study performed at Cape Canaveral Hospital compared sentinel node pathology findings from Touch Prep (cytology), frozen section, H&E, immunohistochemical stain, and compared our results to national benchmark data. A third PI study compared state and national benchmarks of stage III colon cancer by course of treatment. Conclusion and summary In summary, the Cancer Program at Cape Canaveral Hospital has been continuously accredited since its inception in We excelled during our recent accreditation process, receiving four COC Commendations, emphasizing our strength in quality care; cancer education for hospital staff, medical staff, and the community; as well as outreach and screening programs for the community. We support and collaborate with the ACS and the Leukemia & Lymphoma Society, as well as other cancer-related community organizations. These efforts all strengthen our ability to provide state-of-the-art cancer care to the patients in our community. We are proud of our accomplishments and look forward to meeting the challenges of cancer prevention, diagnosis, and treatment in our community in the future. Respectfully submitted, Richard M. Levine, MD RML/amn/sab 3

5 About Cape Canaveral Hospital s Cancer Registry Requests for data as described below* are welcomed and should be directed to: Cape Canaveral Hospital Cancer Registry PO Box Cocoa Beach, FL Tele: Fax: *The Cape Canaveral Hospital Cancer Registry has general information on cancer diagnosis, treatment, and clinical trials for the community. Clinicians may request information on our hospital s cancer trends and statistics by contacting the cancer registrar at Cape Canaveral Hospital s Cancer Registry, under the direction of Susan Gruno, CTR (December 2004 through October 2005) and Susan Finn, CTR (November 2005 to present) utilizes Medical Registry Services IMPAC Medical Systems, a computerized cancer registry data system designed for collecting, following, managing, and analyzing cancer data. The cancer registrar analyzes data based on the patient s medical record and enters the information into the Cancer Registry database. All cancer reports must be completed within six months from the date of the patient s first contact with Cape Canaveral Hospital. Cancer patients are given accession numbers based on the year in which they were first seen at our facility. Since January of 1994, our Cancer Registry has accessioned approximately 6,888 cases. Our Cancer Registry develops a detailed cancer-focused record on every patient who has an active cancer at Cape Canaveral Hospital. We are required to report our cancer cases to the state s cancer registry, the Florida Cancer Data System (FCDS). In addition, our Cancer Registry is required to report any historical primary cancers. Analytic cases are reported annually to the National Cancer Data Base (NCDB), a joint project of the American College of Surgeons (ACoS) and the American Cancer Society (ACS). Data reported to these state and national organizations are used to support research, track trends, initiate epidemiological studies, generate journal articles, and provide data for allocation of services. Our Cancer Registry s certified tumor registrar coordinates our Cancer Program s monthly multi-disciplinary Tumor Board meetings. These meetings provide a forum for physicians and healthcare staff to discuss all major cancer sites for patients diagnosed and/or treated at Cape Canaveral Hospital, and focus on pre-treatment evaluation, staging, treatment strategy, and rehabilitation. Sixty-one patient cases were presented at our Tumor Board in Some of the cases presented consisted of cancers of the breast, lung, colon, bladder, prostate, head and neck, as well as patients with lymphoma and melanoma. The Cancer Registry at Cape Canaveral Hospital conducts annual follow-up on all patients treated for cancer at our hospital. The Cancer Registry is required to maintain a 90% follow-up rate to be in compliance with ACoS Cancer Program Standards. Regular follow-up with a cancer patient is important, not only for the Cancer Registry to be able to maintain accurate follow-up, but more importantly for the patient, since early detection is the link for longer survival. The Cancer Registry currently maintains a follow-up rate of 95%, which exceeds the target rate of 90%. Our Cancer Registry staff members also participate in community outreach for cancer awareness and fundraising events in the Brevard County area (as listed in the 2005 Chairman s Report on pages 1 to 3). Additionally, ACS Support Services conducted through our Cancer Program are listed below. Respectfully submitted, Susan Gruno, CTR, and Susan Finn, CTR 2005 American Cancer Society Support Services* Look Good, Feel Better program Man to Man (prostate cancer support group) Reach for Recovery *Cape Canaveral Hospital also provides leadership to the ACS Community Board. 4

6 Summary of Cancer Registry Data for 2005 In 2005, a total of 559 new cancer cases were accessioned into the Cancer Registry at Cape Canaveral Hospital (see the Primary Site Table on the next page). Of these cases, 497 were analytic (initially diagnosed and/or treated at this hospital). The remaining 62 were non-analytic cases (receiving only subsequent treatment or diagnostic procedures at our hospital). The Cancer Registry maintains a total number of 6,888 cases since the initial reference date of The Primary Site Table on the next page gives a breakdown of all cancer sites by gender, type, and stage. The individual charts in this summary also show how our cancer cases are distributed by gender (Chart I), race (Chart II), and age (Chart III). Additionally, Chart IV compares our hospital s Top Five Cancer Sites to the state of Florida and national percentages. The biggest difference between our 2004 and 2005 top five sites was an increase in skin cancer cases (including melanoma), which in 2005 moved up from sixth to fourth highest number of cases diagnosed and/or treated at Cape Canaveral Hospital from the previous year. CHART I: 2005 CAPE CANAVERAL HOSPITAL CANCER DIAGNOSIS BY GENDER Female 60% 239 Cases 158 Cases Male 40% 5

7 2005 Primary Cancer Sites at Cape Canaveral Hospital The Primary Site Table below reveals anatomical sites for all cancers that were either diagnosed and/ or treated at Cape Canaveral Hospital (analytic) or cancer sites diagnosed and treated elsewhere (nonanalytic) but seen here for subsequent treatment or recurrence of the original cancer. SEX NON- AJCC STAGE PRIMARY SITE TOTAL MALE FEMALE ANALYTIC ANALYTIC UNKNOWN N/A BREAST BRONCHUS & LUNG SKIN COLON BLADDER PROSTATE GLAND LYMPH NODES RECTUM HEMATOPOIETIC UNK PRIMARY SITE KIDNEY PANCREAS STOMACH CORPUS UTERI BRAIN SMALL INTESTINE LIVER-BILE DUCTS OVARY RECTOSIGMOID JUNCTION ESOPHAGUS TESTIS THYROID GLAND TONGUE LARYNX CERVIX UTERI GALLBLADDER MEDIASTINUM, PLEURA BONES, JOINTS, CARTILAGE MENINGES BASE OF TONGUE FLOOR OF MOUTH PAROTID GLAND OROPHARYNX ANUS, ANAL CANAL CONNECTIVE/ SOFT TISSUE VULVA PENIS TOTAL

8 CHART II: 2005 CAPE CANAVERAL HOSPITAL CANCER DIAGNOSIS BY RACE White 442 Other 41 Black 13 Japanese CHART III: 2005 CAPE CANAVERAL HOSPITAL AGE AT CANCER DIAGNOSIS Patients Age 4 7

9 CHART IV: CAPE CANAVERAL HOSPITAL TOP FIVE CANCER SITES DIAGNOSED IN 2005* 35% 32% 30% 25% Patients 25% 23% 20% 15% 17% 16% 14% 11% 10% 11% 10% 9% 10% 9% 6% 5% 0% 5% 3% Breast Lung Colorectal Melanoma Site Cape Canaveral Hospital Florida United States *Cape Canaveral Hospital s analytic cancer cases have been compared to expected cases in the state of Florida and the United States according to the American Cancer Society s Cancer Facts & Figures Bladder

10 Definitions and Abbreviations American College of Surgeons (ACoS): The ACoS Commission on Cancer (CoC) is referenced throughout this report and in some tables, charts, and graphs. The ACoS CoC performs surveys and approves cancer programs nationally based on specific standards and criteria. AJCC TNM Stage: A staging system developed by the American Joint Committee on Cancer (AJCC). The size and/or depth of invasion of a tumor determines the tumor (T) stage. The (N) is determined by lymph node involvement. Distant metastasis (M) is the spreading of the cancer to distant sites. For applicable sites, the T, N, and M determine the stage I, II, III, IV or unknown stage. Higher-staged cancers usually have a poorer prognosis. Analytic case: Cancer cases diagnosed and/or treated for all or part of the first course of therapy at Cape Canaveral Hospital. Florida Cancer Data System (FCDS): FCDS is an incidence registry for the state of Florida and is a central cancer registry administered by the Florida Department of Health operated and maintained by the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine. Non-analytic case: Cancer cases diagnosed and treated elsewhere for the first course of therapy. Reference date: The year in which a cancer registry began collecting and maintaining cancer cases. The date is usually January 1st of a given year. From left: Cape Canaveral Hospital Cancer Registry staff members Sue Finn, CTR, and Carolann Muir. 9

11 Cape Canaveral Hospital 2005 Site-Specific Report: Melanoma Melanoma is a potentially fatal skin cancer, representing 4% of all skin cancers and is the sixth most commonly diagnosed cancer in the United States with approximately 62,000 new cases and 7,900 deaths attributed to melanoma in The incidence rates are increasing faster than any other cancer in our nation. Currently an estimated 1 in 71 individuals are expected to develop melanoma in their life-time, compared to 1 in 600 in 1960, and 1 in 150 in Factors that may be contributing to an increase in melanoma cases may include patterns of sun exposure, possibly a history of severe sunburn, and perhaps global changes such as ozone depletion. Additionally, up to 10% of melanoma cases have a genetic history. A family history of melanoma in immediate family members is associated with an 8- to 12-fold increased risk of melanoma. Additional risk factors include sun-sensitive skin type, immunosuppression, xeroderma pigmentosa, dysplastic mole syndrome, and multiple common or atypical nevi. Approximately 50% of melanomas arise in a solitary lesion on normal skin. Clinical features of melanoma include: asymmetry, border irregularities, color variation, diameter greater than 6 mm, and and enlargement. Additional aspects to monitor include: change in color, change in size, change in shape, inflammation, bleeding, and sensory changes (tenderness or painful skin lesion). This study investigates the following clinical aspects and medical care received by patients diagnosed with melanoma at Cape Canaveral Hospital in Purpose and objectives of the site-specific melanoma study 1. To identify the demographic and staging characteristics of melanoma 2. To evaluate if all patients with melanoma had negative surgical margins when technically feasible 3. To evaluate if all patients who had been diagnosed with melanoma had sentinel lymph node mapping and biopsy when clinically indicated 4. To evaluate if eligible patients with melanoma were referred to medical oncology for adjuvant therapy. Results There were 53 analytic patients diagnosed and/or treated for melanoma at Cape Canaveral Hospital in Patient age range was 30 to 89, with a majority of patients falling into the 70 to 79 age range. There were 32 men and 21 women diagnosed. The pathologic subtypes were as follows: Histologic Distribution Total Percent Malignant melanoma in situ Malignant melanoma Nodular melanoma Lentigo melanoma in situ Superficial spreading melanoma in situ Superficial spreading melanoma Acral lentiginous melanoma Mixed epithelioid and spindle cell melanoma The stages at diagnosis for Cape Canaveral Hospital patients with melanoma in 2005 were: Stage Total Percent I II III IV 0 0 Unknown Patients with melanoma usually undergo an initial biopsy to establish the diagnosis and then a subsequent wide excision to obtain surgical margins that are free of cancer. At Cape Canaveral Hospital all 53 analytic patients underwent 10

12 wide excision. Fifty-two patients were identified as having negative margins. One patient had melanoma in situ involving the margin, but that patient also had positive lymph nodes. Further local surgery was not performed, being not clinically necessary because the patient already had demonstrated metastatic disease. Patients with melanoma with a depth of 1 mm in thickness or greater were recommended to undergo sentinel lymph node mapping and biopsy. These patients are at higher risk for presenting with regional lymph node involvement. If melanoma has metastasized to the regional lymph nodes there is an associated high risk of distant recurrence of melanoma as well as decreased survival. Patients with positive lymph nodes are eligible to be treated with adjuvant therapy (Interferon) or to participate in a clinical trial with the hopes of decreasing relapse rate and improving overall survival. There were 17 patients who presented with melanomas of 1 mm or greater in depth. All 17 patients underwent sentinel lymph node mapping and 16 of these patients underwent sentinel lymph node biopsy. One patient did not have the biopsy performed because the sentinel lymph node was not identified during the mapping technique. Additionally, one patient underwent sentinel lymph node mapping and biopsy with a primary melanoma of less than 1 mm (0.3 mm). Eight patients were identified as high risk for recurrence. Five patients presented with positive lymph nodes (stage III), and three patients with a primary melanoma, stage T3a or higher (final stage II). All eight patients were referred to a medical oncologist for evaluation and treatment recommendations. One patient was treated with adjuvant Interferon; two patients were subsequently referred to the H. Lee Moffitt Cancer Center and Research Institute. One of these patients was treated with adjuvant Leukine and another patient in this group was placed on a clinical trial. The five remaining patients did not receive adjuvant therapy. Conclusions of 53 patients obtained surgical negative margins. One patient with a positive margin of in situ cancer also had positive lymph node involvement of 17 patients with melanomas of 1 mm or greater had sentinel lymph node mapping performed. 16 of these 17 patients had sentinel lymph node biopsy performed. One patient s mapping procedure did not identify a sentinel lymph node. 3. All patients at high risk for recurrence were referred to medical oncologists for treatment recommendations and follow-up. Recommendations 1. Continue Cape Canaveral Hospital Cancer Program public education on skin cancer, risk factors, sun protection, and screening events. 2. Consider five-year survival study for patients with melanoma. Respectfully submitted, Richard M. Levine, MD RML/amn/sab 11

13 2005 Cancer Committee Members PHYSICIANS: CHAIRMAN & QA COORDINATOR Richard M. Levine, MD Medical Oncology PHYSICIAN LIAISON OUTREACH COORDINATOR Alphonse Pecoraro, MD General Surgery CANCER CONFERENCE COORDINATOR Jonathan Charles, MD Pathology Diane Bergau, MD Radiology Michael Corea, MD Urology James Giebink, MD Radiation Oncology Jeffrey Kanski, MD Radiation Oncology Karen Levy, MD Radiology Rodney Moore, MD VP Medical Affairs Paul Thompson, MD Surgery PROFESSIONAL STAFF MEMBERS: Lisa Acosta Corporate Wellness Coordinator Doris Andera American Cancer Society Cyndi Ayres, RN Oncology Unit Donna Crossland, WOCN Wound/Ostomy Care Vicki Crosswell Director, Radiology Rev. Carolyn Dawson Pastoral Care Linda Donohoe, RN Oncology Unit Susan Finn, CTR Cancer Registry Denise Gangraw Center for Learning Susan Gruno, CTR Cancer Registry Kelly Haskins American Cancer Society Debbie Helton Director, Health First Marketing and Public Relations Debra Hemphill Rehabilitative Services Sandra Ingle, RN Director, Med/ Surg Oncology Unit Darlene Kerby American Cancer Society Robin Litman Respiratory Services Janice McCoy, RN, MS VP, Patient Care Services Carolann Muir Cancer Registry Scott Neel, PharmD Pharmacy Cape Canaveral Hospital 701 W. Cocoa Beach Causeway Cocoa Beach, Florida Wanda Otto Hospice of Health First Lori Roche, RD, LD Food & Nutrition Michelle Rogers Private Duty/Home Care Janet Rooks, BSW Social Services/ Case Management Judy Simpson, RN Patient/Staff Community Education Coordinator Susan Stackpoole, MSN, RN Director, Nursing Operations Roberta Van Dusen Executive Director, Hospice of Health First Kathy Wilderotter, RN Performance Improvement Coordinator 12