Goshen Center for Cancer Care 2016 Annual Report

Transcription

1 2016 Annual Report

2 Table of Contents Chairman s Report... 3 The Cancer Committee facts & figures... 6 Annette s second chance Living well on a cancer journey Crystal Breast cancer study They saved my life twice. And they made it possible for me to enjoy this little one.

3 Chairman s Report A note from our Goshen center for Cancer Care Committee Chairman. In 2016, the Goshen Center for Cancer Care delivered outstanding, comprehensive, patient-centered care to the communities it serves. The American College of Surgeons Commission on Cancer (COC) recently completed its triennial survey of our program. We expect to maintain our current level of commendations and awards, highlighting the commitment that we have made to provide excellent care to those we serve. Specifically, we expect commendations in the following areas: Clinical trials accrual Cancer registrar education Public reporting of outcomes CAP compliance Oncology nursing certification RQRS NCDB data collection In addition, the following areas were identified as possible best practices: Monitoring effectiveness Pathology Oncology nursing Palliative care Patient navigation Psychosocial distress screening Quality improvement (RIE) Registry follow-up Registry credentials & education We also received accreditation by the National Accreditation Program for Breast Centers (NAPBC). As our #1 tumor site, management of breast cancer patients requires a highly coordinated approach to care. We have once again the necessary proficiency to achieve such recognition. Our interdisciplinary oncology program continues to grow as we seek the highest quality providers to deliver care in the areas of surgical oncology, radiation oncology, medical oncology and supportive services. Our tumor boards and conferences are functioning at a high level with full representation of all the specialties required. We expect to continue expanding as we add services and providers to our program. With the rapidly changing treatment options for many cancer patients, our DOTs (Disease Oriented Teams) meets weekly to address the current guidelines and state of the art management practices to ensure that our patients are properly treated. We are as dedicated as ever to providing patients with a holistic experience, as evidenced by the integration of our dietary, naturopathic and mind-body counseling services in the routine care of our patients. We continue to place special emphasis on clinical research. This provides patients with unique opportunities to access innovative, potentially groundbreaking therapies without having to leave their community. Finally, it was extremely rewarding to be told during our recent accreditation survey that areas for improvement or growth were hard to find! As gratifying as this may be, it also creates a very high standard for us to meet. The program looks forward to the challenge. Daniel Bruetman MD, MMM Director of Medical Oncology, Dr. Bruetman Here at Goshen, our cancer program is unique in many ways. 3

4 Roderich Schwarz, MD, PhD, FACS Susan Franger, MHA Rita Gingrich, LSCW, OSW-C James Wheeler, MD, PhD Tracy Paulus, CTR Michael Brendle, MD Min Yan, MD, PhD Medical Director, Vice President of Cancer Services, PNI Counselor, Director of Radiation Oncology, Cancer Registry, Radiologist, Radiology Inc. Director of Pathology, Goshen Hospital Surgical Oncologist Cancer Program Administrator Social Worker & Psychosocial Services Coordinator Radiation Oncologist Certified Tumor Registrar & Cancer Registry Quality Coordinator Diagnostic Radiologist Pathologist Cancer Committee Committee Responsibilities Develop and evaluate the annual goals and objectives for the clinical, educational and programmatic activities related to cancer. Promote a coordinated, multidisciplinary approach to patient management. Ensure that educational and consultative cancer conferences cover all major sites and related issues. Ensure that an active, supportive care system is in place for patients, families and Colleagues. 4

5 Beth Otto, CMA Daniel Bruetman, MD, MMM Daniel Diener, MD, FACS Ebenezer Kio, MD, PhD Hollie Carlson, Ms. Ed. Juliet Leamon, BSN, RN, NE-BC Rhonda Griffin, RN, BSN Cancer Registry, Director of Medical Oncology, General Surgeon, Gerig Surgical Services Medical Oncologist, Health Education Coordinator, Oncology Unit Director, Goshen Hospital Clinical Quality and Data Manager, Cancer Conference Coordinator Cancer Committee Chairman & Palliative Care Cancer Liaison Physician Medical Oncologist & Clinical Research Coordinator Community Outreach Coordinator Oncology Nurse Quality Improvement Coordinator Promote clinical research. Monitor quality management and improvement through completion of quality management studies that focus on quality, access to care and outcomes. Supervise the cancer registry and ensure accurate and timely abstracting, staging and follow-up reporting. Perform quality control of registry data. Encourage data usage and regular reporting. Ensure content of the annual report meets requirements. Publish the annual report. Uphold medical ethical standards. 5

6 2015 Facts and Figures Cancer Registry Report Roger I was hoping that I could go back to fooling with my tractors. I can do anything I did before. Cancer Registry department is a hospital-based cancer information center. Certified tumor registrars collect, interpret and record a wide range of demographic, diagnostic and treatment information on all cancer patients who are diagnosed and/or treated at this facility. Since 2004, has been designated as a Community Hospital Comprehensive Cancer Center through the American College of Surgeons/ Commission on Cancer. In September of 2013, this program received a three-year Accreditation with Commendation at the Gold level. This indicates the program performs at the highest level possible and achieved all eight out of eight possible commendations for exceptional achievement. is mandated by Indiana Code to provide Indiana State Department of Health a detailed abstract for each case of malignant disease that is diagnosed and/or treated at this facility, as well as benign brain and related CNS tumors. Cancer data is also submitted to the National Cancer Data Base (NCDB), and comparisons are frequently performed to analyze state and national trends and benchmarking statistics. Quality of registry data is paramount. For this reason, quality assurance procedures, periodic audits from the Indiana State Department of Health and internal quality assurance practices are performed to ensure that Cancer Registry data are complete and correct. In 2015, a total of 809 cases were accessioned by the Cancer Registry: 682 were analytic (new cancer cases) and 127 were non-analytic. During 2015, the Cancer Registry followed 4,275 patients and maintained a follow-up rate of 89.41% on patients diagnosed since the Registry reference year (80% required by the Commission on Cancer) and a follow-up rate of 94.51% for patients diagnosed within the last five years (90% required by the Commission on Cancer). is staffed by certified tumor registrars and cancer registry specialists who work under the guidance of Rhonda Griffin, BSN, manager,. 6

7 T T Top Five Sites 15% 25% 9% NATIONAL ** Breast 231,840 Lung 221,200 Prostate 220,800 Colon 132,700 Urinary 74,000 Bladder 26% 25% State and County Distribution 15% 22% 8% STATE ** Lung 5,510 Breast 4,600 Prostate 4,040 Colon 2,890 Urinary 1,590 Bladder 25% 30% St. Joseph Elkhart 52% LaGrange 5.56% 4.42% T 11% 12% GCCC * 16% Breast 166 Lung 103 Colon 71 Prostate 52 Pancreas 47 23% 38% Steuben 1% Marshall 1% Out-of-State 6.85% Kosciusko 16.26% Noble 3.14% Other IN Counties 6.13% Allen 1% * Registry total patients ** Cancer Facts & Figures 2015, Estimated Numbers of New Cases for Selected Cancers by State, US, 2015* (American Cancer Society, 2015) most frequent diagnoses (analytic patients only) Number of patients Dr. Schwarz We embrace treatment so our patients have a chance for a fulfilled and active life. Breast Lung Prostate Colon Melanoma Non-Hodgkin Pancreas Lymphoma 7

8 Primary site table GENDER CLASS OF CASE AJCC STAGING Primary Site Total Male Female Analytic Non Analytic 0 I II III IV NA UNK ORAL CAVITY, PHARYNX Lip Tongue Salivary Gland Floor of Mouth Gum, Other Mouth Tonsil Nasopharynx Oropharynx Hypopharynx DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon, Rectum, Anus Liver Gallbladder Intrahepatic Bile Duct Other Biliary Pancreas Retroperitoneum Peritoneum, Omentum, Mesentery Jeffery Other Digestive Organs RESPIRATORY SYSTEM Nose, Nasal Cavity, Middle Ear Larynx Lung and Bronchus SOFT TISSUE INCLUDING HEART SKIN I was afraid I would never see the woods or smell a campfire again. Skin: Melanoma Skin: Other Non-Epithelial BREAST Female Breast Male Breast

9 GENDER CLASS OF CASE AJCC STAGING Primary Site Total Male Female Analytic Non Analytic 0 I II III IV NA UNK FEMALE GENITAL SYSTEM Cervix Uteri Corpus, Uterus: NOS Ovary Other Female Genital Organs MALE GENITAL SYSTEM Prostate Testis Penis URINARY SYSTEM Urinary Bladder Kidney Renal Pelvis Ureter Other Urinary Organs EYE, ORBIT Eye, Orbit: Non-Melanoma Eye, Orbit: Melanoma BRAIN, OTHER NERVOUS SYSTEM Brain: Malignant Brain-CNS: Benign, Borderline ENDOCRINE SYSTEM Thyroid Thymus Endocrine: Benign, Borderline LYMPHOMA Hodgkin Lymphoma Dr. von Holzen Non-Hodgkin Lymphoma MYELOMA LEUKEMIA Lymphocytic Leukemia Non-Lymphocytic Leukemia Other Leukemia MESOTHELIOMA MISCELLANEOUS It takes a lot of different people with a lot of different skills to come up with a treatment plan. TOTALS

10 AnnetteD

11 r. Fornalik

12 Annette s Second Chance When doctors told Annette there was nothing left that they could do for her, she turned to Dr. Fornalik and the experts at. There, she received a second opinion, and a second chance. After being diagnosed with stage four ovarian cancer, Annette received extensive treatment at another cancer center. She endured invasive surgery, followed by six rounds of chemotherapy, with each round eroding her quality of life. After everything she had already been through, there was still residual cancer. The surgeons at that other cancer center decided that going back in was too risky and in October of 2015, gave Annette a devastating terminal diagnosis. Christmas in July Christmas is Annette s favorite holiday. So much so that she puts a Christmas tree in every room of her house. Even though Annette had found the team of experts she had been praying for, her new course of treatment kept her from celebrating with her friends and family that year. So she made a promise. If I make it through this, and I m still here in July, we re going to have a great big party to celebrate Christmas with everyone. Restoring quality of life The integrated, multidisciplinary team at focused on restoring Annette s quality of life. With minimally invasive surgery, she was back in the comfort of her own home in days rather than weeks, and had practically no scaring. The nutritionists at Goshen restored I knew I was in the right place with Dr. Fornalik. I felt his kindness and more importantly, his confidence. Annette gave me her trust and willingness to try options to improve her quality of life. Despite a terminal diagnosis, Annette wasn t ready to give up hope. She decided to go to for a second opinion. From the very moment when Dr. Hubert Fornalik took Annette s hands in his and asked her to trust him, she knew her life had been truly touched for the better. Dr. Fornalik, a recognized expert in advanced minimally invasive surgery, wasn t afraid to go back in to deal with the residual cancer. Annette s strength, helping her return to an active life. Most importantly to Annette, Goshen also treated her mind and soul. At Goshen, everyone felt like family, offering their love and support every step of the way. Thankful for every day Thanks to Dr. Fonalik and the team at, Annette was able to have that party in July. And in celebration of every new day they spend together, Annette decided to leave the Christmas tree up all year long. 12

13 Living Well on a Cancer Journey It s how patients with cancer live that makes the difference for Rita Gingrich. She believes each one has the inner power to help with their own healing process and improve their overall quality of life. Rita joins patients on their journey to wellness as a mind-body counselor and certified oncology social worker for Goshen Health Center for Cancer Care. She brings an innovative, patient-centered approach to help patients strengthen their sense of well-being and feel more in control. By supporting patients every step of the way, Rita helps them define how they live and enjoy their lives. In acknowledgment of Rita s devotion to supporting patients with cancer and their families, she received the Innovation Recognition during the 2016 Coaches vs. Cancer Night of the Stars. The honor recognizes her tireless efforts to help patients connect the mind and body throughout their treatment. Rita Gingrich When a family member is diagnosed with cancer, it affects everyone who loves and cares for that person. I m so grateful for the successes our team has had with developing and implementing support programs for children, families, and couples. I m also grateful for many who have supported these endeavors in a variety of ways, including the cancer center s administration, the hospital auxiliary board, many colleagues and volunteers, and also cancer survivors. Rita was among five area cancer care providers honored during Night of the Stars. The annual event brings together community leaders, the American Cancer Society and the National Association of Basketball Coaches to spotlight advocacy programs that increase cancer awareness. Notre Dame Head Basketball Coach Mike Brey served as honorary chair and host of the 2016 event. Rita holds certification in oncology social work and is a licensed clinical social worker. She has been a part of the Cancer Care Integrative Therapies team since

14 James A. Wheeler, MD, PhD Director of Radiation Oncology, Radiation Oncologist Breast Cancer Study Breast cancer screening programs are based on the concept that the earlier a breast cancer is detected, the more likely the patient is to be cured with subsequent treatment. Routine screening mammography can detect many breast cancers that are too small to be detected through self-examination or even a physical examination performed by trained nurses or physicians. Not all abnormalities detected on a mammogram are malignant, and breast biopsy is recommended in most cases before surgical removal of the mass. If the biopsy shows cancer, the breast surgeon meets with the patient to discuss the various surgical options including mastectomy, mastectomy with immediate reconstruction, or breast conserving surgery. When the mass is too small to be felt, the usual technique has been for a diagnostic radiologist to place a wire under image guidance into the breast mass to guide the surgeon in removing the appropriate part of the breast. Although this technique has been the standard for many years, it has several problems. Kathy It is important to me to get back to quality of life. I have a lot to do. The schedules of the diagnostic radiologist, the breast surgeon and the operating room need to be tightly coordinated so that the wire is placed and confirmed to be in the correct position at the appropriate time for the patient to be in the operating room for the scheduled procedure. When several patients are scheduled for breast surgery the same day, this can place undue stress on the radiologist to optimally place the localization wire quickly so as to not delay the operating room schedule. Since the localization wire sticks out of the breast, the longer the wire is in the patient prior to the planned surgery, the greater the opportunity for the needle to be moved out of its correct position. With radioactive seed localization (RSL) a small, low radioactive activity iodine 125 source is placed under image guidance by the diagnostic radiologist a few days prior to the planned surgery. The radiation dose is so low that the patient can carry out normal activities without restriction. At the time of breast conserving surgery, a radioactive counter is used to guide the surgeon to the correct location. The schedules between the diagnostic radiologist and the surgeon are consequently much more flexible. The patient never has a wire sticking out of their breast. There is little opportunity for the marker to be displaced between the time it is placed by the radiologist and the time it is removed in surgery. 14

15 The Nuclear Regulatory Commission places strict requirements on the storage and handling of all radioactive materials and their use in all medical procedures. The operating room team and the pathology team must follow the appropriate procedures related to the handling of the radioactive breast specimen. Careful records must be kept recording the location of the small radioactive source at all times until it has decayed sufficiently to allow safe disposal. When a new procedure is introduced in clinical practice, it is important to carefully evaluate its effectiveness compared to the prior technique. We reviewed the records of the 48 patients who underwent breast conserving surgery for nonpalpable breast tumors between March 17, 2014 and December 31, We compared them to the 36 patients who underwent breast conserving surgery between September 1, 2013 and March 1, 2014, before the RSL technique was introduced. With breast conserving surgery, sometimes the tumor is not fully removed on the first attempt, and the pathologist determines that there is a positive margin, indicating there are tumor cells at the edge of the removed breast tissue. These patients typically are advised to undergo additional surgery before they continue the rest of their treatment course, which may include chemotherapy and/or radiation therapy. Of these, 2/36 wire localization (WL) patients had positive margins, for a positive margin rate of 5.6%. For the patient s undergoing radioactive seed localization, 5 of the 48 patients (10.4%) had a positive margin, but since the likelihood of obtaining a positive margin was low, this small difference was not statistically significant. We also examined the weight of the breast specimens removed, and these were not statistically significantly different between the radioactive seed in the wire localization patients. There was a trend for older patients to have a slightly higher rate of having a positive margin. Physicians at Memorial Sloan-Kettering Cancer Center (MSKCC) published in 2013 the results of their first year of experience with the radioactive seed localization technique. Their patients who underwent radioactive seed localization had a 7.7% positive margin rate compared to 5.5% for their patients undergoing wire localization. At MSKCC they likewise did not see a difference in the weight of the excision specimens between both groups of patients. Physicians from Canada, the Netherlands and many other institutions also found approximately a 10% positive margin rate with either RSL or WL. The radioactive seed localization approach allows for greater patient comfort and greater scheduling convenience with no significant difference between the positive margin rate, the amount of the breast removed (and consequently the same overall cosmetic result), with no added adverse side effects or other significant disadvantages. The results obtained at are consistent with those obtained at Memorial Sloan-Kettering Cancer Center as well as several other excellent cancer centers. Dr. Moore We realized we were both on the same page with how we approach wellness and overall strategies for life. 15

16 Northern Indiana s first comprehensive cancer center 200 High Park Ave. Goshen, Indiana (574) (866) 775-HOPE