Centegra Cancer Program Annual Review 2014

Transcription

1 Centegra Cancer Program Annual Review 2014 Summarizing data from the year 2013

2 welcome Dear Community and Health Care Team Members, As the county s leading provider of comprehensive cancer care, Centegra Sage Cancer Center, a department of Centegra Hospital McHenry and Centegra Hospital Woodstock, is proud to present the 2014 Cancer Program Annual Review. The team at Centegra Health System considers it a privilege to be part of each cancer patient s journey. We are proud to provide education and screening about the prevention and early detection of cancer. We strive to demonstrate our passion for cancer care and continually search for ways to improve the patient and caregiver experience. This year we built and opened a pharmacy in the cancer center where chemotherapeutic drugs are prepared. Pharmacy staff is directly to answer any questions patients or families may have. The pharmacy staff also works closely with our medical oncologists and nursing staff. Quality and safety are always our first priority. At Centegra, we treat the mind, body and spirit. In 2013, we implemented the Survivorship Training and Rehabilitation (STAR) program. Specialty trained clinicians provide patients coordinated cancer rehabilitation. The team consists of physicians, nurses, physical therapists, occupational therapists, registered dietitians and mental health professionals. We also opened an outpatient lymphedema and speech clinic dedicated to improving the quality of life for our cancer patients. Our cancer program is among an elite group in the nation to receive the American College of Surgeons Commission on Cancer Outstanding Achievement Award. This award acknowledges the excellent level of care our organization provides the community. Robust support groups, a wide variety of screenings, educational events and celebrations are conducted annually. We have a wig boutique and offer makeup tips to our patients through partnerships with the American Cancer Society. Providing the full range of cancer care close to home is our goal and we look forward to continuing to meet those needs in the future. Sincerely, Rachel Sebastian Site Administrator, Centegra Hospital McHenry Amy Moerschbaecher Director Oncology and Medical Ancillaries

3 a year in review 2013 Dr. Aslam S. Zahir Chairman, Cancer Committee From Dr. Zahir Our cancer program is surveyed by the American College of Surgeons Commission on Cancer every three years. In 2013, Centegra Hospital McHenry (CH M) was designated as a Comprehensive Community Cancer Program based on the type of services provided and the number of cases diagnosed at Centegra Hospital McHenry. Centegra Hospital Woodstock (CH W) continues to be a Community Cancer Program. In addition, CH M was awarded the Outstanding Achievement Award for the third time in a row. This distinction recognizes the excellent care we provide at Centegra. The Centegra Gavers Breast Center has also been fully accredited by the National Accreditation Program for Breast Centers (NAPBC) and continues to provide complete management of breast cancer with state-of-the-art diagnostics, a multidisciplinary team approach and a navigator to guide patients through the completion of scheduling, testing and treatment. To keep up with the changes of the Commission on Cancer 2012 Cancer Program Standards, Centegra Health System ensures patient-centered care is focused on continuum of care by strengthening the STAR Program and by development of survivorship care plans to bring attention to the specific needs of our cancer survivors. Our cancer program also implemented goals of care conversations dedicated to helping our patients talk about their wishes for end-of-life care. centegra gavers breast Center The monthly educational General Cancer Conferences and the weekly Breast Conferences consistently include discussion of American Joint Committee on Cancer (AJCC) staging and National Comprehensive Cancer Network (NCCN) guidelines for each case presented. Our hospital s pathology department implemented routine molecular marker testing on colon cancer and lung adenocarcinomas for specific genes. Thoracic surgery has grown to provide services to our lung cancer patients and is the backbone of our detection of lung cancer through our lung cancer screening program.

4 review continued Both cancer programs at CH M and CH W participate in the Rapid Quality Reporting System (RQRS), a reporting system and quality improvement tool with data submitted to the National Cancer Data Base (NCDB) every month beginning in We continue a strong partnership with the American Cancer Society to provide valuable community services such as cancer screenings and prevention programs as well as cancer support groups to our patients.

5 review continued Dr. Joseph P. Imperato Radiation Oncology Services Commission on Cancer Cancer Liaison Physician Centegra Sage Cancer Center From Dr. Imperato This is my first year in the role as Cancer Liaison Physician, having followed in the footsteps of Dr. Geoffrey Smoron. It will be difficult to fill the shoes of a man with such a long and distinguished career. As someone who is coming to Centegra from another system where I spent 28 years, I believe I have a unique perspective on this program. The first thing that struck me about all the people involved in our cancer program is the fact that they are happy to be here. That may seem odd, but there is so much upheaval in health care today that many health care workers are more worried about what tomorrow may bring versus what patient needs are today. Secondly, I was very impressed at the staffing levels. Many institutions are cutting corners and forcing individuals to play multiple roles, including areas where they weren t formally trained. Here, we not only have the proper level of staffing among therapists and nursing, but a full complement of workers to fulfill psychosocial, dietary and genetic counseling needs. Third, our technology, from diagnostic to therapeutic, puts us on par with any academic institution, meaning that we can provide leading-edge care for our patients close to home. Our Tomotherapy unit is being fully upgraded to be state-of-the-art, allowing us to deliver radiation therapy as precisely as possible. Our high dose rate brachytherapy unit allows us to treat breast Centegra Sage Cancer Center cancer patients with a one-week course of radiation instead of six-and-a-half weeks. Finally, our infusion center allows patients to receive drugs close to home that their medical oncologists may be unable to provide. By being adjacent to our radiotherapy center, we form a seamless unit that maximizes patient comfort and ease of scheduling. We even have transportation available for patients who are unable to drive themselves. Overall, Centegra Health System, with Centegra Gavers Breast Center, Centegra Sage Cancer Center and the myriad of specialists associated with these organizations, have put together a cancer program that far exceeded my expectations, and one to which I am proud to be a member.

6 quality Quality Improvements Consolidated outpatient chemotherapy services for oncology patients to Centegra Sage Cancer Center. This practice change is based on quality standards and operational efficiencies. The change will allow Centegra to offer the most comprehensive cancer treatment available to our patients while offering all the additional resources, such as social workers, dietitian, counselor, etc. that are available at the Centegra Sage Cancer Center. Performed a Quarter I study on increasing the number of Oncology Certified Nurses at Centegra Health System throughout Surveyed staff and provided informational workshops to address knowledge level and identify candidates to study for and sit for the exam. Currently, five inpatient oncology nurses are preparing to sit for the Oncology Nurse Certification Corporation exam. Dr. Apurva Desai, Medical Oncology, conducted a presentation on Acute Myeloid Leukemia: Clinical Features, Diagnosis and Treatment Overview. A total of 10 nurses attended the presentation and received 1.0 CE credit each. Oncology 101 workshop offered to STAR Program clinicians. Our team recognized the need to increase the knowledge base for non-oncology clinicians who recently completed the STAR training program to better understand the services offered by the cancer program. We conducted two classes highlighting the services offered at the cancer center. We received helpful feedback from physical therapists and other rehab staff at the Q&A session to better understand the cancer patient s journey through treatment. The cancer center will continue offering Oncology 101 to clinicians who complete the STAR program twice yearly. The class will also be open to anyone interested in learning about our services. The radiation program applied for and received approval to conduct a clinical research study on the use of medicinal honey to treat certain types of radiation dermatitis. A $5000 grant was awarded by the Daisy Foundation to fund the purchase of the honey used in the study. The study is currently ongoing through the summer of 2015, and results will be reported shortly after.

7 2013 study Dr. Joseph P. Imperato Radiation Oncology Services Breast Cancer Breast cancer remains a major health care issue for women in this country. It is estimated that 235,000 will develop this disease in ,000 are expected to die of breast cancer, a number that has not changed over the past four years. At Centegra, we have seen a steady increase in the number of women with breast cancer, with a large jump in (Fig.1) This is most likely due to an aggressive marketing campaign for screening mammograms, as well as accreditation by the National Accreditation Program for Breast Centers (NAPBC). In 2013 we saw 216 new cases, an increase of 23% over the prior year. The mix of cases is encouraging, with 83% of women being diagnosed at stage 0, I or II, which compares favorably with the national data. (Fig. 3) Early detection is crucial, because the five-year survival rates for patients that are Stage 0 or I is over 90%. It drops to 81% for Stage II. (Fig. 5) Our survival numbers are slightly lower than the national averages, but this is most likely due to our case mix, which contains more patients with comorbidities and the fact that many of our patients are heavy smokers. Another advantage of early detection is patients have greater treatment options, including breast conservation. Our breast conservation rate has dropped from mid-70 to mid-60. This parallels a national trend where more women, especially Number of Cases Number of New Analytic Breast Cancer Cases CHM & CHW (Duplicate Patient Merge Applied) Figure younger women, are often choosing mastectomy due to testing positive for BRCA 1 and 2. Occasionally, women choose mastectomy due to very dense breasts, where follow up may be more problematic due to fear of breast cancer developing in the other breast, or for purely personal reasons. The strength of our breast cancer program rests on the fact that we have an excellent system of diagnostic radiologists, surgeons, radiation oncologists and medical oncologists, as well as extensive support staff including social and figure 1

8 study continued psychological support and a dedicated team of nurses at every point in the patient s journey. The team ensures patients stay on track and receive needed treatments. This is demonstrated on our NCDB stat sheet (Fig. 6 and 7), demonstrating that % of patients receive chemotherapy, radiation therapy and hormonal therapy within the appropriate time window. The less than 100% most likely represents patient refusal. Overall, our breast program continues a track record of providing the highest level of patient care to our community, without the need to travel to distant academic centers. Patients can remain local, where they will have the support of their families and communities on their road back to health. Percentage of Cases Breast Cancer Age at Diagnosis CHM & CHW Diagnosed Compared to the NCDB Diagnosed Figure CHM & CHW (n=919) 7 9 NCDB (n=1,041,002) 2 1 Percentage of Cases Breast Cancer Stage at Diagnosis CHM & CHW Diagnosed Compared to the NCDB Diagnosed Figure Stage 0 Stage I Stage II Stage III Stage IV Stage Unk CHM & CHW (n=919) NCDB (n=1,041,002) figure 2 figure 3

9 study continued Percentage of Cases Breast Cancer First Course of Surgery CHM & CHW Diagnosed Compared to the NCDB Diagnosed Figure Partial Mastectomy Total Mastectomy CHM & CHW (n=919) Mod Radical Mastectomy 8 NCDB (n=1,041,002) 7 No Surgery Percentage of Cases Breast Cancer Five Year Survival CHM & CHW Diagnosed Compared to the NCDB Diagnosed Figure Stage 0 Stage I Stage II Stage III Stage IV CHM & CHW (n=536) NCDB (n=544351) figure 4 figure 5

10 study continued This page and all contents are 2013 by the NCDB and American College of Surgeons, Chicago, IL Cp 3 R: ch-m The Web-based Cancer Program Practice Profile Report (CP 3 R) offer local providers comparative information to assess adherence to and consideration of standard of care therapies for major cancers. This reporting tool provides a platform from which to promote continuous practice improvement to improve quality of patient care at the local level and also permits hospitals to compare their care for these patients relative to that of other providers. figure 6 Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer (Surveillance) Image or palpation-guided needle biopsy (core or FNA) is performed to establish diagnosis of breast cancer (Quality Improvement) Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >=4 positive regional lymph nodes (Accountability) Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability) Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB-III hormone receptor negative breast cancer (Accountability) Tamoxifen or third generation aromotase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer (Accountability) Measure CoC Std/% Estimated Performance Rates (%) BCS Not Applicable nbx 4.5 / 80% MASTRT 4.4 / 90% BCSRT 4.4 / 90% MAC 4.4 / 90% HT 4.4 / 90%

11 study continued This page and all contents are 2013 by the NCDB and American College of Surgeons, Chicago, IL Cp 3 R: ch-w The Web-based Cancer Program Practice Profile Report (CP 3 R) offer local providers comparative information to assess adherence to and consideration of standard of care therapies for major cancers. This reporting tool provides a platform from which to promote continuous practice improvement to improve quality of patient care at the local level and also permits hospitals to compare their care for these patients relative to that of other providers. figure 7 Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer (Surveillance) Image or palpation-guided needle biopsy (core or FNA) is performed to establish diagnosis of breast cancer (Quality Improvement) Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >=4 positive regional lymph nodes (Accountability) Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability) Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB-III hormone receptor negative breast cancer (Accountability) Tamoxifen or third generation aromotase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer (Accountability) Measure CoC Std/% Estimated Performance Rates (%) BCS Not Applicable nbx 4.5 / 80% MASTRT 4.4 / 90% No Data BCSRT 4.4 / 90% MAC 4.4 / 90% HT 4.4 / 90%

12 accomplishments in 2013 Centegra Hospital McHenry (CH M) is a Comprehensive Community Cancer Program and Centegra Hospital Woodstock (CH W) is a Community Hospital Cancer Program approved by the American College of Surgeons Commission on Cancer (ACoS CoC). Cancer Conferences and Committee Meetings 4 Cancer Committee Meetings were hosted in 2013 and the attendance rate for required members was 93%. 12 monthly General and five Site-Specific Cancer Conferences were held at CH M with 109 cases being presented representing 18% of the analytic caseload. 45 Breast Conferences were held at CH M and 219 cases were presented. With 100% of the cases presented prospectively. 12 monthly General Cancer Conferences were held at CH W with 64 cases being presented representing 22% of the analytic caseload. Cancer Data Management 669 cases were accessioned at CH M with 622 of those being analytic cases. 270 cases were accessioned at CH W with 259 of those being analytic cases. A follow-up rate of 91% was maintained at CH M and 93% at CH W with the requirement being 90% for patients diagnosed in the past 5 years. 38 requests for data were completed. Data submitted to the NCDB from CH M and CH W met all quality criteria on initial submission. Professional Education 2 educational discussions and 7 journal article reviews were conducted at CH M and 1 educational discussion was conducted at CH W during cancer conferences. 3 system-wide educational programs about oncology were offered to physicians and allied health care professionals.

13 accomplishments continued Presentations and Workshops Educational presentations are offered to community organizations, free of charge, who request information on cancer related topics. General Cancer Prevention Round Table Discussion, 1 presentation, 9 in attendance Skin Cancer Prevention and Detection Presentation, 2 presentations, 32 in attendance Community Symposium at McHenry County College The Ins and Outs of Good Colon Health was presented at McHenry County College. Drs. Smoron, Spangler and Bugno presented to the community and discussed recent insights about colon health, nutrition, cancer prevention and early detection. The symposium was a partnership with McHenry County College, where 48 attended. Breast Cancer Prevention, 5 presentations, 107 in attendance Freedom from Smoking, 4 presentations, 28 in attendance

14 accomplishments continued Screenings Colorectal cancer: Fecal Occult Blood Test (FOBT) kits were distributed free of charge to 220 people in the community and were mailed back to Centegra Lab for free processing. Oral, Head and Neck cancer: Free screenings were given by Dr. Shirazi and Dr. T. Hughes in March and April; 47 screenings performed. Skin cancer: Free screenings by Dr. S. Bangash and Dr. W. Dam in June, July and Sept; 64 screenings performed. Prostate cancer: Free screening included digital rectal examination (DRE) and prostate-specific antigen (PSA) by Drs. Lodowsky and Keuer, 57 screenings. Lung cancer: Free Lung CT screening started in July for Freedom from Smoking participants who meet NCCN criteria. Coordinated through the CHS Medical Imaging Department and then expanded to the general public in November. Health Fairs ATTENDED Centegra communicated and distributed educational materials and held conversations with community members at 10 health fairs. Topics included cancer prevention, cancer screenings, cancer signs and symptoms and cancer treatment available at Centegra Sage Cancer Center. Centegra Health Strong Women s Event: provided exhibits about ovarian cancer awareness, cancer prevention and early detection Weigh Less Live More Health Fair: Centegra Health Bridge Fitness Center Integrative Medicine for the 21st Century Community Perspectives: Holiday Inn, Crystal Lake Empowering Women Expo: McHenry County College Del Webb Health Fair Feeling Great Is Ageless Pioneer Center Employee Health Fair Hearthstone Centegra Senior Fair Nurses Symposium: McHenry County College Coviden Health Fair The Clinic: Immanuel Lutheran Church

15 accomplishments continued Partners American Academy of Dermatology provides guidelines, forms and educational materials for activities throughout the year. American Cancer Society provides brochures and pamphlets for activities throughout the year. Oral, Head and Neck Cancer Alliance provides guidelines, forms and educational material for activities throughout the year. Prostate Cancer Education Council (PCEC) provides forms, education material and a tracking site for activities throughout the year. McHenry County College partnered to present The Ins and Outs of Good Colon Health. McHenry County Health Department partnered for smoking cessation programs McHenry County Breast Cancer Task Force

16 support services Dedicated Cancer Support Services The Centegra Sage Cancer Center and other hospital-based programs, along with the Centegra Gavers Breast Center, offer various support services for patients and their family members, including: Financial & Medication Assistance Individual, Group and Family Counseling Wig Program (in partnership with the American Cancer Society and Styling Services) Look Good... Feel Better (in partnership with the American Cancer Society) Breast Cancer Support Group Caregiver Support Groups and Education Programs Bereavement Group Pathfinders Treatment Support Group Survivorship Groups and Programs Emotional and Spiritual Support Cancer Resource Library Home Health Care cancer survivors day 2013, cheri amore garden of hope Hyperbaric Wound Management Pain Management Rehabilitation Services Patient Express transportation for individuals receiving services at Centegra Health System Hospice and Palliative Services via referral Complementary programs such as Yoga, Water Fitness, Expressive Arts and Drumming Centegra Cancer Connection Facebook page National Cancer Survivors Day Celebration

17 registry report Number of Cases Centegra Hospital McHenry & Centegra Hospital Woodstock Analytic Cases Seen Per Year Figure Figure 1 shows the number of analytic cases seen at Centegra Hospital McHenry (CH M) and Centegra Hospital Woodstock (CH W) in the years 2004 through The number of cases seen at CH M during 2013 has shown an increase of 13% when compared to 2004, while CH W showed an increase of 20% for the same time period CHM (n=5,990) CHW (n=2,787) Number of Cases Centegra Hospital McHenry & Centegra Hospital Woodstock Gender and Age at Diagnosis (Duplicate Patient Merge Applied) Figure Males n=316 (40%) Female n=482 (60%) 6 19 Figure 2 shows the gender and age at which patients were diagnosed with cancer and seen at Centegra in Of all the analytic cases, 60% were female, and 40% were male. The majority of patients were older than age 50, with the greatest number of cases clustered in the age range of 60-69, which represented 32% of all patients.

18 report continued Percentage of Cases Percentage of Cases Centegra Hospital McHenry Top Five Sites 2013: Stage at Diagnosis Figure Breast Lung Colorectal Prostate Thyroid Stage 0 Stage I Stage II Stage III Stage IV Unknown Centegra Hospital Woodstock Top Five Sites 2013: Stage at Diagnosis Figure Breast Lung Colorectal Thyroid Bladder Stage 0 Stage I Stage II Stage III Stage IV Unknown Figure 3 shows the stage at diagnosis for the five most common sites seen at CH M in These sites account for 64% of all cases seen. Most breast and thyroid cancers were diagnosed at earlier stages (Stage 0, I and II). Lung and colorectal cancers were diagnosed at later stages (Stage III and IV). Figure 4 shows the stage at diagnosis for the five most common sites seen at CH W in These sites account for 58% of all cases seen. Breast, thyroid and bladder cancers were diagnosed at earlier stages (0, I and II) while most lung cancers patients were diagnosed at later stages (III and IV).

19 report continued Centegra Hospital McHenry & Centegra Hospital Woodtock Site Distribution for Analytic Cases 2013 (n=798, duplicate Patient Merge Applied) Figure 5 Breast Number of Cases Breast Lung Colon Prostate Kidney Thyroid Comparison of Major Sites 2012 Centegra vs. State of Illinois and National Data (Duplicate Patient Merge Applied) Figure Respiratory System Digestive System Urinary System Male Genital Lymphoma/Leukemia Endocrine System Female Genital Brain/CNS Skin & Soft Tissue Head & Neck Other Percentage of Cases National Illinois Centegra Figure 5 represents the primary site distribution for all cancers seen at CH M and CH W in 2013, without duplication of patient cases. Figure 6 compares major sites as a percentage of the total cases seen at Centegra in 2012 to the State of Illinois and the National Cancer Data Base (NCDB). This comparison shows that Centegra had a slightly higher percentage of breast and colon cancers than the state or the national average. The percentage of prostate cancer was lower than the state and the NCDB.

20 2013 cancer committee Aslam S. Zahir, MD Medical Oncology Chairman Joseph P. Imperato, MD, FACR Radiation Oncology Cancer Liaison Physician Nabil O. Ali, MD Pathology Elissa S. Brebach, MD Diagnostic Radiology dr. aslam s. zahir chairman cancer committee dr. joseph p. imperato cancer liaison physician cancer committee

21 committee continued Terrence J. Bugno, MD Radiation Oncology Apurva A. Desai, MD Medical Oncology/Palliative Care Brian M. Keuer, MD Urology Jerry X. Liu, MD Medical Oncology Z. Ted. Lorenc, MD Internal Medicine Alexandra Roginsky MD General Surgery Mark S. Schiffer, MD Diagnostic Radiology Mackie A. Snebold, DO Family Practice Michael B. Soble, MD Medical Oncology Chad Spangler, MD Gastroenterology Wendy L. Ward, MD Pathology Thomas D. Weyburn, DO Medical Oncology/Clinical Research Rachel Sebastian, MHA Administration CH M Sheila Senn, PsyD, LCPC Administration CH W Amy Moerschbaecher, RN, BSN, MA Oncology Administration Lora Anderson, RD, CSO, LDN Nutritional Services/Community Outreach Jill Benedeck, RN, BSN, OCN Oncology Nursing Mattias Carlen Rehabilitative Services Kathleen DeRoche, LCSW, OSW-C Oncology Social Work Mary Dunlop, BS, CTR Cancer Registry Shelly Galasinski, MS, LGC Genetics Counseling Rita Goode, RN, OCN CH W Nursing Lynn Griesmaier, RN, MS Women s Health Katherine Retz, RN, BSN, OCN Oncology Management Soraya Scroggs, RHIT, CTR Cancer Registry Ashwin Shah, PharmD Pharmacy Heather Voss, RN Organizational Performance Improvement Marianna Wolfmeyer, JD, LCPC, CT, DCC Spiritual Care/Palliative Care

22 directory Centegra Hospital McHenry (CH M) Centegra Hospital Woodstock (CH W) Centegra Sage Cancer Center Centegra Gavers Breast Center Cancer Registry (CH M) Cancer Registry (CH W) Emergency Department (CH M) Elgin Emergency Department (CH W) Get Checked! Program Grief/Bereavement Services Centegra Hospital McHenry 4201 Medical Center Drive McHenry, IL Centegra Gavers Breast Center 360 N. Terra Cotta Road Crystal Lake, IL Home Health Care Centegra Sage Cancer Center 4305 Medical Center Drive McHenry, IL Centegra Hospital Woodstock 3701 Doty Road Woodstock, IL 60098

23 directory continued Journey Care Laboratory Services (CH M) Laboratory Services (CH W) Medical Records (CH M) Medical Records (CH W) Medication Assistance Program Nutritional Counseling Patient Express Counseling and Spiritual Care Support Services medical Imaging Centers Centegra Gavers Breast Center Crystal Lake Centegra Health Center Huntley Centegra Health Center North McHenry Centegra Hospital McHenry Centegra Hospital Woodstock Centegra Crystal Lake Medical Arts Medical Oncology/ Hematology Practices Fox Valley Hematology & Oncology, Ltd North Shore Oncology & Hematology Assoc., Ltd Northwest Suburban Oncology & Hematology, Ltd Other American Cancer Society 800-ACS-2345 ( ) Illinois Tobacco Quitline 866-QUIT-YES ( ) National Cancer Institute Info CANCER ( )