Cancer Program Annual Report Applying 2015 Cancer Registry Statistical Data

Transcription

1 CANCER PROGRAM Cancer Program Annual Report 2016 Applying 2015 Cancer Registry Statistical Data

2 Message from Cancer Services Manager As you will see in the following pages of our annual report, this past year at the Cancer Center has brought many changes; the biggest one being the retirement of Nancy Klatt, RN as the manager. She spearheaded many projects over the years and has made an impact in the region on cancer care. I took over for Nancy officially in November. Previously, I worked as a chemotherapy treatment nurse. I am excited for the challenge of continuing the high standard of care that we have provided here at the Cancer Center. We have also added 2 navigators, Doreen Langlois, RN and Robbie Narlock, RN to assist patients and families in coordinating care. We had our survey by the American College of Surgeons, Commission on Cancer and we continue to be a fully accredited cancer program with many areas of commendation. Our goal is to always provide high quality services to our patients and their families. We want patients and families to feel at home and that we are treating them as part of our own family. Beth Nelson, RN, OCN Manager, Altru Cancer Center Altru Health System is accredited as a Community Hospital Comprehension Cancer Program and maintains accreditation with the American College of Surgeons Commission on Cancer.

3 Table of Contents Message from the Cancer Services Manager...inside cover Cancer Committee Membership Cancer Program Accomplishments, Goals, Quality and Enhancements...2 Introduction of new Cancer Physician Liaison...3 Colon Cancer Study at Altru...4 Genetic Testing at Altru Cancer Registry Information & Cancer by Site Mission Improving Health, Enriching Life Vision Deliver world-class health care to the residents of our region. Values Our Patients Meeting the needs and expectations of our patients is our highest priority. Our Care We provide quality care that is demonstrated to achieve the best results for patients. Our Team We work as a team and treat each other with honesty, loyalty and respect. Our Communities We are committed to improving the health of our communities.

4 Cancer Committee Coordinators for 2016 Kevin Panico, MD Cancer Conference Coordinator Beth Nelson, RN, OCN Cancer Registry Quality Control Coordinator Shelly Evenson, RN Quality Improvement Coordinator LeAnne Kilzer, RN, OCN Education/Community Outreach Coordinator Wanda DeKrey, RN, OCN Research Coordinator Vickie Misialek, LSW Psychosocial Services Coordinator Cancer Liaison Physician for 2016 Stefan Johnson, MD General Surgery The Cancer Committee is composed of representatives of primary and specialty care physicians, as well as team members involved in the care of our cancer patients. The multidisciplinary Committee meets at least quarterly to review and evaluate the quality and direction of the overall cancer program, and makes recommendations for improvement. Daniel Walsh, MD, Chairman, Medical Oncology Stefan Johnson, MD, General Surgery Grant Seeger, MD, Radiation Oncology Kevin Panico, MD, Medical Oncology Marshall Winchester, MD, Radiation Oncology Muhammad Siddique, MD, Medical Oncology Mina Hanna, MD, Medical Oncology Tim Weiland, MD, Pathology David Chou, MD, Radiology Laura Lizakowski, MD, Internal Medicine, Palliative Care Todor Dentchev, MD, Medical Oncology Tana Setness Hoefs, MD, Obstetrics & Gynecology Henry Caoili, MD, Physiatrist Jill Wilson, Administrative Director Medical Specialty Care Division Beth Nelson, RN,OCN, Cancer Services Manager LeAnne Kilzer, RN, OCN, Oncology Resource Nurse Jodi Savat, RN, OCN, Inpatient Medical Oncology Shelly Evenson, RN, Quality/Utilization Review Rachel Salberg, NP, Palliative Care Denise Becker, RN, Medical Oncology Wanda DeKrey, RN, OCN, Oncology Research Aaron Kempenich, MS, Physicist Vickie Misialek, LSW, Oncology Social Services/Case Manager Anne Nygaard, NP, AOCNP, Medical Oncology Amanda Dudgeon, NP, Medical Oncology Emily Schmiedeberg, RN, Patient Referral Coordinator Annie Berginski, RN, Outpatient Medical Oncology Cassidy Rhondeau, RN, Outpatient Medical Oncology Julie Sundby, RN, Hospice Case Manager Danielle Conrad, LISCW, Grief Center Kim Sheldon, CTR, Cancer Registry Pam Vigen, CHUC, CTR, Cancer Registry Lindsay Carpenter, Cancer Registry Sara McGavaran, American Cancer Society Peni Rosten, Recorder Cancer Program Annual Report Altru Health System

5 Accomplishments:» Continued full accreditation status from the American College of Surgeons, Commission on Cancer, with the most recent survey visit in October 2015.» Conducted a study of quality on treatment measurements for lung cancer, resulting in better practices for pathology on lung resections and lymph node removal. A study was also conducted looking at the incidence of testing MSI for Lynch Syndrome in colorectal cancer. Study findings are further detailed in Dr. Hanna s report on page 4. Another study was conducted on referral patterns of our oncology patients to hospice. Referrals have increased in 2015 due to steps to educate staff on the referral process and promote more awareness.» Participation in Patient Center Outcome Research Institute (PCORI) Special College of Surgeons Study for breast, colorectal and lung cancers.» Continued participation with the Alliance Group, offering patients access to clinical trials and continued achievement of required number of treatment accruals as per Commission on Cancer standards.» Participated in and sponsored the successful 2016 American Cancer Society s Relay for Life in Grand Forks on June 18, 2016.» Continued success of the Filling the Gap program with events held throughout the year. This program was developed to lessen the financial burden for our patients by assisting with costs for nutritional support, lodging and transportation. In 2015, over $105,000 was given to qualifying patients through this program Cancer Program Accomplishments, Goals, Quality and Enhancements Goals:» Continued participation in community outreach events such as Relay for Life and other educational programs.» Continued successful cancer prevention and screening programs.» Continued coordination of Cancer Program team to maintain full accreditation status from the American College of Surgeons, Commission on Cancer.» Continued development and enhancements of the Survivorship Care Plans. Enhancements:» Development and implementation of oral chemotherapy guidelines following ONC/American Society of Clinical Oncology.» Altru Health System received a grant through Million Hearts to train staff for tobacco cessation for our patients. Consultation and follow-up visits are now provided by our nurse practitioner Cancer Program Annual Report Altru Health System 2

6 Introducing our new Cancer Liaison Physician As of March 2016, Altru Cancer Program is happy to announce the appointment of Stefan Johnson, MD, Department of Surgery as our new Cancer Liaison Physician (CLP). As the CLP, Dr. Johnson s responsibilities are to serve in a leadership role within our cancer program and to be responsible for evaluating, interpreting, and reporting our cancer program s performance using data from the National Cancer Data Base (NCDB). Dr. Johnson reports the results of this analysis to the cancer committee at each quarterly cancer committee meeting. The Cancer Liaison and the cancer committee membership monitors our cancer program s expected estimated performance rates for all accountability measures using the Cancer Program Practice Profile Reports (CP3R). They have implemented an action plan to review and address any accountability measure rate that falls below the expected performance rate. The CP3R reports provide comparative information to assess compliance with standard of care. Utilizing the CP3R reports, as a cancer program, we are able to compare our care to that of other providers allowing us to identify any problems in practice and to implement changes and enhancements for improvement. Below are examples of two CP3R measurements for colon and rectal cancer. In some cases, the total number cancer cases is so low that this will affect the percentages. For example, in 2011 there was only 1 non-concordant colorectal case, but the total number of cases was so low that the measure appeared only 80% concordant. This was reviewed and continues to be monitored as with all cases in the CP3R. Adjuvant chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC stage III (lymph node positive) colon cancer (Accountability) Measure Co Std/% ACT Not Applicable Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is recommended; for patients under the age of 80 receiving resection for rectal cancer (Quality Improvement) Measure Co Std/% RECRTCT % Stefan Johnson, MD Altru Health System 2016 Cancer Liaison Physician Cancer Program Annual Report Altru Health System

7 Colorectal Cancer Study At Altru Health System we currently see an estimated 80 to 90 newly diagnosed colorectal cancers each year. In early 2016 we conducted a Quality Improvement study investigating our colorectal cancer cases. We were interested in studying compliance with national treatment guidelines governing testing for Lynch Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC). Lynch Syndrome is an autosomal dominant genetic condition that has a high risk of colon cancer as well as other cancers including endometrial, ovarian, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin cancers. Per the Mayo Clinic, it is estimated that about 3 out of every 100 colon cancers are caused by Lynch Syndrome. Families of patients with Lynch syndrome usually have more cases of colon cancer than would generally be expected. Lynch Syndrome may also cause colon cancer to occur at an earlier age than is usually seen in the general population. Testing for Lynch Syndrome consists of microsatellite instability (MSI) and/or immunohistochemistry (IHC) testing. These tests are performed to analyze colon and other tumor tissue samples for features suggestive of Lynch Syndrome. Study criteria referenced the 2015 national guidelines (Bethesda Guidelines for HNPCC), with investigators looking closely at colorectal cancer patients younger than age 50 years; patients with additional cancers; and patients with family history of Lynch Syndrome associated cancers. In this study, a total of 68 cases were reviewed. Findings suggest that increased MSI testing should be offered. We identified 15 patients who were eligible for MSI testing and did not receive it. However, ten of those patients met eligibility requirements based on family history alone. It is possible that documentation of family history may not have been reported until after the testing window. The 2016 national guidelines were revised to assure testing of a broader patient population, including all colorectal patients under age 70 regardless of family history. Following the reporting of our findings for this study, there are plans to conduct another Quality Improvement study in 2017 to review further compliance with the new guidelines following awareness and educational efforts. Mina Hanna, MD Medical Oncology 2016 Cancer Program Annual Report Altru Health System 4

8 Understanding Cancer Genetic Risk Assessments ANNE NYGAARD, FNP, AOCNP It seems nowadays that everyone knows someone with cancer. Whether it is a friend, family member, loved one, or acquaintance, it affects us in some way. Cancer will affect approximately 1.6 million Americans in Cancer is the second leading cause of death in the US, accounting for nearly 1 of every 4 deaths. In 2015 it is estimated that 3,800 individuals in ND will be diagnosed with cancer. Cancer can be caused by many factors. Some include: genetic, environmental, medical, and lifestyle factors. One area that we can make a difference in survival rates is cancer genetics. Many of you have probably heard about genetic testing and want to know more. In this article, I will share how genetic testing works, and how it can help in detection and potential prevention of cancer caused by genetic mutation. Cancer genetic testing for breast cancer genes, more commonly known as BRCA, was first introduced in Genetic testing since that time is constantly evolving with the addition of more cancer genetic syndromes. The latest development is cancer gene panels. This is a next generation sequencing technology that assesses inherited mutations in multiple genes simultaneously. Current cancer gene panels vary in size from just two genes (i.e., BRCA1 and BRCA2) to larger panels that include more than 50 genes. Many people have multiple cancers in their family and wonder if genetic testing is right for them. Factors to consider are the types of cancers and age of diagnosis in your family history. We call these red flags. Below are some of the red flags that warrant risk assessment for a breast or colon cancer genetic syndrome.» Breast cancer before age 50» Ovarian cancer at any age» Male breast cancer at any age» Breast and ovarian cancer in the same person» Bilateral breast cancer (cancer in both breasts)» Eastern Ashkenazi Jewish ancestry» Relatives of BRCA mutation carrier» Colon or endometrial cancer diagnosed before age 50» Adenomatous polyps prior to age 40» A large number of polyps (> 10) occurring at any age or over a lifetime» Multiple primary colorectal cancers or other hereditary syndromeassociated cancers Cancer Program Annual Report Altru Health System

9 Currently, genetic risk assessments are performed at the Sanny & Jerry Ryan Center for Genetics and Prevention at Altru Health System in Grand Forks, ND. These assessments look at your family and personal history and other factors to help you decide if and what genetic testing is right for you. Jackie Roberts, FNP, AOCNOP and I, Anne Nygaard, FNP, AOCNP are qualified professionals that assist with this genetic risk assessment and testing. Genetic risk assessment and informed consent prior to testing is important. It helps determine if testing is appropriate for you and your family, and what kind of testing you should undergo. Since genetic factors result in about 5-10 % of cancer cases, it is important to test those who are high risk. Genetic risk assessment and informed consent help you to understand the implications of testing, such as the impact on your health decisions and possible insurance changes. We want patients and their families to understand the impact that genetics can have on their health and the health of their family members. For more information on genetic risk assessment and testing, please call the Sanny & Jerry Ryan Center for Genetics and Prevention at Cancer Program Annual Report Altru Health System 6

10 Cancer Registry Summary KIM SHELDON, CTR, PAM VIGEN, CHUC, CTR, AND LINDSAY CARPENTER The Cancer Registry is part of the cancer program and is located within the Altru Cancer Center. The purpose of the cancer registry is to maintain timely, accurate and complete data on all types of cancer diagnosed and/or treated at Altru Health System. Our reference date is January 1, We currently have 8,318 cases in the database. In 2015, 846 new cases were added to the cancer registry database. The following pages show the site distribution for these patients and also their demographic information. Altru Health System s cancer data is part of national statistics for incidence reporting and research. Our data is submitted to the National Cancer Data Base (NCDB), the Minnesota Cancer Surveillance System (MCSS) and the North Dakota Central Registry Data Base (NDCR). Guidelines are in place so that submission of data to the aforementioned entities complies with HIPAA. The most current NCDB Call for Data was completed in January We submit data to the NCDB as part of the Rapid Quality Reporting System (RQRS). In 2015 we also participated in the Patient Center Outcome Research Institute (PCORI) Special College of Surgeons Study for breast, colorectal and lung cancers. If you have any questions or would like to request data from the cancer registry, please contact registry staff at , or Cancer Program Annual Report Altru Health System

11 Primary Site Cases Male Female Oral Cavity Digestive System Esophagus Stomach Small Intestine Colon Rectum Anus, Anal Canal Liver/Bile Ducts Pancreas Respiratory System Larynx Pleura Lung/Bronchus Bone, Soft Tissue Peritoneums, Connectives Blood & Bone Marrow Leukemia Multiple Myeloma Other Skin Melanoma Other Breast Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Male Genital Prostate Testis Urinary System Bladder Kidney/Renal Pelvis Brain & CNS Brain (Malignant) Other Endocrine Thyroid Other Endocrine Lymphatic System Hodgkin Disease Non-Hodgkin Unknown Primary Site Distribution by Gender In 2015 we saw a total of 846 new cancer patients at Altru Health System. The top five most common sites were: breast, lung, prostate, colorectal and lymphoma Cancer Program Annual Report Altru Health System 8

12 2015 Estimated New Cancers Ten Leading sites by Sex, United States (estimated 2015 cases by The American Cancer Society) Versus 2015 data from Altru Health System. Altru numbers are similar to national estimates. This year, our statistics show a higher number of lung and colorectal cancers in both men and women and a higher number of renal cancers in men. Estimated New Cancers and Distribution by Stage MEN (%) Site United States Altru Health System Prostate 27% 17% Lung and Bronchus 14% 15% Colon and Rectum 8% 12% Urinary Bladder 7% 9% Non-Hodgkin Lymphoma 4% 3% Melanoma of Skin 5% 6% Oral Cavity and Pharynx 4% 4% Kidney and Renal Pelvis 5% 9% Leukemia 4% 4% Liver and Biles Ducts 3% 2% All other Sites 19% 19% WOMEN (%) Site United States Altru Health System Breast 29% 30% Lung and Bronchus 13% 15% Colon and Rectum 8% 9% Endometrium 6% 5% Leukemia 3% 3% Non-Hodgkin Lymphoma 4% 4% Melanoma of Skin 4% 4% Kidney and Renal Pelvis 3% 1% Pancreas 3% 3% Thyroid 6% 1% All other Sites 21% 25% Cancer Program Annual Report Altru Health System

13 2015 Cases per Stage and Age 30% 25% 20% 15% 10% 2015 Distribution by AJCC Stage Statistics show that 846 cases in 2015 were staged. Of these, 441 cases or 52% were localized (early) stages. This is important as many cancers can be cured, especially if found early and catching cancer in its early stage is our goal. 5% % % 26.71% 12.65% 12.56% 18.20% 6.38% 10.64% 0% Stage 0 Stage I Stage II Stage III Stage IV Unknown Not Applicable Cancer Stage Cases per Age Statistics show most of our patients are between the ages of 60 and 80; however, we have seen an increase in younger patients over the past several years Age at Diagnosis 2016 Cancer Program Annual Report Altru Health System 10

14 2015 Cases per Demographics GOLDEN VALLEY DIVIDE BURKE WILLIAMS MOUNTRAIL MCKENZIE BILLINGS SLOPE DUNN DIVIDE HETTINGER BOWMAN ADAMS RENVILLE MERCER GRANT WARD 1 MCLEAN OLIVER MORTON SIOUX BOTTNEAU ROLETTE 16 PIERCE MCHENRY 2 SHERIDAN BURLEIGH EMMONDS BENSON 14 WELLS KIDDER LOGAN MCINTOSH TOWNER 11 STUTSMAN CAVALIER 20 RAMSEY 62 EDDY 4 FOSTER PEMBINA 43 WALSH 45 GRAND FORKS NELSON LAMOURE DICKEY GRIGGS BARNES STEELE 1 RANSOM SARGENT TRAILL 3 CASS RICHLAND 1 The demographics shown on map reflect that 62% of our cancer patients in 2015 are North Dakota residents. 37% were from Minnesota and <1% were from out of state. KITTSON 12 ROSEAU 67 MARSHALL 29 PENNINGTON - 35 RED LAKE - 15 POLK 131 NORMAN MAHNOMEN 3 CLAY WILKIN BECKER 1 LAKE OF THE WOODS 7 BELTRAMI 3 CLEARWATER 2 HUBBARD WADENA KOOCHICHING 1 CASS 1 CROW WING 1 ITASCA AITKIN CARLTON TRAVERSE STEVENS POPE STEARNS BENTON ISANTI SHERBURNE CHISAGO BIG STONE ANOKA WASH- SWIFT KANDIYOHI WRIGHT INGTON HENNEPIN CHIPPEWA MEEKER RAMSEY LAC QUI MCLEOD PARLE CARVER RENVILLE 1 1 YELLOW MEDICINE SCOTT DAKOTA SIBLEY LA LYON REDWOOD NICOLLETE SUEUR RICE LINCOLN BROWN BLUE PIPESTONE COTTON- WATON- EARTH MURRAY WOOD WAN ROCK OTTER TAIL GRANT NOBLES DOUGLAS JACKSON TODD MORRISON MARTIN MILLE LACS KANNABEC PINE GOODHUE WABASHA STEELE OLMSTED DODGE WASECA FAIRBAULT FREEBORN SAINT LOUIS MOWER LAKE WINONA FILLMORE HOUSTON COOKE Many of our patients travel a great distance to receive care at Altru Cancer Center. Our goal through Patient Navigation and various programs is to ease the burden of that distance and to provide excellent quality of care for our patients and their families. North Dakota (524 Cases - 62%) Grand Forks 62 - Ramsey 45 - Walsh 43 - Pembina 20 - Cavalier 18 - Nelson 16 - Rolette 14 - Benson 11 - Towner 4 - Eddy 3 - Traill 2 - Pierce 1 - Richland 1 - Ward 1 - Steele Minnesota (310 cases 37%) Polk 67 - Roseau 29 - Marshall 35 - Pennington 12 - Kittson 15 - Red Lake 7 - Lake of the Woods 3 - Beltrami 3 - Mahnomen 2 - Clearwater 1 - Koochiching 1 - Crow Wing 1 - Becker 1 - Carver 1 - Mcleod 1 - Cass Out of State (12 cases 1%) Cancer Program Annual Report Altru Health System

15 Altru s Promise Every moment of every day, we promise to provide an excellent health care experience. We will be respectful, compassionate and thorough. We know your family and friends are an important part of your care; we will involve them as you wish and extend the same promise of excellence to them. Every day, our patients take time to celebrate in big and small ways. On one recent occasion, our patient, Marlin Jacobson, celebrated with our staff the last day of his treatments which just happened to fall on his 53rd wedding anniversary. Here he celebrates with Kristine Krom, RTT, Radiation Oncology Cancer Program Annual Report Altru Health System 12

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