A B ING TON HO SPITAL J E F F E R SO N H E ALTH 2018 ANNUAL REPORT CANCER

Transcription

1 A B ING TON HO SPITAL J E F F E R SO N H E ALTH 2018 ANNUAL REPORT CANCER

2 TABLE OF CONTENTS The New Asplundh Cancer Pavilion...2 Program Achievements...3 Breast Cancer: 2016 Analysis... 4 Summary of All Cancer Sites...7 Quality Indicators... 9

3 The Sidney Kimmel Cancer Center at Abington Jefferson Health Abington Jefferson Health and the Sidney Kimmel Cancer Center Jefferson Health have reimagined cancer care. Opened in July 2018, our,000-square-foot outpatient center offers a comprehensive continuum of leading-edge outpatient care, clinical research and support services in one modern facility the Asplundh Cancer Pavilion. The vast spectrum of cancer care provided at the Asplundh Cancer Pavilion includes everything needed to outscience cancer, including multidisciplinary clinics, surgical consultations, a chemotherapy/ infusion suite, radiation therapy, clinical research, symptom support, and a dedicated oncology pharmacy all within a peaceful and serene healing environment. Patients interested in clinical trials are now afforded the option of participating in Phase I clinical trials, in addition to Phase II and III trials previously offered by Abington. Comprehensive Personalized Care With our personalized approach to medicine, we design a treatment program specifically for each patient. Through Abington s integration with the renowned NCI-designated Sidney Kimmel Cancer Center Jefferson Health (one of only 70 NCI-designated cancer centers in the country), specialists such as head and neck cancer surgeons travel from Center City to meet with patients and families close to home and with conveniences like free parking. Patient-Friendly Environment Everything a cancer patient might need is available under one roof at the Asplundh Cancer Pavilion, in an environment that is calming, in a building that is designed to be patientfriendly and to bring the outdoors inside. Convenient Location Conveniently located just off the Pennsylvania Turnpike s Willow Grove interchange, the LEED-certified building also features meeting space for cancer support groups, healing gardens, a café, as well as an Image Recovery Center, opening in 2019, which will offer breast prostheses, head coverings and wigs, lymphedema treatments, massages, skincare, and manicures and pedicures safe for cancer patients. Support Services Onsite Other services available to patients include nurse navigators to help coordinate cancer treatment and provide support, fertility preservation, symptom support program, nutrition counseling, financial counseling, social work, a cancer risk assessment program and more. two

4 Program Achievements Clinical Trials In 2017, The Rosenfeld Cancer Center was the third highest enroller in NRG clinical trials internationally. Transitioned to the new Asplundh Cancer Pavilion, which provides state-of-the-art research facilities in which to conduct clinical trials, utilizing the expertise of multidisciplinary physician specialities. Interventional Radiology Incorporated strict criteria for scheduling patients at Asplundh Surgical Center (ASC) in initial interventional radiology approval process. Created safe patient flow for prep, procedures and discharge. Established communication pathway for unexpected complications, emergencies or changes in patient status. Performed bone marrow biopsies and paracenteses. Awaiting state approval for chest ports and PS3 patients. Cross-trained multiple staff members to register, work up patients, complete procedures, recover and discharge the Asplundh Surgical Center patients. Set up Q-Site electronic system of ordering and establishing supply par levels for optimum equipment storage and levels. Medical Oncology Two new hematologists/oncologists (Drs. Patel and Sethi) on staff. Restructured and improved clinical trials portfolio (in collaboration with gynecologic oncology). Hired new clinical trials coordinator to enhance clinical trials offerings. Hired two nurse practitioners for continuity on inpatient oncology ward and for triaging outpatients. Implemented and advanced palliative care outpatient program. Initiated Lu-Dotetate neuroendocrine program (in collaboration with Interventional Radiology) Implemented outpatient geriatric oncology program. Increased infusion and outpatient patient volumes. three

5 Breast Cancer: Abington Hospital Jefferson Health Breast cancer is the most commonly diagnosed cancer worldwide. It is estimated that 266,000 women will be diagnosed with breast cancer and 40,000 will die from the disease in 2018, according to the American Cancer Society surveillance research. For women in the United States, it is the most common cancer and the second most common cause of cancer death. However, breast cancer mortality rates have been decreasing since the 1970s. The morbidity and mortality of this disease is influenced by multiple factors, including early diagnosis, prompt surgical treatment when indicated and the use of comprehensive teams directing adjuvant treatment. The National Comprehensive Cancer Network (NCCN) Guidelines assist in the decision-making process of individuals involved in cancer care. They provide recommendations based on the best evidence available and guide our diagnostic and treatment strategies. We reviewed the data of the patients identified at Abington Hospital in 2016 and compared this to the NCCN treatment guidelines and National Cancer Database (NCDB). In our analysis staging distribution at AH was similar to the NCDB. 17% of cases were stage 0, 51% stage I, 22% stage II, 5% stage III, 5% stage IV at AH compared to 20% stage 0, 43% stage I, 24% stage II, 7% stage III, 4% stage IV in the NCDB reports. 100% (138/138) of patients who were found to be hormone receptor positive were offered hormone therapy. 100% (6/6) of patients who were found to have node positive disease were offered chemotherapy. 97.4% (112/115) of patients offered breast-conserving therapy received radiation therapy (XRT) after breast-conserving surgery. All 115 patients were offered XRT, however two patients were lost to follow-up and one declined therapy in favor of holistic therapy..5% (38/42) of patients with HER2/neu positive invasive breast carcinoma were treated according to the NCCN guidelines with Herceptin. In the four patients not treated; two were lost to follow-up after initial diagnosis; one was not given Herceptin secondary to age, size, and comorbidities and one was a 6 mm carcinoma with a <2mm micrometastasis in 1 node. Herceptin was recommended in accordance to NCCN but a port was not able to be placed after several attempts; the patient declined Herceptin-based therapy and was treated with hormone therapy alone. In conclusion, this analysis suggests that the breast cancer patient population at AH in 2016 were a similar distribution by staging as to the NCDB and treatment followed established NCCN guidelines. We do have a higher number of unknown stages which may be due to documentation omissions or loss of follow-up. We are within the guidelines for recommendations of HER2 therapy, hormonal therapy, and adjuvant XRT. Limitations of this analysis include limited records on some patients who receive most of their care outside of the institution. four

6 Breast Cancer 2016 Data Quality of Care Study Distribution by Age n AJH n All CoC Distribution by Race n AJH n All CoC White Black Asian Other 1.8 Distribution by Stage n AJH n All CoC Stage 0 Stage I Stage II Stage III Stage IV five

7 Breast Cancer 2016 Data Quality of Care Study Distribution by 1st Course Treatment n AJH n All CoC S,R,H S,R,C,H Surg only S,R S,H S,C other None S,C,H Hormone six

8 Summary of All Cancer Sites 2017 Primary Site Analytic* Non-Analytic** Expired Base of Tongue 6 1 Other Tongue 2 Gum 1 Floor of Mouth 2 Palate 3 1 Other Mouth 1 Parotid Gland 3 1 Other Major Salivary Glands 1 1 Tonsil 9 1 Nasopharynx 7 Hypopharynx 2 Esophagus Stomach Small Intestine 15 1 Colon Rectosigmoid Junction 20 1 Rectum Anus & Anal Canal 9 Liver & Intrahepatic Bile Duct Gallbladder 7 3 Other Parts Of Biliary Tract Pancreas Other Digestive Organs 6 3 Accessory Sinuses 1 Larynx Bronchus & Lung Thymus 2 1 Heart, Mediastinum & Pleura Bones & Cartilage of Limbs 1 Bones & Cartilage of Other 4 1 Hematopoietic & Reticuloendo System ** Analytic cases include all cancer patients diagnosed at Abington Jefferson Health who received all or part of their first course of treatment here, and all patients diagnosed elsewhere who received all or part of their first course here. ** Non-analytic cases include cancer patients who were referred to Abington Jefferson Health for recurrence or subsequent therapy. seven

9 Summary of All Cancer Sites 2017 Primary Site Analytic* Non-Analytic** Expired Skin Retroperitoneum & Peritoneum Connective & Other Soft Tissue 8 3 Breast Vulva 7 20 Vagina 2 Cervix Uteri 20 1 Corpus Uteri Uterus, NOS 2 Ovary Other Female Genital Organs 24 3 Placenta 3 Prostate Gland Testis 5 Kidney Renal Pelvis 9 2 Bladder Other Urinary Organs 1 Eye & Adnexa 1 1 Meninges 23 3 Brain Spinal Cord & Other CNS 7 Thyroid Gland 38 2 Adrenal Gland 1 1 Other Endocrine Glands 14 7 Other Sites 4 2 Lymph Nodes Unknown Primary Site Total 1, ** Analytic cases include all cancer patients diagnosed at Abington Jefferson Health who received all or part of their first course of treatment here, and all patients diagnosed elsewhere who received all or part of their first course here. ** Non-analytic cases include cancer patients who were referred to Abington Jefferson Health for recurrence or subsequent therapy. eight

10 Quality Indicators How We Compare to the National Cancer Database In 1998, a Presidential Commission recommended the creation of a national forum in which health care s many stakeholders could, together, find ways to improve the quality and safety of America s health care. This recommendation led to the creation of the National Quality Forum (NQF), a private, not-for-profit, public benefit corporation established in 1999 to standardize healthcare quality measurement and reporting. Established as a public-private partnership, the NQF has broad participation from all parts of the healthcare system, including national, state, regional and local groups representing consumers, public and private purchasers, employees, healthcare professionals, provider organizations, health plans and others involved in healthcare research or quality improvement. Together the organizational members of the NQF work to promote a common approach to measuring healthcare quality and fostering system-wide capacity for quality improvement. The Commission on Cancer (CoC), through the Cancer Program Practice Reports (CP3R), promotes 12 quality indicators utilizing the data submitted to the National Cancer Database. The data are from CP3R and AJH s Performance for Breast Cancer Breast Conserving Surgery and Radiation Therapy Radiation therapy is administered within one year (365 days) of diagnosis for women under the age of 70 receiving breast conserving surgery for breast cancer. Abington Jefferson Health s compliance with this standard is favorable at.3%. Chemotherapy in Hormone Receptor Negative Breast Cancer Patients Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under the age of 70 with AJCC T1c N0M0, or Stage II or III hormone receptor negative cancer. Abington Jefferson Health s compliance with this standard is excellent at 100%, compared to all CoC-approved programs norm of 93.3%. nine

11 Quality Indicators CP3R and AJH s Performance for Breast Cancer Tamoxifen or Third Generation Aromatase Inhibitor in Hormone Receptor Positive Breast Cancer Patients Tamoxifen or third generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1c N0M0, or Stage II or III hormone receptor positive cancer. Abington Jefferson Health s compliance with this standard is favorable at 98.2%, compared to all CoC-approved programs norm of 93.6%. Breast Conserving Surgery Breast conservation surgery rate for women with AJCC clinical stage 0, I or II breast cancer. Abington Jefferson Health s compliance with this standard is favorable at 67.0%, compared to all CoC-approved programs norm at 66.3%. Radiation Therapy and Mastectomy Radiation therapy is considered or administered following any mastectomy within one year of diagnosis of breast cancer for women with four or more positive regional lymph nodes. Abington Jefferson Health s compliance with this standard is excellent at 100%. Image or Palpation-guided Needle Biopsy Performed in Breast Cancer Diagnosis Image or palpation-guided needle biopsy is performed to establish diagnosis of breast cancer. Abington Jefferson Health s compliance with this standard is above the state s average, which is 93.4%. ten

12 Quality Indicators CP3R and AJH s Performance for Colon Cancer Adjuvant Chemotherapy for Node Positive Patients Adjuvant chemotherapy is considered or administered within four months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. Abington Jefferson Health s compliance needs improvement at 80%, compared to all CoC-approved programs norm of 89.5%. Regional Lymph Nodes in Surgically Resected Patients At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. The rate for Abington Jefferson Health s compliance at.9% needs improvement, compared to all CoC-approved programs norm of.3%. CP3R and AJH s Performance for Rectal Cancer Radiation Therapy in Rectal Carcinomas Radiation therapy is considered or administered within six months of diagnosis for patients under age 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. Abington Jefferson Health s compliance with this standard at.9% is favorable, compared to all CoCapproved programs norm of.7%. eleven

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