Methodist s leadership in cancer care continues.

Transcription

1 2017 Aual Report

2 Methodist s leadership i cacer care cotiues. Methodist Estabrook Cacer Ceter is oe of oly 22 cacer care providers i the atio ad the oly oe i the area to ear the 2016 Outstadig Achievemet Award from the Commissio o Cacer (CoC) of the America College of Surgeos. Aoucemet of the award followed CoC cacer program surveys performed July 1 through December 31, The stregth of Methodist s patiet experiece is also validated by patiet satisfactio survey results from Professioal Research Cosultats, Ic. (PRC). This year, Methodist achieved 21 PRC Awards for Excellece i healthcare, icludig umerous 5-Star Awards for our ipatiet ad outpatiet ocology services. Our work to fight cacer ad ehace care cotiues, ad we thak you for your iterest ad support. This is our secod cosecutive CoC Outstadig Achievemet Award ad further cofirmatio of Methodist s success i deliverig outstadig patiet-cetered, evidecebased multidiscipliary cacer care. Our great stregths are ot weakeed by the passage of time or by growth withi our competitive marketplace. Methodist maitais a uique culture ad visio. We possess a uwaverig commitmet to quality ad to those we serve. We place the highest priority o the total patiet experiece Daiel D. Lydiatt, DDS, MD Medical Director Methodist Estabrook Cacer Ceter Josie Abboud, RN, BSN, MBA Executive Vice Presidet ad Chief Operatig Officer Methodist Hospital Patty Bauer, MSHA, RN, RRT Service Executive, Ocology Services Methodist Estabrook Cacer Ceter throughout Methodist, icludig all ocology services. For us, The Meaig of Care is a way of life. It is the special way our people care for patiets ad families, ad it is our total eviromet of care. Our expert, experieced ad compassioate caregivers ad support staff create positive experieces throughout the cotiuum of care for the best possible outcomes, icludig a faster retur to health ad fuctio. 2 3

3 Multiple Myeloma Update Stefao Taratolo, MD Multiple myeloma is a blood cacer of the plasma cells. Normal plasma cells are importat for immue fuctio ad to regulate atibody (or immuoglobuli) productio. Plasma cells are located i the boe marrow ad whe oe becomes cacerous, it reproduces or proliferates. The maligat plasma cells will the make the same type of abormal immuoglobuli called M protei. This M protei ca be detected i the blood ad/or urie. The symptoms ad sigs of myeloma occur due to both the proliferatio of the cells i the boe marrow as well as to the damage the M protei causes whe it deposits i orgas. Multiple myeloma represets 1 percet of all cacers ad 13 percet of hematologic or blood cacers. It is geerally diagosed later i life with the average age of ewly diagosed patiets beig 70 years. Oly a third of patiets are diagosed prior to age 65. It is estimated that 30,280 Americas will be diagosed with myeloma i 2017 (17,490 male ad 12,780 female) ad 12,590 deaths are expected (6,600 male ad 5,930 female). The average life expectacy after a diagosis of myeloma is approximately five years although ewer treatmets have show to improve overall survival. Symptoms Approximately 73 percet of patiets will preset with aemia due to either poorly fuctioig kideys (due to damage from the M protei) ad/or marrow replacemet by plasma cells. Eighty percet of patiets will have boe lesios with about two thirds havig some pai i those areas. Other symptoms iclude recurret ifectios, peripheral europathy ad symptoms from kidey damage (fluid retetio). Laboratory Data Patiets suspected of havig myeloma udergo the followig diagostic studies: complete blood cout, complete blood chemistry, 24-hour urie collectio of protei electrophoresis with immuofixatio, serum I 2017, it is estimated that 30,280 Americas will be diagosed with myeloma protei electrophoresis with immuofixatio, B-2- microglobuli, serum light chais, a boe marrow biopsy with flow cytometry ad FISH pael. Additioal studies iclude a fat pad biopsy to evaluate for a coditio called amyloid ad x-rays (PET sca, MRI of boes or complete radiographs of the etire skeleto). I the ear future, gee expressio profilig will be available to aid i risk stratificatio ad selectio of the most active agets for patiets upfrot. Stagig Myeloma is staged utilizig the Iteratioal Stagig System (ISS). This stagig system is exclusively based o albumi level ad Beta 2 microglobuli. Patiets are staged as Stage I, II or III. The stages correspod to survival predictio: Stage I, 62 moths; Stage II, 44 moths; ad Stage III, 29 moths. The revised Iteratioal Stagig System (R-ISS) added serum LDH ad high-risk chromosomes by fluorescet i situ hybridizatio (FISH). 4 5

4 Multiple Myeloma Update cotiued Survival Stage I Stage II Stage III 5-year Overall Survival Media Overall Survival High Risk Stadard Risk 82% 62% 40% N/A 83 moths 43 moths FISH t(4:14), del 17 p13, chromomome 1, hypodiploid elevated Beta-2- microglobuli ad elevated LDH Hyperdiploid, t(11;14) ormal Beta-2- microglobuli ad ormal albumi 2005, more tha 100 patiets have udergoe Autologous stem cell trasplats at Methodist Hospital with improved results. A recet study published i the April 2017 issue of the New Eglad Joural of Medicie o 700 adult patiets with multiple myeloma showed a improvemet i survival i patiets who were cosolidated with a Autologous stem cell trasplat. Treatmet The treatmet of myeloma has chaged dramatically i the last decade from traditioal chemotherapy drugs to ow iclude targeted therapies (drugs that act more specifically o the cacer cells). This has trasformed the progosis for patiets with myeloma with a media survival of 29 moths i 2000 to a media survival of five years i For more tha 50 years, the maistay of therapy was oral melphala ad predisoe. Multiple poly-chemotherapy agets whe compared to melphala ad predisoe showed similar outcomes resultig i a media survival of 29 moths regardless of the therapy utilized. However, recet research has show that immuomodulatory agets such as thalidomide, lealidomide, pomalidomide ad proteasome ihibitors such as Velcade, Kyprolilis ad Nilaro are impactig survival. High-dose therapy with Autologous stem cell rescue has become the stadard of care for selected fit patiets. Sice New Therapies: Moocloal Atibody Recetly, two ew moocloal atibodies have bee FDA approved for the treatmet of myeloma. Daratumumab is a huma IgG kappa moocloal atibody that targets the CD38 receptor o the cell surface ad kills plasma cells via 6 7

5 Multiple Myeloma Update cotiued multiple immue-mediated mechaisms. Daratumumab demostrated a favorable safety profile ad ecouragig efficacy i heavily pretreated patiets. Daratumumab is FDA approved for secod lie therapy. There are several ogoig trials that icorporate Daratumumab i the first lie settig, prior to stem cell trasplatatio. The secod atibody is Elotuzumab which is also a huma IgG1 moocloal atibody that targets sigle lymphocyte activatio of C7 or SLAM-7 or CS-1 (cell surface glycoprotei CD2) o atural killer cells. More tha 95 percet of marrow plasma cells express SLAM-7. Elotuzumab is admiistered i combiatio with lealidomide. Methodist Hospital is curretly participatig i a research study of Elotuzumab i the frotlie settig, prior to stem trasplat. Coclusio As ca be oted, the rapid advaces i our uderstadig of myeloma biology have resulted i uprecedeted developmet of ew treatmets that have improved survival ad quality of life for patiets. Perhaps more excitig is a research pipelie that bodes for eve a more hopeful future. Although a cure for myeloma may still be some time away, the possibility of covertig myeloma ito a chroic illess (similar to hypertesio or diabetes) is rapidly becomig a reality. Attal, M., Lauwers-Caces, V., Huli, C., Leleu, X., Caillot, D., Escoffre, M. & Avet-Loiseau, H. (2017). Lealidomide, Bortezomib, ad Dexamethasoe with Trasplatatio for Myeloma. NEJM, 376(14), Future There are several excitig ew therapies. Oe promisig aget is chimeric atige receptor T-cells commoly referred to as CAR-T cells. This therapy uses a patiet s ow immue T-cells that are egieered to attack a specific protei o a myeloma cell such as CD-19 or BMSA. 8 9

6 FACT ACCREDITATION: Foudatio for the Accreditatio of Cellular Therapy Kim Blad, DNP, APRN-NP, FNP, AOCN Amog stem cell trasplat programs, oe quality measure stads out: accreditatio by the Foudatio for the Accreditatio of Cellular Therapy (FACT). FACT is a iteratioal accreditatio created to establish ad certify cliical excellece i process ad outcomes ad is the threshold for excellece i cellular therapy (stem cell trasplatatio). FACT accredited orgaizatios volutarily seek ad maitai FACT accreditatio through a rigorous process, demostratig their belief that patiet eeds are paramout. Accreditatio is based o compliace with comprehesive evidece-based stadards set by iteratioal teams of worldreowed experts vested i the improvemet ad progress of cellular therapy. FACT ceters have a reputatio as ceters of excellece that exert adequate quality cotrol over the etire cellular therapy process. Accredited programs maitai the cofidece of medical professioals, third-party payers, ad regulators i the quality of the orgaizatio s cellular therapy services. This accreditatio, which is ofte required by isurace payers, applies to all patiets receivig Autologous stem cell trasplatatio at Nebraska Methodist Hospital. The Autologous stem cell trasplat program received iitial full three-year FACT accreditatio i Compliace with FACT stadards is a ogoig process; successful accreditatio is attributed to strog collaboratio amog departmets ad staff members who care for trasplat patiets. Dedicated to improvig survival, treatmet, ad quality of life for trasplat patiets, Nebraska Methodist Hospital volutarily participates i the Ceter for Iteratioal Blood & Marrow Trasplat Research Program (CIBMTR). The CIBMTR has a etwork of more tha 500 ceters worldwide that cotribute detailed research data o hematopoietic cell trasplats. The primary goal of this research program is to improve the safety ad effectiveess of hematopoietic cell trasplatatio. Patiets receivig stem cell trasplatatio are ivited to take part i this research database, which is oversee by Nebraska Methodist Hospital Istitutioal Review Board. Iformatio about participatio is provided ad patiets must sig a coset form to participate. There are o costs or reimbursemets to the patiet ad participats may withdrawal from the study All treatmet decisios are a partership betwee the care team ad the patiet ad family. at ay time. The goal of this research is to fid ways to make hematopoietic trasplats ad other cellular therapies work better, to help future patiets who eed a trasplat or cellular therapy. Nebraska Methodist Hospital has a stem cell trasplatatio multidiscipliary team focused o the philosophy of holistic, idividualized patiet-cetered care. All treatmet decisios are a partership betwee the care team, the patiet ad family, from iitial diagosis through treatmet ad follow up. Quarterly stem cell trasplat committee meetigs are coducted to review the program, provide educatio for staff members, ad to cotiually improve patiet care. I additio to participatig i the o-site accreditatio ispectio by FACT surveyors, Methodist Hospital also volutarily submits aual reports of trasplat activities to FACT ad the Methodist Cacer Committee. Patiets receivig Autologous stem cell trasplatatio at Methodist Hospital, a FACT accredited orgaizatio, ca be assured that they are i good hads

7 Commuity Outreach Activity Summary 2016 Stadard 1.8 Moitorig Commuity Outreach Commuity Outreach Coordiator moitors the effectiveess of commuity outreach activities o a aual basis. The activities ad fidigs are documeted i a commuity outreach activity summary that is preseted to the Cacer Committee aually. Stadard 4.1 Prevetio Programs Each year the cacer committee provides at least oe cacer prevetio program that is targeted to meet the eeds of the commuity ad should be desiged to reduce the icidece of a specific cacer type. The prevetio program is cosistet with evidece-based atioal guidelies for cacer prevetio. (ACS ad NCCN screeig ad prevetio recommedatios used as referece at MECC.) Stadard 4.2 Screeig Programs Each year, the cacer committee provides at least oe cacer screeig program that is targeted to decreasig the umber of patiets with late-stage disease. The screeig program is based o commuity eeds ad is cosistet with evidecebased atioal guidelies ad evidece-based itervetios. A process is developed to follow up o all positive fidigs Prevetio Programs: Audiece Program Locatio Date Beauty i Bloom - Project Pik d program via Ier Beauty Breast Cacer Survivors A Time to Heal Survivorship Program A Time to Heal Survivorship Program Multiple Myeloma Support Group Project Pik d - The Chef s Table Breast Cacer Survivors A Time to Heal Survivorship Program A Time to Heal Survivorship Program Metro area 3rd grade studets Fightig Cacer With a Fork Educatioal Talk Fightig Cacer With a Fork Educatioal Talk Fightig Cacer With a Fork Educatioal Talk AICR Prevetio Guidelies Nutritio Durig ad After Treatmet Fightig Cacer With a Fork Educatioal Talk & Cookig Demo Fightig Cacer With a Fork Educatioal Talk Fightig Cacer With a Fork Educatioal Talk No Tobacco Challege Omaha, NE 2/4/16 20 First Uited Methodist, Omaha, NE Methodist Estabrook Cacer Ceter, Omaha, NE 3/21/ /22/16 12 Omaha, NE 8/17/16 16 Omaha, NE 8/4/16 16 First Uited Methodist, Omaha, NE CHI Berga Mercy s Cacer Ceter, Omaha, NE Metro area 3rd grade classrooms 10/24/ /20/16 12 October 2016 Number of Participats

8 Satisfactio surveys are provided post-utritio educatio talk. Participats are ecouraged to provide feedback ad of the participats respodig, they evaluated the utritio talk effectiveess as the followig: 100 percet of participats felt staff commuicated clearly ad aswered questios. 91 percet of participats pla o adoptig chages as a result of iformatio. 100 percet of participats felt it was a worthwhile use of their time ad would recommed services to frieds. Screeig Patiet Follow-up Process All participats who atted a commuity screeig receive a thak-you letter with iformatio ad cotact umbers for the cacer prevetio program ad Methodist Health System. A letter is give to them as they leave the screeig. Ay participat with a abormal fidig gets a idividualized letter remidig them of the fidigs ad recommedatio to cotact their persoal health care provider withi oe to two weeks after screeig. If they do t list a persoal healthcare provider, iformatio about the Methodist Health System physicia referral lie is provided. If the participat has listed a healthcare provider ad siged a medical release of iformatio, a letter is set to the physicia alog with a copy of the screeig results. Ay participat with a abormal fidig will receive a phoe call from the cacer prevetio staff withi oe moth of screeig to determie if they have had follow-up, if they eeded assistace with follow-up, ad/or results of follow-up. Notes ad copy of cotacts are kept with screeig charts. Screeig charts are kept for oe year i the cacer prevetio departmet Screeig Programs: Screeig Type Colorectal Breast Oral, Head & Neck Colorectal Oral, Head & Neck Colorectal Breast ad Cervical Oral, Head & Neck Prostate Breast Locatio Date Number of Participats Commuitywide as part of the Great Plais Colo Cacer Task Force Black Family Health & Welless Fair; North High School Black Family Health & Welless Fair; North High School Commuitywide as part of the Great Plais Colo Cacer Task Force March /19/ /19/ April MECC 4/9/ Commuitywide as part of the Great Plais Colo Cacer Task Force See, Test & Treat Screeig Program at Charles Drew Health Ceter Oral Cacer Foudatio Walk at Chalco Hills Cruisig for a Cure Car Show; 8511 Dodge Street, Omaha BiNatioal Health Week; Oe World, Omaha May & Jue /9/ /13/ /11/ /5/ Number Requirig F/U 14 15

9 2016 Cacer Cases Primary Sites Total Aalytic No- Aalytic LIP TONGUE GUM FLOOR OF MOUTH PALATE MOUTH PAROTID GLAND SALIVARY GLAND TONSIL OROPHARYNX NASOPHARYNX PYRIFORM SINUS HYPOPHARYNX ORAL CAVITY ESOPHAGUS STOMACH SMALL INTESTINE COLORECTAL ANUS LIVER GALLBLADDER BILIARY TRACK PANCREAS NASAL CAVITY SINUS LARYNX TRACHEA LUNG THYMUS HEART-PLEURA-MEDIASTINUM BONES-JOINTS-CARTILAGE BLOOD SYSTEM CLL ALL Primary Sites Total Aalytic No- Aalytic SKIN MELANOMA AUTONOMIC NERVOUS SYSTEM PERITONEUM CONNECTIVE TISSUE BREAST VULVA VAGINA CERVIX UTERI CORPUS UTERI UTERUS OVARY FEMALE GENITAL PLACENTA PENIS PROSTATE TESTIS MALE GENITAL KIDNEY RENAL PELVIS URETER BLADDER URINARY ORGANS EYE MENINGES BRAIN CENTRAL NERVOUS SYSTEM THYROID ADRENAL GLAND ENDOCRINE LYMPH NODES UNKNOWN OTHER TOTALS

10 2016 Top Te Cacer Sites AJCC Stage & Age at Diagosis Male % PROSTATE % HEAD/NECK % MELANOMA,SKIN 98 14% COLORECTAL 76 11% LUNG & BRONCHUS 54 7% BLADDER 52 7% KIDNEY & RENAL PELVIS 39 6% PANCREAS 25 4% BLOOD SYSTEM 21 3% LYMPH NODES 14 2% Female 1, % BREAST % CORPUS UTERI % HEAD/NECK % LUNG & BRONCHUS 89 8% MELANOMA,SKIN 75 8% COLORECTAL 70 7% OVARY 58 6% CERVIX 34 3% KIDNEY & RENAL PELVIS 19 2% PANCREAS 18 1% AJCC Stage at Diagosis INSITU 123 6% I % II % III 121 6% IV % NA 97 4% UNKNOWN % Age at Diagosis Male Female % 1 0% % 15 1% % 78 4% % 127 6% % % % % % % % 132 6% % 15 1% Totals

11 2016 Accomplishmets Achieved Commissio o Cacer re-accreditatio with commedatio ad the Outstadig Achievemet Award Achieved Radiatio Ocology re-accreditatio Achieved 14 percet patiet erollmet i cliical research trials of the total umber of patiets screeed. Achieved 7 percet erollmet specific to treatmet trials Collaborated with Methodist Jeie Edmudso to establish a lug cacer screeig program at Methodist Jeie Edmudso Implemeted the electroic health record i the Hereditary Cacer Risk Program Icorporated Palliative Care ito the Lug Cacer Cliic Coordiated Omaha Fashio Week s Cacer Survivor Style Show Created a Ier Beauty satellite locatio o the Ipatiet Ocology Uit Completed refurbishmet of the Ifusio Ceter Icreased Ocology Dietitia coverage at MECC to better support growig demad for services Implemeted educatio ad traiig o Cardizem protocol applicatio for patiets o the Ipatiet Ocology Uit havig heart rate cotrol issues to allow treatmet o the uit versus trasferrig to a higher level of care Created a database for trackig ad moitorig of adherece to NCCN guidelies for pacreatic cacer Icreased effectiveess of cliic to hospital coordiatio for surgical ocology cliic patiets Collaborated with Charles Drew to offer mastectomy fittig services to the low icome ad uisured populatio they serve Cotiued developmet ad implemetatio of CPOE chemotherapy protocols for GYN Ocology Provided ogoig educatio to MECC cliics ad departmets regardig behavioral health services Implemeted FEES (Fiberoptic Edoscopic Evaluatio of Swallowig) Procedure i the Head ad Neck Surgical Ocology Cliic Partered with the America Lug Associatio to create ad facilitate a lug cacer support group Offered a educatioal workshop for larygectomy patiets ad their families Partered with Leap-fora-Cure to host a euroocology coferece for patiets/families ad healthcare professioals Collaborated with Childre s Hospital to implemet a Childre s Thyroid Cliic at Childre s Hospital 20 21

12 2017 MECC Goals Achieve FACT Stem Cell re-accreditatio Itegrate complex illess support services at MECC Explore telemedicie optios for psychiatry cosultatio services at Methodist Wome s Hospital Establish a cetralized outpatiet ifusio schedulig ad fiacial clearace process for the health system Develop reports to track NCCN evaluatio ad treatmet compliace for pacreatic cacer i the Surgical Ocology Cliic Fully trasitio the Head & Neck Surgical Ocology program to Methodist Ehace marketig strategies for Harper s Hope physical welless classes Implemet referral process with Ocology Research team for use of distress screeig ad appropriate social work referrals Ivestigate quarterly partership with Project Pik d to cotiue cacer prevetio utritio classes for breast cacer survivors Support Ocology Certificatio for ursig by participatig i the ONCC FreeTake Certificatio Program with a goal of 10 ipatiet ad 4 outpatiet urses achievig Ocology Certificatio i 2017 Implemet Ehaced Recovery for GYN Ocology patiets udergoig a hysterectomy Ehace teamwork ad commuicatio betwee ipatiet ad outpatiet services for breast cacer care Istall ad implemet a replacemet CT scaer equipped with 4-dimesioal capabilities Istall ad implemet a CT cotrast ijector Parter with Kome Great Plais to provide mobile mammography services i the Omaha metro area Implemet Digital Breast Tomosythesis at MECC Achieve >12 percet patiet erollmet i cliical research trials of the total umber of patiets screeed. Achieve >5 percet erollmet specific to treatmet trials Lauch a ew website specific to Methodist Estabrook Cacer Ceter Desig ad implemet a ocology rehab program Host a head & eck cacer symposium Host a lug cacer symposium 22 23

13 2016 Cacer Committee Members Robert Lagdo, MD Co-Chairma* Daiel Lydiatt, DDS, MD Co-Chairma* Medical Director, Cacer Ceter Josie Abboud Methodist Hospital Admiistratio Amy Bamburg Tumor Registry* Kathry Bartz Ocology Research* Patty Bauer Cacer Ceter Admiistratio* Margaret Block, MD Cheryl Bohacek Ipatiet Ocology Wedy Buchholz Ocology Rehab* Kathy Christiase Cacer Prevetio & Hereditary Risk* David Crotzer, MD Jaso Davis Quality* George Dittrick, MD Surgical Ocologist* Rady Duckert, MD Radiatio Ocologist* Joh Edey, MD Steve Goeser Methodist Hospital Admiistratio David Hilger, MD Tie-Shew Huag, MD Timothy Huyck, MD Peggy Jarrell Ocology Social Worker* Richard Kutilek, MD Radiologist* Stephe Lemo, MD Patrick Leu, MD Lou Lukas, MD Fred Massoomi Pharm.D. Deb Meyers Lug/Thoracic Ocology Cliic* Alireza Mirmira, MD Peter Morris, MD Charles Mosher, MD Pathologist* Geetha Palaiappa, MD A Polich, MD Iria Popa, MD Diae Radolph Home Health ad Hospice James Reilly, MD Cacer Liaiso Physicia Sharlo Rodgers Radiatio Ocology M. Shashidhara, MD William Shiffermiller, MD Medical Staff Admiistratio Kathry Simoe Breast Care Ceter Russell Smith, MD Yugpo Su, MD Stefao Taratolo, MD Jae Theobald, MD Jackie Thiele Palliative Care* Teri Tipto Nursig Admiistratio Kimberly Tomei Surgical Ocology Cliic * Desigates idividuals or positios that are required by the America College of Surgeos Cacer accreditatio program

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15 Methodist Estabrook Cacer Ceter Nebraska Methodist Hospital 8303 Dodge St Omaha, NE 68114