CANCER ANNUAL REPORT Froedtert & The Medical College of Wisconsin Cancer Network at Froedtert Health St. Joseph s Hospital s Kraemer Cancer Center

Transcription

1 CANCER ANNUAL REPORT Froedtert & The Medical College of Wisconsin Cancer Network at Froedtert Health St. Joseph s Hospital s Kraemer Cancer Center 21 data

2 Table of Contents Welcome... 3 Cancer Committee... 4 Cancer Registry Report... 5 Cancer Conferences... 6 Primary Sites... 7 Glossary... 1 Lung Cancer: a Site Specific Study Froedtert & The Medical College of Wisconsin Cancer Network delivers a coordinated system of high-quality cancer care anchored by the specialty expertise of Medical College of Wisconsin physicians and the extensive resources of an academic medical center Data

3 Welcome We are pleased to present our 211 annual report on cancer for the Froedtert & The Medical College of Wisconsin Cancer Network at Froedtert Health St. Joseph s Hospital s Kraemer Cancer Center in West Bend. This report highlights cancer services available for residents of Washington County and surrounding areas, and gives a statistical overview of newly diagnosed cases. Comparisons to state and national statistics are included, where available. You will also find a physician authored report on lung cancer. This year has brought many new developments and accomplishments in cancer care at the Kraemer Cancer Center. In April, we broke ground for the new Kraemer Cancer Center building on the grounds of St. Joseph s Hospital in West Bend. In addition to ongoing general tumor board conferences, in August, we launched a new, dedicated breast cancer tumor board where a multidisciplinary team of experts discusses newly diagnosed and challenging breast cancer cases. In September, we introduced thoracic surgical services in West Bend. Medical College of Wisconsin surgeons are performing state-of-the-art lung cancer surgeries right here in West Bend. Also in September, we submitted our program to a survey by the American College of Surgeon s Commission on Cancer as part of our application to become an accredited Commission on Cancer program. In October, we were awarded three-year accreditation with commendation from the Commission on Cancer. We received seven commendations for exemplary performance on our initial application for accreditation. This was the culmination of three years of work on quality and performance improvement and is quite a remarkable accomplishment. We joined an elite group of 1,5 cancer treatment programs across the country to achieve this recognition of comprehensive and quality treatment of cancers. We added psychosocial support and counseling services for our cancer patients. Your questions are welcome regarding this report and the comprehensive services provided at the Kraemer Cancer Center. For more information or an appointment, please call or You can also learn more about the Froedtert & The Medical College of Wisconsin Cancer Network at Froedtert Health St. Joseph s Hospital s Kraemer Cancer Center by visiting Michael Laird, FACHE President and CEO Froedtert Health St. Joseph s Hospital Candice Johnstone, MD, MPH Medical College of Wisconsin Radiation Oncologist Director, Radiation Oncology, Kraemer Cancer Center Chair, Cancer Committee 3 21 Data

4 Cancer Committee Physician Members Candice Johnstone, MD, MPH Roxanna Aldstadt, MD David Dozer, MD John Fink, MD Patrick Gardner, MD John Haeberlin, MD Gary Herdrich, MD Kaizad Machhi, MD Colin Mooney, MD Richard Rozran, MD April Shera, MD Malika Siker, MD Jeffery Smale, MD Eric Soneson, MD John Tomashek, MD Committee Chair, Radiation Oncology, Medical College of Wisconsin Obstetrics and Gynecology Gastroenterology Cancer Liaison Physician, Pathology Cancer Liaison Physician, Pathology Surgery Hospice Medical Director, Family Practice Surgery Hematology and Oncology, Medical College of Wisconsin Radiology Otolaryngology Radiation Oncology, Medical College of Wisconsin Pulmonology, Quality Assurance Surgery Radiology Kraemer Cancer Center and Hospital Operations Carol Barczak, RN Karen Ferkans-Rupert Martina Hartwell, RN Eric Hollander Jane Jung Sue Knuth, PT Jill McAndrew, LPN, CTR Bob Nichols, RPh Debbie Przedpelski, MSW, APSW Nancy Roecker, BSN, RN, OCN Martha See, RHIT, CTR Karl Schultz Angela Thompson, MS, CGC Gina Wilson, RN Manager, Hematology and Oncology Manager, Radiation Oncology Community Outreach Coordinator, Oncology Nurse Representative, American Cancer Society Cancer Conference Coordinator, CME Coordinator Director, Rehabilitation Services Coordinator, Quality of Cancer Registry Data Certified Tumor Registrar Director, Cancer Care Center Social Worker, Case Worker Quality Improvement Coordinator, Oncology Nurse Director, Cancer Registry Director, Clinical Services Genetic Counselor, Froedtert &The Medical College of Wisconsin Breast Care Navigator 4 21 Data

5 Cancer Registry Report Our goal is to become an American College of Surgeons approved community hospital cancer program in 211. A requirement to achieve this standing is to have an active cancer registry. The Cancer Registry was developed at Froedtert Health St. Joseph s Hospital in 27 with a reference date of Jan. 1, 28. The purpose of the Cancer Registry is to develop and maintain a statistical database on patients who meet specific criteria and who were diagnosed with and/or treated for cancer or other select reportable diagnoses left to right: Candice Johnstone, MD, MPH, at St. Joseph s Hospital. To become an approved Colin Mooney, MD, Malika Siker, MD community hospital cancer program, the Cancer Registry maintains all necessary records, manuals and statistics as required by the American College of Surgeons Commission on Cancer. The Cancer Registry maintains a complete database of information on all cancer cases diagnosed and/or treated at St. Joseph s Hospital. The Cancer Registry database contains 1,263 abstracts of cases from 28 to 21. In 21, 292 new cases were added. Of these new cases, 254 were analytic. This database is an important patient care and quality assessment tool. Data on newly diagnosed cancers are reported to the Wisconsin Cancer Reporting System, a statewide central database. St. Joseph s Hospital cancer data is available for use by medical staff and administration for special studies, medical planning, education and research. Reports generated from state and national sources are useful when comparing quality of care and assist the Cancer Committee in monitoring patient care and recognizing opportunities for improvement. Life-long follow-up activities are conducted annually to confirm the accuracy of survival data for statistical use, as well as to remind patients and their physicians of the importance of continued cancer surveillance. Core follow-up data include dates and types of treatment for persistent or recurrent disease, the site of distant metastases, the site and histology of subsequent primaries, the date of the last contact and the status of the patient. As of Nov. 211, 576 analytic cases are under active follow-up with a follow-up rate of percent, exceeding the 9 percent required rate set by the American College of Surgeons Commission on Cancer for approved cancer centers. The Cancer Registry is staffed by one full time certified tumor registrar. The registrar coordinates and attends bi-monthly tumor conferences. In compliance with Commission on Cancer standard 2.3, the registrar fulfills the role of coordinator for quality of Cancer Registry data. The cancer registrar is a member of the Wisconsin Cancer Registrars Association and the National Cancer Registrars Association and participates in educational conferences provided by these organizations Data

6 Cancer Conferences St. Joseph s Hospital offers bi-monthly tumor conferences held at 7: a.m. on the second and fourth Fridays of each month. Surgeons, hematologist/ oncologists, radiation oncologists, pathologists, radiologists and other health-care professionals are present at each session. Cases in the major cancer sites treated at St. Joseph s Hospital are presented. Current cases are discussed; the discussions include patient history, clinical course, stage and treatment plans with radiological and pathological review. Treatment modalities based on stage of disease are discussed, employing the expertise of the participants. Interdisciplinary Tumor Conference Site Summary Bone Marrow 1 Breast 9 Digestive Organs 6 Colon, Rectum, Duodenum, Esophagus Endocrine System 2 Pancreas Head and Neck 2 Lymphoid Neoplasms 4 Male Genital Organs 1 Prostate Musculoskeletal 1 Soft Tissue Respiratory System 7 Lung Urinary System 1 Bladder Unknown 2 Prospective (35) Total Data

7 Analysis of Cancer Data In 21, there were 292 new cases. Analytic cases totaled 87 percent of reported cases. The Registry does not abstract cases diagnosed and treated only on an outpatient basis in the physician s office. The majority of cases are breast cancer (61, or 24 percent), lung cancer (42, or 17 percent), prostate cancer (23, or 9 percent), bladder cancer (17, or 7 percent), and colorectal cancer (16, or 6 percent). The percentage data is for the total analytic cases. The following table compares these data to estimated new cases for all sites, 21, from the American Cancer Society. Comparisons with this database continue to be useful in detecting significant trends. Primary Sites: Top Five Compared to All Analytic Cases St. Joseph s Hospital Wisconsin United States Breast 24% 14% 14% Lung 17% 13% % Prostate 9% 16% 14% Bladder 7% 5% 5% Colorectal 6% 9% 9% 7 21 Data

8 Primary Sites continued Site Total Class Sex Stage Group Cases Analytic NonAn M F Stage Stage I Stage II Stage III Stage IV N/A Unknown ALL SITES BREAST PROSTATE LUNG/BRONCHUS-NON SM CELL BLADDER LUNG/BRONCHUS-SMALL CELL COLON NON-HODGKIN S LYMPHOMA LEUKEMIA MELANOMA OF SKIN KIDNEY AND RENAL PELVIS PANCREAS MYELOMA TESTIS UNKNOWN OR ILL-DEFINED TONGUE TONSIL RECTUM, RECTOSIGMOID THYROID ANUS, ANAL CANAL, ANORECTUM LARYNX OTHER HEMATOPOIETIC SOFT TISSUE CERVIX UTERI STOMACH SMALL INTESTINE LIVER CORPUS UTERI OTHER NERVOUS SYSTEM OTHER ENDOCRINE LIP FLOOR OF MOUTH OROPHARYNX ESOPHAGUS BILE DUCTS PERITONEUM, OMENTUM, MESENT NASAL CAVITY,SINUS,EAR PLEURA OTHER SKIN CANCER OVARY OTHER FEMALE GENITAL URETER EYE BRAIN HODGKIN S DISEASE Data

9 Statistical Summary The age of patients comprising analytical cases ranged from younger than age 2 (.4 percent) to age 9 and older (3.8 percent). The majority of patients were older than age 59 (67.2 percent), with the greatest number of cases clustered in the range of ages Of all the analytical cases, 55.9 percent (142) were female and 44.1 percent (112) were male. Review of analytical cases by race revealed 1 percent (254 cases) of patients were Caucasian. The distribution by American Joint Committee on Cancer (AJCC) Staging System stage at diagnosis demonstrates that slightly more than half of the patients were stages, I or II (56.7 percent). Patients with stage III disease represented 13 percent and stage IV 16.5 percent, while staging information was non-applicable for 11 percent and insufficient for 2.8 percent of the patients. For more information, contact: Froedtert Health St. Joseph s Hospital Cancer Registry Jill McAndrew, CTR, Cancer Registrar Sex Number Percent Male % Female % Age at Diagnosis Ages Number Percent % % % % % % % % % AJCC STAGE Number Percent Stage % Stage % Stage % Stage % Stage % N/A % Unknown 7 2.8% Total Data

10 References AJCC Cancer Staging Manual, American Joint Committee on Cancer, Seventh Edition Cancer Facts and Figures, 211, American Cancer Society, Inc., Atlanta, Georgia Commission on Cancer, Cancer Program Standards 29, Revised 21 National Cancer Data Base 2-28, Commission on Cancer Benchmark Summary of Cancer Care and Survival, United States National Cancer Data Base Benchmark Reports, Breast Cancer Statistics, web.facs.org/ncdbbmr Glossary of Terms Analytic cases: Cases first diagnosed and/or receiving all or part of their first course of therapy at Froedtert Health St. Joseph s Hospital since 28. First course of treatment: Tumor-directed therapy planned and administered by the physician, which may include multiple modalities of therapy and encompass intervals of a year or more. Non-analytic: Cases not seen at St. Joseph s Hospital for first course of therapy since 28 following diagnosis; cases diagnosed and treated elsewhere; and cases discovered at autopsy; recurrence and other cases required to be reported to the Wisconsin Cancer Reporting System. TNM stage: American Joint Committee on Cancer Staging System, Sixth Edition. T = Size and extent of tumor N = Involvement of regional lymph nodes M = Distant metastasis Class of case: Class assigned to analytic cases to indicate where diagnosis and treatment took place. Class = Diagnosed at St. Joseph s Hospital since 28; had all of first course of therapy elsewhere. Class 1 = Diagnosed at St. Joseph s Hospital; had all or part of first course of therapy at St. Joseph s Hospital and staff physicians offices. Class 2 = Diagnosed elsewhere; had all or part of first course of therapy at St. Joseph s Hospital and staff physicians offices. Class 3 = Diagnosed and all first course treatment done elsewhere and St. Joseph s Hospital participated in diagnostic workup or patient presents with disease recurrence or persistence Data

11 Lung and Bronchus Cancer: A Site Specific Study Jeffery Smale, MD, Pulmonary Medicine, Froedtert Health Medical Group Lung cancer is the leading cause of cancer deaths in Wisconsin among men and women and causes more deaths than the next three causes of cancer death combined. Although more new cases are recorded for prostate cancer in men and breast cancer in women, lung cancer results in far more deaths. In Wisconsin in 211, there will be an estimated 2,94 deaths due to lung cancer and 3,99 new cases diagnosed. Froedtert Health St. Joseph s Hospital treated 42 cases of lung cancer in 21. Women were treated as frequently as men. This does not mirror the female/male ratio found in state and national data. Percentage of Cases by Sex for Lung Cancer St. Joseph s Hospital Wisconsin United States Male Female It is well known that smoking duration and intensity greatly influences the risk of developing lung cancer; a diagnosis of lung cancer typically follows a longer history of smoking. With the absence of proven screening tools for early diagnosis and treatment, prevention of lung cancer by smoking cessation remains the primary tool in the battle against the disease. The average age at diagnosis for patients with non-small cell and small cell cancers did not appear to vary greatly from Wisconsin and national statistics. In 21, the majority of lung cancer patients were well over the age of 5 at diagnosis at St. Joseph s Hospital, and their diagnosis followed a history of years of tobacco smoking Data

12 Distribution of Cases by Age at Diagnosis for Non-Small Cell Carcinoma & Younger & Older St. Joseph s Hospital Wisconsin United States Distribution of Cases by Age at Diagnosis for Small Cell Carcinoma & Younger & Older St. Joseph s Hospital Wisconsin United States At St. Joseph s Hospital in 21, there appeared to be a predominance of squamous cell cancers over other non-small cell cancers. National and state data suggest adenocarcinoma is more prevalent. It is unclear if this has been a trend in other years in the West Bend area. Adenocarcinoma is the most frequent type of non-small cell lung cancer seen in non-smokers. At diagnosis, the majority of patients with non-small cell cancer were at stages 3 and 4. Late stage at diagnosis is typical for lung cancer and contributes to the high mortality of the condition. Sixteen of the 29 patients were able to undergo surgery. After surgery, the percentage of patients who underwent palliative or curative intent radiation therapy or chemotherapy is not documented; however, non-small cell cancer not cured with initial surgery is typically treated without curative intent Data

13 Distribution of Cases by Stage for Non-Small Cell Carcinoma Stage Stage I Stage II Stage III Stage IV Unknown St. Joseph s Hospital Wisconsin United States Comparison for Treatment Modalities for Non-Small Cell Carcinoma None Radiation Rad/Chemo Surgery Surg/Chemo Chemotherapy Surg/Rad/Chemo St. Joseph s Hospital Wisconsin United States Small cell cancer contributed to 13 of the 42 lung cancer cases at St Joseph s Hospital. Of these cases, 61 percent were female, which is higher than the approximately 5 percent ratio seen nationally and in Wisconsin. However, age at diagnosis mirrored the national data. Since small cell lung cancer is typically metastatic at early stages, surgery was not performed as an isolated therapy in any of the cases. TNM staging listed below is not typically utilized clinically in small cell cancer because of metastasis at earlier stages than non-small cell. Because of the difficulty of small cell cancer treatment, 38 percent (5 patients) chose palliative treatment alone at St. Joseph s Hospital in 21. This number is higher than state and national statistics for patients choosing palliative treatment alone: in Wisconsin, it s 2 percent; nationally, that number is 22 percent. The factors leading to this treatment decision path are undetermined; further, it is uncertain whether the decision to engage in palliative care only for small cell cancer is a trend Data

14 Distribution of Cases by Stage for Small Cell Carcinoma Stage I Stage II Stage III Stage IV Unknown St. Joseph s Hospital Wisconsin United States Comparison for Treatment Modalities for Small Cell Carcinoma Rad/Chemo None Chemotherapy Surg/Rad/Chemo Radiation Other St. Joseph s Hospital Wisconsin United States A review of cases seen in West Bend suggests a poor survival rate consistent with national averages. Formal analysis was not performed, as five years of data is not available in our registry Data

15 Summary In summary, the 21 data collected for lung cancer cases in West Bend at St. Joseph s Hospital suggests a tendency for less adenocarcinoma than for other larger series, but the numbers are small. Women at St. Joseph s Hospital accounted for the same number of lung cancer cases as men. This is atypical: men usually account for a higher percentage of cases. A slight trend in 21 toward palliative care was noted for small cell cancer compared to larger groups analyzed. Other data analyzed was similar to state and national averages. Longer periods of analysis will be necessary to determine if the differences are significant. 21 Data