Annual Cancer Registry Report

Transcription

1 Annual Cancer Registry Report 2015

2 2 John R. Marsh Cancer Center Annual Cancer Registry Report

3 Message from the Director What a year! Cancer services and programs at Meritus Health are constantly growing and evolving to reflect the comprehensive needs of the community. This report is our opportunity to share some of the year s highlights. Earlier this year, the American College of Surgeons re-accredited our cancer program for three more years and the radiation oncology department at the John R. Marsh Cancer Center also saw its program re-accredited through the American College of Radiology. Much effort went into the Meritus Center for Breast Health achieving accreditation through the National Accreditation of Breast Centers. Meeting these program standards emphasizes our continuing commitment to provide the best quality care, close to home. Our expert cancer care involves collaborative work, so this year, we added an additional patient navigator to help everyone move smoothly through the resources available. Those include expanded nutritional services, enhanced cancer rehabilitation programs and Hope Soars, a new class providing support for cancer survivors who have recently completed treatment. This annual report also highlights the significant reach of our Make-a-Difference Breast Cancer Screening Program. In 2016, we will celebrate 20 years of service to the community, combining medical and radiation oncology together at the John R. Marsh Cancer Center. With the addition of Meritus Gynecologic Oncology, the Meritus Center for Breast Health and Meritus Cancer Specialists, comprehensive, expert cancer care is truly close to your home through Meritus Cancer Services. Susan Lopp John R. Marsh Cancer Center director Dr. Frederic Kass III, medical director of the John R. Marsh Cancer Center. John R. Marsh Cancer Center Annual Cancer Registry Report 3

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5 Meritus Cancer Services Meritus Center for Breast Health In 2016, Meritus Center for Breast Health received a three-year, full accreditation from the National Accreditation Program for Breast Centers or NAPBC. The accreditation validates that the Meritus Center for Breast Health meets the standards established by the NAPBC for treating women who are diagnosed through the full spectrum of breast disease. Fellowship-trained breast surgeons lead a multidisciplinary team of radiologists, pathologists, medical oncologists and radiation oncologists to provide a collaborative approach to beating breast cancer. Since the center opened in 2014, it has evolved to include a breast cancer high risk assessment program to help women understand their risk of developing breast cancer and oncology nurse navigators to guide patients through diagnosis, treatment and survivorship. Meritus Cancer Specialists The oncologists and hematologists of Meritus Cancer Specialists treat a wide variety of cancers using chemotherapy, hormonal, biological and targeted therapies. As members of a multidisciplinary team, the oncologists participate in care conferences at the John R. Marsh Cancer Center to discuss the diagnosis and treatment of complex patient cases. In 2016, Meritus Cancer Specialists hired two additional physicians to expand its hematology services. The physicians also added 24/7 inpatient rounding to better serve the needs of hospitalized patients. Today, four medical oncologists provide expert cancer care to patients just diagnosed with cancer and those who are already battling the disease. Together, they offer patients a continuity of cancer care in a supportive environment without the need to travel outside the community for treatment. Meritus Gynecologic Oncology Center Nearly 17 years ago, Neil Rosenshein, M.D., a renowned gynecologic oncologist, brought advanced care to women in western Maryland. Today, women in the tristate area come to Dr. Rosenshein for the diagnosis and treatment of ovarian, cervical, uterine, endometrial, vulvar and vaginal cancers. As medical director of Meritus Gynecologic Oncology Center, Dr. Rosenshein has performed thousands of gynecologic oncology surgeries during his 40-plus-year career. He brings advanced training, in-depth knowledge and exposure to constantly evolving treatments. Known for his compassionate care and personalized touch, Dr. Rosenshein s expert surgical skills greatly enhance his patients outcomes. Surgical Oncologist Susan Kesmodel, M.D., of Meritus Center for Breast Health, reviews a mammogram with a patient. John R. Marsh Cancer Center Annual Cancer Registry Report 5

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7 Oncology Nurse Navigators The oncology nurse navigators educate, support and coordinate care across the continuum and serve as a single point of contact for cancer patients and their families. Through clinical experience and training, the navigators guide patients and their families to make informed decisions. They collaborate with the entire medical team, including surgeons, medical oncologists, radiation oncologists, pulmonologists, primary care providers, radiologists, pharmacists, dietitians, physical therapists, occupational therapists, speech therapist, care managers and social workers to ensure all needs of the patients and their families are met. Collaborating with a multidisciplinary team allows for timely cancer screening, diagnosis and treatment and increased supportive care. Navigators are active in survivorship care, helping to ensure that the survivors ongoing health needs are met. These needs may include screening for recurrence and secondary cancers, managing late and long-term effects of treatment, lifestyle changes to reduce cancer risks and managing comorbidities. Navigators coordinate and facilitate survivorship classes. Navigator services are free to all patients at the cancer center. The John R Marsh Cancer Center currently has three clinical nurse navigators: The clinical nurse navigator works closely with patients diagnosed with all cancers except lung. She works to provide a continuum of care, from inpatients who are diagnosed with cancer into the outpatient treatment center, as well as through all phases of cancer treatment into survivorship. This navigator attends community events to educate and encourage screenings for colon, cervical and skin cancers. The lung navigator works with patients diagnosed with lung cancer and with those who are at risk for developing lung cancer by monitoring their lung nodules. In the community, she is active in prevention and early detection by attending health fairs, coordinating lung cancer awareness events and meeting with medical professionals to support and encourage lung cancer screening with the use of low-dose CT. The breast navigator works with patients diagnosed with breast cancer from the time of positive biopsy. She provides personalized support and guidance through all aspects of the breast cancer treatment process. Tara Reed, RN, B.S.N., OCN Clinical Breast Navigator Valerie Rinehart, RN, B.S.N. Clinical Patient Navigator Corey Thomas, RN Clinical Lung Navigator Dr. Neil Rosenshein, surgical oncologist at Meritus Gynecologic Oncology Center. John R. Marsh Cancer Center Annual Cancer Registry Report 7

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9 Total Rehab Care - TRC Speech Language Pathologist s role Team member providing input regarding potential effects of treatment on voice, speech and swallowing Determine patient s level of understanding of upcoming treatment Provide information to patient regarding speech language pathologist or SLP/patient roles during/ post treatment Manage voice, speech and swallowing problems SLP pre-hnc treatment Review expected changes to speech and swallowing Dental care and oral hygiene in relation to aspiration and aspiration pneumonia Xerostomia alleviation and treatment Measurement of oral aperture, discussion of trismus and jaw ROM exercises Prophylactic swallowing exercises dysphagia vs. temporary side effects Explanation for and encouragement of prophylactic placement of GT if appropriate Instrumental Swallowing Evaluation SLP intervention assists to reduce patient anxiety, improve post-treatment compliance and encourage patient as a team member. SLP care during and after radiation Ongoing monitoring (follow up mid treatment, last week of treatment, after treatment completion) Encourage oral intake as tolerated (seeking to avoid PEG dependence w/o oral intake) Encourage daily exercises Re-evaluate at the conclusion of tx (6-8 weeks) SLP role for patient presenting with late radiation dysphagia Sensory issues are also very common Treatment should be intensive and aggressive Patient adherence Inclusion of SLP in the multidisciplinary team increases the potential that the patient will follow their plan of care. Referral pattern is significantly associated with SLP participation Mechanisms for relationship: develop relationship at the onset of care, increase patient understanding of the importance of SLP care, increase legitimacy of the SLP role on HNC team TRC s role in cancer rehab: Most of the rehabilitation patients are being seen postsurgery and/or post-radiation/chemo. They are primarily breast and lung cancer patients, although some patients with head/neck cancers have come during the past year. TRC staff s function is to meet the patients where they are functionally and psychologically. Assessment: Many standardized outcome tools are used to evaluate the patients initially and throughout their treatment fatigue, pain, balance and gait tests. Patients are assessed in how they are functioning in their daily lives and then collaborated with regarding what they want from rehabilitation services before a treatment program is designed with them. Treatment: includes lymphedema treatment with manual techniques and bandaging and assisting with fittings for compression sleeves for self-management. Education provided includes energy conservation and activities of daily living to assist patients to gain independence in their home; information on assistive devices to facilitate their independence; and explanations of appropriate exercises for strength and functional mobility. Fatigue and sickness from chemo can be a deterrent to their participating in rehabilitation, but we persevere as a team. Neurological patients have a multidisciplinary team approach, with physical and occupational therapists to support the SLP. Rehabilitation staff will continue to provide educational sessions in collaboration with the navigator s survivorship series. Jacklyn Garrish, speech language pathologist, works with patients in the John R. Marsh Cancer Center. John R. Marsh Cancer Center Annual Cancer Registry Report 9

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11 Social Work Patient and family counseling The John Marsh Cancer Center provides comprehensive, therapeutic, support services to patients and their families during the course of treatment. Two licensed social workers are on staff to provide short-term, outpatient therapy while treatment is taking place. Psychosocial assessments are completed with most new patients who are undergoing any form of cancer treatment. An encompassing distress screening tool is completed with new patients during their radiation simulation appointments. Referrals are made to local mental health agencies when a patient proves to need ongoing, more intensive, therapeutic services. Social workers also provide patients and their loved ones with assistance in applying for Social Security disability benefits, assistance with state prescription programs, referrals to community agencies, referrals for hospice services, referrals to home health care agencies, arranging for chemotherapy, home infusion setup, assistance with nursing home placement, arrangement of home durable medical equipment and much more.. Support groups The John Marsh Cancer Center provides monthly educational and support programs. The Lymphoma and Leukemia support group is held the third Tuesday of every month and includes complimentary dinners for the patient and his/ her spouse/caregiver. A guest speaker joins the group every month to provide support and education on topics such as survivorship issues, transplants, pain management, alternative therapies and more. The Look Good, Feel Better program or LGFB is offered every second Monday of each month. This program is sponsored by the American Cancer Society and is offered during the day so that patients receiving treatment can attend. A certified beautician facilitates the group. She provides the patients an opportunity to safely express their concerns regarding skin changes and hair loss. The beautician teaches the patients secrets to making their skin look flawless while going through rigorous treatment, as well as tips to properly care for wigs, hats and turbans. A complimentary makeup kit is provided to each patient at the end of the session. The group also offers a way to build relationships and harness ongoing support. Hope Soars is a six-week survivorship program offered three times a year at Robinwood Professional Center. This group is intended for patients who have completed cancer treatment within the last year. The purpose of the group is to assist in transitioning from receiving treatment to post-treatment life. Topics covered include fear of reoccurrence, surveillance of new cancers, fatigue, pain, intimacy and much more. Transportation services The John Marsh Cancer Center provides complimentary transportation services to patients receiving active treatments, as long as they are located at a reasonable distance from the center. The service is intended to reduce the burden for patients trying to pursue treatment who do not have means to get there. Social workers at the center also partner with the American Cancer Society s Road to Recovery program to facilitate transportation of patients to distant appointments, as well as local appointments if family members are unable to help. Entertainers from the John R. Marsh Cancer Center survivors picnic. John R. Marsh Cancer Center Annual Cancer Registry Report 11

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13 Screening Programs The screening program is part of Meritus Health s John Marsh Cancer Center thanks to grant funding from the Avon Breast Cancer Crusade and Susan G. Komen Maryland. Collaborators include the Washington County Health Department Breast and Cervical Cancer Program, Breast Cancer Awareness Cumberland Valley and Meritus Healthcare Foundation. The goal of the program is to eliminate any barriers to breast cancer screening. It is open to anyone, regardless of income, age or residency. Make A Difference Program Services: Free breast health education Free clinical breast exam Free mammogram and/or ultrasound Free transportation within 30 miles Spanish translator available No residency requirements Clinics are held two to three times a month, with a certified nurse practitioner performing a clinical breast exam. Financial assistance is provided for patients who have an order from their doctor for a mammogram and/or ultrasound. A breast health navigator is available to assist patients through the process of screening, diagnosis and treatment. During the past year, staff members have participated in 83 various educational events, including individual and group activities. The program has provided education for approximately 2,300 people, individually and in small groups, on the importance of breast health and early detection. A total of 283 women and one man received breast health education and a clinical breast exam through a series of 36 breast cancer screening clinics or outside referrals. The program has now expanded to include a screening process and educational component for those women who may be at a higher risk for developing breast cancer. For the past three years, an annual Why Knot breast cancer awareness campaign has been conducted for employees at Meritus Health. Employees are challenged with the question why not get a breast cancer screening or encourage someone you know to get screened? Employees are given pink ribbons to tie in a knot around their finger or badge as a reminder. This past year, 380 employees took the program s online pledge. Guests at the annual John R. Marsh Cancer Center survivors picnic. John R. Marsh Cancer Center Annual Cancer Registry Report 13

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15 Volunteer Service Update - John Marsh Greeter Program The greeter program was established to create a fluid transition for oncology patients as the first contact for them when entering the cancer center. The volunteer greeters direct all radiation oncology patients to the office secretary or call medical oncology staff to inform them that their patient has arrived. The medical oncology nurse comes to the waiting area and escorts the patient back for treatment. The greeters are volunteers who were already serving at other locations within the hospital or new recruits hoping to contribute their time to the hospital community. The greeters provide coverage five days a week, Monday through Friday, from 8:00 a.m. to 3:30 p.m. They work two shifts per day; the first shift covering 8 a.m. until noon and the second shift from noon until 3:30 p.m. The program has been established for several months and has proven to be extremely beneficial not only to the oncology patients, but to the staff as well. Patient Assistance Programs Patient assistance programs support patients who are uninsured or under-insured in obtaining IV medications, oral chemotherapy medications and anti-emetics needed in conjunction with oral and/infused chemotherapy medications. Some programs also offer pharmacy related chemotherapy copay assistance and insurance premium reimbursement. Application on the patient s behalf is made to many different manufacturers and foundations to seek oral or IV chemotherapy and anti-emetics at minimal or no cost to the patient. John Marsh Cancer Center staff members work very closely with the Leukemia and Lymphoma Society, CancerCare, CancerCare copay, Chronic Disease Foundation, Healthwell Foundation, Patient Access Network and Patient Advocate Foundation, as well as other groups. Additionally, many manufacturers offer a replacement program for patients who cannot afford the cost of the IV medications and will ship the replacements directly to the cancer center. Organizations including the John Marsh Cancer Center patient emergency fund, Breast Cancer Awareness- Cumberland Valley Inc., Red Devil Fund and the Shirley B. Robison Fund have been instrumental in supporting the needs of our cancer patients, in treatment, through assistance with rent and mortgage payments, household expenses, transportation, utilities, lymphedema gloves and sleeves and basic personal needs. The patient assistance programs have helped thousands of cancer patients, in treatment, by giving them peace of mind so they do not have to worry about the cost of therapy and personal expenses, but rather focus their energy on getting well. Cheryl Roberson, member of the Meritus Medical Center Auxiliary, greets patients at the John R. Marsh Cancer Center. John R. Marsh Cancer Center Annual Cancer Registry Report 15

16 Jennifer Baclawski, registered dietician at John Marsh Cancer Center. Nutrition Services The John Marsh Cancer Center offers many options to learn more about nutritional health. Nutrition education is provided by a registered and licensed dietitian. Between July 2015 and August 2016, the dietitian advised over 300 patients. Services include education, assessment and counseling in: Cancer prevention Therapeutic diets Food safety Nutrition optimization prior to and during therapy Management of treatment side effects Management of specialized feeding regimens such as tube feedings and IV parenteral support Nutrition education for patients, families, caregivers and the general public Dietary guidelines for cancer survivorship All nutrition services are complimentary to patients and families. Patients are referred to nutrition counseling by physicians, nurses, cancer navigators or by request. For more information, please contact: John R. Marsh Cancer Center Annual Cancer Registry Report

17 Top 10 sites National Percentages for New Cancer Cases and Deaths Estimates Estimated New Cases* Estimated Deaths Male Female Male Women Prostate 220,800 (26%) Lung and bronchus 115,610 (14%) Colon and rectum 69,090 (8%) Urinary bladder 56,320 (7%) Melanoma of the skin 42,670 (5%) Non-Hodgkin s lymphoma 39,850 Kidney and renal pelvis 38,270 (5%) Oral cavity and pharynx 32,670 Leukemia 30,900 (4%) Liver and intrahepatic bile duct 25,510 (3%) All sites 848,200 Breast 231,840 (29%) Lung and bronchus 105,590 (13%) Colon and rectum 63,610 (8%) Uterine corpus 54,870 (7%) Thyroid 47,230 (6%) Non-Hodgkin s lymphoma 32,000 (4%) Melanoma of the skin 38,270 (5%) Pancreas 32,670 Leukemia 23,370 (4%) Kidney and renal pelvis 23,290 (3%) All sites 810,170 (100%) Lung and bronchus 86,380 (28%) Prostate 27,540 (14%) Colon and rectum 26,100 (8%) Pancreas 20,710 (7%) Liver and intrahepatic bile duct 17,030 (5%) Leukemia 14,210 (5%) Esophagus 12,600 (4%) Urinary, bladder 11,510 (4%) Non-Hodgkin s lymphoma 11,480 (4%) Kidney and renal pelvis 9,070 (3%) All sites 312,150 (100%) Lung and bronchus 71,660 (26%) Breast 40,290 (15%) Colon and rectum 23,600 (9%) Pancreas 19,850 (7%) Ovary 14,180 (5%) Leukemia 10,240 (4%) Uterine corpus 10,170 (4%) Non-Hodgkin s lymphoma 8,310 (3%) Liver and intrahepatic bile duct 7,520 (3%) Brain and other nervous system 6,380 (2%) All sites 277,280 *Excludes basal cell and squamous cell skin cancers and carcinoma in situ except urinary bladder. 2015, American Cancer Society, Inc., Surveillance Research John R. Marsh Cancer Center Annual Cancer Registry Report 17

18 Site By Sex Tabulation for 2015 Analytic Cases Site Name Total Male Female Number (%) Number (%) Number (%) Base Of Tongue 8 1% 5 63% 3 38% Other Parts Of Tongue 1 0% 1 100% 0 0% Floor Of Mouth 1 0% 0 0% 1 100% Palate 1 0% 1 100% 0 0% Parotid Gland 2 0% 1 50% 1 50% Tonsil 12 1% 11 92% 1 8% Other Oral Cavity 1 0% 1 100% 0 0% Esophagus 12 1% 8 67% 4 33% Stomach 9 1% 4 44% 5 56% Small Intestine 4 0% 1 25% 3 75% Colon 46 6% 25 54% 21 46% Rectosigmoid Junction 8 1% 5 63% 3 38% Rectum 20 2% 17 85% 3 15% Anus & Anal Canal 2 0% 0 0% 2 100% Liver & Bile Ducts 4 0% 3 75% 1 25% Gallbladder 1 0% 1 100% 0 0% Other Biliary Tract 2 0% 1 50% 1 50% Pancreas 21 3% 7 33% 14 67% Nasal Cavity & Middle Ear 2 0% 2 100% 0 0% Larynx 8 1% 6 75% 2 25% Bronchus & Lung % 52 44% 66 56% Heart Mediastinum Pleura 4 0% 1 25% 3 75% Bones Joints & Articular Cartilage 1 0% 1 100% 0 0% Bones Joints & Other Unspecified Sites 1 0% 0 0% 1 100% Blood & Bone Marrow 48 6% 28 58% 20 42% Skin 17 2% 11 65% 6 35% Retroperitoneum & Peritoneum 3 0% 0 0% 3 100% Connective Subcutaneous Other Soft Tissue 4 0% 3 75% 1 25% Breast % 0 0% % Vulva 6 1% 0 0% 6 100% Cervix Uteri 9 1% 0 0% 9 100% Corpus Uteri 42 5% 0 0% % Ovary 11 1% 0 0% % Other Female Genital Organ 2 0% 0 0% 2 100% Prostate Gland 68 8% % 0 0% Testis 6 1% 6 100% 0 0% Kidney 25 3% 17 68% 8 32% Kidney, Renal Pelvis 1 0% 0 0% 1 100% Urinary Bladder 24 3% 20 83% 4 17% Brain 6 1% 4 67% 2 33% Thyroid Gland 16 2% 4 25% 12 75% Lymph Nodes 35 4% 19 54% 16 46% Unk Primary 24 3% 13 54% 11 46% Overall Totals % % % Cases Excluded: John R. Marsh Cancer Center Annual Cancer Registry Report

19 Primary Site Tabulation for 2015 Analytic Cases Primary Site Total Class Sex AJCC Stage A M F 0 I II III IV Unk N/A All Sites Oral Cavity Lip Tongue Oropharynx Hypopharynx Other Digestive System Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other Respiratory System Nasal/Sinus Larynx Other Lung/Bronc-Small Cell Lung/Bronc-Non Small Cell Other Bronchus & Lung Blood and Bone Marrow Leukemia Multiple Myeloma Other Bone Connect/Soft Tissue Skin Melanoma Other Breast Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other Male Genital Prostate Testis Other Urinary System Bladder Kidney/Renal Other Brain & Cns Brain (Benign) Brain (Malignant) Other Endocrine Thyroid Other Lymphatic System Hodgkin s Disease Non-Hodgkin s Unknown Primary Other/Ill-Defined This report Excludes CA in-situ cervix cases, squamous and basal cell skin cases and intraepithelial neoplasia cases. John R. Marsh Cancer Center Annual Cancer Registry Report 19

20 Robinwood Professional Center, Suite 129 Hagerstown, MD