Cancer Program Report 2014

Transcription

1 Cancer Program Report 2014 Queen of the Valley Hospital St Joseph Health

2 Queen of the Valley Hospital Site Table Site Total Class Sex Group Cases Analytic NonAn M F 0 I II ALL SITES LIP TONGUE SALIVARY GLANDS, MAJOR GUM FLOOR OF MOUTH TONSIL OROPHARYNX NASOPHARYNX HYPOPHARYNX ESOPHAGUS STOMACH SMALL INTESTINE COLON RECTUM & RECTOSIGMOID ANUS,ANAL CANAL,ANORECTUM LIVER GALLBLADDER BILE DUCTS PANCREAS RETROPERITONEUM PERITONEUM,OMENTUM,MESENT LARYNX LUNG/BRONCHUS-SMALL CELL LUNG/BRONCHUS-NON SM CELL HEMERETIC MYELOMA OTHER HEMATOPOIETIC BONE SOFT TISSUE MELANOMA OF SKIN OTHER SKIN CA BREAST CERVIX UTERI CORPUS UTERI UTERUS NOS OVARY VULVA OTHER FEMALE GENITAL PROSTATE TESTIS BLADDER KIDNEY AND RENAL PELVIS URETER BRAIN OTHER NERVOUS SYSTEM THYROID OTHER ENDOCRINE HODGKIN'S DISEASE NON-HODGKIN'S LYMPHOMA UNKNOWN OR ILL-DEFINED III IV Unknown

3 Queen of the Valley Medical Center 2014 Overview TOP 5 SITES Breast Lung Prostate Colorectal Lymphoma 11% 9% 38% 18% 24% Sex Distribution Female Male Male 49% Female 51% 0% 20% 40% 60% 80% 100% Class of Case Analytic 75% Non-Analytic 25% Analytic = Cases diagnosed and/or treated at Queen of the Valley Non-Analytic = Cases diagnosed and treated elsewhere but with active disease at Queen of the Valley Analytic Non-Analytic of Disease 27% 22% 22% 15% 8% 5% O I II III IV UNK

4 Standard 4.6: 2014 Assessment of Evaluation and Treatment Planning Breast Cancer IIA, IIB, and IIIA (T3,N1,M0) STUDY PURPOSE: To assess the diagnostic work-up and treatment for IIA-B and IIIA breast cancer patients diagnosed and treated at QVMC compared to the NCCN Preoperative Systemic Therapy Guideline. CoC Cancer Program Requirement: Standard 4.6: Assessment of Evaluation of Treatment Planning: Each year, a physician member of the cancer committee performs a study to assess whether patients within the program are evaluated and treated according to evidence-based national treatment guidelines. The study must determine that the diagnostic evaluation is adequate and the treatment plan is concordant with a recognized guideline. Physician Member of Cancer Committee to perform study: STUDY CRITERIA: Site Specific Sample: Breast Cancer 2012 Cancer Registry Cases, Class of Case (Diagnosed and Treated at QVMC). Total cases to be reviewed: = 24 cases IIA (T2,N0,M0)- 13 cases; IIB (T2,N1,M0, T3,N0,M0)- 6 cases; IIIA (T3,N1,M0)- 5 cases Analysis: Data reviewed for each case included looking at age, co-morbidities, diagnostic work-up, clinical TNM staging elements and first course of treatment documented in the Cancer Registry abstract. Additionally the EMR and Medical Oncology medical record was reviewed for additional information on treatment and genetic testing/counseling. Evidence-based national treatment guidelines to be utilized: NCCN (National Comprehensive Cancer Network) Guidelines Version : Breast Cancer NCCN workup for invasive cancer: History and physical exam (PE: at least breast and axillary lymph nodes findings are documented in EMR) CBC, platelets Liver function tests and alkaline phosphatase Diagnostic bilateral mammogram, ultrasound as necessary Pathology review following CAP guidelines (core biopsy of breast tumor, clinically + axillary LNs) Determination of tumor estrogen/progesterone receptor (ER/PR) status and HER2 status Genetic counseling if patient is high risk for hereditary breast cancer Breast MRI (optional) Consider fertility counseling if indicated Consider additional systemic studies only if directed by signs or symptoms: Chest diagnostic CT, Abdominal +/- pelvic diagnostic CT or MRI, Bone scan or sodium fluoride PET/CT, FDG PET/CT Additional data to collect: Age Co- morbidities Family History of Breast Cancer Second breast primaries First Course of Treatment: This study will focus on assessing whether preoperative chemotherapy was considered for these women with clinical stage IIA, stage IIB, and stage IIIA tumors who met the criteria for breast-conserving therapy except for tumor size and who wished to undergo breast-conserving therapy. Treatment analysis will look at: Fulfills criteria for breast conserving therapy Fulfills criteria for breast conserving therapy except for tumor size: o Was preoperative chemotherapy considered/given Lumpectomy with surgical axillary staging Total mastectomy with surgical axillary staging

5 ASSESSMENT SUMMARY/FINDINGS: Findings to be presented to Cancer Committee November 4, 2014 QVMC Breast Cancer: 2012 Cancer Registry Cases, Class of Case (Diagnosed and Treated at QVMC). Total cases reviewed: = 24 cases IIA (T2,N0,M0)- 13 cases; IIB (T2,N1,M0, T3,N0,M0)- 6 cases; IIIA (T3,N1,M0)- 5 cases DIAGNOSTIC WORKUP SUMMARY: NCCN (National Comprehensive Cancer Network) Guidelines Version : Breast Cancer Diagnostic Workup Number Percentage History & Physical Breast and Axillary LN's % + Family History of Breast Cancer 10 42% Second Breast Primary 4 17% Blood workup: CBC/Platelets/LFT/Alk Pos Not assessed Mammogram, Bilateral 19 79% Mammogram, Unilateral 4 17% Ultrasound % Breast MRI 20 83% Additional Studies PET 4 17% Pathology Ductal 22 92% Lobular 2 8% ER/PR/Her2neu performed % Diagnostic Approach US guided FNA 23 96% Excisional Bx 1 4% Genetic testing/counseling referral Eligible cases: o Family History of Breast Cancer (10 cases) o Early-age-onset ( 50 years) (5 cases) o Two breast primaries in a single person, > age 50 years (4 cases) o Triple Negative (ER-, PR-, Her2-) (1 case) (NCCN Practice Guidelines Criteria for High Risk for Further Risk Evaluation) Cases referred for genetic testing 8 47% QVMC Breast Cancer: 2012 Cancer Registry Cases, Class of Case (Diagnosed and Treated at QVMC). Total cases reviewed: = 24 cases IIA (T2,N0,M0)- 13 cases; IIB (T2,N1,M0, T3,N0,M0)- 6 cases; IIIA (T3,N1,M0)- 5 cases TREATMENT SUMMARY: 17 NCCN (National Comprehensive Cancer Network) Guidelines Version : Breast Cancer

6 First Course of Treatment - 24 total cases Number Percentage Surgical Treatment Breast Conserving Surgery (BCS) 17 71% Mastectomy 4 17% Unknown 2 8% Refused all treatment 1 4% Radiation Therapy for BCS (17 applicable cases) Radiation Therapy given 13 76% Radiation Therapy recommended, unknown if given. Not given at QVMC 2 12% Radiation Therapy recommended, patient refused 2 12% Cases having a mastectomy 4 Radiation Therapy for + Axillary LN (16 applicable cases) XRT given 11 69% Recommended but not given at QVMC 1 6% Recommended but pt refused 1 6% XRT not given or unknown if recommended or given 3 19% Cases with no positive LNs 5 Systemic Therapy (19 applicable cases) Systemic Therapy before Surgery 7 37% Systemic Therapy after Surgery 10 53% Chemo not given: refused 2 11% Chemo not given, both IIA: 1 case: HT given, Age 64, No mention of Oncotype study 2 1 case: HT given, Age 65, Oncotype = low risk score Systemic Therapy with Herceptin (9 applicable cases that were Her2neu +) Herceptin given 7 78% Herceptin recommended, pt refused 2 22% Hormone Therapy (18 applicable cases) HT given 16 89% Recommended but refused HT 1 6% Refused all treatment 1 6% ER/PR negative 4