2016 Cancer Program Annual Report. Based on 2016 Cancer Program Activities and 2015 Cancer Registry Data

Transcription

1 2016 Cancer Program Annual Report Based on 2016 Cancer Program Activities and 2015 Cancer Registry Data

2 Presence Mercy Medical Center - Cancer Committee Cancer Committee Chairman Medical Oncology Mohammed Hussain, M.D. Interim Chairman Cancer Conference Coordinator Pathology Samir Gupta, M.D. Cancer Liaison Physician Radiation Oncology Salitha Reddy, M.D. Cancer Registry Quality Coordinator Radiology Nancy Rifenburg, M.D. Clinical Research Coordinator Administrative Nurse Nancy Budzinski Community Outreach Coordinator Community Education Maria Aurora Diaz Nursing Julie Grumbles Psychosocial Services Coordinator Pastoral Care Rep/Administration Ed Hunter Cancer Registry MaryJo Koehler Becky Iglesias American Cancer Society Representative Ashley Lach Pharmacy David Koeperick Social Worker Cindy Laurent Quality Improvement Coordinator Quality Review Specialist Leslie Liskey Clinical Dietitian Amanda Ruddy Sarah Kestner

3 PRESENCE MERCY MEDICAL CENTER 2015 Primary Site Table Primary Site Total M F Analytic NA Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Cases Tongue Salivary Glands Gum & Other Mouth Tonsil Hypopharynx/Oral Cavity & Pharynx Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Peritoneum, Omentum & Mesentery Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus Soft Tissue (including Heart) Melanoma/Other Skin Cancer Breast Cervix Uteri

4 Corpus & Uterus, NOS Ovary Vagina Vulva Prostate Testis Penis Urinary Bladder Kidney & Renal Pelvis Ureter Brain/Other Nervous System Thyroid/Other Endocrine Hodgkin Lymphoma Non-Hodgkin Lymphoma Myeloma Leukemia Mesothelioma Miscellaneous Total

5 Clinical Research In 2015 the Research Dept. at Presence Cancer Care, a department of Presence Mercy Medical Center, had successfully consented 90 subjects with 85% enrolling and randomized to a clinical trial. We have successfully opened Phase I trials typically performed at academic universities as well as numerous Phase II and Phase III trials. Our high point was the opening of Genentech s Phase III trial utilizing an Anti PD L1 antibody for patients with stage IV lung cancer. This type of treatment known as immunotherapy is working successfully on solid tumors. One of our patients after receiving this therapy was categorized as a complete response; basically her cancer that had spread to different areas had disappeared. She is currently doing very well. This type of treatment is just one of the 26 trials currently available for our patients, our physicians training and dedication allows us to be on the front line of the most current treatments available. The success of Presence Cancer Center has also been awarded with the 2016 Conquer Cancer Foundation of ASCO Clinical Trials Participation Award. This award given out annually to only three community cancer centers within the United States has recognized us for our hard work and dedication to our patients and community. Our participation with the NCI National Clinical Trial Network an affiliate of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University since December 2010 has been outstanding. The accrual rate has been impressive as an affiliate site and has exceeded the expectations consistently with enrollment.

6 Presence Mercy Medical Center Reporting of Outcomes Kidney Cancer Study - Monitoring Compliance with Evidence-Based Guidelines Standard 4.6 Monitoring Compliance with Evidence-Based Guidelines Each calendar year, a physician member of the cancer committee performs an in-depth study to assess whether patients within the program are evaluated and treated according to evidence-based national treatment guidelines. Study results are presented to the cancer committee and documented in cancer committee minutes. The role of this standard is to ensure that evaluation and treatment conforms to evidence-based national treatment guidelines using AJCC or other appropriate staging, including appropriate prognostic indicators. The study must determine that the diagnostic evaluation is adequate and the treatment plan is concordant with a recognized guideline. Any problems identified with the diagnostic evaluation or treatment planning process could serve as a source for a performance improvement (standard 4.8). Presented and extensively discussed at Cancer Committee June 22, Source for this study: This review includes all 2014 and the completed 2015 analytic kidney cancer cases (ICD-0: C64.9 kidney cases only) from Presence Mercy Medical Center s Cancer Registry. This study was conducted because it was noted at Tumor Board that Presence Mercy Medical Center is observing a large increase in the number of urology (including kidney cancer) cases that are presenting for treatment. NCCN (National Comprehensive Cancer Network) complete initial workup includes: H&P CBC, comprehensive metabolic panel Urinalysis Abdominal/pelvic CT or abdominal MRI with or without contrast depending on renal insufficiency Chest Imaging Bone scan (if clinically indicated) Brain MRI (if clinically indicated) If urothelial carcinoma is suspected, urine cytology, ureteroscopy can be considered Consider needle biopsy if clinically indicated (to help guide surveillance, cryosurgery, and radiofrequency ablation strategies)

7 : nephrectomy (preferred) or radical nephrectomy. Active surveillance in selected patients. Ablative techniques in nonsurgical candidates. (pt1b) - nephrectomy or radical nephrectomy I and II nephrectomy V - Potentially surgically resectable primary with solitary metastatic site and surgical metastasectomy Potentially surgically resectable primary with multiple metastatic sites Cytoreductive nephrectomy in select patients prior to systemic therapy. Surgically unresectable 2014 AND COMPLETED 2015 CASES Case # Complete Initial Work Up (see above) Histology Derived Stage of Disease at Diagnosis Appropriate to Stage Additional Information Case #1 (pt1b) Case #2 II (pt3a) * recommended * See Below Case #3 8316/3 Cyst-assoc. renal cell carcinoma I (pt2a) * recommended * See Below

8 Case # Case #4 Complete Initial Work Up (see above) Histology 8312/3 Renal Cell Derived Stage of Disease at Diagnosis C (ct1a) Core bx. Radiofrequency Ablation Appropriate to Stage Additional Information Age at dx 80+ Non-surgical candidate Case #5 Case #6 Case #7 Case #8 Case #9 8317/3 Chromophobe cell renal carcinoma 8255/3 Adenocarcinoma with mixed subtypes 8260/3 Papillary Renal Cell (pt1) (pt1b) V (pt3a) I (pt2a) Rad. Left parietal craniotomy Rt. Shoulder and bronchus Total Multiple metastatic sites

9 Case # Case #10 Complete Initial Work Up (see above) Histology Derived Stage of Disease at Diagnosis V (pt2b) RT to T9-T12 Sutent (chemo) Appropriate to Stage Additional Information Mets to one site - unresectable Case #11 Case #12 Case # /3 Renal Cell Sarcomatoid 8312/3 Renal Cell V (pt3a) Needle bx of kidney and liver mass Mets to multiple sites. Patient died prior to further treatment. Case # /3 Papillary Renal Cell Case # /3 Papillary Renal Cell

10 Case # Case #16 Complete Initial Work Up (see above) Histology 8260/3 Papillary Renal Cell Derived Stage of Disease at Diagnosis Appropriate to Stage Additional Information Case #17 II * See Below Case # /3 Chromophobe Cell Renal Cell (pt1b) Case # /3 Renal Cell Unk N/A N/A Dx. at age 80+. Another Malignancy dx 2 weeks after kidney dx. for 2 nd primary cancer discussed & patient elected hospice only. Case #20 (pt1b)

11 Case # Case #21 Complete Initial Work Up (see above) Histology 8130/3 Derived Stage of Disease at Diagnosis I (pt2b) Appropriate to Stage Additional Information Case #22 V CT guided liver bx Sutent (chemo) Case #23 Case # /3 Papillary Renal Cell Case #25 Case # /3 Renal Cell V (ct1a) Rib lesion needle bx. Sutent and palliative RT spine and rib Renal Mass Core bx. Radiofrequency Ablation Multiple metastatic sites Patient is 80+ y/o.

12 Case # Case #27 Case #28 Case #29 Case #30 Complete Initial Work Up (see above) Histology 8317/3 Chromophobe cell renal carcinoma 8255/3 Adenocarcinoma with mixed subtypes 8317/3 Chromophobe cell renal carcinoma Derived Stage of Disease at Diagnosis II (pt3a) Appropriate to Stage Additional Information Case #31 Case #32 Case # /3 Papillary Renal Cell (clinical only) Needle core bx. & Radio- Frequency Ablation Patient is 80+ y/o at diagnosis.

13 Case # Case #34 Case #35 Complete Initial Work Up (see above) Histology Derived Stage of Disease at Diagnosis II (pt3b) Appropriate to Stage Additional Information Patient died one week after surgery no further treatment * Case #2 - Per 10/7/14 operative report: The need for total nephrectomy was discussed, given the size and location of the tumor. However, given history of hypertension and diabetes, we thought it would be best to try to perform a partial nephrectomy. * Case #3 Tumor size 80 mm. No documentation that indicating why a partial nephrectomy was done instead of a radical nephrectomy. * Case #17 - Because of concern for atrophy and compromise of the left kidney due to hydronephrosis, it was elected to perform partial nephrectomy. It was also noted that clinically the mass appeared close to the hilum. Sutent = Sunitinib Discussion: Extensive discussion took place. Incidence is increasing possibly because of imaging. Patients undergo a CT scan for other reasons and an incidental kidney mass is found. Symptoms were reviewed and staging was discussed. We had a total of 35 patients with 22 stage I, 3 stage II, 2 stage III, 5 stage IV, and 1 unknown. It was noted that renal cell carcinoma is the most common type of kidney cancer. The literature states that 80% of renal cell carcinomas are clear cell carcinoma. We did meet the NCCN guideline criteria for complete initial workup. In this study, 17 (49%) cases were found to be clear cell carcinoma. recommendations are determined by patient s stage of disease at diagnosis. We did meet all of the guidelines. 17 patients underwent partial nephrectomy with 2 of those patients being stage II and stage III. These 2 patients were treated with partial nephrectomy because of limited kidney function. Thirteen patients had radical nephrectomy. 2 patients with ablative surgery, 1 patient was hospice (patient soon after diagnosis of renal cell carcinoma was found to have another malignancy), 2 patients underwent targeted therapy. Three cases were discussed because partial nephrectomy was performed instead of the suggested radical nephrectomy. All three cases

14 were found to have contraindications to radical nephrectomy. It was noted that there are many new targeted therapies with Sunitnib/Sutent being the most commonly used at this facility. Our pathologist pointed out that the number of urology cases has increased recently and the numbers of reportable urology cases are expected to continue to increase during He also noted that having the robot is another significant factor for this increase in urology cases being seen here. Ablation was discussed along with the factors needed to determine reportability. No single follow-up/treatment plan is appropriate for all patients and should be individualized based on patient requirements. Clinical evaluation was performed on 100% of these cases.

15 TUMOR BOARD CONFERENCES The goal of the Tumor Board Conference is to provide current information to the medical staff and to provide consulting services to the clinicians about specific cancer cases presented at the conference. Tumor Board uses a case presentation format that facilitates a multidisciplinary approach for treatment. Discussion includes patient management options, reference to national treatment guidelines, prognostic indications and the availability for clinical trials. The ultimate treatment decision rests with the patient s physician who can review the various opinions with his/her patient and determine the most appropriate management for the patient. During 2015, physicians presented 118 cases at Tumor Board Conferences. This total represents approximately 15% of our analytic caseload. Primary sites or histologies presented in 2015 include: Breast, Lung, Colon/Rectum, Prostate, Lymphoma, Bladder, and Kidney. Tumor Board Conferences are held the 1 st Tuesday of every month. A teleconference Tumor Board is held in conjunction with PSJMC and takes place the 2 nd Wednesday of every month. Tumor Board Conference activity is monitored and evaluated by our designated coordinator Sam Gupta, M.D. The Tumor Board Conference Coordinator regularly reports all conference activity to the cancer committee. Case selection is coordinated by presenting physicians, Sam Gupta, M.D. and the Cancer Registry staff. Any physician wanting to present a case may contact the Cancer Registry at We encourage all physicians, students, and allied health professionals to attend these conferences. Continuing Medical Education credits will be offered for attendance.

16 Number of Cases Diagnosed Case Distribution by Year and Primary Site (Analytic Only) Breast Prostate Bronchus/ Lung Primary Site Colon Bladder Kidney/ Renal Pelvis

17 Percentage of Total 2015 Cases 2015 Comparison Site Table United States, Illinois, Presence Mercy Medical Center United States Illinois 0 Female Breast Colon/ Rectum Bronchus/ Lung Non-Hodgkin Lymphoma Primary Site Prostate Urinary Bladder Presence Mercy Medical Center When comparing the data from Presence Mercy Medical Center to data from Illinois and the United States, some differences were noted. Presence Mercy Medical Center was noted to have a lower percentage of prostate cancer. This lower number of cases could reflect the increasing diagnosis and treatment of these malignancies at local outpatient facilities and physician offices. Presence Mercy Medical Center is affiliated with Presence Regional Cancer Center in Joliet. This merger has significantly increased the number of reportable malignancies at our facility. The high number of breast and lung cancer cases is directly related to this merger. Many patients receive first course treatment at Presence Regional Cancer Center. The first year of our merged cancer registry is We continue to see a wide fluctuation in reportable cases (both numbers and sites). Additional data continues to be needed to determine the long-term impact on the registry statistics. We are continually monitoring these changes and look forward to having better comparative data in the upcoming years. Sources: United States and Illinois Data: American Cancer Society: Cancer Facts and Figures 2015 Presence Mercy Medical Center: Cancer Registry Analytic Data 2015

18 Glossary of terms Analytic Case: A case initially diagnosed and/or receiving all or part of the initial course of treatment at Presence Mercy Medical Center. Non-analytic Case: A case initially diagnosed and treated elsewhere, seen at Presence Mercy Medical Center for subsequent treatment. TNM Staging American Joint Commission on Cancer Staging System based on the assessment of three components: T The extent of primary tumor N The extent of regional lymph node metastasis M The absence or presence of distant metastasis CS- Collaborative Staging ACC American Joint Committee on Cancer NCDB- National Cancer Data Base

19 Links to websites American Cancer Society- American College of Surgeons Commission on Cancer- American Society of Clinical Oncology- American College of Radiology- College of American Pathologists- National Cancer Institute- National Cancer Institute/Clinical Trials- National Comprehensive Cancer Network-

20 Report compiled by MaryJo Koehler and Becky Iglesias North Highland Avenue Aurora, Illinois Presencehealth.org/presence-mercy-medical-center-aurora