REPORT 9 American College of Surgeons Approved Program
Cancer Treatment Center Report 9 Welcome to the 9 edition of the St. Peter s Hospital Cancer Treatment Center Annual Report. This report describes in detail the incidence of cancer and oncology services offered by St. Peter s Hospital in the past year. This has been an exciting and rewarding year for St. Peter s Cancer Treatment Center. Because of the hard work and dedication of our experienced, physicians and staff, we are able to continue providing outstanding cancer treatment. St. Peter s is proud to be re-accredited by the Commission on Cancer of the American College of Surgeons for another three years; verification that we are meeting established national standards to ensure our cancer patients receive the best possible care. St. Peter s received the recognition following an on-site evaluation by a physician surveyor this past summer. The Center demonstrated compliance with all standards and received special commendation in five areas that represent the full scope of the cancer program. This year, St. Peter s is excited to launch a new Women s Health Institute which will include a Breast Center that is committed to provide the highest level of breast cancer treatment. A nurse navigator has been hired to work with each patient who is diagnosed with breast cancer to ensure the most efficient and appropriate individualized treatment by a multidisciplinary team. The Hospital is especially proud of and grateful for the Cancer Treatment Center s Board-certified physicians and compassionate, professional staff who rigorously fight cancer each day. St. Peter s is also appreciative of its many friends whose generous gifts have helped provide the newest technology available and other improvements in the Center. Please take a moment to review this year s successes and other information in this report. John Solheim, FACHE President and CEO CANCER TREATMENT CENTER REPORT 9 2
Cancer Committee The Cancer Committee of St. Peter s was established in 1995 and is composed of members from all hospital services involved in the care of cancer patients. The committee meets every two months to plan and assess all cancer-related activities at St. Peter s Hospital. The duties of the Cancer Committee are to provide leadership for the Cancer Program and evaluate the quality of cancer patient care and supervision of the Cancer Registry. The goals of St. Peter s Cancer Committee include: offering a comprehensive, integrated health care delivery system, improving the overall health status of the community, achieving and sustaining balanced financial performance of resources, promoting a culture of teamwork and excellence, being accountable to the communities we serve, continuing to improve the quality of care, and to deliver the most advanced treatment for our patients. 8-9 Cancer Committee Membership Robert Pfeffer, M.D. Radiation Oncology/Chairman Thomas C. Weiner, M.D. Medical Oncology Natalie Gonzales, D.O. Surgery/ Physician Liaison Ron Mow, M.D. Urology Don Schultz, M.D. Pathology Maria Braman, M.D. Pathology, NAPBC Mark Kreisberg, M.D. Hospitalist Maria Huntley, M.D. Ob/Gyn Jim Haley, M.D. VPMA Administration Amy Grassey, MBA Director, Clinical Operations Mary Thomas, RN, OCN Cancer Treatment Center Sherry Regensburger, RN, BC, CHPN Pain Management/Hospice Nicole Walden, JD Quality Specialist Janis Ahlstrom, BSW Social Services Julie Petre, PharmD Pharmacy Jennifer Colegrove, RD Nutrition Education Marjean Heisler, PT, MPH Director, Rehabilitation Terri Stevens, LPN Cancer Treatment Center Karrie Fairbrother, BSN, RN, DNC Education Jeanne Andre, CTR Cancer Registry Cancer Program Coodinator Peggy Stebbins, APR Director, Public Relations & Marketing St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 3
Cancer Registry Jeanne Andre, CTR, Cancer Program Coordinator TThe Cancer Registry is a data collecting system that is used to maintain and analyze clinical cancer information on all inpatients and outpatients diagnosed and/or treated for cancer at St. Peter s. The data is used for the purpose of research, education, and outcome measurements. St. Peter s Cancer Registry was established January 1, 1991 and is an essential component of an approved cancer program. There are currently over 5, cases entered into the registry. The registry is responsible, by law, for identifying and reporting all malignant and certain benign tumors to the Montana Central Tumor Registry. St. Peter s registry participates in submitting statistical data to the National Cancer Database (NCDB) and the Facility Information Profile System (FIPS) data-sharing project with the American Cancer Society (ACS). These NCDB studies include St. Peter s cancer database as a part of national statistics for incidence reporting and cancer research, which provides a comprehensive and comparative database of combined national data and St. Peter s registry data. In 8, a total of 332 cases were collected, with 313 (94%) analytic cases and 19 (6%) non-analytic cases. Analytic cases are the basis for the statistical reporting and analysis for the Registry. Quality assurance of registry data is accomplished by a random review of % of all abstracted data by physician members of the Cancer Committee. In 8 a total of 332 cases were collected, with 313 (94%) analytic cases and 19 (6%) non-analytic cases. The software program automatically performs quality edit checks on all abstracted cases. Lifetime patient follow-up of all cancer patients is a primary goal of the registry. This process not only provides reminders to the physicians and patients to schedule regular examinations for continued medical supervision, but also provides data for clinical outcomes. Annual follow-up ensures early detection and treatment of a recurrence of their cancer or early diagnosis of a subsequent cancer. The registry continues to maintain a 98% follow-up rate on all patients known to be alive. Tumor Conference Tumor Conferences are held on the first and third Wednesday of each month to provide a multidisciplinary forum for discussion of current cancer cases. Physician members discuss the diagnosis, clinical staging, treatment guidelines and options, and outcomes for each case to help determine the best possible treatment plans for the patient. Pathological and diagnostic imaging interpretations of each case are also presented. All physicians and professional employees involved in the care of cancer patients are invited to attend. St. Peter s Hospital, through an agreement with the University Washington School of Medicine, provides continuing education credits for physicians. Each conference is accredited for 1. hour CME credit. During 8, a total of 21 conferences were held with 55 cases presented, 98% of these cases were prospective, i.e. discussed at a time where diagnostic evaluation, treatment and follow-up care would be influenced. To schedule case presentations or for further information, please call Jeanne Andre at 444-2176. St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 4
Demographics Five most frequent sites St. Peter s National Cancer Hospital 8 Incidence 8 Breast...67...21% 194,28...13% Lung...44...14% 219,4...15% Prostate...31...% 192,28...13% Colorectal...26...8% 146,97...% Lymphoma-NH...16...5% 65,98...5% Total new cases at St. Peters Hospital...313 Estimated new cases nationally...1,479,35 ACoS and St. Peter s Hospital Cancer Registry data Observed Five year Survival 9% St. Peter s 8 National 7 6 5 Breast Prostate Colon Lung Age and sex at diagnosis 8 6 Number of cases Female 5 Male AGE -19-29 -39-49 5-59 6-69 7-79 8-89 9-99 Cancer Incidence at St. Peter s Top Four Sites 3 8 8 7 6 Cancer Incidence Sex Distribution 3 8 18 16 Number of cases 5 3 4 5 6 7 8 Breast n 53 73 71 6 71 67 Lung n 5 43 44 46 45 44 Colorectal n 29 33 25 23 34 26 Prostate n 24 27 32 43 31 Number of cases 1 1 8 6 3 4 5 6 7 8 Male n 128 1 129 124 137 117 Female n 163 159 179 156 174 196 St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 5
Cancer Incidence 8 St. Peter s National 313 1,479,35 % of total % of total St. Peter s National 313 1,479,35 % of total % of total St. Peter s and National Comparisons St. Peter s National 313 1,479,35 % of total % of total ORAL...................2.2%......2.4% Tongue.......................6.............7 Mouth......................................7 Pharynx......................9.............8 Other.........................6.............1 DIGESTIVE.............13%......18.6% Esophagus.................1.6............1.1 Stomach.....................9............1.4 Small Intestine.............6.............4 Colorectal..................8.3............9.8 Liver / Biliary...............9............2.1 Pancreas....................1.6............2.8 Other Digestive..........................3 RESPIRATORY.........14.7%......16% Larynx.......................6.............8 Lung and Bronchus......14............14.8 Other Respiratory.......................3 BONE...................%........2% CONNECTIVE TISSUE...3%.......7% SKIN - MELANOMA....1.9%......4.6% BREAST................21%......13.1% GENITAL...............17.2........19 Cervix Uteri.................6.............7 Corpus Uteri...............3.8............2.8 Ovary........................1.9............1.5 Other Female.............................3 Prostate..................................13 Testis.........................9.............6 Other Male...............................8 URINARY................2.9........8.8 Bladder.....................1.3............4.8 Kidney / Ureter...........1.6............3.9 EYE................................1 BRAIN..................12.8........1.5 ENDOCRINE.............1.9........2.6 Thyroid.....................1.9............2.5 Endocrine / Other.......................1 MULTIPLE MYELOMA.............1.6%......1.4% LEUKEMIA.............2.5%.......3% Lymphocytic..............1.9............1.4 Myeloid......................6.............8 Other Leukemia.........................4 LYMPHOMA / OTHER BLOOD..........9%........5% Hodgkin s...................9.............6 Non-Hodgkin s............5.............4.6 Other Blood...............2.8............. ALL OTHER............8.3%......2.1% TOTALS.............%....% Source: St. Peter s Hospital Cancer Registry data and CA: A Cancer Journal for Clinicians St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 6
8 Analytic Cancer Cases by Sex and Stage STAGE PRIMARY SITE Total M F I II III IV UNK ORAL Tongue 2 1 1 1 1 Mouth Pharynx 3 2 1 1 2 Other 2 2 1 1 DIGESTIVE Esophagus 5 5 1 4 Stomach 3 2 1 1 1 1 Colon 13 4 9 6 3 3 1 Rectum 13 7 6 1 3 3 3 2 1 Liver/Biliary 2 1 1 1 1 Pancreas 5 5 2 3 RESPIRATORY Larynx 2 2 1 1 Lung 44 16 28 7 3 6 26 2 Other Respiratory BONE CONNECTIVE TISSUE 1 1 1 SKIN Melanoma 6 3 3 3 2 1 BREAST 67 67 23 17 15 7 4 GENITAL Cervix Uteri 2 2 1 1 Corpus Uteri 12 12 1 5 2 2 1 1 Ovary 6 6 2 2 1 1 Other Female Prostate 31 31 1 21 4 4 1 Testis 3 3 2 1 STAGE PRIMARY SITE Total M F I II III IV UNK URINARY Bladder 4 2 2 2 1 1 Kidney / Ureter 5 4 1 4 1 EYE BRAIN / CNS 9 6 3 9 ENDOCRINE Thyroid 6 2 4 4 1 1 LEUKEMIA Myeloid 2 2 2 Lymphocytic 6 5 1 6 OTHER BLOOD / LYMPH TISSUES Hodgkin s 3 1 2 3 Non-Hodgkin s 16 1 15 4 2 3 4 3 Myeloma 5 2 3 5 Other Blood 9 6 3 9 ALL OTHER 26 8 18 4 2 9 7 4 TOTALS 313 118 195 28 6 61 48 76 Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: St. Peter s Hospital Cancer Registry data St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 7
Breast Center As part of St. Peter s new Women s Health Institute, this year a new Breast Center is being established to coordinate stateof-the-art breast cancer care diagnosis and support services. As nurse breast care navigator, I am the patient s advocate here to assist with access and coordination of emotional, financial, and medical resources. An integral part of the Breast Center as breast care navigator, I am available to all patients with questions about breast health. Those patients who have an abnormal mammogram that requires additional diagnostic imaging will be given the opportunity to consent for me to contact you directly. I will assist the patient in accessing services and overcoming any barriers to quality care. Located within the beautiful new women s area of the Diagnostic Imaging Department, the Breast Center includes two mammography imaging suites furnished with full-field digital technology as well as a consultation office. If further studies are needed, I offer emotional support and call upon a team of experts who can stand by the patient to assist her in every way. My goal is to provide women with the very best services available and, should they need it, the best possible plan for early and effective treatment. There is also a new Health Resource Center Kari Parmer, R.N. Breast Care Navigator staffed by American Cancer Society trained volunteers who assist breast cancer patients and their families and friends in accessing the latest breast care-related information, education and support, including information about clinical trials and new treatment options. The Breast Center is about life and it is the one place in Helena to learn about the risk for cancer. The mission of the oncologists, other doctors, and technicians is to deliver the highest quality of care in an exceptional, compassionate manner, because making women well is their mission. St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 8
Ovarian Cancer Most recent estimates for ovarian cancer show 21,55 new cases in the breast, or colorectal cancer Family history of ovarian cancer, United States for 9 with 14,6 A woman s cancer risk is higher if her mother, sister or daughter has been diagnosed with ovarian deaths. Approximately % of ovarian cancers are diagnosed at an early stage, both at St. Peter s cancer. The younger the family member at diagnosis, the higher the risk. The risk increases with and nationally. Sixty percent of St. Peter s patients were diagnosed at later Stage III and IV the number of relatives with the disease. The increased risk can come from the father s side of the compared to 74% nationally. Early diagnoses have shown to improve the chances for successful treatment and longer survival. Nationally family as well as the mother s side of the family. ovarian cancer is the ninth most common cancer in women and it ranks fifth as the cause of Most ovarian cancers happen after a woman Age death in women. Nation-wide over half the reaches menopause. Women who have had children and have breast fed their children have a women diagnosed with ovarian cancer is over the age of 6, in our service area 74% of the women lower risk for ovarian cancer. are age 6 or greater. Detecting early stage ovarian cancer can be Estrogen replacement therapy and difficult as there are no routine screening tests or hormone replacement therapy exams. Women with a high risk, such as those Some studies suggest women using estrogen with a strong family history of the disease, may after menopause increase their risk. The risk be screened with blood tests and ultrasound. seems higher in women taking estrogen alone One screening blood test, CA-125, is a protein in (without progesterone) for at least 5 to years. the blood that may be higher than normal in The risk is somewhat lower with women taking some women with ovarian cancer. An ultrasound both estrogen and progesterone. may also be useful in finding tumors and determining if a mass is a fluid-filled cyst or a solid Obesity mass. A biopsy of the mass is the only way to determine if there are cancerous cells present. of death from ovarian cancer if they are over- Women have a greater risk as well as higher rate Some of the risk factors for ovarian cancer weight. Studies show the risk went up 5% in the include: heaviest women. Diet A recent study of women who followed a low-fat diet for at least 4 years showed a lower risk of ovarian cancer. While the Pap test helps to detect cervical cancer early, it is not useful in finding ovarian cancer. Early cancer of the ovaries tend to cause somewhat vague symptoms such as swelling or bloating of the abdomen; pelvic pressure or stomach pain; trouble eating or feeling full quickly; and frequent and sudden urination. Patients should always see their physician if any of these symptoms are getting worse or last for more than a few weeks. Sources: St. Peter s Cancer Registry data; American Cancer Society; NCDB Commission on Cancer St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 9
Ovarian Cancer St. Peter s Hospital 3-8: First course treatment for Ovarian Cancer Patients Ovarian cancer: Stage at diagnosis Percent of cases TREATMENT COMBINATIONS % % % % 5% 6% 7% Surgery Chemotherapy Surgery/chemotherapy Surgery/radiation/chemotheraphy No treatment Percent of cases 5% St. Peter s Hospital STAGE I STAGE II STAGE III STAGE IV St. Peter s Hospital 3-8: Age at diagnosis for patients with Ovarian Cancer Ovarian cancer: Five-year survival Percent of cases 35% 25 15 5 Percent of survival rate 9 8 7 6 5 National St. Peter s Hospital AGE -29-39 -49 5-59 6-69 7-79 8-89 9-99 STAGE I STAGE II STAGE III STAGE IV St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9
Esophageal & Gastroesophageal Junction Cancer N ation-wide an estimated 37,6 new upper gastrointestinal (GI) cancers originating in the esophagus, the gastroesophageal (GE) junction, and stomach, are expected to be diagnosed in 9. Over 25,15 deaths are expected to occur due to this cancer. The most common site of esophageal cancer is in the lower third of the esophagus, where it often involves the GE junction or gastric cardia (upper portion of the stomach). There are two major histological types of esophageal cancer squamous cell carcinoma, and adenocarcinoma. Eighty-five percent of esophageal cancer at St. Peter s was diagnosed as adenocarcinoma and 85% originated in the distal third of the esophagus or gastric cardia. Between 3 and 8, seventy-three percent of all esophageal cancers at St. Peter s were diagnosed in males with twenty-seven percent females. National statistics also show men are three times more likely than women to be diagnosed with this cancer. The risk of esophageal cancer goes up with age. It is rarely found in patients under the age of 55. At St. Peter s, 6% of the patients were between 6 and 79 years of age. Major risk factors include longstanding heartburn or gastroesophageal reflux (GERD) and Barrett s esophagus. This occurs because of long-term acid reflux from the stomach into the lower esophagus. GERD is often associated with obesity and high body mass index. Tobacco and alcohol raise the risk of squamous cell carcinoma (SCC) in esophageal cancers. Studies have shown the risk of SCC decreases substantially after smoking cessation. Drinking alcohol also increases the risk, and combining smoking and alcohol raises the risk even more. Esophageal cancer cases at St. Peter s show 31% are current smokers, while 5% used tobacco previously. Eleven percent used alcohol at diagnosis, with 31% former alcohol users. Overall five year survival rate is around 16% for all stages of esophageal cancer. Sources: St. Peter s Cancer Registry data; American Cancer Society; CA: A Cancer Journal for Clinicians; January/February 9 St. Peter s Hospital 3-8: Age at diagnosis for patients with Esophageal Cancer % 25 Female Male 15 5 AGE -49 5-59 6-69 7-79 8-89 9-99 St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 11
Esophageal Cancer St. Peter s Hospital: First course treatment by stage Esophageal Cancer Esophageal cancer: Five-year survival TREATMENT COMBINATIONS I II III IV UNK Total Surgery 3.8% 3.8% 7.7% Radiation 3.8% 3.8% 7.7% Chemotherapy 11.5% 3.8% 15.3% Surgery/chemotherapy 3.8% 3.8% Surgery/radiation/chemotheraphy 3.8% 3.8% Radiation/chemotherapy 3.8% 15.3% 3.8% 7.7% 3.8% 34.4% Treated 3.8% 7.7% 11% 23% 11% 72.7% Not treated 15.3% 3.8% 7.7% 26.8% Percent of survival rate % 15 5 National St. Peter s Hospital St. Peter s Hospital: Observed survival rate with Esophageal Cancer % 9% 8% 7% Survival rate 6% 5% % % % % Stage I Stage II Stage III Stage IV Esophageal cancer: History of Tobacco and Alcohol use Former use: if patient has not used substance six months prior to diagnosis 7% Percent of cases 6 5 Tobacco Alcohol 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 Months from diagnosis PRESENT FORMER NEVER St. Peter s Hospital CANCER TREATMENT CENTER REPORT 9 12
DEFINITION OF TERMS AJCC American Joint Commission on Cancer organized for cancer staging and end results reporting. Analytic Case Diagnosed and/or received the first course of treatment at St. Peter s Hospital. Non-Analytic Diagnosed and received all of the first course of treatment elsewhere prior to admission to St. Peter s for subsequent treatment; or a case diagnosed at autopsy. Incidence Newly occurring cancer cases during a given period of time. Stage of Disease The extent of disease determined at the time of initial work-up for the first course of treatment. In Situ Neoplasm which fulfill all microscopic criteria for malignancy except invasion. Local Neoplasm which appears entirely confined to the organ of origin. Regional Neoplasm which has spread by direct extension to immediately adjacent organs, tissues and/or has metastasized to regional lymph nodes. Distant Neoplasm which has spread beyond adjacent organs or tissue by direct extension and/or has developed secondary metastatic tumors; has metastasized to distant lymph nodes or has been determined to be systemic in origin. TNM Stage The extent of disease determined clinically or pathologically using standards proposed by the American Joint Commission on Cancer (AJCC) Staging System. TUMOR: Primary tumor size/extent of disease. NODE: Regional lymph node involvement. METASTASIS: Absence or presence of distant metastasis. References: CA A Journal for Clinicians; January/February 8. Published by the American Cancer Society, Inc., Atlanta, GA. OncoLog, Registry Software. Berkeley Heights, N.J. NCDB, Commission on Cancer, ACoS. Benchmark Survival Report 2475 Broadway Helena, Montana 5961 www.stpetes.org Cancer Treatment Center Report: 9 Published January