PROOF 12/12/13 Summa Cancer Institute 212 Annual Report Specialists Technology Clinical Trials Research
A message from the Medical Director Summa Cancer Institute is a comprehensive center at the forefront of cancer care. We fight complex, advanced stages of cancer every day with advanced, targeted treatment options based on the latest clinical guidelines. The foundation of Summa Cancer Institute is our talented specialists. They provide care in a multidisciplinary setting. Many of our physicians were born in Northeast Ohio and returned here after their training, becoming part of the community. They provide a level of personalized care that goes beyond clinical excellence. Our care includes: Radiation oncology specialists who deliver treatment with pinpoint accuracy that spares healthy tissue and organs Hematologists and medical oncologists who provide chemotherapy, immunotherapy, hormonal therapy, as well as other treatments Surgical oncology, including minimally invasive surgical techniques Specialized patient support programs and services focused on nutrition, mental health, pain and symptom management, home care, alternative medicines and support groups We also are a national leader in research and clinical trials with more than 1 clinical trials available at any one time. Our cancer specialists serve on committees for the National Cancer Institute, allowing Summa to offer groundbreaking treatments, even before they become the standard of care. Summa has earned prestigious national accreditation and recognition from numerous national organizations, including American College of Surgeons Commission on Cancer (CoC), National Accreditation Program for Breast Centers (NAPBC), the American Society of Clinical Oncology (ASCO) and the American College of Radiology (ACR), among others. Our oncology services are available at locations throughout Summit, Medina and Portage counties. No matter where they choose to access care within Summa Health System, our patients will be immediately directed to a cancer specialist at the Jean and Milton Cooper Cancer Center on the campus of Summa Akron City Hospital, Parkview Center at Summa Barberton Hospital, Summa Health Center at Lake Medina, or our offices at Summa Western Reserve Hospital and Robinson Memorial Hospital, an affiliate of Summa Health System. We also offer inpatient consults at Summa Wadsworth-Rittman Hospital. When our specialists and services are combined, Summa Cancer Institute offers patients a level of compassionate care that is more personalized and less institutional. Our goal is to cure the cancer, whenever possible, while improving our patients quality of life. R. Douglas Trochelman, M.D., F.A.C.P. System Medical Director, Summa Cancer Institute Summa Health System
Cancer Registry Summary 212 The cancer registry is an essential component of a Commission on Cancer-accredited cancer program. Summa Cancer Institute achieves its goals by collecting and reporting quality cancer data in support of its business planning and outreach initiatives. Data collected by the cancer registry is an invaluable tool in the fight against cancer. As accredited CoC facilities, our registries collect demographic and disease-specific data elements on each cancer patient presenting for diagnosis or treatment. The information collected is utilized by physicians, administration and other healthcare professionals. Among the many uses are: Measuring quality outcomes Tracking community outreach initiatives Supporting clinical, diagnostic and treatment research Evaluating the effectiveness of current treatment modalities Presenting data for individualized patient treatment planning Submitting to local and national databases for incidence and outcome comparison Summa Cancer Institute CONTENTS Cancer Registry Summary 212 1 Statistics 2 Summa Akron City and St. Thomas Hospitals 2 Summa Barberton Hospital 4 Robinson Memorial Hospital, an affiliate of Summa Health System 6 Outcomes Measures 8 Reducing health disparities for uninsured and underinsured women through mammography, breast health education 8 Improving lymphedema outcomes 1 Research 12 Summa leads way on CPS-3 enrollment 12 summahealth.org/cancer Technology 13 Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) 13
Summa Akron City and St. Thomas Hospitals 212 Primary Cancer Sites Summa Akron City and St. Thomas Hospitals Primary Site Total Sex Class of Case M F Analytic Non-Analytic Breast 277 4 273 271 6 Lung/Bronchus 196 97 99 192 4 Colon 95 5 45 9 5 Corpus Uteri 9 9 88 2 Prostate 62 62 59 3 Non-Hodgkin's Lymphoma 59 31 28 58 1 Bladder 52 36 16 51 1 Kidney/Renal 43 27 16 41 2 Unknown Primary 39 13 26 39 Leukemia 38 2 18 37 1 Ovary 36 36 34 2 Rectum 34 21 13 34 Thyroid 29 6 23 29 Melanoma 27 13 14 24 3 Other Digestive Sites 26 7 19 26 Pancreas 22 12 1 22 Cervix Uteri 19 19 18 1 Multiple Myeloma 17 8 9 16 1 Esophagus 16 14 2 16 Brain (Malignant) 16 5 11 15 1 Other Oral Sites 14 8 6 14 Anus/Anal Canal 12 2 1 12 Vulva 12 12 12 Testis 1 1 9 1 Stomach 9 3 6 9 Larynx 9 6 3 9 Tongue 8 6 2 7 1 Liver 8 5 3 8 Connective Soft Tissue 8 6 2 6 2 Hodgkin's Disease 8 4 4 8 Other Throat Sites 7 6 1 7 Other Urogenital Sites 7 5 2 7 Other Blood/Bone Marrow 5 4 1 5 Bone 5 1 4 4 1 Lip 4 3 1 4 Other Male Genital Sites 4 4 4 Other Brain 4 2 2 4 Other Female Genital Sites 3 3 3 Other Ill Defined Sites 2 1 1 2 Oropharynx 1 1 1 Hypopharynx 1 1 1 Nasausinus 1 1 1 Other Endocrine Sites 1 1 1 Total 1,336 55 831 1,298 38 2 212 ANNUAL REPORT
Summa Akron City and St. Thomas Hospitals 212 Breast Lung and Bronchus Colorectal Corpus Uteri Prostate 62 9 129 196 277 5 1 15 2 25 3 NUMBER OF CASES Top Five Cancer Sites Summa Akron City and St. Thomas Hospitals cancer registry accessioned 1,336 new cancer cases for 212. This graph illustrates the most frequent primary sites seen at this facility. They account for more than 55% of all new cancer cases in 212. NUMBER OF CASES 3 25 2 15 1 5 Breast Lung and Bronchus Colorectal Corpus Uteri Female Prostate Male Female/Male Top Sites The top five sites for all patients are breast, lung, colorectal, uterine and prostate. The gender distribution for these top sites is represented in the graph. Other: 4% Wayne: 3% Stark: 5% Medina: 8% Portage: 1% Summit: 7% County of Residence The majority (7%) of the patients presenting to Summa Akron City and St. Thomas Hospitals reside in Summit County. This is represented by the accompanying chart. 3 212 ANNUAL REPORT
Summa Barberton Hospital 212 Primary Cancer Sites Summa BARBERTON HOSPITAL Primary Site Total Sex Class of Case M F Analytic Non-Analytic Lung 14 54 5 12 2 Breast 97 97 94 3 Colon 32 13 19 31 1 Pancreas 22 8 14 22 Non-Hodgkin's Lymphoma 19 15 4 19 Rectum 13 9 4 13 Prostate 13 13 1 3 Leukemia 12 9 3 1 2 Esophagus 9 6 3 9 Corpus Uteri 9 9 8 1 Liver 8 6 2 8 Bladder 8 7 1 8 Stomach 8 3 5 8 Melanoma 7 3 4 6 1 Unknown Primary 7 2 5 7 Tongue 6 4 2 6 Larynx 6 3 3 6 Multiple Myeloma 6 6 6 Ovary 6 6 6 Other Digestive 4 4 4 Other Blood & Bone Marrow 4 2 2 4 Brain (Malignant) 4 4 4 Other Brain & CNS 4 2 2 4 Thyroid 4 4 3 1 Cervix Uteri 3 3 3 Other Oral Cavity 2 2 2 Anus/Anal Canal 2 1 1 2 Other Respiratory 2 2 2 Connective/Soft Tissue 2 2 2 Vulva 2 2 2 Kidney 2 1 1 1 1 Hypopharynx 1 1 1 Other Female Genital 1 1 1 Testis 1 1 1 Other Urinary 1 1 1 Other Endocrine 1 1 1 Hodgkin's Disease 1 1 1 Other Ill-Defined 1 1 1 Total 434 171 263 419 15 4 212 ANNUAL REPORT
Summa Barberton Hospital 212 Lung and Bronchus 14 Breast Colorectal Pancreas Non-Hodgin s Lymphoma 19 22 45 2 4 6 8 1 12 NUMBER OF CASES 97 Top Five Cancer Sites Summa Barberton Hospital s cancer registry accessioned 434 new cancer cases for 212. This graph illustrates the most frequent primary sites seen at this facility. They account for more than 65% of new cancer cases in 212. 12 Female Male NUMBER OF CASES 1 8 6 4 2 Lung and Bronchus Breast Colorectal Pancreas Non-Hodgkin s Lymphoma Female/Male Top Sites The top 5 sites for all patients are lung, breast, colon, pancreas and non-hodgkin s lymphoma. The gender distribution for these top sites is represented in this graph. Other: 2% Stark: 8% Wayne: 1% Summit: 67% County of Residence The majority (67%) of the patients presenting to Summa Barberton Hospital reside in Summit County. This is represented by the accompanying chart. Medina: 13% 5 212 ANNUAL REPORT
Robinson Memorial Hospital An affiliate of Summa Health System 212 Primary Cancer Sites ROBINSON MEMORIAL HOSPITAL Primary Site Total Sex Class of Case M F Analytic Non-Analytic Breast 7 2 68 7 Lung/Bronchus 57 34 23 56 1 Prostate 32 32 32 Colon 29 14 15 29 Bladder 27 2 7 27 Rectum 1 6 4 1 Non-Hodgkin's Lymphoma 1 5 5 1 Corpus Uteri 1 1 1 Unknown Primary 8 5 3 8 Ovary 7 7 7 Pancreas 6 4 2 6 Leukemia 6 4 2 6 Esophagus 5 5 5 Liver 5 4 1 5 Testis 4 4 4 Digestive System - Other 4 3 1 4 Skin - Other 4 3 1 4 Melanoma 4 1 3 4 Cervix Uteri 4 4 3 1 Larynx 3 3 3 Multiple Myeloma 3 1 2 3 Thyroid 3 3 3 Vulva 3 3 3 Oral Cavity - Other 2 1 1 2 Tongue 2 1 1 2 Brain (Malignant) 2 1 1 2 Kidney/Renal 1 1 1 Connect/Soft Tissue 1 1 1 Nasal/Sinus 1 1 1 Blood & Bone Marrow - Other 1 1 1 Anus/Anal Canal 1 1 1 Female Genital - Other 1 1 1 Bone Brain (Benign) Hodgkin's Disease Hypopharynx Lip Oropharynx Stomach Other/Ill-Defined Total 326 157 169 32 6 6 212 ANNUAL REPORT
Robinson Memorial Hospital An affiliate of Summa Health System 212 Breast Lung and Bronchus Colorectal Prostate Bladder 27 32 39 1 2 3 4 5 6 7 8 NUMBER OF CASES 57 7 Top Five Cancer Sites Robinson Memorial Hospital s cancer registry accessioned 326 new cancer cases for 212. This graph illustrates the most frequent primary sites seen at this facility. They account for almost 7% of new cancer cases in 212. NUMBER OF CASES 7 6 5 4 3 2 1 Breast Lung and Bronchus Colorectal Female Male Prostate Bladder Female/Male Top Sites The top five sites for all patients are breast, lung, prostate, colorectal and bladder. The gender distribution for these top sites is represented in this graph. County of Residence Other: 2% Summit: 2% Trumbull: 3% Portage: 93% The majority (93%) of the patients presenting to Robinson Memorial Hospital reside in Portage County. This is represented by the accompanying chart. 7 212 ANNUAL REPORT
Outcomes Breast Cancer Screening COMMUNITY OUTREACH PROGAMS Reducing health disparities for uninsured and underinsured women through mammography, breast health education Summa Screens provides free screening and diagnostic mammograms, breast ultrasounds, and breast health navigation services throughout the continuum of care to ensure appropriate follow-up to lowincome women who are uninsured or underinsured. Awareness and education empowers people to make informed choices about their health. According to the Susan G. Komen Northeast Ohio County Characteristics (29), 5,7 age-appropriate women in Summit County are in need of mammography services. More than 15 percent of those women are uninsured, resulting in more than 7,6 women without access to recommended breast health services. 1 For many uninsured women, the thought of scheduling a mammogram can bring about a lot of heavy emotions. Many women wonder how they ll pay for the testing and may even decide to not make an appointment because of their inability to pay. Summa Screens helps by taking those worries away. This is the heart of what the Summa Health System program is all about. The program provided 732 breast imaging services in 212. Of those services, 64 were to unique patients. In 212, we provided 317 screening mammograms, 225 diagnostic mammograms and 19 diagnostic breast ultrasounds. In 212, Summa Screens diagnosed 11 cases of breast cancer. Often, women say, I wouldn t have received my mammogram without Summa Screens. Our mission is to take away barriers for women who are in need of a mammogram. Through a generous grant from Susan G. Komen for the Cure, the American Cancer Society, the Women s Board of Summa Health System, Summa Foundation and private donors, Summa Screens is equipped to offer free mammography services to lowincome, uninsured and underinsured women in our community. Patient Comments Everyone was very helpful. When the mammogram came back with results that were scary for me, they were reassuring and helped me schedule a follow-up bilateral ultrasound. I can t thank Summa Screens enough for the emotional and financial support. I would like to express my gratitude for being able to participate in Summa Screens. My routine mammogram indicated that I needed to have a diagnostic mammogram and ultrasound of my left breast. I have no insurance coverage, and I m a 15-year cancer survivor. The diagnostic mammogram provided by Summa Screens ruled out breast cancer. I can t tell you what peace of mind this gave me. I lost my job and insurance but knew that I needed my 6-month follow-up. I had an irregular mammogram prior. I called the office crying and upset, and the lady on the phone told me about Summa Screens and there would be no cost to me. I can t tell you how that made me feel. Even though I felt sad and worried, she provided immediate comfort. And I am thankful to say that everything turned out OK. Thank you. 1 Schmidt M, Brown B, Eve-Cahoon H, Thompson C, McCarroll M, Scott ED. Reducing Health Disparities for Uninsured and Underinsured Women through Mammography and Breast Health Education. Summa Akron City Hospital, Akron, OH. 8 212 ANNUAL REPORT
NUMB Screening Mammograms Mammograms Ultrasounds Screening Mammograms: 317 43% Mammograms: 225 31% Male Ultrasounds: 19 26% Who Benefits from Summa Screens? 7 Ethnicity 6 5 5 4 NUMBER OF PATIENTS* NUMBER OF PATIENTS* 2 1 8 3 4 2 3 1 2 1 Female Female Screening Mammograms Mammograms Male Ultrasounds Mammograms Total Imaging Services: 732 1% Screening Total Unique Patients Served: 64 Mammograms Ultrasounds Caucasian asia African- American Asian Native American Hispanic ic Other, not specified Refused Gender NUMBER OF NUMBER PATIENTS* OF NUMBER PATIENTS* OF PATIENTS* NUMBER OF PATIENTS* 5 4 3 8 7 2 6 4 5 1 35 4 3 3 25 2 2 1 15 1 5 4 35 3 25 2 15 1 5 Caucasian asia Age Range Female Screening Mammograms Mammograms Male Under 4 4-49 4 5-64 65+ Ultrasounds Number of Cancers Diagnosed Stage Cases 1 African- Screening Mammograms Asian Native Mammograms Hispanic ic Other, Ultrasounds 1 Refused American American not specified Screening Under 4 4-49 4Mammograms5-64 Mammograms 65+ Ultrasounds Mammograms Screening Mammograms Ultrasounds 1A 2 1B 2 1 2A 4 2B 2 3 3A 3B 3C 4 1 Total 11 *Graphs based on 732 patient visits 9 212 ANNUAL REPORT
Outcomes Lymphedema EVIDENCE-BASED INTERVENTIONS Improving lymphedema outcomes Problem Summa Barberton Hospital patients who underwent axillary dissection (AD), axillary radiation (AX) or both procedures were not consistently and proactively referred for a lymphedema prevention consultation. Hypothesis The first line of defense against lymphedema is prevention. The risk factors of lymphedema can be minimized by preventing infection and avoiding behaviors/procedures that restrict lymph flow. Prior to or immediately following axillary surgery and/or axillary radiation, it is essential to decrease the risk of infection, prevent injury and avoid increased pressure to the involved arm/breast tissue. By proactively referring patients who have had AX, AD or both prior to surgery/radiation, or immediately following surgery/radiation (within two weeks) for lymphedema consult, lymphedema may be prevented and/or the lymphedema incidence will be recognized at onset with treatment modalities initiated promptly, decreasing the severity of lymphedema 2. Intervention Educate treating physicians (surgeons, medical oncologists, radiation oncologists) to identify appropriate patients for lymphedema consultation referral. Patients with AD, AX or both were referred for lymphedema consult prior to surgery/radiation or within two weeks following surgery. The breast care navigator was available to assist with the referral process as needed. 2 Stout-Gergich N, et al. Preoperative Assessment Enables the Early Diagnosis and Successful Treatment of Lymphedema. Cancer. 28 Jun 15;112(12):289-19. Findings In 212, patients who had AD, AX or both 9 Patients referred or offered referral for lymphedema consult 9 Percentage of appropriate referrals 1% Number of patients referred to Summa Health Center at Anna Dean 7 Number of patients referred to outside therapy center 1 Number of patients who refused lymphedema consult 1 Referrals made preop 1 Referrals made within two weeks of surgery 3 Patients seen within two weeks of surgery 2 Average number of visits per patients seen for therapy 3 Incidence of lymphedema 2/7, or 3% 1 212 ANNUAL REPORT
In 21, 4 of 13 eligible patients were not referred for physical therapy/occupational therapy (2 had comorbidities/ecf). In 211, 1 of 12 eligible patients were not referred for physical therapy/ occupational therapy In 212, of the seven patients seen in physical therapy at Summa Health Center at Anna Dean, these referrals generated a total of 34 physical therapy treatment sessions. One of these patients had a second round of therapy in 212 for treatment of edema. There were a total of three patients that had signs of edema and were treated in 212. Of these referrals, two patients carried over for the treatments in 213. massage techniques, skin care, and strengthening exercises as appropriate for the patient s lifestyle. Early diagnosis and timely treatment provided more successful outcomes for the patients and less long-term complications than patients who do not receive this lymphedema prevention and early identification education. Data compiled and Study Completed by Tami O Connor, PTA, Kari Kovach, BSN, RN, Barb Saylor, BSN, RN, Cherie Hart-Spicer, M.D., Quality Improvement Coordinator Conclusion By proactively referring patients for lymphedema consultation prior to surgery/radiation or immediately following surgery, lymphedema was either prevented, or it was detected early and treated promptly. The lymphedema consultation provided patients with knowledge of lymphedema signs/symptoms, techniques to stimulate the lymphatic system, ROM exercises, 11 212 ANNUAL REPORT
Research Preventing Cancer CANCER RESEARH ACCRUALS Summa leads way on CPS-3 enrollment CPS-3 (Cancer Prevention Study-3) is a research study conducted by the American Cancer Society that aims to help better understand how to prevent cancer. It is a long-term study not a clinical trial. Participants between ages 3 and 65 and with no personal history of cancer (not including basal or squamous cell skin cancer) will be asked to complete surveys every few years for the next 2 to 3 years. The American Cancer Society s Epidemiology Research program recruits men and women in the United States and Puerto Rico for CPS-3. Led by Kari Kovach, BSN, RN, Summa Barberton Hospital enrolled 134 individuals in the CPS-3 study in 212, surpassing its goal by six. This made Summa the only site in Ohio to meet its intended goal. Summa s Kari Kovach enrolls individuals in the CPS-3 cancer study during the 212 Relay For Life of Barberton. Study enrollees were asked to complete a brief survey, provide physical measurements and allow a certified, trained phlebotomist to collect a small blood sample. At home, participants will receive periodic follow-up surveys and newsletters for the next 2 to 3 years. 12 212 ANNUAL REPORT
Technology Radiation Oncology PRECISE, NON-INVASIVE TREATMENT Summa Cancer Institute s radiation oncology program is equipped with Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) technology, including image guidance. Powerful, advanced Stereotactic Radiosurgery allows our specialists to reach tumors deep inside the body without the risk of surgery. Through SRS and SBRT, we treat tumors virtually anywhere in the body including the brain and lung, as well as tumors requiring highly focused precision or are medically inoperable. With custom tracking, we also treat small tumors close to critical organs. This provides patients with more precise and non-invasive treatment. Through this technology our radiation oncologists pinpoint the exact location of a tumor and deliver the radiation treatments more directly while decreasing exposure to surrounding tissue in days, not weeks. Summa s Stereotactic Radiosurgery technology includes stereo fluoroscopy and dual-diagnostic X-ray capabilities, allowing real-time imaging and precision even for the most challenging treatment techniques, especially those that involve moving targets like lung, liver and prostate cancers. Photo courtesy Brainlab Summa is one of only two major health systems in Northeast Ohio to earn the prestigious American College of Radiology (ACR) accreditation in radiation oncology. 13 212 ANNUAL REPORT
Summa Health System (8) 237-8662 summahealth.org/cancer CAN-13-1969/CS/JM/11-13