14 GEATON AND JOANN DECESARIS CANCER INSTITUTE CANCER REGISTRY ANNUAL REPORT Using 13 Cancer Registry Data DeCesaris Cancer Institute
Cancer Committee Members 13 COC Coordinators Barry Meisenberg, MD Medical Director, DeCesaris Cancer Institute Chair, Cancer Committee, Stephen Cattaneo, MD Thoracic Surgeon Cancer Liaison Physician (11-13) Joanne Ebner, RN, BSN, TTS Community Outreach, Coordinator Samir Shah, BS, CTR Manager Cancer Registry Cancer Registry Quality Coordinator Required Physician Members Michael LaPenta, MD Palliative Care/Hospice Carol Pressey, MD Primary Care Physician, Family Practice James Reinig, MD Diagnostic Radiologist Sanford Robbins, MD Director Pathology Lorraine Tafra, MD Medical Director & Breast Surgeon The Breast Center Angel Torano, MD Radiation Oncologist Required Members Cathy Copertino, BSN, MS, OCN Executive Director, DeCesaris Cancer Institute Cancer Program Administrator Bonnie Bresnahan, RT (R) (T) Director Radiation Oncology & Cancer Registry James Caldwell, Ph.D. Director Pharmacy Jan Clemons, RN, MSN, OCN Clinical Director Nursing, Inpatient Oncology Maria Geronimo, RN, MSN, MBA Program Coordinator, Thoracic Oncology Evelyn Graze, RN, MSN, OCN Director, Infusion Center Susan Hull AAMC Oncology Surgery Elizabeth Wiley Genetics Counselor Shirley Knelly, MS, CPAQ, LCADC Corporate Compliance Officer, Vice President Patient Safety, President Pathways Mathew LeBlanc, RN, OCN Rehabilitation Navigator Maureen Shackelford, RD, LD Nutritionist Jackie Shanahan, RN, OCN Nurse Navigator Erika Siegrist, MS, RN, OCN Director, Research Office Ashley Varner, MSW, MBA, OSW-C Counselor, The Breast Center Amy Welsh, MBA PR/Marketing Members Arun Bhandari, MD Hematology Oncology Peter Graze, MD Hematology Oncology Stephen Proshan, MD General & Colorectal Surgeon Jason Taksey, MD Hematology Oncology Stanley Watkins, MD Hematology Oncology Sharon Cameron Outreach Community Health Marguerite Cook, CFRE, CAP AAMC Foundation Teresa Putscher, RN, BSN, OCN Nurse Navigator Susanne Tameris Practice Manager, Annapolis Hematology and Oncology Kathy Whittaker, RN, BSN Manager, Patient Advocacy Senayt Assefa American Cancer Society Representative 1
Geaton and JoAnn DeCesaris Cancer Institute Delivering Excellence with a Team Approach Anne Arundel Medical Center (AAMC) is home to the Geaton and JoAnn DeCesaris Cancer Institute, a comprehensive, regional leader in cancer care that provides the latest in prevention, screening, diagnosis, treatment and survivorship. The DeCesaris Cancer Institute recruits and retains the highest-caliber physicians, nurses and staff. These highly skilled individuals come together with the patient to form a team where each perspective is honored and explored to ensure we have the most comprehensive, holistic view of each patient, along with his or her unique health status and how we can best restore health. Comprehensive Services The DeCesaris Cancer Institute continues to expand and increase the services available to our cancer patients and their families. We provide services across the continuum of cancer care, including prevention, highly specialized diagnostic and treatment services, community support, survivorship resources and end-of-life care. Each month, multiple disease-specific tumor boards teams of providers and staff whose experience spans all cancer disciplines meet to review the majority of cancer cases at AAMC. This multidisciplinary review ensures that we continue to deliver the best, most appropriate care to each patient. In 13 total reportable cases were 1,831. National Cancer Survivors Day: Living Life in Full Bloom Each June, patients, families, and supporters join DeCesaris Cancer Institute staff to commemorate National Cancer Survivors Day. AAMC s Living Life in Full Bloom provides a joyous day of celebration, featuring survivors, physicians and care team members. We also recognize community members who have done an especially remarkable job of advancing the cause of survivorship. Attendees can take advantage of free workshops to learn about the benefits of nutrition, complementary medicine and exercising. Our program in 14 featured Joel Ben Izzy, storyteller and national keynote speaker. More than 0 people attended the event in 14. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 14 Annual Report 2
DeCesaris Cancer Registry The DeCesaris Cancer Institute Cancer Registry systematically tracks the diagnosis, treatment, and follow-up of patients diagnosed with cancer. The data we collect provides researchers, physicians and healthcare providers information needed to improve the outcome of cancer treatment. The American College of Surgeons Commission on Cancer (CoC) requires that cancer programs maintain an percent tracking rate of all eligible cancer patients starting from the reference year (00) and a percent follow-up rate on all cancer patients diagnosed with cancer within the last five years. In 08 and 11, the AAMC Cancer Registry received commendation from the CoC for meeting and exceeding these standards. Standard 5.3 = Follow-up since registry reference date 00 Standard 5.3 Follow-up of Patients Since 00 Total number of cases since 00: 16,5 Required follow-up rate: % Current follow-up rate: 86.75% 166 patients = 1% follow-up Standard 5.4 = Follow-up within last 5 years; 09-13 Standard 5.4 Follow-up of Patients DIAGNOSED WITHIN last 5 years Total number of cases within last 5 years: 7,411 Required follow-up rate: % Current follow-up rate: 92.59% 75 patients = 1% follow-up All Tumor Boards for 13 74% of Cases Discussed Prospectively Exceeding Standard 1.7 Conference Total Tumor Med Onc. Rad Onc. Surgeon Pathologist Radiologist Cases Prospective Board Conf. Presented Cases 3 1 Brain/CNS 49 49 Not Required 36 3 3 2 GU-ONCOLOGY 23 23 22 23 Not Required Not Required 129 129 3 GYNOCOLOGY 11 11 11 11 11 Not Required 56 53 4 THORACIC 49 417 322 5 BREAST 197 196 6 GENERAL 37 37 37 35 37 36 239 226 7 HEMATOLOGY 37 37 37 35 37 36 239 226 Total Average % Average % Average % Average % Average % Total Cases Total Cases attendance Attendance Attendance Attendance Attendance 232 99% 99% 99% 99% 91% 1,441 1,326 Reviewed 1. Images 2. NCCN Compliance 3. Diagnostics 4. AJCC Staging Add 5. Research Trial Eligibility Case discussion includes consideration of the need for genetic testing and counseling, palliative care, psychosocial care, nutrition, and rehabilitation services
Measuring Performance Commission on Cancer s Rapid Quality Reporting System (RQRS) PRESENTING 13 CANCER REGISTRY DATA The DeCesaris Cancer Institute voluntarily participates in the CoC s Rapid Quality Reporting System (RQRS). This reporting and quality improvement tool provides real clinical-time assessment of hospital-level adherence to National Quality Forum (NQF)-endorsed quality of cancer care measures for breast and colorectal cancers. The six rating dials, one for each of the measures monitored and reported through RQRS, show the year-to-date facility performance rate achieved in 13. Reading the Dials 2 3 1 The year-to-date (YTD) performance rate is based on the total number of cases for which chemotherapy has or was expected to be administered within the past year (365 days). For this measure, this includes all cases of patients diagnosed within the past 24 months. 3 Shaded areas represent the range of performance rates for other participating programs: Green: Top quartile, 75 th 0 th Yellow: th 75 th percentile Red: 25 th th percentile 1 78.6% n=14 2 Red needle points to the current YTD performance rate. Breast Measures 91.3% n=216 n=28 98.9% n=268 Radiation therapy is administered within one year (365 days) of diagnosis for women under age receiving breast-conserving surgery for breast cancer. Combination chemotherapy is considered or administered within four months (1 days) of diagnosis for women under age with AJCC T1cN0M0 or stage II or III hormone receptor-negative breast cancer. Tamoxifen or third-generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1cN0M0 or stage II or III hormone receptor-positive breast cancer. COLON Measures* RECTAL Measures 91.5% n=35 At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. n=24 Adjuvant chemotherapy is considered or administered within four months (1 days) of diagnosis for patients under age with AJCC stage III (lymph node positive) colon cancer. n=3 Radiation therapy is considered or administered within six months (1 days) of diagnosis for patients under age with clinical or pathologic AJCC T4N0M0 or stage III receiving surgical resection for rectal cancer. * The colon cancer measure for the number of nodes removed and pathologically examined reflects the proportion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. The rates shown in these dials indicate the proportion of patients for whom adjuvant chemotherapy was expected to be started within the last 365 days. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 14 Annual Report 4
Measuring Performance Commission on Cancer s Rapid Quality Reporting System (RQRS) The DeCesaris Cancer Institute strives to meet and exceed national averages. The following graphs demonstrate our efforts to continually improve the delivery of quality cancer care. Breast MAC Breast HT Breast BCS % % % % % % % % % % % % 08 09 11 12 13 08 09 11 12 13 08 09 11 12 13 MAC AAMC MAC Maryland State HT AAMC HT Maryland State BCS AAMC BCS Maryland State MAC-combination chemotherapy is considered or administered within four months (1 days) of diagnosis for women under age with AJCC T1cN0M0, or stage II or III hormone receptornegative breast cancer. Performance Rate>=% HT-tamoxifen or third-generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1c N0 M0, or stage II or III hormone receptor-positive breast cancer. BCS-radiation therapy is administered within one year (365 days) of diagnosis for women under age receiving breast-conserving surgery for breast cancer. Performance Rate>=% Colon ACT Colon 12RLN Rectal AdjRT % % % % % % % % % % % % 08 09 11 12 13 08 09 11 12 13 08 09 11 12 13 ACT AAMC ACT Maryland State 12RLN AAMC 12RLN Maryland State AdjRT AAMC AdjRT Maryland State ACT-adjuvant chemotherapy is considered or administered within four months (1 days) of diagnosis for patients under age with AJCC stage III (lymph node positive) colon cancer. Performance Rate >=% 12RLN-The colon cancer measure for the number of nodes removed and pathologically examined reflects the proportion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. Performance rate>=% AdjRT-radiation therapy is considered or administered within six months (1 days) of diagnosis for patients under age with clinical or pathologic (AJCC T4N0m) or stage III receiving surgical resection for rectal cancer. Performance Rate>=% Measuring performance is one of the cornerstones of our ongoing efforts in collaboration with the Commission on Cancer s Rapid Quality Reporting System. Multiple quality measures have been identified as areas where we seek to meet and exceed national averages, including disease sites of breast, lung, colon, and gastric cancers. Colon Cancer Site Specific Review Luqman Dad, Md. CLP (14-16) Specifically, in we identified that our Colon cancer cases were falling below the standards set by the Commission based on published evidence. This assessment led to our Quality Improvement Initiative on Colon Cancer to improve the number of nodes removed and pathologically examined. We were pleased to report that in 14, our node count averaged 18 nodes per case, with the majority having or more nodes. Furthermore, other areas that we are currently focusing efforts on quality improvement include quality measures related to number of nodes pathologically examined following lung and gastric surgery. Our goal is over the coming year to demonstrate improvements in both these areas, so as to enhanced data for our clinicians and patients on accuracy of cancer stage, prognosis, and hopefully outcomes. 5
13 DCI Cancer by Body System and Sex Oral Cavity & Pharynx 28 Lung & Bronchus 1 (15%) Thyroid 33 (3%) Lung & Bronchus 1 (13%) Pancreas 17 (2%) Kidney & Renal Pelvis 32 Breast 567 (51%) Kidney & Renal Pelvis 11 (1%) Urinary Bladder 27 Ovary 11 (1%) Males Females Colon & Rectum (8%) Uterine Corpus 38 (3%) Prostate 161 (22%) Colon & Rectum 48 Non-Hodgkin Lymphoma 29 Non-Hodgkin Lymphoma 31 (3%) Melanoma of the Skin Melanoma of the Skin 17 (2%) Leukemia 29 All Other Sites 3 (28%) All Other Sites 199 (18%) Leukemia (1%) Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 14 Annual Report 6
Summary by Body System, Sex, Class, Status and Best AJCC Stage Report Sex Class of Case Status Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Analy NA Alive Exp Stg. 0 Stg. I Stg. II Stg. III Stg. IV Not Staged Unk. ORAL CAVITY & PHARYNX 41 (2.2%) 28 13 41 0 31 2 5 4 11 18 1 0 Lip 1 (0.1%) 0 1 1 0 1 0 0 1 0 0 0 0 0 Tongue 17 (0.9%) 11 6 17 0 13 4 1 0 3 5 8 0 0 Salivary Glands 5 (0.3%) 3 2 5 0 4 1 0 3 0 2 0 0 0 Floor of Mouth 2 (0.1%) 2 0 2 0 2 0 1 0 0 0 1 0 0 Gum & Other Mouth 3 (0.2%) 1 2 3 0 1 2 0 1 0 0 2 0 0 Nasopharynx 1 (0.1%) 1 0 1 0 1 0 0 0 0 0 1 0 0 Tonsil 4 (0.2%) 2 2 4 0 4 0 0 0 1 1 2 0 0 Oropharynx 2 (0.1%) 2 0 2 0 1 1 0 0 0 1 1 0 0 Hypopharynx 5 (0.3%) 5 0 5 0 4 1 0 0 0 2 3 0 0 Other Oral Cavity & Pharynx 1 (0.1%) 1 0 1 0 0 1 0 0 0 0 0 1 0 DIGESTIVE SYSTEM 226 (12.3%) 128 98 226 0 143 83 1 47 52 55 65 2 4 Esophagus 18 (1.) 15 3 18 0 6 12 0 1 5 2 9 0 1 Stomach 23 (1.3%) 15 8 23 0 12 11 0 5 6 6 6 0 0 Small Intestine 11 (0.6%) 6 5 11 0 8 3 0 0 2 3 5 0 1 Colon Excluding Rectum 82 (4.5%) 41 41 82 0 66 16 0 16 25 0 1 Cecum 21 11 21 0 17 4 0 7 1 7 6 0 0 Appendix 3 2 1 3 0 3 0 0 0 0 1 1 0 1 Ascending Colon 13 7 0 16 4 0 6 3 8 3 0 0 Transverse Colon 14 6 8 14 0 13 1 0 3 5 2 4 0 0 Splenic Flexure 1 0 1 1 0 1 0 0 1 0 0 0 0 0 Descending Colon 4 2 2 4 0 3 1 0 0 2 2 0 0 0 Sigmoid Colon 11 3 8 11 0 9 2 0 2 3 4 2 0 0 Large Intestine, NOS 8 5 3 8 0 4 4 0 1 2 1 4 0 0 Rectum & Rectosigmoid 26 (1.4%) 19 7 26 0 22 4 0 9 6 1 0 0 Rectosigmoid Junction 4 4 0 4 0 3 1 0 2 2 0 0 0 0 Rectum 22 15 7 22 0 19 3 0 7 4 1 0 0 Anus, Anal Canal & Anorectum 9 (0.5%) 2 7 9 0 8 1 1 1 6 1 0 0 0 Liver & Intrahepatic Bile Duct 16 (0.9%) 6 16 0 7 9 0 3 1 4 6 1 1 Liver 12 8 4 12 0 5 7 0 3 1 3 3 1 1 Intrahepatic Bile Duct 4 2 2 4 0 2 2 0 0 0 1 3 0 0 Gallbladder 2 (0.1%) 0 2 2 0 0 2 0 0 0 1 1 0 0 Other Biliary 3 (0.2%) 1 2 3 0 3 0 0 0 3 0 0 0 0 Pancreas 31 (1.7%) 17 14 31 0 7 24 0 6 7 2 16 0 0 Retroperitoneum 2 (0.1%) 2 0 2 0 2 0 0 2 0 0 0 0 0 Peritoneum, Omentum & Mesentery 2 (0.1%) 0 2 2 0 2 0 0 0 0 1 1 0 0 Other Digestive Organs 1 (0.1%) 0 1 1 0 0 1 0 0 0 0 0 1 0 RESPIRATORY SYSTEM 267 (14.6%) 123 144 267 0 132 135 2 28 5 1 1 Nose, Nasal Cavity & Middle Ear 2 (0.1%) 1 1 2 0 1 1 0 0 0 0 1 1 0 Larynx 14 (0.8%) 11 3 14 0 9 5 0 5 4 0 5 0 0 Lung & Bronchus 2 (13.7%) 1 1 2 0 121 129 2 74 24 99 0 1 Trachea, Mediastinum & Other Respiratory Organs 1 (0.01%) 1 0 1 0 1 0 0 1 0 0 0 0 0 BONES & JOINTS 1 (0.1%) 0 1 1 0 1 0 0 1 0 0 0 0 0 SOFT TISSUE (including Heart) 11 (0.6%) 8 3 11 0 9 2 0 6 2 3 0 0 0 SKIN EXCLUDING BASAL & SQUAMOUS 49(2.7%) 31 18 49 0 44 5 4 23 12 6 4 0 0 Melanoma Skin 47 (2.6%) 17 47 0 43 4 4 22 12 6 3 0 0 Other Non-Epithelial Skin 2 (0.1%) 1 1 2 0 1 1 0 1 0 0 1 0 0 BREAST 571 (31.2%) 4 567 571 0 553 18 112 248 147 44 17 0 3 FEMALE GENITAL SYSTEM 68 (3.7%) 0 68 68 0 8 3 44 2 9 0 0 Cervix Uteri 9 (0.5%) 0 9 9 0 8 1 0 6 0 1 2 0 0 Corpus & Uterus, NOS 38 (2.1%) 0 38 38 0 35 3 0 1 5 2 0 0 Corpus Uteri 36 0 36 36 0 34 2 0 28 1 5 2 0 0 Uterus, NOS 2 0 2 2 0 1 1 0 2 0 0 0 0 0 Ovary 11 (0.6%) 0 11 11 0 8 3 0 7 0 2 2 0 0 Vulva 5 (0.3%) 0 5 5 0 5 0 3 1 0 0 1 0 0 Other Female Genital Organs 5 (0.3%) 0 5 5 0 4 1 0 0 1 1 3 0 0 MALE GENITAL SYSTEM 171 (9.3%) 171 0 171 0 169 2 1 26 118 17 9 0 0 Prostate 161 (8.8%) 161 0 161 0 159 2 0 18 117 17 9 0 0 Testis 8 (0.4%) 8 0 8 0 8 0 0 7 1 0 0 0 0 Penis 2 (0.1%) 2 0 2 0 2 0 1 1 0 0 0 0 0 URINARY SYSTEM 81 (4.4%) 62 19 81 0 65 16 15 31 12 9 13 0 1 Urinary Bladder 34 (1.9%) 26 8 34 0 27 7 11 8 2 2 0 1 Kidney & Renal Pelvis 43 (2.3%) 32 11 43 0 35 8 2 21 3 7 0 0 Ureter 4 (0.2%) 4 0 4 0 3 1 2 0 1 0 1 0 0 BRAIN & OTHER NERVOUS SYSTEM 64 (3.5%) 24 64 0 45 19 0 0 0 0 0 64 0 Brain 27 (1.5%) 15 12 27 0 14 13 0 0 0 0 0 27 0 Cranial Nerves Other Nervous System 37 (2.) 9 28 37 0 31 6 0 0 0 0 0 37 0 ENDOCRINE SYSTEM 62 (3.4%) 21 41 62 0 61 1 0 34 7 2 2 16 1 Thyroid 46 (2.5%) 12 34 46 0 45 1 0 34 7 2 2 0 1 Other Endocrine including Thymus 16 (0.9%) 9 7 16 0 16 0 0 0 0 0 0 16 0 LYMPHOMA 67 (3.7%) 32 35 67 0 52 15 0 17 15 11 2 2 Hodgkin Lymphoma 7 (0.4%) 3 4 7 0 7 0 0 1 2 3 1 0 0 Non-Hodgkin Lymphoma (3.3%) 29 31 0 45 15 0 16 13 8 19 2 2 NHL - Nodal 33 19 14 33 0 25 8 0 8 7 6 0 2 NHL - Extranodal 27 17 27 0 7 0 8 3 1 13 2 0 MYELOMA 29 (1.6%) 17 12 29 0 22 7 0 0 0 0 0 29 0 LEUKEMIA 39 (2.1%) 29 39 0 29 0 0 0 0 0 39 0 Lymphocytic Leukemia 27 (1.5%) 21 6 27 0 24 3 0 0 0 0 0 27 0 Acute Lymphocytic Leukemia 1 1 0 1 0 1 0 0 0 0 0 0 1 0 Chronic Lymphocytic Leukemia 23 17 6 23 0 3 0 0 0 0 0 23 0 Other Lymphocytic Leukemia 3 3 0 3 0 3 0 0 0 0 0 0 3 0 Myeloid & Monocytic Leukemia 7 (0.4%) 5 2 7 0 4 3 0 0 0 0 0 7 0 Acute Myeloid Leukemia 6 4 2 6 0 2 4 0 0 0 0 0 6 0 Chronic Myeloid Leukemia 1 1 0 1 0 1 0 0 0 0 0 0 1 0 Other Leukemia 5 (0.3%) 3 2 5 0 2 3 0 0 0 0 0 5 0 Other Acute Leukemia 4 3 1 4 0 2 2 0 0 0 0 0 4 0 Aleukemic, Subleukemic & NOS 1 0 1 1 0 0 1 0 0 0 0 0 1 0 MESOTHELIOMA 5 (0.3%) 5 0 5 0 4 1 0 1 1 0 2 0 0 MISCELLANEOUS 79 (4.3%) 42 37 79 0 45 34 0 0 0 0 0 79 0 Total 1,831 725 1,6 1,831 0 1,465 366 1 563 0 217 265 233 12
13 Caseload by Diagnosis 1,831 Cases in 13 Brain/CNS 4% Breast 31% Hematopoietic 9% SKIN 3% Endocrine 3% Miscellaneous 5% Genitourinary 14% Head & Neck 2% Respiratory 15% GYN 4% Digestive Systems 12% 5-Year Analytic Caseload Comparison SITE 09 11 12 13 Head & Neck 36 37 31 28 41 Respiratory 251 2 233 236 272 Digestive System 194 182 193 222 226 GYN 48 61 71 84 68 Genitourinary 2 259 252 243 252 Skin 62 74 63 63 49 Breast 4 444 482 477 571 Brain/CNS 63 42 43 54 64 Hematopoietic 144 166 165 154 166 Endocrine 56 48 46 44 62 Miscellaneous 42 29 33 42 62 1,6 1,582 1,612 1,647 1,831 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 14 Annual Report 8
13 Cancer by Race Breast Caucasion 78.18% (448) African American.42% (117) Asian Indian or Pakistani, NOS Other Asian, including Asian/Oriental, NOS Other Bronchus & Lung Prostate Caucasion 86.17% (218) African American 12.65% (32) Asian Indian or Pakistani, NOS Other Asian, including Asian/Oriental, NOS Caucasion 88.2% (142) African American 11.8% (19) Other Hematopoietic & Reticuleondo System Skin Caucasion 87.74% (93) African American 11.32% (12) Other Asian, including Asian/Oriental, NOS 0.94% (1) Caucasion (52) 9 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 14 Annual Report 9
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