Summa Cancer Institute. Improving Patient Centered Timeliness of Care 2014 ANNUAL REPORT

Summa Cancer Institute Improving Patient Centered Timeliness of Care

A message from the Medical Director Cancer Registry Summary 214 Summa Cancer Institute offers patients the latest surgical techniques, advanced treatment options and access to clinical trials while still providing the personalized care patients value close to where they live and work. Our patients are at the center of everything we do. We treat people not conditions at Summa Cancer Institute. Summa Cancer Institute continues to grow as one of northeast Ohio s most comprehensive cancer centers, thanks to the generosity of our supporters and the vision of our physician leaders. In 214, Vincent and Nancy DiGirolamo significantly strengthened their support of the Vincent and Nancy DiGirolamo Endowed Chair in Oncology and the annual Vincent and Nancy DiGirolamo Oncology Symposium, both established through the couple s generosity in 27. Their philanthropic giving now exceeds $4 million and continues to help advance cancer research, clinical excellence and compassionate cancer care. Plans were made to build a new Breast Center on the campus of Summa Akron City Hospital, to purchase and install 3D tomography equipment for all eight breast screening locations across the region by 215 and to remodel the Breast Imaging Center at Summa Akron City Hospital. Three benefactors made generous gifts to support these projects: the Walter W. Born Foundation; the Women s Board of Summa Health System; and Charlotte Hamor and Robert Hamor, MD. Three separate quality studies focused to improve both access to and the timeliness of cancer care from abnormal finding with remarkable, patient-centered outcomes. Significant reductions in the number of days to access and receive care were achieved in radiology and during breast and lung cancer screening. In these studies, the role of nurse navigation proved effective to expedite follow-up from abnormal finding. Summa Cancer Institute continues its outreach program with the Summa Screens program. This program provides free mammography services to low income women who are uninsured or underinsured. Financial support is provided by Susan G. Komen Northeast Ohio, the Stephen A. Comunale, Jr. Family Cancer Foundation, the Kent Area Chapter of Links, Inc. through private donors. In 214, cancer services at Summa Barberton Hospital received three-year reaccreditation by the American College of Surgeons Commission on Cancer (CoC). Approval by the CoC is given only to facilities willing to undergo a rigorous evaluation process, performance review and on-site review every three years. The annual Vincent and Nancy DiGirolamo Oncology Symposium, which has drawn more than 1, medical professionals to Summa, brings together multidisciplinary cancer experts who share clinical practices and research innovations. In 214, the 7th annual symposium highlighted geriatric oncology and featured topics such as: the geriatric oncology interface, external beam radiation therapy for elderly cancer patients and how best to navigate the elderly oncology patient. The cancer registry is an essential component of a program accredited by the Commission on Cancer (CoC). 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 used 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 summahealth.org/cancer Summa Cancer Institute CONTENTS Cancer Registry Summary 214 3 Statistics 214 4 Summa Akron City and Summa St. Thomas Hospitals 4 Summa Barberton Hospital 6 Outcomes 8 TIMELINESS OF CARE Summa Barberton Hospital: Radiology Time Study 8 Nurse Navigators: Breast Care Access Project 1 Lung Cancer: Timeliness to Care 13 Breast Cancer Screening 14 Pink Ribbon Program 16 Personalized Medicine 18 Lung Health Day 2 Recognition 21 Accreditation 21 Membership 22 Summa Physicians Inc. 23 New Cancer Specialists 23 In conjunction with Lung Cancer Awareness month, the 1st Annual Lung Health Day Symposium was presented at Summa Barberton Hospital and the Summa Health Center at Wadsworth-Rittman drawing almost 1 participants. As Summa Cancer Institute continues to grow and change, our goal remains unwavering: to cure 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 Vincent and Nancy DiGirolamo Endowed Chair in Oncology Summa Health System 3 SUMMA CANCER INSTITUTE

Summa Akron City and St. Thomas Hospitals Summa Akron City and St. Thomas Hospitals 214 214 Primary Cancer Sites SUMMA AKRON CITY AND ST. THOMAS HOSPITALS Top Five Cancer Sites Primary Site Total Sex Class of Case M F Analytic Non-Analytic Breast 393 3 39 375 18 Lung/Bronchus 271 148 123 263 8 Corpus Uteri 132 132 124 8 Prostate 13 13 9 13 Colon 97 4 57 89 8 Non-Hodgkin s 77 34 43 7 7 Bladder 61 44 17 55 6 Rectum 51 33 18 5 1 Kidney/Renal 51 27 24 49 2 Ovary 49 49 47 2 Leukemia 44 28 16 42 2 Thyroid 42 12 3 41 1 Unknown Primary 41 22 19 41 Melanoma 39 24 15 27 12 Pancreas 38 19 19 38 Cervix Uteri 31 31 3 1 Brain (malignant) 27 16 11 26 1 Esophagus 26 23 3 24 2 Connect/Soft Tissue 25 18 7 21 4 Other Brain & CNS 25 6 19 24 1 Vulva 22 22 2 2 Multiple Myeloma 2 11 9 18 2 Other Oral Cavity 19 12 7 18 1 Larynx 19 13 6 18 1 Other Endocrine 19 7 12 18 1 Stomach 17 11 6 16 1 Liver 17 12 5 17 Other Digestive System 15 9 6 15 Testis 15 15 14 1 Other Blood & Bone Marrow 14 7 7 14 Anus/Anal Canal 13 5 8 13 Hodgkin s Disease 1 3 7 1 Brain (benign) 8 3 5 7 1 Other/Ill-Defined 8 5 3 8 Other Skin 7 2 5 7 Other Female Genital 7 7 7 Tongue 5 2 3 4 1 Other Urinary System 4 2 2 4 Oropharynx 2 1 1 2 Bone 2 1 1 2 Hypopharynx 1 1 1 Other Respiratory System 1 1 1 Lip Nasal/Sinus Other Male Genital Total 1,868 723 1,145 1,76 18 NUMBER OF CASES 4 35 3 25 2 15 1 Breast Lung/Bronchus Corpus Uteri Prostate 5 Colon 13 97 132 271 1 2 3 4 Female/Male Top Sites NUMBER OF CASES Female Breast Lung/Bronchus Corpus Prostate Colon Uteri 393 Male Summa Akron City and St. Thomas Hospitals cancer registry accessioned 1,868 new cancer cases in 214. This graph illustrates the most frequent primary sites seen at these facilities. They account for nearly 53 percent (996 cases) of new cancer cases in 214. The top five sites for all patients are breast, lung, corpus uteri, prostate, and colon. The gender distribution for these sites is presented in this graph. 4 5

Summa Barberton Hospital Summa Barberton Hospital 214 Primary Cancer Sites SUMMA BARBERTON HOSPITAL Top Six Cancer Sites Primary Site Total Sex Class of Case M F Analytic Non-Analytic Breast 122 1 121 117 5 Lung/Bronchus 59 31 28 58 1 Colon 36 14 22 33 3 Non-Hodgkin s 15 7 8 14 1 Corpus Uteri 14 14 14 Bladder 14 11 3 14 Pancreas 13 1 3 13 Prostate 13 13 8 5 Rectum 12 9 3 12 Esophagus 1 5 5 1 Kidney/Renal 9 5 4 9 Melanoma 8 7 1 3 5 Unknown Primary 8 5 3 7 1 Liver 7 3 4 7 Multiple Myeloma 7 5 2 6 1 Stomach 6 3 3 6 Leukemia 6 3 3 5 1 Other Brain & CNS 5 5 5 Other Oral Cavity 4 4 4 Larynx 4 4 4 Connect/Soft Tissue 4 3 1 3 1 Tongue 3 3 3 Other Digestive System 3 3 3 Other Skin 3 1 2 3 Ovary 3 3 2 1 Brain (malignant) 3 1 2 3 Other/Ill-Defined 3 2 1 3 Hypopharynx 2 2 2 Anus/Anal Canal 2 2 2 Other Respiratory s System 2 2 2 Cervix Uteri 2 2 2 Testis 2 2 2 Thyroid 2 2 2 Hodgkin s Disease 2 2 2 Lip 1 1 1 Nasal/Sinus 1 1 1 Other Blood & Bone Marrow 1 1 1 Bone 1 1 1 Other Endocrine 1 1 1 Vulva Other Female Genital Other Male Genital Other Urinary System Brain (benign) Total 413 166 247 388 25 Breast Lung/Bronchus Non-Hodgkin s Lymphoma 2 4 6 8 1 12 14 NUMBER OF CASES Female/Male Top Sites NUMBER OF CASES Colon Corpus Uteri Bladder 14 12 1 8 6 4 2 15 14 14 Breast 36 Lung/ Bronchus 59 Colon Non-Hodgkin s Lymphoma Corpus Uteri 122 Female Bladder Male 214 Summa Barberton Hospital s cancer registry accessioned 413 new cancer cases in 214. This graph illustrates the most frequent primary sites seen at this facility. They account for nearly 63 percent (26 cases) of new cancer cases in 214. The top six sites for all patients are breast, lung, colon, non-hodgkin s lymphoma, corpus uteri, and bladder. The gender distribution for these sites is represented in this graph. 6 7

OUTCOMES Summa Barberton Hospital Timeliness of Care From abnormal radiology report to biopsy 16 days Dr. Syed Zaidi, Medical Director Radiology; Matthew Wenger, RPA, RRA, RT; Kelly Parke, RN; Cindy Jones, RN, BSN, OCN, CTTS; Dr. Cherie Hart-Spicer, Quality Improvement Coordinator, Radiology Time Study Problem Summa Barberton Hospital s radiology department determined that the elapsed time from an abnormal radiology finding to biopsy / procedure was taking too long, potentially compromising patient care. Criteria for Evaluation/Data to Assess The study data was collected from abnormal imaging results, written orders and the biopsy schedule. Process Radiology Associates of Canton and Summa Barberton Hospital s radiologist and radiology practitioner assistant (RPA) flagged radiology reports where findings indicated the presence of a possible neoplasm(s). The flagged reports were further stratified by patients hospital registration (inpatient, outpatient and emergency room). The reports were followed by the radiology clinical coordinator and the oncology nurse navigator RNs. The nurse navigator RNs contact the referring physician about patients abnormal radiology reports and help patients navigate through the diagnostic process by expediting services in order to achieve a rapid diagnosis. Data Reviewed Data was reviewed for the time period between July 213 to June 214, during which more than 6, radiology reports were flagged for review and follow up. Summary of Findings The following data was compiled by Dr. Syed Zaidi, Matthew Wenger, Kelly Parke and Cindy Jones. Abnormal Radiology Report to CT Biopsy Order Year Year Total Average Inpatient Outpatient 213 15.9 days 4.4 days 27.4 days 214 6.9 days 2.6 days 11.2 days TIME INTERVAL IN DAYS 3 25 2 15 1 5 27.4 4.4 2.6 213 214 Inpatient Outpatient 11.2 Written Order to Actual Biopsy Procedure Date Year Year Total Average Inpatient Outpatient 213 3.9 days.96 days 6.7 days 214 3.1 days 1.1 days 5.49 days TIME INTERVAL IN DAYS 8 7 6 5 4 3 2 1.96 6.7 213 214 Inpatient 1.1 Outpatient The flagging of all radiology reports suspicious of neoplastic disease and establishing an effective follow up process conducted by the clinical radiology coordinator and oncology nurse navigator has significantly reduced the time to biopsy in both inpatient and outpatient settings. The only exception was found in the inpatient setting where the time from written order to the CT biopsy took slightly longer in 214 than it did in 213. 5.49 National Guidelines and Benchmarks American College of Radiology Practice Guidelines and Technical Standards Recommendations and Interventions It is recommended that the radiology department continue to review the process, documentation tools and metrics in order to continue to improve the time from abnormal finding to diagnosis. The radiology department has budgeted for and is in the process of obtaining a software data mining program called Montage. Montage is designed to improve the notification process for abnormal reports, which will help Summa Health continue to make a positive impact on patient outcomes. Next Steps and Methods to Monitor Quality of Care Implement Montage data mining software and conduct an ongoing review to ensure quality of care. 8 9

OUTCOMES Nurse Navigators BREAST CARE ACCESS PROJECT Timeliness of Care From abnormal diagnostic mammogram to biopsy 21 days Dr. Melanie Lynch, Medical Director, Breast Program; Dr. Lauren Kinsell, Radiology; Sharon Lieb Inzetta, RN, MS, CBCN, CN-BN; Heidi Eve-Cahoon, MSN, RN, CNP, CBCN, Laura Musarra, BS, MBA; Marlo Schmidt, MS, MBA The Role of Nurse Navigators in an Interdisciplinary Breast Program Introduction The Institute of Medicine (IOM) Quality Cancer Care report (dated September 1, 213) states that Cancer care is often not as patient-centered, accessible, coordinated or evidence-based as it could be. The report provides recommendations to improve cancer care. One of the goals in the IOM report is to improve process measures, including timeliness, access and coordination of care. In 214, Summa Health System created a team to make improvements to cancer care services consistent with the IOM goals. One of the first projects the team took on was improving access to breast care. Background/Problem Breast care was not as patient-centered, accessible, coordinated or evidence-based as it could be at Summa Health. The National Consortium of Breast Centers standard is 6.5 business days between diagnostic mammogram to biopsy. In contrast, Summa patients were waiting an average of 29 days. Goal Statement The goal of the project was to improve access to coordinated, high-quality, team-based care for women with a breast concern, an abnormal mammogram, a palpable breast mass or who were at increased risk for breast cancer due to high-risk pathology or family history. Intervention/Initiative/Activity The project team began with an assessment of current services in two populations: the community providers who refer patients to Summa and the patients who experience the continuum of care from abnormal mammogram to surgical consult, biopsy, diagnosis and treatment. Primary research was conducted with referring physicians in small groups and through an online survey. Breast cancer survivors were asked via email to serve as a member of a patient advisory group to help Summa improve its services. The first patient advisory group meeting took place on April 16, 214. Patient s recommendations were consistent with findings that indicate that the most anxiety-ridden, stressful time in the survivorship continuum is that period of time between being informed of a potential problem to learning the outcome of diagnostic procedures. One patient put it best when she said, Once you are aware of an issue, nothing goes fast enough. The results of the research indicated that there were significant scheduling and communication issues in both the physician and patient populations. Patients recommended that Summa take steps to: Shorten the time to diagnosis, including: Time from screening to diagnostic mammogram Time from biopsy to meeting with a breast surgeon Time spent waiting during the diagnostic testing process Provide patients with someone to talk to during the diagnostic process These issues were addressed in several ways: Process Improvement Change A standardized physician order form to provide referring physicians and breast patients with a Recommended Diagnostic Plan of Care was created which is faxed between offices and given to the patient. Imaging was asked to block protected time on the schedule to add diagnostic breast procedures. Performance targets were established and a data collection, tracking and reporting process was created. Patient Experience Change An oncology nurse navigator was already in place to guide patients diagnosed with breast cancer, but patient feedback indicated a need to hire a navigator to support patients during the diagnostic process which starts when a breast biopsy is indicated. The project team presented their findings and recommendation to senior management and the decision was made to fund the new breast care nurse navigator position. The National Accreditation Program for Breast Cancer Centers (NAPBC) sets standards for patient navigators to provide individualized assistance to patients, families and caregivers to help them overcome barriers to care. These services include, but are not limited to: Providing education, support and coordination to assist patients in securing appointments Providing educational resources on breast health, breast cancer and breast care Connecting patients and families to resources and support services Promoting communication between patients and healthcare providers Coordinating services throughout the breast care continuum Enhancing patients quality of life, sense of autonomy and self-determination for managing their own health Reinforcing and strengthening the physician-patient relationship Summa s breast nurse navigators: Specialize in breast health Provide individualized assistance to patients Coordinate care to ensure timely and best care possible Build a supportive relationship with patients and families Provide emotional support, counseling and education Facilitate patient appointments Nurse Navigators Left: Heidi Eve-Cahoon, MSN, RN, CNP, CBCN Right: Sharon Inzetta, RN, MS, CBCN, CN-BN 1 11

OUTCOMES BREAST CARE ACCESS PROJECT (CONTINUED) OUTCOMES Lung Cancer Timeliness to the Care of Patients with Newly Diagnosed Lung Cancer 1 Timeliness of Care From first abnormal lung finding to first cancer treatment 19 days Outcomes The cancer survivorship continuum begins at the first abnormal mammogram and continues for the rest of a woman s life. Cancer patients face many challenges and decisions along the way. Summa s patient advisory group provided valuable information about the patient experience which enabled Summa to make positive changes to improve care, including: Better coordination of care between outpatient specialists and outpatient primary care providers Increased access to services Reduced time between when a patient is notified about an abnormal mammogram to biopsy Went from an average of 29 days to 8 days from abnormal mammogram to biopsy (January - March 214 vs. 215) Adding a breast care nurse navigator to provide specialized nursing care to support patients and their families during the diagnostic process # OF DAYS Diagnostic Mammogram to Surgical Consult 16% 14% 12% 1% 8% 6% 4% 2% % 15 5.3 11.4 12.5 2.9 2.4 January February March # OF DAYS 2 15 1 5 Surgical Consult to Biopsy Includes Weekends 15.9 6.8 12.5 The most significant outcome of this project is the positive impact it has had on patient experience. Patients now spend less time waiting for a diagnosis. If they do need treatment, they can immediately find out what their options are and get all of their questions answered promptly by a nurse navigator. When they leave the breast surgeon s office after a consultation, they have a treatment plan in place; they also know what their next steps are and what they can expect during treatment. What do these process improvements actually mean for patients? According to Summa surgical oncologist Dr. Melanie Lynch, these changes translate into a lower misery index for women facing a potential cancer diagnosis. She quantified the value of this new way of providing care in a presentation to colleagues: Annually, Summa performs an estimated 8 breast biopsies. By reducing the time from abnormal mammogram to biopsy from 29 days to 8 days, women spent 21 fewer days waiting for results. In effect, annually these changes will enable 8 women to avoid 16,8 days of misery. 15.7 5.4 5.2 January February March 214 215 # OF DAYS Diagnostic Mammogram to Biopsy 35 3 25 2 15 1 5 3.9 12.1 23.9 28.2 8.3 7.6 January February March Background Timeliness and access to diagnostic medical services has an impact on lung cancer care. Up to 75 percent of American patients with lung cancer are found to have advanced stage or already metastasized disease at the time of diagnosis. The Summa Cancer Institute recognized a need to improve both access to and the timeliness of lung cancer care. The diagnosis and staging of lung cancer relies on input from multiple medical and diagnostic service providers. It was theorized that patient navigation could be an effective way to reduce communication barriers to timely, efficient and high-quality lung cancer care. Objective The goal was to test the hypothesis that the use of nurse navigation would improve both the timeliness and access to diagnostic medical services among patients with newly diagnosed lung cancer. Methods The role of nurse navigator began at Summa Cancer Institute on October 1, 213. An oncology-certified nurse navigator was expected to: Help streamline the diagnostic process Provide patient support and education Coordinate specialty consultation in pulmonary medicine, surgical oncology, medical oncology and radiation oncology Facilitate a multidisciplinary thoracic specialty tumor board A review was conducted of 46 patients with lung cancer in order to evaluate access to care and the timeliness of the care received in both the non-navigated and nursenavigated cohorts. Results The average lag time between the first abnormal chest X-ray (or CT scout film) to first cancer treatment was initially 64 days. But after hiring a lung cancer nurse navigator, that lag narrowed to 45 days, which was a 19-day drop in time to first cancer treatment. Nurse navigation can be cited as a meaningful factor in the timeliness of care. However, it is difficult to say whether the service expeditor role or the tumor board facilitator was most critical in reducing the time from first abnormal finding to first cancer treatment. It also is important to note other variables which can affect timeliness of care, including: Being elderly (older than age 7 years) Being diagnosed in a teaching hospital Having the initial referral be to a nonpulmonary medicine physician The number of diagnostic tests The number of medical services needed to reach a diagnosis Having more than one comorbidity Limitations Long-term follow up on clinical outcomes remains premature. Conclusion This study shows that the implementation of effective nurse navigation improved overall access and timeliness of lung cancer care in a community oncology practice. 1 Charles A Kunos, MD, Sally Olszewski, RN, BSN, OCN, and Eric Espinal, MD. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lunch cancer. The Journal of Community and Supportive Oncology. June 215. Vol. 13/Number 6, pages 219: 224. 12 13

OUTCOMES Community Benefit 214 Breast Cancer Screening COMMUNITY OUTREACH Who Benefits from Summa Screens? 84 Patient Navigation Services 676 Breast Imaging Services 13 Cancers Diagnosed Summa cancer institute 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 for low income women who are underinsured or uninsured. Awareness and education empowers people to make informed choices about their health. Summa Screens helps by taking this worry away. It is the heart of what this Summa Health program is all about. In 214, Summa Screens: Provided 676 breast imaging services; of those services, 331 were to unique patients Ethnicity - Imaging Services and Navigation 214 PERCENTAGES OF SERVICES 1% 8% 6% 4% 2% % Caucasian African- American Asian Hispanic Other, not specified Native American Refused Providing You the Best in Breast Care Summa Screens is a cancer screening program that provides free mammograms, breast ultrasounds and core biopsies to low-income, uninsured or underinsured women. If you re interested in qualifying for free breast imaging services, call (33) 375-73 Summa Screens Mammography Program According to the Susan G. Komen Northeast Ohio County Characteristics (29), approximately 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. For many uninsured and underinsured women, the thought of scheduling a mammogram can bring be stressful. They wonder how they will pay for testing and may even decide to forego an appointment. 214 Screening Data Type of Breast Imaging Service # % Screening Mammograms 326 48% Diagnostic Mammograms 2 3% Diagnostic Ultrasounds 15 22% Total Imaging Services 676 1% Type of Navigation Only Service # % Screening Mammograms 58 35% Diagnostic Mammograms & Diagnostic Ultrasounds 16 65% Total Navigation Only Services 164 1% Provided 326 screening mammograms, 2 diagnostic mammograms and 15 diagnostic ultrasounds Provided 164 newly insured patients with breast navigation services. These were primarily individuals recently insured through healthcare reform.* Diagnosed 13 cases of breast cancer Financial support is provided by Susan G. Komen Northeast Ohio, the Stephen A. Comunale, Jr. Family Cancer Foundation and through private donors. As a result, Summa Screens is equipped to offer free mammography services to low income women who are uninsured or underinsured in our community. Screening Mammograms Gender NUMBER OF PATIENTS NUMBER OF PATIENTS 8 7 6 5 4 3 2 1 Age Range 4 35 3 25 2 15 1 5 Female Imaging Services (Diagnostic Mammograms and Ultrasounds) Male Under 4 4-49 5-64 65+ NUMBER OF BREAST CANCERS DIAGNOSED Stage Cases 3 1 1A 4 1B 2 2A 3 2B 3 3A 1 3B 3C 1 4 1 Total 13 14 15

OUTCOMES Pink Ribbon Program Community Benefit 214 374 Procedures 2 Surgical Consultations 5 Cancers Diagnosed COMMUNITY OUTREACH Breast and Cervical Cancer Project Pink Ribbon Program 214 Ohio s Breast and Cervical Cancer Project (BCCP), also referred to as the Pink Ribbon Program, is a statewide, high-quality breast and cervical cancer screening, diagnostic testing and case management program offered at no cost to eligible women in Ohio. Started in 1994, it is funded through the Centers for Disease Control and Prevention (CDC) and the State of Ohio General Revenue funds and through participating health care providers. The services include: Pelvic exams Pap tests Clinical breast exams Mammograms Diagnostic testing, including ultrasound and biopsy Who can receive these services? Women are eligible for Pink Ribbon if they meet the following criteria: Live in households with income less than 2 percent of the poverty level Have no insurance Are 4 years of age or older for Pap tests, pelvic exams, clinical breast exams and diagnostic mammograms Are 5 years of age or older for screening mammograms The screening process is very quick and it takes only a few minute to conduct the phone call to find out if a woman is eligible. Ideally, clients are enrolled in the program before any imaging or testing is completed. But patients can be enrolled at the breast imaging center and/or at the surgeon consultation office prior to the biopsy. It is important to note that once a biopsy has been completed, the client cannot be enrolled with a positive diagnosis for cancer. So again, it is important to get women enrolled as soon as the need is identified. If patients are diagnosed with cancer while enrolled in the Pink Ribbon program, they are fast-tracked into an Emergency Medicaid program to pay for their cancer treatment. Many of Summa Health s physicians, including primary care, family practice and general surgeons, are enrolled in Ohio s Pink Ribbon program. The majority of our Pink Ribbon patients are seen by a family practice physician for an initial consultation, physical exam and in-office testing. Patients are then sent to one of Summa s Breast Imaging Centers for screening or diagnostic mammograms and breast ultrasounds. If a client has a biopsy recommendation, Pink Ribbon then helps coordinate a surgical consultation with a participating Summa surgeon. In 214, Summa Health provided 374 procedures to 165 clients and identified 5 positive breast cancer cases. We continue to be committed to the early detection and treatment of all cancers and to providing underserved patients access to cancer screenings through programs like Ohio s Pink Ribbon program and through programs developed at Summa Health. Summa Akron City Hospital Locations PROCEDURES & CLIENTS Summa Barberton Hospital Locations TOTAL 214 Breast biopsy 25 4 29 Clinical breast exam 34 16 5 Colposcopy with biopsy 1 1 Diagnostic mammogram 37 25 62 Endometrial Biopsy Fine needle aspiration HPV test 7 4 11 LEEP MRI Pap test/ pathology RPT 12 8 2 Pelvic exam 33 14 47 Screening mammogram 74 36 11 Ultrasound 26 12 38 Other, MRI, LEEP 6 6 Total # of Procedures 254 12 374 Total # of Clients 123 49 172 Total # of Appointments with Breast Surgeons Total # Positive Breast Cancer Cases Total # Positive Cervical Cancer Cases * Unduplicated Numbers SURGICAL BREAST CONSULTATIONS 16 4 2 OUTCOMES 3 2 5 16 17

OUTCOMES Personalized Medicine CAROL THOMAN The key to treating breast cancer is to combine and sequence The key to treating breast cancer is to combine and treatments in such a way that gives patients the maximum benefit and the best chance of survival, said Melanie Lynch, M.D. sequence treatments in such a way that gives patients the maximum benefit and the best chance of survival. ~ Melanie Lynch, M.D. Left: Heidi Eve-Cahoon, MSN, RN; Middle: Carol Thoman; Right: Melanie Lynch, M.D. Personalized medicine gave Carol Thoman the edge she needed to fight and win against breast cancer Carol Thoman is a self-described optimist, so she didn t panic when she was told she had breast cancer. I knew I was going to beat it, Carol says. A positive attitude is important when facing a formidable foe like breast cancer. Equally important is having a team of cancer specialists dedicated to high quality patient care by your side when waging that fight. Carol is fortunate to have such a team at Summa Cancer Institute. In January 214, Carol underwent a screening mammogram at the Jean and Milton Cooper Cancer Center on the campus of Summa Akron City Hospital. A mass was detected. Follow-up imaging and a core biopsy followed. Carol was quickly diagnosed with HER2-amplified breast cancer. The biopsy showed that the cancer was particularly aggressive. The key to treating breast cancer is to combine and sequence treatments in such a way that gives patients the maximum benefit and the best chance of survival, said Melanie Lynch, M.D. Lynch is the breast surgeon who treated Carol. She is the medical director of the Breast Program at Summa Cancer Institute and a Summa Physicians Inc. surgical oncologist. The standard approach to treating breast cancer has been to perform surgery first, followed by other therapies such as chemotherapy and radiation, Lynch said. But we ve developed criteria that indicate when patients would have a better chance at a good clinical outcome by administering chemotherapy before surgery. Both Dr. Lynch and Carol s oncologist, Joseph Koenig, M.D., agreed that Carol s treatment should begin with chemotherapy, combining two therapies which target the HER-2 protein identified on Carol s tumor. One of the drugs used was only recently approved for use by the U.S. Food and Drug Administration (FDA). We re always on the lookout for those patients that will benefit from targeted therapies, Lynch said. Following the targeted chemotherapy regimen, Carol underwent breast cancer surgery, which was performed by Dr. Lynch in October 214. At the same time, plastic surgeon Douglas Wagner, M.D., performed a breast reconstruction. Today, Carol Thoman is doing well. Her cancer has responded to the targeted chemotherapy treatment and she is a cancer survivor. She continues to follow up regularly with Drs. Lynch and Koenig, along with other members of her cancer care team, including nutritionists, physical therapists and cancer care nurse navigator. Aside from the team of cancer experts she found at Summa Cancer Institute, Carol also values the emotional support provided by Heidi Eve-Cahoon, MSN, RN. No question was ever left unanswered, according to Carol, thanks to Heidi. Eve-Cahoon is a breast care nurse navigator at The Jean and Milton Cooper Cancer Center. Eve-Cahoon offered Carol emotional support, counseling and education along each step of the treatment process. Summa Cancer Institute treats me like I m family, said Carol. Everybody cares and they show it. The staff is upbeat and positive. It begins the moment you enter the building. What is personalized medicine? Physicians now analyze a tumor s genetic makeup in order to make crucial decisions about how to treat a patient s cancer. This customized treatment allows doctors to select the most effective medication or therapy and administer it using the proper dose or regimen for that specific patient s cancer. Personalized medicine is a popular term used to describe this new way of practicing medicine. In Carol Thoman s case, her breast surgeon (Dr. Lynch) took a sample of a Carol s tumor during a biopsy and had it analyzed. With the results, Carol s oncologist (Dr. Koenig) could predict which combination of therapies would be the most effective against Carol s cancer. This focused approach to cancer care gave Carol the edge she needed to beat breast cancer and become a cancer survivor. 18 19

OUTCOMES 214 Lung Health Day COMMUNITY OUTREACH 1st Annual Lung Health Day Community Outreach Program November was Lung Cancer Awareness month. Under the direction of Cindy Jones RN, BSN, OCN, CTTS, Oncology Nurse Navigator at Summa Barberton Hospital, the 1st Annual Lung Health Day Symposium was presented at Summa Barberton Hospital and the Summa Health Center at Wadsworth-Rittman. The events drew approximately 1 participants, which included not only Summa Health employees, but also members of the Barberton, Rittman and Wadsworth communities. Chido D. Vera, M.D., an interventional radiologist with Radiology Associates of Canton, discussed the benefits of screening high risk patients using low dose CT scanning. Dr. Vera cited a lung screening study which demonstrated the benefits of early detection of lung cancer, where prompt treatment can make a significant difference in outcome. Megan Dean, M.ED., AT, Summa Health educator, provided information about the harm which can be caused by tobacco use; the benefits of tobacco cessation; the myths of electronic cigarettes; and how to use humor as a coping mechanism (instead of tobacco) for dealing with stress. The symposium was a positive learning opportunity for both Summa employees and residents of the community we serve as evidenced by pre-test and post-test surveys completed by about 77% of the participants. Aggregate Impact Question Number Total 1 2 3 4 Pre-Test Correct (Raw) 47 6 59 56 128 Pre-Test Correct (Normalized) 61.4 7.79 76.62 72.73 166.23 Post-Test Correct (Raw) 67 5 67 74 19 Post-Test Correct (Normalized) 89.33 66.67 89.33 98.67 253.33 % Change [(Post-Pre/Pre) x 1] 46.35% 755.56% 16.59% 35.67% 52.4% Cindy Jones RN, BSN, OCN, CTTS Pre-Test samples size: 77 Post-Test sample size: 75 Recognition Accreditations Cancer Program American College of Surgeons Commission on Cancer Our three cancer centers the Jean and Milton Cooper Cancer Center on the campus of Summa Akron City Hospital, Summa Barberton Hospital s Parkview Center and Summa Health Center at Lake Medina are fully accredited by the American College of Surgeons Commission on Cancer (CoC). CoC accreditation is the hallmark of excellence and ensures that quality standards are consistently met and/or exceeded by our dedicated cancer care team members. Radiation Oncology American College of Radiology Summa Health is one of only two major healthcare systems in northeast Ohio to earn the prestigious American College of Radiology (ACR) accreditation in radiation oncology. This places Summa Health amongst a select group of cancer care providers nationwide. Accreditation is awarded only to facilities that meet specific practice guidelines and technical standards developed by ACR after a peer-review evaluation by board-certified radiation oncologists and medical physicists. Medical Oncology The Quality Oncology Practice Initiative Summa Health is one of a few cancer centers in Ohio to meet quality measures for medical oncology from the American Society of Clinical Oncology s Quality Oncology Practice Initiative (QOPI). QOPI is an oncologist-led, practice-based quality improvement program, whose goal is to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. Breast Imaging American College of Radiology The Breast Imaging Center at Summa Barberton Hospital s Parkview Center was designated a Breast Imaging Center of Excellence (BICOE) by the American College of Radiology (ACR). The BICOE designation is awarded to breast imaging centers that achieve excellence by seeking and earning accreditation in all of the ACR s voluntary breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program. The breast imaging services at Parkview Center are fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. www.acr.org/quality-safety/accreditation Breast Cancer Program National Accreditation Program for Breast Cancers Parkview Center at Summa Barberton Hospital has earned the gold standard for breast cancer care from the National Accreditation Program for Breast Centers (NAPBC). During the 213 NAPBC survey of Parkview Center, Summa s Breast Program was recognized in seven areas of best practices compared to other programs surveyed nationally. This accreditation recognizes Summa Health as providing the highest standard of care for its patients. 2 21

214 SUMMA HEALTH Recognition New Cancer Specialists Membership New Cancer Care Team Members in 214 NRG Oncology NRG Oncology is a non-profit research organization formed to conduct oncologic clinical research and to broadly disseminate study results for informing clinical decision making and healthcare policy. It brings together the National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group (RTOG), and the Gynecologic Oncology Group (GOG) each recognized internationally as a research leader. NRG Oncology embodies an impressive legacy in the conduct of multi-institutional phase II and phase III clinical trials and a history of undertaking phase I and translational biological studies imperative for oncologic research of the future. NRG Oncology seeks to improve the lives of cancer patients by conducting practice-changing multi-institutional clinical and translational research with emphases on gender-specific malignancies including gynecologic, breast, and prostate cancers and on localized or locally advanced cancers of all types. The foundation of Summa Cancer Institute is our talented, multidisciplinary team of specialists. As we continue to grow as one of northeast Ohio s most comprehensive cancer centers, we continue to invest in talent to aid us in our fight against complex, advanced cancers. Oncology Navigators Sharon Lieb Inzetta, RN, MS, CBCN, CN-BN Breast Care Nurse Navigator Our physicians and staff provide a level of personalized care that goes beyond clinical excellence. Summa Health welcomed the following new members to our multidisciplinary cancer care team in 214: Sandy Kohut, RRT Lung Navigator Infusion Services Elise J. Longfellow, RN, ASN Clinical Coordinator Oncology Financial Counselors Leslie Morgan-Pfaff Coordinator Patient Financial Assistance Lindsey Stephen Coordinator Medication Assistance Programs 22 23

Summa Cancer Institute Improving Patient Centered Timeliness of Care CAN-15-24275/EL/12-15/375