MOUNT SINAI HOSPITAL CANCER CARE CENTER 2016 ANNUAL REPORT

MOUNT SINAI HOSPITAL CANCER CARE CENTER 2016 ANNUAL REPORT

We are proud of the patients we serve and our outcomes in cancer care and treatment. Our physicians, nurses, pharmacists and support staff are fully committed to putting our knowledge, experience and compassion forward to ensure the best possible outcome for each patient. We understand our responsibility as the humble servants of those who seek our assistance. 2

Table of Contents Cancer Committee Chair s Report...4 From The Cancer Program Administrator...5 Cancer Registry Report...6 Clinical Trial Accrual...9 Oncology Nursing... 11 Prevention and Screening Programs... 12 Accountability and Quality Improvement Measures... 13 Survivorship Program... 16 Support Programs... 17 Partner Services Provided... 18 Cancer Committee 2016... 19 3

Cancer Committee Chair s Report The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools. Mount Sinai Hospital s division of oncology has collaborated with seven other institutions in Chicago to participate in an ongoing collaborative to improve supportive care in oncology. The following are some of the Cancer Program s accomplishments: Enhancement of the patient experience with the establishment of the supportive oncology clinic comprising of a team of providers such as an oncology pharmacist, nurse navigator, social worker, financial counselor and behavioral therapy technician. Through our relationship with the Coleman Foundation we were part of the development of a tool to measure psychosocial distress in our patients in order to provide appropriate resources for our patients. Expansion of our Survivorship Program to include all new early stage cancer patients diagnosed at our institution. Expanded inpatient palliative care and hospice services for our patients to meet and support their needs at a time when they are most vulnerable. Expansion of the multidisciplinary tumor board to include head and neck cancer and neuroncology, which gives physicians the ability to collaborate and discuss the best evidence-based treatment options. Continued community commitment through providing health fairs and screenings for head and neck cancer at the Mexican Consulate, as well as additional events that staff participated in during the year. Pam Khosla, MD Chief, Department of Oncology/Hematology Cancer Committee Chair 4

From The Cancer Program Administrator Sinai s Cancer Program Annual Report has a slightly different look this year. We have re-designed the annual report to be a summary of our accomplishments and outcomes. To that end, this annual report is more specifically designed to meet Standard 1.12, Public Reporting of Outcomes of the American College of Surgeons Commission on Cancer s (CoC) accreditation standards. Therefore, it is the responsibility of the Commission on Cancer Oncology Committee to provide a report of patient or program outcomes to the public. We also report on efforts to form partnerships to help meet the needs of the community we serve within our geographical area. Standard 4.1 Prevention Programs Standard 4.2 Screening Programs Standard 3.3 Survivorship Standard 4.6 Monitoring Compliance with Evidence-Based Guidelines Lastly, we continue to form partnerships in order to meet the many needs of the community we serve within our geographical area. While Standard 1.12 only requires that we report on one area, the Oncology Committee decided it was important to publicly show our performance results in several areas. Sameer Shah, PharmD, MHA. System Director of Pharmacy, Respiratory, Sleep Lab & Neurodiagnostics 5

Cancer Registry Report The following lists the primary sites of cancer diagnosis at Mount Sinai Hospital for patients in 2016. 2016 Analytical Case Distribution Report Count (N) Percent (%) Tongue 7 1.67% Salivary Glands 1 0.24% Gum & Other Mouth 1 0.24% Tonsil 4 0.96% Oropharynx 2 0.48% Hypopharynx 3 0.72% Esophagus 4 0.96% Stomach 8 1.91% Colon & Rectal Cancer 49 11.72% Liver 2 0.48% Gallbladder 3 0.72% Other Biliary 1 0.24% Pancreas 4 0.96% Larynx 8 1.91% Lung & Bronchus 56 13.40% Soft Tissue (including Heart) 4 0.96% Melanoma Skin 1 0.24% Breast 102 24.40% Cervix Uteri 6 1.44% Corpus Uteri 17 4.07% Ovary 6 1.44% Prostate 77 18.42% Urinary Bladder 13 3.11% Kidney & Renal Pelvis 9 2.15% Thyroid 13 3.11% Other Endocrine including Thymus 1 0.24% Hodgkin and NHL - Nodal 16 3.82% Total 418 100.00% 6

Top Cancer Sites 2016 Analytical Data Lung 20% Colon & Rectal 17% Breast 36% Prostate 27% 2016 Analytical Case Distribution Report by Age / Sex Male Female Total 0 29 4 8 12 30 39 2 12 14 40 49 18 35 53 50 59 54 71 125 60 69 84 56 140 70 79 25 37 62 80 89 6 5 11 90+ 1 0 1 Total 194 224 418 500 400 300 200 100 0 0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Total Total 12 14 53 125 140 62 11 1 418 Female 8 12 35 71 56 37 5 0 224 Male 4 2 18 54 84 25 6 1 194 7

Cancer Care Provided by Race 2011 through 2015 National Cancer Data Base (NCDB) Percent (%) 60 40 20 9% 0 White 55% Black Race / Ethnicity 31% Hispanic 2% Asian and Pacific Islander 3% Other/ Unknown Race / Ethnicity N % White 180 9.34% Black 1,062 55.11% Hispanic 599 31.08% Asian & Pacific Islander 29 1.5% Other / Unknown 57 2.96% Total 1,927 100% Race / Ethnicity White Black Hispanic Asian and Pacific Islander Other / Unknown Insurance Status by Race/Ethnicity Insurance Status Totals Not Private/ Insured Managed Medicaid Medicare Other Insurance Status Government Unknown N % 21 37 78 42 2 180 11.7% 20.6% 43.3% 23.3% 1.1% 100% 9.34% 30 205 458 362 2 5 1,062 2.8% 19.3% 43.1% 34.1% 0.21% 0.5% 100% 55.11% 91 119 277 109 3 599 15.2% 19.9% 46.2% 18.2% 0.5% 100% 31.08% 4 4 17 4 29 13.8% 13.8% 58.6% 13.8% 100% 1.5% 7 19 19 12 57 12.3% 33.3% 33.3% 21.1% 100% 2.96% Total 153 384 849 529 2 10 1,927 100% 7.9% 19.9% 44.1% 27.5% 0.1% 0.5% 100% 2017 National Cancer Data Base (NCDB) Commission on Cancer (CoC), Thursday, December 14, 2017 Mount Sinai Hospital continues to follow its mission to commit to improve the health of the individuals we serve, regardless of race or their ability to pay for health care services. 8

Clinical Trial Accrual Clinical trials at Mount Sinai Hospital s Cancer Center continue to grow. We offer advanced treatment options for adult patients, clinical trials, translational research and procurement of tissue for research. Historical Trends in Percent of Accrual of the Total Analytical Case Load to Clinical Trials % of Annually 15 10 5 0 National Average: 4% 2013 2014 2015 2016 Mount Sinai Hospital has received commendation from the American Society of Clinical Oncologists for its last two surveys for prominent clinical trials participation. Mount Sinai Hospital averages more patients on trials than any other neighboring community hospital. Nicole Leahy Research Assistant and Niraj Patel, Clinical Research Coordination 9

2016 Mount Sinai Hospital Clinical Trial Statistics 2016 Trial Accruals Disease by Cancer Type 4% 2% Patient Diversity in Research Caucasian 4% 8% 6% Asian 13% Colon 9% Lung 17% Breast 54% Hispanic 35% African American 48% Clinical trials are an indispensable weapon in the fight against cancer, and provide patients with valuable treatment options that may not be available to them otherwise. In 2016, Sinai s research program had over 25 cancer trials available for our patients (most of any community hospital in Chicago). We provided important education opportunity to students, residents and staff to learn about the role research plays in fostering innovation in modern medicine and cancer care. We aim to continue its role as part of the Cancer Moonshot initiative, originally launched by President Obama. 10

Oncology Nursing The oncology nurses at Mount Sinai Hospital s Cancer Center provide care to cancer patients of low income many of whom need supportive services. Care is provided in both outpatient and inpatient acute care settings. Nurses go through specialized education and training in general cancer diagnoses, the safe handling and administration of chemotherapy, radiation and many other diagnostic and therapeutic procedures. Certification in chemotherapy and biotherapy occurs when nurses meet specific eligibility requirements and pass a rigorous multiple-choice examination, to evaluate their specialized knowledge, skills and experience. The certification process establishes minimum competency standards and recognizes those who have met these standards. Patients can feel confident in their Caregivers when they receive care from a certified nurse. Certification is required by the American College of Surgeons Commission on Cancer. Outcome: This past year, three additional nurses earned their certification in oncology. Overall, 100-percent of our 34 nurses are certified in chemotherapy and biotherapy administration, thereby giving us commendation level for this standard during our most recent Commission on Cancer survey in 2016. 11

Prevention and Screening Programs Standard 4.1 Prevention Programs Standard 4.1 states Each year, the cancer committee provides at least one cancer prevention program that is targeted to meet the needs of the community and should be designed to reduce the incidence of a specific cancer type. This year, the prevention programs focused on presentations regarding breast and colon cancer at the Univision Health Fair in June 2016, and head and neck cancer at the Mexican Consulate of Chicago in April 2016. Standard 4.2 Screening Programs Standard 4.2 states Each year, the cancer committee provides at least one cancer screening program that is targeted to decreasing the number of patients with late stage disease. In 2016 screening programs focused on two cancers: breast and head and neck cancers. The events were held in the community and referrals to Mount Sinai Hospital. Breast Cancer. The Helping Her Live program in 2016 provided education to 520 participants Outcome:114 free mammograms were provided to women who met criteria. Head and Neck screening was performed at the Mexican Consulate located in the Near West Side neighborhood. Outcome: Two participants were referred to Sinai Medical Group for further testing. 12

Accountability and Quality Improvement Measures The Cancer Registry at Mount Sinai Hospital s Cancer Center submits data annually to the National Cancer Data Base (NCDB). The data elements required for submission to NCDB are utilized by the Commission on Cancer in evaluating and assessing quality measures that have been developed to ensure patient-centered treatment outcomes. The quality measures are endorsed by the NQF (National Quality Forum). Breast Cancer Accountability Measure Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer Mount Sinai Hospital 100% State of Illinois 93.1% All CoC Commission on Cancer Approved Programs 90.9% Accountability Measure Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer Mount Sinai Hospital 100% State of Illinois 95.6% All CoC Commission on Cancer Approved Programs 91.1% Neil Seif, MD Radiation Oncologist 13

Colon Cancer Accountability Measure At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer Mount Sinai Hospital 100% State of Illinois 91.4% All CoC Commission on Cancer Approved Programs 91.2% Accountability Measure Adjuvant chemotherapy is recommended, or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC stage III (lymph node positive) colon cancer Mount Sinai Hospital 100% State of Illinois 90.7% All CoC Commission on Cancer Approved Programs 89% The CoC requires the Cancer Committee to review the quality of patient care using CoC quality reporting tools appropriate to the patients who are treated by the program each year. The most recent information from 2015 shows that Mount Sinai Hospital has exceeded all local and national bench marks for breast and colon cancer care for the above performance. 14

Accountability and Quality Improvement Measures (continued) Compliance with NCCN Guidelines In 2016, a chart audit was conducted on non small cell lung cancer patients who were diagnosed in 2016. A total of 50 patients were reviewed according to the National Comprehensive Cancer Network guidelines in the treatment of lung cancer. Results of Data A random sample of 10% of lung patient s from 2016 were assessed to determine if treatment met the NCCN guidelines for care of patients with NSCLC. The patients chosen were stage IV, stage III and stage II. An audit tool was developed and approved by Dr. Kassem based on the NCCN NSCLC version3.2017 11/16/2016. Based on the following results patients with stage I-IV lung cancer were managed appropriately according to NCCN guidelines. 15

Survivorship Program One of a patient s biggest fears after treatment is the fear of reoccurrence of their disease. To help our patients deal with their concerns and to improve patient compliance with follow up and screenings after treatment, we have developed the Cancer Survivorship Program. This program offers patients educational, clinical, spiritual and psychosocial support as they begin their journey as a cancer survivor. To meet their needs, all patients are scheduled a visit in the Survivorship clinic six months after completing treatment. From that point, patient nurse navigators, social worker, dietitian, nurse practitioner and other professionals remain available to address any concerns related to diagnosis and treatment and the impact they may have on one s life. Total Patients Seen in 2016 by Type of Cancer Cancer Type Total Patients Seen Breast 39 Lung 3 Colon 5 Non Hodgkin 5 Prostrate 3 Testicular 3 Endometrial 1 Head and Neck 1 Hodgkin s 2 Ovarian 1 Rectal 1 Renal 1 16

Support Programs The Cancer Center at Mount Sinai Hospital is a resource center for all oncology patients, their families and the community. In conjunction with treatment modalities, we strive to meet the physical, emotional, social and spiritual needs of each person who relies on us for care. Our goal is to empower and support patients and families. Support programs help individuals cope with cancer and manage lifestyle changes and challenges. Support and networking with the American Cancer Society, Gilda s Club and the Coleman Foundation allows us to provide services to our patients to meet their emotional, social and spiritual needs. 17

Partner Services Provided American Cancer Society : 110 patients were referred and provided with 185 services. Services included the Look Good Feel Better program teaching women beauty techniques to cope with skin changes and hair loss, as well as other supportive services such as transportation and assistance with wigs and personal health needs. Services Provided Disease Types Service Provided by Disease Type Service Type # Provided Look Good, Feel Better 17 Personal Health Manager 158 Transportation All Types 24 Wigs 33 Lung 11% Breast 32% Colon 10% Unknown 47% Gilda s Club provides weekly art and craft activities to patients and family daily outside of the treatment center. Coleman Foundation helped develop tools to measure patients distress. They also provided educational and informational material. Other Supportive Service: To continue to meet the needs of our patients, we have a certified nurse navigator available to help individuals and families with appointments and scheduling tests and procedures. Our oncology social worker counsels patients and families as they face various challenges. She assists with stress reduction, improving coping skills and locating needed services. Our dietitian meets with patients during and after treatment to ensure that nutritional needs are adequately understood and met. Pastoral care services are available to patients and their families, and a chapel located within the hospital may be used for quiet reflection. Our patients and families are surrounded by a team dedicated to addressing their needs to the best of our ability. 18

Cancer Committee 2016 Physician Membership Pam Khosla, MD Cancer Committee Chairperson Monica Lorimer, MD Cancer Liaison Physician Ivica Vucic, MD Diagnostic Radiologist Mohammed Kassem, MD Medical Oncologist Shan-Ching Ying, MD Pathologist Neil Seif, MD Radiation Oncologist Monica Lorimer, MD Surgeon Kishore Bobba, MD Palliative Care Team Member Non-Physicians Members Sameer Shah, Pharm, MHA Cancer Program Administrator Catherine Cassingham, MSW Social Worker Maria Arreola, CTR Certified Tumor Registrar Amy Wright, RN Performance Improvement Coordinator Shakuntala Shrestha RN, APN Genetics Representative Sandra Ramirez RN Community Outreach Coordinator Niraj Patel Clinical Research Coordinator Beth Zabinsky Registered Dietician Rev. Romulo Manching Pastoral Care Representative Jessica Smith American Cancer Society Representative Alnierys Venegas Sinai Urban Health Institute Lorena Vaca Cancer Conference Coordinators 19