2015 ancer 2016 ancer Program Report · 2018. 12. 11. · Directory of Terms 14 Palliative are...

2015 Cancer

Program Report 2016 Cancer

Program Report

Incorporating a statistical summary of

the 2015 cancer registry data.

Schneck Medical Center

INDEX

Chairman’s Message 3

Cancer Committee 4

Screenings, Support & Education 5

Cancer Registry Report 6

Schneck Data 7

Perspective 9

Prostate Cancer Analysis 10

Cancer Liason Report 13

Directory of Terms 14

Palliative Care Program 15

Schneck Medical Center (812) 522-2349

Toll Free (800) 234-9222

Cancer Services Center (812) 522-0480

Cancer Registry (812) 522-0475

Screening Information Line (812) 522-0477

Community Wellness (812) 523-5861

Diagnostic Imaging (X-Ray) (812) 522-0144

Diagnostic Laboratory (Lab) (812) 522-0152

Home Services & Hospice (812) 522-0460

Nutrition Services (812) 522-0148

Pain Center (812) 524-4253

Patient Services (812) 522-0440

(Social Work, Case Management, Discharge Planning)

Psychological Services (812) 522-5739

Rehab Services (812) 522-0177

Schneck Foundation (812) 524-4244

Smoking Cessation Classes (812) 522-0401

Wound Care (812) 522-0177

The vision of the Cancer Program at Schneck Medical Center is to be the provider of choice for cancer care in our community. Our mission is to provide excellence in prevention, diagnosis, and treatment throughout the continuum of cancer care. Schneck Medical Center’s Community Cancer Program is based on the standards prescribed by the American College of Surgeons, Commission on Cancer (ACoS, CoC). Schneck is accredited with Commendation by the ACoS, CoC. The CoC recommends that this program publish an annual report. A time lag is caused by the length of time which may occur between diagnosis and first course of treatment and the time required for generation of data.

SERVICE DIRECTORY

2016 Annual Cancer Program Report

CHAIRMAN’S MESSAGE In 2016, the Cancer Center at Schneck Medical Center had another incredible year of growth and recognition. Jackson, and its neighboring counties, can be proud of the multiple accolades of their local cancer center, but particularly for achieving an accreditation with commendation from the American College of Surgeons,

Commission on Cancer (ACoS, COC). This award exemplified the incredible work and rigorous adherence to standards of treatment as well as demonstrating excellence in patient care. This was facilitated through the strong leadership of Dr. Dolores Olivarez, our full-time cancer oncologist, and Dr. Higinia Cardenes, our full-time radiation oncologist, as well as Dr. Amanda Dick, our cancer liaison physician, Dr. LeAnn Stidham, our radiologist, and our extremely dedicated staff.

In addition to the high honor of receiving the Outstanding Achievement Award (OAA) from the ACoS, COC, the Cancer Center was also able to share in other honors and recognition. The nursing staff at Schneck Medical Center received the Magnet distinction for the third time, a designation indicating a gold standard in hospital-wide nursing care and professional achievement. The Cancer Center also received an accreditation for use of the breast MRI in the detection of breast cancers. Our Palliative Care program achieved The Joint Commission Certification in December 2015.

Technology and innovation remain an important aspect of providing the best cancer care. Schneck’s Cancer Center has demonstrated its dedication to obtaining these technologies through the acquisition of key pieces of equipment this year. Stereotactic radiation equipment has been added to our arsenal. This is a device that uses a high dose beam of radiation to reduce the number of overall treatments used for certain types of cancers. A 4D, 16 slice CT simulator was also purchased. This allows extremely precise imaging that can be used to obtain accurate imaging while the patient is breathing with chest rise and falling. Also, contrast media can be used for head and neck cancers to discover the relationship of blood vessels to the

cancer.

Patient safety and access has also been expanded over this last year. A walker to be used by patients with weakness and debility has been placed in the cancer center to prevent falls. New Philips monitors have been installed within the rooms to more accurately follow vital signs as well as use for heart monitoring. Two additional clinical rooms have been added to improve patient access. Dieticians are now meeting with patients on-site for weekly education. Also, there has been a “hard-wiring” of safety huddles each morning for staff to discuss mutual patients and the daily plan.

The Cancer Center also continues to partner with the community and with surrounding institutions. An action plan was developed to continue community assessments and screenings for prostate, breast, cervical, and skin cancer. A goal of achieving 80% of colon cancer screens by 2018 has been set. We are also participating in research studies focusing on lung DNA testing.

The Cancer Center at Schneck Medical Center demonstrates an ongoing commitment to meeting and exceeding the standards of cancer care, and we are pleased that our patients can receive such care without having to leave their community.

Grant J. Olsen, M.D.

2015 Distribution by County Schneck Medical Center Total Analytic Cases 264

Schneck serves Jackson County as well as

many surrounding counties in Indiana.

Jackson 163 Jennings 46 Scott 19 Bartholomew 19 Ripley 3

Jefferson 3 Washington 3 Brown, Cass, Decatur, Johnson, Monroe, Putnam 1 each Out-of-State 2


CANCER COMMITTEE The Cancer Committee is comprised of physicians and other healthcare professionals dedicated to providing the community with state-of-the-art cancer control efforts in prevention, early diagnosis, pre-treatment evaluation, staging, treatment, rehabilitation, and surveillance. The Committee provides leadership to plan, initiate, stimulate, and assess all cancer-related activities at Schneck. Members include:

Sally Acton, RN, BSN, OCN, MSM, Director, Cancer & Palliative Care Services (Cancer Program Administrator) Aaron Banister, PhD, HSPP, Mental Health & Wellness (Psychosocial Services Coordinator)

Donna Butler, MSN, ANP-BC, OCN, ACHPN, FAAPM, Palliative Care

Higinia Cárdenes, M.D., Ph.D., Radiation Oncologist

Debbie Clontz, RN, BSN, OCN, Oncology Nurse, Cancer Services

Leighana Crenshaw, MSW, LSW, Case Manager, Patient Services

Bridgett Cope, RN, BSN, CMSRN, COS-C, Hospice

Tammi Covert, OTR, Rehab Coordinator, Rehab Services

Amanda Dick, M.D., General Surgeon (ACoS Cancer Liaison Physician)

Sherry Dowling, CTR, Cancer Registrar, Cancer Services (Cancer Conference Coordinator)

Dolores Olivarez, M.D., Medical Oncologist (Clinical Research Representative)

Grant Olsen, M.D., Hospitalist (Chairman)

Amy Pettit DNP, RN, NE-BC, CSSBB, VP of Nursing Services and Chief Nursing Officer

Lynda Richey, RN, BSN, OCN, Oncology Nurse and Nurse Navigator, Cancer Services (Community Outreach Coordinator)

LeAnn Stidham, M.D., Diagnostic Radiologist

Ann Wenderoth, Coordinator, Health Initiatives, Great Lakes Division, American Cancer Society

J. Wesley Whitler, M.D., Pathologist (Quality of Cancer Registry Data Coordinator) Suki Wright, MSM, CSSBB, Director, Organizational Excellence and Innovation (Quality Improvement Coordinator)


COMMUNITY OUTREACH

Lynda Richey, Community Outreach Coordinator, monitors outreach activity, assuring that materials and staff are available for screening and educating the community. She reports these events to the Cancer Committee.

Screenings Early detection is the key to finding cancer in an early stage, thus providing a better chance for cure. Screenings can detect cancers in early stages, before symptoms would prompt a physician office visit. Schneck Medical Center provided the following screenings:

ColoCare, a test for detecting blood in the stool, was distributed for colon cancer screening at numerous health events.

Skin cancer screenings were held by a local dermatologist at the Cancer Center. Prostate cancer screenings were held in September by Dr. Kartha at the Cancer Center. Breast health and cervical screenings were held in October. CT lung cancer screening is available through Schneck Diagnostic Imaging.

Public Education Public education is provided through many venues. Professional staff of the Schneck Cancer Center provides information about prevention, detection, and good health habits to various community organizations. In addition, instruction and literature about various cancer topics are provided at community events.

Support Psychological services and social workers are available to provide emotional support and assistance with community resources throughout the disease process. Other venues for support include the following:

Research

Computers with internet access are located in our Resource Center with easy access to the National Cancer Institute and clinical trials. Patient tracking of those participating in clinical trials is being done by the cancer center staff.

Lynda Richey, RN, BSN, OCN

Community Outreach Coordinator

Cancer support group Leukemia & Lymphoma support group Fresh Start Smoking Cessation program Nutritional counseling Genetic testing and counseling through referral Cancer navigation program

Grief counseling Free wig bank (ACS) Look Good Feel Better program (ACS) Road to Recovery (ACS) Reach to Recovery (ACS) Palliative Care Team


SCHNECK CANCER REGISTRY SUMMARY

A follow-up rate of 80% for all analytic patients is required by the ACoS, CoC.

SCHNECK CANCER PATIENTS ENTERED IN THE LAST FIVE YEARS SUMMARY

A follow-up rate of 90% for analytic patients entered in the last five years is required by the ACoS, CoC. Calculations based on July 2016 follow-up. Cancer Registry reference date: January 1, 1986

Total number of cases in registry since 6227

Total number of cases requiring follow-up 4659

Less number of deceased cases 3016

Total number of cases followed 1632

Cases with current follow-up 1167

Total follow up rate 90%

Total number of cases in registry last five years 1223

Total number of cases requiring follow-up 922

Less number of deceased cases 383

Total number of cases followed 539

Cases with current follow-up 468

Total follow up rate 92.3%

Quality of the Cancer Registry is monitored and reported quarterly to the Cancer Committee. This includes monitoring of case finding, accuracy of data collection and staging, abstracting timeliness (RQRS), follow-up, and data reporting.

As a pathologist, Dr. Whitler also oversees the quality of the pathology reporting system.

J. Wesley Whitler, M.D. Quality of Registry Data

Coordinator

The Cancer Registry collects and monitors all types of cancer diagnosed or treated in our institution. We strive to provide accurate and complete cancer information, timely data reporting and strict patient

confidentiality. Cancer Registry data is utilized to monitor specific cancer trends. We have implemented the Rapid Quality Reporting System (RQRS) to support our efforts in maintaining a high-level of evidence-based cancer care.

Our Cancer Program is accredited by the American College of Surgeons, Commission of Cancer, CoC, with gold level compliance receiving the CoC Outstanding Achievement Award again in 2016.

Currently, I am serving a second term as treasurer of the Indiana Cancer Registry Association. As a member of the National and State Cancer Registrars’ Associations, I have the opportunity to interact with registrars across the nation and to stay current with required changes in coding documentation.

Please take a few moments to look over the graphs on the following pages. While the cancer registry compiles the data, this is truly a reflection of everyone working together to care for our patients.

Sherry L. Dowling, CTR, Cancer Registrar

CANCER REGISTRY REPORT


SCHNECK CANCER CASES BY PRIMARY

0 10 20 30 40 50 60 70

Other/Ill Defined/Unknown

Soft Tissue (inc head/ neck)

Ovary

Testis

Pharynx

Stomach

Liver

Tongue

Kidney & Renal Pelvis

Pancreas

Larynx

Corpus Uteri

Multiple Myeloma

Melanomas of the Skin

Non-Lodgkin's Lymphoma

Rectum and Rectosigmoid

Leukemia

Urinary bladder

Thyroid Gland

Prostate

Colon

Breast

Lung & Bronchus

Analytic

Non-Analytic

*Other includes sites with frequency of two or less.

Lung cancer is our top analytic site, followed by breast, colon, prostate, and urinary bladder cancers. Prostate cancer is highlighted later in this report by Dr. Ryan Malone. Our top sites coincide with the top sites nationally.

2015 Frequency by Primary Site 328 Total: Analytic 264, Non-Analytic 64

58/10 47/7

22/0

15/7

9/7

11/3

5/4

11/2

2/1

6/2

7/1

4/1

18/0

4/1

3/0

1/2

10/3

2/7

6/2

7/1

5/0

5/2

6/1


SCHNECK CANCER CASES BY PATIENT DISTRIBUTION

4

13

2926

29

26

10

45

27

19

26

10

0

5

10

15

20

25

30

35

40

45

50

In Situ I II III IV N/A or Unknown

Male Female

2 2

7

22

32

44

16

21

9

14

2831

28

22

4

0

5

10

15

20

25

30

35

40

45

50

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Male Female

2015 Age at Diagnosis 264 Analytic Cases: 127 male, 137 female

2015 AJCC Stage at Diagnosis 264 Analytic Cases: 127 male, 137 female

Cancer incidence rises with age, with most cases affecting adults in mid-life or older. Females

predominated at 137 of the total 264 cases.

The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Detecting cancer in an earlier stage can often lead to a higher survival rate. The majority of females were diagnosed at Stage II or earlier.


PERSPECTIVE After skin cancer, prostate cancer is the leading cancer in men. This data is derived from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. Per the SEER database, the estimated number of new cases in 2016 will be over 180,000

men. The percentage of new cancer cases will represent over 10% of the population. Estimated deaths in 2016 from prostate cancer will be 26,000 with an overall percent of cancer specific death of over 4.4%. The risk to a man of developing prostate cancer over his lifetime is 12.9%. At Schneck Medical Center, there were 15 cases of prostate cancer diagnosed and treated in 2015. Of 15 cases, the ranges were three cases from ages 50-59, three cases this from 60-69, and nine cases from the ages of 70-79. The stage breakdown according to these numbers reveals seven cases of stage IIA, four cases of stage IIB, two cases of stage III disease, and two cases of stage IV disease. The treatment associated was radiation for one patient, radiation plus hormonal manipulation for 11 patients, one patient who underwent surgery and chemotherapy, one patient underwent surgery and radiation therapy, and one patient underwent surgery with radiation and hormonal manipulation. As you can see from the national statistics, prostate cancer, while survivable, certainly can be more challenging. Once prostate cancer moves beyond its initial stages it becomes very challenging to treat and manage. While the percentage of death from prostate cancer is not as high as its prevalence, the sheer volume makes this a significant disease.

Also demonstrated is the multi-modality approach that Schneck Medical Center has to offer patients. These treatments are cutting edge and available without patients needing to travel for state of the art treatment. Schneck Medical Center also supports evidence based medicine. Recent recommendations on PSA testing have made this diagnosis challenging. While recognizing the shortcomings of this test, the medical community has taken this data point among others to help limit the need for unnecessary biopsy and diagnosis. The role of diagnosing and knowing when to intervene with treatment versus surveillance continues to be an active goal of prostate cancer treatment.

Dr. Ryan Malone


3 3

9

0

5

10

50-59 60-69 70-79

SCHNECK PROSTATE CANCER DATA

7

4

2 2

0

2

4

6

8

2A 2B 3 4

The seventh decade of life was the most common for incidence of prostate cancer.

Almost half of patients were diagnosed at stage 2A.

2015 Age at Diagnosis 15 Analytic Prostate Cases

2015 AJCC Stage at Diagnosis 15 Analytic Prostate Cases

1

11

1 1 1

0

5

10

15

Radiation and Diagnostic

biopsy

Radiation, Hormonal

Therapy, and DiagnosticBiopsy

Surgery, Chemotherapy,

Hormonal Therapy, andDiagnostic Biopsy

Surgery, Radiation

Therapy, and DiagnosticBiopsy

Surgery, Radiation

Therapy, and HormonalTherapy

2015 First Course of Treatment 15 Analytic Prostate Cases

The majority of patients received radiation, hormonal therapy, and diagnostic biopsy as the first course of treatment.


PROSTATE CANCER NCDB COMPARATIVE ANALYSIS

1

10

38.5

35

15.5

0

3.5

24

41

25

6

0.50

5

10

15

20

25

30

35

40

45

40-49 50-59 60-69 70-79 80-89 90-99

SMC

NCDB

13.5

67

1.5

1268

71.5

95.5 6

0

10

20

30

40

50

60

70

80

I II III IV Unknown

SMC

NCDB

Percentage of Cases, Age at Diagnosis* Schneck Medical Center & NCDB 2003-2013 Total Analytic Cases: 117 Schneck, 1,340,047 NCDB

Percentage of Cases, AJCC Stage at Diagnosis* Schneck Medical Center & NCDB 2003-2013 Total Analytic Cases: 117 Schneck, 1,340,047 NCDB

Incidence of cancer increases with age, with most cases affecting men in their 60s and 70s. Schneck’s age groups at initial diagnosis tend to be older than national rates.

The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Data shows the majority of prostate cancers are diagnosed in the earlier stages of disease.


PROSTATE CANCER ANALYSIS (CONT.)

25

35

2 2.5

18

10

3.5 4

46.5

20

1.5 1

14.5

46.5

6

0

5

10

15

20

25

30

35

40

45

50

Surgery Only Radiation Only Surgery &Radiation

Surgery,Radiation &

HormoneTherapy

Radiation &Hormone

Therapy

HormoneTherapy Only

OtherSpecified

Therapy

No FirstCourse of

Treatment

SMC

NCDB

Percentage of First Course of Treatment* Schneck Medical Center & NCDB 2003-2013 Total Analytic Cases: 117 Schneck, 1,340,047 NCDB

Schneck’s first course of treatment very closely matches national statistics. Many patients only require surgery. Depending upon the stage of disease, national guidelines recommend additional treatment.

* Comparison data provided by 2016 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) as of Wednesday, September 28, 2016.

RESEARCH Schneck joined Indiana University in a lung cancer screening research study, “Measuring Stigma and Health Beliefs about Lung Cancer Screening in Long-Term Smokers.” This study should help us better understand factors that may influence screening behavior and help us identify effective recruitment methods.


COC CANCER LIAISON PHYSICIAN END OF YEAR REPORT Breast cancer remains one

of the most common

cancers among American

women. We can expect

12% of women to develop

breast cancer in their

lifetime. In 2016, an

estimated 300,000+ women

will be diagnosed with

breast cancer. The majority of those cancers will

be invasive. Over 40,000 women will die from

breast cancer in 2016. As terrifying as these

numbers seem, it is also important to know that

there are currently over 2.8 million breast cancer

survivors currently living in the United States

alone.

Breast cancer rates are decreasing and survival

rates are improving thanks to decreasing

utilization of hormone replacement therapy and

early detection. For women diagnosed with

Stage 0 or I breast cancer, survival rates

approach 100%. For those with stage II disease,

survival rates are over 93%. Appropriately timed

screening and administration of treatments help

create good outcomes for those faced with this

disease.

Here at Schneck, we are fortunate to have an

amazing team of doctors and nurses that are

highly trained and skilled at the diagnosis and

treatment of breast cancer. In 2015 we treated

47 new patients with breast cancer. Early

detection through screening and fast track to

biopsy and consultation are the first steps to

successful treatment. We will continue to

provide free breast cancer screening clinics as

key to early detection in our community.

Review of CoC guidelines show 100%

compliance at Schneck Cancer Center for

appropriate and timely administration of

chemotherapy, radiation and hormone

receptor therapy; and for the use of core

needle biopsy as gold standard for diagnosis

of breast cancer. We also received

accreditation for breast MRI.

Once again, I am proud to be a part of the

cancer committee that has achieved an

Outstanding Cancer Center Award again in

2016. I look forward to helping more patients

find a cancer free future with the help of our

amazing staff here at Schneck Cancer Center.

Amanda Dick, M.D. Cancer Liaison Physician


COC CANCER LIAISON PHYSICIAN END OF YEAR REPORT (CONT)

DIRECTORY OF TERMS AJCC Stage of Diagnosis: Depending on the TNM classifications or anatomic extent of disease, cases are placed into “Stage Groupings” or levels of disease. Early disease is classified as Stage 0 with the stage increasing with the amount of disease present.

Analytic: Cases diagnosed and/or treated initially at Schneck Medical Center since the Cancer Registry reference date of January 1, 1986.

Non-Analytic: Cases diagnosed and/or treated elsewhere; cases diagnosed and treated at Schneck Medical Center prior to the Cancer Registry reference date of January 1, 1986, and which have returned with recurrent disease during the current year; cases diagnosed at autopsy; or known cases diagnosed and initially treated in a staff physician’s office.

Survival: Observed rate is the calculation made without correcting for other types of mortality.

NCBD, CP3R Performance Rate Comparisons**

BREAST CARCINOMA

NATIONAL MEASURES

Our Program

(SMC)

Our State (IN)

Our Census Region

Our ACS Division

(Lakeshore)

My CoC Program

Type (CCP)

All CoC Programs

BCSRT - Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer

100% 95% 93% 92.3% 90.2% 91.5%

HT - Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB - III hormone receptor positive breast cancer.

100% 94.2% 93% 92% 90.1% 91.2%

MASTRT - Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with ≥ 4 positive regional lymph nodes

100% 95.3% 90.4% 90.7% 86.3% 87.6%

nBx - Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer.

100% 91.3% 90.7% 91.8% 88.1% 90.3%

National performance measures are used to measure treatment practices. Schneck monitors and compares data in an effort to maintain a high-level of cancer care. Schneck’s performance rate exceeds others across the nation.

** Comparison data provided by COC, Quality Improvement Program (CQIP) Annual Report 2015, updated February 2016, and reviewed October 4, 2016.


PALLIATIVE CARE PROGRAM

Rev. Stephen Barrett has been a Hospice/Palliative Care Chaplain at Schneck since 2011. A pastor for twelve years, he is a member of the Association of Professional Chaplains.

Aaron Banister, Ph.D., is a licensed counseling psychologist specializing in health psychology, cognitive behavioral therapy, and anxiety-based disorders. He has been with Schneck since 2013.

Donna Butler, MSN, ANP- BC, OCN, ACHPN, FAAPM, has been focusing on palliative care since 2003. She is certified in oncology, advanced hospice, and palliative care nursing and a fellow of the American Academy of Pain Management.

Anita Collins, MSN, FNP-BC, has been a nurse practitioner since 2008, focusing on pain management. She has worked at Schneck Medical Center since 1991.

Leighana Crenshaw, MSW, LSW, has been a social worker since 1994, joining Schneck in 2000. She has been active in the Palliative Care program since 2011. David Hartung, DO, is the medical director of the Palliative Care Program. Dr. Hartung joined Schneck’s medical staff in 2005. He is board certified in family medicine.

Schneck’s palliative care team will work with primary care physicians to combine pain and symptom

control in all aspects of our patient’s care plan.

Brittaney Haynes, RRT, is a Registered Respiratory Therapist. With Schneck since 2007, she is the disease management Patient Care Supervisor for the respiratory care department. Brittaney joined the Palliative Care team in 2016. Colette Mills, RN, BSN, CHPN, has been an RN since 1989. With Schneck Hospice since 2008, she has served on the Palliative Care team since 2011. She is a certified Hospice and Palliative Care nurse.

Dana Prieto, RN, BSN, OCN, is an experienced nurse with training in pediatrics, medical/surgical, ICU and oncology. She become an RN in 2007, joining Schneck in 2010. Dana has served on the Palliative Care team since 2012.

PALLIATIVE CARE PROGRAM UPDATES The program began in 2011 and has since expanded its

role with the addition of Anita Collins, who follows

chronic illnesses such as COPD and CHF. These illnesses

often begin within the inpatient setting.

Performance improvement is continually monitored

and demonstrates improved symptom management.

The program became accredited by The Joint

Commission in December of 2015.

Donna Butler and Anita Collins spoke about the

program in November at the Center to Advance

Palliative Care (CAPC). The poster presentation

highlighted the program’s commitment to supporting

the grieving process by holding memorial services for

employees to remember patients lost and to recognize

the caregivers.

2015 ancer 2016 ancer Program Report · 2018. 12. 11. · Directory of Terms 14 Palliative are...

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