Annual Report 2012

Our mission is to improve the outcomes of our patients with cancer, ease their pain and suffering, help patients and families live a better quality of life despite these challenges, and provide a compassionate, understanding, and safe environment.

The Foley Cancer Center has been honored to receive generous support from others over the years. Every gift helps to make a difference to those who need advanced and compassionate health care. We see gratitude on the faces of our patients and their families every minute of every day!

Gifts large and small have allowed us to change and improve the lives of our families, friends and neighbors.

Special thanks to the students at Christ the King School, who have created beautiful cards each year to cheer up our patients and raised money to support our programs and to the organizers and generous donors featured below. On behalf of our patients and their families, along with our physicians, nurses and clinical staff, thank you for your support.

The Pink Truck

Patten Oil’s pink truck initiative continues to raise awareness and critical funds for the Foley Cancer Center. Since the pink truck first hit the road in May 2009, the truck has generated nearly $12,000 in support for the Foley Cancer Center.

Mary Wells Heath 5K Memorial Run

Held in memory of avid runner, Mary Wells Heath, since 2007 has raised $14,700 in support of the Foley Cancer Center.

3rd Annual Pink the Rink

The Castleton Women’s Ice Hockey Team held the 3rd Annual Pink the Rink at Spartan in November. Specially designed hockey jerseys were auctioned prior to the game and a variety of events at the game made a special night for fans and supporters of the Breast Care Program. Since 2010, the team has raised over $21,000 diagnosis.

A Special Thanks10th Annual Alan Woodard Memorial Ride

Held in honor of Alan Woodard, an avid biker, the memorial motorcycle ride is held in June and raises valuable funds for the Foley Cancer Center. Bikers ride from Woodard Marina in Bomoseen to Americade in Lake George, NY in tribute to Alan who passed away in 2001.

5th Annual Gayle Sheldon Memorial Ride and Family Fun Day

In honor of Gayle Sheldon, her children and their families honor their mother who fought a cou-rageous battle with glioblastoma, a type of brain tumor that is among the most common and devastating of all brain tumors. The event and proceeds from the event help to raise awareness of brain cancer and raise vital funds to improve the quality of life for patients and their families living with the struggles of cancer.

Birthday Boy Donates Gifts to Foley Cancer Center

When soon-to-be five year old Myles Tristan Donohue decided to have his birthday party at Milky Way Organic Farm, he also decided to give back to others who face the challenges of a cancer diagnosis.

The birthday boy decided that, in lieu of presents for himself, he would ask that party guests make a donation to the Foley Cancer Center in honor of the help his father, Joe received as a cancer patient.

Thank you, Myles for your generosity!

Chairman’s ReportThe Foley Cancer Center is thriving! We continue to provide the very best compassionate, state-of-the-art cancer care right here in Rutland, Vermont. We are very proud of the Rutland community which so generously supported the capital campaign which brought us our fabulous new Varian

linear accelerator. We feel very well positioned for the future with this versatile piece of modern radiation therapy equipment. Please see the details of Dr. Lovett’s report for a more in depth understanding of this past year of radiation therapy.

We are exceptionally proud of our oncology certified nurses. Several of our nurses participated in recertification or first time certification. Congratulations to all!

We continue to work closely with our cancer liaison physician, Victor Pisanelli, Jr., MD, who provides us with guidance in the overall cancer program and with interpretive expertise reviewing data and our cancer program goals.

Our Breast Care Program flourishes under the direction of Loreen Eddy, RN. Loreen helps women navigate the complexity of breast health, and chaperones patients through the appointments, biopsies and procedures often necessary for our patients with abnormal mammograms. We continue to see patients in a timely fashion and pride ourselves on the speed with which women move from initial evaluation through final diagnostic and therapeutic appointments.

The Palliative Care Program has grown and expanded under the leadership and clinical expertise of Eva Zivitz, CHPN and Jessica Rappeno, RN. The hospital community has embraced the program and the benefits to our patients and their families are immeasurable. Our community is aware of the help palliative services provide. In hospital care is more efficient, less costly, and is tailored to the wishes and understanding of each patient. Over the past 5 years we have seen an average of 20% growth annually in the number of patients served by our palliative care team. Please read the report on Palliative Care to learn more about this critically important service.

During 2012, Samantha Helinski, RN BSN CWOCN took over the reigns of the inpatient

oncology unit on the 5th floor of the hospital. Sam brings great enthusiasm and personal experience to her new position. We look forward to reinforcing initiatives focusing on the specialized needs of our cancer patients, particularly, pain management and symptom evaluation. We have begun a “lunch and learn” collaboration among the professionals in the outpatient cancer center and the inpatient unit to share our expertise and ultimately benefit our patients. Keep up the good work, Sam!

Sheela Martel, OCN has worked tirelessly to monitor and collect data related to several quality initiatives. Sheela and her nurse colleagues keep meticulous records day in and day out. The careful review of these data every quarter and their presentation at our quarterly cancer program committee meetings keeps us aware of the efficiency and changing dynamics in our very busy outpatient clinic. This work continues to be critical to our daily successes.

Our research office is vibrant. We continue to encourage patients to enroll on clinical trial when possible and appropriate. Several national cooperative trials are open and we have strong relationships with several pharmaceutical companies who bring us new therapies. We are proud to offer these trials to patients who otherwise would have to travel long distances to obtain these drugs which often are not yet approved for general use.

We are lucky to have an enthusiastic and motivated oncology pharmacist right in our clinic. Clare Coppock, RPH, has developed educational tools and materials so our patients understand their treatments better. With all of the changes happening almost on a daily basis in the world of oncology drugs, it is essential to closely collaborate with our pharmacist. Our patients reap the benefits.

Jessica Greco, MSW, is now a mom to Olivia Marie Greco (OMG). Jess manages all aspects of the psychosocial needs of our patients, from counseling, to financial aid, to support group organization and more. Her demands have increased as more and more patients are feeling the brunt of the economic and social stresses of their cancer diagnoses. We thank the hospital administration for their continued support of our social worker position.

David Cranmer is a cancer survivor who is chairman of the organization, Vermonters Taking Action Against Cancer (VTAAC), a positiion supported by the American Cancer Society. David has been a regular member at our cancer program committee meetings and has been exceptionally helpful. He informs us about much of the

grassroots activities in Vermont and has helped direct several initiatives locally. We continue to work with David and the rest of the state to encourage appropriate colorectal cancer screening activities, mammography, and general cancer awareness. David has also been a supporter of our cancer survivorship initiative which has begun during 2012.

The National Marrow Donor Program (NMDP) enrolls potential donors who might be called on to donate bone marrow or stem cells for in need patients who do not have a sibling match for their stem cell or marrow requirements. Kerry Ellis, IT Analyst, has been the most successful individual in the Northeast raising awareness and enrolling new potential donors. Several donors who signed up under Kerry’s direction have been called to become donors for patients with leukemia. Thank you Kerry for all you do and have done.

We are proud of our relationship with the community through our various education and outreach projects. In particular we have created a regular program with the Rutland Free Clinic to screen women for breast and cervical cancer and provide appointments for pap smears and mammograms. These services are essential and are being provided free of charge and supported by a grant from Komen.

Every month, gynecologic oncologists from Fletcher Allen Health Care in Burlington (FAHC) hold a clinic in the cancer center for our patients with new or existing diagnoses of gynecologic malignancies. The clinic is popular and well received. Cases are reviewed with our local gynecologists for quality assurance and perr reviewed. The planning and easy follow-up provided by this clinic is a great convenience to our patients who otherwise would have to travel more than 60 miles one way for their office visits.

We continue to have and develop an important relationship with Rutland Area Hospice. Julie Scott, RN, regularly presents data and information about the national hospice initiatives and undercurrents. Hospice is critical for our community and we are proud of the strong and professional relationship we maintain.

As you can see, we are busy here in Rutland. Our programs are quite diverse, all essential, all growing. We are proud to serve our community with a group of professionals who recognize just how important all of these services are.

Allan Eisemann, MD

©2013 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Developer: Florin PetrescuThursday, February 14, 2013

Comparison of Rutland Area Cancer Data with the National Cancer Database Annual Report 2012

Testicular Cancer

Testicular Cancers are a relatively rare group of neoplasms which are categorized by the cellular elements found in the pathologic specimen. Germ cell tumors (testicular cancers) can have any of several cell types. Seminoma cells (pure or mixed), embryonal cells, yolk sac elements, choriaocarcinoma, and teratomatous elements are the cellular components found in testicular germ cell tumors. Testicular cancers are highly curable. The staging has been very carefully evaluated and the treatment options have been studied and systematized with the emphasis on evidence based decision making.

We looked at the period 2000-2010 and compared our testicular cancer data to the NCDB data set. (Figure 1) 19 cases of testicular cancer were diagnosed in Rutland.

Approximately 70 % of cases in the Rutland data set and in the national data set were stage I. Approximately 10 -20% of cases was stage II, and approximately 10% were stage III. Given the small numbers of cases overall in the Rutland data set, the correlation with the NCDB data set is quite consistent. In both the Rutland and NCDB data sets, approximately 50% of all cases were pure seminomas.

(Figure 2) The remainder of the cases were classified as mixed germ cell tumors or non-seminomatous. None of the Rutland cases were pure choriocarcinoma or pure yolk sac tumors. Both of these subtypes are rare. Pure yolk sac tumors and pure choriocarcinomas comprise less than 10% of all germ cell tumors. All patients who were diagnosed during this 10 year period are alive and free of disease.

Process Improvement: Financial Need

During 2012 the cancer center conducted a survey of 50 patients who were sequentially selected to answer questions about services provided or lacking. We were looking for services patients felt were lacking which would allow us to create an improved service plan based on patient request. Although we assist patients with financial needs, patients did say that not enough attention was paid to financial needs. As a direct result of this questionnaire, we implemented a new formal system designed to address this deficit. We initiated a formal program for our social worker to speak with each new patient and

speak with all patients under treatment about their financial situation and financial needs. After 3 months, the program was reevaluated for its success. An additional 25 patients were surveyed for the success of the program. Patients clearly recognized that an initiative was under way. Patients confirmed a significant improvement in our inquiries about financial need. We plan to periodically survey patients for how supported they feel regarding financial need and financial distress.

In 2012 in radiation oncology we have continued to improve processes in the delivery of treatment. We have partnered with our physics staff to begin the process of applying for certification with

the American College of Radiology. The first step of that process is to formalize our policies and procedures for the delivery of radiation for patients in our clinic. With our new Varian Trilogy Linear Accelerator, we must now update all our procedures for the new treatment planning, record and verify, and treatment delivery systems to assure high quality delivery of treatment.

We have already begun treatment with our Varian Rapid Arc system for the delivery of IMRT treatment. The Rapid Arc system delivers efficient treatment to patients who are often in pain, and allows throughput of patients to ease their pain, and to allow them more time for their personal life, minimizing their on treatment time.

We still have plans for the future for whole body stereotactic radiation and have begun

Radiation Oncologygathering the necessary equipment and expertise for this endeavor.

We have also, in May 2011, joined with Fletcher Allen Health Care for the physician coverage of our department. Dr Lovett, formerly a member of a Burlington based private physician group has joined Fletcher Allen Health Care and the University of Vermont, where he is an Associate Professor of Radiology. This alliance gives us more formalized peer review processes, which have been and will continue to be strengthened in the future. We have established a web link, with which we can do peer review of each patient’s treatment, within the first week of treatment.

Finally Dr Lovett has become a member of the American Society of Therapeutic Radiology’s Government Relations and Information Technology Committees. Through these committees we in Rutland will seek to influence the future of Radiation Oncology on a nationwide basis. Community service such as this brings a distinctive Rutland and Vermont touch to this very important cancer treatment field.

For a research project (APQI Study), we have partnered with a local high school student,

one who has completed the hospital’s HIPPA certification course, to review all patients who have received definitive radiation for lung cancer since our new linear accelerator was commissioned in May of 2011. This research can be found in this Annual Report in synopsis form. It has already been reviewed by our Investigational Review Board, presented at the Rutland High School Science Fair, at a Translational Research symposium at the Vermont Cancer Center at the University of Vermont, it is scheduled to be presented at the Vermont State Science Fair in the spring of 2013, and it is pending approval to be presented at the Annual Scientific Meeting of the American Society of Therapeutic Radiology, in Atlanta in the fall of 2013. It is titled “Comparison of Four Potential Parameters for Predicting Radiation Pneumonitis in Lung Cancer Patients”. This research adds to the literature on a common complication of radiation treatment for lung cancer. (See attached poster presentation)

Richard Lovett, MD

Comparison of Four Potential Parameters for Predicting Radiation Pneumonitis in Lung Cancer Patients

Christina Lovett Rutland High School, Rutland Regional Medical Center, Vermont Cancer Center

Radiation Pneumonitis is a sub-acute reaction to radiation in which the lungs develop inflammation. It occurs when the lungs receive radiation over the threshold dose due too large an area of lung tissue. Currently common parameters for monitoring lung dose are the Volume of Lung Receiving 10 Gray (V10), the Volume of Lung Receiving 20 Gray (V20). Both are measured in percent of total lung volume. V10 should be kept below 40% and V20 should be kept below 20% to avoid radiation pneumonitis. Depending upon the volume of the tumor present, the radiation ports necessary to treat a patient may or may not meet these parameters. Unfortunately, these two parameters are only two points on a curve of radiation exposure, the Dose Volume Histogram (DVH). .

Introduction

Four images of a patient with l u n g c a n c e r r e c e i v i n g radiotherapy. The first image is a digital radiograph with the whole lung volume shaded in purple. The second shows the location of the tumors (GTV, gross tumor volume) in blue. The third shows the expanded PTV or potential tumor volume in mauve. The fourth image shows the radiation port in yellow. This is the anterior port size and shape. .

Radiation oncologists use a Dose-volume histogram (DVH), which is a graph that compares the ratio of total structure in percent and the relative dose in cGy, when creating a treatment plan for a patient. The patient’s treatment is planned using a three-dimensional CT scan. The doctor looks at the entire CT scan and contours the tumor in each slice of the scan and the volume of lung tissue. Then the computer program shows the doctor how much radiation is given to the lung volume using a dose volume histogram. .

Dose Volume Histogram

Above is a super imposition of the DVHs from the patients that I used in the project showing the variability of the lung radiation dose for the group of patients. .

Question Is the area under the Dose- Volume Histogram able to predict radiation pneumonitis in lung cancer patients? .

Hypothesis If I take the integral of the Dose-Volume Histogram graph then it could potentially be a useful way to measure lung tolerance because it takes into account the amount of radiation the lung receives (instead of V10 and V20). .

Procedure Step 1: Record the patient identification number, admission date, pathology, stage, Clinical Treatment Volume (CTV), Gross Tumor Volume (GTV), whole lung volume, ratio of GTV and whole lung volume, Potential Tumor Volume (PTV), ratio of PTV and whole lung volume, percent of lung that receives 1000 cGy (V10), percent of lung that receives 2000 cGy (V20), minimum does of radiation that the lung received, max dose of radiation that the lung received, and the mean does of radiation that the lung r e c e i v e d . . Step 2: Record dose for every 10% of the DVH. Step 3: Use a scientific calculator to calculate the quartic function, and then the integral of the DVH curve. Step 4: Make nine graphs comparing each parameter to one another using regression analysis.

Data Patients N= 22

Stage

I 5

II 3

IIIa 10

IIIb 4

Mean Follow-up 6.8 months

Patients Expired 7

Patients Recurred

6

Patients with Pneumonitis

1

Volume (Average)

Whole Lung

4087 cc

PTV 227.6 cc

PTV/ Whole Lung

5.8%

Pathology

Adenocarcinoma 8

Squamous Cell 5

Small Cell 3

Large Cell 1

Non Small (NOS) 3

Carcinoma 2

Materials & Method Twenty two consecutive lung cancer patients from a single institution (Rutland Regional Medical Center) were chosen from patients treated from May 2011 to February 2013. All patients were treated definitively with doses to the tumor of 60- 66 Gray. All were treated on a Varian Trilogy Linear Accelerator, with treatment planning done on a Varian Eclipse Radiation Treatment Planning Computer. To maintain patient confidentiality, patients were known only by their medical record number. .

Results & Analysis

Comparisons of V10, V20, and Area Under the DVH Curve, and Mean Lung Dose and Energy for the patients analyzed with linear regression lines placed along with R e g r e s s i o n Co e f f i c i e n t f o r e a c h r e g r e s s i o n . .

As one can see the regression coefficients are as follows:

V10 vs. V20 .62 Mean dose vs. V10 .60 V10 vs. AUC .64 V20 vs. AUC .92 Mean dose vs. AUC .95 Mean dose vs. V20 .95 V20 vs. Energy .44 V10 vs .Energy .55 Mean Dose vs. Energy .39

Thus the V20, the Mean Lung Dose and the Area Under the DVH Curve all have a strong relationship to one another as shown by the high Regression Coefficient value.

Discussion In this experiment I examined the Area Under The DVH Curve (AUC) to see whether it can be used to predict radiation dose to the normal lung in a patient being treated for lung cancer. I used a comparison of the AUC with three commonly used parameters of lung exposure, the Mean Lung Dose, the Volume of the Lung Receiving 10Gy (V10), and the Volume of the Lung Receiving 20Gy (V20). The Area Under the DVH Curve can be measured using common mathematic techniques (integral calculation of the DVH curve) and can be calculated for any patient irradiated. The Area Under the DVH Curve has a strong relationship with the V20 and the Mean Lung Dose. I also converted the AUC measured in Gy versus percent of lung volume, to Gy versus kilogram of lung tissue. This measures the AUC in Joules (Gy/kg) given to the lungs. The number of Joules given to the lungs was closely related to the V20 and mean lung dose, but the relationship was not as close, most likely because it introduced a new variable, total lung volume to the analysis.

. This experiment used the parameter of Area Under the DVH Curve calculated by using DVH Curves with Dose versus percent of lung volume. This was done to compare all DVH curves to one another using percent as the unifying factor since each patient had a different whole lung volume. I measured the whole lung volume in each patient and using my data, the radiation energy imparted to the lungs in joules could be calculated from the Area Under the DVH Curve by using actual lung volume rather than percent lung volume (1 Gray equals 1 joule delivered per Kilogram of tissue). . This experiment examined 22 consecutive patients treated over 22 months in a single institution. All patients treated were inoperable by stage or for medical reasons. Seven of 22 patients (68% survival) thus far have expired, one has developed radiation pneumonitis (4.5%). Six patients have recurred (27.3%). All received chemosensitization as part of their regimen. However although my data is accurate, I noticed two possible errors. When I collected the ten points on the patients’ DVH graphs, I rounded to the hundredth place. Also, the graphing calculator rounded when calculating the integral. When I first calculated the integral I experienced a few problems. Microsoft Excel did not produce accurate trend lines for my graph. Therefore when I used those trend lines in the stand alone project to calculate the integral, the integrals were wrong. If I were to do this project again I would have just used my graphing calculator to calculate the integral.

.

Conclusion The Area Under the DVH Curve can be used to examine patients for radiation lung dose. It is shown to have a strong correlation with the V20 and the Mean Lung Dose. Further research must be done to determine whether this easily measured parameter is truly useful in the delivery of safe radiation to lung cancer patients. A prospective study could follow with pulmonary function testing done before and after radiation to test for lung toxicity.

.

References • Halperin, E. (2008). Principles and practice of radiation oncology.

(5th ed.). Philadelphia: Wolters Kluwer/ Lippincott Williams and Wilkins.

• Leibel, S. (1998). Textbook of radiation oncology. (1st ed.). Philadelphia: W.B. Saunders Company.

• Pass, H. (1996). Lung cancer: Principles and practice. Philadelphia: Lippincott- Raven

Credit Richard D. Lovett M.D.

Comparison of Four Potential Parameters for Predicting Radiation Pneumonitis in Lung Cancer Patients

Christina Lovett and Richard Lovett, MDRutland High School, Rutland Regional Medical Center, Vermont Cancer Center

RAVNAH Hospice Program and the Foley Cancer Center2012, again, was a year that had many changes as is common with most hospice programs. Fluctuating census and shorter length of stays certainly affect Hospice programs. RAVNAH continues to serve patients in Rutland County as well as Bennington County which includes the communities of Manchester, Arlington, Sunderland and Sandgate. Services in those communities are provided by Manchester Health Services as part of the -Southwestern Vermont Hospice Network. The towns of Dorset and Rupert, although in Bennington County, are serviced by RAVNAH.

There were 201 new admissions in 2012 and 154 deaths during that same period. 34 patients were non death discharges. 12 patients were discharged from the program as they no longer met the qualifications required to remain on the hospice program. 22 patients revoked because they either were seeking treatment or were refusing services. 138 referrals came from community based physicians or practices, 85 from an acute care facility, 7 from a long term care facility and 3 from other sources. The average length of service was 59.51 days. The median length of stay was 30 days. Our average daily census for 2012 was 31.

CMS continues to be most concerned with those patients who were on 7 days or less and those on service for 180 days or more. At RAVNAH, 51 patients were on service for 7 days or less and 18 for more than 180 days

Staffing was more stable during 2012. A volunteer coordinator was hired in late January. A part time nurse was added in the spring but one nurse decreased her time. The fulltime nurse also decreased her hours in the fall to work on another agency project. The social worker resigned in the spring and a master’s prepared social worker was hired who started in June.

Volunteers logged over 1500 hours of direct patient contacts and travelled over 8600 miles. There are approximately 70 active volunteers. The singing group known as

Trillium number about 60 and usually sing in groups of 4-8. The Trillium group sings for patients every two weeks and may sing for community events and funerals also. The group also sings at the annual Tree of Remembrance service. Volunteers have also participated in helping in the office. One training was held in the late winter for 8 weeks with sixteen participants.

The chaplain/spiritual advisor visits with hospice patients as referrals are received. She has conducted funerals and graveside services and held remembrance observances at an Assisted Living Facility and a senior housing residence. The chaplain also participates in the weekly interdisciplinary meetings.

The bereavement coordinator conducted 2 support groups of six sessions each and three bereavement workshops during 2012. There were three editions of a bereavement newsletter mailed to families, local clergy and mental health professionals. A Tree of Remembrance ceremony was held in December with about 175 community and family members attending.

RAVNAH continues with Start the Conversation presentations to the community. These presentations are conducted by hospice staff and the community relations office.

Staff attended the annual hospice conference at Lake Morey. One staff member attended the NHPCO Leadership conference in Maryland and another attended the Clinical Conference in Florida. We also participate in webinars with topics pertinent to hospice.

Hospices across the country began to collect data in October regarding what is known as the Comfortable Dying Measure. This measure asks patients to answer questions specific to pain on admission and at 48 hours after admission. This data will be required to be submitted to CMS in 2013. Although the first data will comprise only 3 months, data collected in 2013 will be collected on a yearly basis and submitted in the following year. Further data will be required to be submitted in the following years but the measures have

not been determined as yet. There will be a penalty if the data is not submitted timely.

RAVNAH is a member of the National Hospice and Palliative Care Organization (NHPCO) as well as the Hospice Council or Vermont and the Visiting Nurse Association of America. (VNAA)These organizations are advocates for hospice, meet with legislative representatives and provide opportunities for education.

Hospice continues to be an important part of the services that RAVNAH provides to those in the community that have an appropriate diagnosis and meets the criteria of the Medicare Hospice Benefit.

2012 was a quiet year for Tumor Registrars doing abstracting. There were no major changes to coding rules or software upgrades. The only change was the new Commission on Cancer Program Standards. For the registry, the majority of the standards are relatively unchanged despite the new numbering and order of them. There are new standards for our cancer program that will be phased in by 2015. These are all patient related including patient navigation, psychosocial distress screenings, and having a survivorship care plan in place. Tumor Registrars are the data warehouse of cancer programs. Most of the standards involving data are required to be monitored by the registrar. The following are some of the standards that we as a cancer program need to comply with.

Standards 1.2 and 1.3 Cancer Committee Membership and Attendance. As a cancer program we are required to have a committee that oversees our work. This committee needs to meet once per quarter and has specific clinical and organizational members that are required to attend. Members need to attend at least 50% of our meetings. Our committee meetings are where we come together to make decisions and review projects that we have been working on.

Tumor Registry 2012

Tumor Registry 2012 (continued from previous page)Standard 1.6 Cancer Registry Quality Control Plan. High quality data is required to accurately assess treatment outcomes and patient survival. Thus, a registrar’s work is reviewed at multiple levels. First by the registrar in abstracting and completing a case, then by a committee that reviews cases, a second complete review is done by the Vermont Cancer Registry, and lastly the data is reviewed by the NCDB. Our committee’s review includes looking at the registrar’s abstract of the case and comparing that with the information in the patient’s chart. Data reviewed includes: timeliness, casefinding, and accuracy of many date elements. A minimum of 10% of our annual cases need to be reviewed each year.

Standard 1.7 Monitoring Cancer Conference Activity. Here are Rutland Regional we have set the standard of having at least monthly Tumor Board meetings. Usually, we go above our goal and have at least 3 per month if not 4. Tumor Board is a meeting where treating physicians and other clinical personal get together to discuss specific cases that we are treating. Discussion focuses around diagnosis, treatment options, and patient wishes. By working together we can more effectively and efficiently treat our patients, all the while making sure their needs and wishes are met, to be best of our ability.

Standard 1.11 Cancer Registrar Education. Tumor Registrars are required to have continuing education each year in order to retain their certification. Education credits can be gained through many different activities including conferences, courses, and presentations. Registrars need to earn a total of 20 credits every 2 years. In the fall of 2012, the Vermont Cancer Registry held a conference for all of the state’s registrars. Topics included the new CoC standards, changes to the hematopoietic database, casefinding, and the environmental public health tracking system. Standards 5.3 and 5.4 Follow-up of All and Recent Patients. Registrars are required to follow their patients from the date they were diagnosed or treated at the facility. Data on each patient needs to be updated at least once

every 15 months. Data that is usually collected is vital status and if their malignancy is still present and being treated. At Rutland Regional we try to make contact with approximately 1,000 patients each month that we do not have current information on. Each month about a 1/4-1/3 of these patients’ cases are updated. Reasons for the low percentage mostly include patients that have moved away without giving and new contact information. Despite this we still reach the standards requirement that at least 90% of our patients are followed on within the 15 month timeframe.

Standards 5.5 and 5.6 Data Submission and Accuracy of Data. Each year cancer programs are required to submit their annual cases to the National Cancer Data Base (NCDB). This requires upgrading software that will collect the correct cases to be submitted. Registrars run reports that include these cases and then

put them through a series of edits that find any errors within the cases. Even though cases are edited at the time of abstraction a small number of cases will have errors at the time of NCDB submission. The cases found to have errors are reviewed by registrars and any errors are corrected prior to NCDB submittals.

These are just some of the standards that the tumor registry must follow. There are many others that affect the cancer program for both administrative and clinical personnel. From standard goals on the number of patients to enter clinical studies, to program improvement, to following specific treatment guidelines based on a patient’s diagnosis. Being part of a certified cancer program sets all of us up to have higher standards in the work we do, and having our patient’s health be our number one priority.

Total 2012 2011 2010 2009 200839 8 4 7 16 41 0 0 0 1 0

11 5 2 2 1 14 1 0 0 3 03 0 0 0 3 05 0 1 1 3 02 1 0 0 1 0

11 1 1 3 3 32 0 0 1 1 0

337 61 65 62 70 7933 11 5 8 3 612 4 4 2 1 111 0 4 3 3 1

155 24 26 30 40 3551 10 8 8 7 187 1 2 0 4 08 1 0 2 3 23 0 0 1 0 2

11 2 3 3 3 041 8 11 5 5 125 0 2 0 1 2

318 59 46 65 79 692 1 0 0 1 0

20 4 1 7 6 2296 54 45 58 72 67

3 0 1 0 2 09 2 2 1 1 3

69 5 12 26 15 1166 5 12 24 15 103 0 0 2 0 1

352 84 63 75 68 6293 21 20 16 14 227 1 2 0 1 3

72 15 17 13 10 1713 5 1 2 3 21 0 0 1 0 0

224 27 49 36 60 52218 25 48 35 59 51

6 2 1 1 1 1119 21 22 26 26 2480 13 18 14 20 1538 8 4 11 6 91 0 0 1 0 0

35 3 5 4 11 1222 3 4 2 6 713 0 1 2 5 517 0 2 5 4 613 0 2 4 3 44 0 0 1 1 2

91 22 16 15 20 1811 3 1 1 2 411 3 1 1 2 480 19 15 14 18 1459 14 8 12 13 1221 5 7 2 5 223 5 5 2 4 743 9 14 5 8 724 5 8 3 4 419 4 6 2 4 384 20 19 14 13 18

1,856 347 345 359 411 394TotalMISCELLANEOUSMyeloid & Monocytic LeukemiaLymphocytic LeukemiaLEUKEMIA

NHL - ExtranodalMYELOMA

NHL - NodalNon-Hodgkin Lymphoma

Hodgkin - NodalHodgkin LymphomaLYMPHOMAOther Endocrine including ThymusThyroidENDOCRINE SYSTEMCranial Nerves Other Nervous SystemBrainBRAIN & OTHER NERVOUS SYSTEMUreterKidney & Renal PelvisUrinary BladderURINARY SYSTEMTestisProstateMALE GENITAL SYSTEMVulvaOvaryCorpus & Uterus, NOSCervix UteriFEMALE GENITAL SYSTEMBREASTOther Non-Epithelial SkinMelanoma -- SkinSKIN EXCLUDING BASAL & SQUAMOUSSOFT TISSUEBONES & JOINTSLung & BronchusLarynxNose, Nasal Cavity & Middle EarRESPIRATORY SYSTEMPeritoneum, Omentum & MesenteryPancreasOther BiliaryGallbladderLiver & Intrahepatic Bile DuctAnus, Anal Canal & AnorectumRectum & RectosigmoidColon Excluding RectumSmall IntestineStomachEsophagusDIGESTIVE SYSTEMOropharynx & HypopharynxTonsilNasopharynx

Primary Site

Gum & Other MouthFloor of MouthSalivary GlandsTongueLipORAL CAVITY & PHARYNX

The Breast Care Program at Rutland Regional Medical Center had a very busy year, hosting many events to raise awareness of breast cancer and breast health, also engaging women in the conversation. We held our Mother’s Day Magic event and had 90 children participate. We hosted a successful luncheon for seniors with approximately 30 attendees. Additionally, we actively participate in health fairs around the state. Our one-on-one sessions with mammography patients continue to work well, meeting with hundreds of women. Perhaps our greatest success in that regard, however, has been our continued collaboration with the Rutland Free Clinic, where we meet with uninsured/underinsured women and arrange mammograms for them all in our now very streamlined process. Pink Day in Depot Park continues to be very popular. Nearly 200 people stopped by our booth, participating in our educational activity and receiving important breast health information. Our third annual Pink the Rink with the Castleton State College Women’s Hockey Team was again a huge success with a great turnout. The Breast Care Program’s in-hospital events, such as Pink Day at Rutland Regional Medical Center and the Delicious in Pink Bake Sale also continue to be popular and well supported.

In addition to all the community events we host, support and attend, we also remind everyone the Breast Care Program is here to meet with patients every day for imaging, care, education and reassurance. It is the combination of our efforts in the hospital, as well as out in the community collaborating with these other groups that makes the Breast Care Program what it is.

The support and funding from larger organizations, such as Komen, as well as the community as a whole makes the success of the Breast Care Program possible year after year. Without everyone working together as well as they do, it would be difficult to spread our message; early detection is the best protection.

At our November meeting, Golden Swab Awards were presented by Jennifer St Peter, Account Executive, Be The Match at Rhode Island Blood Center. These awards are presented yearly and are in appreciation of contributions to, and support of, the Be The Match Program. 2012 recipients were Linda McKenna from the Foley Cancer Center, Jill Jesso-White from Marketing at Rutland Regional Medical Center, and volunteers extraordinaire Dave White (also a Rutland Regional employee) and Morgan Tyminski.

In July, Emily Packard, 15 yr old racecar driver, approached the Foley Cancer Center about doing something for kids with cancer. While the FCC doesn’t treat children, social worker Jessica Greco thought of a patient with children who are race fans. On July 20th, the patient’s daughter’s birthday, Emily and her family brought the race car to Rutland Regional Medical Center as a surprise for the family. Emily’s mother, Jennifer, baked a cake in the shape of the racecar for the birthday girl. The family was also honored at Devil’s Bowl Speedway that night — even getting a ride around the track in the pace car with Emily driving. The rest of the race season, Emily displayed the Be The Match logo on her race car and the team will be holding a marrow registration in the spring.

In November, Kerry Ellis, Program Coordinator, attended the National Marrow Donor Program’s Annual Council Meeting in Minneapolis. This conference brings together professionals involved in transplantation from around the world and provides updates on the state of transplant science, the registry, new initiatives, and educational workshops. A highlight of this year’s meeting was a first time meeting between a transplant patient and the donor who saved her life. The donor was from our partner donor center, the Rhode Island Blood Center.

In 2012, we had 28 drives and added 374 donors. Thirteen were called for additional testing and two actually donated. Our fundraising added $4,697 for this program.

Pharmacy ProgramBreast Care

ProgramMarrow Donor

Program

The Foley Cancer Center continues to offer Clinical Trials to our eligible patients. Four patients went on study in 2012 as well as the 25 patients we continue to follow. Two new studies through Millenium Pharmaceuticals were opened in 2012. One for lymphoma and one for metastatic breast cancer.

We currently have 12 clinical trials available. These can be viewed on the Rutland Regional Medical Center website at www.RRMC.org. Respectfully submitted,Rebecca Denofer, RN, OCNClinical Research Coordinator

Research and Clinical Trials

The Pharmacy Program at the Foley Cancer Center had its first dedicated 6th year pharmacy student complete a 6-week rotation this year. This student provided opportunities for education sessions on new therapies for the nurses and providers, plus he met with many of the patients to review their complete medication regimen. The pharmacists continue to meet with all patients to review their medications and to answer any questions they may have about their chemotherapy regimen or any other medications they are taking. The pharmacists and technicians continue to work with the providers and nurses to provide safe and effective chemotherapy treatments to all patients treated at the Foley Cancer Center.

Social Work ReportJessica Greco, MSWThe Foley Cancer Center has an Oncology Social Worker who provides counseling and offers support to patients and their families. Jessica has a Master’s Degree in Social Work and is a member of the Association of Oncology Social Work.

2012 Support Group Meetings 2012 Support Group Meetings

W2W Support Group

Meetings are held on the 1st Tuesday of every month from 5-7pm in the CVPS/Leahy Community Health Education Center. Beverages are provided, meals are potluck.

Man to Man Support Group

Meetings are held on the 4th Wednesday of every month at 5:30pm in the CVPS/Leahy Community Health Education Center. Contact Bob Harnish at 802.483.6220 or Jim Russell

at 802.362.2244.

Tea for the Soul

A support group for caregivers of persons with cancer. This group meets in Conference Room #3 from 2-3:30pm the 1st and 3rd Wednesdays of each month. Please contact Jessica

Greco at 802.747.1693 for more information.

Look Good Feel Better

Look Good/Feel Better is a free program through the American Cancer Society for people undergoing cancer treatment. Beauticians registered with the Program in the Rutland area

provide consultations and tips about makeup and wigs to teach you skills to enhance your appearance.

Grief Support Group

A support group for those who have lost a loved one to cancer. This group meets biweekly in the social work lounge from 5-6:30pm. Please contact Jessica Greco at 802.747.1693

for more information.

Yoga Group

A six week program focusing on helping cancer patients break the cycle of stress, quiet the mind and learn relaxation techniques. The classes are guided by a cancer survivor and

Kripalu yoga instructor. For more information please contact Jessica Greco at 802.747.1693

Palliative Care ProgramPalliative Care is defined as specialized care that is an extra layer of support for patients and their families who are facing serious, chronic, or life-threatening illness. The care aims to provide patients with relief of distressing symptoms, and helps patients and their families understand and cope with the impact of serious illness. Regardless of prognosis or diagnosis, the Palliative Care team helps to educate patients, their loved ones, and the care team about their options for keeping treatment plans in line with patient goals and values.

The Palliative Care Program at Rutland Regional Medical Center has been providing support and education to patients, families, staff, and the Rutland community since 2005. Begun on the foundations of the Advanced Illness Coordinated Care out-patient program of the Foley Cancer Center, the Palliative Care Program consists of two Hospice and Palliative Care certified nurses who are available to patients who have been admitted to the hospital. These nurses meet

individually with patients and their families, and coordinate with the rest of the multi-disciplinary care team. In 2012, its seventh full year of operations, the Palliative Care Program received 654 referrals.

Although the main function of the Palliative Care Program is to give direct patient care, another important role is to promote awareness and education on end-of-life issues to the Rutland community of lay-public and health care professionals. Palliative Care nurses provide in-services to hospital staff, collaborate on hospital policy development, present at various community events, and are active members of the Vermont Act 25 Pain and Palliative Care Task Force, the Rutland County Caregiver Coalition, the Rutland CHF Re-admissions Reduction Collaborative, and the Hospice and Palliative Care Council of Vermont (HPCCV). The team also attends to its own professional development by regular participation in the Center for the Advancement of Palliative Care (CAPC) audio-conferences, the annual

HPCCV conference, and the International Congress on Palliative Care.

In keeping with the national trend for the expansion of Palliative Care, Rutland Regional Medical Center’s program has shown an increase in the numbers of patients seen in the Intensive Care Unit and the Emergency Department. During 2012 the team has also been working with a local Extended Care Facility to develop a pilot program to provide out-patient consultations for residents of both their short stay and long-term departments. Through education, collaboration, and direct care, the Palliative Care team looks forward to continuing to improve quality of life for patients and the state of end-of-life care for our community.

The Foley Cancer Center and the American Cancer Society partnered on several fronts to offer support services to cancer patients in Rutland county. In 2012, about 15% of the patients in Rutland utilized a service from the Society.

The Society coordinates a breast cancer support program which matches newly diagnosed patients with breast cancer survivors. The Reach to Recovery program is very active Rutland County and 25 matches were made in 2012. In addition, the Society coordinates a prostate cancer support group called Man-to-Man. This group meets monthly at the hospital and offers different

speakers and open discussions. Nearly 40 men participated in these groups in 2012. The Society also offers the Look Good.... Feel Better program monthly in the hospital. This program is geared toward helping women deal with the appearance-related side effects of cancer treatment. The Foley Cancer Center has offered full support of these services and is committed to informing and referring patients to these and other services as needed.

The American Cancer Society also offers books and resources to cancer patients. In 2012, approximately $550 in materials was provided to the breast care center and hospital support groups, including books on

understanding your cancer and dealing with a diagnosis. The Society also offers access 24 hours a day to patients and caregivers to information and support through its Cancer Resource Network at 1.800.227.2345. The Foley Cancer Center offers patients information on all services provided by the American Cancer Society. Respectfully Submitted, Leigh SampsonCommunity Executive, Health InitiativesNew England DivisionAmerican Cancer Society, Inc.

American Cancer Society Report

Complementary Therapies ProgramHealing the Whole PersonRutland Regional Medical Center has joined the growing number of hospitals that offer complementary therapies in a more formalized way as part of its treatment options to selected groups of patients. Complementary therapies are used alongside our more mainstream medical and surgical services.

What is Reiki?Reiki (pronounced Ray-key) is the art of energy healing. Reiki, or Universal Life Force energy, is a healing practice that originated in Japan and is used to relieve stress and promote healing. It can assist healing on all levels including mental, emotional and spiritual. Pleasant and relaxing, Reiki is frequently used in conjunction with conventional medicine and is intended to enhance, not replace, medical, surgical and nursing care in the hospital setting.

The goal of providing Reiki services is to offer relaxation, decrease stress, promote sleep and decrease anxiety, all of which support the recipient’s innate healing capacity. Volunteers can provide complimentary Reiki sessions to 1CU/PCU and 5th Floor patients who have requested the service. Let your nurse know if you would like to schedule a session. There is no charge for this service. Requests for Reiki sessions will be honored based on practitioner availability.

What Happens in a Reiki Session? In a Reiki session, the recipient lies down or sits comfortably, fully clothed or covered by hospital apparel. The room is quiet or there may be soft music playing. The Reiki practitioner places their hands lightly on or a few inches over the person’s body, palms down and uses a series of 12 to 15 different hand positions. Each position is held for 2-5 minutes, and the practitioner’s hands are never under clothing or bedding.

The recipient usually feels warmth and a tingling sensation. The recipient can ask the session to be terminated at any time, for any reason. What is Acupuncture? Acupuncture is the insertion of very fine, sterile needles into the body at precise points on the body. It has been used historically to treat specific disorders and to aid in strengthening vital energy of the body. These points have been confirmed by electro-diagnostic research. How Does Acupuncture Work?Acupuncture is based on the Chinese theory of the vital energy called Qi (“chee”) that all living things possess. When Qi flows freely through the body, it protects, warms, nourishes, and integrates bodily functions. When it is blocked, pain, dysfunction, or illness can occur. Acupuncture removes obstructions, promoting the free flow of Qi to restore health. Acupuncture also guides Qi to the channels that are deficient and drains Qi from places of excess seeking to restore energetic balance What Can Acupuncture Treat?Acupuncture can be used to treat many health problems, from acute or chronic pain to managing a number of chronic conditions and can also be used to maintain a sense of well-being.

There is no charge for Acupuncture for Foley Cancer Center & Palliative Care patients.

Acupuncture offered in Physical Medicine & Rehabilitation incurs a fee.

Healing Therapies? The C.A.R.E. channel (Continuous Ambient Relaxation Environment – channel 35) and Guided Imagery (channel 2) are two 24-hour television channels that have been proven effective for pain management, patient restlessness, stress reduction, and palliative care. The C.A.R.E. channel includes more than 70 hours of scenic nature video

accompanied by soothing instrumental music and includes day and night cycles to support the circadian rhythms.

You have the choice between various Guided Meditation programs, Children’s programs, and Nighttime programs to aid with sleep. There is also a Pre-Procedure program to ease tension, a Post-Procedure program to encourage confidence in the healing process, and a Labor and Delivery program for the early stages of labor and managing pain.

Animal Assisted Therapy (AAT) and Animal Assisted Activities (AAA) are therapies in which certified therapy animals are used to enhance a person’s educational, physical, cognitive and psychological being. Studies indicate a statistically significant reduction in anxiety for numerous disorders when people interact with animals. In both AAT and AAA people have received benefits of distraction, stress reduction, increased self-worth, emotional regulation, and re-connection to the outside world.

The animals are therapy certified through various international and regional animal agencies. Rutland Regional started using this therapy in its psychiatric wing and offers visitation on our 5th floor.

Persons wishing to use this therapy must talk with their attending physician or nurse in order to coordinate visits/sessions with the animal handlers.

Accredited Since 1984

2012 Cancer Program Committee Members

J.C. Biebuyck, MD

MaryLou Bolt

Kathleen Boyd, RN

Nina Buss, Ladies First

Maureen Chamberlain, MS, RHIA

Clare Coppock, RPH

David Cranmer – VTAAC

James F. Cromie, MD

Leonard DeLorenzo, PA

Rebecca Denofer, RN

Kelly Doaner

Carol Egan, CNO

Loreen Eddy, CBEC,CBPN-IC

Allan Eisemann, MD

Kerry Ellis

Kim Flory-Lake

Holly Fox, OCN

Amanda Freund, MS

Karen Alcorn, RN

Jessica Greco, MSW

Samantha Helinski, RN, BSN, CWOCN

Jill Jesso-White

Chrissy Littler

Rick Lovett, MD

Sharon Mallory

Sheela Martel, OCN

Linda McKenna, PA, Director

Tony Masuck, MD

Vic Pisanelli, MD

Jessica Rappeno, RN BSN, OCN,CHPN

Suzanne Redden, MD, Hospitalist

Barb Robinson, VP

Leigh Sampson

Julie Scott, RN Bridget Tarbell, CTR

Howard Weaver, MD

Eva Zivitz, CHPN