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KAISER PERMANENTE

ANNUAL CANCER REPORT 2018

MEDICAL CENTER

THE PERMANENTE MEDICAL GROUP

CANCER COMMITTEE

DECEMBER 2018

FRESNO

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OUR MISSION IS SIMPLE: Support our specialists in providing the best in

personalized cancer care. Kaiser Permanente’s integrated health care system

brings together a team of specialized physicians and cutting-edge technology

to provide each patient with the best in personalized cancer care.

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OUR COMMITMENT to Patients

Cancer care touches our lives both professionally and personally. It is a top

priority at Kaiser Permanente. All of our physicians work on cancer in one way or

another—whether to prevent it, detect it early, treat it when we find it, care for the

survivors, or comfort those who may pass away as a result of the disease. We’ve

made huge strides and continue to challenge ourselves through our commitment

to every patient.

OUR WORLD-CLASS Cancer Care Team Includes:

• Experienced specialists who treat

high volumes of patients

• Support at every step of care: risk

reduction, screening, diagnosis,

treatment, and survivorship

• Seamless and timely care

coordination

• Cutting-edge technology

• Patient-centered care

Our specialists work collaboratively to ensure world-class cancer care treatment

and outcomes for every patient, by leveraging our expertise, investing in cutting-

edge technology, and pushing the boundaries of what’s possible.

Cancer Care Achievements

Integrated Approach to Cancer Care……..5

Commission on Cancer Accreditation …...7

Kaiser Permanente’s Cancer Research

Paves the Way for Improved Outcomes…..9

Trends in Cancer Diagnosis……………..10

Appendix…………………………………..12

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Cancer Care Achievements

Cancer care is complex. We simplify screening, diagnosing, and treating patients with cancer

through our integrated approach to care.

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INTEGRATED Approach to Cancer Care

As one of the largest integrated health care systems in the United States, we can quickly adapt to advances

in treatment. We bring those benefits to our patients every day to perform thousands of treatments each year. At the

same time, we create truly transformational innovations. Both rapidly adapting and developing new advancements

is only possible by leveraging our specialists’ knowledge from many disciplines and medical centers linked together

by our electronic health record system.

We continuously weave advancements in equipment

and techniques with each patient’s medical history,

preferences, and unique needs. This means we

can automatically review incidental findings, such

as a thoracic imaging study that can be reviewed

by various experts. This process facilitates rapid

and consistent follow-up on unexpected cancer

discoveries at imaging.

Our expert care team will work together to:

• Review newly flagged cases

• Meet with each patient to discuss next steps,

treatment options, and personalized care

recommendations

It is the same as getting a second, third, and fourth

opinion at the start of the process.

Our integrative approach to care also allows us to

apply the most effective screening protocols to save

more lives, such as using universal reflex genetic

testing for Lynch Syndrome of all newly diagnosed

colorectal cancer patients.

Our multispecialty physician team will:

• Recommend multiple ways to provide patient-

centered care

• Bring cutting-edge treatment to patients

This multidisciplinary approach is distinctive of our

medical group and doesn’t exist in the fragmented

fee-for-service health care sector. We’re able to

standardize the best possible care, giving our patients

their best chance to beat cancer.

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CANCER CARE represents a large portion of our work at Kaiser Permanente. Only heart

disease affects more people than cancer in the United States, and the number of cancer cases

is quickly growing to surpass heart disease soon. We have an opportunity that other health care

systems may not—to change that trajectory. The Commission on Cancer provides a foundation

to focus on key quality care standards and our cancer program can lead this change.

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COMMISSION on Cancer Accreditation

There are more than 1,500 Commission on Cancer (CoC) accredited cancer

programs in the United States, representing only 30 percent of all hospitals

and treating more than 70 percent of all cancer patients. All Kaiser Permanente

Northern California facilities are accredited. To earn this prestigious

accreditation, a cancer program must meet or exceed 34 quality care

standards, be evaluated every 3 years, and maintain levels of excellence in the

delivery of comprehensive patient-centered care.

When cancer patients seek care at

a CoC-accredited cancer center,

they gain access to comprehensive,

state-of-the-art cancer care close

to home. Kaiser Permanente takes

this one step further. Our integrated

health care system allows for true

multidisciplinary, end-to-end care,

and treats cancer as a complex group

of diseases treated by a team of

specialists. Because of this approach,

patients have access to clinical trials,

new treatments, genetic counseling,

and patient-centered services,

including psychosocial support,

patient navigation, and a survivorship

care plan. We improve our patients’

quality of life—both before and after

cancer. These integrated partnerships

result in improved patient care.

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Clinical Trials Matter to Us

We’re proud to offer cancer patients access to cutting-edge treatment through

participation in clinical trials.

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Kaiser Permanente’s Cancer Research

Paves the Way for Improved Outcomes

We’re recognized for participating in numerous clinical trials with national and international research

organizations. All of our medical and radiation oncologists are investigators on our cancer research

team. There are more than 70 clinical trials available to patients at any given time. Because of this,

we offer patients access to cutting-edge treatment options and research in symptom management,

screening, and prevention.

In 2014, Kaiser Permanente was awarded

a 5-year grant of 10.4 million dollars from

the National Cancer Institute (NCI) to

conduct cancer clinical trials and cancer

care delivery research studies. We joined

4 other Kaiser Permanente Regions to

form an NCI Community Oncology

Research Program (NCORP). This new

program represents 1 of every 40 patients

in the United States and continues to bring

cutting-edge treatment options to our

patients while comparing existing cancer

treatments on a patient-by-patient basis.

The new funding will allow Kaiser Permanente

to expand its focus on research into care

delivery by:

• Evaluating alternative treatment delivery

systems

• Examining disease prevention

• Exploring pain and symptom management

• Investigating disparities in cancer outcomes

and how to eliminate them

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TRENDS in Cancer Diagnosis

The cancer registry is an essential component of the Commission on Cancer (CoC) accredited cancer

program and an invaluable tool in the fight against cancer. Like all CoC-accredited facilities, Kaiser

Permanente maintains a cancer registry and contributes data to the National Cancer Database (NCDB).

This nationwide oncology outcomes database is the largest clinical disease registry in the world. All

types of cancer are tracked and analyzed through the NCDB and used to explore trends in cancer

care. CoC-accredited cancer centers, in turn, have access to information derived from this type of data

analysis, which is used to create national, regional, and state benchmark reports.

Our cancer registry data aids in identifying trends, assists in program planning, and allows our

continuous evaluation of cancer care.

Specialists at this hospital interface with patients throughout our system. Our specialists’ experience

within the system is summarized in Table 1.

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Table 1. Kaiser Permanente, Northern California RegionAll Cancer* Cases Diagnosed 2013-2017: All Behaviors, All Stages

Leading Diagnoses by Year of Diagnosis (Ranked for 2017 Diagnoses)

SOURCE: Kaiser Permanente—Northern California Regional Cancer Registry (10/04/2018)

PRIMARY SITE OR TYPE 2013 2014 2015 2016 2017 Total

BREAST 3,885 3,746 3,937 3,873 3,926 19,367

MELANOMA 2,026 2,273 2,503 2,607 2,620 12,029

PROSTATE 2,449 1,443 1,729 1,788 2,052 9,451

COLORECTAL 1,559 1,685 1,652 1,687 1,648 8,231

LUNG/BRONCHUS 1,753 1,778 1,807 1,752 1,627 8,717

URINARY BLADDER 840 864 901 920 850 4,375

CORPUS UTERI 650 759 742 823 816 3,790

NON-HOD. LYMPHOMA 730 862 841 889 814 4,136

KIDNEY/RENAL PELVIS 606 585 716 748 732 3,387

BRAIN/OTHER NERVOUS 721 793 724 673 564 3,475

ORAL CAVITY/PHARYNX 466 508 525 521 529 2,549

PANCREAS 476 505 532 529 482 2,524

THYROID 396 411 479 448 455 2,189

ALL LEUKEMIA 534 535 497 545 366 2,477

LIVER/INT. BILE DUCTS 368 452 436 401 336 1,993

STOMACH 247 299 294 328 299 1,467

OVARY 247 303 285 263 232 1,330

MYELOMA 248 267 280 267 224 1,286

ESOPHAGUS 150 164 184 168 179 845

SOFT TISSUE/HEART 161 149 150 170 169 799

ANUS/ANAL CANAL 165 180 187 188 165 885

VULVA 162 169 154 161 154 800

TESTIS 108 121 131 122 124 606

HODGKIN LYMPHOMA 83 116 88 115 108 510

OTHER ENDOCRINE 187 169 170 157 96 779

SMALL INTESTINE 78 85 89 99 95 446

CERVIX UTERI 87 93 90 107 86 463

LARYNX 81 70 93 80 84 409

OTHER SKIN 83 97 118 104 83 485

OTHER BILIARY 67 73 59 79 67 345

ILL-DEFINED 661 607 574 540 355 2,737

ALL OTHERS 397 421 447 467 460 2,192

TOTAL 20,671 20,573 21,414 21,619 20,797 105,074

*NOTE: Brain/Other Nervous Category includes Benign/Borderline tumors

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Program GOALS

In 2018, Kaiser Permanente Fresno aimed to increase use

of the Fresno Medical Center’s Cancer Care microsite.

This website provides up-to-date information about cancer

care and treatment. Nurse leaders Corina Avram, RN, and

Fidelia Coras, RN, led this project. By using a multifaceted

approach, microsite usage increased from 34 visits in

September to 161 visits in October. This was a increase of

473 percent.

The success was achieved by:

1. Introducing the website in our weekly patient education

class.

2. Providing individual education for patients receiving

chemotherapy.

3. Providing the website link in patient After Visit Summaries.

4. Promoting usage among colleagues, patients, and care

providers.

This work will continue so we can provide patients with

comprehensive and accurate information that is important to

understanding their disease and treatment plan. This

knowledge empowers our patients and their families,

encouraging them to be informed care partners.

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Reducing Unnecessary Post-Operative

Appointments

Under the leadership of Cancer Liaison Physician

Nicole Hill, MD, Surgery, the Comprehensive Cancer

Care Committee sought to reduce the number of

unnecessary post-operative appointments for

surgical breast cases.

Approximately 30 percent of lumpectomy patients

had a post-operative appointment before pathology

results were available. Without these results,

physicians are unable to determine a care plan,

causing patients undue time and stress.

After reviewing our data, we determined that

scheduling post-operative follow-up appointments

seven to 10 days after the procedure enables us to

provide better informed care and decrease the

number of unnecessary appointments.

Our breast surgeons now follow this practice and we

have seen a 77 percent decrease in unnecessary

post-operative appointments. This saves our

members time, money, and additional stress.

Increasing Melanoma Surveillance Compliance

Under the leadership of Dermatology Chief Alan

Blankenship, MD, our Comprehensive Cancer Care

Committee improved the annual skin screening

compliance of patients diagnosed with melanoma.

National Comprehensive Cancer Network’s

guidelines indicate patients should have – at a

minimum – an annual skin screening.

A review of 2015 and 2016 melanoma cases

showed there was an opportunity for improvement.

By leveraging technology, Dermatology added

prompts in Kaiser Permanente HealthConnect, our

electronic health record system, to remind staff to

check and schedule patients for this annual skin

screening. Staff also review a reminder list and will

proactively call patients who have not been seen for

this annual screening.

Dermatology also created an educational flier that

highlights the importance of these annual skin

screenings to encourage patients to take these

preventive care steps. Self-skin exam education is

also available.

Quality IMPROVEMENTS

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In the COMMUNITY

We proudly support American Cancer

Society’s Making Strides Against Breast

Cancer walk.

resilience. Kaiser Permanente also led an

energizing Instant Recess session to get

attendees moving.

We host a certified, year-round farmers

market at our medical center every

Wednesday for employees, patients and the

community. Education materials highlight

healthy eating for cancer prevention,

managing weight and more. Kaiser

Permanente providers and health educators

have booths to educate shoppers about

smoking cessation, colorectal cancer

prevention, summer skin care, and the

importance of preventive screenings.

Kaiser Permanente Fresno is committed to the

communities it serves. In 2018, our physicians

and employees promoted total health at the

Central California Women’s Conference on

Sept. 25.

Assistant Physician in Chief of Medicine

Specialties and Oncology Chief Brandy

Box-Noriega, MD; Commission on Cancer

Physician Liaison Nicole Hill, MD, Surgery;

Medical Weight Management Program

Manager Lisa Huiras; and Women’s Health

Liaison Amanda Reeve, MD, Ob-Gyn, led a

panel discussion about “Women’s Health

and Well-being” highlighting wellness and

preventive care, stress management, and

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Screening PROGRAM

Kaiser Permanente has an integrated care delivery system

to promote cancer screening. During doctor appointments,

women are encouraged to book their mammogram.

Kaiser Permanente Fresno also has a recognition program

called “I Saved a Life” that acknowledges employees and

physicians who book these preventive cancer screenings

for our members. Often times, this leads to an early

diagnosis of cancer which prompts immediate treatment.

Employees in a variety of departments are trained to

ensure our members are up-to-date on their preventive

screenings.

Outreach is also done at our weekly farmers market. For

example, on Sept. 26, Cancer Program Administrator Sofia

Juarez scheduled members for their mammograms,

educated about the importance of mammograms in early

detection of breast cancer, and provided tips about breast

self-examination.

Our continued efforts in screening have led to early

detection of cancer for our members. The multidisciplinary

cancer committee’s work has helped support local

screening efforts.

Prevention PROGRAM

Cancer prevention is a top priority at Kaiser Permanente

Fresno. In 2018, our prevention efforts were focused on

melanoma skin cancer.

Melanoma is the 2nd most common cancer in our local

patient population. Each year, over 2,500 members are

diagnosed with this disease. Providing educational

outreach is critical.

On June 6, 2018, Kaiser Permanente Fresno hosted an

educational event where 175 participants received

sunscreen and skin protection tips, including how to protect

one’s skin during the summer months.

The educational event was hosted by Anna Cruz, RN,

Dermatology; Carmen Arambula, MSN, Oncology; and

Cheryl Nassrallah, MSN, Oncology.

A follow-up survey was used to determine the impact of the

outreach. Of the 27 respondents, 100 percent said that the

education influenced their personal decision to wear

sunscreen more frequently in order to prevent skin cancer.

Our committee found that health education in an informal

setting promotes engagement and positive health behavior.

ABOVE and BEYOND:

new National

Comprehensive

Cancer Network

guidelines for lung

cancer screening.

Dedicating time to

work with our

community partners is

important to our

physicians and

leaders. They are

committed to providing

education and advice

to help our

communities be

healthier and to save

lives.

screening for early

detection.

Lung cancer is

responsible for the

highest number of

cancer deaths. Dr.

Rivera wanted to

ensure that health

professionals

outside of Kaiser

Permanente

understood the

importance of CT

screening in lung

cancer diagnosis.

Working with nursing

partners in the

community helps

spread knowledge

and adoption of the

Oncologist Gabriel

Rivera, MD, regularly

demonstrates his

commitment to

improving cancer

screening and

diagnosis for early-

stage lung cancer.

On December 1, 2018,

Dr. Rivera spoke to

150 nurses and allied

health professionals at

the Annual Oncology

Nursing Society

Symposium in Fresno.

He provided education

on lung cancer and

emphasized the

importance of

Computer

Tomography (CT)

Gabriel Rivera, MD, Oncology

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CANCER Committee Members Role Member Designee Chair Brandy Box-Noriega, MD Grace Inouye, MD

Diagnostic Radiologist Sandra Carlsen, MD Robert Croutch, MD

Pathologist Yujie Xu, MD Sidney Carpenter, MD

Surgeon Nicole Hill, MD Subhendra Banerjee, MD

Medical Oncologist Gabriel Rivera, MD Grace Inouye, MD

Radiation Oncologist Giatri Dave, MD Li Liu, MD

Cancer Liaison Physician Nicole Hill, MD Subhendra Banerjee, MD

Cancer Program Administrator Cheryl Nassrallah, MSN, OCN Sofia Juarez, BS

Oncology Nurse Corina Avram, RN, Fidelia Coras, RN

Social Worker / Case Manager & Coordinator Rana Yamamura, LCSW Stasha Moreno, MSW

Certified Tumor Registrar & Coordinator Michael Oehrli, CTR, MPA Iram Rana, CTR

Palliative Care Theresa Chang, MD Jacob Silva, RN

Genetics Professional / Counselor Tamara Treisman, LCGC Jamie Fisher, LCGC

Cancer Conference Coordinator Rosa Granado Kimberly Capriola, MPH

Quality Improvement Coordinator Elisa Porter, BA Christi Donsanouphit, MHA

Community Outreach Coordinator Carmen Arambula, RN, MSN Ann Pettersson

Clinical Research Representative Coordinator Mei-Fang Yu, RN Sophie Masters

Rehabilitation Representative Maripet Caralde, PT May Cortez, PT

Surgical Oncologist Reza Rahbari, MD

American Cancer Society Jennifer Giese

Cancer care requires a

multidisciplinary

approach and

encompasses

numerous physician

and non-physician

professionals who

provide program

leadership and

represent the full scope

of care.

The Comprehensive

Cancer Care

Committee was

established in 2016 in

support of Commission

on Cancer accreditation

and to ensure an

extraordinary care

experience for members

and patients living with

cancer.

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Some photos may include models and not actual patients.© 2016, TPMG, Inc. All rights reserved. Regional Health Education. 06832 (Revised 10/18)