Cancer Care Center
2011 Annual Report (Statistical Data from 2010)
Rush‐Copley Cancer Care Center
MISSION
To provide excellence in cancer care while meeting the needs of our community and recognized as the leading cancer care provider in greater fox valley area.
VISION To become the region's leading cancer care provider. This will be accomplished through enhanced relationships with the Rush‐Copley medical staff, employees and community organizations.
OUR PROMISE At Rush‐Copley Medical Center, we pride ourselves on providing everyone with extraordinary service. In fact, we're so confident that you'll love our service, we're offering you this guarantee – the first of its kind in Illinois and among the first in the country: If you feel we haven't lived up to our Promise for any reason, we will give you two movie ticket passes or a grocery store gift certificate. Just ask a caregiver or any hospital representative.
OUR PHILOSOPHY We recognize and address cancer as a continuum including: education, screening, diagnosis, treatment, survivorship, as well as end of life, social, and spiritual issues. We believe in a patient’s right to comfort, including symptom management and pain control. We recognize our responsibility to the community to provide information, access to services, and health promotion. We believe in a holistic approach to cancer care, encompassing body, mind, and spirit of the patient, family, and community.
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ABOUT US Rush‐Copley Cancer Care Center is a comprehensive cancer care program accredited by the Commission on Cancer of the American College of Surgeons. The Center offers care to ambulatory and inpatient adults, and young adults, requiring infusion services, or radiation therapy for malignancy, hematological disorders, pain management, symptom management, palliative care. Patients also have access to clinical trials through our cancer research program. September 2011 marked a significant milestone in our program’s history. We opened doors to a brand new state‐of‐the art comprehensive cancer center for the greater fox valley region. The cancer care expansion and renovation project included a 7,000 sq.ft. addition to expand space for outpatient cancer care services. The new cancer care space is a little over 20,000 sq.ft. and boasts the latest design elements, enhanced patient convenience & privacy etc. Clinical Services
Clinical Trials This year, more than 4% of cancer patients at Rush‐Copley were enrolled in Clinical Trials. Participating in clinical trials helps the patient play an active role in one’s own health and encourages long term follow up, which is key to controlling cancer. Currently, Rush‐Copley is actively participating in several clinical trials involved in cancer control, prevention and treatment. The Institutional Review Board at Rush‐Copley monitors trials and protects study participants. Rush‐Copley participates in pharmaceutical trials sponsored by major drug manufacturers and affiliated with institutions such as the Carle Clinic’s Research and Clinical Trials department.
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Outpatient Infusion Center Rush‐Copley’s infusion center provides a full range of outpatient infusions, including chemotherapy, blood transfusions, IV antibiotics etc. With easy access to laboratory and radiology services, specially trained nurses, an oncology pharmacist, a dietitian and a licensed social worker provide comprehensive care. The infusion center houses an on‐site pharmacy unit to mix high‐risk medications such as chemotherapy, biotherapy, antibiotics, nutritional supplements etc.
Inpatient Oncology Unit The inpatient medical oncology/hematology unit at Rush‐Copley is a 32‐bed, all‐private room setting. All of the nurses are specifically trained to care for those experiencing hematological/oncologic related illnesses. Cancer care at Rush‐Copley is patient‐entered. In support of providing a healing environment, a full compliment of services is provided by our specialty‐based social work, pastoral, dietary consultation and case management services. Through this multidisciplinary case management model, we guide each patient and family through their cancer care experience.
Advanced Technology We have had a very successful year treating patients on High Dose Rate (HDR) Brachytherapy procedure – Mammosite®. Providing women treatment options when they are faced with breast cancer is extremely important. Working closely with area surgeons we have been an area wide leader in breast conservation therapy. Rush‐Copley has a state‐of‐the‐art Linear Accelerator for patient care offering External Beam Radiation Therapy (EBRT), Three Dimensional Conformal Radiation Therapy (3D‐CRT), Intensity Modulated Radiation Therapy (IMRT). The department has a dedicated 16‐slice Wide Bore CT Scanner for simulations and RPM TM (Real‐time Position Management system). The RPM system allows clinicians to correlate tumor position in relation to the patient's respiratory cycle. The center upgraded its linear accelerator in 2009 to include Image Guided Radiation Therapy (IGRT) and plans to add Stereotactic Radio Surgery (SRS) capabilities in the next two years. Staying on the cutting edge of technology is an important aspect of Rush‐Copley’s radiation oncology program. Programmatic affiliation with academic medical centers such as Rush University Medical Center is being established and will be initiated by July 2012.
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Radiation Oncology Rush‐Copley’s Radiation Oncology department continues to offer the highest level of service for all patients who seek radiation treatments. Over the past year the radiation oncology team has continued to provide comprehensive, compassionate, care to all of our patients we serve. Led by a regionally renowned Radiation Oncology group, Oncology Nurse Specialists, Radiation Therapists, Medical Physicists, Dosimetrists, and support staff all work diligently together to ensure the patients receive the highest level of care.
Community Outreach & Education
Screenings
• Colorectal Cancer Screenings during March 2011 using FOBT kits. • Special screening mammograms were conducted during the month of Oct 2011. • Online cancer risk assessments available for use on the website.
Community Partnerships
• Celebrated National Cancer Survivors Day in June 2011 with over 650 in attendance. • Regional sponsor for American Cancer Society’s Relay for Life events. • Partnering with Living Well Cancer Resource Center for their Annual Bridge Walk • Look Good… Feel Better program offered in partnership with the American Cancer
Society. • Breast cancer support group offered the second Tuesday of every month. Spanish
sessions are also offered onsite during the same time.
Physician Education
• Weekly tumor board sessions • Afternoon of CME program was
conducted in December 2011. Sessions on Colorectal Cancer were presented by oncologist, colorectal surgeon, GI Specialist and Radiation Oncologist.
Breast Health Outreach
Grant funding from the Susan G Komen for the Cure enabled Rush‐Copley to continue the breast health outreach and education program for an additional year (2011‐12). The program will conclude in March 2012. The program aims targeted outreach to the underserved community in Aurora, Illinois by expanding the infrastructure of our patient navigation program. Some of the highlights of the program for 2011 have been:
• 44 educational presentations/activities • 601 women educated on breast cancer/health • 130 women received navigation and case
management services (screening mammograms, appointment assistance and transportation assistance) made possible through the grant.
Cancer Data Management Activity Report The Cancer Registry team collects and analyzes all reportable cancers diagnosed and/or treated at Rush‐Copley Medical Center. Data is maintained, analyzed and reported for the purpose of research, quality improvement and analysis of cancer care. The team is also responsible to coordinate the bi‐monthly Oncology Committee meetings and weekly Tumor Board conferences. Registry data is available to medical and administrative staff to use for audits, special studies and research. For further information, please contact Vickie Burdick, Lead Tumor Registrar at 630‐978‐6245 or Prema Ramakrishnan, Tumor Registrar at 630‐978‐6718. The Cancer Registry is a critical part of the Cancer Care team at Rush‐Copley. The team is responsible for,
• Identifying and accessioning cancer cases. • Collecting information on all diagnostic & screening services. • Adhering to the current Standards set by Commission on Cancer & the Illinois
State Cancer Registry. • Documents diagnosis, disease stage and treatment on each patient in the
database • Completes abstract on each patient in a timely fashion • Conducts annual follow‐up on all analytic cases • Performs quality control of registry data • Responds to data request for administrative and research purposes • Submits data to National Cancer Data Base (NCDB)
2010 Activities & Accomplishments
• 656 Analytic and 65 Non‐Analytic cases accessioned in 2010 • Follow‐up rate throughout the year exceeded the Commission on Cancer
mandatory standards of 90% (from reference year 2000) • Submission of data to the Illinois State Cancer Registry (ISCR), the National
Cancer Database (NCDB) and the American Cancer Society • More than 12% of cases reviewed by a physician for quality of registry data, AJCC
staging & compliance with CAP protocols per Commission on Cancer Standards • Physician‐staged cases by AJCC Staging exceed the 90% goal
The Rush‐Copley registry team would like to thank all of the staff, physicians and office personnel who respond to our letters requesting treatment and follow‐up information. The registry also wishes to thank the volunteers, nursing staff and allied health professionals who give their time and support to the registry throughout the year, Their assistance enables us to grow and fulfill our commitment to provide a valuable resource to the Hospital and the community.
Major Site Comparison
Rush‐Copley Illinois* United States*
Site # % # % # %
Breast (Female) 195 28 8,770 14 207,090 14
Lung 75 11 9,190 14 222,520 15
Colorectal 67 10 6,340 10 142,570 9
Prostate 54 8 8,730 14 217,730 14
Lymphomas (NHL) 30 4 2,690 4 65,540 4
Total 685 63,890* 1,529,560*
Sources: Rush‐Copley Cancer Care Registry (Analytic Cases only) American Cancer Society’s Cancer Facts and Figures 2010
Source: NCDB, Commission on Cancer, ACOS/ACS 1998‐2002
FOCUS ON SKIN CANCER ‐ MELANOMA (SITE SPECIFIC ANALYSIS)
Kaushik Patel, MD ‐ Chair, Rush‐Copley Oncology Committee
Epidemiology Melanoma is the most lethal form of skin cancer. Incident of melanoma has tripled in last 20 years in America. About 70,000 Americans will develop invasive melanoma every year. This is one case in 57 Americans, lifetime. This represents 2000% increase as per SEER data since 1930. Risk Factors
Major Site Comparison
Rush‐Copley* Illinois** United States**
Site # % # % # %
Breast (Female) 195 30 9,510 14 230,480 14
Lung 71 11 9,210 14 221,130 14
Colorectal 65 10 6,240 10 141,210 9
Prostate 63 10 9,340 14 240,890 15
Gyne 48 7 2,620 4 59,180 4
Total 656 65,610* 1,596,670*
Sources: * Rush‐Copley Cancer Care Registry (Analytic Cases only) **American Cancer Society’s Cancer Facts and Figures 2011
CASE DITRIBUTION BY PRIMARY SITE (ANALYTICAL CASES ONLY)
0
50
100
150
200
250
20062007200820092010
2006 150 49 64 47 17 37
2007 224 50 104 50 18 41
2008 205 70 94 67 27 46
2009 195 67 75 54 36 37
2010 195 65 71 63 34 29
Breast Colorectal Lung Prostate Uterus Thyroid
Source: Rush‐Copley Cancer Care Registry (Analytic Cases only)
FOCUS ON SKIN CANCER ‐ MELANOMA (SITE SPECIFIC ANALYSIS ‐ Kaushik Patel, MD ‐ Chair, Oncology Committee)
Introduction Cancer of the skin is by far the most common of all cancers. Melanoma accounts for less than 5% of skin cancer cases but causes a large majority of skin cancer deaths. The American Cancer Society's most recent estimates for melanoma in the United States are for 2012:
• About 76,250 new melanomas will be diagnosed (about 44,250 in men and 32,000 in women). Incidence rates for melanoma have been rising for at least 30 years.
• About 9,180 people are expected to die of melanoma (about 6,060 men and 3,120 women). From 2004 to 2008, the death rate in whites has been dropping in those younger than 50, but has been stable in women or rising in men older than 50.
Melanoma is more than 10 times more common in whites than in African Americans. Although before age 40, incidence rates are higher in women than in men, after 40, rates are almost twice as high in men as in women. Overall, the lifetime risk of getting melanoma is about 2% (1 in 50) for whites, 0.1% (1 in 1,000) for blacks, and 0.5% (1 in 200) for Hispanics. The risk for each person can be affected by a number of different factors, which are described in the section called “What are the risk factors for melanoma?” Risk Factors Most common risk factors for melanoma is genetics, i.e. family history of melanoma, multiple benign or atypical nevi, and previous history of melanoma. Immunosuppressant is also a risk factor. Another common risk factor for melanoma is UV exposure. This can be in the form of sunlight exposure or tanning bed exposure. Tanning beds are WHO classified carcinogen. Sun sensitivity (people who burn easily and do not tan) is also a risk factor. Formation and Progression of Melanoma
There is a well‐defined model of formation and progression of melanoma in humans. (Clark's model). In the past 10‐20 years we have also gained significant molecular and genetic knowledge of formation of melanoma from normal melanocytes. Orderly progression of melanoma and time it takes to progress allows melanoma to be clinically recognized early under surveillance. This makes early recognition and treatment a vital part of melanoma treatment currently.
Diagnosis
Suspicion for melanoma is very important in early diagnoses. Often the first sign of melanoma is a change in the size, shape, color or feel of a mole. Most melanomas have a black or black‐blue area. Melanoma may also appear as a new mole. It may be black, abnormal or "ugly looking." It can be in any part of body including under nails, mouth, vagina and anal areas. Examination of these areas in high risk individuals is important. Melanomas can also occur in eyes, mucosa of GI tract and meninges (covering of brain).
Thinking of "ABCD" can help you remember what to watch for:
• Asymmetry ‐ the shape of one half does not match the other • Border ‐ the edges are ragged, blurred or irregular • Color ‐ the color in uneven and may include shades of black, brown and tan • Diameter ‐ there is a change in size, usually an increase
Melanoma can be cured if it is diagnosed and treated early. If melanoma is not removed in its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. If it spreads to other parts of the body it can be difficult to control. Suspected melanomas are diagnosed with excisional biopsy. Shave biopsies should not be done. More extensive testing may be necessary if there is a suspicion for spread of melanoma. Staging
There are actually 2 types of staging for melanoma. Clinical staging is based on what is found on physical exam, biopsy/removal of the main melanoma, and any imaging tests that are done. Pathologic staging uses all of this information, plus what is found during biopsies of lymph nodes or other organs if they are done. At Rush‐Copley we have seen a higher proportion of stage 1 Melanoma cases which coincides with national trends.
Source: National Cancer Data Base (NCDB) 2009
Melanoma Skin Cancer by Stage
0%
20%
40%
60%
Rush-CopleyIllinoisUSA
Rush-Copley 23% 45% 14% 9% 5% 0% 5%
Illinois 16% 44% 12% 9% 3% 10% 7%
USA 17% 39% 14% 8% 5% 9% 8%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 NA Unstagable
Treatment All melanomas of the skin should be treated with wide excision. Sentinel lymph node may need to be removed if melanoma meets certain criteria for thickness. Currently Interferon is approved in US for certain cases of melanoma to reduce chance of recurrence after surgical removal. This decision requires detailed oncology evaluation and discussion. For metastatic melanoma various treatment options exist. These include IL‐2, Interferon, chemotherapy, Immunotherapy and targeted therapy. These treatments however are not curative in nature except in few cases. There is significant research ongoing in this area. At Rush‐Copley majority of our cases are treated with surgery only and other specified therapies are chemotherapy and radiation for some selected cases. Source: National Cancer Data Base (NCDB) 2009 Prevention Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. It is important to recognize that one can do a lot to protect oneself from skin cancer, or to catch it early enough so that it can be treated effectively. Much of this exposure comes from the sun, but some may come from man‐made sources, such as indoor tanning lamps. Avoid sun exposure, midday sun especially. Best protection for skin is a article of clothing, shade and sunscreen in that order. Avoid tanning beds. Be very familiar with your skin and report any changes in the mole or new moles immediately to your physician.
First Course Treatment for Melanoma of Skin
0%
20%
40%
60%
80%
100%
RCM CIllinoisUSA
RCMC 86% 14%
Illinois 92% 8%
USA 87% 13%
Surgery Only Other Specified Therapy
Age Distribution Unlike many other common cancers, melanoma has a wide age distribution. It occurs in younger as well as older people. Rates continue to increase with age and are highest among those in their 80s, but melanoma is not uncommon even among those younger than 30. In fact, it is one of the more common cancers in young adults. At Rush‐Copley we see a higher proportion of patients in the 40 to 49 age group due to the fact that our patient base is very young compared to other communities across the state/nation.
Source: National Cancer Data Base (NCDB) 2009
Five‐year Survival Rates
Observed survival rate for Melanoma at Rush‐Copley is significantly higher than national and state levels. The National Cancer Database (NCDB) survival reports provide statistical information for benchmarking cancer programs across the nation.
Observed 5-year Survival Rate
81%
79%
78%
76%
77%
78%
79%
80%
81%
82%
Rush-Copley State of Illinois National
Source: National Cancer Data Base (NCDB) 1998‐2002
Age Group of Melanoma of Skin Cancer
0%
5%
10%
15%
20%
25%
30%
35%
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+
Rush-CopleyIllinoisUSA
ONCOLOGY COMMITTEE MEMBERSHIP
PHYSICIAN MEMBERS NON‐PHYSICIAN MEMBERS
Kaushik Patel, MD, Chair Medical Oncology
Mary Shilkaitis, RN, MS Administration
Salitha Reddy, MD, Vice‐Chair Radiation Oncology
Vickie Burdick, BS, RHIT, CTR Cancer Registry
Kurian Abraham, MD, Cancer Liaison Pathology
Prema Ramakrishnan, BA, CCS‐P, CTR Cancer Registry
Joseph T. Meschi, MD * Medical Oncology
Judi Bonomi, RN, MS, OCN Cancer Care Center
Ho S. Myong, MD * Medical Oncology
Ronny Philip, MS, MBA Cancer Care Center
Syed A. Akbar, MD Radiology
Nancy Donner, PharmD Pharmacy
Craig Weinstein, MD Surgery
Mira Vujovic, RN, MSN, APN Breast Health Program
Mohammad Khan, MD Pain Clinic
Jeff Coleman, RN, CMSRN Cancer Care Center
Mohammed Raheem, MD * Medical Oncology
Sarah Jensby, MSW Social Services
Richard J. Tom, MD * OB/GYN
Amanda Baker, CCRP Cancer Clinical Research
Tariq Rahim, MD * Gastroenterology
Doreen Jantz, RN Day Surgery/PACU
Ted Kulzcyzki, MD * Internal Medicine/Primary Care
Rosalinda Saucedo, MS Breast Health Outreach Coord.
* Ex‐officio member
GLOSSARY OF TERMS
Analytic: A case initially diagnosed and/or receiving all or part of the initial course of treatment at Copley Memorial Hospital.
Non‐analytic: A case initially diagnosed and treated elsewhere, seen at Rush‐Copley for subsequent treatment.
First Course of Treatment: The initial tumor‐directed treatment(s) as planned by the treating physician. Generally begun within four months of diagnosis.
TNM staging: Determined at the time of first course of treatment. Requirement of the Managing Physician assists with treatment direction.
T=Tumor: The extent of the primary tumor. N=Node: The absence or presence and extent of regional lymph nodes. M=Metastasis: The absence or presence of distant metastasis.
LINKS TO WEB SITES • American Cancer Society – www.cancer.org
• American College of Radiology – www.acr.org
• American College of Surgeons Commission on Cancer – www.facs.org/cancer
• American Society of Clinical Oncology – www.asco.org
• American Urological Association – www.auanet.org
• College of American Pathologists – www.cap.org
• National Cancer Institute – www.cancer.gov
• National Comprehensive Cancer Network – www.nccn.org
• Oncology Nursing Society – www.ons.org
• Illinois State Cancer Registry ‐ www.idph.state.il.us/cancer/statistics.htm
• American Cancer Society – www.cancer.org
• Rush‐Copley Medical Center – www.rushcopley.com
The annual report is a summary of the information readily available with the cancer care tumor registry department. For additional information, contact Vickie Burdick, Lead Tumor Registrar at 630‐978‐6245 or [email protected]
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