2013 cancer program annual report - mercy conferences bring cancer care specialists together to ......

2013 Cancer Program Annual Report

Public Reporting of Outcomes

Public Reporting of Outcomes - 2013 Annual Report Page 1

The Cancer Center began doing Survivorship Care

Plans on patients in 2013. By January 1, 2015 SCP’s

will be required on all patients receiving care.


Multidisciplinary Cancer Conferences

Our commitment to Commission on Cancer Accreditation and a growing focus on outcomes research that demonstrates increased patient satisfaction and cancer outcomes is steadfast. These multidisciplinary conferences involve surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nurses and ancillary support staff. The conferences are certified as continuing medical education for physicians. These conferences bring cancer care specialists together to share ideas, discuss management, and review national treatment guidelines and the latest research findings, in order to create the best treatment plan or management plan for individual patients. The ancillary support staffs are there to assist with providing patients additional services to ensure the best care experience. Cancer Conference meets the 1

st & 3

rd Tuesday of the month.

At each Cancer Conference, the discussion involves the review of the patient’s medical history, imaging studies, pathology and current methods of treatment. Appropriate staging is discussed for applicable cases. National Comprehensive Cancer Network (NCCN) treatment guidelines are referenced to ensure treatment plans are in line with nationally recognized standards. In addition, any applicable clinical trials are reviewed and discussed. Treatment recommendations are formulated based on a multidisciplinary consensus and presented to the patient’s managing physician. Final therapeutic decisions rest with the managing physician and the patient. All information presented at these conferences is confidential and considered part of the quality improvement process.

2013 Cancer Conference totals:

187 Total Cases Presented 152 Prospective

81% Cases presented Prospectively 100% Medical Oncology Attendance

100% Radiation Oncology Attendance 96% Surgery Attendance

100% Pathology Attendance 78% Diagnostic Radiology Attendance

100% Working Stage given on cases presented


Clinical Cancer Committee The Cancer Committee is a standing committee of Mercy Hospital Ada’s Medical staff. The committee meets quarterly to plan, assess and implement all cancer-related programs and activities at the hospital. The committee’s goals ensure MHA offers a coordinated, multidisciplinary approach to cancer prevention and treatment supported by state-of-the-art technology and specially-trained staff. The committee strives to continually improve patient survival and outcomes to enhance the quality of life for all cancer patients, regardless of diagnosis. These goals are accomplished by an emphasis on wellness, education, prevention, survivorship, research and stringent monitoring of comprehensive quality cancer care.

2013 - Educational Activity Activity Focus Update on Endometrial Cancer – Lisa Landrum, MD, Ph.D. presented the lecture to 14 physicians & 10 nursing & allied Health Staff Dr. Landrum practices at the Peggy & Charles Stephenson Cancer Center in OKC. 02/11/13

Cancer Related Specific Cancer

treatment Staging Site- Specific Prognostic

Indicators National Treatment

Guidelines/Protocols

Risky Business – What’s your risk for Breast Cancer? Sharon Nall, APRN-CNS, MS, OCN, CBCN, Advanced Practice Oncology and Breast Specialist, Mercy Cancer Resource Center, Mercy Hospital, OKC 11/21/13

Cancer Related Specific Cancer

treatment Staging Site- Specific Prognostic

Indicators National Treatment

Guidelines/Protocols


AMERICAN CANCER SOCIETY SERVICES OFFERED @ MHA DURING 2013

Total Served: 57 Newly Diagnosed: 38

Prevention Program -

Clinical Cancer Committee provides at least 1 cancer prevention program yearly

that is targeted to meet the needs of the community and should be designed to

reduce the incidence of a specific cancer type. The prevention program is

consistent with evidence-based national guidelines for cancer prevention.

Colorectal Kits (FOBT) were handed out to the community -

2010 - 29 kits handed out - 20 returned - 1 abnormal

2011 – 63 kits handed out – 25 returned - 0 abnormal

2012 - 50 kits handed out - 27 returned - 0 abnormal

Information Service Provided # Patients # Services Provided

# Newly Diagnosed

# Services Provided to

Newly Diagnosed

General Information 44 47 28 30

Information & Navigation 1 1 1 1

ACS Days Information or ACS Book 29 29 19 19

Lodging 2 10 2 10

Look Good Feel Better-Group 8 8 7 7

Personal Health Manager 22 22 15 15

SR Met w/Resource Referral 3 4 2 2

Transportation Gas Card 9 9 7 7

Wig 4 4 2 2


Mercy Ada Community Health Improvement Plan – Patient Navigation

Priority #2- Access to Care Project Early Detection: Mercy Hospital Ada is working on plans to implement a very successful program conducted at Mercy Hospital in OKC entitled, “Project Early Detection.” This program serves the uninsured or underinsured women in need of breast health services. It includes breast health education, screenings, diagnostic procedures and appropriate treatment referrals. The program is conducted by the Community Benefit Department with a grant by the Susan Komen Foundation, along with other monies from the hospital.

Priority #3 – Cancer Cancer Support Group: A former oncology nurse will be leading a new Cancer Support Group entitled, “Life Matters” on the 3

rd

Wednesday of each month. It will be specific to women, battling all forms of cancer. Our collaborating partners will be the Pontotoc County Health Department and Chickasaw Nation Medical Center. Screenings: Prostate, Colorectal and Breast screenings planned at no charge to participants. Relay for Life: Mercy Hospital Ada has been the highest fund-raiser for the Pontotoc County Relay for Life for the last three years. Raising a total for 3 years of $51,662.00


Diagnostic Imaging

Services Facility Referred

Angiography

X

Breast Specific Gamma Imaging (BSGI)

X

Bronchoscopy X

Computerized Axial Tomography Scan

(CT) X

Digital Radiography for Mammography X

Echocardiography X

Fluorescence Bronchoscopy

X

Magnetic Resonance Imaging (MRI) X

Magnetic Resonance (MR) Mammography

X

Mammography X

Mediastinoscopy X

Nuclear Medicine X

Positron Emission Mammography (PEM)

X

Positron Emission Tomography Scan (PET) X

Stereotactic Guided Biopsy X

Ultrasound X


Radiation Oncology


3D Conformal Radiation Therapy X

Brachytherapy - High Dose Rate (HDR)

X

Brachytherapy - Low Dose Rate (LDR)

X

Computerized Treatment Planning X

Cyberknife

X

Electron Beam X

External Beam Radiation Therapy X

Gamma Knife

X

High Dose Rate (HDR) MammoSite

Radiation Therapy System X

Hyperthermia

X

Image-Guided Radiation Therapy (IGRT)

X

Intensity Modulated Radiation Therapy

(IMRT) X

Linear Accelerator X

Proton Beam

X

Selective Internal Radiation Therapy

(SIRT) X

Stereotactic Radiosurgery

X

Systemic Radioisotopes

X


Surgical Procedures


Ultrasonic Surgical Aspiration

X

Microwave Ablation

X

Catheter based Partial Breast

Irradiation (ex: MammoSite) X

Limb Perfusion

X

Hyperthermic Intraperitoneal

Chemotherapy X

Robotic Assisted Procedures

X

Intraoperative Radiation Therapy

X

Cryosurgery X

Minimally Invasive Surgery X

Radiofrequency Ablation

X

Sentinel Lymph Node Biopsy X


Mercy Hospital Ada Cancer Program

Who We Serve Mercy Hospital Ada Cancer Program serves the needs of our community and surrounding areas. The chart below shows the numbers and disease sites of the cancer cases:

Analytic cases by Disease Site • 2010-2013

Gender Distribution • 2010-2013


Age at Diagnosis • 2010-2013

Race • 2010-2013


Cancer Registry Report The Cancer Registry (CR) continues to provide timely statistics and quality improvement studies to the Cancer Committee. This reporting aids in identifying trends, opportunities for improved patient care, and ensures compliance with national cancer care and treatment guidelines. Cancer Registry also submits cancer data to the Oklahoma Central Cancer Registry (OCCR) and National Cancer Data Base (NCDB). In addition, the Registry supplies statistics to the Facility Information Profile System (FIPS) which is part of the American College of Surgeons. The FIPS is a data sharing project that benefits consumers and providers of cancer care. FIPS Level II data is information comprised of cancer caseload data which includes cancer cases diagnosed and treated at the hospital within a specified year (by site and stage). This data is also available to the public.

Cancer Registry Data Requested/Presented:

Continue to assist the Cancer Center to assess the potential number of cases for a particular clinical trial or research study.

Cancer Registry data was supplied to the Mercy Hospital Ada Foundation for a grant

MERCY HOSPITAL ADA vs. OKLAHOMA vs. USA


Primary Site by Body System, Sex, Class and Best AJCC Stage

2013 Sex Class of

Case Stage Distribution - Analytic Cases Only

Primary Site Total M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 Unk

ORAL CAVITY & PHARYNX 5 3 2 5 0 0 0 0 1 2 2 0

Tongue 2 0 2 2 0 0 0 0 1 1 0 0

Salivary Glands 1 1 0 1 0 0 0 0 0 0 1 0

Tonsil 1 1 0 1 0 0 0 0 0 1 0 0

Other Oral Cavity & Pharynx 1 1 0 1 0 0 0 0 0 1 0 0

DIGESTIVE SYSTEM 43 14 29 40 3 2 6 7 12 8 1 4

Esophagus 3 2 1 3 0 0 1 0 0 1 0 1

Stomach 2 0 2 2 0 0 0 0 0 2 0 0

Small Intestine 2 1 1 2 0 0 0 0 1 0 0 1

Colon Excluding Rectum 18 3 15 16 2 1 1 4 6 4 0 0

Cecum 1 0 1 1 0 0 1 0 0 0 0 0

Ascending Colon 3 0 3 3 0 0 0 1 2 0 0 0

Splenic Flexure 1 0 1 1 0 0 0 0 1 0 0 0

Descending Colon 3 1 2 2 1 0 0 0 0 2 0 0

Sigmoid Colon 10 2 8 9 1 1 0 3 3 2 0 0

Rectum & Rectosigmoid 6 4 2 6 0 0 1 1 3 1 0 0

Anus, Anal Canal & Anorectum 3 1 2 3 0 0 1 0 2 0 0 0

Liver & Intrahepatic Bile Duct 2 2 0 1 1 0 1 0 0 0 0 0

Gallbladder 3 1 2 3 0 1 1 1 0 0 0 0

Pancreas 2 0 2 2 0 0 1 1 0 0 0 0

Peritoneum & Omentum 2 0 2 2 0 0 1 0 0 0 1 0

RESPIRATORY SYSTEM 42 22 20 40 2 0 4 3 13 17 0 3

Larynx 8 5 3 8 0 0 2 0 5 1 0 0

Lung & Bronchus 34 17 17 32 2 0 2 3 8 16 0 3

SOFT TISSUE 2 1 1 1 1 0 0 0 1 0 0 0

SKIN EXC. BASAL & SQUAMOUS 6 5 1 6 0 0 2 0 2 2 0 0

Melanoma -- Skin 5 5 0 5 0 0 1 0 2 2 0 0

Other Non-Epithelial Skin 1 0 1 1 0 0 1 0 0 0 0 0

BASAL & SQUAMOUS SKIN 1 0 1 0 1 0 0 0 0 0 0 0

BREAST 20 0 20 20 0 2 5 11 0 2 0 0

FEMALE GENITAL SYSTEM 15 0 15 14 1 0 6 1 4 0 0 3

Cervix Uteri 3 0 3 3 0 0 1 0 2 0 0 0

Corpus Uteri 10 0 10 9 1 0 6 1 1 0 0 1

Ovary 1 0 1 1 0 0 0 1 0 0 0 0

Vulva 1 0 1 1 0 0 0 0 1 0 0 0

MALE GENITAL SYSTEM 35 35 0 34 1 0 13 16 2 2 0 1

Prostate 32 32 0 31 1 0 12 16 1 2 0 0

Testis 3 3 0 3 0 0 2 0 1 0 0 0

URINARY SYSTEM 31 19 12 29 2 13 5 6 4 0 0 1

Urinary Bladder 20 11 9 20 0 13 1 5 1 0 0 0

Kidney & Renal Pelvis 11 8 3 9 2 0 5 1 3 0 0 0

CENTRAL NERVOUS SYSTEM 4 1 3 4 0 0 0 0 0 0 4 0

THYROID 2 0 2 2 0 0 1 0 0 0 1 0

LYMPHOMA 10 6 4 10 0 0 2 2 3 2 0 1

Hodgkin Lymphoma 2 1 1 2 0 0 0 1 0 1 0 0

Non-Hodgkin Lymphoma 8 5 3 8 0 0 2 1 3 1 0 1

MYELOMA 4 0 4 4 0 0 0 0 0 0 4 0

LEUKEMIA 7 4 3 6 1 0 0 0 0 0 6 0

CLL 3 2 1 2 1 0 0 0 0 0 2 0

Acute/Chronic Myeloid Leukemia 4 2 2 4 0 0 0 0 0 0 4 0

THROMBOCYTHEMIA 2 0 2 2 0 0 0 0 0 0 2 0

MDS 1 1 0 1 0 0 0 0 0 0 1 0

UNKNOWN PRIMARY 4 1 3 4 0 0 0 0 0 0 4 0

Total 234 113 121 222 12 17 49 47 42 36 24 7

STG UNK = 2 N/A, 5 BX ONLY

STG 88 = 4 UNK, 7 N/A, 11 BM, 2 BLOOD


Colon and Rectum New cases: An estimated 102,480 cases of colon and 40,340 cases of rectal cancer were expected to occur in 2013. Colorectal cancer is the third most common cancer in both men and women. Colorectal cancer incidence rates have been decreasing for most of the past two decades, which has largely been attributed to increases in the use of colorectal cancer screening tests that allow for the detection and removal of colorectal polyps before they progress to cancer. From 2005 to 2009, incidence rates declined by 4.1% per year among adults 50 years of age and older, for whom screening is recommended, and increased by 1.1% per year among those younger than age 50.

Deaths: An estimated 50,830 deaths from colorectal cancer are expected to occur in 2013, accounting for 9% of all cancer deaths. Mortality rates for colorectal cancer have declined in both men and women over the past two decades; from 2005 to 2009, the rate declined by 2.4% per year in men and by 3.1% per year in women. These decreases reflect declining incidence rates and improvements in early detection and treatment.

Signs and symptoms: Early stage colorectal cancer does not typically have symptoms; therefore, screening is usually necessary to detect this cancer in its early stages. Symptoms of advanced disease may include rectal bleeding, blood in the stool, a change in bowel habits, cramping pain in the lower abdomen, decreased appetite, or weight loss. In some cases, blood loss from the cancer leads to anemia (low red blood cells), causing symptoms such as weakness and excessive fatigue. Timely evaluation of symptoms consistent with colorectal cancer in adults younger than age 50 is especially important due to the increase in colorectal cancer incidence in this age group in recent years.

Risk factors: The risk of colorectal cancer increases with age; 90% of cases are diagnosed in individuals 50 years of age and older. Modifiable factors associated with increased risk include obesity, physical inactivity, a diet high in red or processed meat, alcohol consumption, long-term smoking, and possibly very low intake of fruits and vegetables. Hereditary and medical factors that increase risk include a personal or family history of colorectal cancer and/or polyps, a personal history of chronic inflammatory bowel disease, and certain inherited genetic conditions (e.g., Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis [FAP]). Studies have also found that individuals with type 2 diabetes are at higher risk of colorectal cancer.


Consumption of milk and calcium and higher blood levels of vitamin D appear to decrease colorectal cancer risk. Regular use of nonsteroidal anti-inflammatory drugs, such as aspirin, also reduces risk. However, these drugs are not recommended for the prevention of colorectal cancer among individuals at average risk because they can have serious adverse health effects. Study results are mixed about the association between menopausal hormone therapy and colorectal cancer.

Early detection: Beginning at age 50, men and women who are at average risk for developing colorectal cancer should begin screening. Screening can detect and allow for the removal of colorectal polyps that might have become cancerous, as well as detect cancer at an early stage, when treatment may be less extensive and more successful. In 2008, the American Cancer Society collaborated with several other organizations to release updated colorectal cancer screening guidelines. These joint guidelines emphasize cancer prevention and draw a distinction between colorectal screening tests that primarily detect cancer and those that can detect both cancer and precancerous polyps. There are a number of recommended screening options that vary by the extent of bowel preparation, as well as test performance, limitations, time interval, and cost.

Treatment: Surgery is the most common treatment for colorectal cancer. For cancers that have not spread, surgical removal may be curative. A permanent colostomy (creation of an abdominal opening for elimination of body waste) is rarely needed for colon cancer and is infrequently required for rectal cancer. Chemotherapy alone, or in combination with radiation, is given before or after sur-gery to most patients whose cancer has a higher risk of recurring or spread to lymph nodes. Adjuvant chemotherapy (anticancer drugs in addition to surgery or radiation) for colon cancer in otherwise healthy patients 70 years of age and older is equally effective as in younger patients; toxicity in older patients can be limited if certain drugs (e.g., oxaliplatin) are avoided. Several targeted therapies are approved by the FDA to treat metastatic colorectal cancer: bevacizumab (Avastin) and ziv-aflibercept (Zaltrap) block the growth of blood vessels to the tumor, and cetuximab (Erbitux) and panitumumab (Vectibix) block the effects of hormone-like factors that promote cancer growth.

Survival: The 1- and 5-year relative survival rates for persons with colorectal cancer are 84% and 64%, respectively. Survival continues to decline to 58% at 10 years after diagnosis. When colorectal cancers are detected at an early, localized stage, the 5-year survival is 90%; however, only 39% of colorectal cancers are diagnosed at this stage, in part due to the underuse of screening. If the cancer has spread regionally to involve nearby organs or lymph nodes at the time of diagnosis, the 5-year survival drops to 70%. If the disease has spread to distant organs, the 5-year survival is 12%.

(taken from ACS Facts & Figures, 2013)


Colon and Rectum 1990-2013

More than 90 % are diagnosed after age 50. The average age at diagnosis is 72.


COLON CANCER STAGING

Stage 0 Colon Cancer This is the earliest stage possible and is also called carcinoma in situ. "Carcinoma" refers to cancer that starts in epithelial tissue and "in situ" means original position or place. Colon cancer is considered stage 0 when it hasn't moved from where it started; it's still restricted to the innermost lining of the colon

Stage 1 Colon Cancer In this stage, cancer has invaded beyond the innermost layer of the colon into the middle layers (submucosa & muscular wall) of the colon. Stage 1 is referred as Duke's A colon cancer.

Stage 2 Colon Cancer This is referred as Duke's B colon cancer. Colon cancer is considered stage 2 after it moves beyond the muscular wall of the colon. Sometimes colon cancer is still considered stage 2 after it has extended into nearby organs

Stage IIA. The cancer has grown through the muscle layer of the colon wall but has not involved the serosa.

Stage IIB. The cancer has grown through the outermost layer of the colon wall to involve the serosa. Stage IIC. The cancer has grown through the outermost layer of the colon wall and invades into

nearby tissues.

Stage 3 Colon Cancer If colon cancer is found in lymph nodes, it has reached stage 3 & is referred as Duke's C colon cancer.

Stage IIIA. This can describe one of two situations: 1) the cancer is in the inner and middle layers of the colon wall; it may have spread to the muscle layer; and it affects between one and three lymph nodes or fat tissues near a lymph node or 2) the cancer involves only the submucosa and affects between four and six lymph nodes.

Stage IIIB. This can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between one and three lymph nodes or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects between four and six lymph nodes or 3) the cancer involves the submucosa and/or muscular wall and it affects seven or more lymph nodes.

Stage IIIC. This can describe one of three situations: 1) the cancer is through all the layers of the colon wall and affects between four and six lymph nodes or 2) the cancer is through the muscle layer and/or the outer layer of the colon wall and affects seven or more lymph nodes or 3) the cancer is in all layers of the colon wall, has spread to adjacent organs, and could affect lymph nodes or fat tissue near the lymph nodes.

Stage 4 Colon Cancer This is referred as Duke's D colon cancer, stage 4 is the most advanced colon cancer stage. In general, stage 4 colon cancer has spread to nearby lymph nodes and other parts of the body. Common destinations include the liver and the lungs.

Stage IVA. The cancer may have gone through the colon wall, possibly affecting nearby lymph nodes or organs, and has spread to one organ.

Stage IVB. The cancer may have gone through the colon wall, possibly affecting nearby lymph nodes or organs, and has spread to more than one organ or the abdominal wall.



Histology/Behavior Number

(82610) Villous adenoma, NOS (NON-ANALYTCAL) 3

(89361) Gastrointestinal stromal tumor, NOS (NON-ANALYTICAL) 1

(82401) Carcinoid tumor of uncertain malig potential (APPENDIX) 6

(82102) Adenoca in situ in adenomatous polyp 10

(80702) Squamous cell carcinoma in situ, NOS 2

(81402) Adenocarcinoma in situ, NOS 3

(80102) Carcinoma in situ, NOS 1

(82612) Adenocarcinoma in situ in villous adenoma 2

(82632) Adenoca in situ in tubulovillous adenoma 20

(80703) Squamous cell carcinoma, NOS 22

(80413) Small cell carcinoma, NOS 2

(80103) Carcinoma, NOS 6

(80003) Neoplasm, malignant 3

(80833) Basaloid squamous cell carcinoma 3

(80513) Verrucous carcinoma, NOS 3

(81403) Adenocarcinoma, NOS 560

(81423) Linitis plastica 1

(82103) Adenocarcinoma in adenomatous polyp 9

(82403) Carcinoid tumor, NOS (except of appendix) 2

(82453) Adenocarcinoid tumor 1

(82613) Adenocarcinoma in villous adenoma 4

(82633) Adenocarcinoma in tubulovillous adenoma 24

(84803) Mucinous adenocarcinoma 47

(84813) Mucin-producing adenocarcinoma 14

(84903) Signet ring cell carcinoma 4

(85603) Adenosquamous carcinoma 1

(85743) Adenocarcinoma w/ neuroendocrine differentiation 1

(88903) Leiomyosarcoma, NOS 1

(96803) Lymphoma, malig, large B-cell, diffuse, NOS 2

Total 758

2013 cancer program annual report - mercy conferences bring cancer care specialists together to ......

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