2013 cancer program report - schneck medical center€¦ · (social work, case management,...

2013 Cancer

Program Report

Incorporating a statistical summary of

the 2012 cancer registry data.

Schneck Medical Center

INDEX SERVICE DIRECTORY

Chairman’s Message 3

Cancer Committee 4

Screenings, Support & Education 5

Cancer Registry Report 6

Schneck Data 7

Perspective 9

Breast Cancer Analysis 10

Stage I Survival Comparison 13

Directory of Terms 13

Lung Cancer Screening 14

Palliative Care Program 15

Schneck Medical Center (812) 522-2349

Toll Free (800) 234-9222

Cancer Services Center (812) 522-0480

Cancer Registry (812) 522-0475

Screening Information Line (812) 522-0477

Community Wellness (812) 523-5861

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

Diagnostic Laboratory (Lab) (812) 522-0152

Home Services & Hospice (812) 522-0460

Nutrition Services (812) 522-0148

Pain Center (812) 524-4253

Patient Services (812) 522-0440

(Social Work, Case Management, Discharge Planning)

Psychological Services (812) 522-5739

Rehab Services (812) 522-0177

Schneck Foundation (812) 524-4244

Smoking Cessation Classes (812) 522-0401

Wound Care (812) 522-0177

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

2013 Annual Report

CHAIRMAN’S MESSAGE

Our mission of providing excellence in care to the patients of Jackson and surrounding counties has met with tremendous success in 2013. This is in large part due to our team leadership at the Schneck Cancer Center, including Dr. Dolores Olivarez, full-time

cancer oncologist; Dr. B. Olipuram Jose, radiation oncologist; Dr. Amanda Dick, cancer liaison physician; Dr. LeAnn Stidham, radiologist; Melanie McGlothlin, High Risk Breast Clinic nurse practitioner; Donna Butler, Palliative Care Program nurse practitioner; Sally Acton, director; and Lynda Richey, manager and patient navigator. As a reflection of the hard work and dedication of our cancer care team, the Cancer Center received accreditation with commendation from the American College of Surgeons Commission on Cancer this year. This distinction recognizes the high quality cancer care we provide at the Schneck Cancer Center, and we plan to continue to improve upon this care with the next cycle of accreditation in 2016. A focus on processes of care was at the forefront this year. The patient navigation process was enhanced. A patient navigator guides a patient through the steps of initial diagnosis and then subsequent follow-up and treatment plans. In addition to improving this process, a social worker has been scheduled within the Cancer Center to help our patients overcome other obstacles they may face during their course of treatment. We are also focusing on the survivors of cancer and developing a survivorship care plan to bring attention to their specific needs. The well-being and comfort of our patients continues to be a priority for the Cancer Center

team. We have implemented the National Comprehensive Cancer Network (NCCN) Psychosocial Distress Screening Tool to identify patients requiring additional needs and support. Our Palliative Care Program, aimed at improving the quality of life for those with chronic diseases, including cancer, has also been expanded to include home care. Sally Acton, Cancer Center director, gave a lecture titled “Initiating Palliative Care in an Outpatient Rural Cancer Center” at the Survey Savvy Workshop. The presentation highlighted the challenges and importance of being able to provide palliative services in a rural setting. The Schneck Cancer Center continually distinguishes itself as a top performer in all aspects of cancer care, but more importantly, it continues to receive a wonderful reputation from the community it serves.

Grant J. Olsen, M.D.

2012 Distribution by County Schneck Medical Center Total Analytic Cases 231

Schneck serves Jackson County as well as many

surrounding counties in southern Indiana.

Jackson 159 Jennings 42 Scott 17 Bartholomew 6 Washington 3

Johnson 1 Marion 1 Owen 1 Out of State 1


CANCER COMMITTEE

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

Sally Acton, RN, BSN, OCN, MSM, Director, Cancer & Pain Services (Cancer Program Administrator)

Gina Bane, CPCS, Director, Medical Staff Services

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

Leighana Crenshaw, MSW, Case Manager, Patient Services

Tammi Covert, OTR, Rehab Coordinator, Rehab Services

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

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

Vicki Johnson, MSN, RN, NE-BC, CSSBB, Vice President of Nursing Services and Chief Nursing Officer

Terri Jones, Coordinator, Health Initiatives, Great Lakes Division, American Cancer Society

B. Oliapuram Jose, M.D., DABR, FACR, Radiation Oncologist

Suzie McDonald, RN, BSN, MHA, Nurse Manager, Hospice Services

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

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

Lynda Richey, RN, BSN, OCN, Manager, Cancer Services (Community Outreach Coordinator)

LeAnn Stidham, M.D., Diagnostic Radiologist

Brenda Smith, Psy.D., Clinical Psychologist, (Psychological Services Coordinator)

J. Wesley Whitler, M.D., Pathologist (Quality of Cancer Registry Data Coordinator)

Suki Wright, MSM, CSSBB, Director, Organizational Excellence and Innovation (Performance Improvement Coordinator)

2013 Annual Report

COMMUNITY OUTREACH

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

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

ColoCare, a test for detecting blood in the stool, was distributed for colon cancer screening in Jackson, Jennings, Scott and Washington counties. Skin cancer screenings were held by Dr. Kevin Crawford and Dr. Michael Sheehan at the Cancer Center. Prostate cancer screenings were held in September by Dr. Brian Scholbrock at the Cancer Center. Breast health screenings, prostate screenings, oral and skin screenings were held this fall in Jackson, Jennings, Scott, and Washington counties.

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

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

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

Lynda Richey, RN, BSN, OCN

Community Outreach Coordinator

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

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


SCHNECK CANCER REGISTRY SUMMARY

A follow-up rate of 80% for all analytic patients is required by the ACoS, CoC. Cancer Registry reference date: January 1, 1986

SCHNECK CANCER PATIENTS ENTERED IN THE LAST FIVE YEARS SUMMARY

A follow-up rate of 90% for analytic patients entered in the last five years is required by the ACoS, CoC. Calculations based on September 11, 2013 follow-up.

Total number of cases in registry since

reference date

5390

Total number of cases requiring follow-up 4063

Less number of deceased cases 2521

Total number of cases followed 1542

Cases with current follow-up 1143

Total follow up rate 90.2%

Total number of cases in registry last five years 1201

Total number of cases requiring follow-up 977

Less number of deceased cases 381

Total number of cases followed 596

Cases with current follow-up 567

Total follow up rate 97.0%

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

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

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

Coordinator

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

patient confidentiality. The Registry also monitors our treatment practices and compares our survival data to national statistics. We strive to achieve excellence in care utilizing the NCCN treatment guidelines. We are in the process of implementing the Rapid Quality Reporting System to support our efforts in maintaining a high-level of evidence-based cancer care.

This year started with a rush as we uploaded reports into the new Survey Application Record system in preparation for our CoC survey in March. Schneck is a professional practice site for cancer registry students and we had the opportunity to train a student this year.

I serve on the Indiana Cancer Registry Association Board of Directors as Immediate Past President and Nominations Committee Chair and will complete my three-year term of office in November. This has been a wonderful experience and an excellent opportunity for professional growth.

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

Sherry L. Dowling, CTR Cancer Registrar

CANCER REGISTRY REPORT

2013 Annual Report

SCHNECK CANCER CASES BY PRIMARY

0 10 20 30 40 50 60

Other/Ill Defined/Unknown

Ill-Defined Digestive

Esophagus

Hodgkin's disease

Bone

Palate

Sinus

Vulva

Salivary Gland

Thyroid Gland

Cervix Uteri

Liver

Other Skin Cancers

Ovary

Tonsil

Multiple Myeloma

Tongue

Anus

Small Intestine

Brain & CNS

Larynx

Mouth & Oral Cavity

Benign Brain & CNS

Stomach

Kidney and Renal Pelvis

Pancreas

Corpus Uteri

Other Hematopoietic

Melanomas

Non-Hodgkin's Lymphoma

Rectum and Rectosigmoid

Bladder

Leukemia

Colon

Prostate

Lung & Bronchus

Breast

Analytic

Non-Analytic

Breast cancer is the top analytic site, followed by lung, prostate, and colon cancers and leukemia. Breast cancer

is highlighted later in this report by Dr. Amanda Dick. Our top sites coincide with the top sites nationally.

2012 Frequency by Primary Site 267 Total: Analytic 231, Non-Analytic 36

52/5

45/5

8/10

14/1

11/1

10/1

8/0

8/0

5/3

7/0

5/2

6/0

5/1

5/0

5/0

4/0

4/0

4/0

2/2

3/0

2/1

1/2

2/0

2/0

2/0

2/0

2/0

1/1

1/1

1/0

1/0

1/0

1/0

1/0

1/0

1/0

1/0


SCHNECK CANCER CASES BY PATIENT DISTRIBUTION

6

13

1615

25

19

3

13

31

26

2322

15

4

0

5

10

15

20

25

30

35

0 I II III IV N/A Unknown

Male Female

10

4

17

33

25

12

5

0

6

13

2930

32

21

3

0

5

10

15

20

25

30

35

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

Male Female

2012 Age by Gender at Diagnosis 231 Analytic Cases: 97 male, 134 female

2012 AJCC Stage by Gender at Diagnosis 231 Analytic Cases: 97 male, 134 female

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

The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Detecting cancer in an earlier

stage can often lead to a higher survival rate.

2013 Annual Report

PERSPECTIVE

We are reaching the end of another strong year for the Cancer Center. Congratulations to everyone who spent time making the accreditation process proceed so smoothly this spring. It is a wonderful feeling to have achieved accreditation with commendation and to hear

such positive remarks about our Cancer Center throughout the process. There were 52 patients diagnosed and treated for breast cancer at Schneck in 2012. Upon review of our site-specific survival data for breast cancer patients, Stage I breast cancer patient survival rates for Schneck are 94.1% at five years. This compares with national Stage I breast cancer five year survival rates of 92.2%. Our stage at time of diagnosis is on par with national averages for all stages. The age of patients with new breast cancer diagnoses are also right on par with national averages. Robust screening practices contribute to early diagnosis and treatment. Breast reconstruction after breast cancer surgery has made its way into the spotlight after the famous American actress, Angelina Jolie, underwent bilateral mastectomies with reconstruction earlier this year for positive BRCA testing. The type of reconstruction that Ms. Jolie underwent happens to be the procedure of choice for patients receiving reconstruction here at Schneck: placement of tissue expanders with Alloderm followed by implants. I am happy to report that our cancer center is meeting the nationally recognized guidelines set forth by the NCCN for both breast and colon cancer treatment. Annually, collected and analyzed data

show we are at 100% for treating breast cancer patients with chemotherapy within the recommended timeline and at 88.9% for treating patients with radiation within the recommended timeline. We are also performing above 90% for timely administration of estrogen blockade therapy on those breast cancer patients who would benefit from treatment. The detailed NCBD, CP3R Performance Rate Comparisons are detailed in this report on page 12. A strong patient navigation system and collective commitment to providing best treatment to every patient helps us achieve these levels of care. As we look to the future for the patients that we treat, treatment challenges and new paradigms continue to arise with each new landmark study suggesting ways to better serve each individual patient. Intraoperative radiation as a replacement for post-operative external beam therapy or a radiation boost to the tumor bed is quickly gaining in availability within the United States. That, combined with fewer indications for full axillary lymph node dissection, is making the horizon of breast cancer treatment seem more hopeful for faster treatment, quicker recovery and a return to normal life much faster for patients. How wonderful it will be to embrace the changing face of breast cancer care here at Schneck.

Amanda Dick M.D. Cancer Liaison Physician


1

6

11

16

13

4

1

0

5

10

15

20

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

Male Female

SCHNECK BREAST CANCER DATA

0

4

1

7

1

43

5

34

10

1

7

2

0

2

4

6

8

10

12

Central UIQ LIQ UOQ LOQ Overlapping NOS

LeftRight

9

16

19

7

01

0

5

10

15

20

0 I II III IV Unknown

Male Female

Breast cancer incidence rises with age affecting adults in mid-life or older. The majority of patients diagnosed

here are over 50 years of age.

The majority of breast cancer is found in early stages.

2012 Age at Diagnosis 52 Analytic Breast Cases

2012 AJCC Stage at Diagnosis 52 Analytic Breast Cases

2012 Topography at Diagnosis 52 Analytic Breast Cases

More breast cancers are found in the upper outer quadrant, bilaterally.

2013 Annual Report

BREAST CANCER NCDB COMPARATIVE ANALYSIS

0.7

4.6

18

22.3 22.5

20.4

9.1

2.40.5

4.5

18.4

25.1 23.2

18.2

9

1.1

0

5

10

15

20

25

30

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

SMC

NCDB

16.6

44.1

26.6

9.1

3.10.5

19.2

38.4

26.5

8.5

3.5 3.9

0

5

10

15

20

25

30

35

40

45

50

0 I II III IV Unknown

SMC

NCDB

Percentage of Cases, Age at Diagnosis* Schneck Medical Center & NCDB 2000-2010 Total Analytic Cases: 417 Schneck, 2,072,053 NCDB

Percentage of Cases, AJCC Stage at Diagnosis* Schneck Medical Center & NCDB 2000-2010 Total Analytic Cases: 417 Schneck, 2,072,053 NCDB

Incidence of cancer increases with age, with most cases affecting adults in mid-life or older. Schneck’s age groups at initial diagnosis track national trends closely.

The stage of cancer at diagnosis refers to the extent of cancer growth or spread. Data shows the majority of breast cancers were diagnosed in the early stages both nationally and at Schneck.


2009 2010 2011

SMC IN NCDB SMC IN NCDB SMC IN NCDB

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

100% 94.7% 90.4% 100% 94.7% 91.8% 88.9% 92.5% 88.2%

Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1c N0 M0, or stage II of III ERA and PRA negative breast cancer.

100% 94.1% 90.3% 100% 96.0% 92.2% 100% 91.9% 89.4%

Tamoxifen or third generation Aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c N0 M0, or Stage II or III ERA and/or PRA positive breast cancer.

94.7% 89.1% 86.8% 90.5% 93.6% 89.5% 93.8% 85.6% 83.1%

NCBD, CP3R Performance Rate Comparisons*

BREAST CANCER ANALYSIS (CONT.)

18.6

8.436.69 7.85

15.7

20.06

11.92

5.23

4.07

1.45

25.53

9.767.46 8.33

16.29

11.168.9

4.415.59

2.57

0

5

10

15

20

25

30

Surgery Only Sugery &Radiation

Surgery &Chemo

Surgery,Radiation &

Chemotherapy

Surgery,Radiation &HormoneTherapy

Surgery &HormoneTherapy

Surgery,Radiation,

Chemotherapy& Hormone

Therapy

Surgery,Chemotherapy

& HormoneTherapy

OtherSpecifiedTherapy

No FirstCourse ofTreatment

SMC NCDB

Percentage of First Course of Treatment* Schneck Medical Center & NCDB 2000-2010 Total Analytic Cases: 417 Schneck, 2,072,053 NCDB

Data provided by NCDB and ACoS website as of 10/02/13.

2013 Annual Report

FIVE YEAR OBSERVICE SURVIVAL COMPARISON

100 100

97.1

94.1 94.1 94.1

100

99.1

97.6

96

94.2

92.2

88

90

92

94

96

98

100

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

SMC NCDB

Schneck has slightly better overall survival numbers when compared to NCDB statistics.

AJCC Stage I Breast Cancer* Schneck Medical Center & NCDB 2003-2006

Total Cases: Schneck 36, NCDB (2005) 209,551

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

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

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

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

* Data provided is from the NCBD and ACoS website as of 10/01/2013.


LUNG CANCER SCREENING AT SCHNECK

Lung cancer is the leading cause of cancer-related deaths in the US. Survival after five years is only about 15.6%, due in part to advance stage cancer at time of diagnosis. Schneck Medical Center Diagnostic Imaging is pleased to offer a Lung Cancer Screening, a low-dose CT scan of the chest. The cost is $99, collected at the time of the test. Insurance does not typically pay for this screening. No physician order is needed. Results of the CT scan will be sent to the patient and their doctor.

According to the National Comprehensive Cancer Network, only patients considered "high risk" are eligible for this screening. High risk patients include those who are:

Age 55-74 with at least a 30 pack-year smoking history (one pack a day for 30 years or two packs a day for 15 years) who continue to smoke or who quit less than 15 years ago. Age 50 or older with at least a 20 pack-year smoking history (one pack a day for 20 years or two packs a day for 10 years) and at least one additional risk factor (occupational exposure, residential radon exposure, cancer history, family history of lung cancer, or history of lung disease).

If you are at high risk for lung cancer, please call (812) 522-0433 today to schedule your screening.

Nurse Navigation Improvements

Lynda Richey, RN, BSN, OCN and Sally Acton, RN, OCN, MSM presented a poster at the Transforming Oncology Care with Nurse Navigation conference. Using the Design, Measure, Analyze, Improve, Control (DMAIC) model, the poster demonstrated how the Schneck navigation program has improved the efficiency, quality and satisfaction of patients diagnosed with cancer.

Define Measure

Ana

lyze

Improve

Control

Improvements

Added local radiation therapy service line

Developed navigator flow map

IBCAT grant program

Breast screenings with financial support from Schneck Foundation

Implemented palliative care program

Marketing campaign for physician and community awareness

2013 Annual Report

PALLIATIVE CARE PROGRAM

Palliative care is specialized medical care for people with serious illnesses, focused on providing patients with relief from the symptoms, pain, and stress of a serious illness. No matter the diagnosis. The goal of palliative care is to improve quality of life for both the patient and the family. Appropriate at any age and at any stage in a serious illness, palliative care can be provided together with curative treatment. Schneck’s interdisciplinary palliative care team addresses the full spectrum of quality of life needs including pain and other symptom management needs, emotional, psychological, and spiritual problems, family support, advance care planning, and helping patients and families make difficult decisions about medical care in light of progressive illness.

If you or a loved one would like more information on Schneck’s Palliative Care Program, contact the Schneck Cancer Center at 812-522-0480.

Palliative Care Improvements

Donna Butler, MSN, ANP-BC, OCN, ACHPN, FAAPM , Rebecca Ellis, PH.D., RN and Brenda Smith Psy.D., HSPP have a research project accepted by the Center for the Advancement of Palliative Care for the poster session at their November national conference. The project is titled Team Driven Palliative Care Consults and Outcomes. Using a retrospective design, the study included patients from October 2012 through March 2013. The majority of these chronic disease patients were cancer patients. The study demonstrates that the interdisciplinary palliative care team approach helps support patients in improving their quality of life both for the patient and their families by addressing their goals of care, their life goals, and advance care planning.

0

50

100

150

200

250

3Q2011

4Q2011

1Q2012

2Q2012

3Q2012

4Q2012

1Q2013

2Q2013

Home VisitOutpatientInpatient

Interdisciplinary

Team Referrals

Rehab/Extended

Care (5)

Hospice

(6) Home Care

(14)

Social

Work (38) Chaplaincy

(27)

Psychology

(19)

Patient Volume by Type

2013 cancer program report - schneck medical center€¦ · (social work, case management,...

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