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2013 Oncology Institute Patient Outcomes Report

Message from the Lung Leadership Team and Cancer Committee: On behalf of the Lung Leadership Team and Cancer Committee of The Methodist Hospitals, we are pleased to present to you our 2013 Oncology Institute Patient Outcomes Report. This report reflects clinical outcomes on selected lung cancer criteria and outlines lung cancer services offered at The Methodist Hospitals. Our clinical focus for 2013 is early diagnosis of lung cancer. We are happy to share our successful clinical outcomes using 2011 and 2012 data provided by Cancer Registry. We are also proud to highlight our advances with our comprehensive lung program. Please join us in applauding these achievements. B.H. Barai M.D., Chair Cancer Committee

2012 Cancer Statistics The Methodist Hospital top five cancer sites for new analytic* cases in the Cancer Registry database for 2012 were breast, lung, colon, hematopoietic (lymphoma, multiple myeloma and leukemia) and prostate. The distribution of these reported cases are shown on the chart below.

2012 Top Five Analytic Primary Sites*

Hematopoietic (lymphoma &

leukemia)10%

Colon/Rectum19%

Lung25%

Breast38%

Prostate8%

*Analytic cases: Diagnosed at Methodist and received all or part of 1st course of treatment at Methodist. Diagnosed else w here and received all or part of 1st course of treatment at Methodist.

Estimated new cases in 2012 for the top five cancer sites by gender in the United States by the American Cancer Society* is compared to The Methodist Hospitals 2012 actual cases** as noted on the charts below.

Male

14

12

6

5

5

7

2714

29

9

Lung & Bronchus

Prostate

Colon & Rectum

Kidney

Bladder

Percentage of cases

MethodistNational

Female

64

40

12

12

3

29

14

9

4

Breast

Lung & Bronchus

Colon & Rectum

Uterus

Non-Hodgkin lymphoma

Percentage of cases

MethodistNational

*Source of national data: Cancer Facts and Figures 2012, American Cancer Society (estimated new cancer cases). Does not include basal and squamous cell skin cancers and carcinoma in situ except of urinary bladder. **Source of Methodist data: Cancer Registry data base. Does not include carcinoma in situ except of urinary bladder. Excludes benign brain and central nervous system tumors. In comparison with the ACS estimates, the Methodist data reflects a higher incidence of lung cancer and colon cancer in our male population and a lower incidence of prostate cancer. The Methodist female volumes reflect a higher incidence of breast and colon cancer and are consistent in the other sites with the national ACS projected averages.

2013 Focus on Lung Cancer The American Cancer Society estimates that in 2013, the number of newly diagnosed lung cancer cases in the United States will exceed 228,190. Lung cancer accounts for more deaths than any other cancer in both men and women. Approximately 159,480 deaths from lung cancer are expected to occur in 2013. It is estimated that in Indiana 5,500 new lung and bronchus cases will be diagnosed this year. Given the incidence of lung cancer, both nationally and at Methodist, our Cancer Committee selected lung cancer as the focus of our 2013 Patient Outcomes Report. We have discussed the available data for opportunities to continue our improvements in lung care services at Methodist with an aim to increase our early stage diagnoses (Stage I and Stage II). The following charts depict comparison data on the age of the patients at the time of diagnosis and the stage of disease at the time of diagnosis. Comparison data includes 2011 data as the most recent available figures from the American College of Surgeons (ACoS) National Cancer Database (NCDB) Benchmarking Reports.

1%

1%

3%3%

17%

15%29%29%

37%33%

12%

17%

2%2%

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

Non Small Cell Lung Cancer Age at Diagnosis 2011: Methodist Hospital vs American Cancer Society

Great Lakes Division*

ACS Great Lakes Div.Methodist

*IN, OH, MI, WI, ILdata from ACoS, NCDB, public benchmark reports

The above chart reflects that the majority of The Methodist Hospitals’ patients fall into the 70-79 age bracket.

The above chart reflects the patients that are being treated at The Methodist Hospitals’ have been diagnosed at a later stage than the surrounding area, Great Lakes Division. Throughout the year The Methodist Hospitals offers multiple community outreach programs that focus on men’s and women’s health and wellness. Oncology services are part of that focus. We participate in health fairs and distribute smoking cessation information, discuss the risk factors involved with smoking, and encourage men and women to report anything abnormal to their physicians. Lung Cancer Continuous Practice Improvements To promote continuous practice improvement, The Methodist Hospitals performs studies to compare treatment recommendations from Case Review and Tumor Board Conferences with national treatment guidelines. These recommendations are based on the National Comprehensive Cancer Network (NCCN) Guidelines. The NCCN guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. These studies provide a platform to compare Methodist Hospitals’ cancer care performance with other entities. The standards of care for treatment of lung cancer that are monitored by the study and compared to the NCCN guidelines are as follows: Staging, Surgery, Radiosurgery, Chemotherapy and Palliative Treatment. In comparison with the national treatment guidelines, The Methodist Hospitals meets the quality standards endorsed by the NCCN Guidelines, as shown in the graph below.

Lung cancer timeliness of treatment was studied for comparison to the National Benchmarks. The selected indicators are supported by clinical literature and national quality organizations. The lung indicators that were chosen to be examined for the study were: imaging to offer or given diagnostic testing (biopsy), diagnosis to offer or given treatment, and imaging to offer or given treatment. The findings shown in the graphs below revealed that The Methodist Hospitals’ lung cancer timeliness of treatment from imaging to treatment compared with the national benchmarks is better than the national average.

Early Stage Lung Cancer Survival In analyzing the graph below, The Methodist Hospitals’ stage I lung cancer patients diagnosed 2003 through 2006 were compared to National Cancer Database stage I lung cancer patients for the same time period. The Methodist Hospitals’ comparison data revealed a 5 year observed survival rate of 41% and the National Cancer Database observed survival rate of 47%.

Since early stage lung cancer is potentially treatable, The Methodist Hospitals’ has embarked on several lung health initiatives. Our goal is to diagnose lung cancer at an early stage, thus improving patient clinical outcomes. With the addition of the new Electromagnetic Navigation Bronchoscopy (ENB) and Endobronchial Ultrasound (EBUS) technology, The Methodist Hospitals’ Cancer Registry data has begun to show an increase in the shift to earlier diagnosis of lung cancer. This earlier shift in lung cancer diagnosis at Methodist Hospitals is reflected in the following graph.

Lung Care Center Initiatives In 2012, Methodist Hospital’s was the first hospital in the region to acquire Electromagnetic Navigation Bronchoscopy (ENB), the latest in high technology diagnostic lung equipment. Also in 2012, The Methodist Hospitals’ purchased the latest generation of Endobronchial Ultrasound (EBUS). Multidisciplinary Conferences The Methodist Hospitals conducts bimonthly multidisciplinary case review conferences and a monthly multidisciplinary tumor board conference. These conferences bring together a group of cancer specialist to discuss the best treatment options available for each individual with a cancer diagnosis. The multidisciplinary team includes representatives from Thoracic Surgery, Medical Oncology, Radiation Oncology, Pathology, Radiology, Primary Care, Lung Navigation, Clinical Research, and Cancer Registry. The treatment options, based on national practice standards, are then shared with the patient’s physician. Research The Methodist Hospitals has been affiliated with the University of Chicago research network since 2003. Through this collaboration, we have access to hundreds of cancer clinical trials, allowing patients to receive advanced treatments in their local community. These studies aim to reduce morbidity and mortality from cancer, relate biological characteristics of cancer to clinical outcomes and develop new strategies for the early detection and prevention of cancer.

Navigation Patients are supported by the Lung Care Nurse Navigator. The role of the navigator is multifaceted, seeing patients that are at high risk, following up with patients who have a personal history of lung cancer, helping patients who may need a lung biopsy, and helping patients in need of follow-up care after a diagnosis of malignant disease. The navigator works closely with the patient’s primary care physician, as well as the other physician members of the team, in the coordination of care. The patient is supported by the Navigator throughout the continuum of care; from point of screening and detection, through treatment and follow-up. Summary In summary, Cancer Committee and Lung Leadership Team are pleased to provide this overview of our clinical outcome data and accomplishments in our 2013 Oncology Patient Outcomes Report. Our Oncology Program continues to meet the growing needs of our patient population and provide excellent cancer care. We appreciate your choosing Methodist for your health care needs, and remain available to provide you with the most advanced cancer care in the community setting.