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Institute for Cancer

2015 ANNUAL REPORT

Renown Institute for Cancer | 2015 Annual Report

Table of CONTENTS

Letter from the Institute for Cancer Leadership 2

About the Commission on Cancer 3

From the Committee Cancer Chair

Multidisciplinary Centers 4-5

Summary of Services 5-11

Surgical Oncology

Radiation Oncology

Medical Oncology

Infusion Services

Clinical Research

Psychosocial Services

Genetics

Care Navigation

Survivorship

Lung Screening and Accreditation 12

Quality Study for Quality Improvement 13-14

Registry Report 15

Cancer Registry: Frequency by Primary Site and Gender 16-19

Cancer Registry: Top 10 Cancers by Gender 20

Cancer Registry: Patient Age at Diagnosis by Gender 21

Five-Year Trend of Analytical Cancer Cases 22

Patient Resource Guide and Support Services 23-30

Acknowledgments 31

2015 Cancer Committee Roster 32

Page 1


LETTER from the Institute for Cancer Leadership

In 2015, the New Year brought revitalization and a new focus to the Institute for Cancer. With new leadership, our team worked together to create a mission and vision, along with three key initiatives centered around the people we serve.

Driven by this new direction, the Institute for Cancer is proud to share a few of its many 2015 accomplishments, including:

Completion of a 5-year Institute for Cancer Strategic Plan, laying the foundation for improved coordination of services, expanded partnerships and clear goals for program growth

Received a 3-year re-accreditation from the Commission on Cancer (CoC), a program of the American College of Surgeons (ACoS)

Secured a $8.5 capital project to expand the Radiation Oncology center to include two new radiation vaults, resulting in the most advanced radiation center in northern Nevada

It is with great anticipation that our doctors and staff look forward to serving this great community in 2016 and beyond. New programs you can look forward to include improved medical oncology outreach, expanded use of telemedicine, additional clinical trials, enhanced quality reporting, superior coordinated care (referred to as multidisciplinary care), and further access to supportive care programs.

Respectfully,

Christos Galanopoulos, MD, MS, FACS Jo Duszkiewicz, MSA

Renown Health VP/Medical Director Renown Health VP/Administrator

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About the COMMISSION ON CANCER From the Cancer Committee Chair

The Institute for Cancer is pleased to receive re-accreditation from the American College of Surgeons (ACoS) for its Commission on Cancer (CoC) program – the symbol of high-quality cancer care. To our patients, it means you can depend upon the type of care you receive. To our providers, it means you are working at a facility that is up-to-date on the latest cancer expertise and technology. To our hospital administration, you have achieved a level of excellence for which you can be proud to showcase to our community. Finally, to our national healthcare system, together we are improving cancer care by utilizing evidence based outcomes.

The American College of Surgeons has brought together many healthcare organizations representing different facets of cancer care. As an accrediting body, the ACoS have set up a basic infrastructure of a cancer program. One of the requirements of the CoC includes having a cancer committee oversee the program, of which I am fortunate to chair. Each cancer program is also required to collect data of how patients receive care, as well as outcomes. This data is collected in a central location, now called the National Cancer Data Bank (NCDB). At the NCDB, they provide outcome measurements to compare alongside other cancer programs for quality improvement. Overtime, this data has become a standard to review best practices and assure improvements in the care of our cancer patients. In that way, cancer care across the country continually improves. While these standards are rigorous and required a real commitment for achievement, the Institute for Cancer is dedicated to improving quality of life and survival for our patients.

Outcome measurements are also becoming more important with the recent adoption of the Affordable Care Act. Many cancer institutions are currently being reimbursed based upon performing at an acceptable level using many of the CoC standards. It is not a reach of the imagination that this so called "pay-for-performance" will also reach the rest of the cancer programs.

Our Institute for Cancer is proud to continuously achieve accreditation from the CoC since 1996. Through the excellence of our doctors, nurses, allied staff, along with state-of-the-art facilities and technology, the cancer care received by our patients will continue to be the best. It has the CoC stamp of approval.

Respectfully,

James Harris, MD, FACS

Cancer Committee Chair

James Harris, MD, FACS

Page 3


MULTIDISCIPLINARY Centers

COORDINATED CARE

If you are diagnosed with cancer, it is most probable you will need care from multiple doctors and providers to maintain the highest quality of life. Renown Institute for Cancer is located at Renown Regional Medical Center and offers fully integrated cancer services so you have access to treatments and support services in one location.

Providers who may become involved in coordinating your care include:

Radiologists – reads and reports on imaging tests, such as mammography or CT scanning

Specialists – depending on the location of the cancer, you may see a gastroenterologist, pulmonologist, gynecologist, neurologist, or other specialist

Surgeons – work to remove some or all of the cancer cells

Pathologists – processes biopsies and tissue samples to identify the type, grade and stage of the cancer

Medical oncologists – treats the cancer systemically with anticancer drugs

Radiation oncologists – treats the cancer locally with radiation

Medical geneticists – also called a genetic counselor, helping the team understand the genetics and familiar traits to assure personalized medicine

Nurse navigators – assists and coordinates along the progression of care

Support Services – nutrition services, support groups, social work services, financial counseling, healing arts, cancer concierge, and more are available. The Sally de Lipkau Cancer Resource Center, a partnership with the American Cancer Society, offers support services and educational materials for you and your support team

To help our patients navigate this systems of care, multidisciplinary centers at the Institute for Cancer are being developed and improved upon. The purpose of multidisciplinary centers are to allow providers to work together to improve diagnosis, care planning and outcomes.

Currently, the multidisciplinary centers in existence are for patients with breast, gastrointestinal (GI) and lung cancer. Over the next couple of years, new multidisciplinary centers will be developed for other cancer types and the existing centers will expand to include multidisciplinary clinics. In addition, the Institute for Cancer will work towards a more personalized approach to medicine while providing outreach to other communities.

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MULTIDISCIPLINARY Centers Continued

Multidisciplinary centers consist of the following:

Tumor Conferences – a weekly or biweekly gathering of the specialists and support staff allows the team to discuss treatment options for new and existing cancer patients. Current tumor conferences exist for breast, GI, lung and other general cancers.

Care Navigation – our nurse navigators specialize in specific cancers and are available to assist patients and families at the time of diagnosis, and through treatment

Centers of Excellences – our team of providers and staff meet regularly to address areas of improvement, standards, set screening guidelines and develop necessary programs

Summary of SERVICES

To better understand the level care our team provides, we’ve provided a summary of services you can expect when welcomed into the Institute for Cancer. Our team consists of doctors, advanced practice nurses, nurse navigators, registered nurses and other clinicians that offers coordinated, innovative and personalized care to ensure you get the very best treatment close to home.

SURGICAL ONCOLOGY

Surgical oncology is provided in collaboration with your surgeon and the Institute for Cancer’s multidisciplinary program. Renown Regional Medical Center offers a robust, minimally-invasive surgical program.

Renown’s Institute for Robotic Surgery provides physician-guided da Vinci Surgery, a minimally-invasive alternative to traditional open and laparoscopic surgery. Benefits of da Vinci Surgery can include less downtime, a faster recovery, less post-surgery pain, minimal scarring and a shorter hospital stay.

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Summary of SERVICES RADIATION ONCOLOGY

Renown Radiation Oncology is northern Nevada’s most advanced radiation therapy treatment center – receiving the region’s first Radiation Oncology (ACR-RO) accreditation from the American College of Radiology in 2011. Each treatment machine includes Computed Tomography (CT) imaging for up-to-the-moment, pinpoint targeted therapy. Our expert staff includes highly trained doctors, medical physicists, dosimetrists, radiation therapists and registered nurses that are certified and specialize in the care of our patients receiving radiation therapy.

Our radiation oncology team offers several different types of treatments, including:

External beam

Stereotactic Radiosurgery – surgery without a knife

Stereotactic Body Radiation Therapy

High Dose Rate (HDR) Brachytherapy – for breast, lung, gynecologic cancer and others

Low Dose Rate (LDR) Brachytherapy – for prostate cancer

Our care reaches approximately 700 new patients each year. Because of this growth, we are in the process of consolidating our services and remodeling to include two state-of-the-art radiation treatment machines. Construction is expected to be completed by May 2016. This update will meet and exceed the other radiation therapy services provided at Renown, offering a calm healing environment with the patient experience at the focus of our care.

MEDICAL ONCOLOGY

Our medical oncology team provides cancer education and will help you navigate through the disease and treatment processes. By being referred to Renown’s Medical Oncology, our team ensures coordination of care with all doctors and multidisciplinary providers. Because all patients and family members are provided an opportunity to discussion treatment options, decisions are made together for your plan of care.

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Summary of SERVICES INFUSION SERVICES

Infusion services provides outpatient treatment for patients 16-years or older. Our infusion center provides a calm and healing environment designed with you and your family in mind. Treatment is available every day, 365 days a year, with 24 patient treatment areas, including three private rooms and 21 interactive treatment bays. The center also has an on-site pharmacy and lab staffed by an oncology pharmacist and a lab technologist, allowing you to receive treatment more rapidly.

Our experienced staff provides treatment for a variety of diagnoses, including, but not limited to, cancer, multiple sclerosis, anemia, osteoporosis, osteomyelitis, rheumatoid arthritis and more. Registered nurses perform therapeutic phlebotomies, administer chemotherapy and other IV medications and administer blood and platelet transfusions. Nurses also perform lab draws, care of central lines and provide education about specific treatments.

CLINICAL RESEARCH

Clinical trials bring leading-edge therapies to our patient population. The studies offered at Renown Regional Medical Center deliver new treatments and aim at improving quality of life for our patients. Our clinical trials team is a dedicated group of physicians, nurses and clinical research associates all focused on the wellness of our patients. Treatments provide new medication free of charge, or offer innovative ways of treating illnesses that have been shown to impact a patient’s life in a more positive way while fighting cancer.

Through Renown’s affiliation with the National Cancer Institute Community Oncology Research Program (NCORP), we are able to offer our patients a variety of clinical trials. This allows access to state of the art therapies funded at the government level. The NCORP program also allows us to collaborate with our partners in health to address our community’s ever-changing needs while providing access to hundreds of studies.

During the past year, our research program has enrolled 84 (5%) patients in leading-edge therapy for pancreatic cancer. By participating in this particular study, patients were provided an alternative to travelling outside our region for life-saving treatment.

Through affiliation with Peter Lim, MD, FACOG, The Center of Hope, and the Mayo Clinic, we offer several trials to treat gynecologic cancer. This affiliation brings new treatments that are not available outside of major academic institutions.

The Institute for Cancer has opened two additional trials through collaboration with John Gray, MD, FACG, GI Consultants. The first trial aims to increase colon cancer screening and the second to bring new treatment to recurrent Clostridium Difficile Infection (CDI). Through these undertakings, we are able to not only treat cancer, but to also prevent it.

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Summary of SERVICES PSYCHOSOCIAL SERVICES

All cancer patients will experience distress at some point in their treatment. Research has shown that distress in patients with cancer leads to decreased quality of life and can even negatively impact survival.

According to the National Comprehensive Cancer Network (NCCN) guidelines:

All patients should be screened for distress during their initial visit, at appropriate intervals, and as clinically indicated, especially with changes in disease status (i.e. remission, recurrence, progression, treatment-related complications).

At Renown Institute for Cancer, all patients receive distress thermometer screenings. Patients are asked to

rate their distress thermometer on a scale of 0-10, similar to the Wong-Baker pain rating scale. Early evaluation and screening leads to timely management of psychological distress, which in turn improves medical management.

Regularly administered psychosocial distress screenings are provided during:

The patient’s first visit with their medical oncologist at Renown Medical Oncology Group

The patient’s first visit for chemotherapy treatment at Infusion Services

Immediately following the patient’s simulation procedure appointment or following the first radiation treatment received at Renown Radiation Therapy

When a patient transitions from different treatment modalities, such as upon remission, recurrence, progression, during treatment-related complications, or at any time when the medical team deems necessary

If patients have scores of six or higher on the scale our staff members must obtain additional information from the patient. At that point, the patient is referred to an oncology outpatient social worker for further assessment. The social worker then conducts an assessment and provides appropriate resources and referrals pertaining to the type of distress.

In 2015, our team administered 500 distress thermometer screenings to cancer patients. While new patients tend to have higher scores of distress than established patients, our team is able to provide resources and referrals to those who may be in distress due to their cancer diagnosis. Of the distress screenings administered, the top three distress problems identified by patients include insurance or financial stress, emotional or physical problems.

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Summary of SERVICES GENETICS

The Institute for Cancer Genetic Risk Assessment program works with patients whose personal medical history and family history indicates a possible hereditary cancer syndrome. In hereditary cancer, gene mutations can be passed on from generation to generation.

Since October 2015, our program has seen 240 newly referred patients, totaling 461 visits (including return visits). Eighty-seven family members of referred patients were assessed for risk of developing cancer. In addition, clinical advice for 14 people outside of the region were performed.

Some of the accomplishments of the Genetic Risk Assessment program include:

Improved follow-up with patients who are recommended to have genetic risk assessment.

Communication to our referring doctors has also been initiated, becoming a quality indicator

for the Institute

A questionnaire has been developed to identify patients at risk of hereditary cancer before a

diagnosis of cancer is made. This questionnaire will be presented to our referral doctors as

well as incorporated into Renown’s electronic health records

Off-site education and lectures are available through Renown Continuing Education.

Lectures in Carson, Fallon, Quincy, Truckee, and Susanville have been conducted or

scheduled

Research efforts have initiated a number of clinical trials with the aim at improving quality of

life for our patients

The genetic risk assessment team continues to pave the way by expanding its reach to more patients whose hereditary cancer risk should be assessed.

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Summary of SERVICES CARE NAVIGATION

Renown’s Institute for Cancer Nurse Navigator program was established in 2008. This service allows certified oncology registered nurses to serve as a guide to patients and their support system.

Cancer treatment can be confusing with multiple clinicians and healthcare experts involved. That’s where nurse navigators come in – to provide education, support and coordination throughout the continuum of cancer care services – from diagnosis, to treatment and survivorship.

Patients may experience unclear or unmet expectations that are intended be alleviated by having a single expert. By having a nurse navigator, patients can contact them throughout the entire cancer treatment experience. Cancer Nurse Navigators help patients understand and navigate their diagnosis and treatment by providing the information that patients need to make informed decisions about their healthcare. Your Nurse Navigator is also able to offer community resources, as well as clinical and psychosocial support during stressful times.

Nurse Navigators currently provide services to 1,754 cancer patients.

Nurse Navigators (pictured left to right): Denise Wiley, RN, BSN, OCN, Georganna Reynolds, RN, OCN, Lisa Gardner, RN, BSN, OCN. Not pictured: Beth Ahart-Valk, RN, OCN.

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Summary of SERVICES SURVIVORSHIP PROGRAMS

In 2006, the Institute of Medicine (IOM) issued a report recommending every cancer patient receive an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health.

The IOM report recommended patients complete their primary treatment for cancer and provide their primary care doctor with a summary of the treatment and a comprehensive plan for follow-up. The implementation of such a plan would inform patients, and their providers, of the long-term effects of cancer and its treatment, identify psychosocial support resources within the community, and provide guidance on follow-up care, prevention and health maintenance.

A cancer patient’s treatment summary may include, but is not limited to, information related to tumor characteristics including site, stage, grade and prognostic factors. This summary lists the details of treatment received, such as dates, types of surgery, chemotherapy, radiation or other therapies. The summary will also address the patient’s genetics and family history.

The follow-up care section of the treatment summary will include possible late and long-term effects of treatment and their symptoms. Possible psychological effects and the potential need for psychological support should also be addressed.

Renown Institute for Cancer has implemented a program to fulfill that need. Survivorship Care Plans will be sent out to each qualified patient’s primary treating physician for them to review together. Patients can bring this care plan to their primary care provider to help maintain continuity in follow up care and monitoring of potential long-term side effects.

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Lung Screening and ACCREDITATION In December 2013, the U.S. Preventive Services Task Force (USPSTF) released recommendations for annual screening for lung cancer with low-dose computed tomography (CT) in adults 55 to 80 years who have a 30 pack-a-year smoking history and currently smoke or have quit within the past

15 years. This follows the information provided by the National Lung Screening Trial (NLST) indicating that compared to chest X-rays, a low-dose lung CT detected lung cancer at an earlier and more treatable stage, increasing survival rates by 20 percent. Renown Health offers a low-dose lung CT screening and individuals who are current or former smokers should consider this lung screening.

ABOUT THE NATIONAL LUNG SCREENING TRIAL The NLST was a randomized national trial conducted by NCI involving more than 53,000 current and former heavy smokers with a 30 pack-year history, ages 55 to 74. The study compared the effects of two screening procedures for lung cancer – a low-dose helical computed tomography (CT) and standard chest X-ray - on lung cancer mortality and found 20 percent fewer lung cancer deaths among trial participants screened with low-dose helical CT.

LUNG SCREENING ACCREDITATION

Renown Regional Medical Center has been named a Screening Center of Excellence by The Lung Cancer Alliance (LCS) for its ongoing commitment to responsible lung cancer screening.

Designated Screening Centers of Excellence are committed to providing clear information on lung cancer screening and comply with comprehensive standards based on best practices developed by professional bodies such as the American College of Radiology (ACR), the National Comprehensive Cancer Network (NCCN) and the International Early Lung Cancer Action Program (I-ELCAP).

Renown Regional Medical Center practices low dose CT screening for lung cancer and is committed to providing the highest level of patient care. Low dose CT screening has shown to be the only proven method to detect lung cancer at an early and treatable stage. With Renown being a healthcare leader in the region, we are always striving for the highest standards and we are pleased to be part of this leading group, setting an example for responsible screening practices across the country.

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Quality Study for QUALITY IMPROVEMENT BREAST CANCER BIOPSIES AND TIMELINESS OF RESULTS STUDY

Breast cancer is the number one diagnosed and treated cancer at Renown’s Institute for Cancer – treating nearly 400 patients each year. Renown’s Breast Center of Excellence team includes doctors, administrators and allied clinicians who are committed to timely reporting of breast biopsies. In 2015, a study was initiated by Christie Elliott, MD, Medical Director of Pathology and Laboratory Services, Renown Health to uncover delays in pathology reporting specific to breast tissue samples.

A delay was identified with a noticeable delay for patients biopsied on Thursday afternoons. Renown’s pathology laboratory has two specimen processing machines. Biopsies and larger tissue specimen are treated using the same procedure, requiring a minimum of 11 hours (requiring overnight processing) of formalin fixation.

The current College of American Pathology (CAP) processing guidelines for breast specimens that may require testing for HER2 NEU and ER/PR status require specimens receive a minimum of six hours of formalin fixation prior to tissue processing. This means the specimens must be placed in formalin by 12:30 p.m. in order to receive six hours of fixation prior to processing overnight for the standard 11 hour process. If the sample was placed in formalin after 12:30 p.m. it would be held over until the next processing run, 24 hours later.

The study conducted was designed to evaluate the current processing procedure and how many patients were affected by this. The study was limited to patients undergoing needle core biopsy only since all larger breast excisions would need the standard 11 hour process for adequate tissue preparation. The time all breast core biopsies were placed into formalin was recorded. To assure processing was completed by 4 a.m. each day, there was a cut-off time of 12:30 p.m. each day that breast core specimens needed to be placed in formalin. Any specimen placed in formalin after that time would be placed in a queue for next day processing, delaying results at least one day, and up to three days.

RESULTS AND RECOMMENDATIONS OF STUDY

For the first quarter of 2015, the Pathology Lab utilized the current standard work, running both processors on long cycles for all breast biopsy specimens. Ninety-seven breast biopsies were processed during this time period. Of the 97 cases, 37 (38 percent) of the biopsies were placed in formalin after the cut-off time of 12:30 p.m., resulting in a delay of at least one additional day. Graph: Results of Breast Biopsy study

0 20 40 60 80 100 120

Total Biopsies

Delayed Biopsies

2015 First Quarter Breast Biopsy Volume

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PROCESS IMPROVEMENT Dr. Elliott and the pathology team developed a new shorter tissue processing protocol for small tissue biopsies, which would include breast core biopsies. The shorter processing run could be performed in six hours instead of the usual 11 hours. The team planned use one of their two processors to continue using the current, longer process for larger specimens and use the second processors with the new, shorter processing time for the smaller breast biopsies. Breast core biopsies could now be placed in formalin up to 4:30 p.m. and still be processed the same evening via the short processor. This new process could be used daily, as long as the block count for larger samples was 300 or less. RESULTS OF PROCESS IMPROVEMENT The new process was implemented in March 2015, and a new set of data was collected from Mar.-Nov. to evaluate the impact. During this time, 457 patients underwent breast biopsies. 146 (32 percent) were performed after 12:30 p.m. where in the old system the biopsy report would have been delayed an extra day. Following the implementation of the short cycle process, only 13 biopsies (<9%) were held over due to requiring both processors to be used for the longer process (2 cases, 1%) or front office delays in getting the specimens into the pathology lab by the required 4:30 p.m. cut-off time (11 cases, 8%). As more front office staff were educated, the number of delays were reduced.

Graph : Efficacy of breast biopsy improvement project

0 50 100 150 200 250 300 350 400 450 500

Total Biopsies

Would have been Delayed Biopsies

Actual Delayed Biopsies

2015 2nd-4th Quarter Breast Biopsy Volume

38%

2.8%

In summary, the process was improved by reducing the percent of delayed reports from 37% of biopsies, to 2.84%.

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REGISTRY Report Hospital based Cancer Registries are responsible for ensuring that physicians and researchers have the best quality data to work with in evaluating patient care and response to treatment.

Cancer is a reportable disease and the Hospital Registrar is also charged with keeping the hospital compliant with federally mandated reporting requirements – monitoring strict adherence to patient confidentiality laws, tracking the progress of the our cancer programs. This reporting ensures we work to keep abreast of Commission on Cancer Standards of Excellence, and providing the community with information about cancer at the local level. To do this, our staff must achieve and maintain Certified Tumor Registrar (CTR) credentials.

Renown currently has four full-time CTR positions and one follow-up clerk. The National Program of Cancer Registries (NPCR) is working on automating some aspects of the registry to improve operational efficiencies due to the high demand and scarce resources for CTRs, both nationally and locally in Nevada. Automation will also result in improved accuracy of our cancer data. Renown CTRs maintain information on types of cancers diagnosed locally, all treatments rendered to each patient, and maintain annual updates on patients’ status through monitoring of their medical records and though regular contact with their treating physicians. This allows CTRs to report survival information to the Renown Institute for Cancer leadership and physician members.

CTRs also assist in organizing the ten monthly multidisciplinary Tumor Conferences held at Renown. Each Tumor Conference is attended by up to 30 physicians who all specialize in treating cancer, the Renown Nurse Navigation staff and other allied health staff. Renown strives to present 100% of the newly diagnosed Breast Cancer cases, as well as Lung, GI, and other primary sites.

Teleconferencing capabilities are available for consultation with experts at Stanford University for more challenging GI cases.

The Renown Cancer Registry maintains records as far back as 1/01/2006. Our team provides updates to the State of Nevada’s Central Cancer Registry as required on much older cases. The Cancer Registry actively follows 7,571 patients and has a total of 12,335 patients in the registry database. The Commission on Cancer requires accredited programs, like Renown, to maintain accurate records on all Analytic (diagnosed and/or treated at Renown) patients with annual updates on the status of 80% of all of our patients, and at least 90% of more recently (within last 5 years) diagnosed and treated patients.

Renown Institute for Cancer accessioned 1,971 total patients in 2014, of which 1,661 were Analytic cases.

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Cancer Registry: Frequency by Primary Site and Gender

Summary by Body System, Sex, Class, Status and Best American Joint Committee Cancer Stage Report

Sex Class of Case Status Stage

Primary Site Total (%) M F Analytic NA Alive Exp Stg 0

Stg I

Stg II

Stg III

Stg IV

No Stage

ORAL CAVITY & PHARYNX

65 (3.3%) 50 15 58 7 49 16 0 5 8 14 28 3

Lip 2 (0.1%) 2 0 1 1 2 0 0 0 1 0 0 0

Tongue 24 (1.2%) 20 4 21 3 19 5 0 2 1 4 13 1

Salivary Glands 5 (0.3%) 4 1 4 1 5 0 0 0 0 0 3 1

Floor of Mouth 3 (0.2%) 2 1 3 0 0 3 0 0 0 0 3 0

Gum & Other Mouth 3 (0.2%) 2 1 3 0 3 0 0 1 1 1 0 0

Nasopharynx 2 (0.1%) 1 1 1 1 1 1 0 0 0 1 0 0

Tonsil 17 (0.9%) 13 4 16 1 14 3 0 1 4 5 6 0

Oropharynx 2 (0.1%) 1 1 2 0 2 0 0 0 0 1 1 0

Hypopharynx 6 (0.3%) 4 2 6 0 2 4 0 1 1 2 2 0

Other Oral Cavity & Pharynx 1 (0.1%) 1 0 1 0 1 0 0 0 0 0 0 1

DIGESTIVE SYSTEM 362 (18.5%) 220 142 299 63 253 109 9 63 73 70 72 12

Esophagus 38 (1.9%) 31 7 27 11 20 18 1 5 3 9 8 1

Stomach 22 (1.1%) 16 6 19 3 14 8 0 9 3 2 5 0

Small Intestine 12 (0.6%) 5 7 9 3 11 1 0 0 2 6 1 0

Colon Excluding Rectum 108 (5.5%) 58 50 91 17 84 24 5 21 23 20 21 1

Cecum 29 16 13 29 0 17 12 1 3 7 7 11 0

Appendix 8 2 6 8 0 7 1 0 5 3 0 0 0

Ascending Colon 10 5 5 9 1 9 1 1 2 2 2 1 1

Hepatic Flexure 6 4 2 6 0 6 0 0 3 2 1 0 0

Transverse Colon 6 3 3 6 0 5 1 0 2 2 2 0 0

Splenic Flexure 2 2 0 2 0 2 0 0 0 1 0 1 0

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

Sigmoid Colon 28 16 12 25 3 24 4 3 6 6 5 5 0

Large Intestine, NOS 17 9 8 5 12 12 5 0 0 0 2 3 0

Rectum & Rectosigmoid 58 (3.0%) 47 11 48 10 49 9 1 10 17 13 5 2

Rectosigmoid Junction 9 7 2 6 3 9 0 0 1 2 2 1 0

Rectum 49 40 9 42 7 40 9 1 9 15 11 4 2

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Continued Cancer Registry: Frequency by Primary Site and Gender




Stg I

Stg II

Stg III

Stg IV

No Stage

Anus, Anal Canal & Anorectum

12 (0.6%) 4 8 11 1 10 2 1 3 5 2 0 0

Liver & Intrahepatic Bile Duct

35 (1.8%) 25 10 26 9 22 13 0 7 7 3 5 4

Liver 33 24 9 24 9 21 12 0 7 7 3 4 3

Intrahepatic Bile Duct 2 1 1 2 0 1 1 0 0 0 0 1 1

Gallbladder 4 (0.2%) 2 2 4 0 2 2 0 0 0 2 1 1

Other Biliary 9 (0.5%) 3 6 7 2 6 3 0 3 1 0 1 2

Pancreas 53 (2.7%) 28 25 46 7 26 27 1 3 11 10 21 0

Retroperitoneum 4 (0.2%) 1 3 4 0 4 0 0 2 0 1 1 0

Peritoneum, Omentum & Mesentery

6 (0.3%) 0 6 6 0 4 2 0 0 1 1 3 1

Other Digestive Organs 1 (0.1%) 0 1 1 0 1 0 0 0 0 1 0 0

RESPIRATORY SYSTEM 284 (14.5%) 155 129 244 40 163 121 7 63 20 55 97 2

Nose, Nasal Cavity & Middle Ear

4 (0.2%) 2 2 2 2 4 0 0 0 1 1 0 0

Larynx 16 (0.8%) 14 2 15 1 11 5 1 5 1 0 6 2

Lung & Bronchus 264 (13.5%) 139 125 227 37 148 116 6 58 18 54 91 0

BONES & JOINTS 1 (0.1%) 1 0 1 0 1 0 0 0 0 0 0 1

Bones & Joints 1 (0.1%) 1 0 1 0 1 0 0 0 0 0 0 1

SOFT TISSUE 13 (0.7%) 11 2 11 2 8 5 0 3 1 4 2 1

Soft Tissue (including Heart) 13 (0.7%) 11 2 11 2 8 5 0 3 1 4 2 1

SKIN EXCLUDING BASAL & SQUAMOUS

67 (3.4%) 36 31 55 12 55 12 5 17 12 12 7 2

Melanoma -- Skin 61 (3.1%) 31 30 51 10 50 11 5 16 11 11 6 2

Other Non-Epithelial Skin 6 (0.3%) 5 1 4 2 5 1 0 1 1 1 1 0

BASAL & SQUAMOUS SKIN

3 (0.2%) 2 1 0 3 2 1 0 0 0 0 0 0

Basal/Squamous cell carcinomas

3 (0.2%) 2 1 0 3 2 1 0 0 0 0 0 0

BREAST 326 (16.6%) 4 322 283 43 305 21 54 110 79 27 13 0

Breast 326 (16.6%) 4 322 283 43 305 21 54 110 79 27 13 0

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Stg I

Stg II

Stg III

Stg IV

No Stage

FEMALE GENITAL SYSTEM

155 (7.9%) 0 155 131 24 131 24 2 60 10 27 24 8

Cervix Uteri 32 (1.6%) 0 32 23 9 27 5 1 10 1 9 2 0

Corpus & Uterus, NOS 60 (3.1%) 0 60 58 2 56 4 0 37 3 7 5 6

Corpus Uteri 58 0 58 56 2 55 3 0 36 3 7 5 5

Uterus, NOS 2 0 2 2 0 1 1 0 1 0 0 0 1

Ovary 48 (2.4%) 0 48 38 10 36 12 0 8 4 10 14 2

Vagina 1 (0.1%) 0 1 1 0 0 1 0 0 0 1 0 0

Vulva 13 (0.7%) 0 13 10 3 11 2 1 5 2 0 2 0

Other Female Genital Organs

1 (0.1%) 0 1 1 0 1 0 0 0 0 0 1 0

MALE GENITAL SYSTEM 173 (8.8%) 173 0 124 49 163 10 0 27 64 13 13 7

Prostate 161 (8.2%) 161 0 112 49 151 10 0 23 63 12 13 1

Testis 11 (0.6%) 11 0 11 0 11 0 0 4 1 1 0 5

Other Male Genital Organs 1 (0.1%) 1 0 1 0 1 0 0 0 0 0 0 1

URINARY SYSTEM 124 (6.3%) 92 32 113 11 100 24 33 33 15 14 16 2

Urinary Bladder 60 (3.1%) 46 14 54 6 49 11 30 6 11 3 4 0

Kidney & Renal Pelvis 58 (3.0%) 41 17 54 4 46 12 0 27 3 10 12 2

Ureter 3 (0.2%) 2 1 3 0 3 0 2 0 1 0 0 0

Other Urinary Organs 3 (0.2%) 3 0 2 1 2 1 1 0 0 1 0 0

EYE & ORBIT 2 (0.1%) 0 2 2 0 2 0 0 0 0 1 0 1

Eye & Orbit 2 (0.1%) 0 2 2 0 2 0 0 0 0 1 0 1

BRAIN & OTHER NERVOUS SYSTEM

64 (3.3%) 28 36 60 4 45 19 0 0 0 0 0 60

Brain 37 (1.9%) 23 14 35 2 19 18 0 0 0 0 0 35

Cranial Nerves Other Nervous System

27 (1.4%) 5 22 25 2 26 1 0 0 0 0 0 25

ENDOCRINE SYSTEM 78 (4.0%) 23 55 72 6 77 1 0 43 2 6 7 14

Thyroid 65 (3.3%) 17 48 61 4 64 1 0 43 2 6 7 3

Other Endocrine including Thymus

13 (0.7%) 6 7 11 2 13 0 0 0 0 0 0 11

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Stg I

Stg II

Stg III

Stg IV

No Stage

LYMPHOMA 86 (4.4%) 45 41 69 17 71 15 0 19 14 10 19 7

Hodgkin Lymphoma 7 (0.4%) 3 4 6 1 7 0 0 0 3 0 2 1

Non-Hodgkin Lymphoma 79 (4.0%) 42 37 63 16 64 15 0 19 11 10 17 6

NHL - Nodal 46 24 22 36 10 37 9 0 9 3 9 13 2

NHL - Extranodal 33 18 15 27 6 27 6 0 10 8 1 4 4

MYELOMA 28 (1.4%) 13 15 21 7 25 3 0 0 0 0 0 21

Myeloma 28 (1.4%) 13 15 21 7 25 3 0 0 0 0 0 21

LEUKEMIA 46 (2.3%) 31 15 39 7 32 14 0 0 0 0 0 39

Lymphocytic Leukemia 16 (0.8%) 13 3 12 4 16 0 0 0 0 0 0 12

Chronic Lymphocytic Leukemia

14 11 3 10 4 14 0 0 0 0 0 0 10

Other Lymphocytic Leukemia

2 2 0 2 0 2 0 0 0 0 0 0 2

Myeloid & Monocytic Leukemia

28 (1.4%) 17 11 25 3 14 14 0 0 0 0 0 25

Acute Myeloid Leukemia 18 12 6 16 2 7 11 0 0 0 0 0 16

Acute Monocytic Leukemia 3 3 0 3 0 2 1 0 0 0 0 0 3

Chronic Myeloid Leukemia 6 1 5 5 1 5 1 0 0 0 0 0 5

Other Myeloid/Monocytic Leukemia

1 1 0 1 0 0 1 0 0 0 0 0 1

Other Leukemia 2 (0.1%) 1 1 2 0 2 0 0 0 0 0 0 2

MESOTHELIOMA 4 (0.2%) 3 1 4 0 3 1 0 1 0 1 1 1

Mesothelioma 4 (0.2%) 3 1 4 0 3 1 0 1 0 1 1 1

KAPOSI SARCOMA 1 (0.1%) 1 0 1 0 0 1 0 0 0 0 0 1

Kaposi Sarcoma 1 (0.1%) 1 0 1 0 0 1 0 0 0 0 0 1

MISCELLANEOUS 80 (4.1%) 43 37 70 10 44 36 0 0 0 0 0 70

Miscellaneous 80 (4.1%) 43 37 70 10 44 36 0 0 0 0 0 70

Total 1,962 931 1,031 1,657 305 1,529 433 110 444 298 254 299 252

Exclusions: Not Male and Not Female

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Cancer Registry: Top 10 Cancers by Gender

Males

Prostate - 169 (18%)

Lung & Bronchus - 139 (15%)

Colon & Rectum - 105 (11%)

Oral Cavity & Pharynx - 50 (5%)

Urinary Bladder - 46 (5%)

Non-Hodgkin Lymphoma - 42 (4%)

Kidney & Renal Pelvis - 41 (4%)

Melanoma of the Skin - 31 (3%)

Leukemia - 31 (3%)

Pancreas - 28 (3%)

All Other Sites - 257 (27%)

Females

Breast - 323 (31%)

Lung & Bronchus - 125 (12%)

Colon & Rectum - 61 (6%)

Uterine Corpus - 60 (6%)

Ovary - 48 (5%)

Thyroid - 48 (5%)

Non-Hodgkin Lymphoma - 37 (4%)

Melanoma of the Skin - 30 (3%)

Kidney & Renal Pelvis - 17 (2%)

Leukemia - 15 (1%)

All Other Sites - 268 (26%)

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Cancer Registry: Patient Age at Diagnosis by Gender

Page 21


Five-Year Trend of Renown ANALYTICAL CANCER CASES

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Patient Resource Guide and SUPPORT Services Renown Institute for Cancer offers a variety of patient resources to ensure cancer patients and their families have the support and guidance they need throughout their journey.

Acupuncture 775-982-8255

Acupuncture can help alleviate symptoms and side effects associated with a variety of cancers and cancer treatments, such as pain, fatigue, dry mouth, nausea and vomiting. Acupuncture treatments can be given at the same time as other cancer treatments. Check with your insurance, as it may cover your acupuncture treatments.

Cancer Concierge 775-982-6830

The Cancer Concierge is personally dedicated to anticipating the needs of cancer patients and their families by providing helpful, supportive and educational resources, including:

• Cancer information and resources complete with a cancer lending library

• Facilitation of referrals to financial assistance program

• Coordinating transportation and lodging

• Providing boutique services including wigs, scarves, camisoles and prosthetic referrals

• Facilitating complementary therapy service referrals such as acupuncture, healing touch, guided imagery and support groups.

Healing Touch 775-982-6830

Healing Touch is an energy-based treatment that may help decrease pain and relieve associated anxiety. Healing Touch helps create an optimal environment for healing by restoring harmony and balance in the body’s energy system.

Nurse Navigation 775-982-4400

Nurse Navigators are experienced registered oncology nurses dedicated to serving as an ongoing resource to cancer patients from diagnosis through treatment and into survivorship. Nurse Navigators serve as a personal guide to cancer patients and their care providers.

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Nutrition Counseling Services

775-982-3738

Free consultations are available with a registered dietitian to help you with nutrition-related during and after your cancer treatments. Different food or diets can be recommended during treatment.

Palliative & Supportive Care 775-982-4253

The Palliative & Supportive Care program at Renown Health is specialized medical care for patients with advanced stages of cancer and other serious illnesses or diseases such as kidney failure or cardiovascular disease. It’s a partnership between the patient, medical specialist and their family.

Palliative care is provided by a team of doctors, advance practice nurses, chaplains, social workers and other specialists who work together with the patient’s other doctors to provide an extra layer of support. The team supports patients and their families every step of the way, not only by controlling their symptoms, but also by helping patients understand their treatment goals and options. Palliative care is not to be confused with hospice care.

Hospice Care 775-982-4253

Hospice care is meant specifically for those approaching the last stages of life, while palliative care is appropriate for any stage of a chronic illness and can be provided along with other treatments. Renown Hospice Care provides compassionate expertise to meet the emotional, physical and spiritual needs of patients and families in our community. When medical treatments no longer offer a cure, hospice care offers a special way of caring for patients and families facing end-of-life issues, while allowing the patient to be in the comfort of their home.

Patient Financial Advocate 775-982-4110

Patient Financial Advocates are available to help self-pay or underinsured patients determine if they qualify for government assistance programs and the Medical Financial Hardship program at Renown Health. Please call for more information and to schedule an appointment.

Patient Lodging Program 775-982-6830

Renown Health partners with several area hotels and motels to offer patients special room rates, including the Inn at Renown. Patients are encouraged to make reservations as soon as possible to assure room availability. Special room rates may not be available on weekends or during Reno special events. Contact the cancer concierge for more information.

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Sally de Lipkau Cancer Resource Center 775-982-6833

The Sally de Lipkau Cancer Resource Center offers many support services for cancer patients and their families, including:

American Cancer Society (ACS) Affiliate Office 775-329-0609

ACS is a nationwide, community-based health organization dedicated to eliminating cancer as a major health problem. Located inside the Sally de Lipkau Cancer Resource Center, the office provides support services and educational materials to cancer patients.

Look Good…Feel Better® 775-786-1864

This American Cancer Society program, co-sponsored by Renown Institute for Cancer, can help patients look good and feel better by showing patients how to care for skin changes during cancer treatments. Each woman receives a one-on-one makeover and a gift bag of cosmetics donated by nationally known cosmetic manufacturers, as well as instructions on the use of scarves and hairpieces. Registration is required.

The Boutique, located in The Shops at Renown 775-982-5075

The Boutique offers great women’s apparel and gift items to suit many tastes, and it also provide specialty items for patients as well. You’ll find a large selection of headwear for people who have lost their hair due to medical treatments. The Boutique also has products for mastectomy patients, including bras, breast forms and swimwear. There are also certified, trained fitting experts who can assist with these products.

The Inn at Renown 775-982-5003

Located in Renown Regional Medical Center, the Inn at Renown offers out-of-town patients and family members convenient hotel rooms. Call for pricing and availability. Patients may qualify for a medical discount.

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Additional SUPPORT SERVICES offered by Renown Health

Advanced Wound Care 775-982-5003

This program offers comprehensive wound assessment, patient treatment and education, as well as state-of-the-art therapies and care products. Renown’s Advanced Wound Care team works with the patient’s doctor and other providers to provide support services such as nutritional education, which can be critical to proper wound and ostomy healing. The Wound Care clinic also evaluates and treats lymphedema.

Clinical Trials 775-982-5050

Clinical trials offer patients leading-edge therapies resulting from the latest developments in cancer care. Each study answers scientific questions and tries to find better ways to prevent, diagnose or treat cancer. Clinical trial participants receive state-of-the-art care and have the opportunity to contribute to the knowledge and progress of cancer medicine. Renown has access to a broad range of National Cancer Institute (NCI)-sponsored clinical trials. Clinical trials are directed to quality of life, pharmaceuticals and radiation oncology.

Healing Arts 775-982-5545

We recognize that healing is more than getting quality medical care. At Renown Health, we’re working to create an environment that exceeds the boundaries of traditional medicine. The Healing Arts Program supports the arts in our community by employing many forms of expression and bringing them directly to the patient’s bedside, as well as throughout the halls of our facilities.

Visitors to Renown are often greeted by live music from our volunteer pianists. More than 3,000 pieces of original artwork are displayed throughout Renown Regional Medical Center to engage visitors as they navigate the hallways. And during a patient’s stay, there are numerous opportunities to experience the healing arts in ways that interests them. The Healing Arts Program also includes other services such as Pet Therapy, Music and Art at the Bedside and I Am a Survivor.

Lab Services 775-982-5000

Renown Lab Services offers 11 convenient locations throughout Reno, Sparks, Fernley and Fallon. Call 775-982-5000 or visit renown.org/lab for more information including locations, hours of operation or to schedule an appointment.

X-Ray & Imaging 775-982-8100

Renown Health offers many locations for X-Ray & Imaging Services. Please call 775-982-8100 to schedule an appointment or visit renown.org/imaging.

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Renown Home Health 775-982-5860

Home Health is a full-service program that provides at-home care in the Reno- Sparks area. Our staff provides care and education to help restore and maintain patients’ health. Our nurses perform a full assessment in the home and develop customized treatment plans under the direction of the patient’s primary care doctor. Renown Home Health also coordinate care with certified nurses’ aides, rehabilitation therapists and pertinent community services.

Renown Hyperbaric Oxygen Therapy 775-982-4268

Hyperbaric Oxygen Therapy strengthens the immune system with a higher concentration of oxygen. This accelerates the body’s natural healing process and is used for a variety of medical conditions. This therapy can only be used with your doctor’s approval after treatment.

Renown Rehabilitation Hospital 775-982-3500

Renown Rehabilitation Hospital specializes in physical rehabilitation and can help cancer patients with any rehabilitation needs after treatment.

Renown Physical Therapy 775-982-5001

Renown Physical Therapy, offered at one of three outpatient locations, provides exercise information and specialized programs for cancer patients including therapies for physical, occupational and communication disorders that do not require a hospital stay.

Renown Skilled Nursing 775-982-5140

Over the past 30 years, Renown Skilled Nursing has built a reputation for a caring and safe environment. Thanks in large part to our expert nursing staff, our nurses have been trained in the latest techniques to care for our special population – including IV therapy, pain management, respite and palliative care, and wound care. In addition to round-the-clock, high-quality nursing care, at Renown Skilled Nursing our patients also have access to transportation, laundry, barber and beauty shop, on-site dental and podiatry services, financial advice and spiritual support.

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SUPPORT Groups

Cancer Support Group 775-982-6830

This group is for all patients facing cancer. The meeting enables participants to share experiences and express feelings and concerns. All cancer patients, family members and caregivers are welcome to attend.

Men’s Prostate Cancer Support Group 775-772-5805 or 775-982-6830

This group provides a place for men to share how they cope with prostate cancer and offers support and education for patients and survivors through their cancer journey.

ThyCa – Thyroid Cancer Support Group 775-677-9710 or 775-982-6830

Patients, survivors and family members are provided with a place to share their experiences and to give support for individuals with thyroid cancer. Information from ThyCa is available to assist in understanding thyroid cancer.

Women’s Breast and Gynecologic Cancer Support Group 775-982-6830

Patients and survivors are invited to share experiences, concerns and feelings, and offer hope and help to one another through their cancer journey and beyond.

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Community OUTREACH Cancer is a complex disease that affects communities across the country in different ways. Prevention is the best way to fight against cancer. Renown Institute for Cancer believes it is important to get out in the community and lead the way through outreach and education. Throughout the year, Renown partners with other groups and community organizations to insure people get the information they need for better health. Here are some of the events you may our team at supporting and educating this public about cancer:

Moms on the Run This year was the 15th annual event to raise money to support patients with breast and/or gynecological cancers. Renown Institute for Cancer sponsors this event and provides education information for almost 5,000 participants.

American Cancer Society Relay for Life The celebration of cancer survivors and their supporters was held at the Reno Aces Ball Park in 2015. Renown Institute for Cancer partners with ACS, sponsored this event and provided educational materials on breast and lung cancers and information on smoking cessation classes.

Senior Fest Renown Health and the Institute for Cancer sponsored this event for local senior citizens. Wellness and prevention were the focus of this year’s event. Materials on melanoma and the prevention of skin cancer were distributed along with SPF 30 sunscreen. Flu shots were available along with information on the many programs available at Renown.

Susan G. Komen Race for the Cure Renown sponsored the annual Komen event in 2015. There were over 4,800 participants that we shared information on breast health. One of our respiratory therapists was also available to answer questions about the correlation between breast cancer and smoking and promote smoking cessation classes. Julie Locken, MD answered questions on breast health and dense breast tissue.

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Pink Pumpkin Festival Renown sponsored an information booth presenting breast health information in celebration of Breast Cancer Awareness Month.

Great American Smokeout In partnership with the American Cancer Society, American Lung Association, and Renown Respiratory Therapist, the Renown Institute for Cancer educated the employees and community on programs for smoking cessation, tobacco and e-cigarettes. Over 200 people stopped and collected materials and got their questions answered.

Peppermill Hotel & Casino, Employee Benefits Fair Breast health materials were given out by Renown’s Breast Cancer nurse navigator and bi-lingual licensed social worker.

Skin Cancer Lunch & Learn In 2015, the prevention of melanoma and skin cancer was identified as an ongoing community need. A presentation on Skin Cancer Prevention was given by James Harris, MD FACS during Skin Cancer Prevention and Detection month in May. Over 200 people attended this senior luncheon.

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ACKNOWLEDGEMENTS The data analyses included in the 2015 Renown Institute for Cancer Annual Report are based on data from the following:

• Renown Regional Medical Center – Cancer Registry

• American College of Surgeons Commission on Cancer (ACoS – CoC)

• American Cancer Society

• Cancer Program Practice Profile Report of the National Cancer Database (CP3R)

Page 31


Renown Regional Medical Center Institute of Cancer 2015 CANCER COMMITTEE ROSTER

James B. Harris, MD, FACS, Chair Craig Sande, MD

Christos Galanopoulos, MD, MS, FACS, VP/Med Dir John Ganser, MD

Julie Locken, MD Christina Szot, MD

Christie Elliott, MD Peter Lim, MD

Michelle Chu, MD Nathan Slotnick, MD

Aaron Bowman, MD Sowjanya Reganti, MD

Abhinand Peddada, MD Kelle Brogan, MD

James Cohen, MD Holly Kulhawick, CTR

Brian Juell, MD Nina Shaffer, CTR

Jo Duszkiewicz, MSA, VP/Administrator Georganna Reynolds, RN, BSN, OCN

Susan Cox, RT(T), Director Lisa Gardner, RN, BSN, OCN

Thelma Baker, RN, MSN, OCN, Director Denise Wiley, RN, BSN, OCN

Brandy Griggs, RN, Manager Beth Ahart-Valk, RN, OCN

Kelly Worley, RN, BSN, OCN, Manager Susan Allen, PT

Jocelyn Mata, LSW, MSW Leah Nelson

Shannon White, RN, OCN Rebecca Pitts

Karen Martines, MBA, BSN, CPHQ Patty Davidson

Cindy Thomas, BS, MA Kendra Webber

Jessica Harpster

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RENOWN HEALTH

INSTITUTE FOR CANCER

1155 MILL STREET • RENO, NV 89502

775-982-4400

2015 annual report - renown health...renown institute for cancer | 2015 annual report...

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