Saint Anne’s Hospital Prostate Cancer Study

2017

MAKING OUR

BETTERCOMMUNITIES

Radiation Oncology provided in collaboration with Brigham and Women’s Radiation Oncology Associates

2 Esophageal Cancer Study 20162 Prostate Cancer Study 2017

From the Cancer Registry:The Cancer Registry is an information system designed for the collection, management, and analysis of data on persons with a diagnosis of a cancer. Cancer Registrars are data management experts who work closely with physicians, administration, and other health care professionals to provide support for cancer program development, ensure compliance of reporting standards, and serve as a valuable resource for cancer information with the ultimate goal of preventing and controlling cancer. The Cancer Registrar is involved in managing and analyzing clinical cancer information for the purpose of education, research, and outcome measurements.

Maintaining a Cancer Registry ensures that health officials have accurate and timely information, while ensuring the availability of data for treatment, research and education. Cancer Registries strictly maintain confidentiality of patient information and related medical data. All aggregate data are submitted, analyzed and published without any patient identifiers.

SAH Cancer Registry Staff

Kimm Duclos, RHIT, CTR – Cancer Program Coordinator

Jane O’Connell, CTR – Support Specialist

Diana Hughes, CTR - Abstractor

Dawn Loomis – Abstractor

Audrey Potts – Data Specialist

Breast, Colon and Lung Measures SAH

2012 2013 2014

Tamoxifen considered or administered within 1 year of 99% 97% 99% diagnosis for AJCC T1cN0M0, or stage II or III ER and/ or PR positive cancer [HT]

Radiation administered within 1 year of diagnosis for 97% 99% 99% women <70 with breast conserving surgery [BCS/RT]

Combination chemo considered or administered 88% 92% 100% within 4 months of diagnosis for women <70 with AJCC T1CN0M0, or stage II or III ER/PR negative breast cancer [MAC]

At least 12 regional lymph nodes removed and 91% 82% 88% pathologically examined for resected colon cancer [12RLN]

Chemo considered or administered within 4 months 100% 100% 91% of diagnosis for patients <80 with lymph node positive colon cancer [ACT]

Systemic chemo is administered within 4 months to 100% 100% 91.7% day postop or day of surgery to 6 months postop, or it is recommended for surgically resected cases with pathologic lymph node positive (pN1) and (pN2) NSCLC

Surgery is not the first course of treatment for 100% 100% 100% cN2, M0 lung cases

Cancer Program Practice Profile Report (CP3R)

B

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E

A

S

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C O L O N

LUNG

3Prostate Cancer Study 2017

Cancer Registry Data for 2017New Cases Accessioned in 2017 886

Analytic 818

Diagnosis and all or part of 1st course of treatment at SAH 524

Diagnosis elsewhere and all or part of 1st course of treatment at SAH 266

Diagnosis only at SAH 28

Non-Analytic

Treatment for recurrence or metastasis only 68

Total number of Analytic Cases in the Registry 23,082 since Reference Year 1995

Total living patients in follow-up 8,959

Percentage of successful follow-up (target 90%) 91%

Multidisciplinary Case Conferences 71

Lung Case Conferences (with BWH surgeon in attendance) 11

Breast Case Conferences 10

General Case Conference 40

DFCI Tumor Boards and Lectures 10

Cancer Screenings

Screening Mammography 4,983

Screening Colonoscopies 6,200

Free Skin Screening 69

Included are in-situ and unstageable cases.

Included are analytic cases, those cases first diagnosed at SAH and/or received all or part of the first course of therapy at SAH and/or the radiation/medical oncology satellite at Dartmouth.

*Oral Cavity includes mouth, tongue, lip, salivary gland, gum and other mouth.

** ACS figure includes unknown primary and all others Excluded are the non-analytic cases, patients diagnosed elsewhere and received all of their 1st course of therapy elsewhere (recurrent cases).

Saint 2017 ACS Anne’s National 2017 Figures

SITE N % N %

Breast 153 19 255,180 15

Lung 147 18 222,500 13

Prostate 99 12 161,360 10

Colon 31 4 95,520 6

Rectum & Rectosigmoid 14 2 39,910 2

Lymphomas 29 4 72,240 4 Hodgkin’s Dis 2 <1 8,260 <1

Stomach 14 2 28,000 2

Pancreas 23 3 53,670 3

Esophagus 15 2 16,940 1

Oral Cavity & pharynx * 29 4 49,670

Tongue 8 16,400 3

Pharynx 8 17,000

Other oral cavity 9 16,270

Thyroid 28 3 56,870 3

Larynx 7 <1 13,360 <1

Female Genital System 42 5 107,470 6 Corpus uteri 24 61,380 Cervix uteri 7 12,820 Other Gyn 11 33,270

Brain & CNS 14 2 23,800 1

Hematopoietic System 42 5 92,410 6 Leukemia 25 62,130 Myeloma 17 30,280

Bladder 31 4 76,030 5

Kidney & renal pelvis 14 2 63,990 4 Liver 14 2 40,710 2 Gall Bladder & Biliary 7 <1 11,740 1

Melanoma 7 <1 87,110 5

All Others 56 6 All others & 7 unknown primary** 112,040

Total 818 (100) 1,688,780 (100)

SAINT ANNE’S HOSPITAL COMPARATIVE CASE DISTRIBUTION 2017

4 Prostate Cancer Study 2017

SAINT ANNE’S HOSPITAL REGIONAL CANCER CENTER

In 2017, the number of men treated for prostate cancer at Saint

Anne’s Hospital was 94, an increase from 2016 when 83 men were

treated, an increase of 13%.

This may in part be due to an increase in PSA screening. In 2012, the

U.S. Preventive Services Task Force had recommended that men

no longer get their PSA tested. That recommendation was based

on the argument that PSA screening resulted in over-diagnosis

and unnecessary treatment that could leave men impotent and

incontinent. Since that time, there has been an increase in the

use of active surveillance as a management strategy for patients

who appear to have indolent cancers. In early 2017, the task force

changed their recommendation, now recommending that men

aged 55 to 69 have a discussion with their doctor about the pros

and cons of PSA screening.

Of the patients treated at Saint Anne’s, the vast majority (76 of 94

patients, or 81%) had early stage (I or II) disease, exactly the same as in 2016. Eight patients (9%)

had stage III disease, while 9 patients (9%) had stage IV disease. Excluding stage IV patients, the

predominant treatment for 85 patients with stage I-III disease was radiation therapy, either alone (18

patients, or 21%) or in combination with hormonal therapy (41 patients, or 48%). Twenty-three (27%)

patients underwent surgery as primary treatment; of these, 5 also received additional treatment with

radiation (2 patients), hormonal therapy (2 patients) or both hormonal and radiation therapy (1 patient).

This was is accordance with NCCN guidelines.

It should be noted, however, that patients undergoing active surveillance are excluded from this

summary, as they are diagnosed in the urologists’ office and have no contact with the hospital unless

they eventually undergo active treatment. Stage IV patients all received hormonal therapy, either alone

or with some other form of treatment, also consistent with NCCN guidelines.

Prostate Cancer Treatment in 2017How changes in screening guidelines may affect treatment options

By Raymond Dugal, MD, Chief, Radiation Oncology

Raymond Dugal, MD

5Prostate Cancer Study 2017

65%

I II III IV NA UNK

PER

CEN

T (%

)

STAGE

49%

33%

16%

0%

My Facility Other

Stage of Prostate Cancer Diagnosed in 2016Saint Anne’s Hospital, Fall River MA

vs. Comprehensive Community Cancer Program Hospitals in All States Combination: Class of Case 10-14 and Class of Case 20-22 – Data from 738 Hospitals

Stage of Prostate Cancer Diagnosed in 2016Saint Anne’s Hospital, Fall River MA

vs. Comprehensive Community Cancer Program Hospitals in All States Combination: Class of Case 10-14 and Class of Case 20-22 – Data from 738 Hospitals

I II III IV NA UNK

My Facility 16% 65% 8% 10% 1%

Other 17% 55% 13% 11% 0% 3%

16%

65%

8% 10%1%

17%

55%

13% 11%3%

0%

#Stage My (N) Oth. (N) My (%) Oth. (%)

1. I 13 8890 15.66% 16.61%

2. II 54 29670 65.06% 55.43%

3. III 7 7210 8.43% 13.47%

4. IV 8 6125 9.64% 11.44%

5. NA 18 0.03%

6. UNK 1 1617 1.2% 3.02%

Col. TOTAL 83 53530 100% 100%

10 Prostate Cancer Study 2017

Glossary

Adjuvant – additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back.

Diagnostic – scientific methods used to establish the cause and nature of a disease, confirm a diagnosis, identify the type of cancer, or determine the stage of the cancer.

Molecular markers - Specific gene patterns and expressed molecules within tumor cells that provide important insight into the behavior of a tumor and which treatments may be more effective.

Multidisciplinary – a team of professionals with varied qualifications working together; an efficient and effective approach to complex challenges such as cancer care.

Oncology – the study of cancer.

Prognostic Indicator – an indicator of the course of the cancer; the prognosis predicts the outcome and therefore the future for the patient.

Standard of Care – a diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.

Clinical Trial – a type of research that studies a test or treatment given to people to study how safe and helpful the test or treatment is.

CT Scan – Computed Tomography scan, detailed images of internal organs are obtained by this sophisticated X-ray device.

NCCN Guidelines – National Comprehensive Cancer Network, an alliance of 26 of the world’s leading cancer cen ters working together to develop treatment guidelines for most cancers, and dedicated to research that improves the quality, effectiveness, and efficiency of cancer care.

SAINT ANNE’S HOSPITAL REGIONAL CANCER CENTER

11Prostate Cancer Study 2017

Cancer Committee Members 2017

Raymond Dugal, MD, Chairman Monica DaSilva, MD Chief, Radiation Oncology CLP, Breast Surgeon

Phyllis Vezza, MD

Pathologist

Daniel Eardley, MDGeneral Surgery

Stephanie Van Colen, DORadiology

John Yang, MDChief, Medical Oncology

Nancy McKinney, MDMedical Oncology

Peter Ward, MDMedical Oncology

Kristine Walker, MS, RN-BC, NEBCAdministrative Director, Medical Oncology

Donna Rebello, RN, BSN, OCNNursing Leadership

Kimberly Duclos, RHIT, CTRCancer Program Coordinator

Dawn Loomis, RHIT, CTRCancer Registry

Kelly Sheehan, MSW, LICSWOncology Outreach Program CoordinatorSocial Worker

Nancy Sullivan, RN, MS, CCMOncology Nurse Navigator

Melody Barthelemy, MBA, CCRPClinical Research Coordinator

Colleen BrardQuality Resource

Angela Hall-JonesAmerican Cancer Society Representative

795 Middle Street

Fall River, MA

508-674-5600

SaintAnnesHospital.org