cancer annual report
TRANSCRIPT
cancercarechampions.org | Findlay, Ohio |419.423.5522
Cancer Annual Report
2013
(Published 9.10.14)
2013 Cancer Committee
1900 South Main Street | Findlay, Ohio 45840cancercarechampions.org | 419.423.5522
2014 Blanchard Valley Health System Published September 2014
Joce Abbott, BSN, RN, OCNOncology Nursing
Kimberly Benson, RNDirector of Outpatient Specialty Services
Eric Bostick, MDRadiology-Interventional Radiology
Eric Browning, MD Cancer Committee ChairCancer Physician LiaisonGeneral Surgery
Kendra Brooks, MSW, LSWSocial Worker
Heidi Budke, MDQuality Control CoordinatorPathology
Tim Burkart, PharmD Pharmacy
Julie Calvin, RNQuality and Patient Safety
Michelle Clinger, PHDPatient Counseling
Sharon Cole, MDMedical Oncology
Daniel Dawley, MDMedical Director, Hospice
Nancy George, RDLDDietary
Abigail Hartman Public Relations
Jill Jaynes, RT(R)Director of Imaging Services, Cath/Vascular Labs
Elizabeth Kelly, MDiv, LSWSpiritual Care and Social Work/ Psychosocial Service Coordinator
Shannon Kohls, BSN, RN, OCNClinical Research
Bill Kose, MDSenior VP Medical Affairs
Jennifer R. Lammers, RNPatient Navigator
Chaoyang Li, MDMedical Oncology
Stephen Lutz, MD Quality Improvement Coord. Radiation Oncology
Cory Maag, RNClinical Manager 5NU Medical/Oncology
Carolyn Maurer, RN, BSNPalliative Care
Jane Merschman CTRCertified Tumor Registrar
Mohammad Mobayed, MDMedical Oncology
Christine Montgomery, RNClinical Research, Outreach Coordinator
Barbara J Pasztor, BSN, MHSA, RN V.P. Patient Care Services, CNO
Natalie Phoenix, BSN, RN Director of Inpatient Nursing Services
Jamie RennerTumor Registry Coordinator
Kim SimondsBridge Marketing Manager
Bonnie VanSchoik, MT (ASCP), MT (HEW), MLT (ASCP), CLA (ASCP)Director of Laboratory Services
Chris WebbDirector of Rehabilitation Services
Eric Browning, MD Cancer Committee Chair
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Table of ContentsImaging & Woman Wise .............................2New Patient Navigator ...............................2Outpatient Infusion Therapy ......................3Clinical Research ........................................4True Beam TM Cancer Treatment ...............5Community Outreach ................................6New Oncologist Joins BVHS .......................6Cancer Registry Statistics ....................... 7-8Updated Prostate Cancer Guidelines ........9Prostate Site Specific Analysis .............. 9-11
rate screening and diagnostic mammography as well as ultrasound for these patients. HCMSI developed a collab-oration with this group of gynecological practitioners in order to offer services to the uninsured patient.
Last year we focused on streamlining the navigation of our newly diagnosed breast cancer patients. Our goal was to ensure at the time of navigation that the patient received an appointment to see a medical oncologist and general surgeon of their choice. We wanted each patient who was struggling to simply understand their diagnosis to know that their next steps were taken care of by our medical team.
To the right, you’ll see our three year trend for screening and diagnostic mammograms performed at EasternWoods Outpatient Center as well as our Positive Predictive Value for biopsies and can-cers found. Breast imaging statistics for Blanchard Valley Health System in 2013 have exceeded national standards. In comparison, National Positive Predictive Value of
biopsies (percent of biopsies that show cancer) in the US is 10-20 percent, while
2013 Cancer Report for Imaging/Woman WiseBlanchard Valley Health System continues to focus on technology, quality, and service in regard to our Im-aging department. In 2013, Woman Wise (our outpatient mammography department), located within the Eastern-Woods Outpatient Center, continued to hold the honor of BICOE, Breast Imaging Center of Excellence through the ACR (American College of Radiology).
In April 2013, we were once again granted funds in the amount of $37,549 from the Northwest Ohio Affiliate of Susan G. Komen for the Cure. This will provide mammog-raphy services through our HCMSI (Hancock County Mammography Screening Initiative) program. Through this grant were able to serve patients not just in Hancock County, but all surrounding counties.
In May 2013 Women and Children’s Center expanded their practice to the Eastern-Woods Outpatient Center (EWOC). With these addition-al women’s health services offered at EWOC, it has been an excellent way to incorpo-
Oncology Patient NavigatorBlanchard Valley Health System hired Jennifer Lammers, RN as its first oncology patient navigator in the fourth quarter of 2013. This position, a requirement for the oncology program to meet accreditation standards in 2015 from the COC (Commission on Cancer), will be a direct benefit to anyone diagnosed and undergoing treatment for cancer at BVHS.
Through navigation, patient disparities and barriers to care will be identified and addressed in a timely manner, thus ensuring that every patient moves smoothly through the system while receiving quality of care in an effective manner.
To establish a successful navigation program, diligent steps are being taken to identify quality measures and effective processes by collaborating with community diagnostic centers, oncologists, surgeons, primary care physicians and community resource programs. Current areas of focus include, but not limited to, financial, psychosocial, palliative care, nutrition, clinical support, survivorship care planning and end of life care needs.
2011 2012 2013 Screenings 9430 9463 9426
Diagnos4cs 2381 2129 2067
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2013 Mammography Volumes for BVH and Blu>on
2011 2012 2013 Number of Biopsies 297 221 243
Number of Posi6ve Biopsies 97 74 83
PPV 33% 33% 34%
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2013 Posi0ve Predic0ve Value
Blanchard Valley Hospital’s Positive Predictive Value of biopsies for 2013 was 34 percent.
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2013NURSINGANNUAL RE-PORT2013 Nursing Annual ReportTable of ContentsNursingNursing Awards Ban-
quet.................................................................................4Nursing Congress.............................................................................................5Nursing Education...........................................................................................8Critical Care ServicesEmergency Department.................................................................................10Intensive Care Unit........................................................................................12Cardiac Care Unit..........................................................................................13Inpatient NursingObstetrics.......................................................................................................14Special Care Nursery......................................................................................16Orchard Hall..................................................................................................17Bluffton Medical Surgical...............................................................................18Findlay Medical and Oncology......................................................................19Orthopedic and Neurology............................................................................20Care Utilization..............................................................................................22Peri-Operative ServicesFindlay Surgery..............................................................................................24Bluffton Surgery.............................................................................................25Outpatient Specialty Services
Outpatient Infusion TherapyThe concept of outpatient infusion therapy services at Blanchard Valley Hospital was born back in the late 1980s, when most of the treatments now provided in outpatient infusion therapy were given in the inpatient setting. As insurance and reimbursement changed, the need to provide outpatient services became evident. The inpatient oncology unit was the original home for outpa-tient infusion services. Most of the early treatments provided were subcutaneous injections and blood transfusions. Over time, additional IV therapies and chemotherapies became available in the outpatient setting.
The Growth of Infusion Therapy:
The Outpatient Infusion Therapy Clinic at Blanchard Valley Hospital opened in its current space in 2006 with the focus of meeting the unique needs of adult cancer and medical patients in our community in an outpatient setting. Located on the third floor of the Ruse Building, Infusion Therapy patients enjoy a view that overlooks Main Street. There are six patient recliners and two patient rooms with beds to meet the physical needs of the patients receiving treatment.
In 2013, BVHS provided care for patients whose orders came from 177 different physicians. BVHS sees a variety of diagnoses and provide a variety of treatments. In general the treatments BVHS provide include:• IV therapies including, but not limited to:
o IV Fluid Administrationo Chemotherapy—both simple and complex
administrationo Monoclonal Antibodies—i.e. Remicade,
Rituxan, Herceptin, Benlystao IV Antibioticso IV Iron, Venofero IVIGo Blood Product Transfusionso Albumino Bisphosphonates—ie Aredia, Zometa, Prolia
• SQ and IM injections• Implanted port access, blood draws and heparin flush• PICC line care, dressing change, flush• Therapeutic phlebotomies
Infusion Therapy is staffed by four full time, one part time and three temporary on call (TOC) registered nurses. These
nurses have many years of oncology and infusion therapy experience. All are BCLS, ACLS, and Chemo certified. In addition, two full time secretaries assist in patient care and coordinating treatments, as well as all the behind the scenes work that helps keep things running smoothly.
In 2013, Infusion Therapy celebrated three nurses achieving Oncology Certified Nurse (OCN) status. Amy Pfahler, Cindy Smith and Deneen Corbin are joined by Joce Abbott and Jane McKee in being oncology certified nurses in Infusion Therapy.
Infusion Therapy is open Monday through Saturday with appointment times between 7 a.m. and 5 p.m.
Pictured, infusion therapy nurse Joce Abbott, BSN, RN, OCN providing care and support to a cancer patient.
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In the past year, the Clinical Research department has made many changes and continual improvements in patient care. The department switched its tracking system from paper to electronic, and developed a patient calendar for the E1Z11 breast cancer study. That calendar is now the new standard calendar being used by the Dayton Clinical Oncology Program (DCOP), the program BVHS works with to bring national cancer clinical trials to our local community. In addition, new protocol was added so that treatment trial patients are now followed by two registered nurses for accuracy and appropriate treatment per protocol. Clinical Research was proud to welcome Dr. Mobayed as a new principal investigator and Dr. Browning as a new member of the Board of Directors for DCOP in 2013 as well.
Clinical Research & Outreach
YEAR 2012 2013
All Colonoscopies 1970 2038
Colonoscopies 1025 1126
Reported Colonoscopies from the Surgery Center
YEAR 2012 2013 Surgery Center 1025 1126 BVHS 554 588 Year Total 1579 1714 Increase of screening colonoscopies from previous year.
Combined ScreeningColonoscopies - Findlay
7.9%
The Ohio Colorectal Cancer Prevention Initiative (OCCPI) Study
Clinical trials are the key to “finding the cure.” Standard cancer treatments used today are the direct result of clinical trials of the past. En-rollment in a clinical trial can provide access to newer drugs or treatment procedures that might not otherwise be available. Enrollment may also provide information for
Clinical Research: Our Contribution to the Future of Cancer Care
the prevention and control of cancer. The goals of clinical trials are to answer specific questions about cancer, find better ways to prevent or de-tect it, and find better ways to treat or improve patient care.
The clinical research department is staffed by award winning nurses and
physicians. BVH nurses have received awards from the Dayton Clinical Oncology Program (DCOP) for top accrual in 2008 - 2013.
Dr. Sharon Cole was named the Top Accruing Physician by DCOP in 2008 - 2013.
Understanding colorectal can-cer is a necessity for learning how to prevent it, treat it and beat it. While the majority of colorectal cancers are part of aging, some are caused by factors we can’t yet explain. That’s why The Ohio State University Comprehensive Cancer Center, with funding from the Pelotonia race, devel-oped a research study called The Ohio Colorectal Cancer Prevention Initiative (OCCPI). The study was implemented in the spring of 2013 exclu-sively in the state of Ohio with a goal to accrue 4,000 newly diagnosed colorectal patients by the end of 2014. In 2013, BVHS accrued half of all eligi-
ble patients to the study, which accounted for 14 patients. When a patient is accrued to the study, it is required that they submit a small blood sample, a tumor sample and complete an online question-naire. The patient then receives free tumor screening for Lynch Syndrome, followed by free genetic testing and counseling if eligible. If the patient is found to have Lynch Syndrome (the most common type of hereditary colorectal cancer), then their family can have genetic testing and counseling for free as well. The BVHS research department will continue to introduce this valuable study to all eligible patients until the study closes.
Dr. Sharon Cole was named the Top Accruing Physician by DCOP in 2008 - 2013. 4
Shannon Kohls, BSN, RN, OCNClinical Research andChristine Montgomery, RNClinical Research, Outreach Coordinator
Screening
On December 19, 2013, the Blanchard Valley Health System Board of Trustees unanimously approved plans to build a $4.25 million comprehensive regional cancer center, to adjoin the radiation therapy center on the EasternWoods campus in Findlay. As part of the ongoing commitment by BVHS to offer the best cancer care available, the new center will enhance efforts to cure cancers and provide easy access for patients. According to Kimberly Benson, director of oncology services, “A comprehensive community cancer center will allow us to consolidate many cancer services in one location and add support services that patients and their loved ones need during cancer treatment and recovery. With this expansion, patients will have one location to receive exceptional cancer care in Findlay, Ohio.” Plans for the expansion are currently being developed, and groundbreaking is planned for November 2014.
In 2013, Blanchard Valley Regional Cancer Center (BVRCC) added new equipment to aide in the fight against cancer. The new cancer treatment system, called TrueBeam™, offers advanced radiation therapy for some of the most complex cancers.
The TrueBeam system is de-signed to deliver more pow-erful cancer treatments with accuracy and precision. In ad-dition, the system integrates new imaging technologies to complete treatments more quickly while monitoring the motion of tumors.
The TrueBeam system also offers faster imaging at lower radiation doses. The system can generate three-dimensional images to fine tune tumor targeting in less time than other X-ray systems, minimizing the amount of X-ray radiation
received by the patient. These images allow the physician to fine-tune a patient’s position prior to and during the treatment process.
According to Kimberly Benson, director of oncology services for Blanchard Valley Health System, “The True-Beam system allows for a more comfortable experience
for the patient because he or she spends less time in treatment. And, faster delivery of the radiation treatment means there is reduced chance for tumor motion during treatment, which helps protect nearby healthy tissues and organs.”
Cancers that can be treated by the TrueBeam system include,
TrueBeam™, Cancer Treatment System at Blanchard Valley Regional Cancer Center
but are not limited to, head and neck, lung, breast, abdomen and liver.
For more information about the TrueBeam system or cancer treatment from Blanchard Valley Health System, visit www. cancercarechampions.org
Pictured, left, radiation oncologist, Stephen Lutz, MD pictured with Andrea Rigsby, RT.
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Dr. Mobayed completed medical school at Damascus University School of Medi-cine in Damascus, Syria. He completed his residency in internal medicine at the Detroit Medical Center, Wayne State University in Detroit, Michigan and his fellowship in hematology/medical oncology at the Karmanos Cancer Institute, Wayne State University also in Detroit.
Dr. Mobayed is board certified in internal medicine, hematology and medical oncology.
Dr. Mobayed has formed Blanchard Valley Hematolo-gy and Oncology Associates.
New Oncologist Joins BVHS
TrueBeam™, Cancer Treatment System atBlanchard Valley Regional Cancer Center
Mohammed Mobayed, MD
Hematology/Medical Oncology
2013 Community OutreachBVHS associates participated in 20 community outreach events with the opportunity to speak to and pass out literature to about 3,500 people regarding prevention and screening.
Community Skin Cancer Screening held June 6, 2013. 107 participants attended. Drs. Cairns, Patel and Rower performed the screenings.
Dr. Mobayed gave a talk on anemia to about 50 University of Findlay pharmacy students and a presentation on skin cancer education to approximately 100 employees of Marathon in Findlay.
First ever Susan G. Komen event held in Findlay, Ohio on September 28, 2013. The event brought in 3,100 participants! Pictured below.
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The Blanchard Valley Health System Cancer Registry has been collecting data in accordance with state and national guidelines since our cancer program ref-erence date of January 1, 2003. The data collected includes demographic, cancer identification (primary site, histology, stage of disease, treatment), follow-up and survival data. BVHS data is routinely reported to the Ohio Cancer Incidence Surveillance System (OCISS), Ohio’s Central Registry. BVHS data includes both our hospital and cancer center patients and is reported to the National Cancer Data Base (NCDB).
In addition to being utilized at cancer conferences and in the BVHS annual report, the medical staff, administration, other departments, and other cancer registries also utilize the data. The data is used as a clinical surveillance mechanism to review patterns of care and outcomes and in long-range planning for services.
Lifetime follow-up is performed on our patients on at least an annual basis. Ongoing follow-up benefits patients by reminding them that routine medical examinations are recommended to en-sure early detection of recurrence or new primary malignancies. This also benefits physicians by potentially bringing lost patients back under medical supervision. In addition, the follow-up information is used to compare outcome results with regional, state, and national standards.
Cancer Registry
DIAGNOSIS # OF PERCENTCOUNTY CASES HANCOCK 258 48.9%SENECA 76 14.4%WOOD 52 9.8%HARDIN 48 9.1%WYANDOT 34 6.4%PUTNAM 34 6.4%ALLEN 10 1.9%HENRY 5 0.9%SANDUSKY 4 0.8%AUGLAIZE 2 0.4%OUT OF STATE 2 0.4%LOGAN 1 0.2%LUCAS 1 0.2%OTTAWA 1 0.2%TOTAL CASES 528 100.0%
COUNTY OF RESIDENCE AT DIAGNOSISAnalysis of county of residence at diagnosis reveals that the majority of patients diagnosised at BVHS reside in Hancock County. The breakdown is demonstrated below.
2013 ANALYTIC CASES
Bone & Soft Tissue ... 9
Unknown Primary.......12
Skin .........14
Oral Cavity....18
Brain & CNS ...20
Endocrine ....21
Lymphatic System .......21
Female Genital .......28
Blood & Bone Marrow .......32
Male Genital .......32
Urinary System .......49
Digestive System .......82
RespiratorySystem .......86
Breast ...... 103
All Sites Total 528
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BVHS OHIO U.S.BREAST 103 19.5% 9,060 13.6% 232,340 14.0%LUNG 78 14.8% 10,230 15.4% 228,190 13.7%COLON 38 7.2% 5,890 8.8% 142,820 8.6%BLADDER 31 5.9% 3,020 4.5% 72,570 4.4%PROSTATE 29 5.5% 8,530 12.8% 238,590 14.4%TOTAL 528 100.0% 66,610 100.0% 1,660,290 100.0%
TOP SITESThe top sites accessioned at Blanchard Valley Health System in 2013 are displayed here. Comparison of our incidence rate to Ohio and the U.S. is demonstrated.
TREATMENT # OF CASES PERCENTNone 101 19.1%Single Modality Therapy 217 41.1%Surgery Only 134 25.4%Chemotherapy Only 35 6.6%Radiation Only 33 6.3%Hormone Only 7 1.3%Other 7 1.3%Biological Response Modifier 1 0.2%
Multimodality Therapy 210 39.8%Surgery/Radiation 41 7.8%Chemotherapy/Radiation 35 6.6%Surgery/Chemotherapy 33 6.3%Surgery/Chemo./Radiation 26 4.9%Surgery/Radiation/Hormone 23 4.4%Surgery/Hormone 11 1.8%Surgery/Chemo./Radiation/Hormone 8 1.5%Chemo./Hormone/Biological Response Modifier (BRM) 6 1.1%Surgery/Chemotherapy/BRM 5 1.0%Radiation/Hormone 5 1.0%Surgery/Radiation/BRM 3 0.6%Chemotherapy/BRM 2 0.4%Chemotherapy/Hormone 2 0.4%Chemotherapy/Radiation/BRM 2 0.4%Radiation/BRM 2 0.4%Surgery/Radiation/Hormone/BRM 2 0.4%Surgery/Chemotherapy/Radiation/BRM 1 0.2%Chemotherapy/Radiation/Hormone 1 0.2%Radiation/Hormone/BRM 1 0.2%Surgery/Radiation/Other 1 0.2%
TOTAL CASES 528 100.0%
TREATMENTAnalysis of the 2013 analytic cases, 19.1% of the patients had no treatment documented, 41.1% received single modality treatment, and 39.8% received multimodality treatment.
Age Range Male Female10 - 19 1 120 - 29 0 030 - 39 3 1340 - 49 12 3050 - 59 45 5560 - 69 73 7470 - 79 65 5380 - 89 38 5290 - 99 5 8TOTALS 242 286
AGE AND SEXOf the analytic primaries, 242 (45.8%) were males and 286 (54.2%) were females. The majority of both males and females were diagnosed between the ages of 60-69.
STAGE # OF PERCENTGROUP CASES0 42 8.0%I 151 28.6%II 81 15.3%III 58 11.0%IV 121 22.9%UNK 5 0.9%N/A 70 13.3%TOTAL CASES 528 100.0%
STAGE AT DIAGNOSISAnalysis of the 2013 analytic primaries reveals that the majority were diagnosed at AJCC Stage I (28.6%), 8.0% at Stage 0, 15.3% at Stage II, 11.0% at Stage III, 22.9% at Stage IV, and 0.9% at Unknown Stage. 13.3% of the primaries were not eligible for AJCC staging.
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Prostate DIAGNOSED 1/1/2013 –12/31/2013 SITE SPECIFIC ANALYSIS
Updated Guidelines for Prostate Cancerby:DrAndreGilbert
Last year, the American Urological Association (AUA) released guidelines for the early detection of prostate cancer. It is important to note that these guidelines are for asymptomatic men (patients with no urinary voiding symptoms).
These guidelines are directed toward men between 55 and 69 years of age, with emphasis on shared deci-sion-making with their physicians to decide if the PSA test should be done. The reasons behind this more conservative approach rely on: risks associated with the prostate biopsy, some prostate cancers are slow growing, not all prostate cancers need treatment, and if treated, associated risks and side effects can compromise the patient’s quality of life (ex: urinary incontinence, erectile dysfunction).
It is important to remember that a select group of patients, including African Americans and men with a family history of a close relative with prostate cancer, are in a different screening category and should be more vigilant in this regard. The AUA encourages an open discussion with your physician about PSA testing for prostate cancer screening.
Signs And SymptomsEarly prostate cancer usually has no symptoms. With more advanced disease, men may experience weak or interrupt-ed urine flow, the inability to urinate or difficulty starting or stopping the urine flow, the need to urinate frequently, espe-cially at night, blood in the urine, or pain or burning with urination. Advanced prostate cancer commonly spreads to the bones, which can cause pain in the hips, spine, ribs, or other areas.
Risk FactorsThe only well-established risk factors for prostate cancer are increasing age, African ancestry, and a family history of the disease. About 60% of all prostate cancer cases are diagnosed in men 65 years of age and older, and 97% occur in men 50 and older. African American men and Jamaican men of African descent have the highest documented prostate cancer incidence rates in the world. The disease is common in North America and northwestern Europe, but less common in Asia and South America.
Genetic studies suggest that strong familial predisposition may be responsi-ble for 5%-10% of prostate cancers.
Recent studies suggest that a diet high in processed meat or dairy foods may be a risk factor, and obesity appears to increase risk of aggressive prostate cancer. There is some evidence that occupational exposures of firefighters (e.g., toxic combustion products) moderately increase risk.
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Analysis of the BVHS primaries age at diagnosis re-veals that the majority of the males were diagnosed at age 70-79.
2013 BVHS Cancer Annual Report | Findlay, Ohio | 419.423.55222014 Blanchard Valley Health System
(Published 9.10.14)
For all stages combined, about 96.7% of men with prostate cancer survive 1 year after diagnosis. The 5-Year relative survival rate for all stages combined is 81.9%.
A comparison of the analytic primaries diagnosed 2003-2006 of NCDB (all programs) and BVHS is demonstrated below.
* Stages I, III, and IV are statisticallyinsignificant due to the low number of cases diagnosed and treated at Blanchard Valley Hospital.