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Oncology Report 2007 final full bleed
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Oncology Report 2007 final full bleed

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  • 1. Cancer Care Resource Center By. Barbara VanRysdam, MSH, RD Jason Barrett Senior VP of Operations Michael DiBella, MD VP UM/PI Melanie Miles-Kent, RHIA QM Director/Coordinator QC Cecilia Huffman, RHIA HIM Director Patty McAnnally, RN, MSN Nursing Cynthia Woolbright, MSW Social Services Barbara VanRysdam, MSH, RD CCRC Education & Outreach Coordinator Betty Willis, RD/LD, MSH, MBA Clinical Dietitian Joe Mark, LMHC Mental Health & EAP Laraine Kessen, RN Nursing Claudia Downs, RHIT, CTR Tumor Registry Supervisor Charisse Creech, RHIA Tumor Registrar Shelly Whiteman, BSN Director, CCRC Clinical Oncology Coordinator Regina Ballard American Cancer Society Representative Professional Staff Cancer Committee Members 2005-2006 Physician Cancer Committee Members 2005-2006 April Mendoza, MD Cancer Program Chair, Radiation Oncology Marc Warmuth, MD Physician Liaison / Conference Coordinator, Hematology/Oncology Keith Justice, MD Hematology/Oncology Daniele Montgomery, MD Oncology Pod Director Hematology/Oncology, Ruth Streeter, MD Coordinator Cancer Registry Data Hematology/Oncology, Mason Long, MD Internal Medicine Yanet Pantaleon, MD Pathology Leopoldo Gonzalez, MD General Surgery James Builteman, MD Radiology Eneida Gomez, MD Psychiatry Scott Corneal, MD Physical Med & Rehab Martin Kubiet, MD Pulmonology Breast MRI Technology - Flagler Imaging Center By: James Builteman, MD In 2007, the Flagler Imaging Center initiated its Breast MRI Program. The most up-to-date breast coil technology was acquired, allowing bilateral (both sides at the same time) studies to be done. These are then reviewed by the radiologist on a dedicated computer workstation. This system represents state-of-the-art breast MRI technology. Importantly, patients can have the studies done conveniently in the comfortable environment of our outpatient imaging center. Breast MRI has become an integral part of staging our patients newly diagnosed with breast cancer. This allows the most appropriate treatment decisions to be made. It also is emerging as an important adjunct to screening mammography in women considered at high risk for developing breast cancer, particularly those with strong family histories of the disease. The 2006 analytical data in our tumor registry included 562 newly diagnosed cases of cancer. These 562 individuals underwent treatment and continued care within our community. Due in large part to the continued dedication of the Cancer Committee, our local physicians are able to offer cancer patients the most current options for diagnosis and treatment. This dedication to utilizing cutting edge cancer research and technology places Flagler Hospital in the top 25% of hospitals nationwide. This elite group of hospitals is recognized by the American College of Surgeons Commission on Cancer by their endorsement of our accredited cancer care program. We are proud of our continued accomplishments and accreditation by the Commission on Cancer (CoC). In order to maintain accreditation by the CoC, our cancer care program must adhere to published core standards. We must also implement and maintain ongoing quality improvement studies, a community outreach program, multidisciplinary cancer conferences, and quality control of our cancer registry data. The Cancer Committee maintains a strong quality improvement program with the goal of advancing cancer care in our community. The approval of our 2007 goals and quality improvement studies on breast cancer treatment coincided with an announcement by the American College of Surgeons regarding joint approval and implementation of new quality measures in breast and colon cancer. The measures were also endorsed by the American Society for Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), and National Quality Forum (NQF). For the first time, institutions will be held accountable for their performance in cancer care based on adherence to these standards. The Flagler Hospital Cancer Committee was already in the process of implementing these standards through quality improvement programs and education of all physicians involved in the care of a patient newly diagnosed with breast or colon cancer. Once again, we are on the forefront of advancements in the treatment of cancer. Our multidisciplinary cancer conference provides a forum for physicians and allied health professionals to collaborate and educate each other on the many aspects of care involved in the treatment of cancer patients. Another goal for 2007, is to establish a site specific multidisciplinary patient centered clinic. In this setting, newly diagnosed breast cancer patients will be able to have their case reviewed by multiple physicians from various specialties including surgery, medical oncology, radiation oncology, pathology and radiology. These physicians will work together to recommend a treatment pathway for each individual, which adheres to the nationally accepted guidelines endorsed and implemented by the American College of Surgeons and NCCN. I am proud to be a member of the Flagler Hospital community and honored to serve as the Chair of the Cancer Committee for the past two years. The many members of this committee work tirelessly and are rewarded only with the knowledge that their efforts will ensure the best possible cancer care for our patients and their families. Chair Report By. April Mendoza, MD 1 The Cancer Care Resource Center moved to its new location, Suite 1010 in Flagler Hospital, in July of 2007. The new library houses books, videos, DVDs, and other resources pertaining to oncology, specific cancers, treatment, managing side effects, caregiving, self-help, spirituality, and wellness. Also featured are two computer stations with internet access for visitors to collect more information pertaining to their specific situation. Another addition to the Resource Center is a beautiful boutique-styled gift closet with wigs, hats, scarves, prosthetic bras and prosthesis available to cancer patients at no charge. Support groups for patients, families, and caregivers meet monthly in the library and programs such as “I Can Cope” and “Look Good Feel Better” are held on a regular basis. The CCRC staff works closely with the Oncology Program at Flagler Hospital to provide patients with the best possible resources to make them as well educated and comfortable as possible during this difficult time in their lives. The staff of the CCRC is dedicated to following each patient during their diagnosis, treatment and beyond, in an effort to ensure that every patient who comes through the CCRC receives the quality care and compassion that is always provided to patients at Flagler Hospital. This year, Flagler Hospital participated in its first National Cancer Survivors Day. The event was held in the Flagler Hospital Atrium on June 8, 2007. Activities such as an art show, musical entertainment, refreshments, guest speakers and door prizes were featured. Plans are already underway for the 2008 Survivors Day celebration. The CCRC’s Third Annual Women’s Health Education Seminar took place at Flagler Hospital on September 22, 2007, with nearly 100 people in attendance. This year’s seminar featured six of Flagler Hospital’s physicians, covering a variety of important aspects of women’s health. All proceeds from the seminar benefitted the Cancer Patient Emergency Fund, which continues to provide assistance to patients who are experiencing financial difficulties while undergoing cancer treatment. In September of 2007, the CCRC was notified that it was awarded the American Cancer Society’s Community Education Grant to address cancer disparities. The grant will be used for a community health fair aimed at providing information on breast cancer early detection and prevention, and other types of cancer prevention to the African American population in St. Johns County and surrounding communities. The CCRC staff hopes to make this an annual event.
  • 2. PRIMARY SITE TOTAL SEX STAGE M F 0 I II III IV UNK N/A ALL SITES 562 259 303 47 112 119 69 98 63 54 ORAL CAVITY 13 8 5 0 5 0 2 4 2 0 LIP 1 1 0 0 1 0 0 0 0 0 TONGUE 4 1 3 0 1 0 1 0 2 0 OROPHARYNX 1 1 0 0 0 0 0 1 0 0 HYPOPHARYNX 0 0 0 0 0 0 0 0 0 0 OTHER 7 5 2 0 3 0 1 3 0 0 DIGESTIVE SYSTEM 109 60 49 7 12 24 21 30 14 1 ESOPHAGUS 9 5 4 0 1 0 2 5 1 0 STOMACH 7 3 4 1 1 2 0 2 1 0 COLON 47 27 20 5 7 11 12 8 4 0 RECTUM 11 7 4 0 3 3 3 1 1 0 ANUS/ANAL CANAL 1 0 1 1 0 0 0 0 0 0 LIVER 6 5 1 0 0 2 1 0 3 0 PANCREAS 18 8 10 0 0 3 1 12 2 0 OTHER 10 5 5 0 0 3 2 2 2 1 RESPIRATORY SYSTEM 123 68 55 0 29 7 31 39 17 0 NASAL/SINUS 0 0 0 0 0 0 0 0 0 0 LARYNX 7 5 2 0 2 0 4 0 1 0 LUNG/BRONCHUS 115 62 53 0 27 7 27 39 15 0 OTHER 1 1 0 0 0 0 0 0 1 0 BLOOD & BONE MARROW 13 5 8 0 0 0 0 0 0 13 LEUKEMIA 6 4 2 0 0 0 0 0 0 6 MULTIPLE MYELOMA 7 1 6 0 0 0 0 0 0 7 OTHER 0 0 0 0 0 0 0 0 0 0 BONE 0 0 0 0 0 0 0 0 0 0 CONNECT/SOFT TISSUE 2 0 2 0 0 0 0 0 2 0 SKIN 15 6 9 3 4 2 0 4 2 0 MELANOMA 15 6 9 3 4 2 0 4 2 0 OTHER 0 0 0 0 0 0 0 0 0 0 BREAST 111 1 110 22 38 34 4 6 7 0 FEMALE GENITAL 20 0 20 5 4 0 1 2 8 0 CERVIX UTERI 5 0 5 1 3 0 0 1 0 0 CORPUS UTERI 4 0 4 0 1 0 0 0 3 0 OVARY 7 0 7 0 0 0 1 1 5 0 VULVA 3 0 3 3 0 0 0 0 0 0 OTHER 1 0 1 1 0 0 0 0 0 0 MALE GENITAL 51 51 0 0 1 45 1 0 4 0 PROSTATE 50 50 0 0 0 45 1 0 4 0 TESTIS 1 1 0 0 1 0 0 0 0 0 OTHER 0 0 0 0 0 0 0 0 0 0 URINARY SYSTEM 38 26 12 10 14 4 2 2 6 0 BLADDER 16 10 6 10 5 1 0 0 0 0 KIDNEY/RENAL PELVIS 22 16 6 0 9 3 2 2 6 0 OTHER 0 0 0 0 0 0 0 0 0 0 BRAIN & CNS 21 7 14 0 0 0 0 0 0 21 BRAIN (BENIGN) 1 0 1 0 0 0 0 0 0 1 BRAIN (MALIGNANT) 8 3 5 0 0 0 0 0 0 8 OTHER 12 4 8 0 0 0 0 0 0 12 ENDOCRINE 13 8 5 0 2 1 5 1 0 4 THYROID 9 5 4 0 2 1 5 1 0 0 OTHER 4 3 1 0 0 0 0 0 0 4 LYMPHATIC SYSTEM 18 11 7 0 3 2 2 10 1 0 HODGKIN’S DISEASE 3 2 1 0 1 1 0 1 0 0 NON-HODGKIN’S 15 9 6 0 2 1 2 9 1 0 UNKNOWN PRIMARY 14 8 6 0 0 0 0 0 0 14 OTHER/ILL-DEFINED 1 0 1 0 0 0 0 0 0 1 2006 Site Table For accession year 2006, a total of 859 new cases were entered into the cancer registry database. This represents an 8% increase over the previous reporting year. Of the total caseload, 562 were newly diagnosed cases, meaning these patients were first diagnosed and/or treated at Flagler Hospital or a combination thereof (Fig 1). The remaining cases (non-analytic) were classified as historic and/or recurrence. The projected cancer incidence for 2006 totaled 1,399,790 according to the American Cancer Society Cancer Facts and Figures. Based on the national estimates for that year, 51% of the cancers were expected to occur in males and 48% in females. The actual reported occurrences at Flagler Hospital were 46% male and 54% female, respectively (Fig 2). The 10 most frequently diagnosed sites are illustrated in Figure 3. However, the top leading sites between genders combined are lung, breast, colorectal, prostate and kidney. Collectively, these accounted for 63% of the newly diagnosed cases in 2006. Lung and breast cases at Flagler Hospital ranked far above average in comparison to national figures. Since the registry reference year (1999), and based on the most complete year, there have been over 5,000 new cases entered into the registry database (Fig 4). As the registry matures, follow-up activities become increasingly challenging, since all analytic patients are followed for life. Our follow-up rate has always been maintained above the recommended 90% requirement. Registry personnel remain abreast of national and state reporting guidelines to maintain the most timely, accurate, and comprehensive database. As the information becomes available, each patient’s abstract is continuously updated to reflect the most complete information regarding management of the cancer. This data allow us to draw conclusions, report outcomes, and analyze the cancer care delivered at Flagler Hospital. Registry Report / 2006 Data Summary By. Claudia Downs RHIT, CTR Legend: Highlighted = Top Sites Fig 1 3 The Oncology Nursing Unit has been experiencing many new changes in the past year. We have been provided a Nurse Manager who is responsible for day-to-day operations and is a working member of the unit staff. The nursing department has implemented electronic medication verification and computerized documentation this year. We are currently rolling out Iatrics, which allows physicians to complete discharge orders and discharge medication reconciliation through our hospital-wide, patient based computer system. These changes in the computerized documentation system and medication administration process have increased accuracy and patient safety. The long awaited remodeling of the East end of our unit (E-pod) is expected to begin by the end of the year. This remodeling will provide a more updated environment with a “homey” feel. The changes will make the atmosphere for our most ill cancer patients more serene, and is expected to provide some comfort to those patients and their families who spend countless hours at the bedside. Several of the registered nurses are actively working toward certification as oncology nurses. More than half of the registered nurses are now chemotherapy certified. The Infusion Room is now providing outpatient chemotherapy to those patients whose conditions warrant this level of care. Those newly diagnosed cancer patients are being referred to the American Cancer Society more rapidly. Our area Leukemia and Lymphoma Society has provided us with packets for those patients with new Leukemia or Lymphoma diagnoses, and have provided us with an online registration process. With the assistance of this organization and our Cancer Care Resource Center, we are able to provide a stronger level of community support and resources for our patients. Through the assistance of both Community Hospice and Haven Hospice, we have been able to provide inservices to all levels of the oncology nursing staff regarding pain management, end of life care, dealing with grief for both the families and the staff, and recognizing the signs of end of life. The Chaplain Program here at Flagler Hospital plays an active role in providing spiritual guidance and comfort to our patients. Flagler Hospital, with support and guidance from the Cancer Committee, has developed standards to ensure continued ACoS accreditation, improved ACS collaboration, and patient education regarding the resources available to them. From admission through discharge and treatment, cancer patients are assured continuity of care. Nursing Report By. Patty McAnnally, RN, MSN, CMSRN, CNL-BC 42% 44% 46% 48% 50% 52% 54% Male Female Flagler National -Fig 2- 2006 Analytic Accessions by Gender National vs. Flagler Hospital 0% 5% 10% 15% 20% 25% Lung Breast Prostate ColonKidney/RP Pancreas BladderM elanom a NHL Unk Prim Flagler National -Fig 3- Frequently Diagnosed Cancers in 2006 0 100 200 300 400 500 600 700 1999 2000 2001 2002 2003 2004 2005 2006 Accession Year NumberofCases Analytic Non- Analytic -Fig 4- Accession by Class Since Reference Year 4
  • 3. 4 SITE SPECIFIC STUDY – A FOCUS ON BREAST CANCER By. Marc A. Warmuth, MD The Flagler Hospital staff and physicians are committed to providing comprehensive oncology care to our community and surrounding areas. One part of that commitment is analyzing and benchmarking results for our annual report. Each year, a specific cancer is studied in order to ensure that Flagler Hospital is meeting national and state standards. Breast cancer remains one of the most commonly diagnosed cancers in the United States. Statistics from the American Cancer Society estimate that approximately 215,000 people were diagnosed with breast cancer in 2006, and that there were approximately 41,000 deaths from breast cancer in the same year. Breast cancer is the most frequently diagnosed cancer in women, and is the second leading cause of cancer death in women. At Flagler Hospital, breast cancer is one of the most commonly diagnosed cancers. In 2006, 111 new cases of breast cancer were diagnosed. Figure 1 demonstrates an increase in the total number of breast cancers diagnosed from the initiation of the hospital’s cancer registry in 1999 until the present. Of the 111 patients, 90 were diagnosed and treated at Flagler Hospital and 11 were diagnosed elsewhere but received treatment at Flagler. The remaining 10 patients were diagnosed at Flagler Hospital but received treatment elsewhere. Figure 2 depicts the stage at diagnosis of patients at Flagler Hospital as compared to national and state of Florida statistics. Flagler Hospital has a slightly higher percentage of stage I and IV patients and a slightly lower percentage of stage 0, II and III. Treatment for breast cancer typically involves a multimodality approach, using a combination of surgery, radiation, chemotherapy, and hormonal therapy. Statistics from Flagler Hospital as compared to national and state of Florida data, are shown in Figure 3. Flagler’s data shows similar rates across the various treatment categories. Overall survival is presented in Figure 4. This table demonstrates a similar 5 year survival rate for patients at Flagler Hospital in comparison to state of Florida and national statistics. Flagler Hospital’s cancer registry began tracking statistical records in 1999, so therefore only 245 breast cancer patients with 5 years of follow up data were available for analysis. Despite the limited number of patients, the Flagler Hospital survival rates are remarkably similar to those from the state of Florida and national databases. In summary, the data presented in this report demonstrates that Flagler Hospital breast cancer statistics are similar to those of combined data from hospitals across the state of Florida and the nation. This applies to stage at diagnosis, treatment type, and overall survival. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 0 I II III IV UNK Stage at Diagnosis Flagler Florida National -Fig 1- Total Number of Breast Cancer Cases Diagnosed Since Reference Year -Fig 2- Flagler Hospital’s Breast Cancer Diagnosis’ Compared to State and National 0 20 40 60 80 100 120 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year of Diagnosis Numberofcases 0% 5% 10% 15% 20% 25% 30% 35% Surgery Surg/Rad Surg/Chemo Surg/Horm Surg/Chemo/Rad Surg/Rad/Horm S/C/R/H Surg/Chemo/Horm Other Spec Ther Flagler Florida National 0% 20% 40% 60% 80% 100% 120% Begin 1 2 3 4 5 YearsSurviving Flagler Florida Nation al -Fig 3- Total Breast Cancer Treatment Flagler Hospital Comparison to State and National -Fig 4- Overall Survival Percentages Flagler Hospital Comparison to State and National American Cancer Society The American Cancer Society collaborates with the Cancer Care Resource Center at Flagler Hospital, and continues to provide free pro- grams and services to new and existing patients. This reporting year, ACS registered over 2,200 newly diagnosed cancer patients in the First Coast Area. Flagler Hospital achieved a 102.9% goal in registering newly diagnosed patients. Flagler Hospital is continuously making new strides in registering newly diagnosed patients, and providing service for all cancer patients and their families. For additional information, please call 904-825- 4132. Tumor Board Presentations To place a case on the Tumor Board agenda for ei- ther prospective presentation or retrospective re- view, please contact the Cancer Registry at 819-4473 or 819-4779. Cancer Related Support Groups Cancer General Support Groups Look Good... Feel Better Man to Man Prostate Support Group Breast Cancer Support Group Reach to Recovery Road to Recovery I Can Cope Ostomy Support Group Co-Sponsored by the Flagler Hospital Cancer Care Resource Center and the American Cancer Society. References American Cancer Society Cancer Facts and Figures, 2006 ACOS, National Cancer Database- Benchmark Reports AJCC- American Joint Committee on Cancer, Cancer Staging Manual, Fifth & Sixth Edition Special Presentations in 2006 4/1/06 Recent advances in the management of ovarian carcinoma – Tate Thigpen, MD, Professor of Medicine & Director – Div of Oncology, University of Mississippi 5/4/06 Grand Rounds – Stealth and Brain Lab. Recognize appropriate candidates eligible for Stereotactic Radiation – Miguel Machado, MD, Flagler Hospital 9/7/06 Impact of Genetic Evaluation on Medical Management: Update on cancer genetics – Jeanne W. Brunger, MD., C.G.C Myriad Genetic Labs Summary of Cases Presented in 2006 In 2006, 92 cases were presented at the facility-wide conferences. All major sites were discussed with a documented 86% prospective rate. Multidisciplinary attendance was 85% above the required committee standard and the average attendance. Oncology Conferences January: Colon, Breast, Lung and Anus February: Breast, Lung and Pancreas March: Breast, Brain and Pancreas April: Colon, Lung, Esophagus, Lymph Nodes, Breast, Prostate, Pleura, Stomach, Pancreas and Unk. Primary May: Unk. Primary, Thyroid, Head and Neck June: Breast July: Breast, Kidney, Ovary, Pancreas and Colon August: Brain, Lung, Colon, Breast and Unk. Primary September: Lymph Nodes, Breast, Kidney, Stomach, Colon, Appendix, Bladder, Thyroid and Skin October: Endometrium, Unk. Primary, Bone Marrow and Penis November: Breast, Colon, Testis and Skin December: Breast, Bladder, Prostate and Adrenal Gland 6

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