We set the standard for cancer care.

We set the
standard for
cancer care.
2012 Oncology Annual Report
With a special report on Outreach Services
and how we care for our community.
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Table Of Contents
A Message From Our Chair..................................................................................................3
Services & Locations............................................................................................................. 4
Special Feature: Community Outreach.......................................................................... 6
A Survivor’s Story................................................................................................................... 8
Treatment Modalities:
Radiation Therapy.............................................................................................................. 9
Chemotherapy.................................................................................................................... 9
Genetics & Risk Assessment........................................................................................ 9
Research & Clinical Trials............................................................................................ 11
Clinical Nutrition.............................................................................................................. 11
Breast Reconstruction................................................................................................... 12
Pathology & Laboratory Services............................................................................. 12
Support:
Nurse Navigation.............................................................................................................. 13
Spiritual Care....................................................................................................................14
Palliative Care...................................................................................................................14
Women’s Task Force....................................................................................................... 15
Cancer Registry:
Cancer Registry Report................................................................................................. 16
Providing Care for All..................................................................................................... 16
Abstracting for the Cancer Registry......................................................................... 22
Patient Care Conferences............................................................................................23
Follow-up Coordination for the Cancer Registry................................................. 25
Oncology Committee...........................................................................................................26
Phone Directory..................................................................................................................... 27
Affiliates, Approvals & Accreditations......................................................................... 27
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A Message From Our Chair
Saint Joseph Regional Medical Center’s Comprehensive Oncology Program provides
patients access to innovative tools and talented and compassionate cancer professionals.
Our multi-disciplinary team includes expert physicians, nurses, researchers, oncology
specialists and an expansive outreach services program.
A common purpose unites us: caring for our community. Inside this report you will
find a special feature on our community outreach efforts, including advocacy, prevention
and early detection programs, tobacco cessation initiatives and our strong partnerships
with community cancer resources.
In 2012, SJRMC, along with Michiana Hematology Oncology, focused emphasis
on breast care and breast cancer services in our community. This started with the
emergence of a breast care program facilitating the care from diagnosis, mammogram,
early detection, expediting the biopsy time and eventually the treatment planning.
The Breast Care Program at SJRMC is comprised of a dedicated nurse, geneticist and
physicians who work in collaboration to practice evidence-based medicine.
We are committed to doing everything we can to provide the best cancer care possible – and greater peace of mind –
for the communities we serve.
Bilal Ansari, MD
Oncology Committee Chairman
Saint Joseph Regional Medical Center Oncology Program
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Services & Locations
Center for Women’s Health
Saint Joseph Regional Medical Center provides access to
cutting-edge cancer services and care for patients across
Michiana.
Mishawaka & South Bend
Mishawaka Campus
611 East Douglas Road, Suite 123
Mishawaka, IN 46545
574.335.6216
The Center for Women’s Health, located in the Medical
Office Building connected to the hospital, offers a unique
and convenient experience for Michiana women. The Center
is committed to the importance of early detection and
promotion of breast health with leading edge technology and
a highly trained staff. All the resources and technology our
staff needs to effectively and efficiently care for patients are
in one convenient location. The Center is accredited by The
National Accreditation Program for Breast Centers.
5215 Holy Cross Parkway
Mishawaka, IN 46545
574.335.5000
Garcia Family Foundation Oncology Unit
The Garcia Family Foundation Oncology Unit, located
on the sixth floor of the Mishawaka Campus, is specially
designed to create a soothing environment for patients
with cancer. Our goal is to provide excellent care
effectively manage cancer, its treatments and its side
effects to allow the patient the highest quality of life.
Services
•Two digital mammography units
•Digital state-of-the-art biopsy room
•Ultrasound
•Bone Density Screening
All of our providers are specially trained to care for cancer
patients. Our nurses attend Oncology Nursing Society
chemotherapy/biotherapy provider courses in order to
administer these medications to our patients. The Unit
also includes a large Hospice Room to accommodate
patients with special needs or a longer length of stay.
Lymphedema Treatment Clinic
611 East Douglas Road, Suite 140
Mishawaka, IN 46545
574.252.3616
The Lymphedema Treatment Clinic, located in the
Medical Office Building connected to the hospital, offers
a comprehensive approach to help patients manage
lymphedema. The program is a collaboration between
Roger Klauer, MD, of Saint Joseph Family Medicine at
Elm Road, and Joanna Hartman, Physical Therapist, of
SJRMC’s Outpatient Rehabilitation. Patients are seen by
both professionals simultaneously in an initial evaluation. A
treatment course is outlined and the patient is scheduled
with a certified lymphedema therapist in a location that fits
their clinical needs, insurance coverage and driving distance.
Team of Experts
•Oncology Certified Nurses
•Oncologists & Physicians who specialize in cancer
treatment
•Case Manager
•Chaplain
•Clinical Dietician
•Oncology Pharmacist
•Physical, Occupational & Speech Therapists
Team of Experts
•Physiatrist
•Nurse Navigator
•Physical Therapists
•Appointment Scheduler
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Services
•Gynecologic Oncologists
•Medical & Radiation Oncologists
•Imaging Services
•Genetics & Risk Assessment
•Financial Assistance
•Complementary Medicine
•Master Nutritional Therapist
•Nurse Navigator
•Oncology Rehabilitation
•On-Site Laboratory
•Pain Management Consultations
•Second Opinion Clinic
•Support Groups
•24-Hour Nursing Assistance
•Personal Appearance & Image Boutique
•Advanced Cancer Research
Saint Joseph Medical Imaging Center
53940 Carmichael Drive
South Bend, IN 46635
574.335.8100
Saint Joseph Medical Imaging services are available at
the Mishawaka Campus and a freestanding location on
Carmichael Drive in South Bend. Our state-of-the-art
equipment ensures the best possible detection and diagnosis
of a variety of conditions. Technology has substantially
improved the quality of exams, and our facilities offer many
of the newest and best devices on the market. Our expert
staff of radiologists and technicians is dedicated to quality
care and treating every patient with dignity, respect, and
compassion. All of our images are digitally acquired and
graphically stored for future reference and quick access. The
Center is accredited by The National Accreditation Program
for Breast Centers.
Services
• Bone Density
• CT Scan
• Mammography
• MRI
Plymouth
Plymouth Cancer Institute
• X-Ray & Fluoroscopy
• Ultrasound
• PET/CT Imaging
Michiana Hematology Oncology
1915 Lake Avenue
Plymouth, IN 46563
574.936.3181
The Plymouth Cancer Institute offers patients who live
in Marshall County and surrounding communities access
to the latest treatments conveniently close to home. Our
medical oncologists, radiation oncologists and specially
trained nurses provide expert cancer care in a soothing
and healing environment.
5340 Holy Cross Parkway
Mishawaka, IN 46545
574.237.1328
All the cutting-edge cancer services and care that a
patient may need can be found under one roof at Michiana
Hematology Oncology’s Regional Cancer Center, a joint
venture located directly across the street from the
Mishawaka Campus. This state-of-the-art freestanding
facility was designed by highly skilled experts in cancer care
who asked for input from real patients to ensure that it was
designed as a welcoming place. Technically advanced and
completely integrated, this Regional Cancer Center treats
the whole person.
Services
•Radiation Therapy
•Outpatient Infusion Center
•Laboratory & Imaging
•Nutritional Counseling
•Oncology Patient Navigator
•Spiritual Care
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Special Feature: Community Outreach
This is how we are called to care. As a not-for-profit health care provider, Saint Joseph
Regional Medical Center (SJRMC) offers health and wellness programs at no or low
cost as part of our mission.
Outreach Services works to evaluate and respond to these critical needs in our
community. These services include the operation of our community health centers,
medical education, subsidized care, early detection and prevention programs,
screenings, health fairs and more.
Advocacy
Community Outreach Nurse, Betty Greene, RN, serves as
an Associate Director of Advocacy for Alliance for Clinical
Trials in Oncology. On a local level, she holds education and
awareness seminars within the community. On the national
level, she advocates for dollars for cancer research and
strives to create awareness regarding the dangers of
silicone implants.
Prevention & Early Detection
Oral Cancer Screenings
In 2012, Community Outreach implemented use of two
Valscope machines for oral cancer screenings. One machine
is housed at the Sister Maura Brannick, CSC, Health Center,
and one is with the Outreach Services department to be
used out in the community. The machines are only operated
by a licensed Dental Hygienist or Dentist.
Tobacco Cessation
SJRMC is the lead agency for St. Joseph County’s
Smoke Free and Tobacco Free Initiatives through the
Indiana Department of Health. Jill Sabo, MSW, TTS, of
Outreach Services serves as the coordinator of Tobacco
Free St. Joseph County. Jill is the only Trained Tobacco
Specialist (TTS) in Indiana, trained by the Mayo Clinic.
Many different cancers are linked to tobacco use and
Jill’s ideas to monitor and implement programs that are
evidence-based (through the Centers for Disease Control
and Prevention) and/or are cost effective (for patients, the
hospital and tax payers) are proven to increase the overall
health of our community. Many of the initiatives may
also affect Meaningful Use, an initiative of the Centers for
Medicare & Medicaid Services. In addition, Jill conducts
free cessation classes throughout the year for those who
choose to eliminate their smoking habits.
Glucose Screenings
One of the screenings done at nearly all health fairs and
screening events is a glucose screening. New glucose
machines were purchased in the fall of 2011 to meet
updating requirements. Operators must be trained
and verified with SJRMC database in order to offer
screenings. Glucose screenings can help detect diabetes
and, as a result, can prevent liver cancer. In addition,
postmenopausal women with “high” blood glucose levels
are nearly twice as likely to develop colorectal cancer
over 12 years than those who had low levels, a study
showed. Researchers examined 4,500 women ages 50
to 70 and found that 35 patients in the “high” group – not
quite high enough to be diabetic – developed colorectal
cancer by the end of the study period, compared with only
18 in the “low” group. The findings appear in the British
Journal of Cancer.
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Mammography
The Foundation of SJRMC was the recipient of an Indiana
Breast Cancer Awareness Trust (IBCAT) Award, allowing us
to provide free mammograms to women in our community.
SJRMC also received a similar award from the Kelly Cares
Foundation earlier in the year. Grants such as these allow
us to take the Mobile Medical Unit to sites in South Bend,
Plymouth, and Mishawaka, offering women with little or
no insurance the opportunity for a digital mammogram
screening. In 2012, the Kelly Cares Foundation provided
43 women with mammograms and IBCAT provided an
additional 39. Together these two grants allowed 82
women to receive mammograms that would not have been
able to receive this important health care screening. More
importantly, of the 82 women screened, more than 10
women were referred for further follow-up.
In addition to the special grant-funded opportunities for
mammograms, the Mobile Medical Unit’s primary focus
is increasing the availability/access of mammograms
for women throughout our community. Going to the
neighborhoods where transportation may be a challenge
and/or going to places of employment have proven to
increase women’s continued medical maintenance. In
2012, the MMU went to 409 locations, available to the
public and private sector. On average, the Mobile Medical
Unit provides 80-100 mammograms a month, depending
on time of year and location. Many women have told staff
of the unit that they would not have gotten their exam
done if it were not for the convenience of the mobile unit.
20 community organizations. The list of free cancer
screenings offered included prostate cancer, skin cancer,
oral cancer, CO and smoking cessation. The goal of Touch
Base is to encourage and promote the early detection and
treatment of disease among men.
Partnerships
American Cancer Society
The American Cancer Society (ACS) is an active partner
with SJRMC, with a local representative being a member
of the Tobacco-free St. Joseph County Coalition, housed
at SJRMC. Together, ACS and tobacco-funded counties
throughout Indiana, including St. Joseph County, worked
diligently to achieve a comprehensive smoke-free law to
protect all workers in Indiana. Although we were able to
get a smoke-free law passed to protect some workers, it
is not a comprehensive law. As a result, the Tobacco-free
St. Joseph County Coalition will continue to work with our
legislators, both locally and at the state level, to improve
the environment for all workers.
Michiana Hematology Oncology & SJRMC
As Community Outreach continues to grow and
partnerships are strengthened, opportunities will
become available in many different forms. A most recent
partnership-strengthening example is the Oncology
Service Line. Service associates from SJRMC and Michiana
Hematology Oncology are coming together to build upon
the strong foundations the two organizations offer. Merging
and communicating each other’s strengths will provide our
mutual patients with the best health care and recovery
care possible. This endeavor is sure to bring positive
changes in our near future for all involved.
Health Fairs
Outreach Service sponsors countless health fairs
and opportunities for community members to access
screenings and health education free of charge.
Ounce of Prevention
Ounce of Prevention (OOP) is a local organization whose
focus is to increase breast cancer awareness and support
systems through fund-raising and events. OOP is a
generous supporter of the SJRMC - Plymouth Cancer
Institute and families who have been impacted by cancer
in the greater Marshall County community. In 2012, OOP
enabled the SJRMC-Plymouth Cancer Institute to purchase
a new CD player and stereo system for its radiology
treatment room. Many studies have found that listening to
music can help to reduce pain, relieve stress and provide
an overall sense of well-being for cancer patients. SJRMC
is grateful for the work done by OOP, and looks forward to
continuing this great partnership going forward.
One of our largest events is the Penn-Harris-Madison
Educational Foundation Silver Mile Family Wellness Event
in May. SJRMC has an impressive presence at the fair,
which includes representation from most of our hospital
departments and ancillary services.
Together with Greater St John’s Missionary Baptist
Church on South Bend’s Westside, SJRMC also sponsors
the Greater St. John’s Health Fair. The event provides
screenings to a large portion of our African-American
community. The unique resource offered at this event is
free Prostate screenings for men via a blood test.
Touch Base at the Cove, which provides a series
of free health screenings for men, is organized by
RiverBend Cancer Services* with the help of more than
*NOTE: Read more about SJRMC’s partnership with
RiverBend Cancer Services on page 15 of this report.
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Patient, Survivor & Volunteer
By Ruby J. Barts
In October of 1999, my husband and I were looking forward to a
European Tour – a military tour to Belgium and Germany where
he had served during WWII.
Before our trip, I noticed that I had some vaginal spotting –
it was small, no larger than the head of a straight pin. I knew
something was not right; however I did not have time to see a
doctor before the trip. So I watched for more spotting, and saw
nothing for a few weeks. In November, I had another episode
of light spotting; it stopped and then started again, eventually
worsening. I called my family doctor and during the scheduled
appointment I received a pap smear and the physician ordered a
pelvic ultrasound. Several days afterward, my physicians called
me with a report from the pap smear of “atypical,” and referred
me to Dr. Jane Howell, a gynecologist, who I saw on
December 20, 1999.
The waiting was nerve-racking over the holidays, as I put up
decorations and our Christmas tree. I lost my cool and started
pounding on my husband’s shoulders shouting, “This cancer
may kill me, but it has a heck of a battle on its hands.” From
that point, everything changed, my spirits were better because I
had to come to terms with the problem.
On January 4, 2000, I had a biopsy, and Dr. Howell called me
with the results of the procedure. This time, I was referred to a
new doctor in town – Dr. Michael Method. She told me that if he
were not located here, I would have had to go to Indianapolis.
Dr. Michael Method was the first and only gynecological
oncologist in our region at that time. As you know, we now have
two gynecological oncologists here in the area. My appointment
with Dr. Method was January 20. For the next week I had a different test almost every day and started pre-op two days prior to
surgery on January 30.
During my hospitalization, I had difficulty breathing because I was use to taking my medicine in the early morning. The nurse
recognized my difficulties, discussed my medication schedule, and at that time it was decided that I was able to be discharged
home and was recommended to get back on my regular medication schedule. I was discharged on February 4, two days earlier
that I had anticipated. During my first follow-up appointment with Dr. Method, he sent me to see the radiation oncologist, Dr. Guy
Kedziora. His nurse explained the radiation treatments I needed, and I started treatments. I had a total of 28 treatments, finishing
on March 11. On April 25, 2000, I saw Dr. Method in follow-up – and then saw him periodically for the next 5 years.
Today, almost 13 years later, I am cancer free. I volunteer at the Michiana Hematology Oncology, Mishawaka office
where I see Dr. Method on occasion. I enjoy talking to the patients and encouraging them when they come in for
treatment or follow up. I also volunteer at Saint Joseph Regional Medical Center’s Cancer Registry department on a
weekly basis.
On December 5, 2012, I celebrated my 80th birthday and feel very fortunate to be around.
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Treatment Modalities
Radiation Therapy & Chemotherapy
Radiation Oncology services at SJRMC offer advanced comprehensive radiation therapy programs, with individualized
treatments for each patient.
The oncology team consists of a specially trained oncology nurse, radiation therapist, dosimetrist and physicist, who each work
with the patient to ensure the highest quality, safety and best possible outcomes.
SJRMC has partnered with Michiana Hematology Oncology in the delivery of state-of-the-art Radiation Therapy at the new
cancer center, including the region’s first and only Linear Accelerator with “rapid arc” technology and respiratory gaiting.
The Linear Accelerator speeds up treatment for patients and delivers more targeted radiation, minimizing exposure to surrounding
healthy tissues. The 120-leaf MCL provides custom blocking around critical structures while optimizing radiation dose to the target
area, creating precise treatment custom to each patient.
Cone beam CT helps to obtain diagnostic CT-like quality images with the Linear Accelerator. This technology delivers more
precise treatments much faster than other technologies, and allows for pinpoint accuracy of radiation directly at the tumor site.
RT vision is able to obtain 3D images of patients in real time such that breathing may be tracked during treatment. In
addition, our staff uses Oncovision, a computer software program that allows diagnostic imaging to be integrated into
treatment planning.
We offer MammoSite®, a unique therapy option that provides targeted radiation and a shorter treatment time for breast cancer
patients. The therapy concentrates just on the cancerous area of the breast, minimizing exposure to surrounding healthy tissues.
For many women, the 5-day treatment plan is a preferred alternative to multi-week, daily radiation treatments. Radiation
Oncologist Binh Tran, MD, administers the tumor-specific therapy. Not all patients are eligible. SJRMC uses national guidelines
in recommending appropriate treatment.
Outpatient Infusion
Patients receiving treatment can do so conveniently at one of our three Outpatient Treatment & Infusion Centers, located in
Mishawaka and Plymouth. Services provided include, but are not limited to:
• Chemotherapy administration
• Catheterizations
• Blood & blood product transfusions
• Injections
• IV medication administration
• IV fluids for hydration
• Dressing changes
Genetics & Risk Assessment Center
Our Genetics & risk Assessment Center is the only one of its kind in the area. Staffing consists of a board certified
physician medical director and a licensed certified genetic counselor who will meet with patients who have a personal
and/or family history suggestive of hereditary cancer syndrome.
Genetic Counseling
Cancer genetic counseling aims to identify individuals and families with heritable cancer susceptibility for the purpose of
promoting cancer-risk assessment and awareness, early cancer detection and cancer prevention.
A cancer genetic counselor is a medical professional with expertise in genetics, heritable cancer syndromes and counseling.
Cancer genetic counselors can use their unique training and specialized education to help you translate complex genetic
information into practical decision-making.
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A cancer genetic counselor can:
• Help identify patients at risk for a heritable cancer syndrome and can discuss personalized surveillance and preventative
options for those individuals.
• Determine the most appropriate genetic test(s) and the most informative approach to genetic testing for patients and their
families.
• Identify the most informative family member to test.
• Interpret genetic test results.
• Help patients and their physicians understand and apply genetic test results to medical management decisions.
• Connect patients to supportive, informative and research-related resources.
Genetic Testing
If an individual decides to pursue genetic testing, a small sample of blood will be drawn and sent to a lab for analysis. For some
genetic tests, a mouth swab or a saliva sample can be used instead of a blood sample. Results take approximately two weeks
and will be discussed at a follow-up visit with the genetic counselor.
Health Insurance Coverage
Yes, in most instances insurance companies will cover a portion of the cost for genetic counseling and testing. The patient
can call their insurance in advance to determine coverage. There are laws in place that protect individuals in a group health
insurance from discrimination based on having the test and/or the results of the test.
Hereditary Breast Cancer
Only about 10% of all breast cancer is actually inherited. Therefore, most cancer is not passed down from generation to
generation. Many common cancers (e.g. breast, colon, uterine, etc.) are tumors that can be related to ten or more cancer
susceptibility genes, which is why genetic counseling and testing is an integral part of cancer care today.
Facts About Hereditary Breast Cancer
• Only about 5-10% of all breast cancer is inherited. Most cancer is sporadic and happens by chance.
• Men can develop breast cancer. Men can have a gene which predisposes them to breast cancer.
• When you are considering your family history, both your mother’s and your father’s family are important. Just because the
cancer in your family is on your father’s side does not make it less important.
• Families with hereditary breast cancer have a higher incidence of breast cancer but also other cancers, such as ovarian,
prostate, and pancreatic cancer.
• Generally, inherited cancers occur earlier, before the age of 50.
• If an individual has an inherited form of cancer, they also have a higher chance to develop a second cancer.
• When an individual is identified to have an inherited form of cancer, there are options: increased surveillance and
preventative surgery.
• If an individual has an inherited form of breast cancer their surveillance changes. They are followed every three to six
months and start screening (mammograms) between the ages of 25 and 35.
Referral Criteria
• An individual diagnosed with breast cancer diagnosed under the age of 50
• Bilateral or two separate breast cancers in the same individual
• Breast and ovarian cancer in the same individual
• An individual diagnosed with breast cancer at any age with two or more relatives on the same side of their family with
breast, ovarian and/or pancreatic cancer.
• An individual with more than one primary cancer
• An individual diagnosed with ovarian cancer
• Individuals diagnosed with a triple negative breast cancer under the age of 60
• Individuals with questions regarding their risks of developing cancer and their unique family history of cancer. 10
Research & Clinical Trials
The Northern Indiana Cancer Research Consortium (NICRC) is comprised of the following five member institutions: Elkhart
General, Lakeland Hospital, Indiana University LaPorte Hospital, Memorial Hospital of South Bend, INC., and Saint Joseph
Regional Medical Center with campuses in Mishawaka and Plymouth, Indiana. The NICRC has one affiliate institution: Howard
Regional Health System located in Kokomo, Indiana.
SJRMC supports the NICRC by providing Certified Oncology Research Nurses and Certified Clinical Research Professionals
that assist our physicians in presenting clinical trials, cancer control trials, treatment medications and provide risk and
benefits associated with each trial.
In year 2011, 13.5% of the analytic cases accrued to a clinical trial, thus exceeding national standards provided by the
American College of Surgeons.
On May 23, 2012 the NICRC hosted a Clinical Trial Awareness Night at the Salvation Army Kroc Center. The event included
a health fair, investigator’s meeting and public presentation. Dr. Worta McCaskill-Stevens from the National Cancer Institute
spoke to both the investigators and patients along with University of Notre Dame men’s basketball coach, Mike Brey. Five
patient advocates also shared their stories in regards to clinical trials.
The Success of the NICRC CCOP can be attributed to the cooperative effort by the competing hospital systems along with
the affiliate institution with committed investigators and a dedicated, knowledgeable research staff. Teamwork between
all of these components has developed into a strong clinical research presence in the Indiana and Michigan area. Continued
support and participation will only increase this successful outreach by the NICRC.
Clinical Nutrition
Nutrition is an important part of cancer treatment. Our Clinical Nutrition
Services provide evidenced-based nutrition therapy for a continuum of
nutritional care for the patient. Effective management of nutritional issues
requires early intervention. Achieving adequate nutritional status means
getting enough calories and protein to prevent weight loss, regain strength,
and rebuild healthy tissues. Eating well while being treated for cancer can
help the patient prevent or reverse malnutrition, maintain lean muscle mass,
support the immune system, better tolerate treatment-related side effects,
and heal and recover quicker.
Outpatient consults are available for the newly diagnosed patient who
wants to maintain good nutritional status during treatment to help feel
better and stay stronger. Our dietitians work with patients in the hospital to
improve nutritional status, hydration and weight maintenance. Aggressive
chemotherapy, radiation and surgical treatment may lead to altered
taste, anorexia, dysphasia or dehydration, which can result in malnutrition,
treatment interruption or morbidity. The dietitian can help to develop an
individualized plan that can include co morbidities such as dysphagia, bowel
obstruction, open wounds, maldigestion and malabsorption.
SJRMC dietitians also participate in community health wellness and cancer
screening programs, promoting cancer prevention and evidence-based
nutrition therapy.
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Breast Reconstruction
For women facing the loss of one or both breasts due to an incidence of cancer, there are both physical and emotional
concerns.
That’s why SJRMC has performs a nipple-sparing surgery that allows for reconstruction of the breasts in a single, solitary
procedure with mastectomy.
First, the Becker Expander implant functions as a tissue expander that is put in place during the mastectomy. It then converts
to a breast implant once the tissues have been expanded sufficiently. This eliminates the more commonly required second
surgery to place a separate implant.
The new procedure is less invasive. And it allows surgeons to preserve more breast tissue so women experience much less
prominent scarring and a natural appearance. As a result, women can wake up from surgery cancer-free — and feeling whole.
When complications occur with breast reconstruction, it’s often from poor blood flow or poor circulation in preserved tissue.
With new SPY imaging available at SJRMC, surgeons can monitor blood supply during surgery and make critical, real-time
decisions to help improve results.
Independent studies in breast reconstruction have already shown that the use of SPY decreases rates of:
• Post-operative tissue death
• Non-healing wounds
• Subsequent surgery requirements
• Prolonged hospital stays
Pathology & Laboratory Services
The South Bend Medical Foundation (SBMF), celebrating its 100th Anniversary Year, continues to support Oncology Services
at SJRMC. As a regional laboratory with extensive immunohistochemical and molecular pathology capabilities, SBMF can
provide special guidance during the diagnosis and treatment of oncology patients.
In 2012, electronic provisional reports were devised to provide diagnostic information to clinicians to allow them to proceed
with diagnostic studies while the final pathologic evaluation was being delayed for special studies. In a partnership with
Dendreon, SBMF began offering apheresis services in the local community necessary for a specialized immunotherapy
for prostate cancer patients. SBMF was also inspected by the College of American Pathologists, and recertified by this
prestigious organization. Additional immunohistochemistry, molecular and flow cytometry procedures were developed and
made available to the cancer patients in our area.
SBMF considers support of outreach programs such as the Touch Base at the Cove men’s health fair initiative an important
part of its mission. Testing and collection services were provided for the event by our organization.
The partnership between SBMF and SJRMC continues to provide state-of-the-art pathology and laboratory services not
available to most communities of our size.
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Support
Nurse Navigation
Cancer is a word that conjures fear, worry and anxiety. SJRMC offers help, understanding and care to cancer patients
and their families during this difficult and overwhelming time. Our nurse navigator service is offered free of charge,
and is available to patients over the phone, or in person at SJRMC in both Mishawaka and Plymouth. At the Plymouth
Campus, the Nurse Navigator is available thanks to a grant provided by Ounce of Prevention, a local organization whose
focus is to increase breast cancer awareness and support systems through fund-raising and events.
The Oncology Nurse Navigator is a professional nurse who has experience working with people with cancer and
understands how challenging the journey can be. The navigator helps remove roadblocks to treatment, so that patients
are able to keep their appointments, follow their treatment regimen, and receive the support services they need. The
goal of the nurse navigator is to make sure that the comprehensive and varied cancer care services offered through
health care providers and the community is accessible to all patients.
Nurse Navigators provide and assist patients with:
• Emotional support
• Coordinate services among medical providers
• Find financial assistance resources
• Arrange transportation
• Educate patients and families about their disease and treatment plan
• Link patients to health care resources quickly
• Translate medical terminology
• Communicate with physicians and other members of the healthcare team
• Obtain referrals to community services for support groups
• Arrange palliative care, hospice and home healthcare services
• Facilitate timely access to quality medical, psychosocial care
Pastoral Care
Our Spiritual Care team strives to visit with
patients and their families and be fully present
to meet their spiritual and emotional needs. This
applies to all, regardless of religious affiliation.
Chaplains affirm these needs through empathic
listening and focusing on what is most meaningful
to those we serve. They address religious concerns,
perform rituals, and pray for relationships,
anxieties, fears, doubts, uncertainties, end-of-life
decisions, sadness and grief, to name a few.
For our Catholic patients, a priest is available
for sacramental needs and may be reached
through the on-call chaplain. Eucharistic ministers
bring communion daily to patients who register
themselves a Catholic.
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Support
Palliative Care
Chronic, debilitating, or life-threatening illnesses, such as cancer, congestive heart failure, heart disease, COPD/emphysema,
cystic fibrosis, stroke, multiple sclerosis, can become difficult and complex for patients, their families, and healthcare
providers to manage.
As these illnesses progress, pain and symptom management may become more challenging which often affects all aspects
of the patient’s quality of life and care.
Some of the other aspects of a patient’s life that can be affected include:
• Relationships with family, friends, and/or caregivers.
• Need for others to assist with care (loss of independence).
• Psychosocial, emotional and spiritual needs/concerns. To meet specific patient/family needs, members of the SJRMC Palliative Care Services Team consist of:
• Physician
• Advanced Practice Nurse
• Chaplain
• Social Worker
• Pharmacist
• Rehabilitation Professionals
• Nurse Navigator and/or Case Manager
Multidisciplinary Palliative Care Services at SJRMC will assist patients, families, and healthcare providers with pain and
symptom management, and with the integration of the patients’/families’ hopes, goals, beliefs, and desires into the plan of
care. Palliative Care Services are not only for patients facing the end of life, when life-sustaining treatments become less
effective or are no longer effective, but can also be helpful during the early stages of the afore mentioned illnesses.
The overall purpose of our program is to focus on relieving discomfort and distress, and collaborating with the patient/family
and other healthcare providers to achieve the best possible quality of life for our patients and their families.
Women’s Task Force
Founded in 2001 as an all-volunteer group of women cancer survivors, the Women’s Task Force of SJRMC promotes
prevention, awareness and the importance of early detection of cancer.
Secret Sisters Society®
The Secret Sisters Society Mammogram and Cervical Screening Program provides initial testing to women ages 40-49
who qualify financially. The program allows patients to choose where they want to receive their screening. More 4,000
screenings have been provided or scheduled at the following sites:
42% - Saint Joseph Regional Medical Center
37% - Elkhart General Hospital
21% - Memorial Hospital
Percentage of women served from the following counties:
54% - St. Joseph County
38% - Elkhart County
5% - Marshall County
3% - Other
14
The 2012 Secret Sisters Society Luncheon celebrated
its 11th year at a new venue and by honoring one of
its founding members, Joan Lennon. The event drew
a crowd of more than 950 people and continued
its tradition of serving lunch followed by a style
show featuring models from young to older, all
of whom are cancer survivors. Proceeds from the
Secret Sisters Society Luncheon are used to provide
mammograms to uninsured and underinsured
women. The program is unique in that the women can
have their mammogram done at a site convenient to
them from any one of the local hospitals, including
Saint Joseph, Memorial, or Elkhart Hospital.
Young Survivors
The Young Survivors Mammogram Program provides
screenings to women under 40 who do not have
insurance or cannot otherwise afford testing.
The program allows patients to choose where they
want to receive their screening.
Our Secret Sisters Society models - all cancer survivors - pose after the
2012 Luncheon & Style Show.
Since March of 2010, Young Survivors has provided 238 screenings at the following sites:
44% - Elkhart General Hospital
29% - Saint Joseph Regional Medical Center
21% - IU Health Goshen Hospital
6% - Memorial Hospital
Radiology, Inc., South Bend Medical Foundation and X-Ray Consultants play an important role in providing screenings
by providing services at the above hospitals. The Secret Sisters Society and Young Survivors programs are administered
through United Health Services, local administrator for the State of Indiana Breast and Cervical Cancer Program
(BCCP).
RiverBend Cancer Services
In 2012, the Women’s Task Force and RiverBend Cancer Services strengthened their working relationship with a
collaborative partnership that provides RiverBend Cancer Services with much-needed funds to continue providing many
worthwhile and necessary programs for the cancer community.
In July, SJRMC provided a sponsorship in honor of Joan Lennon, Women’s Task Force founder and coordinator,
to RiverBend to provide counseling, support, education and prevention services. For the next four years, SJRMC
will continue to offer a sponsorship for these services. Additionally, for the next five years, beginning in the fall of
2012, SJRMC will be the premiere sponsor of RiverBend Cancer Services’ annual public cancer education program,
Breakthrough, Changing the Way You Think about Cancer. This will allow RiverBend the opportunity to provide an
innovative program/speaker that educates and informs the community about important issues surrounding the topic of
living well with cancer.
RiverBend Cancer Services and SJRMC’s Cancer Registry and Oncology services will continue to work with one another
to ensure that oncology patients in our area have the assistance and support they need.
15
Cancer Registry
Report by Marian Brown, CTR, Cancer Registry Manager
Cancer Registry Report
Cancer Registries across the country are on a mission to help eradicate cancer by collecting data about patients who
have been diagnosed with cancer. The data collected will help researchers understand the disease and what types
of treatments will be used to control or manage the cancer. With the help of many cancer registries all over the US,
we have found that cancer is caused by both external factors such as tobacco, infectious organisms, chemicals, and
radiation and internal factors such as inherited mutations, hormones, immune conditions, and mutations that occur
from metabolism.
The American Cancer Society estimates that in 2012 about 173,200 cancer deaths will be caused by tobacco use.
The data collected by registries have been determined that all cancers caused by cigarette smoking and heavy use of
alcohol are totally preventable. Because of the cancer data collected in cancer registries researchers have found that
early detection and screening examinations are known to reduce mortality in certain cancers such as breast, colon,
rectum, and cervix. According to the American Cancer Society, cancers that can be prevented or detected earlier by
screening account for at least half of all new cancer cases. The overall goal of the Cancer Registry is to assist in the
reduction of incidence and mortality due to cancer by providing data for research and intervention programs.
The Cancer Registry at SJRMC consist of three full-time certified tumor registrars (CTR), one full-time cancer conference
coordinator, and one full-time follow up coordinator who also coordinate department meetings and manage two dedicated
volunteers. Staff support the Cancer Programs at both the Mishawaka Campus and the Plymouth Campus.
Providing Care For All
On November 6, 2012, millions of Americans went to the polls to vote in light of the controversial Patient Protection
and Affordable Care Act (PPACA), or as it is commonly known, Obamacare. This is the perfect opportunity to discuss
how the Affordable Care Act can impact people with cancer and their families.
SJRMC, as a member of Trinity Health, work hard to ensure that we provide the greatest possible benefit to the 32
million uninsured Americans who will have access to affordable health care coverage, the millions more who won’t be
denied coverage for pre-existing conditions, and to health care providers seeking to deliver the best possible care.
16
Number Uninsured and Uninsured Rate: 1987 to 2011
60
Numbers in millions
Recession
50
48.6 million
40
Number uninsured
30
20
10
0
20
Rates in percent
16
15.7 percent
Uninsured rate
12
8
4
0
1987
1990
1993
19961
19992,3
2002
2005
2008
20104 2011
1The data for 1996 through 1999 were revised using an approximation method for consistency with the revision to the 2004 and 2005 estimates.
2Implementation of Census 2000-based population controls occurred for the 2000 ASEC, which collected data for 1999. These estimates also reflect the results of follow-up verification
questions, which were asked of people who responded “no” to all questions about specific types of health insurance coverage in order to verify whether they were actually uninsured. This
change increased the number and percentage of people covered by health insurance, bringing the CPS more in line with estimates from other national surveys.
3The data for 1999 through 2009 were revised to reflect the results of enhancements to the editing process.
4Implementation of 2010 Census population controls.
Note: Respondents were not asked detailed health insurance questions before the 1988 CPS.
The data points are placed at the midpoints of the respective years. For information on recessions, see Appendix A.
Source: U.S. Census Bureau, Current Population Survey, 1988 to 2012 Annual Social and Economic Supplements.
In 2011, at the Mishawaka Campus, 55.7% of the new cancer cases collected were insured by Medicare and 25.2% by
private insurance. In totally, 62.7% of the cancer cases in 2011 were funded by the U.S. healthcare system.
SJRMC 2011 Primary Payer Report
Not Insured
20
2.6%
Insurance, NOS
52
6.8%
Private Insurance
194
25.2%
Medicaid
54
7.0%
Medicare
428
55.7%
Unknown
21
2.7%
REFERENCES
As a faith-based organization, SJRMC
acts on behalf of justice and strives to
care for the poor and vulnerable. Our
work is a ministry through which we are
privileged to serve people at some of the
most significant moments of their lives.
We serve everyone regardless of status
or ability to pay. The cancer registry
associates at SJRMC are proud of the
work that we do and will continue to fight
the good fight to achieve complete healing
of the mind, body and spirit.
1. DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith, U.S. Census Bureau, Current Population Reports, P60-243, Income, Poverty, and health Insurance Coverage in the Unites
States: 2011, U.S. Government Printing Office, Washington, DC, 2012; http://www.census.gov/prod/2012pubs/p60-243.pdf. Accessed October 31, 2012.
2. American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012. Accessed October 30, 2012.
3. Trinity Health – Novi, Michigan
4. American College of Surgeons Cancer Programs Cancer Program practice Profile Reports, Version 2, CP3R (v2) – Overview. Commission on Cancer. First Released: November 2008. Last Updated:
August 2012. https://cromwell.facs.org/BMarks/BCR_RQRS0/BCR_Overview.pdf
5. Hutchinson, Carol, Steven Roffers, April Fritz. Cancer Registry Management: Principles and Practice. Copyright 1997 by the National Cancer Registrars Association, Inc. Lenexa, Kansas.
17
Cancer Registry
Summary of New Cases
In 2011, our Certified Cancer Registrars collected a comprehensive total of 1,138 new cases into the METRIQ
Mishawaka Cancer Registry database. Of these, 769 were analytic cases, or by definition, those patients diagnosed and/
or treated at SJRMC’s Mishawaka Campus.
2011 Primary Site Table
NHL - Extranodal
Leukemia
Liver, GB & other biliary
Myeloma
Head and Neck
Upper GI tract
Melanoma - Skin
NHL - Nodal
Thyroid & other endocrine
Brain & other nervous system
Other & unspecified sites
Pancreas
Urinary bladder
Urinary system (excludes bladder)
Male genital system
Female genital system
Colorectal
Lung & other resp organs
Breast
0
20
40
60
18
80
100
120
140
160
180
Cancer Registry
The top five primary sites seen at SJRMC are breast, lung & bronchus, colon & rectum, prostate, and urinary bladder.
When compared with cases collected in Indiana and overall U.S.; urinary bladder and colon & rectum are comparable.
SJRMC is seeing a higher incidence of breast cancer and a much lower incidence of prostate cancer cases as compared
to state and national data.
Top Five Primary Site Comparison
25%
SJRMC
20%
INDIANA
USA
20%
18%
15%
16%
13%
14%
15%
14%
13%
10%
8%
9%
9%
5%
0%
5%
Breast
Lung & Bronchus
Colon & Rectum
Prostate
Berrien
8.5%
Cases By County
This map illustrates the cancer cases
distributed by county of residence at time of
diagnosis and/or first course of treatment
received at SJRMC.
LaPorte
1.2%
Starke
1.4%
5%
4%
Urinary Bladder
Cass
2.6%
St. Joseph
69%
Elkhart
6.8%
Marshall
6.9%
Other IN
Counties
2.6%
Fulton
1%
19
5%
Rapid Quality Reporting System
Because SJRMC is an accredited cancer program and are committed to improving the quality of cancer patient care
we participate in the cancer programs practice profile reports (CP3R) as well as the Rapid Quality Reporting System
(RQRS). These programs are tools provided by the American College of Surgeons Commission on Cancer for accredited
cancer programs to promote and facilitate evidence-based cancer care.
The measures for the Cancer Program Practice Profile Reports (CP3R) was led by the National Quality Forum (NQF)
bringing together payers, consumers, researchers, and clinicians to promulgate performance measures of breast and
colorectal cancers in which the CoC has been actively engaged in. Joint efforts with the American Society for Clinical
Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) developed a similar set of measures for
breast and colorectal cancer. Facilitated by the NQF, the CoC, ASCO, and NCCN agreed to synchronize their developed
measures to ensure that a unified set were put forth to the public.
Four of the measures included in the CP3R(v2) were endorsed by the NQF as accountability measures, meaning that
these measures can be used for such purposes as public reporting, payment incentive programs, and the selection of
providers by consumers, health plans, or purchasers. The measures relating to regional lymph node examination for
resected colon cancers and radiation therapy for advanced stage rectal cancer are quality improvement measures and
are intended to be used for internal monitoring of performance within an organization.
The two latter measures are surveillance measures and can be used at the community, regional, and/or national level
to monitor patterns and trends of care in order to guide practice change where appropriate, policymaking, and resource
allocation. None of these measures are designed to assess individual hospital or physician performances.
The RQRS participation is voluntary and serves to assess compliance with four National Quality Forum – endorsed
quality performance measures for breast and colon cancers and two surveillance measures for colon and rectal cancers in real clinical time.
RQRS Performance Measures
Breast
• BCS/RT: Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast
conserving surgery for breast cancer.
• MAC: Combined chemotherapy is considered or administered within four months (120 days) of diagnosis for women under
70 with AJCC T1c N0 M0, or Stage II or III hormone receptor-negative breast cancer.
• HT: Tamoxifen or third generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis
for women with AJCC T1c N0 M0, or Stage II or III hormone receptor-positive breast cancer.
Colon
• ACT: Adjuvant chemotherapy is considered or administered within four months (120 days) of diagnosis for patients under
the age of 80 with AJCC Stage III (lymph node-positive) colon cancer.
• 12RLN: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.
Rectal
• ADJRT: Radiation Therapy is considered or administered within six months (180 days) of diagnosis for patients under the
age of 80 with clinical or pathological AJCC T4 N0 M0 or Stage III receiving surgical resected for rectal cancer.
20
Rapid Quality Reporting Comparison Report for SJRMC & Comprehensive Cancer Programs
2010 Data
Rapid Quality Reporting Comparison Report for SJRMC & All Programs in the US
2010 Data
21
Some Expectations of RQRS
• By participating in RQRS we can improve patient care with access to real clinical time performance rates.
• As you see we have some work to do based on the AdjRT figure shown. However all others are comparable to the other
measures or better.
• We can monitor and prevent patients from experiencing a delay in treatment or catch patients who are at risk of “slipping
through the cracks.”
• Compare performance rates at SJRMC with other participating cancer programs as we have done here.
• Encourage timely and accurate collection of adjuvant treatment information.
Statement of Patient Confidentiality
One very important aspect of the Cancer Registry is to secure patient confidentiality. All information contained in
a patient’s medical record in any form is considered confidential. It is the responsibility of each associate to ensure
patient confidentiality of all patient information encountered during the collection, maintenance, and dissemination of
cancer data. Cancer data abstracted into the registry database is considered confidential patient information and we
take every measure to ensure the confidentiality of each of the patients diagnosed and/ or treated here at SJRMC by
abiding by the following procedures:
• SJRMC and the American College of Surgeons have entered into a Business Associate Agreement to protect patient
Protected Health Information (“PHI”), as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA”)
for the submission of de-identifiable cancer data annually.
• The Cancer Registry at SJRMC abides by all privacy practices as required by law and our mission to maintain the privacy of
individually identifiable patient health information.
• Patient case profiles for the cancer patient care conferences contain no patient identifiable information. A number is
assigned to reference each case presented. Patient profiles used for discussion at the patient care conferences are not
a part of the patient’s permanent hospital record and are disposed of in a secure confidential container for shredding
immediately after each conference.
Abstracting for the Cancer Registry
Report by Leonora B. Feden, CTR & Judy A. Libera, CTR
Each morning in the Cancer Registry, we receive copies of all pathology reports, which were generated for SJRMCMishawaka campus the day before. Each path report is reviewed for evidence of a malignancy, the history of cancer,
ambiguous terminology that suggests cancer diagnosis or physician information that includes an oncologist.
After careful review of each report, the flagged reports are crosschecked against our dedicated cancer database
(METRIQ) to see if the case has already been entered. This database holds information on every cancer case that was
either diagnosed or treated at SJRMC. The case is then entered and abstracted within the appropriate time frame. An
“abstract” is a complete summary of a patient’s cancer from date of diagnosis through completion of treatment, and
lifetime follow-up.
Entering a new case requires knowledge of what is required by Indiana State Law to be reported electronically
on a monthly basis. Since the American College of Surgeons (ACOS) Commission on Cancer as a Comprehensive
Community Cancer Program (CCCP) also accredits SJRMC, abstractors must be aware of cases that are required
by ACOS for inclusion in the Cancer Registry, and are subsequently reported to the National Cancer Database
(NCDB). Accordingly, SJRMC has a “Reportable List” which serves as a basic guide to the Cancer Registry for those
malignancies that are mandated for reporting by either the State or ACOS. This list is reviewed and updated periodically
when there are changes in reporting rules.
22
Once a case is entered, it is ready to be abstracted, which requires review of all reports available through the electronic
medical record (EMR) and other sources of documentation. At present, there are four EMR systems we have access
to in the Registry for completing our abstracts. Abstracting must be performed by or supervised by a CTR (Certified
Tumor Registrar).
There are more than two hundred data fields per case required for completion. The Facility Oncology Registry Data
Standards (FORDS) manual provides definitions and detailed instructions for coding diagnosis, treatment, and outcomes.
These fields include: demographics, cancer identification (anatomic site and tissue type), stage or extent of disease, first
course of treatment, and outcomes. In addition to consulting various EMR systems, abstractors may have to contact
treating physician offices either by phone or letter to complete the treatment information not otherwise available.
Cases are completed within 5 months of diagnosis. This is considered timely as the maximum length of time to
complete a case is 6 months according to ACOS. The Rapid Quality Reporting System (RQRS) is a new, voluntary,
prospective quality-reporting tool providing real clinical time assessment of case and hospital level adherence to
quality of cancer care measures. Specific cases are reported within 3 months of diagnosis in order to meet this
requirement. Each case requires a complex validation system and staging algorithm that generates edits, all of which
must be cleared prior to reporting the cancer case to the State or NCDB. Abstractors are responsible for this process.
In addition, the Cancer Registry at SJRMC is a multi-facility Registry. Therefore, we have additional casefinding and
abstracting duties for our Plymouth Campus. We receive pathology and radiation oncology reports from SJRMCPlymouth for review. The Plymouth Registry is separate, yet linked to our SJRMC-Mishawaka Registry. Our final source
of casefinding for both campuses includes review of ICD-9-CM codes generated by both campuses to pick up clinical
cancer diagnoses not found on pathology or radiation oncology reports.
As an abstractor at SJRMC, we support our Cancer Conferences by facilitating set-up, physician sign-in, staging and
clean up. Abstractors rotate conference-staffing duties as assigned by the Registry Manager. We also participate in
community activities, such as Relay for Life, Secret Sister’s Society Luncheon, and various fundraising efforts. We
attend hospital, local, state, and national CME conferences to maintain the required level of CME’s. Every two years,
the National Cancer Registrar’s Association requires proof of CME attendance in order to maintain the CTR credential.
Quality of data in the Cancer Registry is critical since our data is used at the community, state and national levels to
make important public health decisions, and to help allocate resources effectively. We consult with our physicians on a
personal basis to this end, and appreciate the wonderful working relationship we have developed with physicians in the
community who help support our Cancer Program.
Patient Care Conferences
Report by Wendy Clingan, Cancer Conference Coordinator
In this age of information technology, we still believe in care that puts the patient at the center of the care team by
involving them in all treatment decisions. In 2011, SJRMC sponsored:
Mishawaka Campus
Plymouth Campus
51 conferences12 conferences
1,297 physicians in attendance
92 physicians in attendance
176 cases presented 41 cases
158 cases prospective (90%)
23
Each conference consists of an expert medical team of highly skilled, compassionate doctors and clinicians who work
together to deliver a personalized treatment plan tailored to the patients needs.
It is the responsibility of the cancer conference coordinator to act as the liaison between the medical community and
the Cancer Registry. My role as the coordinator is to maintain current office information on each physician and their
frontline office staff as well as a yearly visit to evaluate the effectiveness of our working relationship.
Each medical office receives a yearly schedule of the conferences as well as, monthly site-specific filers. Up to
four cases are discussed per conference. Once a physician calls to schedule a case it is my job as the conference
coordinator to gather the needed radiographs, pathology slides and patient background information that is used to
develop the patient profile which will be given to all the participants. During this time leading edge medical therapies
and groundbreaking research to patient-specific clinical trials are discussed to offer the most complete care possible.
The morning of each forum the room is set – up. All audiovisual equipment, computers and microscope are up and
running. A patient profile and conference evaluation form is placed at each physician’s seat at the table. All of our
medical professionals who attend these cancer forums enjoy a continental breakfast and a gourmet coffee cart.
Some of our patients choose to attend the conference when their case is being presented. To make sure their arrival
at the conference center is as stress-free as possible, we coordinate all the details. During the forum they become the
center of the care team by having their questions answered and involving them in the treatment decision. A private
conference room is also available for their team to meet in at the end of the conference. We want every patient to leave
knowing that the best doctors and hospitals are treating them from the start.
These forums are also used as a time for guest speakers to update the attendees on new hospital services, clinical
trials and treatment modalities. This year some of our speakers included:
Zach Schafer, PhD
“Carcinoma associated fibroblasts and their role in
breast cancer progression”
Samuel McGrath, MD
“The importance of margins in DCIS treatment”
William Kaliney, MD
“Poorly differentiated Breast Lesions”
Michael Rotkis, MD
“Management of the Axilla”
David Taber, MD
“The Significance of DCIS”
To maintain the highest level of participation, each conference is evaluated for its overall quality and content. After the
conference all of the attendance information is sent to the Medical Education assuring each attendee is credited for his
or her participation. Information for each case, such as when the case was presented and how it was staged is entered
into the patients’ record in the METRIQ database and the “Cancer Conference Grid.” All the backup paperwork is then
given to the appropriate abstractor.
Staging
Cases in which a diagnosis or treatment was provided here at SJRMC needs to be staged in the patient abstract. One
of the duties of the conference coordinator is to assure that proper staging is made available. There are a number
of different ways that a physician provides this information, such as presentation at a cancer conference, through
treatment dictation or operative notes. If none of this is available, a site-specific staging form is sent to the physician to
complete. Upon return the information is then recorded in the abstract.
24
Case Finding
It is important that every prospective case from our hospital be entered into the METRIQ database, so it is the job of
the cancer conference coordinator to look through the ICD-9 coding reports and the South Bend Medical Foundation
pathology specimen report to look for missed cases. These are then brought to the attention of our abstractors for
further evaluation.
Physician Data Base in METRIQ
It is also the responsibility of the conference coordinator to maintain the “Physician Database” in METRIQ to assure that
all contact information is up to date.
Yearly CME Paperwork
Each year, The Cancer Conference Coordinator must file CME accreditation application paperwork for the Mishawaka
and Plymouth campuses for the next year. At this time the physician moderators for each conference must be chosen,
disclosure statements signed and schedules for that year attached.
Follow-Up Coordination for the Cancer Registry
Report by Vanessa Perkins, Follow-up Coordinator
Follow-up is essential to evaluate cancer care outcomes. The data outcome results are compared with regional, state
or national statistics.
In my role as Follow-up Coordinator, I am responsible for obtaining and recording outcomes of more than 6,000 analytic
cancer patients annually. Each month I generate a report of all patients whose last date of contact is 13 months prior to
the last contact date. Cases are delinquent (lost) if the follow-up interval exceeds 15 months.
Using data obtained from Pathology, Radiology, Radiation Oncology reports, as well as Physician notes and Cancer
Conference minutes I cross reference each patient to obtain the last contact date and status of their cancer and well
being. This information is entered in our METRIQ database.
For those patients that I do not find information on, a letter is mailed or a phone call is made. Letters are mailed to the
patients, physician, or secondary contacts with a self-addressed envelope. On some of the letters that I get back from
patients, the patient will express their appreciation for my concern about their health and for their care at SJRMC. I do
pray for the patient and family who are not doing well.
Another important part of Follow-Up Coordination is death information. This information is obtained about patients in
the registry’s database in order to maintain accurate survival data. We have two special volunteers who come in weekly,
Ruby Barts and Accamma Koshy, who both celebrated their 80th birthday this year. They check each patient in the
Social Security Death Index and other online references to avoid us sending letters to the family of a patient who may
have expired. They also monitor local obituaries, county death lists, and our facilities weekly death report to identify
and record death information.
The American College of Surgeons requires the registry have a follow-up rate (FU) of 80% for all analytic patients and
90% for patients diagnosed in the last 5 years for those programs that are accredited. As of date, our FU rate for all
patients is 96.74%, and our FU rate for patients diagnosed in the last 5 years in 98.31%.
25
Oncology Committee
Bilal Ansari, MD*
Cancer Committee Chair
Medical Oncologist
Lisa Barnaby, CCRP
Clinical Research
Coordinator
Cancer Research
Erica Bory, RD, CD
Clinical Dietician
Marian Brown, CTR
Cancer Conference
Coordinator
Certified Tumor Registrar
Cancer Registry Manager
Jose Bufill, MD
Genetic Program Director
Medical Oncologist
Robert Carbonell*
Chaplin Spiritual Care
Kathy Deka
American Cancer Society
Bernadette Dolezal*
Lead Mammography
Technician
Center for Women’s Health
Gwen Ehler, RD, CD
Clinical Dietician
Corrine Reno, PharmD*
Clinical Pharmacist
Stacy Garton, MSW, LCSW
Psychosocial Services
Coordinator
Mental Health Professional
Michael Rotkis, MD
Cancer Liaison Physician
General Vascular Surgeon
David Hofstra
Quality Improvement
Coordinator
Director, Diagnostic Imaging
Jackie Sandkuhler-Kiel, RN
Case Manager
Amer Kazi, MD*
Neurology/Pain Management
Gretchen Skurla, MS, CGC
Genetic Counselor
Chris Karam*
Chief Operating Officer
Amelia Taggart, RN, OCN*
Manager, Oncology
Department
Camilla Shaw, RN, BSN
Oncology Nurse Navigator
Roger Klauer, MD
Cancer Registry Quality
Coordinator
Lymphedema Clinic
Robert Tomec, MD
Pathologist
Medical Director, South Bend
Medical Foundation
Louis Pace, RN, MSN
Pain Control Specialist
Pain Management
Scott Vance, MBA
Director of Rehabilitation
Services
Kate Voelker
Community Outreach
River Bend Cancer Society
Carol Walker MSN, RNC-NIC
Cancer Program
Administrator
Administrative Service Line
Director
Susan Whitehead, RN**
(Replaced as of 7/17/12)
Case Management
Carol (Cari) Wilson
Community Outreach
Coordinator
Binh Tran, MD
Radiation Oncologist
Vanessa Perkins
Recorder
Linda Tuthill, MD
Diagnostic Radiology
26
*Not pictured
Phone Directory
Saint Joseph Regional Medical Center – Mishawaka
5215 Holy Cross Parkway
Mishawaka, IN 46545
574.335.5000
Center for Women’s Health – Plymouth....... 574.935.2310
Center for Spiritual Care.................................... 574.335.5139
Clinical Nutrition.................................................... 574.335.2431
Garcia Family Foundation Oncology Unit......574.335.6110
Lymphedema Clinic...............................................574.252.3616
Medical Imaging Center...................................... 574.335.8100
Oncology Patient Navigator...............................574.231.6474
Oncology Research.............................................. 574.231.6484
Outpatient Treatment & Infusion Center
Elm Road............................................................ 574.335.8525
Mishawaka..........................................................574.335.1120
Radiation Therapy Mishawaka.........................574.204.7860
Radiation Therapy Plymouth............................ 574.935.2353
Saint Joseph VNA Home Care.........................574.335.8600
Women’s Task Force............................................. 574.237.7377
Wound Healing....................................................... 574.335.6210
Saint Joseph Regional Medical Center – Plymouth
1915 Lake Avenue
Plymouth, IN 46563
574.936.3181
Michiana Hematology Oncology
5340 Holy Cross Parkway
Mishawaka, IN 46545
574.237.1328
Community/National Agencies
American Cancer Society...................................574.257.9789
American Cancer Society
Response System................................................800.ACS.2345
Cancer Information Services..........................800.4CANCER
Center for Hospice & Palliative Care, Inc..... 574.243.3100
Marshall County American
Cancer Society........................................................866.522.2111
RiverBend Cancer Services................................574.287.4197
United Health Services....................................... 574.247.6047
Online
Saint Joseph Regional Medical Center
www.sjmed.com
American Cancer Society
www.cancer.org
Center for Hospice & Palliative Care, Inc
www.centerforhospice.org
Women’s Task Force
www.womenstaskforce.org
RiverBend Cancer Services
www.riverbendcancerservices.org
Northern Indiana Cancer Research Consortium
www.nicrc.org
United Health Services
www.uhs-in.org
Saint Joseph Regional Medical Center
Mishawaka Campus.............................................574.335.5000
Plymouth Campus.................................................574.936.3181
Michiana Hematology Oncology....................... 574.237.1328
Cancer Institute – Plymouth............................. 574.935.2353
Cancer Genetics & Risk
Assessment Center...............................................574.231.6477
Cancer Registry..................................................... 574.335.3920
Care Management................................................ 574.335.3100
Center for Women’s Health – Mishawaka.....574.335.6216
Affiliates, Approvals & Accreditations
Affiliations
American Academy of Family Physicians
American Board of Family Practice
American Hospital Association
American Medical Rehabilitation Providers Association
Association of Community Cancer Centers
Catholic Health Association
(Consolidated Catholic Health Care)
Indiana Hospital Association
Indiana University
Rehabilitation Institute of Chicago
Riley Hospital for Children
Riley Trauma Life Center
South Bend Medical Foundation
Approvals
Indiana Board of Health
Indiana State Nurses Association
Indiana State Emergency Medical Services Commission
Medicare & Medicaid Programs
Accreditations
American College of Radiology
American College of Surgeons’ Commission on Cancer
American Council on Graduate Medical Education
American Registry of Radiologic Technology
Association for Clinical Pastoral Education
College of American Pathologists
Joint Commission on Accreditation of Healthcare
Organization
National Accreditation Program For Breast Centers
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At Saint Joseph Regional Medical Center, our values
give us strength.
That character guides every decision we make — even
when those decisions are complicated, costly, or hard.
We honor our mission to heal body, mind, and spirit by
investing in technology, people, and capabilities that
allow us to set the standard for quality care. Because
we answer to a higher calling.
This is healthcare, inspired by faith.
Our Mission
We serve together in Trinity Health,
In the spirit of the Gospel,
To heal body, mind and spirit,
To improve the health of our communities,
And to steward the resources entrusted to us.
South Bend
Mishawaka
Plymouth
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sjmed.com