2010 Cancer Annual Report

Transcription

Mercy Memorial Cancer Care
2010 ANNUAL REPORT
2010 Cancer Care Annual Report
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Contents
Dear Community Resident,
Letter from the CEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The strength of a common goal. This is what unites every member of the patient care team at Mercy
Memorial Hospital System. We work passionately, coordinating our efforts to provide the best cancer
treatment services to our community. We know that cancer touches not just one person at a time, but a
patient’s entire network of family and friends. Our goal is to provide outstanding clinical care and superior
service that is close to home.
Letter from the Chairman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Letter from the Cancer Committee Liaison Physician . . . . . . . . . . . . . 5
Program Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2009 Cancer Registry Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Dr. Charboneau – Colon Cancer Outcomes Analysis. . . . . . . . . . . . . 17
2009 Colon Cancer Treatment Comparison . . . . . . . . . . . . . . . . . . . . 19
Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Monroe Cancer Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mercy Memorial Cancer Connection. . . . . . . . . . . . . . . . . . . . . . . . . . 24
To this end, we have taken important steps to create a comprehensive, holistic cancer program. In March
2010, we broke ground on a cancer treatment center on Stewart Road with our partners, Karmanos Cancer
Institute and ProMedica Health System. The center will provide radiation therapy, chemotherapy
administered by the physicians of the Toledo Clinic, clinical trials and other advanced treatments – and a
community room for education, workshops and support groups. The Mercy Memorial Cancer Connection
also will be located at the center and will provide transportation, nutritional supplements, wigs, medical
equipment and many other support resources, at no cost to qualifying cancer patients.
In addition, this past year the Hospital’s medical imaging department began a PET/CT service, which is a
vital component for diagnosing and staging cancer. For breast cancer patients, we also introduced the nurse
navigator program, which features a board-certified oncology registered nurse who works in partnership
with physicians. The RN nurse navigator provides tremendous support as a personal guide for patients
and their families as they make their individual care and treatment decisions.
Nurse Navigator Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
PET/CT Imaging Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Rehabilitation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
I am very proud of our recent achievement in earning accreditation by the Commission on Cancer of the
American College of Surgeons. Only one in four hospitals in the United States have reached this distinction,
which means our hospital system is meeting the highest standards of excellence for the cancer care we
provide to our patients.
Introduction of Lymphedema Therapy . . . . . . . . . . . . . . . . . . . . . . . . 31
Mercy Memorial Hospice of Monroe/HomeCare Connection . . . . . 33
All of these exciting accomplishments and new additions to our cancer program are just some of the ways
we have reinforced our commitment to provide the highest quality cancer care to our community.
Community Outreach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Annette S. Phillips
President and Chief Executive Officer
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Mercy Memorial Hospital System
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Mercy Memorial Hospital has achieved a very distinguished milestone in 2010. As of September 2010,
Mercy Memorial Hospital System (MMHS) has been designated as a Community Hospital Cancer Program
by the American College of Surgeons’ Commission on Cancer. This accreditation by the American College
of Surgeons (ACoS) recognizes the commitment by MMHS and its health care professionals to provide
the highest quality care and subsequent improved outcomes as demanded by the ACoS Commission
on Cancer. These goals are met not only through the most up-to-date treatments that are discussed and
prescribed weekly at our multidisciplinary tumor board, but also through aggressive early screening and
prevention programs.
It all starts with a patient-centered approach. When I look at what we have accomplished in the last year,
I can see that every initiative has been designed with the patient in mind. We analyze every aspect of our
care and find new ways to better serve them.
In addition, the Cancer Committee at MMHS has coordinated its efforts with The American Cancer Society
and Mercy Memorial Cancer Connection to assist cancer patients both during and after their treatment with
non-medical issues and allow patients to transition back to healthy, fulfilling lives. Lastly, now that MMHS is
a fully accredited Community Hospital Cancer Program we are able to access the latest and most effective
treatments for our patients, and also can compare our outcomes with national benchmarks. Our goal at
MMHS always has been to provide our community with the most comprehensive cancer care possible.
Now, as an accredited Community Hospital Cancer Program, we have enhanced our ability to do so.
We are also increasing our focus on diagnosis and prevention, placing a greater emphasis on cancer
screenings and providing education in critical areas such as smoking cessation. Through a coordinated
effort to inform our community about cancer prevention and the importance of early intervention, and
with the addition of advanced diagnostic tools and updated cancer treatments, we can help to save
countless lives.
Michael Charboneau, Jr., D.O.
General Surgeon
Cancer Committee Chairman
This starts with clinical trials. For a community hospital of this size, we have very good participation in
national cancer trials. We set a high standard for our treatment, and these studies are key to our goal.
We know that the effective treatments we have to offer to patients today are the result of yesterday’s trials.
So we continue to seek out the most appropriate programs that best address the needs of our patients.
The emotional quality of our care is equally as important. We have examined the psychological effects of
cancer treatment, and we know that care given close to home is better for the patient. So when the new
Monroe Cancer Center opens, we will be able to offer holistic, integrated cancer treatment – including
outpatient radiation therapy and chemotherapy – in one convenient location, streamlining our
patients’ care.
We apply this multidisciplinary team approach throughout our System, including at our main hospital
location, where we offer inpatient chemotherapy on a single floor staffed with nurses trained in cancer
care. For each patient, we offer bedside care that includes physical, spiritual, emotional and
psychological support.
Examining all of the ways we can provide comprehensive, integrated, patient-centered care is central to
our mission to support the health and well-being of our neighbors, family and friends in our community.
Charu Trivedi, M.D.
Medical Oncologist
Cancer Committee Liaison Physician
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Patient Profile: Cathy Villarreal
It’s a gamble taken far too often. A lump or change in the breast is found. But, because of a lack of
insurance or resources to pay for a mammogram, women wait to seek testing or treatment. Many times,
they are risking their lives delaying this important screening.
Fortunately, for Cathy Villarreal and many Monroe-area residents, Mercy Memorial and a grant from
the Northwest Ohio Affiliate of the Susan G. Komen for the Cure helped them avoid this terrifying
waiting game.
“I had noticed a change in my right breast and initially thought that it would have to wait,” Cathy said.
“Then my sister told me about Mercy Memorial’s free screening program funded by the Komen grant.
A couple of days later, I had a new mammogram and ultrasound.”
Cathy benefited from funds made possible by this grant, which allowed her to receive this screening
in time to detect a cancer – in the breast opposite of the one where she felt the initial change – quite
possibly saving her life. She received treatment for an aggressive type of tumor that was caught early
enough to avoid a mastectomy. Although she underwent a lumpectomy, radiation and chemotherapy,
she is thankful for receiving her timely screening.
Following her positive treatment experience, Cathy has been active in helping to raise funds so other
women also can get lifesaving mammograms. In October 2010, she and her entire family raised $2,000
during the first annual “Give Back Golf Classic” at the Links of Lake Erie Golf Course. “With my case,
there wasn’t a lump or anything where I could detect it on my own,” she said. “Without Mercy Memorial’s
Women’s Health Center and the Komen grant, I would have put my exams on the back burner. That’s why
I’m so grateful, and I’m trying to give back as much as I can.”
“Without Mercy Memorial’s
Women’s Health Center and
the Komen grant, I would
have put my exams on the
back burner. That’s why I’m
so grateful, and I’m trying to
give back as much as I can.”
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2009 Cancer Registry Summary
The cancer registry is an essential component of the Commission on Cancer accredited cancer program.
The Cancer Program at Mercy Memorial Hospital System is a strategic partner with CHAMPS Oncology
Data Services who staff the registry with credentialed Certified Tumor Registrars and Commission on
Cancer consultants. CHAMPS personnel help programs achieve their goals by collecting and reporting
quality cancer data in support of their business planning and outreach initiatives.
A Comprehensive Approach to Cancer Care
In September 2010, the American College of Surgeons’ Commission on Cancer accredited Mercy Memorial
Hospital System as a designated Community Hospital Cancer Program. This recognition is the result of a
coordinated effort of surgeons, nurses, clinical care coordinators, radiologists, pathologists, oncologists and
other care team workers – all of whom are focused on providing the most integrated, patient-focused care.
Patients also experience the benefit of a weekly tumor conference, where Mercy Memorial Hospital
System’s multidisciplinary medical team comes together to discuss newly diagnosed cancer cases.
Through the careful review of pathology slides, radiologic studies and other diagnostics that indicate the
current health status of each patient, the team develops an individualized patient treatment plan that
ensures the highest quality of care.
With the opening of the Monroe Cancer Center in 2011, Mercy Memorial Hospital System – in partnership
with Karmanos Cancer Institute of Detroit and ProMedica Health System of Toledo – is taking this level of
integrated care much further, offering patients medical oncology, radiation oncology and complementary
health services in one convenient location that’s close to home.
Mercy Memorial Hospital System also is committed to supporting the overall health of the community
by participating in a wide range of programs that promote cancer awareness and prevention as well as
community cancer screenings throughout the year. This collective effort helps many area residents receive
early detection and appropriate treatment of their cancers.
OUR SERVICES INCLUDE:
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Clinical Trials
Rehabilitative Services
Diagnostic Radiology
Medical Oncology
Surgery
Home Care
Hospice
Bereavement Support Groups
Nurse Navigator
Other Cancer Support Services
Prevention and Early Detection Programs
Data collected by the cancer registry is an invaluable tool in the fight against cancer. The registry collects
demographic and disease-specific data elements on each cancer patient presenting for diagnosis or
treatment. The information collected is utilized by physicians, administration and other health care
professionals. Among the many uses are:
> Measuring quality outcomes
> Tracking community outreach initiatives
> Supporting clinical, diagnostic and treatment research
> Evaluating the effectiveness of current treatment modalities
> Presenting data for individualized patient treatment planning
> Submitting to local and national databases for incidence and outcome comparison
2009 DATA SUMMARY
Mercy Memorial Hospital’s cancer registry accessioned 317 new cancer cases for 2009. The following
graph illustrates the most frequent primary sites seen at this facility compared to the top five sites in
Michigan for 2006.
MERCY MEMORIAL HOSPITAL SYSTEM
TOP FIVE SITES (2009)
STATE OF MICHIGAN
TOP FIVE SITES (2006)
(MOST RECENT MICHIGAN STATISTICS AVAILABLE)
58
46
8156
7603
28
6972
25
19
3709
2345
Breast
Lung
Prostate
Colon
Bladder
Breast
Lung
Prostate
Colon
Bladder
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The top five sites for all patients are breast, lung, prostate, colon and bladder. The gender distribution for
those sites is represented in the graph below.
MALE/FEMALE TOP SITES
Each case accessioned into the registry database is assigned a class of case based on the location of
initial diagnosis and/or treatment, which allows for the evaluation of referral patterns. Class of case
analysis also can be a valuable tool in the planning and allocation of resources at the facility.
CLASS OF CASE DEFINITIONS AND 2009 DISTRIBUTION
Number of Cases at MMHS
60
Analytic (n = 286)
50
Cases Include:
40
30
20
10
0
Lung
Prostate
Colon
Bladder
Female 56
Breast
25
0
17
5
Male
21
28
8
14
2
Class 0
N = 92
Diagnosis at the accessioning facility and the entire first course of
treatment was performed elsewhere.
Class 1
N = 192
Diagnosis at the accessioning facility and all or part of the first course
of treatment was performed at the accessioning facility.
Class 2
Diagnosis elsewhere and all or part of the first course of treatment
was performed at the accessioning facility.
N = 2
FOLLOW-UP
Meaningful survival and outcome
measures require reliable tracking
Patients diagnosed and treated at Mercy Memorial (Class 1) represent 60% of the annual cases. Patients
diagnosed at Mercy Memorial with referral to an outside facility (Class 0) represent 29 percent.
of disease, recurrence and vital
status for the lifetime of each patient
record. Accurate follow-up data
enables Mercy Memorial Hospital
CLASS OF CASE
Other
Class 2 10%
1%
System to compare outcomes
Class 0
29%
with regional, state and national
statistics. The successful follow-up
rate at Mercy Memorial since the
established registry reference
Class 1
60%
year (2007) is 98 percent. The rate
exceeds the Commission on Cancer
requirement of 90 percent.
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The following table details the number of analytic cases (Class 0, 1 and 2) by primary site for 2009.
Stage Distribution – Analytic Cases Only
Primary Site
Total
Stg 0
Stg I
Stg II
Stg III
Stg IV
n/a
*Unk
Total
286
28
54
55
36
55
27
31
Breast
58
6
18
13
9
6
0
6
Prostate
28
0
0
25
1
2
0
0
Lung & Bronchus
46
0
8
2
9
20
0
7
Colon Excluding Rectum
25
0
1
6
10
7
0
1
Urinary Bladder
19
7
8
3
0
0
0
1
Melanoma – Skin
2
1
0
0
0
0
0
1
Kidney & Renal Pelvis
3
0
1
0
0
2
0
0
Corpus & Uterus, NOS
7
0
3
0
0
1
0
3
Rectum & Rectosigmoid
15
0
2
0
3
5
0
5
Ovary
2
0
1
1
0
0
0
0
Gallbladder
1
0
0
0
0
1
0
0
Non-Hodgkin’s Lymphoma – Nodal
5
0
0
0
3
1
0
1
Pancreas
4
0
0
1
0
1
0
2
Thyroid
4
0
2
2
0
0
0
0
Multiple Myeloma
4
0
0
0
0
0
4
0
Non-Hodgkin’s Lymphoma – Extranodal 2
0
0
0
0
2
0
0
Brain
0
0
0
0
0
0
0
0
Other Nervous System
4
0
0
0
0
0
4
0
Soft Tissue (including Heart)
3
0
1
0
0
1
1
0
Leukemia
6
0
0
0
0
0
6
0
Hodgkin’s Lymphoma
2
0
1
1
0
0
0
0
Cervix Uteri
16
13
1
0
0
0
0
2
Other Endocrine (including Thymus)
1
0
0
0
0
0
1
0
Other Female Genital Organs
1
0
1
0
0
0
0
0
Other Male Genital Organs
1
0
1
0
0
0
0
0
Oral Cavity & Pharynx
9
0
1
1
0
5
0
2
Stomach
1
0
0
0
0
1
0
0
Larynx
6
1
4
0
1
0
0
0
All Other
11
0
0
0
0
0
11
0
4 North Unit
Mercy Memorial Hospital System also has added a six-bed unit dedicated to cancer care. Located on a
single floor, this unit offers cancer treatments, including infusion therapy, from a nursing staff specially
trained in cancer care.
*Unknown stage consisted of 16 class of case 0’s (which are exempt from staging) and 11 class of case 7’s (pathology only).
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Patient Profile: Robert Mehrhof
When Robert Mehrhof of Raisinville Township experienced abdominal pain so bad that he couldn’t
move, he originally thought he had gotten food poisoning from a bad hamburger. After his physician
ran some tests, however, he found out he had colon cancer and was referred to Dr. Charu Trivedi.
“The first tests showed that I had tumors throughout my colon, so I was scared,” Robert said. “But that
was only half the story. Following my colon surgery, Dr. Trivedi suspected it might be worse and asked
if I wouldn’t mind going through some more tests. Unfortunately, the CT scan showed I also had
tumors on my liver.”
The Mercy Memorial Hospital team coordinated with Robert’s referring physician to start him on a
chemotherapy course, which successfully shrunk the tumors to a size small enough where they could
be frozen off during a surgical procedure.
“I could tell that I was in good hands,” Robert said. “The whole Mercy staff made me feel comfortable,
and they monitored me closely. Another guy I know with my same case didn’t make it. Originally, I was
afraid of cancer. But, with Dr. Trivedi’s help, I feel like I have it beat.”
“The whole Mercy staff made
me feel comfortable, and they
monitored me closely. Another
guy I know with my same
case didn’t make it. Originally,
I was afraid of cancer. But,
with Dr. Trivedi’s help, I feel
like I have it beat.”
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Dr. Charboneau – Colon Cancer Outcomes Analysis
RETROSPECTIVE REVIEW OF COLORECTAL CANCER PATIENTS
DIAGNOSED AT MERCY MEMORIAL HOSPITAL SYSTEM
Approximately 140,000 new cases of colorectal cancer will be diagnosed each year in the United States.
An estimated 49,000 deaths will occur due to colorectal cancer. Fortunately the incidence has been
decreasing, likely reflecting improvements in mass screening through colonoscopy. Due to improvements
in treatment, mortality rates have decreased as well.
To evaluate the results of colon cancer treatment at Mercy Memorial Hospital System, we performed an
outcomes analysis for patients diagnosed with and treated for colon cancer in 2009. At MMHS our registry
reference year is 2007. Although it is premature to report long-term survival rates regarding colorectal
cancer, several facts stand out since the tumor registry started two years ago. First, our colon cancer
caseload at MMHS has increased by 79 percent between 2007 and 2009. In 2009, 25 patients were
diagnosed and treated at MMHS for colon cancer. This included 17 females and eight males. All 25
patients diagnosed with colon cancer in 2009 elected to receive their subsequent treatment (surgery,
chemotherapy) at MMHS. No patients chose to seek treatment at an outside facility. In addition, since
2007 there have been no reported recurrences of colon cancer for patients who were diagnosed and
treated at our facility.
Michael Charboneau, Jr., D.O.
General Surgeon, Cancer Committee Chairman
The pathologic stages for those patients revealed that only 28 percent of patients were diagnosed
at an early Stage (1 and 2). The majority of the patients had an advanced stage of colon cancer at the
time of presentation. Forty percent of patients diagnosed with colon cancer at MMHS had Stage 3
disease compared with a rate of 23 percent for Stage 3 disease in community hospitals nationwide.
Likewise, 28 percent of those diagnosed at MMHS presented with Stage 4 disease compared to only
15 percent nationally.
STAGE AT DIAGNOSIS: MMHS vs NATIONAL
40%
30%
20%
10%
0%
0
MMHS
16
1
2
3
4
UNK
Community Hospitals Nationwide
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Another pattern emerges when age at the time of diagnosis for colon cancer is analyzed. Compared with
the national averages, MMHS has a nearly five-fold higher incidence of colon cancer in the 20 to 29 age
group. Also an increased incidence of colon cancer was noted in the 80 to 89 age group, which was 30
percent at MMHS versus 23 percent at both state and national levels.
AGE AT DIAGNOSIS: MMHS vs NATIONAL
2009 Colon Cancer Treatment Comparison:
MMHS to NCCN Guidelines
Charu Trivedi, M.D.
DATA SOURCE:
Mercy Memorial Cancer Registry data of newly diagnosed colon cancer cases January 1, 2009 through
December 31, 2009. Analytic cases only were reviewed (Class of Case 0, 1 and 2).
30%
25%
REASON FOR REPORT:
Delivering high-quality patient care remains the focus of the physicians and staff at Mercy Memorial
Hospital System. The Cancer Committee chose colon as the site for analysis in concordance with the
American College of Surgeons’ Standard 4.3. The purpose of the study is to determine if MMHS is
following the current 2009 National Comprehensive Cancer Network (NCCN) guidelines for colon
cancer treatment.
20%
15%
10%
5%
0%
Under 20
National
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90+
MMHS
Clearly we can conclude from the data that our efforts need to be directed toward earlier detection of
colon cancer through screening colonoscopy. Also, we as physicians need a heightened awareness of
colon cancer in younger patients and consequently a lower threshold to perform endoscopy if indicated
based on the patient’s symptoms. In the upcoming year, MMHS – through its Cancer Committee –
has made it a priority to increase efforts to raise awareness of early prevention and detection of this
preventable disease.
Source: National Cancer Data Base, Committee on Cancer, American College of Surgeons, ACoS Benchmark Reports.
FINDINGS:
There were 25 analytic cases diagnosed in 2009. Four cases had no primary site surgery; therefore, 21
cases were eligible for review. Three specific factors were reviewed to determine compliance with the
2009 colon NCCN guidelines.
COMPLIANCE BASED UPON THREE SPECIFIC FACTORS:
1.WAS A PREOPERATIVE CARCINOEMBRYONIC ANTIGEN (CEA) DRAWN PRIOR TO
PRIMARY SITE SURGERY?
2.WAS A COLONOSCOPY PERFORMED PRIOR TO PRIMARY SITE SURGERY?
3.WERE 12 OR MORE LYMPH NODES REMOVED DURING SURGICAL RESECTION?
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PREOPERATIVE CEA DRAWN:
Of the 21 cases eligible for review, four cases were exempt due to perforation or obstruction. In the
remaining 17 cases, 14 had a pre-op CEA drawn for a compliance rate of 82 percent.
PRE-OP CEA DRAWN
n = 17
TWELVE OR MORE LYMPH NODES REMOVED:
Twenty-one cases had a surgical resection performed. Twenty cases had 12 or more lymph nodes
removed for a compliance rate of 95 percent. All efforts are made to obtain and identify 12 or more
lymph nodes. However, one particular case fell outside the parameters despite all efforts by the surgeon
and pathologist.
>12 LYMPH NODES REMOVED
n = 21
18%
5%
82%
95%
Yes
No
Yes
COLONOSCOPY PRIOR TO SURGICAL RESECTION:
Of the 21 cases eligible for review, four cases were exempt due to perforation or obstruction. In the
remaining 17 cases, 16 had a colonoscopy performed prior to surgical resection for a compliance rate
of 94 percent.
COLONSCOPY PRIOR TO SURGERY
n = 17
6%
94%
Yes
No
CONCLUSIONS:
1.Colon cancer management at MMHS was evaluated for compliance and adherence to NCCN 2009
guidelines for three factors: Preoperative CEA drawn prior to surgery, colonoscopy performed before
definitive primary site colon surgery and 12 or more lymph nodes removed during surgical resection
of colon.
2.Preoperative CEA was drawn in 82 percent of cases.
3.Colonoscopy was performed in 94 percent of the cases prior to the surgical resection of primary tumor.
4.Twelve or more lymph nodes were removed in 95 percent of colon resection cases.
5.In summary compliance and adherence to NCCN 2009 guidelines for preoperative colonoscopy
and 12 and more lymph nodes as required was very good with room to improve in terms of drawing
preoperative CEA prior to colon resections.
RECOMMENDATIONS:
1.It is recommended that gastroenterologists, surgeons, oncology specialists and primary care physicians
put special efforts to draw preoperative CEA and have all patients undergo complete colonoscopy
before elective colon resections.
2.Surgeons need to be aware that for adequate results from complete colon resection 12 or more
lymph nodes removed leads to superior outcomes and removal of 12 or more lymph nodes should be
standard at MMHS for superior quality colon surgery performed for the treatment of colon cancer.
No
Educational workshops were conducted to review the staging elements with the surgery department and
all surgeons were provided a reference guide.
REFERENCES:
NCCN Practice Guidelines in Oncology 2009.
Available at www.nccn.org
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Clinical Trials
As part of Mercy Memorial Hospital System’s mission to improve care for current and future patients, the
Clinical Trials Department offers qualified patients the opportunity to participate in one of approximately
50 different Phase II and Phase III National Cancer Institute trials. Available since 2001, Mercy Memorial
Hospital’s clinical trials success has been one of the “best kept secrets” in lower Southeastern Michigan
and was highlighted as a commendation category in the American College of Surgeons’ site review in
August 2010.
These trials range from new drugs used to control cancer to those designed to stop the cancerous
cell growth by preventing DNA from mutinous cells from replicating. All studies are approved through
the Toledo Community Oncology Program Institutional Review Board with the cooperation of Mercy
Memorial Hospital System. The Review Board’s responsibility is to identify the available studies to find
those that are most appropriate for the needs of the population in the Monroe area. Currently, this
includes breast, colon and lung cancer studies among others. The trials are coordinated by Dr. Charu
Trivedi, a principal investigator, as deemed by the National Cancer Institute.
Monroe Cancer Center
The process for getting patients enrolled is streamlined. Karen Whitmire, RN, a clinical research nurse,
reviews the tumor board list to determine if any current patients are eligible and evaluates current studies
to find the best fit for each patient’s needs. After reviewing a patient’s eligibility, she then visits with the
patient to determine if there is interest in participating in the trial.
In March 2010, Mercy Memorial Hospital System broke ground on the Monroe Cancer Center, a stateof-the-art facility that will be the only integrated cancer center in the area, offering coordinated medical
and radiation oncology services under one roof. A joint venture with Karmanos Cancer Institute of Detroit
and ProMedica Health System of Toledo, this 10,000-square-foot facility – which is expected to open in the
second quarter of 2011 – will be located at 800 Stewart Road near the campus of Mercy Memorial Hospital.
“We talk about expectations and the benefits and risks of the program,” Karen said. “I give them fact
sheets and brochures about the clinical trial process. I address any questions or concerns, so they feel
comfortable with the process. If they want to participate, we get the consent forms signed and enroll
them into the clinical trial.”
Mercy Memorial Hospital System and its two partners are investing $6 million into this new treatment
center, which will deliver individualized cancer therapy, the latest protocols for medical oncology and
advanced technology for radiation oncology.
One of the clinical trial nurses accompanies the patient at each doctor and treatment visit to help guide
the patient and to offer support.
Mercy Memorial Hospital System is currently reviewing a number of potential new clinical trials, including
one that focuses on minimally invasive tumor removal and others that explore new techniques in radiation
therapy so patients may stay close to home for these kinds of treatments.
This new facility will fill a distinct need for Monroe County cancer patients, many of whom must travel
outside their communities to receive radiation therapy. The juggling that patients, friends and family
must do to coordinate transportation to Toledo, Ann Arbor or Detroit can add additional stress to a
process that already is emotionally and physically challenging – especially since radiation therapy and
chemotherapy regimens typically can last for weeks. The new Monroe site will provide the perfect
combination of high-quality, patient-centered cancer care that’s close to home.
THE NEW MONROE CANCER CENTER WILL INCLUDE:
> Physician offices
> Laboratory services
> Medical oncology–related services
> Radiation oncology services
> Community room for education, workshops and support groups
> The Mercy Memorial Cancer Connection
> Clinical trials
The treatment center also will bring new jobs to the area. The estimated staff needed for the radiation
oncology area, which will be administered by the Karmanos Cancer Institute, will be approximately
seven full-time positions. A full-time physician and a team of registered nurses, medical assistants and
laboratory staff will be needed for the medical oncology area, which will be administered by the Toledo
Clinic Hematology/Oncology Group. Toledo Clinic will work in partnership with ProMedica and MMHS.
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“During one of the worst times of a patient’s life, you can help ease
the strain by connecting them with the information and resources
they need.”
Mercy Memorial Cancer Connection
In June 2010, the hospital system also acquired the Monroe Cancer Connection – a nonprofit organization
that for years has provided area residents with personalized, non-medical assistance during cancer treatment.
As part of this partnership, the organization has been renamed as the Mercy Memorial Cancer Connection,
which will be located within the Monroe Cancer Center when it opens its doors in 2011. During the transition,
it is being housed at one of the buildings adjacent to the hospital’s main campus.
This acquisition gives Mercy Memorial Hospital System the ability to offer a wide range of support services
that are free to qualifying patients in Monroe County, including:
> Transportation within a 50-mile radius to cancer-related appointments
> Discounted and free nutritional supplements
> Medical supplies and equipment such as shower chairs or wheelchairs
> Wigs and head coverings
> Resource referrals
> Support groups
> A cancer hope network, connecting patients to others with similar cases
> Encouraging “sunshine calls” to monitor patients’ well-being
> Mastectomy supplies
“It offers peace of mind for the cancer patient,” said Donna Bruck, program coordinator for the Mercy
Memorial Cancer Connection and a cancer survivor herself. “Just to know that someone is watching over
your care and helping you find these resources.”
24
In 2003, at the age of 24, Donna was diagnosed with breast cancer at Mercy Memorial Hospital System.
A year later, she began volunteering for the Monroe Cancer Connection while she was finishing up her
teaching degree, and ultimately she was asked to become the organization’s director. Her teaching
background is a perfect fit for her current role. “You get to educate patients,” Donna said. “During one
of the worst times of a patient’s life, you can help ease the strain by connecting them with the information
and resources they need.”
Other than Donna, who is the only full-time employee, the Mercy Memorial Cancer Connection relies
completely on volunteers, and they are always looking for more – as well as for additional donations.
United Way has been the organization’s largest supporter for years, but the organization also has been
active in planning fundraising events and applying for both local and national grants. Most recently, it
was awarded $5,000 through the Pepsi Refresh Project and another $5,000 from the Monroe County
Commission on Aging.
Still, Donna emphasizes that every little bit, even five dollars, can help. “People sometimes give blindly
to charities, not knowing where the money goes,” Donna said. “But when you donate money here, it
could be helping your neighbor.” All the donations collected are used to help patients in the Monroe
communities.
Last year, the organization was able to help about 200 area residents, but given the partnership with Mercy
Memorial Hospital System, which is increasing visibility for the Cancer Connection, she expects to be able
to do much more. Future plans include an increasing focus on holistic treatments such as massage and
Reiki, several community events such as an Ask the Docs seminar and a Walk of Hope, and working with
a local artist to provide therapeutic art to improve patients’ experiences.
25
Nurse Navigator Program
PET/CT Imaging Services
When cancer is diagnosed, patients can be overwhelmed by a sea of information. This information –
meant to help educate – actually can lead to further anxiety and misunderstanding. As part of Mercy
Memorial’s commitment to improving the efficiency and quality of care for patients, the nurse navigator
program assists every newly diagnosed breast cancer patient and serves as their advocate throughout
each phase of treatment.
Improved patient care and streamlined care
are the top two reasons Mercy Memorial
Hospital System began providing PET/CT
services on the hospital campus. With these
additions, Mercy Memorial Hospital became
the first and only medical facility in Monroe
County to offer these services, eliminating
the need for patients to travel outside
the community for both PET and CT
diagnostic tests.
“Breast cancer is probably one of the most
complicated cancers from a patient’s perspective,”
said Debbie Osentoski, RN, the hospital’s first
nurse navigator. “There are many variations to each
individual breast cancer tumor, driving different
surgical and treatment options.”
Patients are introduced to several cancer medical
specialists, supplied with a variety of details and
options, and then need to make prompt
treatment decisions.
The nurse navigator program is designed around
each patient’s needs. A Breast Cancer Certified
nurse helps to interpret the physician’s plan of care
and also provides each patient with a toolkit of items
designed to educate, assist in organization and
facilitate healing. A nurse navigator also may assist
patients in obtaining medication and with referrals
to support groups as well as community and hospital
resources. Timely intervention at key points during a
patient’s treatment trajectory is vital.
The new equipment, known as the Discovery ST, integrates a Positron Emission Tomography (PET)
scanner with a multi-slice Computed Tomography (CT) scanner. Since better image quality translates into
more complete information, this technology gives physicians greater diagnostic confidence, so they can
plan the appropriate treatment. PET/CT scans are used to:
> Diagnose and stage cancer
> Differentiate Alzheimer’s disease from multi-infarct dementia
> Evaluate Parkinson’s and Huntington’s diseases
> Evaluate the extent of disease and recovery following stroke therapy
> Localize seizure focus in patients with intractable, complex seizure disorders
By introducing PET/CT scanning to the Monroe community, we also offer many other benefits to patients,
including convenience, increased patient comfort due to a shorter exam time, greater peace of mind
from knowing that this technology provides comprehensive information, and potential reduction of
invasive procedures.
“Anticipation of individual patient needs and providing support and education leads to very positive
outcomes – for the patient, the family and the entire health care team,” Debbie said.
To date, the program has more than 50 patients being followed by the nurse navigator. In addition to a
greater sense of control by patients, the program has improved the efficiency of care and eliminated the
scheduling delays that can occur with the treatment of this disease.
“Although breast cancer is largely curable, especially with the great strides we have made with early
detection and diagnosis at early stages, for some it can become a chronic disease with second and third
recurrences,” Debbie said. “It’s critical that patients know their options at each stage.”
Patients may be in the program for as little as four months, while others may use the service for well over
a year. At the end of active cancer treatment, all patients are provided with a survivor care packet, which
includes treatment summaries and recommendations for healthy living, continued follow-up
and surveillance.
26
27
Patient Profile: Denise Francisco
Denise Francisco, a breast cancer patient at Mercy Memorial Hospital System, counts herself as one of
the lives that has been saved thanks to the resources offered to her.
“I wish I could have gotten screened earlier, but I simply couldn’t afford it,” Denise said.
Through a free mammogram screening at MMHS, made possible through support from a grant from the
Northwest Ohio Affiliate of the Susan G. Komen for the Cure, Denise’s physician found a lump. Follow-up
tests confirmed that she had early Stage 2 breast cancer. Through Medicaid and other assistance
programs, Denise was able to get the mastectomy surgery she needed, performed by Dr. Gretchen Feller.
“Years ago this was a death sentence,” Denise said. “But Dr. Feller and the breast nurse navigator
showed me all the statistics and explained the procedure and how we’re going to beat this. I had my
mastectomy, and was only in the hospital for one day.”
Following surgery, Denise’s care team recommended that she undergo chemotherapy treatment.
Fortunately, she was eligible for a clinical trial with Mercy Memorial Hospital System. She was hesitant at
first, in part because of everything she had heard about chemotherapy.
“You can’t listen to the negative,” Denise said. “You have to be positive. I was afraid, but the doctors, the
clinical trial nurses and the nurse navigator put me at ease. If it wasn’t for them, it would have been so
much harder.”
Denise also realized that she could help make a difference through the clinical trial. “I wanted to be part
of this, not just for myself, but for my family. Nobody in my family has this, so when I was diagnosed it was
a bit of a shock. But who knows who this could help in the future? I’m looking for a cure and anything
I can do, I’ll do.”
Denise is expected to complete her chemotherapy treatment in early 2011, and she knows that she
also may need to undergo radiation therapy. “I know if I do, they’ll take care of me,” she said. “From
answering all of your questions to putting you in touch with programs you need, you couldn’t ask for
anything better than the support you get from this team.”
28
“You have to be positive.
I was afraid, but the doctors,
the clinical trial nurses and
the nurse navigator put me
at ease. If it wasn’t for them,
it would have been so
much harder.”
29
Rehabilitation Services
Mercy Memorial Hospital System’s Rehabilitation Department recognizes the need to provide skilled,
and top-quality treatment services to the residents of Monroe County and its surrounding areas. As part
of this, we provide comprehensive therapy programs designed to promote functional independence,
optimal range of motion and strength, and decreased pain levels through exercise and meaningful
activities. Each individual treatment program is designed and overseen by a licensed physical therapist,
occupational therapist or speech therapist, and it is administered with the help of skilled support staff.
This team works closely with each patient – and with each other – to provide the highest-quality care.
In upcoming years we will look into additional ways to integrate our services into the hospital system and
our community to better serve the needs of our patients.
ON-SITE REHABILITATION SERVICES AVAILABLE FOR 2010 AND 2011:
> Physical therapy
> Occupational therapy
> Lymphedema therapy
> Speech language pathology
> Oncology massage therapy
> Aquatic therapy
> Low-vision therapy
> Post-op mastectomy check
REHABILITATION SERVICES AVAILABLE BY REFERRAL FOR 2010 AND 2011:
> Exercise therapy
> Prosthetic and orthotic services
THE REHABILITATION DEPARTMENT PROVIDES CARE DURING APPROXIMATELY
25,000 OUTPATIENT VISITS AND 10,000 INPATIENT VISITS PER CALENDAR YEAR.
Introduction of Lymphedema Therapy
In an effort to address a common side effect of breast cancer treatment, Mercy Memorial Hospital System
has added a lymphedema therapist, Denise Braden, OTR/L, CLT-LANA, who is one of only 18 certified
therapists in Michigan. Denise provides comprehensive lymphedema treatment to local patients and to
patients referred from as far away as the Mayo Clinic in Minnesota.
Lymphedema is a condition that results from damage to the lymph system, the garbage disposal system
of the body. When lymph nodes are removed, it becomes difficult for the body to filter waste. This can
lead to a buildup of unhealthy fluid in the tissues, causing swelling and infection – all of which can cause
a patient pain and discomfort. “It can give them a heaviness in their limbs that feels like sponges filled
with water,” Denise said.
Breast cancer patients are particularly at risk for developing lymphedema when they undergo a
mastectomy and have lymph nodes removed. Patients who require radiation therapy are at even greater
risk. “We try to catch it early,” Denise said. “When our patients have a mastectomy and lymph node
removal, we offer a free follow-up evaluation three weeks after surgery.”
Although lymphedema treatment has been available since the Depression Era, this typically involved
using compression pumps to reroute the fluids. It has only been in recent years that more convenient,
noninvasive techniques have been employed in the United States.
Modern lymphedema treatment involves following four steps: Proper skin care to avoid infections,
manual lymphatic draining through light stretching and massaging of the skin, compression bandages
or a garment that is used to reduce the size of the affected area, and simple exercises to help get the
lymphatic fluid moving. During the treatment program, which typically lasts about a month, Denise also
shows patients how to manage their treatment at home and how to take several basic precautions, such
as maintaining a healthy weight, and avoiding sunburns and cuts to prevent swelling and infection.
30
31
Mercy Memorial Hospice of Monroe/HomeCare Connection
Mercy Memorial Hospital System recognizes the growing need for home care for cancer patients – which
has been proven to speed recovery and the healing process – and offers a wide range of services through
HomeCare Connection. Some of the features of this program include:
> Skilled care for individuals recently discharged from a nursing center or hospital or after
outpatient surgery
> Assistance in the transition from hospital or nursing home to home
> Skilled professionals to monitor and manage a medical condition
> Personal care assistance that allows the individual to retain independence
> An opportunity to recover with minimal effects of illness on an individual and the family
One key area of home-based care is hospice, which is also known as end-of-life care. These services are
provided by Mercy Memorial Hospice of Monroe. “The goal is to help a terminally ill patient get the most
quality of life, to live each day to the fullest,” said Sandy Oetting, RN, Hospice Manager. “It’s a vulnerable
time for the patient and family, so we help them through our interdisciplinary team approach.”
Team members include the patient, family, physicians, registered nurses, chaplains, therapists, social workers
and many others. All care is delivered wherever the patient resides and calls home. The goal is to help
the patient achieve an optimal level of health and independence in the comfort and security of a familiar
environment.
“In all cases, we try to make a connection with them and their families, to help them in whatever way we
can,” Sandy said.
Hospice typically is funded through Medicare, which issues strict guidelines for care, starting with the need
for a physician’s order. This is one challenge in hospice care, because physicians feel compelled to save
patients’ lives any way they can.
“We meet doctors one-on-one, and help them to
understand that hospice is an alternative type of care
that focuses on comfort and quality of life.”
“It’s only been over the last couple of years that the medical community as a whole has started
understanding more about end-of-life care,” Sandy said. “We meet doctors one-on-one, and help them
to understand that hospice is an alternative type of care that focuses on comfort and quality of life.”
Mercy Memorial Hospice of Monroe also delivers care to patients in assisted living facilities, group homes
and other medical facilities. Patients typically stay in a hospice program for less than a month. Given this
short amount of time, the care team does everything they can to provide support services to the patient.
“We have certified massage and Reiki therapists, beauticians and many other talented volunteers,” Sandy
said. “We provide flower arrangements to patients through our flower program every other Thursday and a
medication delivery program where volunteers pick up and deliver prescriptions to patients and families who
otherwise could not get out and pick them up. Volunteers are a core part of our program, and we couldn’t
do it without them.”
Given that terminal cancer can strike at any age, the hospice program also delivers care to younger patients,
even those under 21. “It’s tough to see these cases,” Sandy said. “We provide as much emotional support
as we can for the families and do what we can to get them home from the hospital where they can be with
family and friends.”
32
33
C O M M U N I T Y
One of the most effective ways to help our
community fight cancer is to promote awareness,
prevention and the importance of early detection.
Mercy Memorial Hospital System is committed to
this goal, and through several events, educational
programs and other outreach efforts, we spread
this message to thousands of residents in our
community – resulting in the prevention and
early detection of numerous cancer cases.
These programs include:
SMOKING CESSATION COUNSELING
Educators within Mercy Memorial Hospital help
both inpatient and outpatient participants with
smoking cessation, helping to eliminate one of
cancer’s most common risk factors. This education
includes working with the patient to develop
strategies for quitting, which can provide the
encouragement necessary for helping patients
quit for good.
In addition to inpatient counseling, Mercy
Memorial offers a four-week educational and
supportive program to those individuals interested
in receiving assistance to help them quit smoking.
Participants meet with a counselor by phone or
in person. A doctor’s order is required to enroll.
To date, the program has helped 898 inpatient
participants and 46 outpatient participants.
SKIN CANCER SCREENING DAY
This free screening program promotes awareness
of skin cancer and emphasizes prevention while
helping community members detect the disease
when it’s in its most curable stages. In 2010, 79
people took advantage of this program.
34
O U T R E A C H
HEALTH CHECKS
Quarterly health checks in the community in
cooperation with the United Way help to educate
the community on the importance of cancer
prevention, self-examination and early detection.
SUSAN G. KOMEN GRANT AND BREAST
CANCER SCREENING
Thanks to a significant grant from the Northwest
Ohio Affiliate of the Susan G. Komen for the
Cure, many uninsured and underinsured women
who live in Monroe County receive free annual
mammogram screenings at Mercy Memorial
Hospital System. Each year, the Breast Cancer
Screening program provides mammograms to
hundreds of women who had either delayed
or could not afford the screenings. In October,
residents also can attend Spa Saturday, an event
designed to help area women age 40 and over
and who are either uninsured or underinsured.
This annual event features free mammograms,
therapeutic massages and breast health education.
RELAY FOR LIFE TEAM
American Cancer Society’s Relay for Life is a
24-hour walking, camping, celebrating and
sometimes sobering grassroots fundraising event.
In 2010, Mercy Memorial Hospital participated
with more than 50 employees, raising more than
$2,000. The Monroe Relay for Life is one of the
largest in the country, enlisting almost 120 teams,
8,000 participants and raising as much as $350,000
for cancer treatment and research.
PROSTATE SCREENING DAY
Each year, two Mercy Memorial Hospital System
urologists and the Corporate Connection clinic
staff donate their time to provide free prostate
screenings one evening in September. During
the event, men in the community receive a free
digital exam, PSA blood test and prostate health
education. In 2010, 138 men took advantage of
this free screening.
35
718 North Macomb Street
Monroe, Michigan 48162
(734) 240-8400
mercymemorial.org
MMHS Cancer Committee
Annette S. Phillips,
President and Chief Executive Officer
Michael Charboneau, Jr., D.O., Chairman
Charu Trivedi, M.D., Cancer Liaison Physician
John E. Kibble, Executive Champion
Steven Bai, M.D.
Donna Bruck
Navin Jain, M.D.
Caryn Lorentz
Darius Mehregan, M.D.
David Mehregan, M.D.
S.R. Nair, M.D.
M. Patel, M.D.
Mary Bitz, O.T.R., C.H.T.
Megan Coriell, R.H.I.A., C.T.R.
36
Larry Csokasy, L.M.S.W.
Kristin Ferreira, O.T.R.L.
Gail Gedelian, R.T. (R) (M) (BD)
Rev. James Jacobs, M-Div.
Tammy Knapp
Tina Melonakos, Pharm.D.
Cindy Miller, B.S., R.R.T.
Sue Morgan, M.S., R.D.
Debra Osentoski, B.S.N., O.C.N., C.B.C.N
Sandra Oetting, R.N., M.S.N., N.P., C.H.P.N.
Mary Russ, R.N., A.C.M.
Joyce Shankleton, M.S.A., R.N.
Jennifer Strohmeyer, B.S., R.N.
Jackie Swearingen
Karen Whitmire, R.N.

2010 Cancer Annual Report

Transcription

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