Cancer Annual Report 2011 - St. Anthony`s Memorial Hospital

Cancer
Annual
Report
2011
Cancer Committee Chairperson Report
by Dr. Steven Jones, Committee Chair 2011
St. Anthony’s Memorial Hospital, in conjunction with Crossroads
Cancer Center, continues to provide the highest quality of care to our
patients with cancer. Several exciting developments deserve notice.
We are grateful to have developed a strong relationship with the
Cancer Care Specialists of Central Illinois at the Crossroads Cancer
Center, where exceptional medical and radiation oncology services
are provided to patients of this region. Dr. Philip Dy, as the Cancer
Liaison Physician and Research Coordinator for St. Anthony’s, offers
important direction to the hospital’s oncology program. In addition,
Crossroads Cancer Center has enrolled many of our patients in a
variety of clinical trials, providing ongoing research and education
that are vitally important for quality cancer care. Dr. Irene Dy recently
joined Dr. Phil Dy, Dr. Hanna Saba, and Dr. Michael Bruin at the
Cancer Center. Dr. Irene Dy said, “I have a strong interest in medical
oncology because of its challenging and complex nature, and because
I enjoy caring for patients and their families as if they were my own
family.”
Another exciting development is that the important role of radiation
oncology has been emphasized and strengthened this year. Dr. Michael
Bruin has provided monthly education to St. Anthony’s Medical
Staff regarding the appropriate uses of radiation therapy, as well as a
special presentation summarizing the most important principles and
developments in the field of radiation oncology. Crossroads Cancer
Center has recently installed a new state of the art Varian Clinac iX
Linear Accelerator with Rapid Arc Technology. This represents a major
advance in technology that improves precision, decreases toxicity
to normal tissues, and shortens overall treatment time. This enables
physicians to improve the standard of care and treat more patients
safely.
The members of the Medical Staff at St. Anthony’s Memorial Hospital
continue to offer superb medical, diagnostic, and surgical care to
the oncology patients in this region. In general, the Medical Staff
have brought a wealth of expertise and perspective to a variety of the
hospital’s programs, committees, and activities. For example, Dr.
Ruben Boyajian was recently praised by the Commission on Cancer
for his efforts to establish the Women’s Wellness Committee and
Center.
Over 5,000 patients utilized the Women’s Wellness Center this
year, where they have received full-field Digital Mammography
that is the most technologically advanced and accurate form of
mammography available in this region. The Center also offers
minimally invasive stereotactic breast biopsies, Dexa Scans for the
diagnosis of osteoporosis, and a Prosthetic Boutique with certified
Mastectomy Fitters. Representatives of the Women’s Wellness Center
provided educational programs on women’s health issues to over 1,000
people in the greater Effingham area. At the Center itself, Shanna
Hutchens, R.N., and Bobbi Kinkelaar, R.N. (the current and past
Nurse Navigators, respectively), assisted women and their families
in promoting healthy lifestyles, understanding different diagnoses
and treatment options, and coordinating care for the patients.
The American Cancer Society (through Lawrence Underwood)
has been working with the Women’s Wellness Center and other
departments, hosting programs such as “Look Good…Feel Better”,
free Wig and Turban Banks, the “Road to Recovery” (assistance
with transportation), “Support for Recovery” (one-on-one cancer
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survivor mentors), and “Guest Room”
programs (assistance with sleeping
accommodations when traveling for
treatment).
In addition, during the past year, the
Community Relations department
hosted many community programs,
including cancer awareness education
at the Effingham County Fair and area
health fairs, Artisan Fair, Caregivers’
Symposium (providing help to caregivers
as they care for their loved ones), Cancer
Survivor’s Day (organized by Crossroads
Cancer Center), “Girls Night Out”, and “Settings for St. Anthony’s.”
Educational articles were provided to the community, such as “Having
Regular Mammograms Saved My Life” and “Financial Assistance
Available for Mammograms.” Dr. Lana Schmidt, Dr. George Saliba,
and Dr. Jeanine Huddlestun-Johns volunteered their time to provide
cancer screenings, and several suspicious lesions were detected and
later treated. A hugely successful “Real Men Wear Pink” community
campaign was again organized, supporting breast cancer awareness and
encouraging women to have annual mammograms.
We can’t forget to mention the important role of the Physical
Rehabilitation department , including physical therapy, occupational
therapy, and speech therapy, which are available to inpatients and
outpatients as well as those in Home Care and Skilled Care. These
services are of great importance to our patients with breast cancer
who have had surgery and those who deal with lymphedema, as well
as head and neck cancer patients who have had surgery affecting their
speech capabilities.
St. Anthony’s Memorial Hospital Center for Advanced Imaging
continues to offer excellent service. The 64-slice CT Scanner,
16-channel MRI Unit, Nuclear Medicine Suite, and Full-field Digital
Mammography provide state-of-the-art radiological imaging. Dr.
Patrick Conklin, an interventional radiologist who recently joined our
Radiology department, has strengthened our program by providing a
wide range of minimally-invasive procedures in a caring atmosphere.
We have been very fortunate to have such a capable medical and
nursing staff, with excellent radiological diagnostic care, exceptional
surgical services, and outstanding medical and radiation oncology
providers. In addition, our certified tumor registrar, Jill Navarro, has
worked closely with the Medical Staff to provide quality data about
our cancer patients and has administered many aspects of our cancer
program. Her contributions have been invaluable.
Recently, the Commission of Cancer gave St. Anthony’s Memorial
Hospital and Crossroads Cancer Center an Outstanding Achievement
Award for our collaborative cancer care program. This is a very
prestigious award that places our Cancer Program in the top 5% of the
accredited programs in the United States.
We wish to thank all of the individuals who strived so diligently this
year, as always, to provide outstanding and compassionate care to our
patients.
Cancer Committee Members
2012
Steven Jones, MD
Pathology
Chairperson
Phillip Dy, MD
Medical Oncology,
Cancer Liaison Physician
Omer Aker, MD
Radiology
Marilyn Boone, RT (R)(T)
Women’s Wellness Manager
Ruben Boyajian, MD
General Surgery
Michael Bruin, MD
Radiation Oncology
Bob Esker
Senior Advisor
Mary Finley, RN
Director of Medical Staff & Quality Services
Carol Gapsis, RN
Pastoral Care Manager
Lisa Hoelscher
Community Relations
Shanna Hutchens, RN
Nurse Navigator
Angela Kelly, RN
Surgical Services
Jill Navarro, CTR
Cancer Registrar
Teri Phillips, RHIA
Health Information Manager
Annette Schnabel, DPT
Executive Director of Strategy and Administration
Kelly Sager, RN
Director of Patient Services
Kristi Smith, RN
Surgical Care Manager
Janet Strange, RN
Social Services
Lawrence Underwood
American Cancer Society
Denise Hahn, RN
Physical Rehabilitation Manager
Coordinators
Cancer Conference
Steven Jones, MD, Pathology
Quality Control/Cancer Registry
Jill Navarro, CTR
Quality Improvement
Mary Finley, RN
Community Outreach
Marilyn Boone, RT (R)(T)
Psychosocial Services
Janet Strange, LCSW
Clinical Research
Phillip Dy, MD
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Cancer Registry Report
Jill Navarro, Cancer Registrar
Interesting Statistics Effingham County
Percentage of Illinois Women
40 and older
Who Have a Mammogram
Illinois............................................90.8%
Effingham County.........................94.5%
Source: Illinois Behavorial Risk Factor Surveillance
System survey data, 2004-2006
Top Five Primary Sites
of Effingham County
Prostate................................. 163
Breast.................................... 154
Lung..................................... 131
Colorectal............................. 106
Bladder................................... 55
Source: Illinois Department of Public Health,
2004-2008
Percentage of Illinois Adults
18 and Older
Who Currently Smoke
Illinois.............................................20.9%
Effingham County.............................20%
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Cancer Registry Report
The cancer registry collects and analyzes data on every
cancer patient seen at St. Anthony’s Memorial Hospital.
The registrar is also in charge of cancer committee
meetings and keeping data to ensure our hospital and
physicians are following the best practices related to
cancer patient care. This has been a busy year for the
cancer registry and for the St. Anthony’s Memorial
Hospital Cancer Committee. Our Commission on
Cancer reaccreditation survey took place in October and
our hospital received eight commendations, the most
commendations a cancer program is able to achieve.
This took dedication and contributions from every
member of the Cancer Committee, and is an outstanding
demonstration of the professionalism our community has
come to expect.
SAMH BASIC STATS: In 2011, St. Anthony’s Memorial
Hospital entered 336 new cancer patients into the
database, twenty more than 2010. Out of these patients,
172 were males and 163 were females. The best data
comes from the 323 primary cancers that were either
diagnosed or treated at St. Anthony’s Memorial Hospital.
The most diagnosed primary site was breast cancer, for the
second year in a row, followed by lung and prostate cancer.
2011 Annual Report Site Table
Class of Case
Sex
AJCC Stage at DX (Analytic Cases Only)
Non
StageStageStage StageStageStageUnstg
Primary Site
Cases Analytic AnalyticM F 012 3488
Unk
Digestive System
Esophagus
Stomach
Small Intestine
Colon Excluding Rectum
Rectum & Rectosigmoid
Anus, Anal Canal & Anorectum
Pancreas
Peritoneum, Omentum & Meser
52 50 2 29 23 29914
1303
550500
0
0
0
3
0
2
220110
0
0
1
1
0
0
220020
0
0
2
0
0
0
29 28 1 17 12 268 7500
990630
2
1
3
3
0
0
100100
0
0
0
0
0
1
321030
1
0
0
1
0
0
110010
0
0
1
0
0
0
Respiratory System
Larynx
Lung & Bronchus
54 49 5 27 27 0133 6240 3
440220
1
1
1
1
0
0
50 45 5 25 25 0122 5230 3
Soft Tissue
330120
0
1
1
1
0
0
Skin Excluding Basal & Squamous (Melonoma)
14
140861
10
2
0
1
0
0
Breast
55
Female Genital System
Cervix Uteri
Corpus & Uterus (NOS)
Ovary
Vulva
17134 0170
10
0
2
0
0
1
220020
2
0
0
0
0
0
12 8 4 0 12 070 1000
220020
0
0
1
0
0
1
110010
1
0
0
0
0
0
Male Genital System
Prostate
Testis
47470470 0
11
29
4
1
0
2
46460460 0
10
29
4
1
0
2
110100
1
0
0
0
0
0
Urinary System
Urinary Bladder
Kidney & Renal Pelvis
4746 1 331416
18
33
303
3938 1 281116
14
31
202
880530
4
0
2
1
0
1
54
1
0
55
151610 9 2 0 2
Brain & Other Nervous System (Cranial Nerves)
440130
0
0
0
0
4
0
Endocrine System
Thyroid
Other Endocrine including Thymus
330120
1
0
0
1
1
0
220110
1
0
0
1
0
0
110010
0
0
0
0
1
0
Lymphoma
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
19 19 0 12 7 043 5403
220020
0
1
1
0
0
0
17 17 0 12 5 042 4403
Myeloma
660420
0
0
0
0
6
0
Leukemia
Lymphocytic Leukemia
Myeloid & Monocytic Leukemia
550320
0
0
0
0
5
0
110100
0
0
0
0
1
0
440220
0
0
0
0
4
0
Mesothelioma
110100
0
0
1
0
0
0
Miscellaneous
990630
0
0
0
0
9
0
TOTAL
336 323 13 173 163 349260 45502517
5
2011 CANCER INCIDENCE BY SITE & SEX
Analytic Cases
FEMALE
MALE
St. Anthony’s
St. Anthony’s
NationalMemorial
NationalMemorial
Hospital
Hospital
Breast
30% 34%
Lung & Bronchus
14%
15%
Colorectal
9%9%
Uterine corpus
6%
7%
Urinary Bladder
2%
7%
Melanoma of Skin
4%
4%
Non-Hodgkin Lymphoma4%
3%
Brain & CNS
1%
2%
Kidney & Renal Pelvis
3%
2%
3%2%
Pancreas
Prostate
29%27%
Lung & Bronchus
14%
15%
Colorectal
9%13%
Urinary Bladder
6%
16%
Melanoma of Skin
5%
5%
Kidney & Renal Pelvis
5%
3%
Non-Hodgkin Lymphoma4%
7%
Esophagus
2%3%
Leukemia
3%2%
1%2%
Myeloma
REFERENCE NOTE:
National figures are estimates and exclude basal and squamous cell skin cancers and in situ carcinomas except for the urinary
bladder. The predicted National incidence figures were taken from the “Cancer Statistics 2011”, published by the American Cancer Society. St. Anthony’s
Memorial Hospital figures represent analytic cases only (diagnosed and/or received at least part of their first course of therapy at our facility) during 2011.
County of Residence at Diagnosis
Top 5 Primary Sites
at SAMH
(Analytic Cases Only 2011 cases/SAMH)
#CASES:
6
55
46
40
39
38
Co
lo
rec
tal
50
50
Bl
ad
de
r
60
30
20
10
Pr
os
tat
e
Lu
ng
0
Br
ea
st
Effingham140
Fayette52
Clay34
Jasper38
Shelby17
Marion12
Cumberland12
Richland7
Crawford7
Wayne5
Coles3
Clark2
Bond2
Edwards2
Christian1
Lawrence1
Sangamon1
Percentage of Top Five Primary Sites
COUNTY: 2011 STATISTICS (ALL SITES)/SAMH
(analytic cases only)
AGE AT DIAGNOSIS
AGE:
Number of
Cancer Patients
% of
TOTAL
0-29 41.19%
30-39 72.08%
40-49 236.85%
50-59 6017.86%
Youngest
22
Oldest
95
60-69 8224.40%
70-79 9929.46%
80-89 5215.48%
90+ 92.68%
____________________
TOTAL336
STAGE AT DIAGNOSIS
STAGE
MaleFemale TOTAL
Stage 0 13
21
34
Stage 1 42
54
96
Stage 2 43
17
60
Stage 3 17
31
48
Stage 4 32
20
52
88
1511 26
99
119 20
_________________________________________
TOTAL 173163 336
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Cancer Program Practice Profile Reports (CP3R)
Best Practice Quality Guidelines
for Breast and Colon Cancers
Every year, our cancer registry submits data to the National Cancer Database (NCDB). This data is then analyzed for national statistics,
which can then be used for a variety of reports and publications, as well as treatment guidelines and survival statistics. St. Anthony’s Memorial
Hospital actively participates in this type of data collection and has recently received very favorable reports on compliance with national
treatment guidelines. The Commission on Cancer (CoC) encourages the use of these reports to monitor the quality of data being reported
and to monitor the use of national treatment guidelines. Due to the dedication of the Medical Staff and the Cancer Committee, SAMH with
Crossroads Cancer Center has 100% compliance with five of the applicable quality treatment guidelines. This is a much higher, and more
favorable, quality score than the State and National scores.
This graph shows how St. Anthony’s Memorial Hospital compares with all National CoC-approved cancer programs for each of the measured
quality performance rates.
100
80
St. Anthony’s
60
Illinois
CoC Programs
40
20
0
BCS/RT
MAC
BREAST
HT
ACT
12RLN
COLON
Figure 1
NATIONAL TREATMENT GUIDELINES:
BCS/RT: Radiation therapy is administered within one year of diagnosis for women under age 70 receiving breast-conserving surgery for
breast cancer.
8
MAC:C
ombination chemotherapy is considered or administered within four months of diagnosis for women under age 70 with AJCC
T1cN0M0, or Stage II or III, ERA and PRA negative breast cancer.
HT: Tamoxifen or third generation aromatase inhibitor is considered or administered within one year of diagnosis for women with
AJCC T1cN0M0, or Stage II or III ERA and/or PRA positive breast cancer.
ACT:
Adjuvant chemotherapy is considered or administered within four months of diagnosis for patients under the age of 80 with
AJCC Stage III colon cancer.
12RLN:
At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.
Primary Site – Prostate Cancer
Dr. P.D.L. (David) Nayak / Dr. Steven Jones
In addition to age, there are several other risk factors for prostate
cancer. Race is one important risk factor. Prostate cancer occurs
more commonly in African Americans than in Caucasians, and
occurs least often in Asians and Hispanics. Family history is also
important. Men with a close relative (particularly a brother)
with prostate cancer have a higher risk of getting prostate cancer
themselves. Diet appears to play a small role in prostate cancer—
men who eat more red meat and high-fat dairy products (and few
fruits and vegetables) have a slightly higher risk of prostate cancer.
Other risk factors include having a high level of male hormones
(e.g., testosterone), and some rare genetic mutations.
Unlike some other common cancers, there are usually no symptoms
in prostate cancer until late in the disease. Late symptoms may
include impotence, blood in the urine, incontinence, or bone pain
(from metastases).
The American Cancer Society recommends that men at age 50
(or age 40-45 if there are higher-than-average risk factors) discuss
prostate screening with their physicians, so that the men can make
informed decisions about prostate screening. Screening usually
involves a digital rectal exam (“DRE”, which involves using a finger
to feel the back of the prostate where most cancers arise) and blood
testing for Prostate Specific Antigen (“PSA”) which is often elevated
in patients with prostate cancer or other prostate disorders. The
diagnosis of prostate cancer is most commonly made with needle
biopsies.
The diagnosis and quality treatment of prostate cancer is available
at St. Anthony’s Memorial Hospital in conjunction with Effingham
Urology Associates and Crossroads Cancer Center. St. Anthony’s
Cancer Program offers PSA testing and prostate needle biopsy
performance and interpretation. Once a diagnosis is made, the
tumor is evaluated for its risk of progression (based upon the
stage, Gleason Score, and PSA level), and the urologist will discuss
treatment options with the patient. Treatments vary according
to the age of the patient, the aggressiveness of the tumor, patient
preferences, and other factors. These treatments may include
hormonal therapy (androgen deprivation), radiation therapy
[external beam radiation (offered at Crossroads Cancer Center) or
internal brachytherapy (radioactive “seeds” placed in the prostate;
performed elsewhere)], surgery (open, laparoscopic, or roboticassisted radical prostatectomy), and chemotherapy. For tumors that
appear to have a low risk for progression (such as early low-grade
cancers), active surveillance (“watchful waiting”) may also be an
option. The urologist will discuss these treatment options with each
patient so that the patient may decide which type of treatment is
best suited for them.
Treatment options need to be discussed with a patient’s physician,
because prostate cancers vary dramatically in their behavior. Many
cancers grow extremely slowly (“indolent” cases) and have very
little risk of causing death, even after many years. On the other
hand, other prostate cancers are very aggressive. The side-effects
of prostate cancer treatment also need to be discussed, because
treatments can have some serious side effects that significantly affect
a person’s way of life.
With regard to the overall performance of St. Anthony’s Cancer
Program, the National Cancer Data Base has compiled information
on Best Practice Quality Guidelines for Cancer Care (CP3R). St.
Anthony’s Memorial Hospital (SAMH) scored 100% in every
applicable quality measure for cancer treatment, which is a much
better score than State and National scores, and places St. Anthony’s
Memorial Hospital in the top 5% of the nation (see Figure 1).
The Cancer Committee recently completed a study on five-year
survival rates of prostate cancer patients diagnosed and/or treated at
St. Anthony’s Memorial Hospital (see Figure 2). The study focused
on patients with advanced cancer [American Joint Committee on
Cancer (AJCC) stages III-IV], because localized prostate cancers
often grow slowly, and patients with localized cancer who die within
five years often do so from causes other than their prostate cancer
(such as heart disease, motor vehicle accidents or strokes). The five-
5 Year Survival Rate - Prostate Cancer Patients
100
St. Anthony’s
80
% Survival Rate
Prostate carcinoma is by far the most
common non-skin carcinoma in men in the
United States, and approximately 240,000
new cases are diagnosed each year. One out
of six men will have prostate cancer at some
time in their lives, and about 28,000 men
in the United States die each year from the
disease. Prostate cancer is most commonly
found in men over the age of 50 and the
risk increases steeply with age. In fact, over
80% of all men who live to the age of 100
will have prostate cancer.
NCDB
60
40
20
0
3
4
AJCC Stage at Diagnosis
Figure 2
9
year survival rates for St. Anthony’s patients with stages III-IV prostate cancer (“advanced cancer”) are 96% and 47%, respectively. Although
these survival rates are slightly better than national averages, for all practical purposes the numbers are statistically very similar given the small
number of patients involved in the study.
In addition, the Cancer Registrar analyzed data regarding the stage at which patients are diagnosed with prostate cancer at SAMH (see Figure
3). The analysis showed that 85% of our patients were diagnosed when their cancer was still considered relatively “early” (localized, stages I-II),
which is higher than the national average (80%), and even higher than the Illinois state average (76%). This means that prostate cancers were
diagnosed earlier at SAMH than the state or national averages.
In summary, the Cancer Committee’s prostate cancer studies have
shown that St. Anthony’s Memorial Hospital Cancer Program
continues to offer NCCN-based quality treatments to all prostate
cancer patients. In particular, our hospital scored in the top 5% of
the nation on the National Cancer Data Base Best Practice Quality
Guidelines (CP3R).
5 Year Survival Rate - Breast Cancer Patients
(All Causes of Death)
80
% of Total Prostate Cancer Patients
The Cancer Committee also did a quality study to determine if our
patients with prostate cancer were receiving adequate treatment. A
total of 46 prostate cancers were diagnosed or treated at SAMH in
2011. Of these cases, 29 AJCC Stage II cases were compared against
the National Comprehensive Cancer Network (NCCN) guidelines.
The study showed that 100% of Stage II prostate cancer patients
diagnosed or treated at SAMH did indeed receive the treatment
appropriate to their particular case. The treatments included
biopsy followed by prostatectomy (25 patients), biopsy followed by
prostatectomy and hormone therapy (2 patients), and transurethral
resection followed by hormone therapy alone (1 patient).
70
St. Anthony’s
60
Illinois
NCDB
50
40
30
20
10
0
1
2
3
AJCC Stage at Diagnosis
St. Anthony’s is always striving to diagnose cancer at the earliest
possible stages. As such, our Cancer Program will continue to
emphasize the importance of appropriate prostate cancer screening,
to offer quality PSA testing and biopsy options, to make available state-of-the-art surgical care, and to provide the best quality
medical and radiation oncological treatments.
Observed survival rates (death may be due to causes other than patient’s cancer, such as age and/or co-morbidities.)
National Cancer Database Report 5-year observed survival rates are quoted per latest available data (1/11); Filters for observed survival of colon cancer from 1318
national programs and 73 state programs.
Commission on Cancer, American College of Surgeons, NCDB Reports, Chicago, Il, 2011. The contents reproduced from the applications remains the full and
exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works
based on the original Text, Tables, or Figures.
10
4
Figure 3
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503 North Maple Street
Effingham, Illinois 62401
217-342-2121
www.stanthonyshospital.org