Including 2012 Cancer Registry Statistical Review American College of Surgeons

Cancer Program Annual Report 2014

Including 2013 Cancer Registry Statistical Review

Cancer Center Annual Report 2014

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114 Woodland Street Hartford, Connecticut 06105 860-714-4000 www.saintfranciscare.com

Please visit our Cancer Center website for detailed information about our physicians programs, services and activities.

Cancer Center Website http://saintfranciscare.org/CancerCenter.aspx

Cancer Center Annual Report 2014

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Message from the Medical Director

Saint Francis Care’s (SFC) Cancer Center structure is designed to create high performing clinical and financial programs, encourage physician involvement and deliver value for the populations we serveThe SFC Oncology Service Line, has been transformed around the unique, multidisciplinary nature of oncology care. This new approach is illustrated in the SFC OSL Advisory Council/Cancer Committee. The former cancer committee was expanded and restructured to include representatives of different treatment modalities (surgery, radiation oncology, and medical oncology), support services contributing to patient care (social work, integrative medicine, nutrition, pastoral care and rehabilitation medicine), inpatient and outpatient care sites, and community outreach . The council is charged with administrative oversight, development of new programs, and overall review of cancer care at SFC and its affiliates in accordance with the Commission on Cancer (CoC) requirements for cancer program accreditation. The Advisory Council/Cancer Committee also reports to the SFC Medical Staff’s Medical Executive Committee (MEC) to inform physician leadership and engagement throughout the organization. Examples of the issues addressed by this governing body are below: • • • • • •

the scope of present and potential new cancer services being provided efficient and patient friendly systems for providing multidisciplinary care utilization of services by the Disease Management Programs (DMTs) strategic planning for the future of cancer care academic activities and relationships of the cancer program compliance with established quality measures.

The Cancer Committee meets the first Friday of every month (10 times per year) at 7:30 a.m. and reports to the Medical Education Committee at Saint Francis Hospital and Medical Center.

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Cancer Committee- 2014 Membership Physician Representation Representative Radiology Dr. Anthony Posteraro Pathology Dr. Frank Bauer Radiation Oncology Dr. Joseph Colasanto Medical Oncology Dr. Zia Rahman/Dr. Jonathan Sporn Surgical Oncology Dr. Richard Newman/Dr. Philip Roland Coordinators of Programmatic Activity Cancer Case Conference Coordinator Dr. Alessia Donadio Cancer Registry Coordinator Dr. Philip Roland/Jen Bolduc, CTR Cancer Committee Chair Dr. Jonathan Sporn Cancer Liaison Physician Dr. Philip Roland Cancer Quality Coordinator Melissa Arsenault, RN Community Outreach Dr. Marcus McKinney Cancer Clinical Research Coordinator Dr. James Vredenburgh Administration Representation OSL Executive Dir. Kathleen Noone, RN Oncology Nursing Leadership Melissa Arsenault, RN/ Heidi Cutter, RN Oncology Educator Devon Bandouveres, RN Genetic Counseling Sarah Carroll, CGC Social Worker Patricia Verde, LCSW Surgical Service Line Patricia Jagoe American Cancer Society Juana Adams/Debra Swiderski Accreditation Coordinator Judy Feret/Kathy Noone Palliative Care Dr. Elisa Gil-Pires or Designee Rehabilitation Medicine Carley Hauser, MS, CCC-SLP Supplementary Support Services Representation Nutrition Allison Laudati, RD, CD-N Pharmacy/Research Pharmacist Regina Silk, PharmD Pastoral Care Suzanne Nolan/Designee Integrative Medicine Sharon O’Brien or Designee Disease Management Team Representation Breast Team Dr. Kristen Zarfos Colo-Rectal Surgery /Surgical Oncology Team Dr. Amanda Ayers GYN-Onc Team Dr. Philip Roland Business Planning Representation Financial Services Officer Kaitlin DeVries Business Planning Christopher Hartley

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Tumor Registry Data Jen Bolduc, BS, CTR The Connecticut Tumor Registry is a population-based data set used to identify cancer patterns in the state. The registry's data base includes all reported cancers diagnosed in Connecticut residents since 1935. In addition to diagnosis, the registry tracks follow-up visits, treatment and survival for reported cases. All hospitals and private pathology laboratories in Connecticut are required by law to report cancer cases to the registry. The CT registry is one of five statewide designated surveillance, epidemiology and end results (SEER) databases in the country. SFC was the first in the state to collaborate with the Connecticut State Registry to implement AIM ePath® software for the electronic identification and transmission of all abnormal pathology cases. SFC’s registry readily meets state and accreditation requirements and has expanded over time into a significant population based registry that includes national benchmarks and meaningful patient outcomes. This data can also be used to conduct unbiased population studies. The SFC registry team of 5 certified tumor registrars interfaces directly with the multidisciplinary disease programs. This collaboration between care givers and data collectors facilitates timely data abstraction, ensures quality data collection and assists each disease management program in the development of disease specific and patient focused metrics. As outlined in the quality process section, this data helps identify and prioritize process improvement activities within the service line. A strict quality assurance and data validation process is followed to maintain the validity of the registry data. The process utilizes 2 methods of validation: 1. SFC data base is subject to an annual review by the National Cancer Data Base (NCDB) 2. Internal QA physician review is performed on a percentage of cases. Both reviews have consistently demonstrated high compliance rates validating the data integrity and abstracting methodology. 2014 Quality Assurance Analysis and Outcomes-Tumor Registry Data Time Period: January 1 – December 31, 2013 Class of Case: Analytic Physician, Registry Data Quality Review: 170 Cases have been randomly selected for data quality review. This number was selected based on 2012 analytic case count. Actual requirement of 151cases (10%) for 2013 have been identified by primary site (top 5) and Registrar request for physician input and recommendations. Dr. Roland and Nicole McDermott have organized the review process. 

Breast - 20

Cancer Center Annual Report 2014

(18/20)

90% accuracy

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          

Lung - 12 Cases GyN – 20 cases Prostate 15 cases Heme/lymph – 15 cases Gastric – 15 cases Pancreas – 10 Bladder – 10 Unknown primaries: 10 Prostate: 15 cases reviewed Colon: 6 cases reviewed Bladder - 10 cases reviewed Total 158 Cases Reviewed

(11/12) (19/20) (15/15) (15/15) (14/15) (9/10) (9/10) (9/10) (15/15) (6/6) 9/10)

92% accuracy 95% accuracy 100% accuracy 100% accuracy 93% accuracy 90% accuracy 90% accuracy 90% accuracy 100% accuracy 100% accuracy 90% accuracy

Table 1 Tumor Site Distribution 2013 Primary Site

Stg I

ORAL CAVITY & PHARYNX

Stg 0 0

3

Stg II 2

Stg III 5

Stg IV 9

Lip

0

0

0

0

0

1

Tongue

0

1

1

1

2

6

Salivary Glands

0

1

0

0

0

2

Floor of Mouth

0

0

0

0

1

1

Gum & Other Mouth

0

1

0

0

0

1

Nasopharynx

0

0

0

3

1

4

Tonsil

0

0

0

0

3

4

Oropharynx

0

0

0

0

1

1

Hypopharynx

0

0

1

1

1

3

DIGESTIVE SYSTEM

8

49

54

63

81

281

Esophagus

0

2

4

3

4

14

Stomach

0

8

5

9

9

38

Small Intestine

0

3

4

6

2

16

Colon Excluding Rectum

2

19

23

16

26

88

Rectum & Rectosigmoid

3

10

8

17

6

45

Anus, Anal Canal & Anorectum

2

0

0

3

2

7

Liver & Intrahepatic Bile Duct

0

4

1

1

3

16

Gallbladder

1

0

0

2

1

5

Other Biliary

0

1

4

1

3

11

Pancreas

0

2

5

3

25

37

Retroperitoneum

0

0

0

1

0

1

Peritoneum, Omentum & Mesentery

0

0

0

2

0

2

RESPIRATORY SYSTEM

6

54

32

50

97

244

Nose, Nasal Cavity & Middle Ear

0

1

1

1

1

6

Larynx

3

5

0

0

2

11

Lung & Bronchus

3

48

31

49

94

227

BONES & JOINTS

0

1

0

0

0

1

SOFT TISSUE

0

3

2

3

1

12

SKIN EXCLUDING BASAL & SQUAMOUS

5

9

4

3

7

32

Cancer Center Annual Report 2014

Total (%) 23

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BREAST

56

133

67

26

11

296

FEMALE GENITAL SYSTEM

1

97

7

15

18

142

Cervix Uteri

0

9

2

1

4

16

Corpus & Uterus, NOS

0

68

3

3

5

82

Ovary

0

9

2

10

6

27

Vagina

0

2

0

0

0

2

Vulva

1

8

0

1

2

12

Other Female Genital Organs

0

1

0

0

1

3

MALE GENITAL SYSTEM

0

18

64

16

10

111

Prostate

0

13

62

15

10

103

Testis

0

4

2

0

0

6

Penis

0

1

0

1

0

2

URINARY SYSTEM

36

22

11

8

12

100

Urinary Bladder

32

5

9

2

5

59

Kidney & Renal Pelvis

2

15

1

6

7

36

Ureter

2

1

1

0

0

4

Other Urinary Organs

0

1

0

0

0

1

BRAIN & OTHER NERVOUS SYSTEM

0

0

0

0

0

46

ENDOCRINE SYSTEM

0

16

6

13

1

50

LYMPHOMA

0

10

12

5

31

63

Hodgkin Lymphoma

0

0

1

1

3

5

Non-Hodgkin Lymphoma

0

10

11

4

28

58

MYELOMA

0

0

0

0

0

26

LEUKEMIA

0

0

0

0

0

38

MESOTHELIOMA

0

0

0

1

1

4

MISCELLANEOUS

0

0

0

0

0

Total

112

415

261

208

279

41 1,510

Tumor Boards/ Case Conference Dr. Alessia Donadio- Case Conference Coordinator Tumor Board conferences are a key component of the Cancer Program and integral to patient management at Saint Francis. They provide a valued forum for education, consultation and collaboration. Disease Management Teams present cases for diagnostic assessment while referencing national treatment guidelines, clinical research protocols and other relevant literature for treatment to obtain the best clinical outcomes for our patients.

The committee approved the Tumor Boards/Case Conference schedule for 2014 at the February 2014 Cancer Committee meeting. Cancer Committee approved type, frequency, and required multidisciplinary attendance, total case presentation and prospective case presentation.

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Goal: was established that 15% of analytical cases will be presented at case conferences annually, and 80% will be presented prospectively. Outcome: careful analysis of case conference activity indicates established goal was achieved. 2014 analytical cases= approximately 1360 Total # presented in case conference = 559 % of analytic case presentations= 41% # of cases offered prospectively= 545

% offered prospectively = 97%

List of Tumor Boards and Schedules: which were approved in Feb. 2014 • • • • • • •

General Tumor Board: 10X/ year GYN Tumor Board: Weekly Breast Conference: Weekly GI Tumor Board: 9X/ Year Uro Onc Tumor Board: 6X/ year Heme Malignancies Tumor Board: 4X/ year Radiology/ Oncology: 9X/ year

Annual Education- Oncology Symposium Ms. Devon Bandouveres, RN, MSN, OCN, Clinical Educator, Oncology Service line

Current Trends in Prostate Cancer Symposium October, 2014, Presented at Saint Francis Hospital and Medical Center

Objectives of Program 1. The participant will be able to describe the current recommendations for prostate cancer screening. 2. The participant will be able to describe the current surgical approaches to prostate cancer. 3. The participant will be able to identify current AJCC staging criteria for prostate cancer. 4. The participant will be able to describe different radiation techniques for prostate cancer treatment for early and advanced stage prostate cancer. 5. The participant will be able to describe available resources to patients as they navigate the complex care continuum of prostate cancer treatment 6. The participant will be able to describe current recommendations for bone health monitoring and prevention in prostate cancer patients 7. The participant will be able to identify the indications for appropriateness of genetic counseling and testing in prostate cancer. 8. The participant will be able to describe current areas of research focus in prostate cancer clinical trials. 9. The participant will be able to identify the long-term needs of the prostate cancer survivor.

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Prostate specialists in the field of medical oncology, surgical oncology, radiation, genetics, survivorship, and research spoke about the current trends, recommendations, and advancements in breast cancer. Prognostic indicators and evidence-based national treatment guidelines (including AJCC and NCCN) were reviewed. 5.5 CME credits were offered to Saint Francis Hospital and community health care providers. Over 40 health care providers attended the symposium including, physical therapists, pharmacists, genetic counselors, nurses, mid-levels, and physicians.

Community Outreach The SFC OSL has several programs and services designed to assist cancer patients and their families during their journey with cancer. A sample of those services is outlined below: Behavioral Health Service Line (BHSL) – The OSL works collaboratively with the BHSL to risk stratify and triage patients who are struggling beyond the normal emotional burden of the oncology diagnosis. The population includes patients who may have an underlying psychological disorder, patients who are despondent and displaying signs and symptoms of clinical depression, and/or patients with self-image conflicts related to their cancer treatments. Initial risk stratification is performed by the clinical team and referred to the social worker. The social worker works to further identify patient’s needs and assists them in the referral process to secure additional counseling. Integrative Medicine – SFC believes integrative medicine is an important service for oncology patients. Integrative Medicine provides an extensive list of services, enhancing the clinical team’s approach to a holistic cancer care. Examples of supportive services include pet therapy, art therapy, chair massages, acupuncture, energy therapy, hypnosis and full body massages. Services are provided in the Cancer Center, CBHC, and on our inpatient oncology unit or can be scheduled at the patients’ convenience. Pastoral Care – As a mission driven organization SFC provides care with respect to the spirituality of each patient. SFC provides access through a vibrant staff of professional chaplains in the Department of Pastoral Care. Oncology patients and loved ones can receive spiritual and pastoral care for all beliefs and faith traditions any time during their hospital stay or when visiting the Cancer Center. We also have a chapel and dedicated space for meditation. Additional Services – The following services are also available to oncology patients. • Nutrition Services • Palliative Care services- see section on Palliative Care • Hospice Services • American Cancer Society- to facilitate access to community resources and support services • CT Brain Tumor Alliance • Leukemia and Lymphoma Society Social Workers – A dedicated team of social workers supports our oncology patients and families. They are located in several key locations across our treatment entities. Our dedicated teams of social workers are also the facilitators for support groups offered by our disease management programs. Cancer Center Annual Report 2014

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Some of the support groups SFC hosts include Breast Cancer Support Group, Prostate Cancer Support Group, Head and Neck Cancers Support Group, Gynecologic Cancer(s) Support Group, and Gynecologic Cancer(s) Spouse Support Group. Our social workers also serve as a resource to assist with practical issues, such as insurance coverage, finding community resources and assisting with financial need and barriers to care. Sources of support in the community facilitated by our Social Work staff •

www.cancercare.org Educational and emotional support in person, by phone or internet

•

Cancer Hope Network One-to-One and online support from volunteers who have had cancer

•

Gilda's Club Support for anyone living with cancer

•

LiveStrong (Lance Armstrong) Support and advocacy for people with cancer

•

Malecare, Inc Support for men with cancer

•

Caring Connections Information and support for people planning ahead, caring for a loved one, living with an illness, or grieving a loss

•

Patient Advocate Foundation Solving insurance and healthcare access problems

References: National Cancer Institute – web-site National Cancer Database (NCDB) SEER – Web-site American Cancer Society Facts and Figures St. Francis Hospital – web-site St. Francis Cancer Registry

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