The Cancer Center of Chester County Annual Report 2006 With statistical data from 2005

Transcription

1 06 The Cancer Center of Chester County Annual Report 2006 With statistical data from 2005

2 2005 Statistical Report Community Screenings Screening Participants Normal Results Referred for Follow-up Colon Breast Oral Skin Prostate Top 5 New Cancer Sites : 2005 In 2005, CCH saw a decrease of 1.8% in new breast cancer cases, as compared to their 2004 data. For their colorectal, lung & prostate cases there was a modest increase of 0.9%. Incidence for bladder cases, at 5.5%, remained the same. Therefore, when making the comparison with state statistics as published by the Commonwealth of PA, and with national statistics, as published by the American Cancer Society, it should be noted that: CCH has a lower incidence rate for new colorectal, lung & prostate cases CCH has a higher incidence for new Breast & Bladder cases Primary Site Prostate Lung USA PA CCH Colorectal Breast Bladder The Cancer Center of Chester County Annual Report 20061

3 New Cancer Cases at The Chester County Hospital : 2005 SITE SUB-SITE COUNT SITE SUB-SITE COUNT Oral Cavity & Pharynx 16 Male Genital 99 Lip 1 Prostate 91 Tongue 4 Testis 8 Salivary Glands 2 Urinary System 70 Gum & Mouth 1 Bladder 45 Nasopharynx 2 Kidney & Renal pelvis 24 Tonsil 6 Ureter 1 Digestive System 130 Eye & Orbit 1 Esophagus 11 Central Nervous System 11 Stomach 13 Brain 9 Small Intestine 5 Cranial Nerves or Other CNS 2 Large Intestine 2 Endocrine System 31 Colon 56 Thyroid 30 Rectosigmoid 7 Other Endocrine (including Thymus) 1 Rectum 7 Lymphoma 39 Anus, anal canal 1 Hodgkin 4 Liver 4 Non-Hodgkin (nodal) 19 Gallbladder 4 Non-Hodgin (extranodal) 16 Other Biliary 4 Myeloma 12 Pancreas 14 Leukemia 22 Retroperitoneum 1 Lymphocytic 14 Peritoneum, mesentery, omentum 1 myeloid & moncytic 7 Respiratory System 95 other 1 Nasal cavity, middle ear 2 Mesothelioma 3 Larynx 6 Kaposi Sarcoma 1 Lung & Bronchus 87 All other 49 Soft tissue (including heart) 5 Skin (excluding basal & squamous) 22 melanoma 18 other non-epithelial skin 4 Top 5 sites at CCH for 2005 Breast 175 Female Genital 41 Cervix 4 The most common sites for new analytic cases at Uterus 17 The Chester County Hospital were: colon, lung, prostate, bladder and breast. This matches both state (PCR) and Ovary 12 national (NCDB) trends Vulva 8 The Cancer Center of Chester County Annual Report 20062

4 The Cancer Center of Chester County Colon Study Review Dennis Berman, M.D. Medical Director, The Cancer Center of Chester County and Chairman, Cancer Committee, The Chester County Hospital The Chester County Hospital data for outcomes in colon cancer mirror national results for survival in early stage disease. The stage 3 patients at CCH appear to do somewhat better at 50 months national results are less than 50% survival and our hospital is 75% suggesting perhaps a benefit to adjuvant chemotherapy, which we offer to all our patients with stage 3 disease. It is disappointing that patients still present with stage 4 disease, which shows the Cancer Center Program at CCH needs to continue our education to encourage screening colonoscopy in all patients over the age of 50. Analytic Colon Cancer Cases at CCH Age & Stage at Diagnosis 2000 vs 2005 AJCC Stage at Diagnosis (%) 0 I II III IV Unknown Age Totals The primary risk factor for colon cancer is age, with more than 90% of cases diagnosed being in patients that are age 50 or older. This statement is proven true for the colon patients at The Chester County Hospital with 94.6% of newly diagnosed colon CA patients being over the age of 50 in 2000 and 96.6% over the age of 50 in The Cancer Center of Chester County Annual Report 20063

5 Stage III Colon Cancers Cases Receiving Chemo 1998 to 2003 Comparison CCH to Other Hospital Types Proportion of Cases Receiving ACT: The following is a comparison of Chester County Hospital s Stage III Colon Cancer cases with other Hospitals in Pennsylvania, American Cancer Society (ACS) Division, CoC Comprehensive Community Hospital Category and all CoC Hospitals. CP3R Release Baseline (Jan 2005) Reconciliation (Sept 2006) Hospital Cases % ACT Hospital Cases % ACT 95% CI The Chester County Hospital My State My ACS Division My Category All CoC Programs (wt) (wt) The above table demonstrates that: The Chester County Hospital had 59 cases of Stage III colon cancer between 1998 and 2002 and 86.1% of those cases were treated with Adjuvant Chemotherapy (ACT) following their resection, as stated in the National Comprehensive Cancer Network (NCCN) recommended guidelines. The Chester County Hospital had 75 cases of Stage III colon CA between 1998 and 2003 and 84.7% of those cases were treated with ACT following their resection. The Chester County Hospital has a higher concordance rate than the other hospitals they were compared to for both timeframes. The Cancer Center of Chester County Annual Report 20064

6 Weighted Proportion of Stage III Colon Cancers Receiving Surgery & ACT: CoC-Approved Programs in My State The Chester County Hospital, West Chester PA This graph demonstrates that: The Chester County Hospital (illustrated in red) has a higher concordance than most of the other 73 CoC approved hospitals in the state. The black line appearing in the chart shows the specific value of the weighted proportion of patients receiving Surgery & ACT for each cancer program in the state. The upper and lower bounds of the blue/red bar(s) represent the 95% confidence intervals (95%CI) for each of the computed weighted proportions. These CIs may be narrow or broad, depending upon the number of cases assessed from each cancer program. The precise values of the 95%CI are displayed in the previous table. The computation of the 95%CI is outlined in the Measures, Methods, Data and Evaluation document. The green line is the Concordance Indicator and represents those cancer programs ranked in the top 25% of hospitals providing care according to standard of care guidelines. This line has shifted upward from 79.3% to 87.6% as a result of data reconciliation conducted by CoC approved programs since the initial release of these reports. With each quarterly release update, fluctuations in the Concordance Indicator Line can be expected. Percent of Cases Receiving ACT by Diagnosis Year Stage III Colon Cancers by First Course Therapy The Chester County Hospital, West Chester PA This chart demonstrates that: The proportion of Stage III colon cases that received Surgery & ACT (illustrated in green) after data reconciliation by cancer programs, compared to the proportion receiving other specified treatment (illustrated in blue) in each of the six diagnosis years between 1998 and Note: Other specific treatment includes surgery only and no surgery with palliative care only. The Cancer Center of Chester County Annual Report 20065

7 Number of Cases by Year & Initial Treatment The Chester County Hospital : 1998 to 2003 Reported Colon Cancers by Year and First Course Therapy Dx Year CASES STAGE III CASES FIRST COURSE THERAPY Surgery & ACT Other Specified Rx % % % % % % % % % % % 1 7.7% % % 1 9.1% % % % This table illustrates the number of primary colon cancers reported to the National Cancer Database by The Cancer Data Center at The Chester County Hospital for the diagnosis years 1998 through The first column shows the diagnosis year. The second column shows the number of primary colon cancer cases reported for that diagnosis year. The third and fourth columns show, for each year, the number and percent of reported colon cancers that were determined to have been Stage III cases. The next set of columns shows the number and percent of Stage III cases by the type of first course treatment provided Surgery & ACT or Other Specified Treatment. The percent values shown in each of the treatment modality columns correspond to the values shown on the preceding chart. The above table demonstrates that in: 1998 there were 51 colon cancer cases reported, 20 cases (or 39.2%) were Stage III. Of those 20 cases, 7 (or 35%) were treated with Surgery and ACT and 13 (or 65%) were treated with other treatment modalities there were 24 colon cancer cases reported; 6 cases (or 25%) were Stage III. Of those 6 cases, 5 (or 83.3%) were treated with Surgery and ACT and 1 (or 16.7%) were treated with Other treatment modalities there were 36 colon cancer cases reported; 9 cases (or 25%) were Stage III. Of those 9 cases, 8 (or 88.9%) were treated with Surgery and ACT and 1 (or 11.1%) were treated with Other treatment modalities there were 44 colon cancer cases reported; 13 cases (or 29.5%) were Stage III. Of those 13 cases, 12 (or 92.3%) were treated with Surgery and ACT and 1 (or 7.7%) were treated with Other treatment modalities there were 44 colon cancer cases reported; 11 cases (or 25%) were Stage III. Of those 11 cases, 10 (or 90.9%) were treated with Surgery and ACT and 1 (or 9.1%) were treated with Other treatment modalities there were 50 colon cancer cases reported; 16 cases (or 32%) were Stage III. Of those 16 cases, 13 (or 81.3%) were treated with Surgery and ACT and 3 (or 18.8%) were treated with other treatment modalities. The Cancer Center of Chester County Annual Report 20066

8 Initial Treatment by AJCC Stage Analytic Colon CA Cases for 2005 N/A for AJCC Initial Treatment by AJCC Stage Analytic Colon Cancer Cases for 2005 AJCC Stage IV II Radiation Chemo Surgery & Chemo Surgery None Percent of Cases For resectable colon cancer, the NCCN Clinical Practice Guidelines in Oncology endorse colectomy with en bloc removal of regional lymph nodes. At CCH, 81% of new colon cancer cases had a colectomy and LN dissection performed. Adjuvant Chemotherapy should be considered for AJCC Stage IIA patients with no high risk features and should be administered for Stage IIA high risk, as well as, Stage IIB and Stage III patients. Stage IV patients should have neo-adjuvant chemotherapy then resection, if deemed possible, followed by adjuvant chemotherapy. For Stage IV patients that do not convert to resectable, following neo-adjuvant chemotherapy, then chemotherapy should be switched to therapy for advanced metastatic disease. Please make note of the following for the information shown above: Stage II patients that had surgery only: Chemotherapy was either contraindicated due to comorbid conditions or patient refused Stage II patients with no treatment: No treatment was performed due to comorbid conditions Stage III patients with no treatment: Patients received no treatment due to comorbid conditions Stage III patients with surgery only: Chemotherapy was contraindicated due to comorbid conditions Stage IV patients with surgery only: Chemotherapy was refused or contraindicated due to comorbid conditions Stage IV patients with Radiation Therapy only: Patient refused surgery and chemotherapy Stage IV patient with Chemotherapy only: Surgery was contraindicated The Cancer Center of Chester County Annual Report 20067

9 Cancer Data Center Report The Cancer Data Center is the component of the Cancer Program that is designed to coordinate the collection, research, management, analysis and dissemination of the cancer information at The Chester County Hospital. The data center is the hub for the Commission on Cancer (CoC) approved Cancer Program and plays an integral role for providing a multitude of services and support. All cancer patients diagnosed and/or treated at CCH are entered into the database. The data collected includes patient demographics, medical history, diagnostic findings, cancer treatment, and lifetime follow-up. Data is submitted to the National Cancer Database (NCDB) and the Pennsylvania Cancer Registry (PCR), thus allowing comparative analysis with other hospitals across the nation and state. The Cancer Data Center database is a vital tool used for programmatic and administrative planning, as well as the monitoring of patient outcomes. Statistical reports are generated to analyze referral patterns, patient s survival rates and for educational conferences, journal articles, incidence occurrence, quality audits and process improvement studies. The cancer data center responded to 57 information requests in The reference date for the cancer database at CCH is January 1, There are 15,318 total patients in our database. In 2005, 865 new cases were accessioned, 821 analytic and 44 non-analytic. Annual lifetime follow-up of the patients is conducted, according to the Commission on Cancer guidelines. Currently, the data center is following 5637 patients, with a follow-up rate of 97.4 percent for our living patients since our reference year of For the five year reference date we are following 2776 living patients, with a follow-up rate of 98.3 percent. Both percents of follow-up are above the required rate for the CoC approved cancer program standards. To assure the continued collection and release of high quality data, the Cancer Program Coordinator conducts monthly and quarterly quality reviews; the physician members of the Cancer Committee perform a minimum of a ten-percent quality control case audit annually; and the Cancer Data Center software has built in edits for data entry. The staff of the Cancer Data Center continues to encourage a high level of care for our cancer patients. The certified staff member(s) continue to maintain their certification, while the new cancer data abstractors attend fundamental training courses; all Cancer Data Center staff attend continuing educational conferences; and assist the members of the Cancer Program at CCH with maintaining the three-year approval from the Commission on Cancer of the American College of Surgeons. The Cancer Center of Chester County Annual Report 20068

10 Reports Done by Cancer Data Center at CCH for Cancer Committee 2005 Bladder CA - Analytic Cases 2000 and 2005 Service Area Subsite & Histology Comparison by AJCC Stage 2000 and 2005 cases Comparison Initial Treatment 2000 and 2005 cases Five Year Survival Stage 3 Colon CA Cases (CP3R) Review & Comparative Studies Survival Graphs 2005 Statistical Report Patient Care Studies and Enhancements Analytic Breast Cancer Cases at The Chester County Hospital 2001 and 2005 Clinical History vs Final Diagnosis Correlation for Pathology Enhancing the Educational Venues and Availability for Oncology Nursing Staff Frozen Section Consultation Correlation Review Immunohistochemistry Appropriateness Implementation of a Breast Cancer Nurse Navigator Improvement for Surgical Specimen Processing Long Term Colon Cancer Treatment Trends and Survival Outside Case Correlation Study for Surgical Pathology Proficiency Testing: CAP Survey Reference Lab Reporting Accuracy for ER, PR and HER-2neu Short Term Colon Cancer Diagnosis and Treatment Surgical Pathology Case Turn Around Time Updated Hospital Website to Include an Oncology Link The Chester County Hospital is approved by the Commission on Cancer of the American College of Surgeons and is a member of the University of Pennsylvania Cancer Network. The Cancer Committee 2006 Dennis Berman, M.D., Chairman Medical Oncology Michael McGuire, M.D. Family Medicine David Bobman, M.D. Gastroenterology Dianne Hotmer, M.D. Gynecology Richard Donze, D.O. Medical Affairs/Hospital Administration Calvin Lu, M.D. Medical Oncology Michael Picariello, M.D. Otolaryngology Michael Ward, M.D. Otolaryngology Scott Saul, M.D. Pathology Michael Stefan, M.D. Plastic and Reconstructive Surgery Ann Marie Siegal, M.D. Radiation Oncology Richard Yelovich, M.D. Radiation Oncology William Barry, M.D. Radiology George Trajtenberg, M.D. Surgery Pamela Scott, M.D. Surgery and Commission on Cancer Liaison Kenneth Collins, M.D. Urology Jeanne M. Rogers, RN, Med Abramson Cancer Center of the University of Pennsylvania Nona Blauvelt, RN, MSN,OCN Cancer Center Administrator Angela Matthews Cancer Data Center Secretary Cathy Scallon, RN, MSN, CS Cancer Outreach Nurse Kim Killgore, CTR Cancer Program/IRB Coordinator Eva Smith, RN, BSN Clinicial Leader, West Wing 2 Julie Funk, MS, RD, CDE Community Outreach and Wellness Director Cathy Weidman, RN, MSN Director of Medical/Surgical Nursing Heidi Owen, RN Hospice/Home Care Renee O'Donnell Nutrition Services Blanche Reiner, RN, OCN Oncology Clinical Research Nurse Regina Cohen,PA Pathology Karen Novielli, BSC, MBA Pharmacy Director Colleen Leyden Public Relations Mary Blanco, RN, BSN Quality Management Marge Lang, MSS Social Service THE CHESTER COUNTY HOSPITAL 701 East Marshall Street West Chester, Pennsylvania cchosp.com A service of The Chester County Hospital and the Abramson Cancer Center of the University of Pennsylvania 9 BEYOND GOOD CARE TM The Cancer Center of Chester County Annual Report 2006