ONCOLOGY PROGRAM ANNUAL REPORT

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1 2010 ONCOLOGY PROGRAM ANNUAL REPORT

2 2010 Oncology Program Annual Report & Statistical Review Table of Contents Pages Chairman s Report Oncology Committee Members Pancreatic Study Cancer Registry Report Pediatric Oncology Report Adult Oncology Report- Sierra Medical Center Adult Oncology Report- Providence Memorial Hospital Hospice Report Continuing Medical Education Report La Mariposa Hospice and Oncology Volunteer Services North Oregon El Paso, Texas Published January 2010 by the Sierra Providence Health Network Oncology Committee Breast Cancer Navigator Pathology Dietary Rehabilitation Report Total Care Prevention and Early Detection Program Surgery Gamma Knife Providence Memorial Hospital Oncology Department Annual

3 2010 Chairman s Report has been a productive year for the Sierra Providence Health Network Cancer Program. This has been in part to the hard work of the entire Cancer Committee, however there are a few key members that we would like to recognize for their hard work and commitment throughout Dr. Raul Portillo, our prior Chairman, provides the Committee with leadership, innovative ideas, and has been a mentor to me throughout this year. Dr. Gerard Crecca who serves as the Cancer Liaison Physician. He serves as the Liaison between the American College of Surgeons, ACoS, and our Cancer Program. His dedication and hard work keeps our Program informed on changes and requirements from ACoS. Dr. Harry Wilson, Pathologist, has helped establish a relationship between The University of Texas at El Paso Research Program and our Network. His due diligence and persistence has helped bridge the gap between our facilities and UTEP and has helped form a new partnership to further education and research. Among the top priorities for 2010 has been the application from the Children s Hospital at Providence to the Children s Oncology Group, COG. This process has enabled the Children s Hospital and the Oncology Services provided through our facilities, to provide the latest and most complete treatment to our pediatric patients. We will continue to strive to meet the needs of our pediatric population and look forward to continuing to gain membership into the Children s Oncology Group. The Children s Hospital at Providence has also established a coalition of not for profit organizations in El Paso to provide support services for the children who are diagnosed with cancer and for the children of adult survivors of cancer. The Providence Adult Oncology Infusion Center has increased capacity to 14 chairs to better provide treatment and care for our Oncology Patients. The Infusion Center provides services 7 days a week to include holidays. Our Outreach Programs have also expanded in A free screening of over 400 men was held in 2010 and included not only Sierra Medical Center and Providence Memorial Hospital, but also included the Sierra Providence East Medical Center. Sierra Providence Health Network, SPHN, also launched Breast Cancer Aware, a Wellness Program in conjunction with the El Paso Independent School District. Breast Cancer Aware is a participant assessment survey that identifies women at increased risk for breast cancer. SPHN also continues to work with the American Cancer Society and was successful in helping fundraise for Making Strides Against Breast Cancer. I would like to thank all of the staff and physicians who work so hard to make the Cancer Program at SPHN such a success. Your dedication to provide the best patient care and treatment, has allowed us to become a Network Cancer Program, only 1 of 2 in the State of Texas. As we work hard to maintain our accreditation in 2011, I look forward to continuing to move ahead and to meet our goals in the upcoming year. Panagiotis Valilis, MD Sierra Providence Health Network Chairman Cancer Committee Page 02

4 Oncology Committee Members Physicians Panagiotis Valilis, Medical Oncology, Palliative Care Physician, Chairman Raul M. Portillo, Medical Oncology Craig Cameron, Orthopedic Surgery Al Dominguez, Pharm D. Roberto Canales, Pediatric Oncology Benjamin Carcamo, Pediatric Oncology Gerard Crecca, General Surgery, Cancer Physician Liason Anuradha Gupta, Radiation Oncology Chetan Moorthy, Radiology Judith Pester, Pathology Arturo Vargas, Pathology Harry Wilson, Pathology staff membership Martha Armendariz, CTR Tony Baird, Administrative Director, QI Kim Breitegan, RN, Ambulatory Care Nurse Patricia Carter, RN, Administrative. Dir., Oncology Services & La Mariposa Hospice Pam Emmert, CME - Medical Library Asst. Director Karen Fowler, VP of Patient Care Administration Darla Hernandez, Assistant Director of Pediatrics Ellen Kerr, RN, Breast Cancer Navigator William Keifer, Administrative Director of Acute Care Services Linda Lawson, Chief Nursing Officer Teresa Monzon, Adm. Director of Medical Records Patricia Neria, Occupational Health Services Director Felipe Ornelas, Dietary Irma Pena, Clinical Research Outcomes Analyst Vlasta Pinto, RD, LD, Dietary Lily Ramirez, RN, Director, Oncology Services Claudia Sanchez, RN, Community Outreach Coordinator Martha Silva, ACS, Community Manager Jennifer Speedy, Case Management Page 03

5 2010 Pancreatic Pancreatic Study cancer is a malignant neoplasm of the pancreas. Pancreatic cancer is sometimes called a silent killer because early pancreatic cancer often does not cause symptoms and is therefore often not diagnosed until it is advanced. The prognosis is poor, with fewer than 5% of those diagnosed still alive five years after diagnosis. Complete remission is still rare. According to the National Cancer Institute, by the end of 2010 in the United States, it is estimated that about 43,410 individuals will be diagnosed with this condition, and 36,800 will die from the disease. Female 48% Sex Male 52% We performed a retrospective analysis of the patients with pancreatic cancer diagnosed and/or treated at Sierra Providence Health Network during a five year period from A total of 142 patients were identified. Male Female Of those, 106 patients have expired. We further evaluated surgical treatment, age at diagnosis, sex, and survival. The mean age at time of diagnosis was 69 years old. Of those diagnosed from , 52.11% were male and 47.89% were female. Twenty one of the 142 patients, 15%, were treated with surgery with the following results: 6 patients, 29%, had no residual tumor 3 patients, 14%, had residual tumor 12 patients, 57%, with unknown results Median survival from time of diagnosis is around 3 to 6 months; 5-year survival is less than 5%(World Health Organization). From the total of 106 that expired: 86 patients, 81%, expired during the first year 15 patients, 14%, expired during the second year 3 patients, 3%, expired during the third year 1 patient, 1%, expired during the fourth year Occurance of Death after Diagnosis 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 81% 14% 3% 1% 1% 1year 2 year 3 year 4 year Unknown Page 04

6 PANCREATIC STUDY (cont.) Survival In conclusion, pancreatic cancer has a high mortality rate and a majority of the patients expire within the first year of diagnosis Expired Alive 36 Pancreatic cancer has one of the highest fatality rates of all cancers, and is the fourth highest cancer killer in the United States among men and women. Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year (World Health Organization, 2009). The above data from SPHN follows national trends. Page 05

7 Sierra Providence Health Network Cancer Registry Report Network Cancer Programs, such as the one at Sierra Providence Health Network (SPHN), are approved by the American College of Surgeons (ACoS), Commission on Cancer (CoC). The Network has to follow Standards set by the Approvals Program. The structure is outlined in the CoC Cancer Program Standards 2004, Revised Edition, which ensures that each approved program provides all patients with a full range of diagnostic, treatment, and supportive services either on site or by referral. The Cancer Registry was established at Providence in 1983 and at Sierra in 1989 and most recently Sierra Providence East Medical Center in The Cancer Registry has steadily increased the number of cancer patients that have been entered each year as the Cancer Program has progressed. In 2009, the cancer registry entered 938 patients for Providence, 695 patients for Sierra and 122 patients for Sierra Providence East. Currently a total of 35,164 cases are in the registry database. We are proud to announce that the Network Cancer Program at SPHN achieved the honor of becoming the second out of two Network Cancer Programs in the State of Texas. The data maintained by the Cancer Registry is available for use by the medical staff and other health care professionals for special studies, reports, audits, and research. All data is reported to the Texas Department of State Health Services (DSHS) and to the ACoS National Cancer Data Base (NCDB) Call for Data. An integral part of our Cancer Program is our Cancer Conferences. At Sierra Providence Health Network we conduct weekly Cancer Conference meetings which include an outline of the medical history, physical and surgical findings, and cancer staging. The Cancer Registry at SPHN continuously strives to provide data that can be used to access the results of diagnostic and therapeutic efforts to ultimately improve patient care. In 2010 Thirty-six (36) Cancer Conference meetings were held thus far in the year, with a total of 112 cases being presented. All major cancer sites were discussed (Graph 1.1 & 1.2). A total of 108 cases presented were prospective in their presentation exceeding the 75% prospective presentation required by ACoS with a total of 89%. Page 06

8 SPHN CANCER REGISTRY REPORT (cont.) 2010 cancer conference case distribution 2010 Cancer Conference Case Distribution Breast Colon Prostate Testis Lung Oral Cavity Digestive System Lung Mesothelioma Sarcoma Lymphoma Hematopoietic Urinary System Thyroid Ovary Melanoma Brain Unknown 10% 1% 1% 3% 9% (Graph 1.1) 6% 2% 3% 1% 4% 4% 3%2% 7% 1% 1% 3% 39% 2010 pediatric cancer conference case distribution 2010 Pediatric Cancer Conference Case Distribution (Graph 1.2) 30% 10% Testes 10% Ovary 10% 30% Hematopoietic Sarcoma Kidney 10% Lymphoma Page 07

9 SPHN CANCER REGISTRY REPORT (cont.) In 2009, the Cancer Registry accessioned a total of 1840 cases; of these, 1486 (81%) were analytical cases and 354 (19%) were non-analytic. Analytic cases are defined as those patients who are originally diagnosed and or receive all or part of their first course of cancer-directed treatment at any of our facilities. Non-analytic cases are identified as those patients who were diagnosed elsewhere and completed their cancer-directed treatment elsewhere. The Sierra Providence Health Network Cancer Registry incidence in female patients for 2009 prove 819 new cases and in males 667 new cases. Dividing patients by gender shows that 45% are male and 55% are female. More than 63% of all analytic cases in 2009 involved patients 60 years of age or older. The most common cancer sites in males were Prostate, Lung, Colon, Kidney and Hematopoietic. These five sites comprised 77% of the male malignancies seen in In females, Breast cancer was the most commonly diagnosed cancer in 2009 with 47% followed by Thyroid, Lung, Colon and Meninges. All five sites accounted for 84% of total analytic female cases. Each year the American Cancer Society publishes projection of expected number of cancer cases by applying population-based data from the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program to U.S. Census estimates. Comparison of the five most prevalent cancer sites between SPHN, State and National Men SPHN Percentage Texas * Percentage National * Percentage Prostate % % % Lung 61 4% % % Colon 50 3% % % Kidney 47 3% % % Hematopoietic 44 3% % % TOTAL Female SPHN Percentage Texas * Percentage National * Percentage Breast % % % Thyroid 64 4% % % Lung 56 4% % % Colon 51 4% % % Meninges 43 3% % % TOTAL * STATE Department of State Health Services, Texas Cancer Registry New cases estimated by applying age-, sex, and race/ethnic-specific incidence rates for California, to the Texas 2009 population. Totals may not sum due to rounding. Source: Prepared by the Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, January, * NATIONAL Cancer Facts and Figures 2009, American Cancer Society Rounded to nearest 10. Source: Estimated new cases are based on incidence rates from 41 states and the District of Columbia as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 85% of the US population. 2009, American Cancer Society, Inc., The Commission on Cancer (CoC) of the American College of Surgeons requires that the Collaborative Staging system be completed on all applicable sites and histologies. At diagnosis, seven percent of Sierra Providence Health Network s 1486 analytic cancer cases were Stage 0 (in situ). This is the earliest stage in a tumor and, in general has a higher survival rate than an invasive cancer. Of the invasive cancer treated at SPHN in 2009, 17% were Stage I, a small tumor with no spread to the Lymph Nodes. 14% were Stages II and 8% were Stage III tumors that progressively advanced. Stage IV cancers refers to metastatic disease that has spread to other areas of the body and 11% of these were diagnosed at SPHN in Page 08

10 SPHN CANCER REGISTRY REPORT (cont.) SIERRA PROVIDENCE HEALTH NETWORK Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage 2009 Site Distribution Table Sex Class of Case Status Stage of Disease at Diagnosis PRIMARY SITE TOTAL (%) M F Analy NA Alive Exp 0 I II III IV N/A Unk ORAL CAVITY & PHARYNX 41 (2.2%) Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Oral Cavity & Pharynx DIGESTIVE SYSTEM 322 (17.5%) Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Peritoneum/Omentum/Mesentery Other Digestive Organs RESPIRATORY SYSTEM 161 (8.8%) Nasal/Middle Ear/Sinuses Larynx Lung & Bronchus BONES & JOINTS 10 (0.5%) SOFT TISSUE (including Heart) 13 (0.7%) SKIN 24 (1.3%) Melanoma -- Skin Other Nonepithelial Skin BREAST 316 (17.2%) FEMALE GENITAL SYSTEM 92 (5.0%) Cervix Uteri Corpus & Uterus, NOS Ovary Vulva Other Female Genital Organs MALE GENITAL SYSTEM 192 (10.4%) Prostate Testis Penis URINARY SYSTEM 156 (8.5%) Urinary Bladder Kidney & Renal Pelvis Ureter BRAIN & CNS 135 (7.3%) Brain Other Nervous System ENDOCRINE SYSTEM 135 (7.3%) Thyroid Other (including Thymus) LYMPHOMAS 87 (4.7%) Hodgkin Lymphoma Non-Hodgkin Lymphoma MULTIPLE MYELOMA 24 (1.3%) LEUKEMIAS 54 (2.9%) Lymphocytic Leukemia Myeloid & Monocytic Leukemia Other Leukemia MESOTHELIOMA 6 (0.3%) MISCELLANEOUS 72 (3.9%) TOTAL 1, , , Page 09

11 SPHN CANCER REGISTRY REPORT (cont.) For the last four years the Sierra Providence Health Network top five primary sites have maintained constant until 2008 and 2009 where surprisingly Meninges and Thyroid have managed to creep up into the top five cancer sites for females. SPHN Female Top Five Primary Sites Breast Colon Lung Kidney Thyroid Meninges SPHN Percent Texas Percent National Percent % 641 1% % % 625 1% % % 633 1% % % 647 1% % The obvious imbalance in the top five primary sites in females is the large increase of Meninges over the last two years entered into the Sierra Providence Health Network database in comparison to the incidence estimated from the State and the Nation. Female Meningiomas increase % 6.00% 4.00% 2.00% 0.00% Texas National SPHN Page 10

12 2010 Pediatric oncology annual report The pediatric hematology/oncology clinic is located in the Hilton Tower. The clinic serves west Texas, southern New Mexico and Mexico. There are two independent pediatric oncologists that practice in the clinic. These pediatric oncologists rely on the expertise of a pediatric radiologist and a pediatric pathologist; both are in-house physicians, for diagnosis and follow-up studies. The monthly clinic visits have ranged from 600 to 800. There is a dedicated 14- bed inpatient unit. Two monthly Pediatric Tumor Board meetings are held to discuss patient diagnosis and treatment options. The clinic is also host to a bi-annual comprehensive hemophilia clinic. This bi-annual comprehensive clinic is done in conjunction with Dr. Escobar and the University of Texas at Houston. Children s Providence in conjunction with various community organizations to form a Kidz Cancer Consortium to assist families with children with cancer or family member with cancer. The pediatric oncology nurses care for children with cancer from birth to 21 years of age. The pediatric oncology nurses in the clinic and the floor deliver expert care in a health care environment that is continually changing. The child life specialist assists our families and patients with their psychosocial needs, along with the social worker who assists with the financial needs. The nurses work closely with outside organizations, such as Ronald McDonald House and Candlelighters, to ensure that our families are receiving holistic, quality care. Plans for the year 2010 include submitting an application for membership to the Children s Oncology Group. Page 11

13 2010 Sierra Medical Center adult Oncology Department Annual Report The care/services provided on the oncology unit is a continuum of care for the medical/oncology patient from diagnosis, treatment, to end of life care. Services provided consist of bone marrow aspiration/biopsies, lumbar punctures, lab work, x-rays, chemotherapy, brachytherapy, radioisotopes, blood product administration (platelet, PRBC, fresh frozen plasma), thoracentesis, paracentesis, pleuradesis, thoracoscopy, chest tube insertions and care, as well as stem cell transplant recovery. Additional services include pain management, diabetic wound and pressure ulcer care, diabetes management, medication administration (IV, IM/SQ injections, oral), fluid/electrolyte therapy, parenteral nutrition, assistance with activities of daily living, respiratory therapy, neurological assessment and psychosocial assessment and support, central line and PICC line placement and removals. Nursing staff is also qualified to prepare and educate patients prior to endoscopic procedures, surgical procedures, and care/monitor for the patient after such procedures. Terminal care to include comfort measures (Morphine sulfate drips, PCA, epidural), pain management (palliative radiation), relaxation techniques, emotional and psychological support for patient and family. In-patient Hospice services are also available. In collaboration with the American Cancer Society we sponsor a Dialogue cancer support group on a monthly basis. Monthly staff in-services were initiated starting in November 2009, presentations involving staff and Physicians have been ongoing covering different topics each month based on identification by staff. Plans for the year 2010 include submitting an application for membership to the Children s Oncology Group. Recognized standard/practice guidelines utilized for care provided: The standards/practice guidelines utilized are Texas Board of Nursing, Hospital Policy and Procedure manual, Lippincott Manual of Nursing Practice, JCAHO s standards, Oncology Standards of Practice and unit specific competencies. Every nurse responsible for administering chemotherapy has completed and successfully passed the Oncology Nursing Society s Chemotherapy and Biotherapy Providers Course within one year of employment. Nurses demonstrate annual competencies in chemotherapy administration and many are active in the local Oncology Nursing Society Organization where they have a variety of educational opportunities. Staff also participate in organizing and planning the annual Western Regional Oncology Conference to enhance their knowledge base and improve patient outcomes. Page 12

14 SMC adult ONCOLOGY department annual report (cont.) Goals: Maintain department compliance with documentation of pain management at or above 95%. Maintain Patient First Standards with overall PSMS score of four stars. Maintain compliance with chemotherapy verification form on all chemotherapy drugs given at 96%. Decrease falls to <5%. Population served: General Medical population Newly diagnosed Oncology patients Ages 18 years and over. Patients with Systemic Lupus Erythematosus (SLE) or renal failure who require chemotherapy. Patients receiving radioactive isotopes. Where and when the care/service(s) is/are provided: The Medical/Oncology unit is a 66 bed unit. Patients receive chemotherapy and radiation therapy which are available 24 hrs/7 days a week. Outpatient radiation therapy is available at cancer treatment centers in town and patients are transported to and from centers. There are four (4) suites, twelve (12) private rooms, two (2) negative pressure rooms, twenty four (24) semi-private rooms. Two (2) private rooms are lead lined for radioactive isotope treatment. Key volume statistics for department: 2009 Average Daily Census (ADC) for Medical/Oncology was Total patient days for 2009 was 14,420. Care/services provided by: (Core staffing) Registered nurses, licensed vocational nurses, nurse technicians, certified nursing assistants and health unit coordinators, occupational and physical therapists, phlebotomists, dieticians, social workers, case managers, speech therapists, wound care nurses and spiritual care representatives. Registered nurses are required to complete and pass an Oncology Nursing Society Chemotherapy biotherapy course prior to administration of chemotherapy. Page 13

15 SMC adult ONCOLOGY department annual report (cont.) Support Systems: Medical/Oncology utilizes support services from within the network and outside community. The most frequently utilized services are: American Cancer Society El Paso Diabetes Association Providence Memorial Hospital Diabetic Educators El Paso Cancer Treatment Center Susan G. Komen Race for the Cure National Cancer Survivor Day Power of Pink Oncology Medical Director Rio Grande Cancer Foundation and Green House Cancer Consortium Hospices services Texas Tech Diabetic Clinic The National Institute on Aging The American Heart Association Extended care and rehabilitation facilities Home Health agencies The Medical/Oncology Unit organized the first Prostate Screening at SMC to have MD involvement with providing the digital exam this year. This was very successful as we screened 132 men from the community. SMC participated in fund raising the entire month selling Pink items for American Cancer Society with Making Strides Against Breast Cancer and raised $2400 toward a worthy cause. Staff members also participated in the walk on October 31st. Additional staff members also participated in the Race for the Cure. The Power of Pink display was at Sierra Medical Center the last weekend in October and staff provided information, brochures, and give-aways to the public. Page 14

16 2010 Providence Memorial Hospital ADULT Oncology Department Annual Report Oncology Services: The Oncology Department at Providence Memorial Hospital consists of a 25-bed inpatient unit and a 14-chair infusion center. In addition, the Breast Health Navigator is an employee of Providence but provides services to Breast Cancer Patients across the Sierra Providence Health Network. Finally, La Mariposa Hospice provides Palliative Care and Hospice Services for Providence and the Network. The oncology program is under the guidance of our medical director, Dr. Panagiotis Valilis. Department Descriptions: The mission of the oncology department is to promote excellence in clinical practice, education and administration. The staff provides excellent individualized care for each cancer patient and their families recognizing that the cancer experience is unique for each individual. The inpatient oncology unit at Providence is primarily an oncology unit with 60% of the admitted patients having a cancer diagnosis. The outpatient infusion clinic provides a variety of services; administration of chemotherapies and biotherapies, antibiotic administration, IM and SQ injections, IVIG and steroid administration, phlebotomies and central line dressing changes, as well as PICC line insertions. This year we have seen a significant growth in the volume of infusion services. To address that growth the infusion clinic was remodeled to add an additional 4 chairs growing to a total capacity of 14 treatment chairs. Oncology Nursing: Oncology staff members maintain competency by attending reorientation, annual oncology specific competency and core competency validation. All nurses new to the oncology specialty receive a comprehensive competency based orientation as well as attending a Oncology Nursing Society Chemotherapy Certification Course. Other educational resources available to staff include online courses provided through the Tenet online educational services, Tumor Conferences, Oncology Nursing Society Chapter meetings, Nurse Oncology Education Program, the Annual Western Regional Oncology Conference and regularly scheduled educational offerings presented by nursing experts and physicians. In 2010, 7 of the registered nurses who work in the oncology department are OCN (Oncology Certified Nurse). Page 15

17 SPHN adult ONCOLOGY department annual report (cont.) Performance Improvement: The staff of the inpatient oncology department has been involved in a several performance improvement projects this year. In collaboration with the American Cancer Society the nurses of the inpatient unit added the Personal Health Manager packet to the discharge materials for all newly diagnosed cancer patients. This change in practice has added consistency to the information provided to cancer patients upon discharge from the hospital. In addition the nurses through the Unit Board developed and implemented a chemotherapy flow sheet, which has improved the consistent documentation of chemotherapy across the patient s hospitalization. The staff of the Adult Oncology Clinic introduced a chemotherapy flow sheet and increased the number of nurses who are PICC Line Certified from two to four. The collaboration with the Nutrition Department an order set for Dietary Consults was developed and implemented. This revised order defines clearly the evaluation needs of the patient. In an effort to improve the ongoing assessment and re-evaluation of the patient s dietary needs the Dietician, for nursing and nursing assistants, provided a series of in-services. Page 16

18 2010 Sierra Providence La Mariposa Hospice Annual Report La Mariposa Hospice is a community hospice program that provides a continuum of care for Oncology Patients, who receive Services in Sierra Providence Healthcare Network. These services are coordinated through SPHN Oncology Committee. La Mariposa Hospice accepts patients of all ages. A person must meet specific criteria to be admitted to hospice services. That criterion includes a terminal diagnosis with a prognosis of 6 months or less, certified by the patient s attending physician and the hospice Medical Director. Although the majority of hospice patients have a cancer diagnosis, non-cancer diagnosis such as end-stage heart disease and end-stage dementia are among some of the terminal illnesses hospice patients experience. Longevity and stability of the LMH staff has helped provide the patient s the highest quality of care possible. The goal of the hospice staff is to provide the patient and family with physical, emotional, psychosocial, and spiritual support. The nursing staff has expertise in pain and symptom management. Under the direction of our Medical Directors, Dr. Valilis and Dr. A. Lopez the hospice nurses are able to address the patient s medical and physical issues to keep patients comfortable and promote quality of life and a peaceful death in their home. Community Services: In addition, to direct patient care services, La Mariposa Hospice is committed to providing End of Life Education and Support to the El Paso Community. Programs presented by members of the staff are available for community groups. Listed below are a few of the presentations completed in 2009 through Patient Care at End of Life Hospice Services Advance Directive s End of Life Issues for hospital employees General Inpatient Care: La Mariposa Hospice has a contract relationship with Providence Memorial Hospital and Sierra Medical Center to provide Respite and General Inpatient admissions to the hospice patients. Individuals who are current patients at Sierra Medical Center or Providence Memorial Hospital may meet the criteria for General inpatient hospice if they have a terminal illness and a clinical condition, which requires both hospice services and symptom management. The nursing staff on the Medical and Oncology units at both PMH and SMC received specific training in palliative care from the hospice nursing staff. Although, the patient is in either PMH or SMC, the care of the patient is supervised and managed by the La Mariposa Hospice Team of nurses, social workers and medical directors. The patients in the hospital receive the same hospice services as though they were in their residence. Page 17

19 LA MARIPOSA HOSPICE ANNUAL REPORT (cont.) The General Inpatient admissions to Providence Memorial Hospital and Sierra Medical Center have increased every year since This service has provided support to the nursing staff caring for terminally ill patients and to the family members of those patients. his unique service available to La Mariposa Hospice Patients provides a level of care that often cannot be provided in the patient s residence. Ongoing education for the nursing staff at all three hospitals is a vital part of our mission. Each new healthcare employee of SPHN attends a presentation on End of Life issues and the employee s responsibilities at time of new hire orientation. In addition, the Intake/Palliative Care Nurse is available to address the questions and concerns of any nurse or physician within the SPHN facilities. Volunteer Services: Our Volunteer Coordinator conducts annual volunteer training. The volunteers meet monthly and work on various activities for patients throughout the year for example Easter and Christmas gifts. The Volunteer Coordinator organizes a Holiday Luncheon annually with the help of the volunteers. This event is for the patients, their families and the bereaved families from the prior two years. During Volunteer Appreciation Month our volunteers are honored with an appreciation dinner to show our gratitude for all their hard work and support for hospice. Bereavement Program: Our Bereavement Program is offered to all families for one year after the patient s death. La Mariposa Hospice s Bereavement Coordinator collaborates with another Bereavement Coordinator in the community to offer Coping with Grief and Loss: Support for the Grieving, an organized support group. These support groups have increased in popularity and in 2010 will be offered 4 times compared to twice a year in previous years. A Memorial Service is held each year to celebrate the lives of the patient s that have died on hospice services during the past year. The bereavement program is a valuable part of the hospice program and helps allow the family to begin the normal grieving process. COPING WITH GRIEF AND LOSS SIX WEEK CLOSED SESSIONS CONDUCTED IN COLLABORATION WITH RIO GRANDE CANCER FOUNDATION GRIEF SUPPORT GROUPS HELD Jan 20, 2010 April 21, 2010 July 21, 2010 October 6, 2010 La Mariposa Hospice is available to the Sierra Providence Health Network Facilities and the Community to provide End-of-Life Care to individuals and their family members who have a terminal illness. We continue to develop opportunities to expand our services and meet the needs of the patients and their loved ones, but the Medical Community as well. Page 18

20 2010 Sierra Providence HEATLH NETWORK MEDICAL EDUCATION PROGRAM The Continuing Medical Education/Library Advisory Committee is instrumental in evaluating physician and community needs to provide organized educational activities for medical staff members and other healthcare professionals in the medical community. The SPHN CME program currently holds six years accreditation with commendation, awarded by the Texas Medical Association Committee on Continuing Education. Thirty-eight hours of Adult Tumor Board Cancer Presentations and 11 hours of Pediatric Tumor Board Cancer Presentations have taken place in the last 12 months. On an annual basis the CME Committee, in conjunction with select physicians, nurses, and allied health professionals, coordinate the Annual Western Regional Oncology Conference. Now in its 27th year, the goal is to provide the medical professionals with current technology, treatment, and management for the oncology patient. Various sites are addressed each year to provide continued awareness and ongoing educational opportunities. CME activities include: Monthly activities of both general and specialty subject matters Ongoing conferences for multidisciplinary case presentations Regional symposia Joint sponsorships Library services Series Adult Tumor Board Cancer Case Conferences Pediatric Tumor Board Cancer Case Conferences Pediatric Pearls Case Presentations OB/Gyn Case Presentations Cardiology Mortality & Morbidity Presentations Pediatric Cardiology Mortality & Morbidity Presentations Symposiums for th Annual Western Regional Oncology Conference 33rd Annual Cardiology Update Conference 4th Annual Perinatal Symposium 22nd Annual Pediatric Symposium 7th Annual Faces of Diabetes Conference 31st Annual SWAHAP Medical Education Conference Bioethics Update 2010 Didactic Conferences Dysautonomias: Testing and Treatment Page 19

21 2010 La Mariposa Hospice and Oncology Volunteer Services Cindy Sanchez, Volunteer Coordinator Hospice/Oncology Services, currently manages the volunteer services for hospice and the oncology departments at La Mariposa Hospice, Providence Memorial Hospital, Sierra Medical Center and Total Care West. As the Volunteer Coordinator, she recruits, trains and supervises all aspects of the volunteer program for La Mariposa Hospice and Oncology Services. This includes the Breast Health Resource Center at Total Care West in collaboration with Susan G. Komen. La Mariposa Hospice volunteers are a vital part of our organization. They have various roles; we have administrative volunteers that assist the staff in the office. These volunteers file, answer telephones, make copies etc. The patient care volunteer provides companionship to patients in their home or respite to caregivers. The volunteers also work throughout the year on various projects (crafts), involved in the annual memorial service and assist in planning the annual holiday luncheon for patients and families. They make a Christmas basket and hand deliver them to the patient s home. The Nursing Staff at Providence Memorial Hospital and Sierra Medical Center have implemented the Personal Health Manager for both adult and pediatric cancer patients. As this approach evolved the resource centers have had a less impact. The Breast Health Resource Center at Total Care West opened in This collaboration between SPHN and Komen for a Cure has been successful in providing information to newly diagnosed Breast Cancer Patients. The volunteers who participate in each of these programs are dedicated compassionate individuals. Cindy guides them in their volunteer efforts; however, they drive the programs. Page 20

22 2010 Breast Cancer Navigator The Breast Care Navigator provides individualized guidance to women recently diagnosed with breast cancer. The Navigator follows patients throughout every aspect of treatment, aiding in dispelling fear, linking to financial and quality of life support resources, and being a comfort and friend to patients and their families. Ellen Kerr, RN, Breast Cancer Navigator for Sierra Providence Health Network, works closely with not just patients but also with the community and other healthcare professionals. She has been instrumental in helping to open the Breast Cancer Resource Center at Total Care West in collaboration with Komen for the Cure who provides educational materials & their website on our desktop for patient use. Additional activities and functions of the Breast Cancer Navigator include: A series of TAI CHI CHI GUNG classes focused on breast cancer survivors at risk for or who have developed arm lymphedema; are currently in the 2nd 8 week series taught by Master TAI CHI Instructor, Steve Barowsky. Rio Grande Cancer Foundation provides partial scholarships for those needing it. They are held at Total Care West on Wednesday evenings 6PM - 7PM Sept. 22-Nov. 17 A Breast & Ovarian Cancer support group for women 25 years - 50 years facilitated by Janet Gildea, MD. Total Care West 6P - 7:30P one Monday each month; next meetings are 10/25, 11/22 & 12/20. The group is called INNER WORK and focuses on the mental, spiritual & emotional aspects of this survivor journey to become their new normal selves. Offered a Look Good Feel Better class for cancer survivors currently in treatment or for those who have completed treatment within the last year. This is a class to teach survivors how to makeup their faces with facial changes caused by chemotherapy and how to use scarves, caps, hats and wigs to enhance the appearance they desire. This class would have been held at Total Care West and was scheduled for Tuesday, October 19 from 1PM - 3 PM and is sponsored by the American Cancer Society. Due to a lack of participation, this class was not held, however the option to hold another one in the future remains open. Spoke to a group of female employees from Pepsi Cola Company on 09/23/10 to talk about screening, early detection and community resources; sponsored by the American Cancer Society. Page 21

23 BREAST CANCER NAVIGATOR (cont.) Facilitate the acquisition of fabric, fluff & volunteers to make heart-shaped pillows for breast cancer patients to use to elevate their arms & a smaller pillow to use for the car seatbelts. Supplies provided by the American Cancer Society. Volunteers include survivors & SPHN volunteers. New Co-Facilitator for the Breast Cancer Support Group at Providence Memorial Hospital along with Claudia Sanchez, RN Unit Director of La Mariposa Hospice and Kim Bretinger, RN, Oncolgy Unit PMH. Public Speaking upon request. Page 22

24 2010 Pathology Dr. Michael J. Hayes is a recent addition to our pathology team, providing services at Providence Memorial Hospital and Sierra Providence East Medical Center. Dr. Hayes received his MD degree at Wayne State University in Detroit, Michigan, and completed his residency at the University of Michigan Medical Center in Ann Arbor, Michigan. He has fellowship training in hematopathology and surgical pathology of the breast; and is board-certified in anatomic and clinical pathology and hematopathology. Dr. Hayes performs and diagnoses bone marrow biopsies, including diagnostic interpretation of flow cytometry. Dr. Hayes has also worked extensively with the Ventana VIAS optical imaging system for interpreting prognostic/predictive immunostain markers in breast cancers. With our CAP-approved sample handling methods, VIAS software, robotic VIAS microscope, and optimized Ventana immunostain protocols our lab delivers increased precision and reliability of marker measurement for ER, PR, HER2/neu, Ki-67, and p53. The VIAS system also helps reduce interobserver variability, which is especially crucial for the measurement of HER2/neu overexpression. Selected cases are also referred promptly for HER2 gene amplification FISH testing. Page 23

25 2010 DIETARY A dietitian is an expert in food and nutrition. Dietitians help promote good health through proper eating. They supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. In the medical setting, a dietitian may provide specific artificial nutritional needs to patients unable to consume food normally. Dietary modification to address medical issues involving dietary intake is also a major part of dietetics. The goals of the dietary department are to provide medical nutritional intervention, obtain, prepare, and serve flavorsome, attractive, and nutritious food to patients, family members, and health care providers. The Dietary Department at Sierra Providence Health Network has worked closely with the Oncology Unit to help develop a program that is the most beneficial for Oncology Patients and their needs throughout their treatment. A list of supplements that could be used at med pass to increase calorie & protein intake for the patients especially those who can tolerate only small amounts of nourishment at any one time. Dietary has also assigned a dietitian to work with the Oncology Unit who is familiar with the Oncology patients needs and the staff. Vlasta Pinto RD, LD, who is the dietitian that covers that unit created a med pass list and provided an in-service with the staff. The med pass is currently being implemented slowly with gradual release to all patients. Page 24

26 2010 rehabilitation Providence Memorial Hospital is currently providing services for patients suffering from Lymphedema due to Breast, Uterine, Ovarian, and Colon Cancer. What is Lymphedema? Our bodies have a network of lymph vessels that carry protein-rich fluid to the lymph nodes. The function of the lymph nodes is to filter the lymph fluid before it can be returned to the circulatory system. These nodes are able to increase or decrease in size throughout life, but if any nodes have been damaged or destroyed they will not regenerate. The removal of lymph nodes may cause excess fluid to build up in an extremity thus causing lymphedema. We have an enhanced program which includes two phases: 1. Phase one consists of the following: Educating the patient with proper skin and nail care Manual lymph drainage (which is a superficial massage to stimulate the movement of lymphatic fluid, Compression bandaging (which prevents the re-accumulation of lymphatic fluid), Decongestive exercises (which helps push lymphatic fluid upwards). Teaching the patient proper techniques for self bandaging and self manual lymph drainage Patient is seen five times per week for two weeks then sent to be measured for a garment to the affected limb. 2. Phase two is the self-maintenance phase and consists of patients being seen between two to three times a week in order to verify the patient s independence with the following: Decongestive exercises Self-bandaging Self-manual lymph drainage Page 25

27 rehabiliation (cont.) The lymphedema program has a strong focus on reducing lymphatic fluid and also has a strong focus on increasing active range of motion and strength to the affected shoulder for women who have had a mastectomy. Providence Memorial Hospital provides a range of care for the oncology patients in our outpatient setting. Our services are designed to enhance the quality of life and improve the functional performance of individuals affected by cancer. Our focus for the oncology patient consists of the following: Patient and family education Communication and cognitive evaluations Swallowing evaluations and interventions Assistive devices for laryngectomy patients Evaluation and management of oncology treatment-related fatigue and deconditioning Lymphedema Management The program specialties include: Physical Therapy Occupational Therapy Speech Therapy Page 26

28 2010 Total Care TotalCare is an Outpatient Department of Sierra Medical Center where we offer a full imaging center as well as a dedicated Breast Center. Total Care offers General X-Ray, Phlebotomy, Digital Stereotactic Biopsy, Bone Density, CAT Scan, and open MRI. The equipment at TotalCare, which is useful in detecting cancer, consists of the latest state of the art Digital Mammography equipment, ultrasounds, CT s, MRI s, and X-Rays. Specific for diagnosing breast cancer is the ultrasound-guided biopsy, Stereotactic guided biopsy machines, and the capability to perform MR guided Breast Biopsies. We also have two surgeons that provide their services two days a week for our Breast Center. TotalCare offers the Breast Clinic where surgeons who specialize in breast health will see patients at the clinic. The surgeons perform the clinical exam and order the required diagnostic exams to be completed that same day. This enables the Physician to give the patient the results promptly. Patients who have their biopsies done will have their pathology results within hours. TotalCare has two Registered Nurses who are certified Breast Health Navigators. The Breast Health Navigator serves as a consistent care coordinator across the continuum of illness and recovery. The Breast Health Navigators actively attend health fairs and provide information on breast health. They do presentations at schools for the staff and parents, which include education, prevention and early detection. They serve as a Resource Nurse for education in the community on early detection and to help with the needs of breast cancer patients. Total Care also participates in all events held by the Sierra Providence Health Network. These include Tennis for the Cure, Race for the Cure, as well as working hand in hand with the Susan G. Koman Foundation to promote breast cancer awareness and education. For Breast Cancer Awareness month in October, TotalCare is involved in a number promotional activities. This includes Breast Self Examination handouts and educational materials. Our goal is to not only provide excellent quality imaging to the El Paso Community, but through our Breast Cancer Navigator Program, we strive to be on the forefront of teaching our Community the importance of early cancer detection and prevention. Page 27

29 2010 Prevention and Early Detection Program Annual Report Committee: The Outreach Committee of the Cancer Committee includes staff members from each facility within the SPHN. Together the committee plans and implements an outreach program for the community and the network employees. The goal is to increase awareness of early detection of cancer opportunities and improved the rate of cancer diagnoses at an earlier stage of disease. Each project executed has the support of the Cancer Committee and the specific medical discipline involved. Programs: Prostate Screening: In 2009, Prostate Screenings were offered at Providence Memorial Hospital and Sierra Providence East Medical Center with over 300 men screened. In 2010, prostate screenings were held at all three hospitals; Providence Memorial Hospital, Sierra Medical Center and Sierra Providence East Medical Center; over 404 men were screened. Each facility provided PSA testing and physicians performed digital rectal exams, both were provided at no cost to the men attending. Controversy over the value of prostate screening remains, but every effort is made to educate the men in attendance regarding the limitations of the screening. Breast Cancer Awareness: Power of Pink is an event organized by the Tumor Registrars and nursing representatives from each hospital in El Paso. Power of Pink recognizes newly diagnosed Breast Cancer Survivors with a make over and Glamour Shot Photo. They organize the development of a display of these glamour shots, which travels through out the city during the month of October. The Outreach Committee schedules the displays for each hospital and diagnostic facility. Each hospital and diagnostic facility takes this opportunity to increase awareness through community and employee education and events. In addition to increasing awareness, the diagnostic facilities promote a reduced rate mammogram and extended hours of operation to encourage all age appropriate women to obtain a mammogram. This year, SPHN Worksite Wellness Department will launch Breast CancerAware to the SPHN employees and to one of the school districts. These two employee populations will be able to complete a risk assessment on-line. Women completing the assessment will receive a summary of their personal risk and have the opportunity to schedule a mammogram. Website: The SPHN Website is under construction. The revised website will serve as an avenue to obtain information about the services provided by the Network, but also as a source of diagnosis specific education. The Cancer Committee Annual Report will be posted on the website. Information regarding the oncology services at each facility will be available as well. Links to non-profit support organizations, cancer centers and clinical trial information will be available to individuals who visit the website. Page 28

30 2010 SURGERY Surgery Overview for cancer related disease: The Surgery department at Providence Memorial Hospital provides a wide range of diagnostic as well as interventional surgical treatments for cancer in Urology, Gynecology, Oncology GYN, General, ENT, Neurology, Orthopedic, and Plastic, Cardiovascular, and Pediatric subspecialties. Diagnostic procedures to determine prostate, bladder, cervical, uterine, colon, intestines, breast, thyroid, skin, and brain tumors to name a few, are managed by the wealth of subspecialist surgeons that are available. Diagnostic procedures such as biopsy of prostate under ultrasound guidance, cystoscopy with bladder biopsy, cervical and uterine biopsy, breast biopsy with needle localization, colonoscopy and EGD to diagnose gastrointestinal tumors, biopsy of bones, biopsy of the lung, melanomas, and malignant skin lesions. Interventional surgical treatment options are available as well through the vast subspecialties provided at Providence Memorial Hospital surgery department. Minimally invasive surgery also known as laparoscopic, DaVinci (robotic) surgery, and open procedures are utilized for removal of malignant tumors of the kidneys, stomach, colon, prostate, breast, larynx, lungs, bones, spine, brain, bladder, uterus, cervix, and skin to name a few. With the purchase of the Neoprobe which is a gamma detection system used intraoperatively for lymphatic mapping with breast surgery, prostate surgery, uterine and ovarian; sentinel node biopsy, thyroid/parathyroid, as well as the laparoscopic Neoprobe, allows the surgeon to detect cancerous lymph nodes that are deeply buried in the tissue, and evaluate the potential spread of cancer to the lymphatic system and organs. The Radiology Oncologist physicians will also schedule a patient with cervical cancer for cesium insertion which is a tandem that is placed in the patient to administer radiation therapy post operatively. Page 29

31 2010 GAMMA KNIFE RADIOSURGERY Radiosurgery works in the same manner as other types of therapeutic radiology: it distorts or destroys the DNA of tumor cells, causing them to be unable to reproduce and grow. The tumor will shrink in size over time. For blood vessel lesions such as an arteriovenous malformation (AVM), the blood vessels eventually close off after treatment. Gamma Knife treatment generally involves these steps: Head Frame Placement In order to keep the head from moving during treatment, a box-shaped frame is attached to the head. Pins designed specifically for this purpose fasten the head frame to the skull. The head frame also is a guide to focus the gamma ray beams to the exact location of the lesion being treated. Tumor or Lesion location Imaging Once the head frame is in place, the exact location of the lesion to be treated will be determined using computed tomography (CT scan) or magnetic resonance imaging (MRI). Radiation Dose Planning After the CT or MRI scan has been completed, the radiation therapy team will determine the treatment plan. The results of the imaging scan, along with other information, will be used by a medical physicist to determine the best treatment. Page 30

32 gamma knife radiosurgery (cont.) Radiation Treatment After being positioned for the treatment, a type of helmet with many hundreds of holes in it is placed over the head frame. These holes help to focus the radiation beams on the target. Treatment will last a few minutes up to a few hours, depending on the type and location of the area being treated. Generally, only one treatment session is required for a lesion. A Gamma Knife procedure involves a treatment team approach. The treatment team generally includes a radiation oncologist (a physician specializing in radiation treatment for cancer), a neurosurgeon and/or a neuroradiologist, a radiation therapist, and a registered nurse. In addition, a medical physicist and a dosimetrist work together to calculate the precise number of exposures and beam placement necessary to obtain the radiation dose that is prescribed by the radiation oncologist. Your treatment team may include other healthcare professionals in addition to or in place of those listed here. The Gamma Knife system is one of three types of radiosurgery systems. Gamma Knife systems are cobalt 60 systems, which means they use cobalt as a source for gamma rays. During Gamma Knife treatment, the equipment remains stationary (does not move). Two other types of radiosurgery are: Linear accelerator (LINAC) systems Linear accelerator (LINAC) systems use high-energy x-rays to treat a tumor or other lesion. Some common types of LINAC systems include CyberKnifeÂ, X-KnifeÂ, NovalisÂ, and PeacockÂ. In addition to using x-rays rather than gamma rays, LINAC systems also differ from the Gamma Knife in that the machinery moves around the patient during treatment. For this reason, LINAC systems are able to treat larger tumors and larger affected areas than the Gamma Knife. Areas other than the brain can be treated with a LINAC system. Proton beam therapy or cyclotron Proton beam therapy is a type of particle beam radiation therapy. Rather than using rays of radiation, such as gamma rays or x-rays, particle beam therapy uses particles such as protons or neutrons. Proton beam therapy is the most widely-used type of particle beam therapy. Proton beam therapy may be used for radiosurgery procedures or for fractionated radiotherapy (several smaller doses of radiation over a certain period of time). There are only a few facilities in North America that provide proton beam therapy. Page 31

33 gamma knife radiosurgery (cont.) Reasons for the Procedure Gamma Knife radiosurgery may be used to treat certain conditions of the brain in particular instances. Brain conditions that may be treated with a Gamma Knife procedure include, but are not limited to, the following: Brain Tumors Brain Cancer Arteriovenous malformations, or AVM (a type of blood vessel defect) Trigeminal Neuralgia Acoustic Neuroma Gamma Knife radiosurgery has shown some promise for treating conditions such as tremor and rigidity related to Parkinson s disease, epilepsy, and chronic pain. There may be other reasons for your physician to recommend Gamma Knife radiosurgery. Page 32

34 2010 Providence Memorial Hospital Oncology Department Annual Report Oncology Services: The Oncology Department at Providence Memorial Hospital consists of a 25-bed inpatient unit and a 14-chair infusion center. In addition, the Breast Health Navigator is an employee of Providence but provides services to Breast Cancer Patients across the Sierra Providence Health Network. Finally, La Mariposa Hospice provides Palliative Care and Hospice Services for Providence and the Network. The oncology program is under the guidance of our medical director, Dr. Panagiotis Valilis. Department Descriptions: The mission of the oncology department is to promote excellence in clinical practice, education and administration. The staff provides excellent individualized care for each cancer patient and their families recognizing that the cancer experience is unique for each individual. The inpatient oncology unit at Providence is primarily an oncology unit with 60% of the admitted patients having a cancer diagnosis. The outpatient infusion clinic provides a variety of services; administration of chemotherapies and biotherapies, antibiotic administration, IM and SQ injections, IVIG and steroid administration, phlebotomies and central line dressing changes, as well as PICC line insertions. This year we have seen a significant growth in the volume of infusion services. To address that growth the infusion clinic was remodeled to add an additional 4 chairs growing to a total capacity of 14 treatment chairs. Oncology Nursing: Oncology staff members maintain competency by attending reorientation, annual oncology specific competency and core competency validation. All nurses new to the oncology specialty receive a comprehensive competency based orientation as well as attending a Oncology Nursing Society Chemotherapy Certification Course. Other educational resources available to staff include online courses provided through the Tenet online educational services, Tumor Conferences, Oncology Nursing Society Chapter meetings, Nurse Oncology Education Program, the Annual Western Regional Oncology Conference and regularly scheduled educational offerings presented by nursing experts and physicians. In 2010, 7 of the registered nurses who work in the oncology department are OCN (Oncology Certified Nurse). Page 33

35 PMH Oncology report department annual report (cont.) Performance Improvement: The staff of the inpatient oncology department has been involved in a several performance improvement projects this year. In collaboration with the American Cancer Society the nurses of the inpatient unit added the Personal Health Manager packet to the discharge materials for all newly diagnosed cancer patients. This change in practice has added consistency to the information provided to cancer patients upon discharge from the hospital. In addition the nurses through the Unit Board developed and implemented a chemotherapy flow sheet, which has improved the consistent documentation of chemotherapy across the patient s hospitalization. The staff of the Adult Oncology Clinic introduced a chemotherapy flow sheet and increased the number of nurses who are PICC Line Certified from two to four. The collaboration with the Nutrition Department an order set for Dietary Consults was developed and implemented. This revised order defines clearly the evaluation needs of the patient. In an effort to improve the ongoing assessment and re-evaluation of the patient s dietary needs the Dietician, for nursing and nursing assistants, provided a series of in-services. Support Services: The nursing staff provide the Personal Health Managers to each newly diagnosed cancer patient and reviews the materials provides in the Personal Health Manager the cancer survivors had an opportunity to participate in support groups. Support Group for Spanish speaking survivors and Breast Cancer Support Group alternates meetings every 3rd Wednesday of the month. Each Support Group is held at PMH in the Auditiorium at 6pm. Watch for updates on the support groups for the latest information related to date and time of the support groups. Young Woman s Breast and Cervical Cancer support group held once a month on Total Care West. Once again watch for updates on the support group to be printed in the website. If you have questions about the next support group, please contact Ellen Kerr, RN at Page 34

36 Sierra Medical Center 1625 Medical Center Drive, El Paso, TX (915) Providence Memorial Hospital 2001 N. Oregon St. El Paso, TX (915) The Children s Hospital At Providence 2001 N. Oregon St. El Paso, TX (915) Sierra Providence TotalCare Center 601 Sunland Park Drive El Paso, TX (915) Sierra Providence Trawood Center 2400 Trawood Dr # 100 El Paso, TX (915) Page 35

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