from the Chairs of the Cancer Committee Jayanthi Ramadurai, M.D. & Adam Dickler, M.D.

Transcription

1 2014 ANNUAL REVIEW

2 2014 Message from the Chairs of the Cancer Committee Jayanthi Ramadurai, M.D. & Adam Dickler, M.D. It is my privilege to present the 2014 Cancer Program Annual Report for Little Company of Mary Hospital. Little Company of Mary Hospital has a state-of-the-art Cancer Center offering a holistic approach to cancer treatment healing the mind, not just the body. The Cancer Center specializes in providing personalized compassionate care with the state-of-the-art-technology. The Center, through an affiliation with the Medical Oncology Group of the University of Chicago Hospitals, brings all aspects of medical cancer care together to offer promising new treatments and continuum of care, from diagnosis through survivorship Cancer Program Highlights: The Comprehensive Breast Health Center received NAPBC accreditation and the Women s Choice Award Interventional Radiology offers Y-90 Embolization Addition of a Board Certified Fellowship-Trained Colorectal Surgeon Addition of a Breast Nurse Navigator Addition of a Clinical Research Coordinator Access to SWOG Trials made available through affiliation with Loyola Medical Center Hosted Annual Chicago Area Cancer Registrars Association Meeting Addition of a Varian TrueBeam Linear Accelerator Addition of Therapy Dog to Radiation Oncology The success of Cancer Program s accomplishments is dependent upon the continued leadership from the members of the Cancer Committee as well as the support from the physicians, nurses and staff. We remain dedicated to our mission of providing the highest quality of cancer care and anticipate even a greater success in the future. 1 Jayanthi Ramadurai, M.D. Chairman, Cancer Committee Hematologist/Oncologist Adam Dickler, M.D. Chairman, Cancer Committee Director, Radiation Oncology

3 Frequency Report Summary PRIMARY SITE Oral Cavity & Pharynx PATIENT COUNT MALE COUNT FEMALE COUNT Lip Tongue Gums and Other Mouth Salivary Glands Tonsil Oropharynx Hypopharynx Digestive System Esophagus Stomach Colon (Excluding Rectum) Rectum & Rectosigmoid Junction Anus, Anal Canal &Anorectum Liver-Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Respiratory System Larynx Bronchus and Lung Soft Tissue Soft Tissue (Including Heart) Skin (Excluding Basal & Squamous) Melanoma-Skin Breast Female Genital System Cervix Uteri Corpus & Uterus Nos Vagina Ovary Male Genital System Prostate Gland Testis Urinary System Kidney & Renal Pelvis Urinary Bladder Ureter Endocrine System Thyroid Gland Lymphomas Multiple Myeloma Myeloid & Monocytic Leukemia Unknown Primary Site Five Most Common Cancers Treated at LCMH BLADDER COLON/RECTAL PROSTATE LUNG BREAST 2

4 It Takes a Team Comprehensive Cancer Care Available at LCMH At the Cancer Center at Little Company f Mary, a full spectrum of oncology services is available under one roof. The Cancer Center is accredited by the American College of Surgeons Commission on Cancer, demonstrating that it meets rigorous standards for providing the highest quality of cancer care. Putting Patients First Experts at The Center take multidisciplinary, team approach to treating patients. Medical oncologists, surgeons, radiation oncologist and other specialists work together to determine the most effective treatment plan for patients, says Jayanthi Ramadurai, M.D., and Chair of the Cancer Committee. The Cancer Center is equipped to treat all types of tumors and blood disorders with advanced technology and targeted treatment approaches. In addition, The Center now offers patients the opportunity to participate in clinical trials in collaboration with the National Cancer Institute. These trials give patients access to promising new treatment options that they may not have otherwise been able to receive, says Susan Arnold, M.H.A., R.N., Director of Patient Care Services at LCMH. Supportive Care The Cancer Center also offers a wide range of supportive services, including acupuncture, yoga, healing touch, Reiki and guided imagery, as well as support groups and survivorship programs, all to help patients maintain their quality of life. One of the biggest advantages of coming to Little Company of Mary Hospital, says Dr. Ramadurai, is that you receive excellent oncology services in a smaller, community hospital setting, so you always feel at home. 3

5 Our Cancer Services Participating in Clinical Studies Patients at Little Company of Mary who would benefit from clinical trials have access to promising new medications and the latest therapies usually available only in a university-based hospital through the Hospital s affiliation with the Medical Oncology Group of the University of Chicago Hospitals and SWOG. Radiation Oncology Little Company of Mary offers a broad spectrum of treatment options for the management of benign and malignant tumors via radiation therapy. The Hospital has the latest in linear accelerator technology for radiation therapy all housed in The Cancer Center. As a result of advanced technology, patients at Little Company of Mary exhibit fewer side effects from radiation therapy and physicians are able to preserve more healthy tissue during a course of treatment. New technologies also enable physicians to deliver higher localized doses of radiation to better control the disease. The program is under the direction of a board-certified radiation oncologist. The process involves an initial consultation, treatment planning, treatment delivery and follow-up care. Little Company of Mary offers: CT simulation capable of producing real-time digitally reconstructed radiographs External beam radiation therapy two linear accelerators that produce high-energy X-rays Radioactive seed implants for prostate cancer radioactive isotopes are implanted directly into the tumor in the prostate gland Radiopharmaceutical injection for metastatic bone disease an intravenous therapy delivered through infusion Iodine therapy for thyroid cancer a capsule taken orally and absorbed by the thyroid tissue IMRT an advanced form of radiation that provides three dimensional conformal images customized to tumor and organ structures, resulting in less side effects and toxicities and more radiation directly to intended site IGRT Method of radiation therapy which allows imaging of a tumor and ability to adjust daily radiation beam to normal organ movement and tumor shrinkage Stereotactic Radiosurgery - Radiation procedure which produces focused high intensity beams to precisely treat small tumors like a surgeons knife MammoSite an interstitial radiation therapy that provides brachytherapy to women with breast cancer. This allows a five day course of treatment versus six weeks and minimizes side effects and toxicities of external beam radiation Surgery Little Company of Mary s board-certified surgeons provide patients with the most effective and least invasive surgical procedures. LCM s general surgeons perform many tissue-sparing procedures and use video-assisted thoracic surgery to evaluate tumors. This new procedure assists surgeons to better diagnose, stage and treat patients with cancer. 4

6 5 Our Cancer Services Interventional Radiology LCM employs two board-certified interventional radiologists, who work with a highly trained staff to offer a full spectrum of minimally invasive oncological procedures with a goal of reducing pain, side effects and recovery time. Working with a multidisciplinary team approach, the interventional radio logy staff provides care for patients with various types of malignancies. Advanced ultrasound and CT fluoroscopy equipment are used for minimally invasive procedures, including targeted chemoembolization of tumors and localized tumor 4 destruction of kidney, liver, lung and bone tumors using cryoablation and radiofrequency ablation. MRI Capabilities Little Company of Mary has an advanced 1.5T MRI System. The system delivers unmatched image quality, faster imaging times and offers non-contrast MRI for safe and accurate diagnosis. Our advanced system is so quiet, there is no ear protection necessary for maximum patient comfort. Our system offers sophisticated breast imaging capabilities and guidance for breast biopsies. Medical Oncology Board-certified hematologists/oncologists from Little Company of Mary and the Medical Oncology Group of the University of Chicago Hospitals collaborate to provide patients with the best possible care. The Hospital s Cancer Committee meets quarterly to lead and direct The Cancer Center programs. In addition, physicians and other cancer care professionals from all cancer disciplines meet weekly to confidentially review patients cases and make recommendations for follow-up and treatment. Our Medical Oncology Infusion Center is located on the second floor of The Cancer Center and includes three private chemotherapy bedrooms and eight sunlit chemotherapy treatment bays staffed by certified oncology nurses. Patients have access to two Nurse Navigators and registered nurses who provide personalized assistance along their continuum of care. Little Company of Mary Medical Oncology offers: University of Chicago Medical Oncologist consultations Chemotherapy administration A procedure room for bone marrow biopsies and lumbar punctures Blood product administration Fluid & electrolyte replacement Remicade and Reclast infusions Phlebotomy Growth factor administration Cancer Registry The Cancer Registry captures a complete summary of patient history, diagnosis, treatment and status for every cancer patient diagnosed and/or treated at The Cancer Center. Data is submitted monthly to the Illinois State Cancer Registry Database. The registry also maintains life-time follow-up on all eligible patients. The information collected is used for internal and external studies of survival and disease status, population and studies and outcomes analyses. These studies help experts develop and evaluate treatment protocols as well as monitor quality patient care.

7 Our Cancer Services Integrative Therapy Services In addition to the conventional cancer services, The Cancer Center offers a full array of integrative therapies to support patients during and after their treatments are completed (i.e., radiation or chemotherapy). Free spa services are offered consisting of massages, pedicures, facials, and reiki sessions. All are provided by licensed and/or certified individuals. Integrative Therapy Services are provided at no charge to cancer patients. The Integrative Therapy department focuses on the patient s physical, spiritual and emotional needs. Services available to patients and their families include: Support groups Community resource library Art Therapy Tai Chi Yoga Healing Touch Hypnosis Acupuncture Look Good Feel Better Nutritional Programs Guided Imagery Ellyn Rose Cronin Community Patient Resource Center Our Community Patient Resource Center is a full lending library open to the community. Pamphlets, books, brochures and Internet access are available in this spacious area. The facility is nationally recognized by the American Cancer Society as a Patient Resource Center. Educational materials are available from the American Cancer Society, National Institutes for Health and many other organizations. Genetic Counseling & Testing It is estimated that everyone carries at least 50 significant genetic alterations. As the role of genes in cancer becomes more apparent, the importance of having the services of a genetic counselor specially trained in the heredity of cancer is a growing concern. Genetic counseling allows the opportunity to improve patient care and outcomes, identify patients at risk to help save lives and provide a comprehensive approach to patient care. Little Company of Mary provides this vital service through a referral process. Inpatient Care For patients who are admitted to the Hospital, Little Company of Mary offers a full spectrum of health care services with highly skilled physicians and staff. Nurses are specially trained in oncology to handle the complex needs of cancer patients, including palliative and hospice care. Treating the Whole Person Little Company of Mary recognizes the importance of holistic health in the healing process and is responding to the needs of area cancer patients and their families, who are seeking to improve and maintain their quality of life. Ancillary support services available to patients and families include: Home-based service Home health equipment Hospice Palliative Care Nutrition services Pain and symptom management Pastoral care Physical therapy Case management Speech therapy Wound care Lymphedema Therapy 6

8 Breast Health Program Overview at Little Company of Mary Hospital Prepared By: Nancy Taft, M.D. In 2013, it was estimated by the American Cancer Society that 232,340 women would be diagnosed with breast cancer, and 39,620 were expected to die from this disease. The mortality rate from breast cancer has declined over the last decade. This is largely attributed to a combination of early detection through screening mammography and newer, more effective neoadjuvant and adjuvant therapies. Little Company of Mary Hospital, in conjunction with both employed and private practice physicians, provides a multidisciplinary approach to the treatment of women diagnosed with breast cancer. LCMH has developed a comprehensive program so that patients have access to the newest treatment modalities and clinical trials in a community hospital setting. LCMH s Comprehensive Breast Health Center, was recently awarded a three-year/ full re-accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), along with being accredited through the American College of Radiology (ACR) and has received the designation as a Breast Imaging Center of Excellence. Accreditation by the NAPBC is only given to a select few centers across the country that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. The Breast Imaging Center of Excellence designation is awarded to breast imaging centers that achieve excellence by seeking and earning accreditation in all of the ACR s voluntary breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program. As one of America s best Breast Centers, Little Company of Mary s Nationally Accredited Comprehensive Breast Health Center is headed by Dr. Nancy Taft. Dr. Taft completed a fellowship at the Lynn Sage Comprehensive Breast Center at Northwestern University, and was inducted as a Fellow to the American College of Surgeons as well as being a current member of the American Society of Breast Surgeons and the Society of Surgical Oncology. Additionally, she is a Lieutenant colonel in the U.S. Army Reserves and has served our country in Afghanistan. 7 The surrounding community supports the comprehensive breast center with a generous donation after their annual breast cancer walk. With their support it allowed for expansion of free integrative therapy programs for cancer patients at LCMH, as well as the purchase of Little Company of Mary s two digital mammography systems and implementation of clinical trials. The donations allowed for the addition both a breast nurse navigator, Cara McGuire B.S.N., R.N., and a research coordinator position to the team, who will exclusively assist all of the hospital s breast cancer patients from diagnosis through survivorship.

9 In 2013, there were 58 new breast cancer patients treated in the breast center at LCMH, which resulted in 81 surgical procedures. This consisted of: 38 Lumpectomies 22 Mastectomies 11 Port placements 4 Sentinel node/axillary node dissections 4 re-excisions 2 scar revisions These met the NAPBC criteria for the breast conservation rate, sentinel node biopsy rate, needle biopsy rate, reconstructive surgery referral rate, lumpectomy treated with radiation rate and medical oncology treatment services. Standard LCMH NAPBC Standard 2.3 Breast Conservation Rate: A portion of at least 50% of all patients with early Stage Breast CA (0, I, or II) are treated with BCT 63% 50% Standard 2.4 Sentinel Lymph Node Biopsy Rate: Axillary Lymph Node biopsy is considered or performed for patients with early stage breast cancer (Stage I &II) 100% 100% Standard 2.6 Breast Cancer Staging: Clinical staging is detailed on all H&P, Pre-op note, and surgical reservation; Pathological staging is detailed on all cancer pathology results. 100% 100% Standard 2.9 Needle Biopsy Rate: Palpation guided or image guided biopsy is the initial diagnostic approach rather than open biopsy. 100% 90% Standard 2.18 Reconstructive Surgery Referral Rate: All appropriate patients undergoing mastectomy are offered a preoperative referral to a reconstructive/ plastic surgeon. 100% 100% Standard 2.12 Lumpectomy with Radiation Therapy: Radiation Therapy is administered within ONE year of DX for women under the age of 70 receiving BCT. 100% >90% Standard 2.13 Medical Oncology Treatment Services: Combination Chemotherapy is considered or administered within 4 months, 120 days, of DX for women under the age of 70 with AJCC T1c, Stage II, or III, hormone receptor negative breast cancer. 100% >90% Standard 2.13 Medical Oncology Treatment Services: Tamoxifen or 3rd Generation Aromatase Inhibitor is considered or administered within 1 year of DX for women with AJCC T1c, Stage II, or II hormone receptor positive breast cancer. 100% >90% 8

10 The breast program does two new quality studies every year, to both maintain the NAPBC certification, as well as to look for opportunities to improve the quality and delivery of care and services. In 2013, data was collected which looked at the time from a screening mammogram to biopsy, and the time from the biopsy to pathology results. The initial data revealed that the time from a screening to diagnostic mammogram was an average of 15.4 days, and the time from a diagnostic mammogram to a dictated pathology report was an average of 18.8 days. The time from biopsy to pathology report was an average of 1.7 days. It was also identified during this process that diagnostic mammograms were not consistently being read by the radiologist prior to the patient leaving the department. After the data was presented, a committee lead by Jennifer Murphy, the manager of the mammography department, did an in-depth analysis in which the root causes of the problem were predicted and identified. As a result, corrective actions were taken. There was a revision of the mammogram appointment time slots and daily monitoring of unscheduled biopsies needing to be scheduled. An additional radiologist was hired to help with reading the screening and diagnostic mammograms. There was a shift of the screening mammograms to the outpatient care center freeing the machines at the hospital for more appointment slots for diagnostic mammograms and biopsies. Block time was instituted on Tuesdays and Thursdays for diagnostic mammograms and biopsy procedures. Throughout all of these changes, there was a focus on improved and more consistent communication between the staff and involved physicians. Preliminary results showed a wait time reduced from 15 to 9 days, with a 39.6% reduction for scheduling diagnostic mammograms and biopsies. This has also facilitated more flexibility for patients to get additional imaging and biopsies on the same day they are seen by Dr. Taft in the breast clinic. Although this is a great improvement in delivery of care, resulting in increased patient satisfaction, we continue to work to improve in these areas. The second area of focus was developing a lymphedema program. Two of our physical therapists completed their lymphedema certification. Our breast nurse navigator identifies patients who will be undergoing surgical procedures which include either a sentinel node biopsy or an axillary node dissection, and refers these patients for teaching and evaluation prior to surgery. Studies have shown many advantages to the successful management of lymphedema using pre-operative limb volume measurement and interval post-operative follow up evaluations. This has not only led to earlier detection, but also to decrease anxiety associated with this procedure. As new therapies continue to evolve and survival rates continue to improve, we remain committed to work in multidisciplinary collaboration between the fields of surgery, radiology, pathology, and medical and radiation oncology. These services are enhanced and supported by our physical therapy lymphedema therapists, comprehensive integrative therapy staff, breast nurse navigator and clinical trial coordinator. The breast program here at LCMH provides state of the art comprehensive breast care to the residents here in the surrounding communities. 9

11 S Harlem Avenue Tri-State Tollway Narragansett Ave Ridgeland Ave 1. Little Company of Mary Hospital 2800 West 95th St., Evergreen Park, IL Mary Potter Physicians Pavilion 2850 West 95th St., Evergreen Park, IL Physician Offices, Lab, EKG, X-ray, Bone Density, Speech Therapy, Pharmacy 3. Burbank Medical Center 4901 West 79th St., Burbank, IL Physician Offices, Lab, EKG 4. Oak Lawn Care Station (East) 5660 West 95th St., Oak Lawn, IL Immediate Care, Lab, EKG, X-ray, Occupational Medicine and Physician Offices 5. LCMH Home Based Services 9800 Southwest Highway, Oak Lawn, IL Home Health Care, Hospice and Mobile Medical Care W 79th Street W 87th Street W 103rd Street W 111th Street W 127th Street Pulaski Road SW SW Highway Highway EVERGREEN PARK W 95th Street Central Avenue W 83rd Street 3 Cicero Avenue 12 Kedzie Avenue 10 California Avenue 6. Outpatient Care Center _ Care Station (West) 6700 West 95th St., Oak Lawn, IL Immediate Care, Lab, EKG, X-ray, Mammography, Ultrasound, CT, MRI, PET/CT, Echo, Physician Offices, Pharmacy 7. Diagnostic Center S. Harlem Ave., Palos Heights, IL Lab, EKG, X-ray, Ultrasound, Echo, Treadmill, Holter Monitor 8. Palos Medical Center S. Harlem Ave., Palos Heights, IL Physician Offices 9. Southwest Hospitals MRI Center 5550 West 111th St., Oak Lawn, IL MRI, Ultrasound Western Avenue Ashland Avenue W 79th Street W 83rd Street 57 Vincennes Avenue Halsted Street Vista Family Medicine S. Kedzie Ave., Chicago, IL Physician Office 11. Halsted Medical Center 736 West 95th St., Chicago, IL Lab, EKG, X-ray, Physician Offices 12. Heritage Building 2800 W. 87th St. Chicago, IL (billing) How to Make an Appointment If you have any questions about The Cancer Center, would like cancer information or a tour of the facility, please call If you would like to find a cancer specialist on staff at Little Company, please call Physician Match at About Little Company of Mary The health care facilities are owned and operated by the Sisters of the Little Company of Mary. Since 1930, Little Company of Mary has been a community-based hospital providing advanced medical technologies in a friendly, compassionate environment. In solidarity with the Sisters of the Little Company of Mary, we are entrusted to serve the community through our ministry of Catholic health care. We are the empowered laity the Greater Company of Mary. Rooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity. We strive to live our core values: professionalism, compassion, quality and responsibility. Location and Parking Little Company of Mary has ample free parking for visitors, convenient to the hospital. We have three lots to the east, two lots to the north and one lot west of the hospital. We also have complimentary valet parking available for cancer patients. 10