CATHOLIC MEDICAL CENTER 2006 CANCER PROGRAM SUMMARY

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1 INTRODUCTION: The Catholic Medical Center s Mission is as follows: The heart of Catholic Medical Center is to provide health, healing and hope to all. We offer innovate, quality health care in a compassionate environment, built on trust and respect The Cancer Committee at the CMC strives not only to uphold CMC s Mission, but also to maintain the highest standard of care by initiating programs of ongoing quality assessment and improvement. In 2006, the Cancer Program at Catholic Medical Center (CMC) underwent another successful survey by the American College of Surgeons (ACoS) Commission on Cancer (COC) receiving a three year approval with commendation. CANCER COMMITTEE ACTIVITIES In 2006, the cancer committee reviewed the annual goals and objectives and set new ones for the year. Four coordinators were appointed as outlined in the standards. Each coordinator is designated for the four main areas of cancer care activity: cancer conference, quality control of cancer registry data, quality improvement, and community outreach PROGRAM ACTIVITIES Clinical Cancer Conferences: The multidisciplinary Clinical Cancer Conference was held monthly at CMC. These conferences involve prospective case discussions and are integral in improving the care of cancer patients by contributing to the management process and outcomes, as well as providing education to the physicians and other staff in attendance. There were 90 cases presented or 20% of our annual caseload. Major sites discussed were lung, breast, colorectal, prostate, lymphoma and several unusual cases as they were diagnosed. The average attendance at conference was with all the major medical disciplines being represented. Professional Education: Four Grand Rounds were held at CMC on topics related to cancer diagnosis, treatment or supportive care. The topics presented were: Endoscopic Ultrasonography, Stuart Gordon, MD Dartmouth-Hitchcock Medical Center, Genetics of Breast Cancer: From Theory to Practice, Katarzyna J. Bloch, Dartmouth-Hitchcock Medical Center, General Radio Frequency Ablation Kidney, Brian Lucey, MD, Boston VA Medical Center, Pet C/T, Marc Seltzer, MD, Dartmouth-Hitchcock Medical Center These educational conferences are open to the medical staff and allied health professionals. Robot-Assisted Surgery: The number of urologic cancer patients treated at CMC continued to grow as John Munoz, MD continued use of the da Vinci Robotic Surgical System. In addition, William Selleck, MD has been trained in the use of the da Vinci Surgical System. In 2006, of the 133 prostate cancers, 126 laparoscopic robot-assisted radical prostatectomies were performed. In addition, 4 other robot-assisted surgeries were performed for other urinary tract cancers. New Hampshire Oncology: New Hampshire Oncology continued to offer CMC patients a variety of clinical research programs in breast, lung and colorectal cancer prevention and treatment through

2 participation in the National Cancer Institute sponsored CALBG protocols. Cutting edge medications and treatments were made available through partnership with the pharmaceutical industry as well. Sixteen CMC patients were entered on research protocol trials in 2006 or 3.56% of our analytic caseload. Quality Assurance and Improvements Enhancements: Nutrition Program for Oncology Patients developed. Comfort Care program developed to include Pain Management and Palliative Care. Initiated a Hospital Partnership with American Cancer Society to work together on programs from both CMC and ACS. Additional Digital Mammography Unit added to Breast Care Center. Oncology Brochure developed for CMC to heighten patient awareness of what services are offered at CMC. Increased participation in Smoking Cessation Programs. Radiofrequency Ablation Service started. Studies: Cancer Wellness: Performance status and follow up study conducted. CAP Protocol Compliance with T and N Staging Documentation. Management of patients with Stage III Lung Cancer. (See report in Appendix B) Follow up study regarding decreasing time from diagnosis of breast cancer to start of definitive treatment. Review of compliance of physician staging after new procedures developed. Community Wellness Services: Education, Screening and Prevention Programs Funding was renewed for The Breast and Cervical Cancer Screening program; other screenings included oral cancer and prostate screening. Community based educational programs addressed a variety of wellness topics including women s health topics, colon cancer education, nutrition and healthy eating, smoking cessation programming for both the community and CMC, etc. Our school based programming focuses on maintaining a healthy weight through exercise and nutrition in our three partnership schools. In association with the American Cancer Society, CMC participated in the Great American Smokeout, Daffodil Days, and the Taking Strides against Breast Cancer walk. Breast Health Center: The center saw an increasing number of clients since its opening. A second digital mammography unit and an upright stereotactic unit were added to enhance the capabilities of the center. A study was conducted looking at decreasing the time from diagnosis of breast cancer to the initiation of treatment and a cancer support group was added. Oncology Exercise Program: The exercise program specifically for cancer patients under the direction of Janet Troski, MSN, RN, and Director of Cardiovascular Wellness has been well received by the participants. A patient satisfaction survey was conducted which confirmed the benefits of the program to the patient. 2

3 THE REGISTRY The cancer registry serves as a foundation of Quality Assessment and Improvements. The registry is staffed with a full time Certified Tumor Registrar and a part-time Registry Assistant who work closely with other members of the cancer care team to ensure that quality management studies and program enhancements are conducted throughout the year. CMC s cancer registry has been in existence for over 30 years. There are 5,853 cases in the registry since our reference date of January 1, 1990 of which 5,653 are analytic cases. We have been able to follow 90% or greater of the individuals, which exceeds the American College of Surgeons, Commission on Cancer expected standard of 80%. The CMC cancer registry submits data to the New Hampshire State Cancer Registry as well as the COC National Cancer Database (NCDB). Cancer is a reportable disease by federal law. The state registry was formed to look for cancer clusters and to monitor the incidence of various cancers in the regions of NH. These trends in cancer incidence are then reported to the Center for Disease Control (CDC). The NCDB allows individual institutions to compare their patterns of care with those of other like institutions throughout the United States. CMC s registry data are rigorously monitored for accuracy by several means. A physician advisor who is a member of the cancer committee reviews a sample of abstracts for accuracy entered by the registry staff. This process also monitors the completeness and accuracy of physician staging of the cases as mandated by the COC. The use of the College of American Pathologists or CAP protocols also assures uniform staging of cancer and accuracy of registry data. Lastly, the data are processed through the GENEDITS program provided by the North American Association of Central Cancer Registries (NAACCR). This program further monitors the integrity of the data. This year data submitted to the NCDB had 100% accuracy. For the number and distribution of these cases diagnosed in 2006, see Appendix A. NEW PROGRAMS Goals for 2007 include: Construction of new surgical suite: Construction was started on a new 10 room, state-of-the-art surgical suite to be opened in the fall of New Medical Office Building and Parking Garage: Construction is underway for a new medical office building to include new laboratory services and parking garage across McGregor St. from the main entrance of the hospital. A walkway bridge will connect the two buildings. Collaboration with the American Cancer Society: Plans are underway to enter into a formal agreement with the American Cancer Society. Cancer Services Brochure: The cancer committee has decided to develop a brochure highlighting the oncology services available at CMC. 3

4 Palliative Care Consult Services: A multidisciplinary team has been developed to work with patients, family members, and staff in regards to Palliative Care. The goal is to work with these patients early in their diagnosis and prepare the patient, family members and staff for Hospice Care. Many areas of Hospice Care can be addressed with any of the members of the team. The program is known as the Comfort Care Team. Standing orders for comfort care were developed for use on all the nursing units. Radio Frequency Ablation: Radiologist David Fontaine became certified to offer Radio Frequency Ablation Services at CMC. CONCLUSION In 2006, the Cancer Program at Catholic Medical Center has continued its dedication to provide state-of-the-art cancer care to the communities it serves. The Cancer Program spans the past 36 years and will continue provide the highest quality of cancer care in the region. With the opening of the new Breast Care Center in the spring, CMC offers the latest in state-of-the-art diagnostic equipment. The continued educational and community outreach programs are in keeping with CMC s mission of providing health, healing and hope to all Cancer Committee Members Denis Hammond, MD, Chairman Hematology/Oncology Donna Bennett, IRB, Administrative Liaison Jeffrey Butler, RHIA, HIS Connie Campbell, MD, Surgery Patricia Dillon, RN, Quality Management Charlene Forcier, RN, Director, Palliative Care Program Shirley Foret, CTR, Cancer Program Coordinator Eric Landis, MD, Medicine/Radiology Tina Legere, VP, Patient and Physician Support Services Janet Maher, RN, Breast Health Specialist Paula Mahon, MD, Family Practice Andrea McKee, MD, Radiation Oncology Paul Mertzic, Director, RN, MS Community Health & Wellness Eric Sheffer, MD, Surgery/Pathology Janet Troski, Community Wellness Georgelyn Wizner, LICSW, Director Social Services Joseph Pepe, MD, Ex-Officio President Medical Staff Keith Stahl, MD, Ex-Officio Medical Director John Munoz, MD, COC Liaison Urology/Surgery 4

5 Appendix A Number and Distribution of Case in the Cancer Registry In 2006, 459 new cases of cancer were diagnosed at CMC or newly diagnosed patients received part or all of their first definitive treatment at CMC. These are called analytic cases. In addition, 36 nonanalytic cases were reported to the NHSCR. Non-analytic cases are those cases that were diagnosed and had all the first course of treatment elsewhere, then came to CMC for recurrence/progression of disease. Graph 1 illustrates the distribution of cases by county. CMC 2006 Cancer Cases by County Belknap, 3 Coos, 2 All others, 9 Merrimack, 12 Rockingham, 13 Hillsborough, 61 Hillsborough Rockingham Merrimack Belknap Coos All others The five most common sites of newly diagnosed cancer in order of greatest frequency seen at CMC in 2006 were prostate (29%), lung (17%), breast (%), colorectal (11%), and urinary tract (6%). According to the American Cancer Society s Cancer Facts and Figures 2006, CMC frequency distribution of cancer differs slightly with the state and national distribution which is illustrated in Graph 2 5

6 Percent CATHOLIC MEDICAL CENTER CMC 2006 Top Five Cancer Sites Compared with State and National CMC STATE NATL Prostate Bronchus/lung Breast Colorectal Bladder Site Colorectal, prostate and breast cancers can be detected at early stages through screening programs. Colonoscopies are used as a screening tool in detecting early colorectal cancer. In prostate cancer, the blood test, Prostatic Specific Atigen (PSA) is used as a screening tool as well as a digital rectal exam (DRE). The screening for breast cancer includes but is not limited to imaging such as mammograms, breast self-exam (BSE) and physical exams by the patient s physician. Lung and bladder cancers cannot be detected by any screening process. The Staging of Cancer is used in treatment strategies and determining prognosis. The American Joint Committee on Cancer (AJCC) Cancer Staging is used world-wide. For the top 5 sites of cancer seen at CMC in 2006, the stage at diagnosis is illustrated in Graph CMC Top Five Cancer Sites by AJCC Stage* Stage 4 Bladder, 19 Colorectal, 14 Breast, 3 Bronchus/Lung, 24 Prostate, 4 Stage 3 Stage 2 Bladder, 0 Colorectal, 20 Breast, 7 Prostate, Bladder, 1 Colorectal, 12 Breast, 13 Bronchus/Lung, 5 Bronchus/Lung, 33 Prostate, 81 Bladder Colorectal Breast Bronchus/Lung Prostate Stage 1 Prostate, 0 Bladder, 25 Colorectal, 14 Breast, 43 Bronchus/Lung, 32 Stage 0 Bronchus/Lung, 0 Prostate, 0 Bladder, 31 Colorectal, 33 Breast, Percent References: American Cancer Society Cancer Facts and Figures 2006; AJCC Cancer Staging Manual Sixth Edition; American College of Surgeons Commission on Cancer, National Cancer Data Base 6

7 Appendix B CATHOLIC MEDICAL CENTER STAGE 3 NON SMALL CELL LUNG CANCER QUALITY IMPROVEMENT STUDY Denis Hammond, MD, Chairman, Cancer Committee; David Charlesworth, MD, Cardiothoracic Surgery, Shirley Foret, CTR, Cancer Program Coordinator The incidence rate in lung cancer is declining significantly in men since 1984 and for women, the rate decreased for the first time in Lung cancer is the leading cause of cancer related deaths in both men and women, accounting for about 28% of all cancer deaths in 2004 and about 29% anticipated in More women die each year from lung cancer than from breast cancer. Cigarette smoking is the most important risk factor for lung cancer. Other risk factors include second hand smoke and occupational or environmental exposures. It is felt that the decreasing lung cancer incidence and mortality rates reflect the decreased smoking rates over the past 30 years. Treatment options are determined by the cell type and the stage (extent) of the disease at the time of diagnosis. Recent studies show that survival can be improved by the use of multimodality treatments with the use of chemotherapy and/or radiation therapy in combination with surgery. Due to improved surgical techniques and combined therapies, a 1-year survival relative survival rate for lung cancer has increased from 37% in 1975 to 42% in However, the 5 year survival rate for all stages combined is only %. For localized disease at diagnosis, the survival rate is 49% with only 16% of lung cancer cases being diagnosed at this stage. The observed survival rate for the Catholic Medical Center s 2000 Stage I Non Small Cell Lung Cancer from 2000 was 73%. The observed survival rate for Stage II was 33%. The numbers are small so the statistical significance is questionable. The Catholic Medical Center (CMC) Cancer Committee chose to look at Stage III Non-Small Cell Lung (NSCL) Cancer to evaluate changes in the stage at presentation and changes in treatment approaches. In comparing CMC Stage III NSCL Cancer with like hospitals reporting the Commission on Cancer (COC), National Cancer Data Base (NCDB), in 2004, 33% of the NSCL CMC cases presented at Stage 3 compared with 25% like hospitals nationwide contributing data to the NCDB. In 2000, the percent of Stage 3 cases seen at CMC was 21% compared with NCDB data of 34%. Multimodality treatment has been offered at CMC from early on by referral for radiation and chemotherapy to local and regional tertiary facilities. 7

8 YEARS CATHOLIC MEDICAL CENTER CMC ANALYTIC STAGE III NSCL CANCER BY TREATMENT NUMBER S C R RC SRC SR SC O comb None TREATMENT S=surgery R=Radiation C=Chemotherapy There does seem to be a trend toward involving use of chemotherapy in vs From , the ratio of males to females with NSCL Cancer has changed to replicate the national findings. CMC ANALYTIC NSCL CANCER MALE/FEMALE RATIO Female Male NUMBER In 2004, comparing the stage at presentation of CMC data with NCDB about one third of the cases presented at Stage I. This may well be due to the fact that many patients entered through the NE Heart Institute and during work up were found to have an early stage lung cancer. 8

9 CMC ANALYTIC 2004 NSCL CANCER STAGE AT DIAGNOSIS COMPARED WITH NCDB DATA PERCENT CMC NCDB I II III IV UNK STAGE 0 Conclusions: The diagnosis and treatment of NSCL Cancer at CMC has followed the national trends. In reviewing the data, the ratio of males to females has changed from more males with lung cancer to equal in numbers in the later years. Treatment options have changed, leading away from surgery alone to the option of combination chemo/radiation sometimes in combination with surgery. It is noted that there remain cases where no treatment was given. In some cases this would be patient/family choice or due to co-morbid conditions. References: American Cancer Society: Cancer Facts and Figures, ; American College of Surgeons: National Cancer Data Base For more information about the Cancer Program and the Cancer Registry at Catholic Medical Center, please call Charlene Forcier, RN at or Shirley Foret, CTR at