PARKVIEW CANCER 2014 ANNUAL REPORT

Transcription

1 PARKVIEW CANCER 2014 ANNUAL REPORT

2 DISCOVER WHAT QUALITY CARE TRULY FEELS LIKE. CANCER COMMITTEE Physicians David Trenkner, MD, Chair, Radiation Oncology Associates Sreenivasa Nattam, MD, Vice Chair, Fort Wayne Medical Oncology & Hematology Sean Garrean, MD, Cancer Liaison Physician, Parkview Physicians Group Colon & Rectal Surgery Douglas Gray, MD, FACS, Parkview Physicians Group Cardiovascular Surgery Richard Kelty, MD, Parkview Physicians Group Family Medicine Seung Soo Kim, MD, Allied Hospital Pathologists Albert Morrison, MD, Summit Plastic Surgery Clevis Parker, MD, HMA, FAAFP, ABHPM Medical Director, Palliative Care, Home Health & Hospice, Parkview Health William Petty, MD, FWRadiology Stephen Schreck, MD, ENT Specialists Donald Urban, MD, FACS, Parkview Physicians Group Urology Community Representatives TJ Krasen, Community Program Representative, Great Lakes Division, Inc., American Cancer Society Gail Hamm, LCSW, OSW-C, Cancer Services of Northeast Indiana

3 TABLE OF CONTENTS 4 CANCER CARE OF THE HIGHEST QUALITY 6 LUNG CANCER QUALITY STUDY 13 PALLIATIVE CARE QUALITY STUDY 18 COMMUNITY OUTREACH 20 REAL LIFE STORIES 23 PRIMARY SITE TABLE Parkview Staff Amber Vachon, Quality Management, Parkview Health I Jill Branning, RHIT, CTR, Cancer Registrar/QA Coordinator I Jean Dyben, RN, OCN, Nursing Manager, Radiation Oncology I Nancy Ehmke, RN, MN, AOCN, Oncology Clinical Nurse Specialist I Kathryn Felts, RN, MSN, ACHPN, Palliative Care/ Hospice I Rae Gonterman, Senior Vice President, Parkview Health Cancer Service Line I Heather Hicks, BSN, BS Biol, AS Chem, Quality/Accreditation Specialist I Breck Hunnicutt, RN, Clinical Research Coordinator I Debi Kennedy, Community Outreach Coordinator I Gail Keuneke, RN, BSN, CCM, HIA, Nurse Navigator I Jackie Kintz, RHIT, CTR, Cancer Registrar I Melissa Mishler, RHIT, CTR, Cancer Registrar I Mara Fisher, Tumor Board Coordinator I Gail Place, RN, OCN, Oncology Nursing Manager I Julie Wilkens, RT (R) (T), Technical Manager, Radiation Oncology This annual report was published in December It describes activities from throughout the year and reports 2013 Cancer Registry data.

4 CANCER CARE OF THE HIGHEST QUALITY Providing care for individuals with cancer not only includes high-quality, effective clinical care, but it also includes providing support for patients and their families through many different avenues, each focused on meeting the needs of our patients and their families. David Trenkner, MD Radiation Oncology Associates, Parkview Cancer Committee Chair Rae Gonterman Senior Vice President, Parkview Health Cancer Service Line Parkview Comprehensive Cancer Center s mission is to prevent, treat and cure cancer through medical excellence and compassionate, patient-focused care. Our team of expert physicians and specially trained staff work collaboratively with our patients and their families to accomplish this mission. Providing care of the highest quality is extremely important to all members of our team. In fact, we have included in this publication information on two of this year s quality studies. Research is also an important part of cancer care. Patients at Parkview Comprehensive Cancer Center have access to more than 60 research protocols, including a research study that examines the needs of cancer survivors. Endoscopic Oncology Clinic Our cancer team focuses on many areas at Parkview. For example, much progress continues in the area of endoscopic oncology. Neil Sharma, MD, Parkview Physicians Group Gastroenterology, leads a team of multidisciplinary clinicians to provide diagnosis, staging, treatment planning and supportive care for patients with liver, pancreatic and esophageal cancers. Through our endoscopic oncology clinic, patients cancers are identified and staged. The case is presented 4 I Cancer care of the highest quality

5 CANCER CARE OF THE HIGHEST QUALITY continued at a multidisciplinary Tumor Board where physicians of numerous cancer specialties meet to review the case and determine the best treatment for the individual based upon national, best-practice guidelines. Patients are then scheduled for a clinic visit where they meet with Dr. Sharma, a patient navigator, dietician and social worker, according to their individual needs. The patient navigator is then available to assist patients throughout their journey and connect them to appropriate resources. Outpatient Palliative Care Another service now available for cancer patients, and any individual experiencing a significant illness, is our Outpatient Palliative Care Clinic. Clevis Parker, MD, HMA, FAAFP, ABHPM, medical director, Parkview Home Health & Hospice is a certified Palliative Care physician and a member of Parkview Physicians Group. Dr. Parker and his team assist patients with pain control, symptom management and supportive care services. The goal is to help individuals maintain as high a quality of life as possible during their treatment and ongoing care. More information about this program and a corresponding quality study is provided within this annual report. information about this program and quality study can be found within this report. Early detection and treatment is key to cancer survivorship. We also focus on providing ongoing support for patients and families as they go through their cancer journeys. Several support groups are offered at Parkview in an effort to meet the needs of individuals who are currently going through cancer treatment or are in the survivorship part of their journey. Support groups for breast cancer, prostate cancer and leukemia/lymphoma, as well as a supportive care workshop that focuses on providing support, education and resource materials to cancer patients and caregivers, are available. Parkview s Healing Arts program provides art, music, and movement therapy for our patients and caregivers. Providing care for individuals with cancer not only includes high-quality, effective clinical care, but it also includes providing support for patients and their families through services such as patient navigation, nutritional counseling, genetic counseling, social work support and a survivorship program. Each service is focused on meeting the needs of our patients and their families. Community Outreach Community outreach continues to be a focus for Parkview Comprehensive Cancer Center. Through the first nine months of 2014, more than 4,000 individuals were reached with education and screening opportunities. In addition, Francine s Friends Mobile Mammography program served nearly 3,000 women (as of September 30, 2014), and Parkview s SmartLung CT lung screening program screened 114 individuals between its implementation in August 2013 and September 1, More Cancer care of the highest quality I 5

6 LUNG CANCER QUALITY STUDY > 25.6% of adult Hoosiers smoke cigarettes > Indiana is 1 of 13 states with a higher lung cancer diagnosis rate > CT screening for high-risk current and former smoking patients contributed to a 20% lower incidence of cancer-related deaths Douglas Gray, MD, FACS Parkview Physicians Group Cardiovascular Surgery Lung cancer remains the leading cause of cancer death in the United States in both men and women. Indiana is one of 13 states with a higher lung cancer diagnosis rate, equating to 68.7 to 93.1 per 100,000 people with a diagnosis of lung cancer. In January 2014, the American Cancer Society reported that 430,090 people were living with lung cancer in the United States. It was projected that another 224,210 people will be newly diagnosed with lung cancer before the year s end. The latest data from the Centers for Disease Control showed that 25.6 percent of adult Hoosiers currently smoke cigarettes, leading Indiana to be the 45th state with the highest smoking rate. Cigarette smoking is a primary risk factor in developing lung cancer and, at Parkview, we are committed to raising awareness about this disease. In addition to smoking cessation education, we now offer innovative screenings and advanced treatment options with the goal of improving health outcomes and survival rates of lung cancer. The best prognosis for lung cancer is early detection and early treatment. In 2011, the National Lung Cancer Screening Trial found that low-dose CT screening for high-risk current and former smoking patients has contributed to a 20 percent lower incidence of lung cancer-related deaths. This led to the endorsement of low-dose lung CT screenings for high-risk individuals by the United States Preventive Services Task Force in I Lung cancer quality study

7 LUNG CANCER QUALITY STUDY continued Along with the implementation of the SmartLung CT screening program, Parkview also developed a pilot process for a Lung Nodule Clinic where patients can be referred for prompt diagnostic evaluation of a lung nodule following NCCN guidelines. While surgical resection remains the primary treatment for confirmed lung cancers of stages I, II and IIIA, a multidisciplinary approach is utilized so that each patient receives care focused on their specific needs. A nurse navigator is available to assist patients as they go through the treatment process. The communication and collaboration between pulmonologists, cardiovascular surgeons, radiologists, pathologists, radiation oncologists, medical oncologists, nurse navigators and other support team members, have led to this program s initial success. Sai Ganesh Yarram, MD Radiologist, FWRadiology, Medical Director, Diagnostic Imaging, Parkview Regional Medical Center With early detection and early treatment being so important in the overall survival of lung cancer, Parkview s Cancer Committee identified lung cancer as being one of our Quality Studies for The goal of this study was to evaluate the length of time between pathological diagnosis of lung cancer and initiation of treatment. Taking a multidisciplinary approach, Parkview Health implemented a SmartLung CT screening program in September 2013, making low-dose lung CT screenings available to high-risk patients at eight of its facilities throughout northeast Indiana. Based on the screening guidelines from the National Comprehensive Cancer Network (NCCN) and the United States Preventive Services Task Force, Parkview s SmartLung CT program aims to: > Identify lung cancer earlier in high-risk individuals > Decrease the time from symptoms or initial presentation to first day of cancer treatment > Ultimately increase the survival rate of our lung cancer patients A nurse navigator is available to assist patients as they go through the treatment process. The communication and collaboration between pulmonologists, cardiovascular surgeons, radiologists, pathologists, radiation oncologists, medical oncologists, nurse navigators and other support team members, have led to this program s initial success. One hundred and eight patients were randomly selected from a population of 1,701 patients with a lung diagnosis code in their medical record between January Lung cancer quality study I 7

8 LUNG CANCER QUALITY STUDY continued > Gaps in documented care > Diagnosis and initiation of treatment during an inpatient hospitalization > History of lung cancer and new diagnosis is recurrent The data revealed that prior to the implementation of the SmartLung CT screening program and the Lung Nodule Clinic, the average time from initial lung cancer pathological diagnosis to day one of cancer treatment (surgery, radiation or chemotherapy) was 40.6 days. Eric Peterson, MD Parkview Physicians Group Pulmonary & Critical Care 2012 and September Of these 108 patients, 50 patients were included in the final sample to determine the number of days from initial pathological lung cancer diagnosis to cancer treatment day one. The exclusion criteria for the study were: > Different primary cancers leading to lung cancer The second phase of the quality study included a review of lung cancer cases identified through the SmartLung CT screening program and/or the Lung Nodule Clinic between September 1, 2013, and September 1, Two of the 114 SmartLung CT screening patients were identified with a lung cancer, and six other patients were referred to the Lung Nodule Clinic for evaluation of a suspected lung cancer. The review of these eight cases demonstrated the average time from initial lung cancer pathological diagnosis to day one of cancer treatment was 22.4 days, which is a decrease of 18.2 days from the cases studied prior to the implementation of the SmartLung CT screening and the pilot of the Lung Nodule Clinic. While the time from diagnosis to initial lung cancer treatment improved, we will continue to monitor this process for further improvement opportunities. XPERTISE UCATION UALITY HEALTH ITY IVE CONNECTED COMMUNITY LOGY EING LTH CTED ITY OMMUNITY TECHNOLOGY EALTH EXPERTISE HEALTH QUALITY CONNECTE COMMUNITY TECHNOLOGY ION ITY

9 LUNG CANCER QUALITY STUDY continued In 2013, The Institute of Medicine identified a provision of high-quality cancer care that is available and affordable to all as one of its six goals for cancer care improvement recommendations. Similarly, Parkview places a high priority on providing bestpractice, evidence-based care for all our patients. The Lung Cancer Quality Study was one means of identifying our current state and then focusing on process improvements to promote the importance of early detection and prompt treatment based upon national, best-practice guidelines. Heather Hicks, BSN, BS Biol, AS Chem Quality/Accreditation Specialist, Parkview Comprehensive Cancer Center References: American Cancer Society (2014). Cancer treatment and survivorship [Facts & figures, ]. Center for Disease Control (2011). Lung and bronchus cancer incidence rates by states. Retrieved from cancer/lung/statistics/state.html. Institute of Medicine (2013). Delivering high quality cancer care: Charting a new course for a system in crisis. National Comprehensive Cancer Network (2014). NCCN guidelines for patients: Lung cancer screening. National Lung Screening Trial Research Team (2011). Reduced lungcancer mortality with low-dose computed tomographic screening. New England Journal of Medicine, (365) US Preventative Services Task Force (2013). Screening for lung cancer clinical summary of the U.S. Preventative task force recommendation. Retrieved from lungcanfinalrs.pdf. Retrieved from screening/files/assets/common/downloads/files/lung_screening.pdf D TISE ATIVE EDUCATION COMMUNITY EXPERTISE INNOVATIVE HEALTH CONNECTED COMMUNITY WELL-BEING HEALTH QUALIT HEALTH EDUCATION ED ITY IVE CONNECTED COMMUNITY W LOGY

10 LUNG CANCER QUALITY STUDY continued SmartLung Low-Dose Lung CT Screening September 1, 2013 to September 1, 2014 Number of Individuals Screened = 114 Two of the 17 patients with > 6mm nodules on their SmartLung CT screening were diagnosed with lung cancer through immediate follow-up testing. Thirty-two patients with < 6mm nodules were monitored according to established protocols. Four patients were identified as having a nodule that did not need further follow-up based upon comparison with previous studies. Nodules > 6mm Nodules < 6mm No Nodules Benign 3% 4 patients 15% 17 patients 28% 32 patients 54% 61 patients 10 I Lung cancer quality study

11 LUNG CANCER QUALITY STUDY continued Lung Cancer Diagnosis to First Cancer Treatment (January 1, 2012 to September 1, 2013) Lung cancer patients Days from initial lung cancer diagnosis to first cancer treatment (average 40.6 days) Lung cancer quality study I 11

12 LUNG CANCER QUALITY STUDY continued Lung Cancer Diagnosis to First Cancer Treatment September 1, 2013 to September 1, /6 Lung Nodule Clinic patients and 2/114 SmartLung CT screening individuals were diagnosed with lung cancer between September 1, 2013, and September 1, Five of the eight patients decided to move forward with treatment for their lung cancer. 24 Lung cancer patients Days from initial lung cancer diagnosis to first cancer treatment (average 22.4 days)

13 PALLIATIVE CARE QUALITY STUDY Clevis Parker, MD, HMA, FAAFP, ABHPM Medical Director, Palliative Care, Home Health & Hospice, Parkview Health, Parkview Physicians Group Palliative Care Patients with advanced diseases and multiple chronic illnesses deserve excellent symptom management and care surrounding the impact their disease has on their lives, as well as on the lives of their families. Treating the whole person, and not focusing specifically on one particular organ system, has been shown to be the most satisfying type of care when compared to traditional methods. The field of palliative care was developed to address the needs associated with advanced disease and chronic illnesses and their impact on patients and their families. The Center to Advance Palliative Care defines palliative care as specialized medical care for people with serious illnesses. Palliative care practitioners focus on providing patients with relief from pain, symptoms and stress associated with serious illnesses whatever Palliative care quality study I 13

14 PALLIATIVE CARE QUALITY STUDY continued the diagnosis. The goal of palliative care is to improve the quality of life for patients and their families. The Clinical Practice Guidelines for Quality Palliative Care, developed as part of the National Consensus Project, also provide a definition for palliative care. It states that the goal of palliative care is to prevent and relieve suffering, and to support the best possible quality of life for patients and their families, regardless of the stage of disease or the need for continued therapies. Palliative care can be viewed as a recognized philosophy and is an organized, highly structured system for care delivery. Palliative care expands traditional disease-focused medical treatments to include the goals of enhancing quality of life for patients and families, optimizing function, and helping with decision-making. By providing this type of patient-centered care, patients and their families may experience opportunities for personal growth. Palliative care can be provided concurrently with life-prolonging care, but can also be provided exclusively as end-oflife care. Palliative care specialists are experts in pain and symptom management. Examples of symptoms that are managed by palliative care specialists include: complicated pain associated with advanced illness and cancer, nausea or vomiting, shortness of breath, fatigue associated with advanced illness, loss of appetite associated with illness, psychological pain or suffering, and spiritual pain or suffering. Palliative care providers are also skilled in the art of prognostication, which is the understanding of a person s disease process, as well as its expected outcome. Palliative care specialists also focus on advance care planning, including: living wills, healthcare power of attorney, physician orders for scope of treatment (POST), and documentation related to life-prolonging procedures declaration. Palliative care evaluation is appropriate at any age or stage of a serious illness. Some of the most common diseases that require palliative care assistance include: congestive heart failure, cancer of any type, chronic obstructive pulmonary disease and dementia, as well as other neurological diseases. Palliative care expands traditional diseasefocused medical treatments to include the goals of enhancing quality of life for patients and families, optimizing function, and helping with decision-making. By providing this type of patient-centered care, patients and their families may experience opportunities for personal growth. Palliative care can be provided concurrently with life-prolonging care, but can also be provided exclusively as end-oflife care. The philosophy of palliative care is rooted in its interdisciplinary approach to providing medical care. It is a collaborative effort between physicians, nurses, social workers, chaplains and other specialists who work with patients and their families to provide an extra layer of support and assist with navigating today s complicated medical environment. Each discipline is specifically trained to provide optimum care to these patients and their families. As a part of our interdisciplinary team, we utilize Parkview s pet therapy program with our patients. In 2015, Parkview plans to begin offering the services of the Healing Arts program to our inpatient palliative care patients and families. Whether it s visiting pets, visual artists, musicians, or dancers, we look to engage 14 I Palliative care quality study

15 PALLIATIVE CARE QUALITY STUDY continued Pictured above from left to right are: Chris Brinneman, MSW, LCSW, palliative care social worker, Parkview Home Health & Hospice; Shauna H. Simpson, MSN, APRN, FNP-C, nurse practitioner, Parkview Physicians Group Palliative Care; Clevis Parker, MD, HMA, FAAFP, ABHPM, medical director, Palliative Care, Home Health & Hospice, Parkview Health; Rebecca Moore, BA, palliative care coordinator, Parkview Home Health & Hospice; Tracy L. Brooks, PharmD, BCPS, BCNSP, interim chair, Department of Pharmacy Practice, Manchester University College of Pharmacy; Chris Hepler, RN, MSN, administrator/director, Home Health & Hospice, Parkview Health; Kathryn Felts, MSN, NP-C, ACHPN, nurse practitioner, Parkview Physicians Group Palliative Care; and John C. Westhoff, MSN, FNP-C, nurse practitioner, Parkview Physicians Group Palliative Care. patients and family members in creative ways in order to have the best possible outcome for all involved. Oftentimes, patients and medical providers confuse the specialty of palliative care with that of hospice. While similar in its approach to providing patientcentered care using interdisciplinary team members, hospice focuses on terminal patients with a life expectancy of less than six months. Hospice care is the gold standard care for dying patients and is available when they no longer seek curative interventions. Hospice care providers endeavor to keep patients comfortable and manage their symptoms based on the principles of comfort. While hospice care is limited to patients who are no longer pursing life-saving treatment, palliative care specialists will work with patients who are still pursing life-saving treatments and those who have chosen to forego such treatments. Palliative care quality study I 15

16 PALLIATIVE CARE QUALITY STUDY continued The United States Centers for Disease Control and Prevention states that the top three leading causes of death are heart disease, cancer and chronic obstructive pulmonary disease. The National Comprehensive Cancer Network (NCCN) suggests that more than 1.65 million people are expected to be diagnosed with cancer in the United States in 2014, and approximately 0.6 million of these patients are expected to die from their cancer illness. NCCN further proposes that global cancer rates are expected to continue to rise and are associated with a high number of cancer survivors that are living with symptoms and disabilities directly resulting from their cancer or treatment. The NCCN suggests that the need for comprehensive care for patients with cancer and their families is great. Studies show that more than one-third of patients with cancers report moderate to severe symptoms such as pain, nausea, anxiety, depression, shortness of breath, drowsiness, tiredness, and loss of appetite. Therefore, NCCN encourages specialists in palliative care and oncology to collaborate to provide patients with the best possible quality of life throughout their cancer journeys. Parkview Regional Medical Center recognized the need and importance for palliative care integration. In October 2010, Parkview started a palliative care consultation service with the charges of improving the patient experience at Parkview, improving patients quality of life, and ensuring patients were well informed about their disease process in order to make decisions that were consistent with their core values. In 2011, the palliative care inpatient service saw 341 patients, which translated to 1.9 percent of the hospital s discharges. A successful palliative care program is able to consult on approximately five percent of the hospital s total discharges. In 2012, the inpatient consult service saw 432 patients. In 2013, palliative care conducted 513 consults, of which 156 were related to cancer diagnoses. The increased demand for palliative care services and Parkview s recognition of the importance of palliative care integration has become a focus for Parkview Health. In January 2014, Parkview hired a full-time medical director, and the inpatient palliative care consult service is now on pace to reach 900 or more new consults this year. Throughout six months in 2014, 134 of these consults were related to cancer diagnoses. Parkview Regional Medical Center recognized the need and importance for palliative care integration. In October 2010, Parkview started a palliative care consultation service with the charges of improving the patient experience at Parkview, improving patients quality of life, and ensuring patients were well informed about their disease process in order to make decisions that were consistent with their core values. Based on the NCCN s guideline recommendations and Parkview s commitment to provide excellent care, the Parkview Cancer Committee decided to embark on a quality study. The focus of this quality initiative is to evaluate the timing of a palliative care consult for cancer patients. The aim of this initiative is to provide palliative care services to patients in a timely manner and provide that service regardless of whether that patient is hospitalized or not. A review of palliative care patients in 2013 showed that 156 palliative care consults took place for hospitalized patients with a cancer diagnosis. On average, there were 19 days from palliative care admission to hospice discharge. The cancer committee identified the critical 16 I Palliative care quality study

17 PALLIATIVE CARE QUALITY STUDY continued need to provide a mechanism for cancer patients to receive palliative care earlier in the disease process. As a result, Parkview identified a strategy to develop an outpatient palliative care clinic to better serve our patients. In August 2014, the clinic opened its doors. We plan to measure our impact on the timeline for palliative care referrals, with the goal of referring patients earlier in their cancer journeys. Future plans include providing palliative care services in nursing homes, as well as the homes of our patients. This will complete Parkview Health s community-based palliative care program, allowing patients in need of palliative care services to be seen in a timely fashion and in multiple settings. Palliative care has been shown to reduce symptom burden, improve quality of life and increase the likelihood of the patient dying in a place where he or she is most comfortable. Several studies have also suggested that patients with advanced cancer had an improved survival rate when palliative care was integrated with standard cancer care. Communitybased palliative care services have been shown to decrease multiple unwanted emergency room visits, multiple unwanted hospitalizations, and caregiver or family stress associated with chronic illnesses. Successful palliative care integration early in the continuum of care for cancer patients reduces morbidity and enhances patient and family satisfaction. The patient-centered approach that palliative care specialists provide focuses on the person, not the disease, which is a critical distinction related to palliative care. This approach affords patients and their families opportunities to participate and share in the decision-making process. Palliative care allows them to match the type of care they desire with their core values. This leads to improved experiences physically, emotionally, and spiritually for everyone involved.

18 COMMUNITY OUTREACH Early detection of cancer means treatment can start sooner, which can increase a patient s chances of survival. We reached more than 3,700 individuals with cancer education and prevention information in Education, Prevention and Screenings Parkview Comprehensive Cancer Center emphasizes the importance of screening, education and prevention. Early detection of cancer means treatment can start sooner, which can increase a patient s chances of survival. Our education and prevention programs assist individuals in the process of identifying cancer risk factors. The programs also provide information to help them decrease their risk of developing cancer. We reached more than 3,700 individuals with cancer education and prevention information in From January to September 2014, Parkview reached more than 400 individuals with free skin, oral and prostate cancer screenings. A new screening for lung cancer the SmartLung CT has reached 114 people since its implementation in September 2013 until September 1, In 2014, a total of 2,976 women have been screened through Francine s Friends Mobile Mammography program as of September 30. And since its inception in 2005, nearly 30,000 women have been screened. The mobile mammography program is a partnership between Parkview Health, Breast Diagnostic Center and Francine s Friends. It continues to make mammograms accessible for women at a growing number of sites throughout the area I Community outreach

19 COMMUNITY OUTREACH continued Cancer Screenings Screenings from January 1 September 30, 2014 SKIN CANCER 90 ORAL CANCER 86 PROSTATE CANCER Mammograms Francine s Friends Mobile Mammography Coach 5,000 4,000 4,278 4,557 3,776 3,000 2,947 3,262 3,326 2,000 1,917 2,263 1,000 0 Dec Dec Community outreach I 19

20 REAL LIFE STORIES The stories of survivors, though, are just as important as the number of women we reach. It is through these stories that we build relationships, foster empathy, improve communication and create a sense of community among survivors, healthcare workers, family and friends. Many women at Parkview have battled breast cancer and have used their stories to impact others around them. The following pages feature just a few of these incredible, inspiring stories. I am proud that today, I am going on six years of remission. I m still with Parkview, and I could not be any more grateful. Julie Andrzejewski My story began in April 2007 when the Francine s Friends Mobile Mammography coach visited a Parkview Physicians Group office in southwest Fort Wayne. It had been just two months since my mother died of cancer, and I decided to get a mammogram. I had prayed, prior to her passing, that I could take her pain so she could rest after fighting for two years. Then, I was diagnosed with breast cancer. God did not give me more than I could handle. Doctors caught my cancer early. I had a lumpectomy and went through six weeks of radiation. I worked full-time at Parkview and was a single mother. My daughter was my rock through all of this; she faithfully wore her breast cancer bracelet on my behalf. She constantly reminded me of the good health I do have and that we can do this together. After two years of remission, in November 2009, my breast cancer returned in the same area. My world was turned upside-down. With my daughter and Parkview co-workers by my side, I went through a mastectomy and recovered for five weeks. My co-workers even brought me homemade food. I am happy to be part of Parkview and on a team of such caring people. Jen Will I never imagined at age 31, I would be diagnosed with Stage III breast cancer. I was too young to have breast cancer; I was too busy for breast cancer. My children were 2.5 years and 8 months old. I was supposed to be in the prime of my life. I ll never forget the look on the face of my primary care doctor or the tears in her eyes when she confirmed what my husband and I already knew. After a couple of weeks of more testing and second opinions, I began a 20-week chemo course, followed by a bi-lateral mastectomy and radiation. My medical team threw everything they could at me. I was told that I should expect about 2 years of treatment and reconstructive procedures. 20 I Real life stories