Saint Joseph Mercy Cancer Care Center A n n u a l R e p o r t

Transcription

1 Saint Joseph Mercy Cancer Care Center A n n u a l R e p o r t Data Represented 2006

2 CANCER COMMITTEE MEMBERSHIP Timothy McHugh, MD Chair, Urology/Surgery Liz Beger, RN Palliative Care Louise Bonam Tumor Registrar Joanne Burns Community Liaison Jenny Cotton, MD Pathology Pat Dost, RN Quality Specialist (ad-hoc) Lulu Jordan, BS, RT(T) Radiation Oncology Lynn Joynt, MD Radiology Harry Huff, MD Internal Medicine Sal Jafar, MD Radiation Oncology Kathleen Kasperek-Korelis, MSA Oncology Administration Linda Langmore, LMSW, ACSW Oncology Social Work Beth LaVasseur, RN, MSN Oncology Research Kevin Reynolds, MD Gynecologic Oncology Phyllis Roberts Tumor Registrar Pam Sadewasser, CTR Tumor Registrar Philip Stella, MD Hematology/Oncology Robert Stillman, BSN, RN, OCN Outpatient/Inpatient Oncology Nea Stolaruk Oncology Administration Carol Yarrington, PharmD Oncology Pharmacy

3 Program Highlights The year 2006 has been a busy and rewarding one. Following are highlights of the past year heralded the opening of the Saint Joseph Mercy Woodland Cancer Center in Brighton. The center offers access to advanced radiation planning and treatment with the only linear accelerator in Livingston County, significantly expanded chemotherapy treatment capacity, leading-edge research trials, cancer specialists and cancer support and education programs. The Saint Joseph Mercy Cancer Research Program received the American Society of Clinical Oncology (ASCO) Clinical Trials Participation Award. SJMH is one of only 12 programs in the country to receive this prestigious award and was nominated for this honor by the Mayo Clinic in Rochester, Minnesota. The award honors efforts to improve the care of people with cancer through participation in clinical trials. 1

4 Program Review: 2006 Philip J. Stella, MD In 2006 a total of 2,049 patients with a diagnosis of a reportable neoplasm were seen at St. Joseph Mercy Hospital (see Primary Site Table). Of these, 1,757 (86 percent) were analytic cases, which means they were either diagnosed and/or received their first course of treatment at St. Joseph Mercy Hospital. In reviewing the accessioned cases, 59 percent of analytic patients were diagnosed with local disease. The breakdown of stage of disease for all patients is given in the Primary Site Table Primary Sites % Total A N/a M F B/B Total Oral Cavity & Pharynx Tongue Salivary Glands Floor of Mouth Gum and Other Mouth Nasopharynx Tonsil Hypopharynx Digestive System Esophagus Stomach Small Intestine Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, Nos Rectosigmoid Junction Rectum Anus,anal Canal,anorect Liver Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Respiratory System Nose,nasal Cav & Middle Larynx Lung & Bronchus Bones & Joints Soft Tissue-incl Heart Skin Excl Basal & Squamo Melanomas -- Skin Oth Non-epith Skin Breast ~ continued 2

5 Saint Joseph Mercy Cancer Care Center Primary Sites (con t) % Total A N/a M F B/B Total Female Genital System Cervix Uteri Corpus Uteri Ovary Vagina Vulva Other Female Genital Or Male Genital System Prostate Testis Penis Urinary System Urinary Bladder Kidney & Renal Pelvis Ureter Eye AND Orbit Brain AND OthER Nervous SystEM Brain Cranial Nerves Other Nerves Endocrine System Thyroid Other Endocrine Including Thym Lymphoma Hodgkin-nodal Disease Nhl-nodal Lymphomas Nhl-extranodal Lymphom Myeloma Leukemia Acute Lymphocytic Chronic Lymphocytic Other Lymphocytic Lymphocytic Acute Myeloid Acute Monocytic Chronic Myeloid Myeloid And Monocytic Other Acute Leukemia Aleukemic, Subleukemic Other Mesothelioma Kaposi Sarcoma Miscellaneous Type of AJCC Staging: Best Stage Key: A= Analytic N/A = Non-Analytic M = Male F = Female 0 = Stage 0 1 = Stage 1 2 = Stage 2 3 = Stage 3 4 = Stage 4 Unk = Unknown 88 = Not Applicable B/B = Benign Borderline 3

6 The four most commonly occurring malignancies both nationally and at Saint Joseph Mercy Cancer Care Center are breast, prostate, lung and colon. Breast Analytic Breast Cases Best General Summary Stage 160 Breast Cancer Total Number of Patients We have seen a 12 percent increase in the number of new breast cancer cases which is attributable to outreach and screening activities. The distribution of the stage of disease at diagnosis virtually replicates that of the past few years with approximately 76 percent of our analytic cases diagnosed with in situ or local disease. This is consistent with the National Cancer Institute s information highlighting the ongoing improvement in early diagnosis of the disease. 0 In-situ PROSTATE Total Number of Patients Local Regional Distant Unknown 2006 Analytic Prostate Cases Best General Summary Stage 50 PROSTATE Cancer 0 Local Regional Distant Unknown There was a slight increase in the number of our prostate cancer cases over the past year. Of the 239 analytic cases, 91% were diagnosed with local disease. Early diagnosis remains the nataional trend. Lung Cancer New lung cancer cases remained virtually the same as last year (2006 = 232 cases versus 2005 = 222 cases). This number has remained fairly consistent over the years. Overall, those diagnosed with distant disease continues to be disheartening, with nearly one-half of our population presenting with metastases. This is consistent with national data. LUNG Total Number of Patients Local COLON 2006 Analytic Lung Cases Best General Summary Stage Male Female Regional Distant Unknown 2006 Analytic Colon Cases Best General Summary Stage Colon Cancer Male Female Data continues to demonstrate the trend of women having higher rates of diagnoses at early stages. Total Number of Patients In-situ Local Regional Distant Unknown Best General Summary Stage

7 Saint Joseph Mercy Cancer Care Center PAnCREAS Cancer Patient Care Evaluation Edward Kreske, MD Saint Joseph Mercy Cancer Care Center conducts an in-depth annual review of our incidence and outcomes of care for a specific malignancy in order to compare our program with national norms and ensure our care is consistent with national standards. This analysis meets the accreditation requirements set forth by the American College of Surgeons Commission on Cancer. Pancreas cancer was evaluated this year. The data available for review included national pancreatic cancer data from 1999 and the patient experience at St. Joseph Mercy Hospital during that same year. Additionally, there is data available to compare pancreatic cancer information between 1999 and 2005 at St. Joseph Mercy Hospital. Starting first with the national data in 1999 a total of 3,829 patients was included. Overall five-year survival rates range from 45 percent in patients with in situ lesions to 18 percent in Stage I patients. Survival was less than 10 percent in patients in Stage II and Stage III neoplasms and there was no five-year survival in the patients with Stage IV neoplasms. On a national basis, in 1999 there was no difference in gender regarding survival and fiveyear overall survival was approximately 5 percent. Younger patients did fare better and those patients under 30 had five-year survival of greater than 50 percent with those patients over 30 years old having five-year survival of less than 20 percent. When considered by mode of treatment, those patients who received no treatment had median survivals of three months. Patients who received surgery only had median survival of 12 months. Radiation and chemotherapy only led to median survivals of approximately 10 months. Surgery, radiation and chemotherapy employed together led to a median survival of 18 months. Interestingly, when one looks at five-year survival rates, there was an approximately 20 percent five-year survival rate in those patients who were treated with surgery only or surgery with chemotherapy and radiation; that is, there did not appear to be a significant difference amongst long-term survivors with the addition of radiation and chemotherapy. When compared to SJMH data, it is difficult to draw significant conclusions; however, there are not any significant differences between the SJMH experience and the national data. There is some variance. SJMH patients size sample was 32 broken down into various categories by stage: three Stage I patients, three Stage II patients, six Stage III patients, and 17 Stage IV patients in that year. Three patients were unstaged. Five-year survival was 30 percent in the Stage III patients, which was obviously a bit higher than the national average. Essentially the variances can be explained by the small sample size, really not large enough to make meaningful conclusions on long-term survival data. Interestingly, SJMH had a bit of difference in survival related to gender and did have an approximately 20 percent five-year survival in the male patients. There were no five-year survivors in the female cohort; however, again the sample sizes were fairly small. ~ continued 5

8 PAnCREAS Cancer Patient Care Evaluation continued When essentially compared by mode of treatment, the data was again fairly similar. Patients who did not receive treatment had a median survival rate of six months and those patients who received surgery only had median survivals of 14 months; that, of course, compared relatively closely to the 12-month survival in the national data. The radiation and chemotherapy only group had median survivals of approximately 10 months, which again was almost exactly what was noted in the national data. Patient who received treatment with surgery, radiation and chemotherapy had median survivals of approximately 30 months and a five-year survival rate of 40 percent was noted. This exceeded the experience when looking at the national data. Again, however, the small sample size should be considered. Certainly, there were no glaring examples of survival that would be well below what would have been expected compared to the national data. When further looking at a comparison between the data at St. Joseph Mercy Hospital in 1999 and in 2005, a few differences could be noted. The sample sizes approximately doubled in 2005 with 60 patients being included in the sample as opposed to 32 patients in Interestingly, a few of the differences were the percentage of patients receiving some type of therapy. Initial therapy in 1999 consisted of no treatment for 40 percent of the patients who were obviously deemed in untreatable circumstances and approximately 12 percent of the patients were Five Year Survival Tables For 1999 Pancreatic Cancer Stage Cases % At Dx 1 year 2 years 3 years 4 years 5 years National ST. JOSEPH MERCY HOSPITAL Five-year survival is illustrated above. The small numbers in each cancer stage category make meaningful comparison with national data difficult because of large confidence intervals. The one category of Stage III patients where there are higher numbers at SJMH is comparable to national survival rates. (Five-year survival was 33 percent in the Stage III patients, which was obviously higher than the national average.) 6

9 Saint Joseph Mercy Cancer Care Center initially treated with surgery. In the 2005 cohort, only 26 percent of the patients received no treatment, although the percentage of patients receiving surgical treatment initially was very similar at 13 percent. Of note, the largest number of new patients came from the Livingston County areas with relative stability amongst the other referral areas. Certainly, when one looks at the overall data, there are no significant problems or areas of concern when compared to the national results of the same time period. Histologically, nearly 90 percent of the lesions in the 2005 group were identified as adenocarcinoma. This is a bit higher percentage than in 1999, where approximately 65 percent of the lesions were adenocarcinoma, the remainder being other tumors, including neuroendocrine tumors and a variety of mucinous lesions. Again, differences here primarily relate to the sample size. TABLE TABLE 1 Pancreatic Cancer: Age at Diagnosis (National vs St. Joseph Mercy Hospital) National Male SJMH Male National Female SJMH Female Percentage of Patients Table 1 Information on the age at diagnosis is presented. The majority of patients are diagnosed between ages 70 to 79 for both St. Joseph Mercy Hospital and hospitals nationally. 7

10 Tumor Boards Oncology patients at St. Joseph Mercy Hospital (SJMH) have the benefit of having their cases reviewed at tumor conferences attended by a variety of specialists for the purpose of developing a comprehensive treatment plan. In addition to the weekly meetings of the central tumor board, multidisciplinary, site-specific tumor boards are held monthly for breast, gastrointestinal, genitourinary and head/neck malignancies. The following table notes the frequency of these tumor conferences which ensure that cases are reviewed in a timely and comprehensive manner. Tumor Boards Total Meetings Central Tumor Board 43 (all cancer types) Breast Cancer 34 Gastrointestinal Malignancies 10 Genitourinary Cancers 7 Head and Neck 17 Tumor Registry The Tumor Registry currently has computerized records on over 24,000 total patients, with 12,593 living patients. The Registry has a follow-up rate of 93 percent, which demonstrates the diligence of our tumor registrars and success of our tracking system. Tumor Registry activities for 2006 are included in the chart. Tumor Registry Statistics Total Records in Database 24,312 Living Patients 12,593 Follow-up Rate Percentage (2006 Data) Cases Added to Suspense 1,882 Cases Abstracted 2,052 Follow-up Added 19,498 Data Requests From: Physicians 7 Administration or Research 11 Other Hospitals 24 Other Tumor Registries 84 8

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12 Saint Joseph mercy Cancer Care Center 5301 East Huron River Drive P.O. Box 995, Ann Arbor, MI Remarkable Medicine. Remarkable Care.