2013 STATISTICAL DATA QUALITY AND STANDARDS: WORKING TO MEET AND EXCEED NATIONWIDE QUALITY STANDARDS

Transcription

1 2013 STATISTICAL DATA QUALITY AND STANDARDS: WORKING TO MEET AND EXCEED NATIONWIDE QUALITY STANDARDS

2 The mission of Stony Brook University Cancer Center is to reduce the suffering from cancer by providing world-class multidisciplinary care close to home, conducting innovative research, educating patients and healthcare professionals, and partnering with our community to reach the underserved populations. TA BL E OF C O N T E N T S 3 The Cancer Registry Department Cancer Site Distribution 4 Tumor Board Conferences 7 Laryngeal Cancer Site Survey Quality Management 8 Tongue Cancer Site Survey Cancer Liaison Physician 10 Endometrial Cancer Site Survey The Cancer Committee 11 Cancer Center Phone Numbers 5 2 cancer.stonybrookmedicine.edu

3 QUALITY AND STANDARDS: WORKING TO MEET AND EXCEED NATIONWIDE QUALITY STANDARDS The Cancer Center s departments, tumor boards and committees that consistently ascertain, measure and document the wealth of cancer data and patient information allow our clinicians and healthcare staff to evaluate and plan strategies for improved patient outcomes. The Cancer Registry Department Data provides information that drives research, education, administrative decisions and quality studies in clinical outcomes measurement. And the Stony Brook Cancer Registry database encourages the use of and regularly supplies that data to the entire Stony Brook Medicine community most recently for grant writing, the Surgical Quality Data Use Group and scorecard metrics. Audrey Hassett, CTR, Cancer Registry Abstractor Stony Brook s Cancer Registry maintains a computerized database of cancer patient information on all tumor types. Case ascertainment includes search and analysis of all inpatient, same-day stays, emergency room admissions, ambulatory and clinic encounters, as well as physician practice visits for cancer care. Since its inception in 1984, the Registry has amassed information on all patients with cancer diagnosed and/or treated at Stony Brook. Quality control is performed by applying national standards and utilizing editing software. After undergoing rigorous quality checks and assessments, Registry data is regularly submitted to the New York State Cancer Registry, the National Cancer Data Base, and the National Accreditation Program for Breast Centers, which plays an integral role in meeting regulatory standards for on-site surveys. The Cancer Registry is a recognized component of the Cancer Program, and Registry staff participate in multiple hospital-wide committees and Tumor Boards. In accordance with both New York State law and the Commission on Cancer, all of Stony Brook Medicine s cancer registrars are certified and must participate in continuing medical education seminars, thus offering substantive input at all cancer conferences and committee meetings. They are active in professional association activities and continue to retain membership in both the National Cancer Registrars Association and Long Island Cancer Registrars Association. A VISION FOR THE FUTURE 3

4 Tumor Board Schedule 2013 Tumor Board Conferences Bone and Soft Tissue Sarcoma CME Wednesdays Week 4 Tumor Board conferences are a key component of the Cancer Program and integral to patient management at Stony Brook Medicine. They Breast CME Colorectal CME Fridays Mondays 7 am Weekly Weeks 1 and 3 provide a valued forum for education, consultation and collaboration. Disease Management Teams present cases for diagnostic assessment, while referencing national treatment guidelines, clinical research protocols and other relevant literature for treatment planning, to obtain the best clinical outcome for our patients. In 2013, nine of 13 Tumor Gynecologic Oncology CME Wednesdays 7 am Weeks 1 and 3 Boards offered AMA Category 1 CME credits to eligible attendees. Head and Neck, and Thyroid Tuesdays Weeks 1 and 3 Quality Management Leukemia/Lymphoma CME Fridays 9:30 am Weeks 1, 3 and 4 Cancer Services leadership works to ensure the delivery of safe, effective, efficient and accessible patient care through focused care Liver Mondays Week 2 programs and targeted quality management tools, which encourage the creation, assessment, re-evaluation and redesign of processes and Lung CME Wednesdays 4 pm Weekly systems. Using input from site-focused Disease Management Teams, data collected on selected indicators are compared on Cancer Services Melanoma CME Fridays Week 4 balanced scorecards. Additionally, selected site-focused outcome studies utilizing National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology and Commission on Cancer Program Standards Neurologic Oncology Tuesdays 5 pm Week 3 are reviewed and published annually. The program s effort to monitor quality and improve care is a progressive movement toward a Pediatric Mondays 4 pm Weeks 2 and 4 high-reliability organization, error-free over time. Upper GI and General Oncology Tuesdays Week 3 Cancer Liaison Physician Urology CME Tuesdays Weeks 2 and 4 Meetings are held in the Pathology Conference Room 766, Hospital Level 2. Exceptions are Melanoma, held in the Surgical Conference Room, Health Sciences, T19-020; Urology (fourth Tuesday) in the Urology Conference Room, Health Sciences, Level 9; Head and Neck (third Tuesday) in the Radiation Oncology Conference Room; and Bone and Soft Tissue Sarcoma in the Radiology Large Conference Room. Clinical faculty, Health Sciences students and clinical staff are invited to attend. The Cancer Liaison Physician is a liaison between Stony Brook Medicine and the community, between the national standards organizations and the hospital, between the Cancer Committee and various departments at Stony Brook Medicine, and represents the Cancer Center on the Cancer Committee. The liaison works with Disease Management Teams to develop best practices, evaluate compliance with adopted guidelines, expand participation in clinical trials and improve quality of care. The liaison works with local agencies and the American Cancer Society on outreach and education priorities, as well as providing direction in accordance with the Commission on Cancer guidelines. Philip Bao, MD, has joined the Cancer Committee as its new Cancer Liaison Physician. His arrival will provide a renewed focus on quality initiatives and the goal of providing patients with advanced treatment options. 4 cancer.stonybrookmedicine.edu

5 The Cancer Committee The Cancer Committee is the designated multidisciplinary body for the administrative oversight, development and review of the cancer program at Stony Brook Medicine. The Committee communicates directly with Stony Brook s Medical Board, and its activities and recommendations directly impact programs and activities. Involved with the care of patients with cancer, representatives from medical, surgical, diagnostic and clinical areas along with supportive services are included. Members include clinicians from Medical Oncology, Pediatric Oncology, Surgery, Radiation Oncology, Pathology, Diagnostic Radiology and Survivorship. Hospital Administration, Nursing, Palliative Care, Social Work, Cancer Registry, Pharmacy, Quality Assurance, Nutrition, Physical Rehabilitation, Healthcare Teleservices, Clinical Trials, Patient Advocacy and Community Outreach, and the Chaplaincy augment the Committee s designation as multidisciplinary. Charged with providing leadership, the Cancer Committee must plan, initiate, stimulate and assess the institution s cancer-related activities in accordance with the Commission on Cancer requirements for cancer program accreditation. Stony Brook Medicine earned recognition as a Teaching Hospital-Approved Cancer Program with full commendation on all standards during the last survey, as well as the distinction of Outstanding Achievement Award Cancer Committee Physician Members Theodore G. Gabig, MD, Hematology/Oncology, Committee Chair Philip Bao, MD, Surgery, Cancer Liaison Physician James Davis, MD, Pathology John Fitzgerald, MD, Urology Frederick Gutman, MD, Neurosurgery Lynn Hallarman, MD, Palliative Care Melissa Henretta, MD, MPH, Gynecologic Oncology Andrzej Kudelka, MD, Medical Oncology Seth Mankes, MD, Diagnostic Radiology Brian O Hea, MD, Breast Surgery Robert I. Parker, MD, Pediatric Hematology/Oncology Michael W. Schuster, MD, Leukemia, Lymphoma and Transplantation Tamara Weiss, MD, MS, Radiation Oncology Non-Physician Members Teresa Beutel, MS, Healthcare Services Linda Bily, MA, Patient Advocacy and Community Outreach Coordinator Rose C. Cardin, MSN, RN, Cancer Services Administration Jennifer Fitzgibbon, MS, RD, Oncology Nutrition Jeannie Gaspard, RN, MSN, OCN, NEA-BC, Ambulatory Cancer Center Administration Patricia Hentschel, MS, NP, CCRC, Clinical Trials Susan McCarthy, MS, LMSW, Social Work Christine Northam-Schuhmacher, RN, BSN, MS, Quality Management Candiano Rienzie, DPT, Physical Rehabilitation Grace Swensson, MS, CCS, CTR, Cancer Registry and Committee Coordinator Lori Tischler, RN, Cancer Helpline Stephen Unger, Chaplaincy Scot Weber, RPh, Pharmacy A VISION FOR THE FUTURE 5

6 2012 Cancer Site Distribution Primary Site Patient Types Gender AJCC TNM Stage Group* Total New Re-tx Males Females In situ Stage I Stage II Stage III Stage IV Unk N/A All sites 2,651 2, ,113 1, Oral Cavity Lip Tongue Oropharynx Other Oral Digestive System Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other Respiratory System Nasal Sinus Larynx Lung/Bronchus Other Blood/Bone Marrow Leukemia Multiple Myeloma Other Bone Connective/Soft Tissue Skin Melanoma Other Breast Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other Male Genital Prostate Testis Other Urinary System Bladder Kidney/Renal Pelvis Other Brain and CNS Benign Malignant Other Endocrine Thyroid Other Lymphatic System Hodgkin s Lymphoma Non-Hodgkin s Lymphoma Other/ill-defined Unknown Primary Site *American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system includes all inpatients and outpatients first seen in 2012 at SBM. 6 cancer.stonybrookmedicine.edu

7 Laryngeal Cancer Site Survey Laryngeal cancer statistics are often grouped with other head and neck cancers, since they possess many of the same risk factors. Fortunately significant strides have been made in the treatment of cancer of the larynx, thus improving outcomes for those diagnosed with this disease. The Cancer Center s Head and Neck, and Thyroid Oncology Management Team works together to improve patient outcomes in a comprehensive manner focusing on controlling the disease and improving quality of life. Though the number of new cases of cancer of the larynx continues to drop by single-digit percentages, an estimated 12,260 new cases of laryngeal cancer will be diagnosed in the United States this year, according to the American Cancer Society. These same statistics indicate that the overriding majority of new cases are male. Tobacco and alcohol consumption are the two most significant risk factors for any head and neck cancer. Therefore, the more an individual smokes or consumes alcohol, the greater the risk; and when combined, the risk increases exponentially. With increased duration of exposure to certain chemicals used in petroleum, plastics or textiles, the potential for increased risk is also evident. Age also plays a role, with older age groups affected, particularly in the fifth, sixth and seventh decades of life. Assessment of laryngeal cancer is usually achieved by inspection with a mirror or via direct endoscopic examination. True vocal cords (the glottis) have few, if any lymph nodes, so tumors of that site are less likely to spread to regional nodes, but that is not the case with the supraglottis. Imaging studies can be helpful in identifying lymphadenopathy or extension, but the specimen must be identified pathologically. Early-stage disease may be treated with a singular modality, but later-stage disease warrants combination therapy, achieving very high complete response rates utilizing radiation therapy and chemotherapy concurrently. While Stony Brook promotes preservation of head and neck structures, treatment of laryngeal cancer may affect speech and swallow mechanics as well as a patient s nutritional status. Multidisciplinary evaluation and management by specialists provide optimal care of the patient. Over the course of 10 years, patients with laryngeal cancer treated at Stony Brook University Hospital have benefitted from improved technology, shorter hospital stays and focused efforts to minimize complications while helping patients cope. With the exception of a small group of patients diagnosed with in situ laryngeal cancer, all of Stony Brook Cancer Center s five-year survival outcomes are consistent with national averages. References for Site Survey: American College of Surgeons: Cancer Programs: National Cancer Data Base (NCDB): NCDB Survival Reports. (n.d.) Retrieved 9/8/2013, from American College of Surgeons Commission on Cancer website: facs.org/cancer/ncdb/survival.html (secure access only) AJCC Cancer Staging Manual Seventh Edition (7th ed.) (2010) New York, NY: Springer-Verlag. Cancer Facts and Figures (n.d.) Retrieved 9/5/2013, from American Cancer Society website: cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index National Cancer Institute: SEER Stat Fact Sheets: Larynx. Retrieved 9/10/2013 from website: seer.cancer.gov/statfacts/html/laryn.html Laryngeal Cancer TNM Stage at Diagnosis % 3 25% 2 15% 5% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Stage Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Survival Outcomes 35% 3 25% 2 15% 5% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stony Brook University Hospital National Cancer Data Base Treatment Modalities Surgery Only Radiation Only Surgery & Radiation Radiation & Chemotherapy Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Surgery, Radiation & Chemotherapy Other Specified Therapy No First Course of Therapy A VISION FOR THE FUTURE 7

8 Tongue Cancer TNM Stage at Diagnosis Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Stage Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Survival Outcomes Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stony Brook University Hospital National Cancer Data Base Tongue Cancer Site Survey Tongue cancer is considered one of the oral cavity cancers and one of the pharyngeal cancers. As a result, oral cancers of the anterior two thirds of the tongue are staged using a different schema than oropharyngeal cancers at the base or undersurface of the tongue. For the purposes of this study however, National Cancer Data Base (NCDB) included all diagnosed cases of tongue cancer in its calculations, as did Stony Brook University Cancer Center s Cancer Registry, since they are all grouped under the label of head and neck cancers. More than 13,000 people will be diagnosed with tongue cancer this year. Almost one third of that number represents individuals between the ages of 55 and 64. The incidence is highest in white males. However, one out of 309 people face the possibility of being diagnosed with cancer of the tongue in their lifetime. Not unlike laryngeal cancer, tobacco and alcohol are major risk factors for tongue cancer. Heavy alcohol use combined with smoking make the risk 100 times higher. The human papillomavirus (HPV) can infect any area covered by skin and mucosa, and has been linked with certain types of oral cancer. HPV can be transmitted from the cervix to the oral cavity through sexual contact with an infected partner. A diagnosis of cancer is upsetting for any patient, but a diagnosis of tongue cancer adds to the emotional distress because of the potential for physical impairments associated with the disease. Many oral cancers can be diagnosed early with a routine screening examination, including regular dental checkups. Symptoms may include pain, weight loss, dysphagia, voice changes, difficulty swallowing, fixation of the tongue or a mass in the neck. According to the National Cancer Institute, lymph node metastasis is common because of the rich lymphatic drainage at the base of the tongue. Thus lymph node involvement, as well as size, has prognostic implications for patients with tongue cancer. Treatment options include surgery, radiation therapy and chemotherapy. Organ preservation is critical for the patient but dissection of lymph nodes are important to determine extent of disease. While facial reconstruction has come a long way in restoring both function and esthetics to the patient, preventive and rehabilitative swallowing therapy helps improve quality of life. Targeted drug therapy or intensity modulated radiation therapy, which spares healthy tissue by delivering treatment with pinpoint accuracy, may be used. The Head and Neck, and Thyroid Oncology Disease Management Team monitors these patients closely for response to therapy while encouraging ongoing surveillance for potential recurrence. 8 cancer.stonybrookmedicine.edu

9 Tongue Cancer continued Stony Brook Cancer Center s survival outcomes for tongue cancer seem quite varied, which may be as much a consequence of stage when diagnosed, as it is the number of cases. More than 70 percent of Stony Brook patients with tongue cancer are diagnosed at stages III and IV. When compared to NCDB statistics, national survival outcomes are better, at 17 percent and 11 percent respectively, but fewer people are diagnosed at stages III and IV. In fact, the Cancer Center sees 20 percent more patients at stage III than other teaching hospitals nationwide. Despite the New York State anti-smoking campaign and the media awareness of the effects of HPV transmission, a struggle continues every day to stop or minimize risky behavior. Oral cancer screenings should be regularly scheduled and health education emphasized to encourage early detection and disease prevention. Treatment Modalities 4 35% 3 25% 2 15% 5% Surgery Only Radiation Only Surgery & Radiation Radiation & Chemotherapy Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Surgery, Radiation & Chemotherapy No First Course of Therapy Other Therapy References for Site Survey: Tongue Cancer: American College of Surgeons: Cancer Programs: National Cancer Data Base (NCDB): NCDB Survival Reports. (n.d.) Retrieved 9/8/2013, from American College of Surgeons Commission on Cancer website: facs.org/cancer/ncdb/survival.html (secure access only) AJCC Cancer Staging Manual Seventh Edition (7th ed.) (2010) New York, NY: Springer-Verlag. Cancer Facts and Figures (n.d.) Retrieved 9/5/2013, from American Cancer Society website: cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index National Cancer Institute: SEER Stat Fact Sheets: Tongue. Retrieved 9/10/2013, from website: seer.cancer.gov/statfacts/html/tongue.html Endometrial Cancer: American College of Surgeons: Cancer Programs: National Cancer Data Base (NCDB): NCDB Survival Reports. (n.d.) Retrieved 9/8/2013, from American College of Surgeons Commission on Cancer website: facs.org/cancer/ncdb/survival.html (secure access only) AJCC Cancer Staging Manual Seventh Edition (7th ed.) (2010) New York, NY: Springer-Verlag. Cancer Facts and Figures (n.d.) Retrieved 9/5/2013, from American Cancer Society website: cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index National Cancer Institute: SEER Stat Fact Sheets: Corpus and Uterus, NOS. Retrieved 9/10/2013 from website: seer.cancer.gov/statfacts/html/corp.html A VISION FOR THE FUTURE 9

10 Endometrial Cancer TNM Stage at Diagnosis Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Stage Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Survival Outcomes Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stony Brook University Hospital National Cancer Data Base Treatment Modalities Endometrial Cancer Site Survey The American Cancer Society estimates that one in 38 women will develop endometrial cancer in her lifetime and just under 9,000 more cases will be diagnosed this year compared to five years ago. New York State ranks second in the nation for the number of estimated diagnosed cases. In comparison to all cancers, endometrial cancer is ranked fourth after breast, lung and colorectal. This cancer accounts for an estimated six percent in overall cancers in women. On a positive note, most endometrial cancers are diagnosed at an early stage and have less likelihood of spreading when treated. The most frequently noted symptom of endometrial cancer is abnormal bleeding or spotting, but painful urination or pain during intercourse may also occur. While there is no standard screening for endometrial cancer, it is usually diagnosed in women who are menopausal, when abnormal spotting is least expected. Women over the age of 50 should report abnormal or unexpected bleeding to their physicians immediately. A women s estrogen exposure is a strong risk factor for endometrial cancer, with excessive exposure or longer exposure increasing the risk. Women who began menstruation at an early age, have never given birth, have experienced late menopause or have estrogen-producing ovarian tumors are at a greater risk. As with many other diseases, obesity also increases one s risk of being diagnosed with endometrial cancer. The use of tamoxifen, a drug that helps reduce the risk of breast cancer, can also play a role in developing this cancer. Women with Lynch syndrome, a hereditary predisposition for colon cancer, are at an increased risk for endometrial cancer as well. While a patient s stage of disease is the most important prognostic factor, treatment modalities are recommended in conjunction with that stage. Stony Brook s Gynecologic Oncology Disease Management Team collaborates to define the optimal therapy for each patient. The appropriate surgical management for women with endometrial cancer is total hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node evaluation. Adjuvant therapy is recommended based upon pathologic findings, and therapies are focused on reducing the risk of local-regional failure. Multiple radiotherapy options are also available at Stony Brook, including vaginal brachytherapy and whole pelvic or whole abdomen radiation. Surgery Only Surgery & Radiation Radiation & Chemotherapy Surgery, Radiation & Chemotherapy Stony Brook University Hospital NY Teaching Hospitals US Teaching Hospitals Other Therapy No First Course of Therapy Successful outcomes are noted in the overall five-year survival rates for patients with endometrial cancer treated at Stony Brook University Cancer Center, which are comparable to those of the National Cancer Data Base. 10 cancer.stonybrookmedicine.edu

11 Cancer Center Phone Numbers Phone numbers are in the 631 area code unless otherwise stated. Cancer Center Cancer Helpline... (800) Cancer Registry Cancer Survivorship Program Carol M. Baldwin Breast Care Center Chaplaincy Child Life Program Clinical Trials Colorectal Surgery Dermatology Lynn Hallarman, MD, with patient Judith Pacifico Larkin Diagnostic Radiology Gynecologic Oncology Head and Neck Oncology HealthConnect Hematology/Oncology Leukemia/Lymphoma/Transplant Lung Cancer Evaluation Center Neurosurgical Oncology Nursing Administration Nutrition Pain Management Services Palliative Care Pathology Patient Education Services Pediatric Hematology/Oncology Physical and Lymphedema Therapy Preventive Medicine Radiation Oncology Stony Brook Medicine surgeons (standing): Roberto Bergamaschi, MD, PhD; Ghassan Samara, MD; Mark Marzouk, MD; and (seated) Melissa Henretta, MD, MPH Social Work Services Support Groups Surgical Oncology Upper Gastrointestinal Oncology Urologic Oncology The 2013 Cancer Center Annual Report was developed by Stony Brook Medicine s Cancer Committee and published by the Office of Communications, Stony Brook, NY, November Stony Brook University/SUNY is an affirmative action, equal opportunity educator and employer. This publication can be made available in an alternate format on request H 2013 Photographers: John Griffin, Office of University Communications; Sam Levitan and Juliana Thomas. Brittany Carroll A VISION FOR THE FUTURE 11

12 cancer.stonybrookmedicine.edu Stony Brook University Cancer Center Stony Brook, NY (631)