Cancer Program Annual Report William, Lung Cancer Survivor Read his story on page 4

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1 Cancer Program Annual Report 2009 I William, Lung Cancer Survivor Read his story on page 4

2 A MESSAGE FROM OUR SERVICE LINE EXECUTIVE Friends, You have cancer, is possibly the most terrifying message that one can hear. This year our surgical oncologists, medical oncologists and radiation oncologists had to deliver those words to over 4,000 people. Mothers, fathers, lawyers, teachers, social workers, ministers, fast food workers, community leaders; many are raising young families and others enjoying their great grandchildren. They are black, white, Hispanic, some worship in churches, some in temples and some in Mosques. Most speak English, many do not. Cancer does not discriminate. Elizabeth Pace, MHA We are honored that more Middle Tennesseans chose the multidisciplinary cancer experts in the Saint Thomas Health Services Cancer Program. Located at Baptist Hospital, Saint Thomas Rutherford Hospital and The Dan Rudy Cancer Center at Saint Thomas Hospital; each has been recognized and accredited as a premier community cancer program by the American College of Surgeons Commission on Cancer. Each case documented in this Annual Report is not a case, but a person who has just started a journey. One they never wanted to take challenging their physical, emotional and spiritual health. We were honored to both treat and serve them during their time of need and we celebrate and support their survivorship. This year we have highlighted one of our program s over 27,000 Cancer Survivors. Each survivor has a very different story, but they all are evangelical about one thing early detection and treatment of cancer. We are thankful to all of our survivors who have helped us reach out across Middle Tennessee through our Survivor Campaign. This ongoing campaign utilizes our real survivors and their stories in print media, the internet and at community events to increase awareness and early detection with mammography, colonoscopy, skin and prostate screening. We strive to continually improve both treatment and services to all those who are affected by cancer. This past year over 350 people were enrolled on clinical trials. We expanded our nurse navigation and social work programs, offering three weekly preoperative classes for all women diagnosed with breast cancer in our community. We also launched a multidisciplinary breast tumor conference across all three of our Centers. This allows all of our breast cancer experts throughout Middle Tennessee to review complicated cases. We know that beating cancer takes more than just medicine. Seton Support Services now offers complementary medicine, individual counseling as well as group programs that include gardening, defensive eating, creative writing and knitting programs to support patients and their families. Eliminating cancer is at the heart of all we do. Thank you for your support in these efforts. Sincerely, Elizabeth Pace

3 ABOUT SAINT THOMAS HEALTH SERVICES Saint Thomas Health Services The premier, comprehensive and integrated system providing compassionate, patient centric cancer prevention, detection, treatment and support to the 3 million residents in Middle Tennessee. Our Experience We re dedicated to offering the best in cancer care. In fact, all 3 of our cancer programs have been recognized by the Commission on Cancer (CoC) of the American College of Surgeons as offering high quality cancer care. Each of our cancer programs has been awarded Commendation Level of Accreditation. This is recognition of the quality of our comprehensive, multidisciplinary patient care. We re proud to offer the very best in today s cancer treatment close to home. For more information about the CoC accreditation and what it means for you, visit: Most Frequently Seen Cancers at STHS in 2008 Breast Digestive Respiratory System Female Genital System Male Genital System Urinary System Brain and CNS All Others Total

4 A MESSAGE FROM OUR CHAIRMAN Greetings from the Saint Thomas Rutherford Hospital Cancer Program! The Cancer Program and Cancer Committee have completed another successful and busy year. Patient volumes have grown yet again with 742 patients being diagnosed and/or treated at MTMC, thanks to the hard work of our dedicated and caring Medical Staff and Associates. Patient safety has improved as a result of implementing a process to double check chemotherapy before administration on the oncology unit and a process for radiation therapists to double check new treatment plans before initial treatment. As a result, the number of near misses reported by the radiation therapy department has decreased. The number of chemotherapy nurses has increased during Breast cancer continues to be the top site at MTMC and 2008 data shows an increase in the number of breast patients diagnosed and treated at MTMC. Because of the success stories of patients attending the After Breast Cancer (ABC) Program offered by the YMCA, MTMC decided to provide funding for our patients to attend this program. A fulltime breast nurse navigator has been hired to ease the burdens of working through the therapeutic process for patients and their families. The navigator provides preop education to patients scheduled for surgery and has been very successful with community outreach efforts for the women in Rutherford County. Access to care has been improved with the addition of on-site thoracic surgery availability. Implementation of the LEAN improvement process has resulted in cutting the medication turn around time hospital-wide. Utilizing our registry data, Brian Lee, MD provides us with a survival analysis of prostate cancer patients compared to national data. Many thanks to our doctors, nurses, professional and support staff, volunteers and community members for your dedication to providing the best in cancer care here in our community! Richard Michaelson, MD, Chair Saint Thomas Rutherford Hospital Cancer Committee 4

5 from the cover During an examination, William s doctor discovered that William, an active husband and father of two grown sons, had lung cancer. And so began a treatment program that would not only include quitting cigarettes, but surgery, radiation and chemotherapy as well. For the Murfreesboro resident, who was working in shipping for Yellow Freight at the time, the fact that he was able to receive the advanced treatment he needed so close to his home at Saint Thomas Rutherford Hospital was an enormous benefit. Having my treatment right here in Murfreesboro made everything a lot more convenient, says William. My neighbor was able to take me to treatment and then come back to pick me up when it was finished. Throughout his treatment program, William began constructing a lily pond in his backyard. You know with chemotherapy you have good days and bad days, says William. The pond was a way to stay active on the good days and When William Allen asked his doctor for a prescription that would help him quit smoking in early 2002, he got more than he bargained for. gave me something to look forward to. Today, William says the lily pond, which is home to several large Koi fish, is a wonderful place to relax and enjoy time with family and friends. That is, of course, when he s not venturing out with his wife and fellow Harley enthusiasts on road trips across Tennessee or Florida. Like many cancer patients, William has developed a strong and lasting relationship with his oncology team, Drs. Barton and Lee. Though he swears it s not done in an effort to get a preferred appointment time, he is known for showing up for his annual check ups with his signature Jack Daniel s Chocolate Pecan Pie in hand. My doctors and their staff were so good to me, said William. My annual check ups always fall in December, and making them a pie has become a tradition of sorts. For William, who no longer smokes and is quick to tell others about the importance of not starting, life continues to be an adventure. And he is determined to be an active participant not a spectator. >2009 MTMC Cancer Committee Richard Michaelson, MD Chair Pathology David Beaird, MD Surgery Lingaiah Chandrashekar, MD Gastroenterology Chad Jackson, MD Urology Rick Johnson, MD Diagnostic Radiology Arundati Ramesh, MD Internal Medicine Charles Wendt, MD Radiation Oncology John Zubkus, MD Medical Oncology Kristy Ahlgrim, RN, OCN, Nurse Manager 2A Oncology Jennifer Boling, RT Manager, Radiation Therapy Michael Bratton, RN, MA Chief Nursing Office Michelle Arnold, RN, MBA/HCM, CPHQ Quality Manager, Accreditation Compliance/ Performance Improvement Pam ClenDening, CTR STHS Cancer Program Director Steve Clevenger, RT(R), CRA Director, Medical Imaging & Radiation Therapy Lisa Flamm, RN Director, Case Management Ruth Green, RHIT Director, HIM Danita Hawks, RN, CTR Cancer Quality Coordinator Elizabeth Pace, MHA STHS Service Line Executive Oncology/Women s Health Kim Parham, RN Nurse Manager, STHS Centers for Breast Health Patsy Peyton, RN, CTR Tumor Registry Sharon Tibbits, PT STHS Cancer Centers Program Director Nannette Todd, RN, MHA Director, Patient Care Systems and Med/Surg Division Ryan Simpson, MBA, MSHA, CHE VP Operations Carole Williams, RN Nurse Navigator, Center for Breast Health 5

6 2008 ACCESSIONED CASES at Saint Thomas Rutherford Hospital 6 PRIMARY SITE TOTAL CLASS* SEX Analytic Non-Analytic M F ALL SITES ORAL CAVITY LIP TONGUE OROPHARYNX HYPOPHARYNX OTHER 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 CONNECT/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 OTHER

7 Annual Report 2009 > Saint Thomas Rutherford Hospital PRIMARY SITE TOTAL CLASS* SEX BRAIN & CNS BRAIN (BENIGN) BRAIN (MALIGNANT) OTHER ENDOCRINE THYROID OTHER LYMPHATIC SYSTEM HODGKIN S DISEASE NON-HODGKIN S UNKNOWN PRIMARY OTHER/ILL-DEFINED *Class: Analytic cases include those cases that were initially diagnosed or treated at this facility. Nonanalytic cases include cases referred to this facility for recurrence or subsequent therapy Top Site Comparison 60% 50% 40% 30% 20% 10% 0% Breast (198) Lung (130) Prostate (103) Colon/Rectum (83) All Other (228) MTMC 27% 17% 14% 11% 31% TN 13% 17% 14% 11% 45% National 13% 15% 13% 10% 49% Source: Estimated Cancer Incidence U.S. 2008: American Cancer Society, Cancer Facts & Figures Data Review Analytic Non-Analytic Class 0 = Diagnosed here/treated elsewhere 54 (7%) n/a Class 1 = Diagnosed here/treated here 517 (70%) n/a Class 2 = Diagnosed elsewhere/treated here 171 (23%) n/a Total (Combined: 826) Abstracting Timeliness: 732/742 or 99% of cases were abstracted within 6 months of date of first contact Clinical Trial Participation The St Thomas Research Institute reports MTMC 2008 enrollment as follows: Industry/Pharmaceutical Sponsored: 32 SCRI (Sarah Cannon Research Institute) Investigator Initiated Trials (ITT): 38 SCRI Total 70/742=9% 7

8 SITE SPECIFIC STUDY: PROSTATE CANCER By Brian Lee, MD Figure 1: 87% of MTMC s prostate cancer patients were diagnosed at stage II compared to 71% of the patients in the NCDB database. MTMC 2008 and NCDB 2006 Prostate Comparison Graphs (2006 most current NCDB data available) An estimated 200,000 prostate cancer cases are diagnosed annually in the United States. According to the American Cancer Society s Cancer Facts & Figures 2008, this will account for 13% of all new cancer cases in the U.S. and 14% in Tennessee. Prostate cancer accounts for 14% of all new cancer cases entered into the MTMC Cancer Registry database during Prostate cancer is the second leading cause of death in men behind lung cancer, with 30,000 deaths per year. In 2008 deaths due to prostate cancer accounts for an estimated 5% of all cancer deaths and 10% of all cancer deaths in men. Because of PSA screening, prostate cancer can be detected and treated at an early stage. Post-treatment PSA results are an indicator of biochemical control of prostate cancer. Elevated PSA following treatment is considered biochemical failure. Risk Stratification Risk of Biochemical Failure 1. Low risk: T1c-T2a, Gleason 2-6, PSA 0-10, 2. Intermediate risk: T2b, Gleason 7, PSA High risk: T2c or greater, Gleason 8-10, PSA > 20 Biochemical control at 5 years: 1. Low risk: >80-85% 2. Intermediate risk: 50-75% 3. High risk: < 50% 100% 80% 60% 40% 20% 0 Figure 1. AJCC Stage Comparison for Prostate The higher the risk, the more aggressive treatment is needed to control prostate cancer, such as adding hormone deprivation therapy or external beam + brachytherapy. A PSA rise of >2ng/ml during the year prior to prostate cancer diagnosis, indicates aggressive behavior. These patients are not the best candidates for observation. Early diagnosis is important in improved disease free survival and overall survival. Stage I prostate cancer is an incidental finding. Diagnosis of prostate cancer in stage II improves the therapeutic outcome. Five-year survival for LOCALIZED prostate cancer is 100%..See Figure 2 survival comparison for prostate cancer Too few patients were diagnosed with Stage III, and Stage IV Prostate Cancer at MTMC to perform a meaningful comparison with NCDB. Comparison of histology, race, and age distribution MTMC patient population against NCDB data revealed no significant differences between the two groups. 5 Year Biochemical Control The study group included 226 patients that received all or a portion of treatment for prostate cancer at MTMC during Recent PSA results were obtained on 60% of the cases. PSA control of patients after 5 years: Radical prostatectomy 45/58 (79%) Brachytherapy 51/54 (94%) External beam XRT 19/24 ( 79%) Conclusion In conclusion, MTMC physicians are doing an excellent job diagnosing prostate cancer at an early stage. This translates to improved disease free survival and overall survival. I II III IV UNK MTMC-2008 N= % 5% 4% 4% NCDB-2006 N=5209 3% 71% 8% 4% 14% 8

9 Annual Report 2009 > Saint Thomas Rutherford Hospital PERCENT 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0 Figure 2. 5-Year Survival Comparison for Prostate by AJCC Stage MTMC , NCDB , NCDB data from 89 facilities (AL, KY, MS, TN) DX YEARS Figure 2: As expected, 5 year survival for these patients is excellent. The survival rate is 92.2% for MTMC compared to 86.2% for NCDB. Too few patients were diagnosed with Stage III, and Stage IV Prostate Cancer at MTMC to perform a meaningful comparison with NCDB. MTMC Stage 1 n= NCDB Stage 1 n= MTMC Stage 2 n= NCDB Stage 2 n=19, MTMC Stage 3 n= NCDB Stage 3 n=2, MTMC Stage 4 n= NCDB Stage 4 n=1, Source: National Cancer Data Base 80% Figure 3. Treatment Modality Comparison Figure 3: MTMC 2008 and NCDB 2006 Prostate Comparison Graphs (2006 most current NCDB data available) 60% 40% 20% 0% Surg Rad Rad & Horm None All Other External Beam Brachytherapy MTMC 2008 n=80 27% 59% 3% 7% 4% 40% 60% NCDB 2006 n= % 22% 13% 4% 7% 62% 38% Comparison of histology, race, and age distribution MTMC patient population against NCDB data revealed no significant differences between the two groups. 9