C a nc e r C e nter. Annual Registry Report

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1 C a nc e r C e nter Annual Registry Report 214

2 214 Cancer Registry Report Larraine A. Tooker, CTR Please note that the 214 Cancer Registry Annual Report is created in 214, but it reflects data on cases diagnosed in the year 213. The Carson Tahoe Cancer Registry is a comprehensive, computerized database with a reference date of January 1, 23. Over 6, analytic cases have been recorded through December 213. The registry is one component of the multidisciplinary team committed to providing quality care to cancer patients and their families. The cancer registry collects and manages statistical data on our cancer population. Information collected includes patient demographics, medical history, anatomical site and histology of the primary cancer, extent of disease and treatment. Confidentiality of patient identification and related medical data are strictly maintained. Statistical information gathered from this data is used by area physicians, the Nevada Central Cancer Registry, the National Cancer Data Base and local hospitals to review trends and outcomes for cancer patients. Monitoring survival statistics and disease recurrence helps improve the standard of care for patients who have cancer, certain diseases of the blood and lymphatic systems, and non-malignant brain tumors, as well as providing data to prompt new research studies and clinical trials. Our Cancer Program is an accredited program with the American College of Surgeons (ACoS), Commission on Cancer (COC). Applying for and maintaining CoC approval is a voluntary commitment by a cancer program that ensures its patients will have access to the full scope of services required to diagnose, treat, rehabilitate, and support patients with cancer and their families. The cancer program is able to continually evaluate its performance and take corrective action when necessary. This continuous evaluation reaffirms the commitment of the program to provide quality cancer care. Receiving care at a CoC-accredited cancer program hospital or facility ensures that patients will receive: Comprehensive care including a complete range of state-of-the-art services and equipment A multidisciplinary team approach to coordinate the best available treatment options Information about ongoing cancer clinical trials and new treatment options Access to prevention and early detection programs, cancer education and support services The cancer registry participates in the annual call for data for the National Cancer Data Base (NCDB), as required of ACoS approved programs. The NCDB, a joint program of the Commission on Cancer and the American Cancer Society, is a nationwide oncology outcomes database. The NCDB tracks and analyzes data on all types of cancer. This data is used to monitor trends in cancer care, to create regional and state benchmarks for participating hospitals, and as a basis for quality improvement. The medical staff at Carson Tahoe uses data from the NCDB to compare our cancer experience with hospitals across the nation in an effort to provide the best possible care for our patients. In 213, 823 new cancer cases were added into the registry. 86% (712) of the cases were newly diagnosed and/or treated for first course of treatment at Carson Tahoe. They are referred to as analytic cases. The remaining 14% (111) are considered non-analytic. These are patients that were diagnosed and received first course treatments elsewhere and then later came to our facility for treatment of recurrence or progression of their disease. Other non-analytic cases may be patients whose diagnoses were made in a staff physician office during 213, but were not seen at Carson Tahoe. Patient follow-up is an important part of cancer care. Each patient in our database is followed annually to update information on disease recurrence, subsequent treatment, length of survival and overall well-being. The Commission on Cancer requires a successful follow-up rate of at least 9%. Our follow-up rate at Carson Tahoe is currently at 91%. During 213, 43 cancer conferences were held, allowing for a prospective, multidisciplinary physician review of the case, stage, and discussion of treatment options to improve patient care. The treatment options discussed follow the National Comprehensive Cancer Network (NCCN) treatment guidelines, which are updated regularly to recommend the most recent treatment protocols for specific cancer sites. Multidisciplinary experts work together to achieve the best possible outcomes. The Carson Tahoe cancer care specialists include dedicated physicians, surgeons, medical oncologists, nurses, therapists, dietitians, social workers, pharmacists and lab technicians, plus the staffs of radiation oncology, pathology, pulmonology, radiology and palliative care. Through discussion of the different specialty areas, the group recommends the most appropriate treatment. A total of 176 cases were presented. Of these, 171 cases (97.15%) were prospective. A cancer registry that offers lifelong patient follow-up Ongoing monitoring and improvements in cancer care Quality care that is close to home The cancer registry submits data to the Nevada Central Cancer Registry, which in turn shares information with data collection systems on a national level an invaluable tool in cancer research, particularly in diagnosis and treatment research. 214 Registry Report Page 1

3 Carson Tahoe Health Bladder Cancer Study Roger D. Miercort, MD Survival data from the years for Carson Tahoe Cancer Center revealed that a total of 253 cases of the bladder were diagnosed and treated during this four year period. The vast majority, 24 or 81%, were either Stage or Stage 1. The five year survival rate for Stage was 73%; on the high end when compared to the national Cancer Database of 65% to 81%. Our five year survival data for Stage 1 bladder cancers was 63%, well within the national data range of 52-73%. The NCCN Clinical Practice Guidelines for early stage bladder cancer indicate that the primary treatment should be surgery and, in most cases, followed by immunotherapy with BCG. Radiation and chemotherapy should be used only in those patients who are medically considered non-operable candidates. In our series of Stage patients, with very early disease, 5% received surgery only while the other 5% received both surgery and BCG immunotherapy. In our series of Stage 1 patients, 75% received surgery only, while 25% received both surgery and BCG immunotherapy. This data demonstrates that our local urologists are doing an excellent job of treatment of patients within the NCCN Clinical Practice Guidelines and that our survival data are well within the expected five year national data. The urologists are to be commended for the excellent care given to this group of patients. CTH: Bladder Cancer Surival Rates (23-27) Stage of Disease Enter. yr 1. yr 2. yr 3. yr 4. yr 5. yr 95% Confidence Stage Stage Notice: When comparing survival rates betw een your cancer program and all other CoC-accredited cancer programs; if the confidence intervals of stage-specific or overall survival rates overlap after 5 years, then there is no statistical difference between survival rate of patients at your facility with that of other CoC-accredited cancer programs. 12 Observed Survival For Urinary Bladder 'C67', 'C671', 'C672', 'C673', 'C674', 'C675', 'C676', 'C677', 'C678', 'C679' Cases Diagnosed in Data From 1 Program (Carson Tahoe Health) 1 Cumulative Survival Rate Stage Stage Years From Diagnosis 214 Registry Report Page 2

4 All CoC-Accredited Hospitals: Bladder Cancer Surival Rates (23-27) Stage of Disease Enter. yr 1. yr 2. yr 3. yr 4. yr 5. yr 95% Confidence Stage Stage Stage Stage Stage Notice: When comparing survival rates betw een your cancer program and all other CoC-accredited cancer programs; if the confidence intervals of stage-specific or overall survival rates overlap after 5 years, then there is no statistical difference between survival rate of patients at your facility with that of other CoC-accredited cancer programs. 12 Observed Survival For Urinary Bladder 'C67', 'C671', 'C672', 'C673', 'C674', 'C675', 'C676', 'C677', 'C678', 'C679' Cases Diagnosed in Data From 148 Programs (National) 1 Cumulative Survival Rate Stage Stage 1 Stage 2 Stage 3 Stage Years From Diagnosis 213 Bladder Cases by Stage and Gender Male Female Total Stage % 24.35% 6.87% 6.% Stage % 33.33% 21.74% 33.33% Stage %.% 13.4%.% Stage % 5.% 2.17% 6.67% Stage %.% 2.17%.% Total Registry Report Page 3

5 214 Report Results 213 Analytic v. Non-Analytic Cases Total Cases = 823 Carson Tahoe Cancer Center Analytic Cases by Year Number of Cases 4 3 Number of Cases Analytic, 86% Non-Analytic, 14% Analytic Cases by Cancer Stage Total: 712 Not Applicable for Staging 6% Unknown Stage 5% Stage (In-Situ) 1% Stage 4 19% Stage 1 29% Stage 3 15% Stage 2 16% 213 Distribution of Analytic Cases by State/County Total: 712 CA-Mono Co 1% CA-El Dorado Co 3% NV-Washoe Co 4% Other 8% NV-Churchill Co 4% NV-Carson City 36% NV- Lyon Co 19% NV- Douglas Co 25% 214 Registry Report Page 4

6 213 Carson Tahoe Cancer Patients Gender Comparison Total Analytic Cases: Male Female 213 Top 5 Sites for Male Gender Total: Top 5 Sites for Female Gender Total: 371 4% 45% 35% 4% 4% 3% 35% Percentage Of Male Cases 25% 2% 15% 21% 18% 12% Percentage for Female Gender 3% 25% 2% 15% 18% 1% 9% 9% 1% 8% 5% 5% 5% 5% % Prostate Bladder Lung Colo-Rectal Kidney % Breast Lung Colo-Rectal Thyroid Endometrium 213 Age at Diagnosis Comparison Total: Male Female Age Group 214 Registry Report Page 5

7 25.% Five Most Common Cancers in 213 Total: Prostate Cases by AJCC Stage Total: % 2.% % 15.3% % 5.% 1.3% 8.7% 8.6% % Breast Lung Prostate Colo-Rectal Bladder Stage 1 Stage 2 Stage 3 Stage Colo-Rectal Cases by AJCC Stage Total: Bladder Cases by AJCC Stage Total: Stage (In Situ) Stage 1 Stage 2 Stage 3 Stage Stage (In Situ) Stage 1 Stage 2 Stage 3 Stage Breast Cases by AJCC Stage Total: Lung Cases by AJCC Stage Total: Stage (In Situ) Stage 1 Stage 2 Stage 3 Stage 4 Stage 1 Stage 2 Stage 3 Stage Registry Report Page 6

8 Graph Notes The Analytic and Non-Analytic graph on page 4 shows the percentages of each category for the 213 cases. The Carson Tahoe Cancer Center Analytic Cases by Year Graph on page 4 shows an increase of 22 in reportable cancer cases this year. The Analytic Cases for all Cancer Sites by Stage Chart on page 4 shows where all of our cases were staged at the time of diagnosis. Note that 55% were Staged as Stage (In-Situ), Stage 1, or Stage 2. This reflects that we catch 55% of our cases at an early stage. The Distribution by State/County Graph on page 4 shows that the majority of our patients (8%) live in Carson City, Douglas County, or Lyon County. The Gender Comparison Graph on page 5 specifies the breakout of male and female patients for 213. The next two graphs on page 5 show the break-out of the top five sites for each gender. Kidney cancer was the 5th highest number of cases for the males; while thyroid cancer and endometrial cancer were both tied at the 4th highest for the females. The Age at Diagnosis Comparison Graph on page 5 shows that the two decades where cancer was diagnosed the most often were the ages 6-69 and This is identified with male and female categories, as well. The Five Most Common Cancers Graph on page 6 shows the most common cancers diagnosed and/or treated here at Carson Tahoe. Of all 213 cases at Carson Tahoe, breast cancer was the most common, followed by lung, prostate, colon/rectal, and bladder. The next graphs on page 6 show the top five cancer sites and their breakout by AJCC Stage. The Primary Site Table on page 8 breaks out all of our 213 cancer cases by their primary site. 214 Registry Report Page 7

9 Primary Site Table Data Primary Site Total % Male % Female % ORAL CAVITY & PHARYNX % 2 5.9% 7 1.9% Lip 1.1% 1.3%.% Tongue 1 1.4% 5 1.5% 5 1.3% Salivary Glands 3.4% 2.6% 1.3% Gum & Other Mouth 5.7% 4 1.2% 1.3% Tonsil 4.6% 4 1.2%.% Oropharynx 1.1% 1.3%.% Hypopharynx 3 4.% 3 9.%.% DIGESTIVE SYSTEM % % % Esophagus % 7 2.1% 4 1.1% Stomach 5.7% 3.9% 2.5% Small Intestine 6.8% 6 1.8%.% Colon Excluding Rectum % % % Rectum & Rectosigmoid % % % Anus, Anal Canal & Anorectum 4.6%.% 4 1.1% Liver & Intrahepatic Bile Duct 6.8% 5 1.5% 1.3% Gallbladder 4.6%.% 4 1.1% Pancreas % % 6 1.6% Other Digestive Organs 5.7% 3.9% 2.5% RESPIRATORY SYSTEM % % % Nose, Nasal Cavity, & Middle Ear 1.1% 1.3%.% Larynx 6.8% 5 1.5% 1.3% Lung & Bronchus % % % SOFT TISSUE 2.3% 2.6%.% SKIN (Excluding B asal & Squamo us C ell) % % 2.5% Melanoma % 1 2.9% 2.5% Other Non-Epithelial Skin 1.1% 1.3%.% BREAST % 2.6% % FEMALE GENITAL SYSTEM %.% % Cervix Uteri 1.1%.% 1.3% Corpus & Uterus, NOS %.% % Ovary 7 1.%.% 7 1.9% Other Female Genital Organs 2.3%.% 2.5% MALE GENITAL SYSTEM % %.% Prostate % %.% Testis 5.7% 5 1.5%.% URINARY SYSTEM % % 26 7.% Urinary Bladder % % 15 4.% Kidney & Renal Pelvis % % 8 2.2% Ureter 4.6% 1.3% 3.8% BRAIN & OTHER NERVOUS SYSTEM 8 1.1% 2.6% 6 1.6% Brain 3.4% 2.6% 1.3% Cranial Nerves & Other Nervous Syst 5.7%.% 5 1.3% ENDOCRINE SYSTEM % 9 2.6% % Thyroid % 8 2.3% % Other Endocrine including Thymus 1.1% 1.3%.% LYMPHOMAS % 17 5.% 8 2.2% Hodgkin Lymphoma 1.1%.% 1.3% Non-Hodgkin Lymphoma % 17 5.% 7 1.9% MULTIPLE MYELOMA 5.7% 4 1.2% 1.3% LEUKEMIAS 1 1.4% 7 2.1% 3.8% Lymphocytic Leukemia 3.4% 3.9%.% Myeloid & Monocytic Leukemia 7 1.% 4 1.2% 3.8% MESOTHELIOMA 1.1% 1.3%.% MISCELLANEOUS 9 1.3% 4 1.2% 5 1.3% Total Registry Report Page 8

10 1 st 1st Cancer Center to Receive Gold Level Accreditation in Nevada 1535 Medical Parkway North Carson City CTH is a not-for-profit, 51c3 corporation

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