Cayuga Medical Center. Affiliated with Roswell Park Cancer Institute. Cancer Program

Transcription

1 Cayuga Medical Center Cayuga Cancer Cancer CareCenter Affiliated with Roswell Park Cancer Institute Cancer Program Annual Report 2012

2 2012 Cayuga Medical Center Cancer Committee Chairman s Report Charles Garbo, MD, Chairman Board certified in medical oncology and internal medicine. Graduated University of Vermont Medical School, Burlington, VT. Internship and residency in internal medicine at St. Vincent Hospital, Worcester, MA. Fellowship in hematology and oncology at University of Massachusetts Medical Center, Worcester, MA. Assistant clinical professor of oncology at Roswell Park Cancer Institute, Buffalo,. William Carroll, MD, PhD Board certified in diagnostic radiology. Doctor of Philosophy in physiology from Pennsylvania State University, College Park, PA. Graduated Jefferson Medical College in Philadelphia, PA. Internship in family practice at St. Margaret Memorial Hospital in Pittsburgh, PA. Residency in diagnostic radiology at Geisinger Medical Center in Danville, PA. Fellowship in vascular and interventional radiology at Western Pennsylvania Hospital, Pittsburgh, PA. David Cho, MD Board certified in radiation oncology. Graduated Medical College of Virginia, Richmond, VA. Transitional program internship at New York Hospital Medical Center of Queens, Flushing,. Residency in radiation oncology at New York University, New York,. Assistant professor of oncology at Roswell Park Cancer Institute, Buffalo,. Eric Lessinger, MD Board certified in hospice and palliative medicine and family practice. Graduated New York University School of Medicine, New York,. Internship in internal medicine at Lincoln Medical Center, Bronx,. Residency in family practice at Highland Hospital in Rochester,. Mini-Fellowship in palliative care at Mt. Sinai Hospital, New York,. Medical Director, Hospicare and Palliative Care Services of Tompkins County. David Schwed, MD Board certified in surgery. Graduated SU Upstate Medical University, Syracuse,. Internship and general surgical residency at New Jersey s Morristown Memorial Hospital, an affiliate of Columbia Presbyterian Medical Center in New York,. Daniel Sudilovsky, MD Board certified in cytopathology, anatomic pathology, and clinical pathology. Graduated Case Western Reserve University of Medicine, Cleveland, Ohio. Residencies in anatomic pathology and laboratory medicine at the University of California San Francisco. Fellowship in pathology, cytopathology and surgical pathology. Karen Ames, AAS, BS, MA Director, Quality Assessment Robin Anderson-Eastburn, RN Registered Nurse in Medical Oncology Carolyn Bartell, MSW, ACSW Community Representative Margaret Blackman Director, Patient and Family Services American Cancer Society Pauline Cameron, RN, CHPN Certified in Hospice and Palliative Nursing Director of Patient Services for Hospicare and Palliative Care Services of Tompkins County Ellen Dugan, MBA Vice President of Service Lines Kevin Flint, BSN, RN, MBA-HCM, OCN Director of Medical, Telemetry, and Oncology Nursing Betty McEver, BSN, RN, CRN Oncology Nurse Navigator Bob Riter, MHSA Executive Director, Cancer Resource Center of the Finger Lakes Michelle Rosato, BA, RTT Director, Oncology Services Marguerite Sterling, BSN, RN Registered Nurse in Radiation Medicine, Clinical Research Associate Deb Traunstein, LMSW, MBA Licensed Master Social Worker Sally Van Idistine, CTR Certified Tumor Registrar, Cancer Registry In 2012 the Cayuga Medical Center Cancer Care Program received a three-year accreditation with commendation from the American College of Surgeons Commission on Cancer. During a comprehensive on-site survey in May, we earned the highest possible rating in the category of Community Hospital Comprehensive Cancer Program with recognition for our work in all eight areas of commendation. The cancer care program at Cayuga Medical Center has been accredited since 1985, and we are especially pleased that this year the Commission on Cancer recognized our program for acrossthe-board excellence in all cancer program standards. In January 2012, as part of the Commission on Cancer s Rapid Quality Reporting System (RQRS), Cayuga Medical Center initiated a prospective approach to reporting breast cancer and colorectal cancer patient data. Historically, hospitals submit individual patient data annually on the type and stage of cancer and its treatment to the National Cancer Data Base retrospectively. Only 25 percent of cancer care programs approved by the Commission on Cancer are participating in RQRS. Through this new initiative our cancer care team gets feedback on patient therapy in real time, rather than retrospectively. This helps ensure that patients receive the correct treatment through the course of their therapy and enables our multidisciplinary team to benchmark our care against national standards and other cancer care programs. Receiving a cancer diagnosis is a daunting experience for patients, and negotiating the medical system can be distressing and difficult. To ensure needed support for newly diagnosed cancer patients, the Commission on Cancer is requiring that all certified cancer care programs offer patient navigator services by Cayuga Medical Center s care team is so committed to this important service that in 2011 we welcomed our first oncology nurse navigator, Betty McEver, BSN, RN, CRN. In 2012 we brought on our second nurse navigator, Jacqueline Adam, RN, to work with patients in our Multidisciplinary Breast Care Clinic. Our nurse navigators are playing vital roles in guiding patients and families through the process of diagnosis and treatment. We feel strongly that the medical training our nurse navigators bring to their work with patients is extremely valuable and supplements other available services in our community. The palliative care program at Cayuga Medical Center grew in 2012, particularly in the area of outpatient services. Palliative care is more comprehensive than before. Led by a palliative care physician and nurse practi-tioner, the program includes social work services, nutrition consultations, and spiritual counseling. This can help patients and their families cope with the impact of treatment. Through our comprehensive care teams we are working to build integrated program support services, and will be ready long before the Commission on Cancer 2015 requirement for these services goes into effect. Cayuga Medical Center and Cayuga Hematology Oncology Associates extended local cancer care services in 2012 with the opening of a branch office on the medical center s East Campus. This second site provides easier access to care for area residents on the east side of Cayuga Lake, and in the Lansing, Dryden, and Cortland areas. The additional space also helps us accommodate the increased number of patients we are treating, and it allows us to continue to offer more lines of therapy as they become available for certain types of cancer. Our need for more space relates to several factors, chief among them are the growing population and our expanding service area, the addition to our care team of oncologist Dr. Julie Campbell, and our belief that fewer cancer patients are choosing to go out of town for their care. The vast majority of area patients who seek second opinions at major medical centers actually undergo their treatment locally, having learned that the therapies we provide here are exactly what they would receive elsewhere. The exception to the rule occurs when a patient of ours is eligible to participate in a clinical trial not offered locally or when services needed are not available in town. In those instances we work closely with our colleagues at the clinical tertiary sites to ensure the best care possible for our shared patients was a year of growth and accomplishment. We look forward to continued growth of services and even greater collaboration in the upcoming year. Charles Garbo, MD Chairman, Cayuga Medical Center Cancer Program Cancer Liaison Physician to the Commission on Cancer 1

3 When Cancer Strikes, There s No Place Like Home When Carol Sammis first discovered the lump in her breast she was not overly concerned; she had been diagnosed before with fibroadenomas, which are benign breast tumors. During her annual gynecological check-up in July, ob-gyn specialist Dr. Jose Torrado palpated the lump, recommended that Sammis see a surgeon, and called to set up an appointment with Dr. Cory Foster, a surgeon Sammis already knew and liked. Everything happened pretty swiftly, which is part of the service here, says Sammis. When there is a concern it can be addressed immediately; I didn t have to wait. Only three weeks passed from the time of her appointment with Dr. Torrado and her imaging studies to her breast cancer diagnosis and subsequent lumpectomy with sentinel node biopsy. Following her surgery, Dr. Foster provided guidance as Sammis s care transitioned to her medical and radiation oncologists. A long-time Ithaca resident, Sammis says everyone she spoke with in the community had high praise for the team of caregivers at Cayuga Hematology Oncology Associates and assured her she would be in excellent hands. At age sixty-five, Sammis has been a teacher for forty-four years and is currently an assistant professor and chair of the Early Childhood Education Program at Tompkins Cortland Community College (TC3) in Dryden, New York. It was important to her to be able to keep working throughout her cancer treatment because she has classes every day of the week. I felt that everyone I dealt with at Cayuga Radiation Medicine and Cayuga Hematology and Oncology was very attuned to the great stress and anxiety a cancer diagnosis causes and they were always very reassuring, says Sammis. My husband Bill was with me every step of the way. Sharing life perspectives When I saw my medical oncologist, Dr. Bael, he was very personable and sensitive to my concerns, Sammis remembers. One of the things that impressed me most was his open, sincere manner. Her cancer had not spread beyond the breast tumor that had been surgically removed. Dr. Bael explained that with no further treatment the likelihood of her cancer returning was relatively low, however, with four chemotherapy treatments and radiation therapy her odds for a cure would be even better. Sammis s biggest concern, more pressing than losing her hair, was nausea, but Dr. Bael was able to allay her fears. Chemotherapy regimens have become more focused on nausea prevention, explains Dr. Bael. We have many anti-nausea medications now that are very effective. Our goal is to minimize nausea and other side effects from chemotherapy. Four days before Christmas, on her wedding anniversary, Sammis had her last chemotherapy treatment. She and Bill shared a cake with her caregivers. To Carol s delight, two of her nurses were graduates of the TC3 School of Nursing. I could see the effect of their training. Everything was very well explained and they had a high level of concern for my comfort. The day she started the new semester in January, Sammis underwent the first of her thirty- Dr. Timothy Bael three daily radiation therapy sessions. They were scheduled at 8:00 a.m. to accommodate her teaching schedule. I had the same experience in radiation medicine that I had in Dr. Bael s office, she says. Everyone was kind, sensitive, and always let me know exactly what they were doing. Choosing local There are two aspects of my story that are especially important, Sammis points out. The first was being able to stay in Ithaca. I didn t stay here as a default. I truly believe I have received the very best care there is. The whole experience would have been very different if I had needed to travel out of town. The second aspect of my care that was extremely important to me was that I wanted my life and my job to remain as normal as possible. I was able to go through cancer treatment here with very few interruptions. Having everything I needed right here in town made a big difference for me, says Sammis. Bill was able to go with me to my appointments. It was a very positive experience and I totally trusted the people I was seeing for my care. I could sleep in my own bed every night. And for that, there really is no place like home. Multidisciplinary Breast Care Clinic All women having diagnostic mammograms at Cayuga Medical Center and the Convenient Care Centers in Ithaca and Cortland learn the results of their mammogram before the end of their imaging appointment and have the opportunity to discuss mammographic findings with their radiologist at that time. Women with suspicious mammographic findings or physician-confirmed breast lumps can be referred to Jacqueline Adam, RN, our new nurse navigator for the Multidisciplinary Breast Care Clinic. Jacqueline reaches out to the patient and facilitates scheduling with the clinic as quickly as possible. The clinic, which was launched in January 2012, runs twice a week. Patients meet with a surgeon for a physical exam to discuss concerns, decide whether a breast biopsy is indicated, and decide which method of biopsy is preferred. If a biopsy is indicated, most are performed that same day or scheduled within a day. On the very next clinic day, patients meet with a surgeon and learn the results of their biopsy. If the biopsy is positive for cancer, the surgeon discusses the diagnosis and follow-up treatment plan. Jacqueline contacts Betty McEver, RN, oncology nurse navigator, whose role is to help and support each patient through the continuum of her care. This model of care is typically found only in large medical centers and is part of our medical community s effort to integrate care and bring the most qualified doctors together to streamline and optimize patient care. 2 3

4 Cancer Care Taking Care to a Higher Level Skilled nurses with specialized expertise play a crucial role in the delivery of comprehensive cancer care. Cayuga Cancer Center s nurses are dedicated professionals who continually seek advanced training and certification to better serve patients and their families. We strive for excellence in everything we do. Our patients receive chemotherapy and biotherapy from experienced registered nurses who are certified by the Oncology Nursing Society (ONS) to administer chemotherapy and biotherapy agents. In 2012 Jennifer Fuller, RN, Hannah Potts, RN, Donna Devine, RN, Kevin Flint, BSN, Affiliated RN, MBA-HCM, Kathryn with Lynch, BS, RN, and Betty McEver, RN, achieved additional ONS certification as oncology certified nurses (OCN). In addition, Deborah Danko, RN, holds her certification. Betty McEver, BSN, RN, CRN, became a certified oncology nurse navigator. Marguerite Sterling, RN, also earned a Certificate of Added Qualification in radiation oncology nursing in 2012, which was the first year this certification became available through ONS. This ongoing pursuit of excellence is in keeping with our determined resolution to retain accreditation with commendation. Staying Ahead of the Curve Our comprehensive care teams made significant progress this year in the development of integrated program support services. This concentrated focus on multidisciplinary care helps us provide a more holistic approach to meeting the psychosocial, physical, and spiritual needs of patients and their families through treatment and on into survivorship. A Celebration of Life The first of what will become an annual survivorship event was held in June to honor cancer survivors, caregivers, family members, friends, and our oncology caregivers. Information on health promotion and support services was provided by several local organizations, among them the Cayuga Center for Healthy Living, Rasa Spa, Cancer Resource Center of the Finger Lakes, American Cancer Society, the Ithaca Garden Club, and Gadabout. Speaking at the event Rev. Tim Dean were Cayuga Medical Center chaplains the Rev. Tim Dean and the Rev. Meredith Ellis. Early Bird Farms donated plants and flowers for all the participants of the event. The celebration was closed with a ceremonial white dove release by Soaring Spirits. Committed to Community Involvement Our collaboration and involvement with sister organizations in the community remains very strong. The 19th Annual Walkathon and 5K Run sponsored by the Cancer Resource Center of the Finger Lakes raised over $140,000 for support services, transportation, and comfort care to help local cancer cancer program highlights Roswell Park Cancer Institute patients. More than fifty people from Cayuga Medical Center participated in 2012, raising $4,450. We also had an excellent turnout at Relay for Life events in both Cortland and Ithaca. Our fifty walkers at the Ithaca relay raised over $10,000. We show our continued support through participation in additional events throughout the year also; such as Hospicare s Women Swimmin, ACS Community and Coaches vs. Cancer, and many others. We are fortunate to have these wonderful resources right here locally, in our community. Breast Care Nurse Navigator Jacqueline Adam, RN, has joined our care team in the newly created position of breast care nurse navigator. She is the point-of-contact person for the Multidisciplinary Breast Care Clinic for patients who have abnormal imaging results or who have a physician-confirmed breast lump. In her new role she serves as a liaison, patient advocate, and support person for patients going through their initial diagnosis. Jacqueline also works closely with oncology nurse navigator, Betty McEver, RN, to facilitate a seamless transition of care for patients with a positive diagnosis of breast cancer. Extending Local Cancer Care Services Cayuga Hematology Oncology Associates (CHOA), a service of Cayuga Medical Center, has opened a new branch office on the medical center s East Campus, located just off Warren Road in Ithaca. This new site provides convenient access to care for patients who live or work on the east side of Cayuga Lake, and in the Lansing, Dryden, and Cortland areas. A board-certified oncologist from CHOA sees patients by appointment five days a week. Experienced registered nurses, who are certified by the Oncology Nursing Society (ONS), administer chemotherapy and biotherapy. Patients undergoing therapy can relax in a beautiful treatment area that is full of windows and natural light. Jennifer Fuller, RN, OCN, at CHOA East Campus 2011 Analytic Case Site Distribution 2011 Statistics 5 Year Trend of Major Sites at Cayuga Medical Center Number of New Cases Site 2011 Total Males Females 2010 Breast % 18% Lung % 13% Colorectal % 8% Bladder % 4% Melanoma % 4% All other sites % 53% Total all sites % 100% Analytic: Cancer diagnosed and/or received first course of treatment at. : National Cancer Data Base. Distribution by County 2011 Analytic Cases Other 3% Cayuga 4% Cortland 6% Tioga 3% Schuyler 3% Breast Lung Tompkins 81% While most of our cases come from Tompkins County, we continue to have about 20% of our cases from neighboring counties Colorectal Analytic/Non Analytic by Year CasesAnaly1c/Non Analy1c by Year Cases Bladder Analytic: Patients diagnosed Analy1c and/or Non Analy1c any of their first course of treatment administered at. Non Analytic: Patients diagnosed and first course treatment administered elsewhere. Patients with pathology or lab specimens only. 37 Melanoma A number of prostate cases were diagnosed through our medical staff that did not require treatment in the hospital; therefore they were not included in these numbers. 368 Analytic Non Analytic

5 A Study of Non-Small Cell Lung Cancer at According to the American Cancer Society, an estimated 226,160 new cases of lung cancer are expected in 2012, accounting for about 14% of cancer diagnoses. The incidence rate has been declining in men over the past two decades, from a high of 102 (cases per 100,000 men) in 1984 to 72 in In women, the rate has just begun to decrease after a long period of increase. From 2004 to 2008, lung cancer incidence rates decreased by 1.9% per year in men and by 0.3% per year in women. Non-Small Cell Lung Cancer Incidence Trend Lung cancer accounts for more deaths than any other cancer in both men and women. An estimated 160,340 deaths, accounting for about 28% of all cancer deaths, are expected to occur in Death rates began declining in men in 1991; from 2004 to 2008, rates decreased by 2.6% per year. Lung cancer death rates did not begin declining in women until 2003; from , rates decreased by 0.9% per year. Gender differences in lung cancer mortality patterns reflect historical differences between men and women in the uptake and reduction of cigarette smoking over the past 50 years. Stage at Initial Diagnosis Unknown 2% Stage I 16% Non-Small Cell Lung Cancer First Course of Therapy Other Therapy Sugery Chemotherapy Surgery Only No Treatment Radiation Only Chemotherapy Only 2% 4% 6% 4% 7% 12% 16% 15% 18% 21% 22% 21% Non-Small Cell Lung Cancer Observed Survival by Overall Stage Analytic Cases Analytic Cases % 48% 33% 24% 20% 15% 100% 46% % 23% 19% 17% Stage II 9% Radiation Chemotherapy 21% 28% Cayuga Medical Center s non-small cell lung cancer survival rates for years 1-5 mirror national statistics A study of analytic non-small lung cancer cases at Cayuga Medical Center was carried out covering 184 patients diagnosed from 2007 through Age at Initial Diagnosis Stage IV 47% Unknown 9% Stage I 24% Stage III 27% Stage II 7% 0 5% 10% 15% 20% 25% % First course of therapy at shows fewer patients get surgery only and more get chemotherapy. This is at least in part because over the 5 year period there was a lower percentage of early stage cancers and a higher percentage of cases not amenable to surgery because they were stage IV. In spite of having a case mix of higher stage cancers, our overall survival numbers mirror national averages. On review of a representative sample of 2011 cases, the therapy given conformed to national treatment guidelines (NCCN). Summary Non-small cell lung cancer data was analyzed and compared to national figures (). The number of lung cancer cases has remained relatively constant at Cayuga Medical Center. Our survival data is very similar to national averages. The care given conforms to appropriate national standards of care. 35% % 25% 20% 15% 16% 16% % % 29% 33% 16% 14% Stage IV 36% Cayuga Medical Center s stage at diagnosis shows a larger percent of late stage cancers. Stage III 24% Charles Garbo, MD Chairman, Cayuga Medical Center Cancer Program 10% 7% 6% 5% 2% 1% 0% < age distribution is similar to that in the database. Gender at Initial Diagnosis Females 47% Males 53% Females 44% Males 56% 6 7

6 The Community Network Comparison of Estimated Cancer Program Practice Profile Reports (CP3R) Performance Rates Breast & Colon Cancer Ties to other community agencies, such as the American Cancer Society, Hospicare and Palliative Care Services of Tompkins County, Cancer Resource Center of the Finger Lakes, and the Cancer Services Program of Cortland and Tompkins Counties, strengthen cancer services provided by Cayuga Medical Center. The National Quality Forum (NQF) brought public and private payers together with consumers, clinicians, and researchers to collaborate on standardized performance measures for breast and colorectal cancer as the national movement towards Pay for Performance (P4P) heightens. The Commission on Cancer (CoC) was active instituting the Cancer Program Practice Profile Reports (CP3R) to promote the importance of charting and coding accuracy in line with evidence based practice guidelines. These reports provide CoC- approved programs the ability to examine program specific breast, colon, and rectal cancer care practices for each of the NQF endorsed, evidence-based measures. Cayuga Medical Center () results are illustrated in the following graphs. These results show a significantly higher level of concordance with the standard of care over New York State and national facilities demonstrating the dedication of our interdisciplinary team and medical staff to providing quality care to our patients BCS/RT - Radiation therapy is administered within 1 year of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer MAC - Combination chemotherapy is considered or administered within 4 months of diagnosis for women under 70 with AJCC T1c N0 M0, or Stage II or III ERA & PRA negative breast cancer HT - Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year of diagnosis for women with AJCC T1c N0 M0, or Stage II or III ERA and/or PRA (+) breast cancer. 81% 91% 87% 2010 ACT - Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for patients under the age of 80 with Stage III (lymph node positive) colon cancer. 77% 84% 82% 82% 89% 88% 100% 100% 100% The American Cancer Society (ACS), in partnership with Cayuga Medical Center s cancer program, provides diagnosis-specific information, referrals to community and ACS resources, and critical peer and professional support to all those facing a cancer diagnosis. ACS offers a number of educational and supportive programs for people living with a cancer diagnosis and their families. ( Cancer Resource Center of the Finger Lakes offers personalized support and information to area residents affected by cancer. Services include: one-to-one assistance; several support groups (Friday Noon Women s Group, Thursday Evening Women s Group, Men s Breakfast Club, Young Adult Group, Living with Advanced Cancer Group, Prostate Cancer Group); a well-stocked lending library; a boutique with free wigs, hats, and other items; wellness programs such as yoga and water aerobics; resource guides; numerous volunteers who provide assistance to cancer patients and their families at the Cancer Resource Center and at Cayuga Medical Center; and an experienced, caring local staff. ( Glossary AJCC Staging: Analytic: Non-Analytic: First Course of Treatment: Cancer Resource Room is located at Cayuga Medical Center on the first floor of the adjacent medical office building. The resource room is operated by Cayuga Medical Center through an affiliation with the Cancer Resource Center of the Finger Lakes, which serves as the lead agency for this service. The room is open daily to provide support, information, and respite to people with cancer and their loved ones. The room is also available for use by other community cancer organizations such as the American Cancer Society. Cancer Services Program of Cortland and Tompkins Counties helps those with little or no health insurance gain access to services to reduce the risk of breast, cervical, prostate, and colorectal cancers. For more information please call (607) Hospice and Palliative Care Services of Tompkins County provides inpatient and outpatient palliation and hospice services in patients homes, at the hospital, in nursing homes, and at the Nina K. Miller Center for Hospicare and Palliative Care. ( American Joint Committee on Cancer (AJCC). Classification of malignant disease to denote how far the cancer has advanced. Malignancy is categorized by (T) Tumor, (N) Nodes, and (M) Metastasis. Patients diagnosed and/or any of their first course of treatment administered at. Patients diagnosed and first course treatment administered elsewhere. Patients with pathology or lab specimens only. Initial cancer-directed treatment or series of treatments planned and usually initiated within four months of diagnosis or as determined by the physician (12 RLN) - At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Observed Survival: Estimate of the probability of surviving all causes of death for a specified time interval calculated from the cohort of cancer cases. 94% NCCN: National Comprehensive Cancer Network clinical practice guidelines. As of October, % 86% References: 1. Cancer Facts & Figures American Cancer Society. 2. National Cancer Data Base (). 3. American Joint Committee on Cancer Staging Manual 8

7 Cayuga Cancer Center 101 Dates Drive Ithaca, (607)