THE CANCER CENTER 2014 ANNUAL REPORT CONTAINING 2013 STATISTICS

Transcription

1 THE CANCER CENTER 2014 ANNUAL REPORT CONTAINING 2013 STATISTICS

2 TABLE OF CONTENTS CONTAINING 2013 STATISTICS Acknowledgement... 3 Cancer Committee Members... 4 Chairman s Report Tumor Conferences... 6 ANALYTIC CASES Top Ten Sites Five Year Comparison Frequency by Selected Sites... 7 Incidence by Site and Sex 2013 Cases County at Diagnosis Race and Sex Primary Payer Age at Diagnosis... 9 AJCC Stage SEER Stage at Diagnosis 2013 Cases...10 Collaborative Stage at Diagnosis 2013 Cases...10 First Course of Treatment 2013 Cases...11 In Depth Report...12 ANALYTIC LUNG CANCER CASES Frequency by Year of Diagnosis Race by Sex Race by Sex Age at Diagnosis Age at Diagnosis Zip Code at Diagnosis Zip Code at Diagnosis County at Diagnosis County at Diagnosis SEER Stage at Diagnosis SEER Stage at Diagnosis Histology at Diagnosis Histology at Diagnosis Treatment at Diagnosis Treatment at Diagnosis Five-Year Relative Survival by SEER Stage...20 Five-Year Observed Survival by AJCC Stage...20 Glossary of Terms

3 2014 ANNUAL REPORT Trumbull Memorial Hospital Cancer Program 2014 ANNUAL REPORT CONTAINING 2013 STATISTICS Acknowledgements Our special thanks to the following individuals for their contributions and cooperation in making this publication possible. It would be impossible without them. Robert Bennett, M.D., Cancer Committee Chairman, Trumbull Memorial Hospital Mohammed Rashid, M.D., Cancer Committee Liaison Physician, Trumbull Memorial Hospital Administration All Cancer Committee Members All Cancer Ancillary Care Services Trumbull Memorial Hospital Marketing and Public Relations Cancer Registry Staff Delores Miller Connie Wagoner, CTR, RHIT This publication is produced annually by the Cancer Registry staff in cooperation with Trumbull Memorial Hospital s Marketing & Public Relations Department. For additional copies, please call (330) or (330)

4 TRUMBULL MEMORIAL HOSPITAL 2014 CANCER COMMITTEE MEMBERS Robert Bennett, M. D. Chairman, Pathology Lori Hemrock, M.D. Medical Oncology James Port, M. D. Radiology Mohammed Rashid, M.D. Cancer Liaison Physician - Surgery Roger Tokars, M. D. Radiation Oncology Luana Andamasaris, RN, OCN Radiation Oncology Nurse Andrew Davis, RN, BSN Nurse Manager Inpatient Oncology Bettina Dohn, RN, Quality Coordinator Rev. Joe Doran Pastoral Services Darla Habosky, RTT - Lead Radiation Oncology Therapist Linda Heater, RN, BSN, Chief Quality Officer Lucille Klingensmith, PT Rehabilitation Services Alisa Mahan-Zeitz, Health Initiative Representative American Cancer Society Kathryn Martin, RN, SCN, OCN, CBCN Nurse Navigator Angela Mines, LSW Oncology Social Worker Jay de los Reyes, Chief Operating Officer, Administration Nevine Sedra, R.P.H. Pharmacy Lori Sylvester, RN, MSN Vice-President Outpatient Services, Administration Connie Wagoner, RHIT, CTR, CMT Cancer Registry 4

5 2014 ANNUAL REPORT Trumbull Memorial Hospital Cancer Committee Chairman s 2014 Annual Report The Cancer Committee continues to seek ways to improve the care of the cancer patient at Trumbull Memorial Hospital. The committee members includes a team of dedicated professionals within the specialty areas of Oncologic Surgery, Pathology, Radiology, Medical Oncology, and Radiation Oncology. Additional team members include representatives from Hospital Administration, Nursing Services, Physical Therapy, Nutritional Therapy, Social Services, Hospice Care, Pastoral Care, and the American Cancer Society. The TMH Cancer Program continuously strives to meet, and exceed, the accreditation standards by the American College of Surgeons Commission of Cancer. In 2013, the Commission on Cancer again awarded our program a Certification of Approve with the Commendation. Areas of performance receiving commendation included registrar education, reporting of outcomes, pathology reporting, nursing care, and abstracting timeliness. The TMH Cancer Program has maintained its unblemished accreditation for 31 consecutive years. From an education standpoint, the Cancer Committee continues to plan and oversee bimonthly tumor conferences, organize annual Cancer Symposiums, and assist the American Cancer Society in providing awareness and screening programs to the general public. The TMH Tumor Registry, under the supervision of Connie Wagoner CTR, RHIT, identified 484 new cancer cases at our institution in Statistics derived from these cases have been forwarded to the Ohio Cancer Incidence Surveillance System and National Cancer Institute Database for comparison with data derived from previous years and to compare our data with other accredited cancer programs. In comparison to national averages, the Mahoning Valley has maintained a high incidence of lung cancer among its residents. This year, we have provided the demographic, diagnostic, treatment, and survival statistics for all lung cancer diagnosed and treated at Trumbull Memorial Hospital in Dr. Roger Tokars, a TMH Radiation Oncologist, has provided an excellent overview and interpretation of the lung cancer data in this Annual Report. The committee wishes to thank the TMH medical staff, hospital staff, administration, and local community for their continued support of the Cancer Program. Robert C. Bennett, MD Chairman, Cancer Committee, Trumbull Memorial Hospital 5

6 2013 TUMOR CONFERENCES Site Prospective Retrospective Anus 1 Bile Duct 1 Breast 17 Colorectal 9 Esophagus 3 Gastric 3 Kidney 1 Leukemia 1 Lung 10 Melanoma 5 Merkel Cell Carcinoma-Skin 1 Myeloma 1 NH Lymphoma 6 Ovary 2 Nasal Cavity 1 Pancreas 1 Prostate 1 Soft Palate 1 Soft Tissue (Sarcoma) 3 Testicle 2 Thyroid 3 Uvea 1 Total 74 Total Tumor Conferences Held 24 Total Cases Presented 74 Prospective 100% Trumbull Memorial Hospital holds multidisciplinary Tumor Conferences twice a month, the second and fourth Tuesdays of every month in Conference Room B at noon, with lunch provided to all physicians and ancillary staff. The first Conference of the month is moderated by Dr. Roger Tokars, and the fourth Tuesday of the month is moderated by Dr. Robert Bennett who rotates case presentation with the medical staff. All cases are discussed by representatives from medical and radiation oncology, and pathology. During 2013, 74 prospective cases were presented. Category 1 CME hours are granted for all of our Tumor Conferences. 6

7 2014 ANNUAL REPORT TOP TEN SITES - FIVE YEAR COMPARISON - ANALYTIC CASES ONLY Site Breast Lung Colorectal All Urinary Bone Marrow/All Lymphomas Prostate Pancreas/Liver/Biliary Head/Neck/Larynx All Female Genitalia All Others TOTAL ANALYTIC CASES FREQUENCY BY SELECTED SITES SITE TMH OHIO USA Female Breast 24.6% *13.00% 28.7% Lung 17.6% 14.6% 13.0% Colorectal 7.6% 8.4% 8.0% NH Lymphoma 5.9% 3.2% 4.0% Urinary Bladder 7.2% 4,3% 4,6% Prostate 5.2% 12.9% 27.0% Melanoma of Skin 5.2% 4.7% 4.5% Leukemia 3.1% 2.8% 3.0% Corpus Uteri 0.8% 3.4% 6.0% *Note: Ohio and USA exclude in-situ carcinomas for all sites except bladder. Trumbull Memorial Hospital's breast incidence includes in-situ cases (36). The incidence for invasive breast cancer is 17.1% (83 cases). In 2013 TMH had a higher incidence of lung cancer than the USA and Ohio; however, it has decreased from 2012, TMH has implemented the lung nurse navigator program and hopefully this will decrease lung cancer incidence even further. In 2013 the incidence of prostate cancer continues to be lower than the USA and Ohio which include prostate cancer cases from urologists' offices and other hospitals. 7

8 INCIDENCE BY SITE AND SEX ANALYTIC CASES Site #Cases Male Female Breast Lung Colorectal Bladder Lymphoma Prostate Skin/Melanoma Head/Neck/Larynx Esophagus/Stomach/Small Intestine Blood/Bone Marrow Kidney/Renal/Pelvis/Ureter Pancreas Thyroid Connective/Subcutaneous Tissue Gallbladder/Other Biliary Cervix Uteri/Corpus Uteri Ovary Brain Bones & Joints Anus Testis Vagina Unknown Primary TOTAL

9 2014 ANNUAL REPORT 2013 ANALYTIC CASES COUNTY AT DIAGNOSIS AGE AT DIAGNOSIS County #Cases Percent County # Cases Percent % Ashtabula 7 1.5% % Butler 1 0.1% % Geauga 1 0.1% % Mahoning % % Mercer 2 0.4% % Portage 2 0.4% % Trumbull % % Out of State 2 0.4% % % TOTAL % % % % % % 100 and Over 1 0.2% RACE & SEX TOTAL % # Cases Percent Caucasian Females % African-American Females % Asian Females 1 0.1% Caucasian Males % African-American Males % TOTAL % PRIMARY PAYER #Cases Percent Medicare/Managed care Plan % Managed Care Provider/HMO/PPO % Medicare with Private Supplement % Medicare with Supplement % Medicaid Mgd Care Plan % Medicare with Medicaid Eligibility % Medicare without Supplement % Medicaid 3 0.6% Not Insured/Self Pay 2 0.4% Tricare 2 0.4% Military 1 0.1% Private Insurance/Fee for Service 1 0.1% TOTAL % 9

10 2013 ANALYTIC CASES AJCC (TNM) DOMINANT STAGE AT DIAGNOSIS Stage # Cases Percent Stage % Stage % Stage II % Stage III % Stage IV % Unknown Stage 9 1.8% Not Applicable % TOTAL % SEER STAGE AT DIAGNOSIS Stage # Cases Percent In-Situ % Localized % Regional % Distant % Unknown/Not Applicable % TOTAL % COLLABORATIVE STAGE GROUP AT DIAGNOSIS Stage #Cases Percent Stage % Stage I % Stage II % Stage III % Stage IV % Unknown Stage 9 2.0% Not Applicable % TOTAL % 10

11 FIRST COURSE OF TREATMENT 2014 ANNUAL REPORT 2013 ANALYTIC CASES Type of Treatment # Cases Percent Surgery Only % Surg/Rad/Hormone % Surgery/Chemo % Chemotherapy Only % Chemotherapy/Radiation % Surgery/Hormone % Radiation Only % Surgery/Radiation % Surgery/Chemo/Radiation % Surgery/Chemo/Radiation/Hormone % Hormone Therapy 8 1.7% Other 5 1.0% Surgery/Chemo/Hormone 5 1.0% Radiation/Hormone 3 0.6% Chemo/Hormone 2 0.4% Chemo/Radiation/Other 1 0.1% Surgery/Rad/Other 1 0.1% Radiation/Other 1 0.1% Chemo/Other 1 0.1% Biopsy Only/No Treatment/Went Elsewhere % TOTAL % Surgery Only Surg/Rad/Hormone Surgery/Chemo Chemotherapy Only Chemotherapy/Radia Surgery/Hormone Radiation Only Surgery/Radiation Surgery/Chemo/Radi Surgery/Chemo/Radi Hormone Therapy Other Surgery/Chemo/Hor Radiation/Hormone Chemo/Hormone Chemo/Radiation/Ot Surgery/Rad/Other Radiation/Other Chemo/Other Biopsy Only/No Series1 Series4 11

12 2014 In-Depth Report LUNG CANCER Lung cancer is a cancer that usually starts in the lining of the bronchi (the main airways of the lungs), but can also begin in other areas of the lungs including the bronchioles, or alveoli. It is the second most common cancer in both men and women, but is the leading cause of cancer death in both men and women. The American Cancer Society estimates 224,210 new cases of lung cancer will be diagnosed in 2014, with 159,260 deaths. Each year more people die of lung cancer than colon, breast, and prostate cancers combined. About 2 out of 3 lung cancers diagnosed are in people 65 years of age or older, with the average age being 70. Only 2% of all cases are in those 45 or younger. In 2013 Trumbull Memorial Hospital (TMH) had a higher incidence of new lung cancer cases (17.6%) than the United States (13.5%), and the State of Ohio (14.6%). Lung cancers are generally divided into 2 types: non-small cell lung cancer (squamous / adenocarcinoma / large cell carcinomas) which accounts for 85% to 90% of all lung cancers, and small cell carcinoma. The risk factors for lung cancer include smoking (80% of lung cancer deaths are a result of smoking), second hand smoke, radon, asbestos exposure, talc, cancer causing agents in the work place, personal or family history of lung cancer, and air pollution. DIAGNOSIS In addition to a complete history and physical to assess for risk factors and symptoms, there are multiple diagnostic tests to assist in the diagnosis of lung cancer. We depend on our Radiologists, Pathologists, Pulmonologists and Cardiothoracic Surgeons to assist us in this team effort. Chest x-ray, CT scans, and or PET scans are useful imaging procedures. Following radiological suspicion of lung cancer, the diagnosis must be confirmed with tissue. This can be achieved by needle biopsy, bronchoscopy (a flexible tube into the airways), mediastinoscopy (an incision to sample lymph nodes along the wind pipe), thoracoscopy (an incision in the side of the chest to insert a camera and look for suspicious areas), or thoracentesis (a needle placed into the chest to remove fluid). Trumbull Memorial Hospital has a Lung Cancer Screening program using advanced technology of low-dose CT scanners that produce exceptional images for the detection of lung cancer. The National Cancer Institute has demonstrated that the use of this screening in high risk individuals (includes age and smoking history) can help reduce the chance of lung cancer deaths. TREATMENT Specific treatment for lung cancer is determined by the type and extent of the cancer as well as age, overall medical condition, anticipated tolerance to treatment, and the person s preference or opinion. Many people get a combination of therapies or multimodality treatment. The treating members of the Lung Cancer Team include the Cardiothoracic Surgeon, the Medical Oncologist, and the Radiation Oncologist. Treatment for lung cancer will include one or more of the following: Surgery The surgeon can remove a small piece of lung, a whole lobe, or the entire lung on the affected side. This is usually done on earlier stage cancers. In % of diagnosed lung cancers at TMH received surgery as part or all of their treatment. Radiation Therapy High-energy radiation is precisely sent to cancer cells from a linear accelerator. 42% of those diagnosed with lung cancer at TMH received radiation as a portion of their treatment in Intensity Modulated Radiation Therapy (IMRT) utilized at TMH is capable of delivering a higher dose of radiation to the tumor while limiting the side effects. Chemotherapy Anticancer drugs are used to treat cancerous cells, usually interfering with the cells ability to grow or reproduce. There are many different drugs or combinations of drugs. Each individuals plan is determined by their oncologist. In % of those diagnosed at TMH had chemotherapy included as part of their plan. Targeted therapy These are drugs that target specific parts of cancer cells or nearby cells that help them grow (i.e. blood vessels). They can be used alone or in combination with chemotherapy. PROGNOSIS As with most cancers, early diagnosis and treatment greatly improve survival. At TMH the 5 year survival rate for earlier stage I and II lung cancers is 33% - 44%, but only 3% -6% in late stage III and IV diagnoses. Overall survival in non-small cell lung cancer for all stages at TMH is 5.7% compared to 6% in the entire United States. The best way to improve these statistics is to stop smoking. Roger Tokars, MD 12

13 2014 ANNUAL REPORT Analytic Lung Cancer FREQUENCY BY YEAR OF DIAGNOSIS * Year Total Analytic Cases #Lung Cases Percent % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % *According to the American Cancer Society's "CA-A Cancer Journal for Clinicians" January/February 2014, pages 11 and 12, of the estimated 1,665,540 new cancer cases in the US, 224,210 are lung cases (13.5%). Trumbull Memorial Hospital had a higher incidence of lung cancer cases (17.6%) than the US as well as the State of Ohio (14.6%) in 2013 according to the ACS "Cancer Facts & Figures 2014", page 5 (6,760 of the 67,000 estimated new lung cancer cases). 13

14 RACE BY SEX ANALYTIC LUNG CASES Race #Cases Percent Caucasian Females % Caucasian Males % African-American Females 4 4.7% African-American Males 2 2.6% TOTAL % RACE BY SEX LUNG CASES Race #Cases Percent Caucasian Females % Caucasian Males % African-American Females % African-American Males % Other Races-Females 3 0.1% Unknown Race 1 0.0% TOTAL % AGE AT DIAGNOSIS LUNG CASES AGE AT DIAGNOSIS LUNG CASES Age Range #Cases Percent Age Range #Cases Percent % % % % % % % % % % % % % % % % % % % % % % % % % % 100 and over 0 0.0% 100 and over 1 0.1% TOTAL % TOTAL % 14

15 2014 ANNUAL REPORT Analytic Lung Cancer ZIP CODE AT DIAGNOSIS 2013 ZIP CODE AT DIAGNOSIS Code #Cases Percent Code #Cases Percent % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % TOTAL % % % % % % % % % % % % % % % % % % % % % TOTAL % 15

16 Analytic Lung Cancer COUNTY AT DIAGNOSIS 2013 ANALYTIC LUNG CASES County # Cases # Cases Trumbull % Mahoning 3 3.5% Geauga 1 1.2% Portage 1 1.2% TOTAL % Trumbull Mahoning Geauga Portage COUNTY AT DIAGNOSIS ANALYTIC LUNG CASES Trumbull % Mahoning % Portage 7 1.3% Ashtabula 6 1.1% Mercer 3 0.6% Others 2 0.4% TOTAL % Trumbull Mahoning Portage Ashtabula Mercer Others 16

17 2014 ANNUAL REPORT SEER STAGE AT DIAGNOSIS ANALYTIC LUNG CASES SEER Stage Description #Cases Percent 0 In-Situ 0 0.0% 1 Localized % 2,3,4,5* Regional % 7 Distant % 9 Unknown Stage 3 4.0% TOTAL % 2,3,4, 5* Unknown Stage Distant Regional Localized In-Situ Series2 Series SEER STAGE AT DIAGNOSIS ANALYTIC LUNG CASES SEER Stage Description # Cases Percent 0 In-Situ, Non-Invasive 1 1.0% 1 Localized % 2,3,4,5 Regional % 7 Distant % 9 Unknown % TOTAL % 2,3,4, Unknown Distant Regional Series2 0 1 Localized In-Situ, Non-Invasive Series1 *Note: SEER Stage 2 means Regional by Direct Extension; 3 means Regional to Nodes; 4 means Regional by Direct Extension and to Nodes; 5 means Regional NOS. 17

18 LUNG CANCER HISTOLOGY 2013 In 2013 Trumbull Memorial Hospital had 85 cases of lung cancer diagnosed with 89.4% having non-small cell, adenocarcinoma, squamous cell carcinoma, or other histology with 10.6% small cell carcinoma. HISTOLOGY # CASES TOTAL Non-Small Cell % Squamous Cell Carcinoma % Adenocarcinoma % Others % Small Cell Carcinoma % TOTAL % In Trumbull Memorial Hospital had 536 lung cancer cases diagnosed with 14% small cell carcinomas and 86% non-small cell carcinoma, adenocarcinoma, squamous cell carcinoma, carcinoma NOS, and other carcinoma. HISTOLOGY # CASES PERCENT Adenocarcinoma % Squamous Cell Carcinoma % Large Cell Carcinoma, NOS % Carcinoma, NOS % Others % Small Cell Carcinoma % TOTAL % 18

19 2014 ANNUAL REPORT TREATMENT MODALITIES 2013 Type of Treatment # Cases Percent Surgery % Radiation % Chemotherapy % Radiation/Chemotherapy % Biopsy Only/Refused Tx/Too Ill for Tx % Surgery/Radiation 1 1.0% Surgery/Chemotherapy 1 1.0% Surgery/Chemo/Radiation 1 1.0% TOTAL % Surgery Radiation Chemotherapy Radiation/Chemotherapy Biopsy Only/Refused Tx/Too Ill for Tx Surgery/Radiation Surgery/Chemotherapy Surgery/Chemo/Radiation TREATMENT MODALITIES Type of Treatment #Cases Percent Surgery % Chemo/Radiation % Radiation % Biopsy Only/Refused Tx/Too Ill for Tx % Chemotherapy % Surgery/Chemotherapy % Chemo/Radiation/Other 8 1.4% Surgery/Chemo/Radiation 5 0.9% Radiation/Hormone 3 0.6% Chemo/Radiation/Other 4 0.4% TOTAL % Biopsy Only/Refused Tx/Too Ill for Tx Chemotherapy Surgery/Chemotherapy Chemo/Radiation/Other Surgery/Chemo/Radiation Radiation/Hormone Chemo/Radiation/Other TOTAL 19

20 FIVE-YEAR RELATIVE SURVIVAL RATE BY SEER STAGE SEER STAGE # Cases-TMH TMH USA* Localized % 54.0% Regional % 28.0% Distant % 4.0% Unknown % Not Available ALL STAGES % 18.0% *Reference: The American Cancer Society's "CA - A Cancer Journal for Clinicians" January/February 2014, page 26 and "Cancer Facts & Figures 2014", page 15. The 5 year relative survival rate for small cell lung cancer is (6%) lower than that for non-small cell (18%). The 5 year relative survival rates for the USA lung cancer cases are from the analytic cases. FIVE-YEAR OBSERVED SURVIVAL BY AJCC STAGE *The five-year OBSERVED survival rate for lung cancer for TMH and the USA using the AJCC Staging System as reported to the American College of Surgeons Commission on Cancer web site utilizing NCDB (National Cancer Data Base) data is as follows: Non-Small Cell Lung Cancer Cases TMH USA Occult No Cases 12.7% Stage 0 No Cases 23.1% Stage I *33.2% 46.8% Stage II 43.7% 27.6% Stage III 3.1% 11.2% Stage IV 6.1% 2.7% OVERALL SURVIVAL **5.7% 6.0% Small Cell Lung Cancer Cases TMH USA Occult No Cases 10.8% Stage 0 No Cases 5.8% Stage I 33.2% 21.8% Stage II **5.0% 16.9% Stage III 4.9% 9.5% Stage IV **1.9% 1.6% OVERALL SURVIVAL 15.6% 18.0% *Data excludes cases designated as "other types" (carcinoma unspecified, malignancy NOS, etc.) ** Survival statistics from TMH registry data. 20

21 2014 ANNUAL REPORT GLOSSARY OF TERMS CLASS OF CASE Analytic Patients who were diagnosed and/or treated as part of their first course of treatment at Trumbull Memorial Hospital. These are Class of Case 00 through 22. Non-Analytic Patients diagnosed previously and now with recurrence, patients diagnosed at our facility prior to our reference year (1983) and cancers diagnosed at autopsy. These cases are not included in survival statistics. These are Class of Case 30 through 38. FIRST COURSE OF TREATMENT The initial cancer-directed treatment or series of treatments, usually initiated within four months of the date of diagnosis. PRIMARY SITE: The anatomical location within the human body considered to be the point of origin of the malignancy. STAGE OF DISEASE The extent the cancer spread as determined at the time of first evaluation. In-Situ The tumor meets all criteria for malignancy except invasion. Local The tumor is confined to the site of origin. Regional The tumor has spread by direct extension to adjacent organs and/or has metastasized to regional lymph nodes. Distant The tumor has spread beyond the immediate adjacent organ by direct extension, has developed secondary or metastatic tumors, has metastasized to distant lymph nodes, or has been determined to be systemic in origin. Unknown/Unspecified/Not applicable There is no AJCC staging available, or cannot be determined from the medical record or medical authority. PROTOCOL GROUPS COG Children s Oncology Group NSABP - National Surgical Adjuvant Breast and Bowel Project SWOG Southwest Oncology Group Pharmacology Research Groups Local/Institutional trials REFERENCE American Cancer Society: Cancer Facts & Figures 2014 American Cancer Society: A Journal for Clinicians, January/February 2014 American College of Surgeons Commission on Cancer NCDB data. AJCC Cancer Staging Manual, Seventh Edition ICD-O, Third Edition (International Classification for Diseases for Oncology) SEER Summary Staging Manual, 2011 (National Cancer Institute) 21

22 Trumbull Memorial Hospital 1350 East Market Street Warren, Ohio, Phone: (330)