Cooper Cancer Institute 2011 Statistical Annual Report

Transcription

1 Cooper Cancer Institute Statistical Annual Report

2 Dear Friend, For most of us, the close of a year is a time of reflection of looking back on our accomplishments, and perhaps, recognizing where we could have done more. It is also a time to set goals for the year ahead to enter the New Year with a renewed sense of spirit, of re-dedication to our purpose, and a commitment to finding and creating new opportunities. As this report will demonstrate, this past year has been one filled with many achievements, but for many people throughout Cooper Cancer Institute (CCI), can be characterized as a year of planning bringing to reality our vision and hope for the future. Teams of physicians, nurses, and other clinical and administrative staff have worked tirelessly throughout the past year planning for the opening of the new Cooper Cancer Institute in Camden and the renovation and expansion of our cancer services at Cooper Voorhees. And the work continues. Throughout this process, the two questions we ask along every point in the decisionmaking process are: What is best for our patients? Is there a better way to do this? With these questions as our guide, we incorporate best practices in cancer care into the design of the physical environment, the acquisition of new diagnostic and treatment technologies, and the development of our operational structure taking the steps to learn, adapt, and lead the way into the future. Innovative thinking, counsel from the best of the best, community engagement, and a singular focus on providing the best possible cancer care to our patients it s what we have always done and what we will continue to do. With another remarkable year behind us, the coming year holds even greater possibilities. Sincerely, Generosa Grana, MD Director, Cooper Cancer Institute Head, Division of Hematology/Medical Oncology Cooper University Hospital If you don't know where you are going, you'll end up someplace else. YOGI BERRA

3 Cancer Registry Report Cooper University Hospital s Cancer Registry supports the activities of the Cancer Committee and Cooper Cancer Institute. The Registry staff oversees the collection, quality assurance, lifetime follow-up and analysis of data from patients diagnosed with cancer who receive all or part of their care at Cooper and those others deemed reportable. The Cancer Registry working database has, cases since with a successful follow-up rate of %. Cancer centers report specifics of diagnosis, stage of disease, medical history, patient demographics, laboratory data, tissue diagnosis, and medical, radiation, and surgical methods of treatment for each cancer diagnosed at their facility. The data is used to observe cancer trends and provide a research base for studies into the possible causes of cancer with the goal of reducing cancer incidence and death. Registry data also serves as an ongoing resource to the Cancer Committee in determining the most effective allocation of resources, in determining community education and outreach initiatives and in monitoring program quality. The Registry provides vital statistics and information to clinicians and researchers as well as local, state and national cancer databases and cancer-related organizations. This contribution of information advances the body of knowledge in the field of cancer and ultimately has a positive impact on cancer patient care. For Cooper s data to be comparable to those collected at other programs around the country, the registrars adhere to data rules established by the collecting and credentialing organizations. Keeping up with these changes can be challenging, but Cooper Cancer Registrars understand the significance of their work and are experts in their field. Diane Bush, CTR, Manager Jacqueline Ellis-Riffle, CTR, Cancer Registrar Annette Harley, CTR, Cancer Registrar Cancer Registry Department Staff Brian Palidar, RHIT, CTR, Cancer Registrar Karen Staller, RHIT, Cancer Registrar Cooper University Hospital Cancer Committee* Mandatory Members Generosa Grana, MD Chair, Cancer Committee Head, Division of Hematology/Medical Oncology, Director, Cooper Cancer Institute Umar Atabek, MD Head, Division of SurgicalOncology Cancer Liaison Raymond Baraldi, MD Chief, Department of Radiology Kristen Brill, MD Head, Division of Breast Surgery Director, The Janet Knowles Breast Cancer Center Diane Bush, CTR Manager, Cancer Registry Department Dana Clark, MS, MS Cancer Genetics Counselor Kim Krieger, BA, CCRP Acting Manager, Clinical Research Office, Division of Hematology/ Medical Oncology Lisa McLaughlin, MSW, LSW, OSW-C Social Worker, CCI Tamara LaCouture, MD Chief, Department of Radiation Oncology Ann Steffney, MSN, RN, OCN Breast Cancer Nurse Navigator, CCI Acting Administrative Designee Carol Stratton, MSPT, ATC, CLT Director, Physical Rehabilitation Services Evelyn Robles-Rodriguez, RN, MSN, APN-C, AOCN Oncology Advanced Practice Nurse Director, Oncology Outreach Programs Roland Schwarting, MD Chief, Department of Pathology and Laboratory Medicine Barbara Sproge, MSN, RN, OCN Clinical Educator, Palliative Care Program Other Attendees Jaime Austino, MSN, RN, OCN Genitourinary Cancer Nurse Navigator, CCI Linda Goldsmith, RD, CSO Outpatient Cancer Nutritionist, Food and Nutrition Services Dianne Hyman, MSN, RN, OCN Camden Nurse Navigator, CCI Frank Koniges, MD Attending Physician, Department of Surgery Robert Lumpe Chaplain, Pastoral Care Susan Maltman, MSN, RN, OCN Clinical Manager, Division of Gynecologic Oncology Alicia Michaux, MSRD Outpatient Cancer Nutritionist, Food and Nutrition Services Alice O Brien, RN, OCN, HP(ASCP) Leukemia/Lymphoma Nurse Navigator, CCI Cori McMahon, PsyD Director of Behavioral Medicine, Division of Hematology/Medical Oncology Leslie Tarr, MSW, OSW-C Social Worker, CCI Jackie Tubens, RN, MSN GI Nurse Navigator, CCI Charu Vora, RN, BSN, OCN, MSW, BS Lung Cancer Nurse Navigator, CCI David Warshal, MD Head, Division of Gynecologic Oncology *Committee members at time of publication.

4 Top Five Cancer Sites (M/F Combined) PERCENT OF TOTAL ANALYTIC CASES -. C A N C E R R E G I S T R Y R E P O R T Prostate Colon/Rectum Corpus Uterus Lung Breast Breast Lung Corpus Uterus Colon/Rectum Prostate TOTAL CCI Patient s County of Residence at Diagnosis PERCENT OF TOTAL ANALYTIC CASES COUNTY AT % DIAGNOSIS of CASES Camden.% Burlington.% Gloucester.% Atlantic.% Cumberland.% Outside State.% Cape May.% Salem.% Mercer.% Ocean.% Other/Unknown.% TOTAL % BURLINGTON % GLOUCESTER % CAMDEN % OTHER % { Atlantic % Cumberland......% Outside State......% Cape May % Salem % Mercer % Ocean % Other/Unknown...%

5 C A N C E R R E G I S T R Y R E P O R T Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report ANALYTIC COMPLETE Primary Site Total (%) Sex Class of Case Status Stage Distribution Analytic Cases Only Male Female Analy NA Alive Exp Stage Stage I Stage II Stage III Stage IV Unk ORAL CAVITY & PHARYNX (.%) Tongue (.%) Salivary Glands (.%) Floor of Mouth (.%) Gum & Other Mouth (.%) Nasopharynx (.%) Tonsil (.%) Oropharynx (.%) Hypopharynx (.%) DIGESTIVE SYSTEM (.%) Esophagus (.%) Stomach (.%) Small Intestine (.%) Colon Excluding Rectum (.%) Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid (.%) Rectosigmoid Junction Rectum Anus, Anal Canal & Anorectum (.%) Liver & Intrahepatic Bile Duct (.%) Liver Intrahepatic Bile Duct Gallbladder (.%) Other Biliary (.%) Pancreas (.%) Retroperitoneum (.%) Peritoneum, Omentum & Mesentery (.%) Other Digestive Organs (.%) RESPIRATORY SYSTEM (.%) Nose, Nasal Cavity & Middle Ear (.%) Larynx (.%) Lung & Bronchus (.%) BONES & JOINTS (.%) Bones & Joints (.%) SOFT TISSUE (.%) Soft Tissue (including Heart) (.%) SKIN Excluding Basal & Squamous (.%) Melanoma Skin (.%) Other Non-Epithelial Skin (.%) BREAST (.%) Breast (.%)

6 C A N C E R R E G I S T R Y R E P O R T Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report ANALYTIC COMPLETE (continued) Primary Site Total (%) Sex Class of Case Status Stage Distribution Analytic Cases Only Male Female Analy NA Alive Exp Stage Stage I Stage II Stage III Stage IV Unk FEMALE GENITAL SYSTEM Cervix Uteri Corpus & Uterus, NOS Corpus Uteri Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs MALE GENITAL SYSTEM Prostate Testis Penis Other Male Genital Organs URINARY SYSTEM Urinary Bladder Kidney & Renal Pelvis Ureter BRAIN & OTHER NERVOUS SYSTEM Brain Cranial Nerves Other Nervous System ENDOCRINE SYSTEM Thyroid Other Endocrine including Thymus LYMPHOMA Hodgkin Lymphoma Non-Hodgkin Lymphoma NHL Nodal NHL Extranodal MYELOMA Myeloma LEUKEMIA Lymphocytic Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia Other Leukemia MESOTHELIOMA Mesothelioma KAPOSI SARCOMA Kaposi Sarcoma MISCELLANEOUS Miscellaneous Total (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%) (.%),,,,

7 Measuring Quality How do patients know if they are receiving good quality healthcare? How do physicians and nurses identify the steps that need to be taken for better patient outcomes? And how do insurers and employers determine whether they are paying for the best care that science, skill, and compassion can provide? Performance measures Performance measures give the healthcare community a way to assess quality of care provided against recognized standards. While quality measures come from many sources, those endorsed by the National Quality Forum (NQF) have become established as among the best. An NQF endorsement reflects rigorous scientific and evidence-based review, input from patients and their families, and the perspectives of people throughout the healthcare industry. One of the ways Cooper Cancer Institute assesses the quality of the care we give to our cancer patients is to compare our performance in NQF standards to those of other hospitals in New Jersey and the United States. National Quality Forum has established six measures for quality care in breast, and colon and rectal cancer. Below you will find how Cooper Cancer Institute compares to other hospitals in New Jersey and across the U.S. in these critical performance measures. Cooper Cancer Institute data surpasses all bench marks local, state, regional and national. Performance for NQF Breast Care Measures.%.%.% National Standard for Breast Conserving Surgery and Radiation Therapy Radiation therapy is administered within one year ( days) of diagnosis for women under the age of receiving breast conserving surgery for breast cancer. Cooper Cancer Institute s compliance with this standard was very favorable at.%, compared to the state norm of.% and the national norm of.%. CCI NJ US %.%.% National Standard for Chemotherapy in hormone receptor negative breast cancer patients. Combination chemotherapy is considered or administered within months ( days) of diagnosis for women under with AJCC TcNM, or Stage II or III hormone receptor negative breast cancer. Cooper Cancer Institute s compliance with this standard was very favorable at %, compared to the state norm of.% and national norm of.%. CCI NJ US

8 %.%.% National Standard for Tamoxifen or third generation aromatase inhibitor in hormone receptor positive breast cancer patients. Tamoxifen or third generation aromatase inhibitor is considered or administered within one year ( days) of diagnosis for women with AJCC TcNM, or Stage I hormone receptor positive breast cancer. Cooper Cancer Institute s compliance with this standard was very favorable at %, compared to the state norm of.% and the national norm of.%. CCI NJ US Performance for Colon and Rectal Cancer NQF Measures.%.%.% National Standard for Regional Lymph Nodes in Surgically Resected Patients At least regional lymph nodes are removed and pathologically examined for resected colon cancer. The compliance rate for Cooper Cancer Institute was very favorable at.%, compared to the state norm of.% and the national norm of.%. CCI NJ US.%.%.% National Standard for Adjuvant Chemotherapy for Node Positive Patients Adjuvant chemotherapy is considered or administered within months ( days) of diagnosis for patients under the age of with AJCC stage III (lymph node positive) colon cancer. The compliance rate for Cooper Cancer Institute was very favorable at.% compared to the state norm of.% and the national norm of.% CCI NJ US %.%.% National Standard for Radiation Therapy of Stage III Rectal Cancer Radiation therapy is considered or administered within months ( days) of diagnosis for patients under the age of with clinical or pathologic AJCC TNMo or Stage III receiving surgical resection for rectal cancer. The compliance rate for Cooper Cancer Institute was very favorable at %, compared to the state norm of.% and the national norm of.%. CCI NJ US

9 C O O P E R C A N C E R I N S T I T U T E Breast Cancer Report A N N U A L R E P O R T Kristin L. Brill, MD, FACS Director, The Janet Knowles Breast Cancer Center Director, Section of Breast Surgery Epidemiology Breast cancer prevails as the most common cancer among women, and remains the second leading cause of cancer death in women. It is estimated that, women will be diagnosed with breast cancer in, and, women will die of the disease. The overall lifetime risk of developing breast cancer can be expressed as about one in eight women, with an average age of years. The breast cancer incidence rate began to decline in after peaking at per, women in. The dramatic decrease of almost % from to has been attributed to reductions in the use of hormone replacement therapy. However, from -, the most recent five years for which data are available, breast cancer incidence rates were stable. Besides being female, increasing age is the most important risk factor for breast cancer. Potentially modifiable risk factors include obesity, use of hormone replacement therapy, physical inactivity, and excessive alcohol consumption. It is well recognized that a history of atypical cells or LCIS on biopsy or exposure to highdose radiation to the chest also increases risk of developing breast cancer. Risk is also increased by a family history of one or more firstdegree relatives with breast cancer (though most women with breast cancer do not have a family history of the disease). Inherited mutations in breast cancer susceptibility genes, referred to as BRCA and BRCA mutations account for approximately %-% of all female and male breast cancer cases, but are very rare in the general population (much less than %). Demographics Tumor Registry data at Cooper University Hospital from indicates that individuals received a portion or all of their breast cancer care at Cooper University Hospital. Data from - compared to shows the counties served have remained Analytic Breast by County Analytic Breast by County Camden:.% Cumberland:.% Gloucester:.% All Other:.% Atlantic:.% Burlington:.% Camden:.% Cumberland:.% Gloucester:.% All Other:.% Atlantic:.% Burlington:.%

10 Age at Diagnosis for Breast Cases at Cooper University HealthCare vs. NCDB, National Cancer Data Base ( most current year availiable) % % % Percentage % % % % + Unknown Age at Diagnosis CUH CUH NCDB NCDB stable, with nearly half of treated individuals originating from Camden County. Other regions served include Burlington and Gloucester counties. While the average age of diagnosis of breast cancer is, the average age at diagnosis at Cooper is in the th decade, with % of those treated at Cooper diagnosed under the age of. This compares to the National Cancer Data Base (NCDB) data from showing only % of the newly diagnosed cases occurred in those under the age of. This might be explained by the combined efforts in community outreach and education, high risk assessment, as well as a dedicated breast imaging team with a variety of current breast imaging technologies. Stage at diagnosis at Cooper compares to national data, with the majority of breast cancer patients being diagnosed as early as Stage, Stage or Stage cancers. Breast cancer survival correlates strongly with stage at diagnosis, so that early stage breast cancer has significantly better survival rates. When Cooper University Hospital survival data is compared to national survival data from the National Cancer Data Base, -year survival rates are nearly AJCC Stage at Diagnosis for Breast Cases at Cooper University HealthCare vs. NCDB, National Cancer Data Base ( most current year availiable) % % % % % Percentage % % % % CUH CUH NCDB % A B A B A B C Unk Stage NCDB

11 Five Year Survival Rate - Analytic Breast Cancer Cases by AJCC Staging Cooper University HealthCare vs. National Cancer Data Base % % Percentage % % % % % Cooper NCDB Stage Stage Stage Stage Stage identical for the lower Stage to Stage breast cancer patient. However, Cooper observes slightly higher -year survival rates in Stage and Stage patients. The different treatment patterns of surgery, chemotherapy, hormonal therapy and radiation reflect the multimodality approach and tailored treatment plans created by collaborative efforts at the Janet Knowles Breast Center. Treatment patterns change over time with advancements in technology and practice changing information. The data indicates that from to, about % of patients were offered chemotherapy as part of their treatment. In, only % of individuals had chemotherapy incorporated as part of their treatment. This is likely due to innovations in identifying tumor potential and risk through genomic profiling that allows clinicians to better identify those patients who might benefit from chemotherapy. Similar trends can be observed as more treatment options are available with respect to radiation, surgery and reconstructive surgery. - Breast Cancer Treatment Total Cases Analytic Breast Treatment Total Cases Other Surgery/Hormone/Radiation/Chemo Surgery/Hormone/Radiation Surgery/Hormone/Chemo Surgery/Hormone Surgery/Chemo/Radiation Surgery/Radiation Surgery/Chemo Surgery Chemo Number of Cases Other Surgery/Hormone/Radiation/Chemo Surgery/Hormone/Radiation Surgery/Hormone/Chemo Surgery/Hormone Surgery/Chemo/Radiation Surgery/Radiation Surgery/Chemo Surgery Chemo Number of Cases

12 Comprehensive Care at the Janet Knowles Breast Cancer Center This year, the Janet Knowles Breast Cancer Center was awarded NAPBC (National Accreditation Program of Breast Centers) accreditation. This status recognizes the program as a multidisciplinary, integrated and comprehensive breast program, dedicated to the improvement of quality of care and outcomes of women with breast disease. This multidisciplinary team of experts consists of: Breast Radiologists Medical Oncologists Breast Surgeons Radiation Oncologists Plastic and Reconstruction Surgeons Pathologists Medical Geneticists Nurse Practitioners Nurse Navigators Social Workers The group meets regularly to review cases and discuss and determine optimal treatment options. Education, Outreach, Screening In concordance with the spirit of the Cooper mission, the Outreach Screening Project provides screening services, education, and access to care for newly diagnosed cancers. The screening project provided more than screening mammograms in with the identification of new cancers, treated at Cooper. The Breast Imaging Center at Cooper University Hospital consists of a team of fellowship trained, dedicated breast imagers and staff who provide a variety of imaging and biopsy techniques, currently at three sites in our region. They offer digital mammography, breast MRI, high resolution ultrasound and contrast enhanced mammography. The standard of care for breast cancer diagnosis has moved toward image guided biopsy and diagnosis and away from surgical biopsy for diagnosis. To this end, they perform vacuum-assisted core biopsy under mammogram, ultrasound or MRI. More recently, Cooper has committed significant resources to the development of the breast reconstruction program with the addition of two fellowship trained microvascular plastic surgeons for a total of five plastic surgeons who offer an array of reconstructive options. Members of the team are trained to perform tissue transfer techniques allowing more sophisticated, and realistic results. Working closely with the breast surgeons to determine surgical options, a woman may be offered options that range from breast conservation with a lumpectomy, to possibly a skin or nipple sparing mastectomy involving the immediate reconstruction of the breast shape. Radiation Oncology continues its commitment to incorporating innovative technologies into its arsenal of treatment options including IMRT, Cyber Knife and most recently, partial breast radiation. As an alternative to the standard whole breast radiation, a patient may now be offered a shorter course of breast radiation using a radiation delivery device inserted into the lumpectomy cavity. In, the Janet Knowles Breast Center was deemed a Center of Excellence for this partial breast radiation technique, acknowledging the institution as having the most experience with this technique in the region. Cooper Cancer Institute is at the forefront of clinical research by offering a variety of clinical trials to eligible patients. Patients have access to NCIsponsored national trials, as well as pharmaceuticalsponsored trials. The Cancer Genetics Program evaluates and counsels women who may be high risk, and provides testing that can be used to guide treatment and prevention. Our team takes pride in its collaborative approach toward identifying and educating patients about their particular treatment options, clinical trials available for adjuvant radiation and chemo therapy, and ongoing support through diagnosis, decisionmaking, treatment and long term surveillance. The Janet Knowles Breast Center has earned the reputation as the region s leading breast center for expertise, cutting edge technologies and compassionate care.

13 New Cooper Cancer Institute To Open Fall Progress continues on the construction of the new Cooper Cancer Institute in Camden. The four-story,, square foot building will house all outpatient cancer care services on the Camden campus under one roof. The new $ million building will be located adjacent to Three Cooper Plaza on Haddon Avenue just steps away from the hospital and the new medical school further developing the footprint and spectrum of services available on the Health Sciences Campus. In the new building, physicians from various medical disciplines (e.g. medical oncology, radiation oncology, surgical oncology, gynecologic oncology, and urology) will conduct concurrent, complementary clinical sessions, fostering professional interaction and collaboration. Patients get the benefit of easy access to advanced treatment technologies, groundbreaking clinical trials, and a full range of supportive care services in one facility. In addition to the new building, the project includes service enhancements and equipment upgrades at the Cooper Voorhees facility with the addition of a second linear accelerator and the installation of a permanent PET/CT.

14 ...COOPER... CooperHealth.org/cancer World Class Care. Right Here. Right Now. George E. Norcross, III Chairman Joan S. Davis Vice Chairman John P. Sheridan, Jr. President and CEO