2014 CANCER PROGRAM ANNUAL REPORT With Statistical Data from 2013

Transcription

1 2014 CANCER PROGRAM ANNUAL REPORT With Statistical Data from 2013

2 Table of Contents Cancer Care Committee 3 Central Florida Health Alliance 4 Leesburg Regional Medical Center 4 The Villages Regional Hospital 4 Cancer Care Services 4 The Clinical Program 5 Patient Navigator 7 Psychosocial Services 7 Support Groups 7 Music and Pet Therapy 7 Cancer Suvivorship Event 7 Diagnostic Radiology 8 Laboratory Services 8 Medical Oncology 8 Radiation Oncology 9 Clinical Research 9 Hospice 9 Cancer Conferences 10 Grand Rounds and Staff Education 10 Commitment to the Community 11 Community Medical Care Center 12 Relay for Life 12 Leukemia & Lymphoma Society 12 Community Wellness 13 Cancer Registry Report 13 Cancer Data Analysis (2013 Statistics) Breast Cancer 17 Signs & Symptoms 17 Risk Factors 17 Early Detection 17 Treatment 17 Data Analysis

3 Cancer Care Committee The Cancer Care Committee is composed of representatives of primary and specialty care physicians, as well as team members involved in the care of cancer patients. This multidisciplinary committee meets at least quarterly to evaluate the quality and direction of the cancer program. Several sub-committees meet throughout the year to make recommendations to the full Cancer Care Committee for program improvement. Medical Staff Leonel Edwards, MD Pathology, Diagnostic Pathology Associates Quality Improvement Director Adrian Finol, MD Adrian J. Finol, MD, PA Cardiothoracic Surgery Chair, Cancer Care Committee Jorge Freire, MD Radiation Oncology, Moffitt Cancer Center TVRH Cancer Registry Quality Coordinator Farhaad C. Golkar, MD Farhaad C. Golkar, MD, PA General Surgery Maen Hussein, MD Florida Cancer Specialists Hematology / Oncology Vasundhara Iyengar, MD Florida Cancer Specialists Hematology / Oncology Vice Chair, Cancer Care Committee Sachin Kamath, MD Radiation Oncology, Moffitt Cancer Center TVRH Rakesh Rohatgi, MD Rakesh Rohatgi, MD, PA Hematology / Oncology Rohini Sastry, MD Rohini Sastry, MD, PA Pain Management Anton Serafini, MD Lake Medical Imaging and Vascular Institute Diagnostic Radiology Sandeep Thaper, MD Florida Cancer Specialists Hematology / Oncology Cancer Liaison Physician & Cancer Conference Coordinator Central Florida Health Alliance Team Phyllis Baum Vice President and Chief Quality Officer Ryan Belen, MBA, R.T. (T) Chief Radiation Therapist, Moffitt Cancer Center The Villages Regional Hospital Heather Benson, CTR Cancer Registry Magda Castro, CTR Cancer Registry Clayton Davis Director, Rehabilitation Nadeen Davis, RN, OCN LRMC Infusion Center Becky Ernst Chaplain and Palliative Care Michelle Fagan, PharmD, BCPS Pharmacy Sandria George, RN, BSN, MHA Med-Surg, Administrative Nursing Director Kathy Houser Administrative Director, Marketing Community Outreach Coordinator Carol Hutchison, CTR Cancer Registry Elizabeth Jernigan, RN, MSN, OCN,CTR Cancer Center Administrator & CFHA Administration Nichole Kelly Oncology Co-Management & Quality Representative Jennifer McKathan American Cancer Society Debbie Olsen, RN, MPH, OCN, CCRC Research Nurse Research Coordinator Ida Perea, MSW, LCSW Oncology Social Worker Psychosocial Services Coordinator Beth Sanford-Richman, RN MSN-HCSM,CMSRN Director, LRMC Medical & Oncology Eve Spotts, RD/LD/N Dietitian Jodi Stump, RN, VA-BC TVRH Infusion Center Kristi Todd, RN Patient Navigator Mary Vanderplas Chaplain and Palliative Care -3-

4 Central Florida Health Alliance The Central Florida Health Alliance is a not-for-profit family of hospitals including Leesburg Regional Medical Center (LRMC) and The Villages Regional Hospital (TVRH). LRMC has been serving its community for over 50 years and TVRH for over 10 years. Our health system consistently ranks at the top of its class when it comes to quality care, which is why our patients are extremely satisfied with our exceptional care, services and facilities. Our hospitals have been rated as the top hospitals for working families in the Central Florida market and recognized on the AARP s list of the Best Employers for Workers over 50. Leesburg Regional Medical Center At LRMC, we offer everything from cardiovascular and orthopedic care to women s services, including obstetrics. Over time our hospital has grown, creating space for new services and programs while ensuring that we have the latest surgical and diagnostic technology available to meet the ever changing health care needs of those communities we serve. The new Urgent Care Center on the Campus of LRMC opened earlier this year and an additional 25 private patient rooms are planned for The Villages Regional Hospital At TVRH, our services include emergency care to orthopedics and cancer care. To meet the needs of our growing community and to ensure an even higher level of care and service, The Villages Regional Hospital is in the midst of a $50 million expansion. The new 173,000 square foot five-story North Tower is scheduled to be finished in early 2015 and will house additional inpatient and surgical beds as well as a new intensive care unit. The second phase of the expansion, which is scheduled for completion in the fall of 2015 will increase the size of the hospital s emergency department, add operating rooms and add treatment rooms. The expansion will give TVRH the ability to better serve patients by improving access to health care with a total capacity of 323 acutehospital beds. Cancer Care Services If you re facing a battle against cancer, you don t have to travel far to receive innovative, comprehensive and compassionate care Leesburg Regional Medical Center and The Villages Regional Hospital provide supportive and continuing services for our patients and their families. Our Cancer Care Services include: Board Certified Physicians The Joint Commission Accreditation Commission on Cancer Accreditation with Commendation, Gold Rating, Leesburg Regional Medical Center and The Villages Regional Hospital Commission on Cancer 2012 Outstanding Achievement Award, Leesburg Regional Medical Center Moffitt Cancer Center The Villages Regional Hospital (50,000 square foot outpatient facility) State-of-the-art diagnostic technology, including PET/CT, True Beam Linear Accelerator, Infusion Chairs and pumps Outpatient Infusion Centers Dedicated Inpatient Oncology Unit with private patient rooms Oncology Certified Nurses Patient Navigator to help patients, caregivers and families with the cancer journey Psychosocial Services Outpatient Rehabilitation Services American Cancer Society Resource Center Patient Libraries -4-

5 The Clinical Program Leesburg Regional Medical Center and The Villages Regional Hospital provide compassionate care and the most advanced cancer treatments available for patients. The goal of patient care services is to provide appropriate individualized, planned and coordinated care throughout the patient s visit. The physical, psychosocial and spiritual needs of patients and their families are fulfilled by a variety of medical, nursing, pharmacy, dietitians, social worker, rehabilitation and other health care professionals. The Leesburg Regional inpatient oncology unit, located on the fourth floor, is a 12-bed unit with private rooms dedicated to the care of cancer patients and their families. Four positive pressure rooms are available on the oncology inpatient unit to accommodate neutropenic patients. Visitation is welcome 24 hours every day. Interdisciplinary rounds began in June 2014 on Tuesdays and Thursdays, weekly, on the Inpatient Oncology Unit. The Interdisciplinary team consists of: Case Manager Chaplain Dietitian Clinical Social Worker Oncology Patient Navigator Oncology Social Worker Pharmacist Registered Nurse Unit Director and Administrative Director -5-

6 The Team has assisted in the care and treatment of patients with various diagnoses, including breast cancer, melanoma and Stage IV colon cancer. These rounds benefit the staff to help manage the patient s cancer and the rounds are beneficial to the patient as there is a better communication process. A tool has been developed to focus round discussions and assist with note taking. The Leesburg Regional Outpatient Infusion Center recently moved to a convenient, easy accessible location, in the new Urgent Care Center on the LRMC Campus. The Outpatient Infusion Center at The Villages Regional Hospital is located in the Moffitt Cancer Center TVRH. The Cancer Center Administrator oversees the outpatient Infusion Centers. The patient education process was improved for patients receiving chemotherapy for the first time in the outpatient Infusion Centers in Those patients are now scheduled for extra time with experienced oncology nurses before receiving any treatment for patient education and to receive information about their disease, treatment, possible side effects and instructions for dealing with various issues that may occur. Another improvement for the Infusion Centers included a new process for documenting patient charges with new software, thus eliminating patient and staff issues with billing. All nurses administering chemotherapy to patients are certified through the Oncology Nursing Society (ONS) as chemotherapy and biotherapy providers. Oncology nursing certification for all nurses providing oncology care is strongly encouraged. A patient resource library is available on the oncology unit at Leesburg Regional and at the Moffitt Cancer Center TVRH to help cancer patients learn more about their diagnosis or treatment. New cancer patients are referred to the American Cancer Society for additional resources, as needed. Spiritual Care Services at the CFHA continues to be involved with the cancer program. Providing spiritual and emotional support to patients and their families, our Spiritual Care Services team is available 24 hours a day, 7 days a week. Chaplains are an integral part of -6-

7 the healthcare team, making daily rounds and providing competent spiritual support. Our chaplains visit all newly admitted patients, including those in critical care areas, and serve as liaisons with local community ministers. A core of caring volunteers keeps vigil with patients who are dying and don t have others caring for them through The Compassionate Companioning at the End of Life Program. At CFHA, our team of volunteer, compassionate companions includes employees, auxiliary members and community members. Volunteers participate in an orientation where they learn the details of how the program works and what is involved in being a compassionate companion as well as what to expect at the different stages of dying. Patient Navigator A diagnosis of cancer can be overwhelming for patients as well as their families. Cancer patients and their families have a dedicated nurse who helps them through their cancer journey. As the patient s advocate, the navigator works with physicians and others involved in the patient s care to ensure the patient has access to education, support and resources needed to make informed choices. The patient navigator can help improve the quality of care that patients receive, and patient navigation programs may help extend or even save patients lives. The patient navigator identifies and eliminates barriers that prevent individuals from getting proper care with appropriate health care providers in a timely manner. The goal is to have a patient scheduled for an appointment with the appropriate health care provider in a three-day turnaround time, whether it is locally or at a tertiary care center. Psychosocial Services An oncology social worker provides counseling and other services that can reduce stress for cancer patients and their families through all phases of their cancer experience. All cancer patients first seen in the outpatient Infusion Centers for chemotherapy and for radiation oncology services at the Moffitt Cancer Center TVRH are screened for psychosocial distress. The oncology social worker participates in the inpatient rounding and is available for all inpatient and outpatient cancer patients at Leesburg Regional and The Villages Regional Hospital. Support Groups We proudly host local support groups for patients and caregivers. Several other support groups meet at various locations in the surrounding communities. Participants are invited to come together with people who are facing similar challenges and learn better ways to manage their health. Music and Pet Therapy Music and pet therapy were introduced this year in the lobby of the Cancer Center. Studies show that music and pet therapy can be an excellent complimentary treatment for patients and benefits can include physical, mental and emotional well-being. Volunteers come in daily to play the piano, guitar or accordion while other volunteers bring their therapy dogs for patients and staff to enjoy. Cancer Survivorship Event Cancer patients were invited to an event celebrating cancer survivorship and offering support to those still battling the disease. The event was also designed to identify resources available to anyone who has defeated the disease and is interested in enhancing their quality of life after doing so. A general presentation celebrating survivorship and highlighting a number of resources available to survivors was provided to participants, and then representatives from Support Services, Nutrition Information and Spiritual Care were available to discuss available services or assistance. Additionally, attendees could speak with the Cancer Center s nurse navigator, participate in -7-

8 cancer rehab screenings and receive a free pre-screening for eligibility of the lung cancer screening at a reduced price. The event, titled Surviving and Thriving: Beating Cancer and Living Your Best, was held at the Waterfront Inn on January 29th. The goal was to show the community that defeating cancer is more probable than ever before and highlight the continuum of care they have right here that can take them from detection, through treatment and on to living a good quality of life. Diagnostic Radiology Diagnostic Radiology at Leesburg Regional and The Villages Regional Hospital performs a full range of diagnostic and interventional procedures offered to patients receiving inpatient as well as outpatient care. Electronic images and reports are transmitted digitally via Picture Archiving and Communications Systems (PACS); this eliminates the need to manually file, retrieve or transport film jackets. PACS breaks down the physical and time barriers associated with traditional film-based image retrieval, distribution and display. A digital portable x-ray machine is available for improved patient care. Leesburg Regional has a three-year term of accreditation in Digital Mammography by the American College of Radiology. This accreditation is awarded to facilities for the achievement of high practice standards, qualifications of personnel and adequacy of equipment. Laboratory Services The Laboratory Department takes pride in the staffs attentiveness to quality issues, timeliness and costeffectiveness when meeting the needs of both the patient and patient s physician. The laboratories at the Leesburg Regional Medical Center and The Villages Regional Hospital are accredited by the College of American Pathologists (CAP). These labs continually update their protocols to obtain tumor markers applicable to site-specific cancers as new information is published to improve cancer care. Along with other tests, tumor markers can be used to help show if cancer is present, determine the type of cancer, determine prognosis and, in some cases, help show if treatment is working. Medical Oncology Our medical oncologists, who keep up with the everchanging cancer treatments, are committed to improving the diagnosis and treatment of patients with cancer. -8-

9 This group of physicians determines the appropriate chemotherapy, immunotherapy or hormonal therapy for cancer patients, and they are involved with the overall treatment planning. Medical oncologists educate patients about their disease, treatment options and potential side effects from treatment. Radiation Oncology Radiation oncology is available at various locations throughout the community. Those facilities are committed to delivering compassionate and innovative care for our patients. This rapidly changing field, with several evolving technologies, offers the most advanced, precise and sophisticated cancer treatments available. The advanced technology is managed by radiation oncologists, with the help of highly trained Dosimetrists, Medical Physicists and Radiation Therapists. Radiation oncology services are available at the Moffitt Cancer TVRH. The Varian True Beam Linear Accelerator delivers state-of-the-art, fast, accurate, non-invasive radiation treatment to the brain and body in a calm, tranquil setting. The robotic couch ensures the patient is in an exact position so cancerous tissue is treated, sparing the normal cells. Clinical Research Clinical trials contribute to science and provide better care for patients. Central Florida Health Alliance participates in cancer research and has access to new treatments and medications through the affiliation with the H. Lee Moffitt Cancer Center and Research Institute. In 2001, Moffitt was awarded the Comprehensive Cancer Center status by the National Cancer Institute (NCI). They are the only Floridabased hospital with this designation. Collaborative care planning can, many times, result in patients receiving the finest possible cancer care close to home, while having access to Moffitt s international renowned physicians, treatment options and research participation. Many of our cancer patients choose to enroll in clinical trials related to cancer prevention, cancer diagnosis, cancer screening, cancer treatment, cancer quality of life or cancer tissue studies. Many of our clinical trial patients continue to followed, having been enrolled in clinical trials in the past, which also contributes greatly to science and the most up-todate cancer care. Hospice Various hospices provide support and care for patients in the last months of an incurable disease to help them live as full and comfortable a life as possible. These agencies address the physical, emotional and spiritual needs of patients and families they serve. Medicallydirected teams of professionals and volunteers treat the whole person during the end stages of the illness and follow the family and caregivers for one year -9-

10 after death. Hospice services are available in the patient s home, extended-care facilities or in special designated hospice houses. Cancer Conferences Cancer Conferences are a key component to the multidisciplinary approach of a Commission on Cancer accredited Cancer Program. Cancer Conferences bring physicians of multiple disciplines (surgery, medical oncology, radiation oncology, pathology and radiology) into one room to discuss recently diagnosed cases, difficult cases and cases of interest. This approach enables the treating physician to discuss patient care with a broad spectrum of specialties. Discussions include patient medical history, diagnostic testing, surgical procedures, stage of disease at diagnosis, treatment options including palliative care, pain management and survival outcomes. Cancer Conferences are also used to educate physicians in new techniques, tools and technology in the field of cancer diagnosis and treatment. Cancer Conferences are certified for AMA PRA Category 1 Credit TM by Orlando Health. Cancer Conferences are scheduled at 7:00 am on Thursdays at the Cancer Center TVRH, and patients from both facilities are included in discussions. Physicians are encouraged to submit cases for presentation by contacting the Cancer Registry. The medical staff physicians and health care professionals are encouraged to attend Cancer Conferences to enhance patient care. These conferences are available remotely through secure internet access with the capability to view films and pathology. Physicians can actively participate in the discussions with the remote access. Grand Rounds and Staff Education The education of the physicians, nurses and ancillary staff remain an essential part of the Central Florida Health Alliance Cancer Program. Team members are encouraged to become involved in professional healthcare organizations to continue their education and network with others in their specialty or area of expertise. Quarterly, Grand Rounds are also certified for AMA PRA Category 1 Credit TM by Orlando Health, and they are open to physicians, nurses and other team members. These educational programs presented by the H. Lee Moffitt Cancer Center and Research Institute staff -10-

11 promote improved patient care and awareness through high quality, evidence-based education activities, presented in an organized, professional manner. The educational content includes state-of-the-art cancer diagnosis and treatment topics, including cancer stage at diagnosis, followed by case presentations. In addition to Cancer Conferences and Grand Rounds, the nursing and ancillary staff meets regularly at both facilities for updates on new drugs or therapies. Oncology nurses are encouraged to become certified by the Oncology Nursing Society. Nurses administering chemotherapy are required to maintain certification according to the Oncology Nursing Society standards. Commitment to the Community We are proud of our partnerships in the community and the outreach programs in which we participate. Our dedicated medical professionals and volunteers contribute countless hours to the community outside of our hospitals and participate in many different health events. Screenings, wellness events and educational classes are offered to the community by the CFHA to raise awareness in community of the importance for prevention and early detection of cancers. Additionally, these programs educate the community of available services about various cancers as well as innovative diagnostic procedures and treatments. Outdoor fun is year-round fun in Central Florida. Central Florida Health Alliance, in partnership with the Mole Patrol from the H. Lee Moffitt Cancer Center and Research Institute, held a skin cancer screening and educational event to raise awareness of too much sun exposure, which can cause premature aging of the skin and increase the risk of skin cancer. Eighty-four individuals attended the event on September 27th at the Wound Care Center. Fifty-one individuals were identified as having a suspicious finding requiring follow-up. Those individuals were given a copy of their screening record and a list of qualified dermatologists recommended for follow-up. It is estimated that more than 50,000 Americans will develop some form of Head & Neck Cancer in Fortunately, most of the cancers are preventable and can be successfully treated in their early stages. Dr. Jeffrey Russell, Medical Oncologist at the H. Lee Moffitt Cancer Center and Research Institute, discussed the -11-

12 signs, symptoms, risk factors and treatment options at two educational programs in Leesburg and The Villages for Head & Neck Cancer. Free screenings were offered after the education sessions. Thirty-five individuals were screened and four were recommended to follow-up with a head and neck specialty physician regarding potential issues. Community Medical Care Center CFHA has partnered with First Baptist Church of Leesburg to meet the medical and dental needs of our community with dignity and passion. The Community Medical Care Center is a not-for-profit medical clinic that offers primary care for uninsured adults and children (ages three and up) with incomes below the federal poverty level. The Clinic, which serves more than 7,200 patients annually, receives no state funding. A small staff is augmented by the services of more than 100 volunteers, including many healthcare professionals. Relay for Life The American Cancer Society Relay for Life is a lifechanging event that gives everyone in communities across the globe a chance to celebrate the lives of people who have battled cancer, remember loved ones lost, and fight back against the disease. At Relay, teams of people camp out and take turns walking or running around the track or path. Each team is asked to have a representative on the track at all times during the event. The Central Florida Health Alliance supports the Relay for Life and every year, the staff conducts unique Relay for Life fundraisers to support these events held throughout the local area. The American Cancer Society can be contacted for specific dates and locations. Leukemia & Lymphoma Society Dr. Jennifer Cultrera was nominated as Woman of the Year for 2014 by the Leukemia & Lymphoma Society (LLS) Northern & Central Florida Chapter, where she also serves on the board of directors. Dr. Cultrera joined a spirited competition with the local chapter and led fundraising efforts to help continue blood cancer research. Dr. Cultrera, who practices at the FCS offices in Leesburg and The Villages, raised over $50,000 for the local chapter. Community Wellness The Wellness Center has been helping community members stay healthy for over 20 years. Staffed by degreed -12-

13 exercise specialists, the Wellness Center participates in community health fairs teaching participants how to incorporate fitness and wellness into their lives. As a way to encourage physical wellness in the community, our Wellness Center hosts a series of 5K and 10K races in the local area throughout the year. Cancer Registry Report The Cancer Registry is an essential component of the Cancer Programs at the Central Florida Health Alliance. The Cancer Registry staff works closely with the Cancer Care Committee to assure the Cancer Program meets or exceeds standards established by the Commission on Cancer. The registry has responsibilities, including the accurate and timely collection of information on cancer diagnosed and/or treated at Leesburg Regional Medical Center and The Villages Regional Hospital, as well as the management and analysis of this data. The information collected, such as demographics, anatomic site, tests, treatment and extent of disease, has multiple uses, which include outcome reporting, patient care reviews, physician education, clinical research and hospital planning. The Cancer Registry has three Certified Tumor Registrars, which ensures quality, accurate data. Two more staff members will be sitting for the Certified Tumor Registrar examination administered by the National Cancer Registrars Association Council on Certification in October The data collected by the Cancer Registry at both hospitals are electronically submitted to the Florida Cancer Data System (FCDS) and the National Cancer Database (NCDB). This allows comparative analysis with other hospitals or databases. Data analysis for specific sites can be done to compare elements, such as site, demographics, histology, stage of disease, treatment modalities and survival to other published state, regional or national data. This information provides the cancer program benchmarking opportunities to patterns of patient care and survival. Leesburg Regional Medical Center and The Villages Regional Hospital was among the select few institutions in the region chosen to receive the Jean Byers Award for Excellence in Cancer Registration awarded by the Florida Cancer Data System. Based on the level of accordance with national standards for timeliness and completeness of data, the Jean Byers Award recognizes excellence in these key constituents of running an exceptional registry program. The award is given in honor of Jean Anne Byers, who passed away in 1996 following a long career dedicated to promoting oncology research and education in Florida. A major priority of the registry is collecting, handling and disseminating patient information while maintaining strict patient confidentiality. Another important function of the registry is to provide annual lifetime follow-up of every patient diagnosed and/or treated for cancer at Leesburg Regional Medical Center and The Villages Regional Hospital. The information ensures continuous medical surveillance and also provides end results and survival statistics and is used in the assessment of treatment effectiveness. The registry staff participates in ongoing cancer-related education at the local, state, regional and national levels to maintain abstracting skills and to maintain credentials in their field. The registry staff also works closely with the various coordinators to organize Cancer Conferences, Grand Rounds and Cancer Care Committee meetings. The registry staff participates in community outreach programs. Physicians and other healthcare professionals are encouraged to utilize data collected. The Cancer Registry staff can be reached at (352)

14 Cancer Data Analysis and Comparison (2013 Statistics) Local cancer statistics are continually analyzed to compare incidence, stage, age and gender at diagnosis as well as other parameters. This evaluation of data is important to ensure the hospital s experience in cancer care is comparable to that of other hospitals on state and national levels. The Central Florida Health Alliance is committed to providing patients with the best possible cancer care in the area. The Cancer Program began in 1996 for Leesburg Regional Medical Center and 2010 for The Villages Regional Hospital. To date, 25,586 patients have been entered into the Central Florida Health Alliance Cancer Registry database. In 2013, there were 2,177 new cancer cases added into this database, and of those, 1,113 cases were newly diagnosed cancers. Breast was the most dominant disease, closely followed by lung, then colon, bladder and Non-Hodgkin s Lymphoma. The data in Figure 1 is somewhat inconsistent with projected American Cancer Society figures for Florida Figure 1: Central Florida Health Alliance 2013 Newly Diagnosed Cancer Cases *National Comparison of Selected Cancer Sites *Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2013 BREAST 14.0% 22.6% 13.3% LUNG 13.7% 21.6% 15.2% PROSTATE 1.9% 14.4% 14.6% COLORECTAL 8.6% 11.9% 8.7% BLADDER 4.4% 6.9% 4.8% NH LYMPHOMA 4.2% 4.2% 4.3% CORPUS UTERI 1.7% 3.0% 2.6% Figure 1: 2013 CFHA Newly Diagnosed Cancer Cases compared to estimated number of new cases, nationally and for Florida, from the American Cancer Society Cancer MELANOMA 2.5% 4.6% 4.5% Facts & Figures LEUKEMIA 1.1% 2.9% 2.9% CERVIX 0.4% 0.7% 0.8% Central Florida Health Alliance 2013 Actual Data ACS Projected Figures Florida 2013 ACS Projected Figures NaSonal

15 and nationally. The lower incidence of melanoma and prostate cancer is most likely due to free-standing facilities with specialists in dermatology for skin cancers and urology with radiation therapy services for prostate cancer in the local area. Higher incidences of breast, lung, colorectal and bladder are most likely due to the local, older retirement-age population. The Villages is the largest and fastest growing retirement community in the nation. As can be seen in Figure 2, the most common age for cancers first seen in 2013 at the Central Florida Health Alliance was the years of age group followed by the year old age group. The primary sites for cancers first seen at the Central Florida Health Alliance in 2013 are listed by gender and stage at diagnosis in Table 1. The cancer stage at diagnosis is helpful to clinicians in treatment planning and predicts survival. The American Joint Committee on Cancer (AJCC) defines how far the cancer has spread by classifying the disease into four main stage groups, or extent of disease. Some cancer sites do not have sitespecific staging classifications available. Figure 2 Central Florida Health Alliance Age by Gender, 2013 Newly Diagnosed Cases Male (473) Female (640) -15-

16 Table 1: 2013 CFHA Analytic Cases, Primary Site by Gender and Stage Group at Diangosis PRIMARY SITE TOTAL GENDER STAGE GROUP M F INSITU I II III IV UNKNOWN N/A ALL SITES ORAL CAVITY TONGUE OROPHARYNX HYPOPHARYNX OTHER DIGESTIVE SYSTEM ESOPHAGUS STOMACH COLON RECTUM LIVER PANCREAS OTHER RESPIRATORY SYSTEM 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 MALE GENITAL PROSTATE TESTIS OTHER URINARY SYSTEM BLADDER KIDNEY/RENAL OTHER BRAIN & CNS BRAIN (MALIGNANT) OTHER ENDOCRINE THYROID OTHER LYMPHATIC SYSTEM HODGKIN'S DISEASE NON-HODGKIN'S UNKNOWN PRIMARY

17 Breast Cancer According to the American Cancer Society, an estimated 232,670 new cases of invasive breast cancer are expected to be diagnosed among women in the United States during 2014; about 2,360 new cases are expected in men. Excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women. Signs and Symptoms Breast cancer typically produces no symptoms when the tumor is small and most treatable. Therefore, it is important for women to follow recommended screening guidelines to detect breast cancer at an early stage. Larger tumors may become evident as a breast lump, which is often painless. Less common symptoms include persistent changes to the breast, such as thickening, swelling, distortion, tenderness, skin irritation, redness, scaliness or nipple abnormalities, such as ulceration, retraction or spontaneous discharge. Breast pain is more likely to be caused by benign conditions and is not a common early symptom of breast cancer. Risk Factors Increased breast cancer risks include weight gain after the age of 18, being overweight or obese (for postmenopausal breast cancer), use of MHT (combined estrogen and progestin), physical inactivity and alcohol consumption. In addition, recent research indicates that long-term heavy smoking also increases breast cancer risk, particularly among women who start smoking before first pregnancy. Risk is also increased by a family history of breast cancer, particularly having one or more affected firstdegree relatives (though most women with breast cancer do not have a family history of the disease). Scientists now believe that most familial breast cancer is due to the interaction between lifestyle factors and more common variations in the genetic code that confer a small increase in breast cancer risk. Individuals with a strong family history of breast and/or certain other cancers, such as ovarian and colon cancer, should consider counseling to determine if genetic testing is appropriate. Prevention measures may be possible for individuals with breast cancer susceptibility mutations. Women should receive counseling before undergoing surgical procedures for breast cancer prevention. Early Detection Breast cancer screening for women at average risk includes clinical breast exam and mammography. Mammography can often detect breast cancer at an early stage, when treatment is more effective. Numerous studies have shown that early detection with mammography saves lives and increases treatment options. Steady declines in breast cancer mortality among women since 1989 have been attributed to a combination of early detection and improvements in treatment. Treatment Taking into account tumor size, extent of spread, and other characteristics, as well as patient preference, treatment usually involves breast-conserving surgery (surgical removal of the tumor and surrounding tissue) or mastectomy (surgical removal of the breast). Numerous studies have shown that for early breast cancer (cancer that has not spread to the skin, chest wall, or distant organs), long-term survival is similar among women treated with breast-conserving surgery plus radiation therapy and those treated with mastectomy. Women undergoing mastectomy who elect breast reconstruction have several options, including the materials used to restore the breast shape and the timing of the procedure. Underarm lymph nodes are usually removed and evaluated during surgery to determine whether the -17-

18 tumor has spread beyond the breast. In women with early stage disease, sentinel lymph node biopsy, a procedure in which only the first lymph nodes to which cancer is likely to spread are removed, has a lower chance of long-term side effects (e.g., lymphedema, arm swelling caused by the accumulation of lymph fluid) and is as effective as a full axillary node dissection, in which many nodes are removed. Treatment may also involve radiation therapy, chemotherapy (before or after surgery), hormone therapy (e.g., selective estrogen response modifiers, aromatase inhibitors, ovarian ablation), and/or targeted therapy. Postmenopausal women with early stage breast cancer that tests positive for hormone receptors benefit from treatment with an aromatase inhibitor (e.g., letrozole, anastrozole, or exemestane) in addition to, or instead of, tamoxifen. For women whose cancer tests positive for HER2/neu, several therapies are available that target the growth-promoting protein HER2. The US Food and Drug Administration (FDA) revoked approval of bevacizumab (Avastin) for the treatment of metastatic breast cancer in 2011 because of evidence showing minimal benefit and potentially dangerous side effects. Data Analysis Local breast cancer data for the Central Florida Health Alliance (CFHA) were compared to the National Cancer Data Base (NCDB), a clinical oncology database sourced from registry data that are collected in more than 1,500 Commission on Cancer (COC)-accredited facilities nationwide. NCDB is jointly sponsored by the American College of Surgeons and the American Cancer Society, and this database represents approximately 70 percent of newly diagnosed cancer cases nationwide. Data from the Leesburg Regional (LRMC) were compared to the available data from NCDB, which included the years 2000 to Data for The Villages Regional Hospital (TVRH) were compared to the NCDB for the years 2010 and 2011 since this facility only started collecting data as a COC-accredited Cancer Program in In Figures 3 and 4, the age groups are compared for LRMC and TVRH respectively to the NCDB data. Figure 3 Age Groups for Breast Cancers Diagnosed and/or Treated, 2000 to 2011 Leesburg Regional Medical Center Compared to National Cancer Data, All Types Hospitals, All States 35% 30% 25% 20% 15% 10% 5% 0% Under and 40 over LRMC 2.0% 5.6% 13.0% 30.8% 31.6% 15.4% 1.6% NCDB 4.3% 17.3% 24.4% 23.5% 19.0% 10.1% 1.4% -18-

19 Figure 4 Age Groups for Breast Cancers Diagnosed and/or Treated, 2010 and 2011 The Villages Regional Hospital Compared to National Cancer Data Base, All Types Hospitals, All States 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Under and 40 over TVRH 0.0% 8.3% 8.3% 50.0% 25.0% 8.3% 0.0% NCDB 3.8% 16.0% 24.3% 26.5% 18.3% 9.7% 1.4% Figure 5 Histology Types, Breast Cancer, Diagnosed and/or Treated, 2000 to 2011 Leesburg Regional Medical Center Compared to National Cancer Data Base, All Types Hospitals, All States 80% 70% 60% 50% 40% 30% 20% 10% 0% Infiltrating Duct Carcinoma Lobular Carcinoma, NOS Infiltrating Duct & Lobular Carcinoma Infiltrating Duct Mixed w/other Types of Carcinoma Other Specified Types LRMC 70.4% 5.9% 2.7% 4.8% 16.3% NCDB 65.5% 9.9% 5.4% 5.2% 14.1% -19-

20 Figure 6 Histology Types, Breast Cancer, Diagnosed and/or Treated, 2010 and 2011 The Villages Regional Hospital Compared to National Cancer Data Base, All Types Hospitals, All States 70% 60% 50% 40% 30% 20% 10% 0% Infiltrating Duct Carcinoma Lobular Carcinoma, NOS This data comparison shows that most breast cancers are diagnosed at a later age locally than those included in the NCDB database, mainly because LRMC and TVRH are located near large retirement areas in Central Florida. While breast cancer is less common at a young age, younger women tend to have more aggressive breast cancers than older women Breast cancer is categorized by histology type, which helps with selecting the best treatment. Figures 5 and 6 show that the histology types for breast cancers seen at LRMC and TVRH are similar to the data reported by the NCDB Breast cancer is classified in stages (or extent of disease) according to the American Joint Committee on Cancer (AJCC). Breast cancer staging is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, neck, and inside the chest, and whether the tumor has metastasized (M), or spread to a more distant part of the body. Larger size, Infiltrating Duct & Lobular Carcinoma Infiltrating Duct Mixed w/other Types of Carcinoma Other Specified Types TVRH 45.8% 12.5% 4.2% 4.2% 33.3% NCDB 65.3% 10.3% 4.4% 7.3% 12.7% nodal spread, and metastasis have a larger stage number and a worse prognosis. Once the tumor (T), Node (N) and metastasis (M) categories are classified, an overall stage is assigned. There are five stages of breast cancer, ranging from insitu (noninvasive) to Stage IV where the cancer has expanded to other areas of the body. Breast cancers are further subdivided to group tumors associated with similar prognoses. Outcomes are more accurately predicted by these stage groupings When comparing the LRMC and TVRH data to the NCDB, the breast cancer stage at diagnosis is relatively similar as can be seen in Figures 7 and 8. The most common stage of cancer at diagnosis is Stage I (disease is confined to the breast), which most likely represents improvements in early detection efforts. Most often, if the stage of the cancer is higher, prognosis or chance for survival will be poorer. -20-

21 Figure 7 Stage Groups for Breast Cancer, Diagnosed and/or Treated, 2000 to 2011 Leesburg Regional Medical Center Compared to National Cancer Data Base, All Types Hospitals, All States 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Insitu I II III IV Unknown or N/A LRMC 12.3% 46.6% 25.6% 6.3% 3.4% 5.7% NCDB 20.9% 38.5% 25.2% 7.8% 3.7% 3.9% Surgery is the most common treatment for breast cancer as shown in Figures 9 and 10 for LRMC and TVRH respectively. Patients treated at LRMC and TVRH were treated similar to patients diagnosed and/ or treated at other cancer programs reporting data to the NCDB (as seen in Figures 9 and 10). Survival rates are often used as a standard way of discussing a person s prognosis (outlook) in similar situations. The five-year observed survival rate refers to the percentage of patients who live at least five years after being diagnosed with cancer. Many of these patients live much longer than five years after diagnosis. Survival rates are often based on previous outcomes of large numbers of people who had the disease. Many other factors may affect a person s outlook, such as age and health, the presence of hormone receptors on the cancer cells, the treatment received, and how well the cancer responds to treatment. The most recent data from the NCDB were used to compare survival to LRMC data. This survival analysis could not include data from TVRH as those cases were not available for the years included in the NCDB database (due to the TVRH reference date of 2010). In Figure 11, the survival rate is similar for the 387 patients diagnosed and/or treated at LRMC compared to 544,351 patients in the NCDB database for the years 2003 through 2006 (according to the AJCC Stage Edition 6). The prognosis and five-year survival for female breast cancer patients has improved over time. Improved long-term survival can be achieved by earlier detection, more effective modern therapy and healthier lifestyle. The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, in general, express moral support for women with breast cancer and it is most commonly seen during National Breast Cancer Awareness Month, which is October. -21-

22 Figure 8 Stage Groups for Breast Cancer, Diagnosed and/or Treated, 2010 and 2011 The Villages Regional Hospital Compared to National Cancer Data Base, All Types Hospitals, All States 60% 50% 40% 30% 20% 10% 0% Insitu I II III IV Unknown or N/A TVRH 17.2% 51.2% 19.6% 7.2% 4.3% 0.5% NCDB 20.4% 40.9% 23.8% 8.5% 3.9% 2.6% Figure 9 First Course of Treatment for Breast Cancer Diagnosed and/or Treated, 2000 to 2011 Leesburg Regional Medical Center Compared to National Cancer Data Base, All Types Hospitals, All States 30% 25% 20% 15% 10% 5% 0% Surgery Only Surgery & Radiation Surgery & Chemo Surgery, Radiation & Chemo Surgery, Radiation & Hormone Surgery & Hormone Surgery, Radiation, Chemo & Hormone Surgery, Chemo & Hormone Other Therapy No Treatment / Observation LRMC 29.2% 18.7% 7.3% 10.0% 12.4% 6.7% 8.4% 3.5% 2.8% 1.1% NCDB 21.3% 10.3% 7.1% 9.0% 17.7% 9.9% 10.7% 4.9% 6.3% 2.8% -22-

23 Figure 10 First Course of Treatment for Breast Cancer, Diagnosed and/or Treated, 2010 and 2011 The Villages Regional Hospital Compared to National Cancer Data Base, All Types Hospitals, All States 25% 20% 15% 10% 5% 0% Surgery Only Surgery & Radiation Surgery & Chemo Surgery, Radiation & Chemo Surgery, Radiation & Hormone Surgery & Hormone Surgery, Radiation, Chemo & Hormone Surgery, Chemo & Hormone Other Therapy No Treatment / Observation TVRH 22.0% 21.5% 8.1% 9.1% 13.9% 10.5% 8.1% 2.9% 2.4% 1.4% NCDB 18.2% 8.7% 6.9% 7.5% 20.4% 12.2% 11.2% 5.1% 6.7% 3.1% Figure 11: LRMC Five-Year Observed Survival Rates for Breast Cancers, Compared to NCDB, Diagnosed and/or Treated in , All Stages (AJCC Stage Edition 6) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% LRMC n: 387 NCDB n: 544,

24 Resource ResouRce Directory DiRectoRy Cancer Center, TVRH (352) Leesburg Regional Medical Center Cancer Conferences /Tumor Boards (352) Cancer Registry (352) Clinical Research Nurse (352) Clinical Research Nurse (352) Foundation, LRMC (352) Health Information (Medical Health Information Records) (352) Medical Records, LRMC (352) Inpatient Oncology Unit (352) Infusion Health Information Center, Outpatient (352) Nutritional Medical Records, Services TVRH (352) Oncology Co-Management Infusion Outpatient Center, LRMC (352) (352) Pastoral Care (352) Infusion Outpatient Center, TVRH Patient Navigator (352) (352) Patient Nutritional Relations Services, LRMC (352) Patient Scheduling Nutritional Services, TVRH (352) (352) Pharmacy Services (Outpatient) (352) Oncology Co-Management Physician Referral (352) (352) (800) Pastoral Care, LRMC (352) Social Worker & Support Groups, Oncology (352) Volunteers & Auxiliary (352) Pastoral Care, TVRH (352) The Villages Regional Hospital Patient Navigator (352) Cancer Registry (352) Patient Relations, LRMC Clinical Research Nurse (352) (352) Patient Health Information Relations, TVRH (352) (Medical Records) (352) Patient Inpatient Scheduling Oncology Unit (352) (352) Pharmacy Infusion Center, Services, Outpatient LRMC (352) (352) Moffitt Cancer Center at TVRH (352) Physician Referral Nutritional Services (352) (352) (800) Oncology Co-Management (352) Social Worker & Support Groups Pastoral Care (352) (352) Volunteers Patient Navigator & Auxiliary, LRMC (352) Patient Relations Volunteers & Auxiliary, TVRH (352) (352) Patient Scheduling (352) Wellness Center Physician Referral (352) (352) (800) Wound Healing & Radiation Oncology (352) Hyperbaric Center (352) Social Worker & Support Groups, Oncology (352) Volunteers & Auxiliary (352) Wellness Center (352) East Dixie Avenue, Leesburg, FL East Dixi Avenue, Leesburg, FL (352) (352)