Mercy Oncology Annual Report 2016

Transcription

1 Mercy Oncology Annual Report 2016 Mercy Hospital Cancer Program Mercy Hospital offers a multidisciplinary patient-centered cancer program that ensures quick access to advanced imaging services including Breast MRI and Ultrasound, CT Scan, Interventional Radiology, Low-dose Lung CT Scan, Mammography and MRI. Our care model includes tumor conference participation, clinical navigators and social support services. Mercy offers the following specialties: Breast Surgery, ENT, Gastroenterology, General Surgery, Genetics, Gynecology, Hematology, Oncology, Palliative Care, Pulmonology, Surgical Oncology and Urology.

2 Mercy Cancer Committee Roger Inhorn, MD, is the Medical Director of the Oncology/Hematology Center at Mercy. He earned his undergraduate degree from the University of Wisconsin at Madison and his MD and PhD at Washington University in St. Louis. He completed his internship and residency at Brigham and Women s Hospital in Boston, then served a fellowship in oncology at the Dana-Farber Cancer Institute. Before joining Mercy he was Associate Director of Oncology-Hematology at St. John s Mercy Medical Center in St. Louis and the principal investigator for the St. Louis site of a National Cancer Institute-sponsored clinical research program. Dr. Inhorn has a particular interest in the treatment of breast cancer patients. He is Board-certified in oncology and internal medicine. The Mercy Hospital Cancer Program is pleased to provide our first annual report to introduce some of the exciting developments in cancer care that are happening within our system. Mercy Hospital s commitment to excellence in cancer care has been recognized by continuous accreditation by the American College of Surgeon s (ACOS) Commission on Cancer since In 2015 we received accreditation as a Comprehensive Community Cancer Program, a higher standard of accreditation based on the growth of our program. To achieve this recognition we demonstrated excellence in patient care throughout the continuum of their treatment. In addition to leading-edge treatment, including access to clinical trials, we provide psychosocial support, survivorship care, physical rehabilitation services, nutritional support and palliative care services. Patients treated within our program are discussed in multidisciplinary tumor conferences, where medical oncologists, radiation oncologists, surgeons, pathologists and radiologists collaborate to formulate optimal treatment plans incorporating the most recent evidence-based medicine. Mercy Hospital s Breast Care Center s commitment to excellence was recognized through independent accreditation by the ACOS National Accreditation Program for Breast Centers (NAPBC). In this report we highlight surgical advances available to our breast cancer and colorectal cancer patients. We are proud that cancer care at Mercy Hospital offers leading-edge medicine that is provided by a patient-centered, compassionate team of professionals. Roger C. Inhorn, MD, PhD Chair, Mercy Cancer Commtitee

3 Cancer Care at Mercy Hospital Quality Initiatives The Mercy Hospital Cancer Program has been nationally accredited by the American College of Surgeons Commission on Cancer since 2006, which means demonstration of compliance with data driven performance measures for the provision of quality cancer care. National accreditation provides a comprehensive model for the delivery of multidisciplinary care and meaningful quality measures to monitor quality and patient outcomes. The cancer program must demonstrate ongoing compliance with 34 standards and quality metrics that hold the program accountable to the highest level of evidence-based, patient-centered comprehensive cancer care. Access to the full scope of cancer care services necessary to diagnose, treat, rehabilitate and support must also be demonstrated. Our Breast Center, managed by Mercy Breast Care Specialists of Maine, has been nationally accredited by the National Accreditation Program for Breast Centers (NAPBC), since The NAPBC requires that each breast program comply with a comprehensive set of 29 standards which hold the programs to the highest level of evidence-based care. Some of the standards required to be monitored by the two programs are: Annual Caseload Breast Conservation Rate Cancer Survivorship Care Coordination and Navigation Clinical Trial Accrual Community Outreach and Education Follow-up Rate Interdisciplinary Conference Activity Needle Biopsy Rate Quality and Outcomes Pathological review of lymph nodes Prevention and Screening Reconstructive Surgery Rate Support and Rehabilitation Clinical and Programmatic Initiatives The Mercy Hospital Cancer Program also conducted a number of clinical and programmatic initiatives in 2016: Cardiac Monitoring in patients receiving HER- 2 Targeted Drug Therapy Comprehensive cancer family history (first and second degree relatives) Electronic Chemotherapy Physical Order Templates and Treatment Pathways Fast Track Recovery pathway for laparoscopic colon surgery Oral Chemotherapy Clinical Pathway and Monitoring Utilization of molecular biomarkers in clinical decision making against National Comprehensive Cancer Network

4 Meeting and Exceeding the Benchmarks Mercy Top Analytical Cases by Disease Site Mercy Hospital Comprehensive Cancer Program provides patient-centered, quality care for a wide range of cancers and conditions. Expertise in the treatment and management of a variety of cancers helps support patients ability to receive their cancer care close to home and within the same healthcare system where they receive other medical care. This allows all healthcare providers to work from the same patient medical record and reduces duplicate testing and paperwork. Breast 26% 31% Lung Bladder Colorectal 4% Oral Cavity and Pharynx 5% 6% 6% 6% 16% Prostate Kidney and Renal Pelvis Other Mercy exceeds expectations by spending time with patients that never feels rushed or impersonal. Mary, Mercy Cancer Patient Connected to the Community We Serve Outreach that Lowers Risk Mercy Hospital is committed to making a difference in the health of the community it serves. The Cancer Program participates in and supports ongoing cancer awareness, community outreach and education to promote cancer screening, early detection and healthy lifestyles in order to reduce cancer risk. Mercy Cancer Program outreach for Breast Cancer awareness depicting the benefits of Digital Mammography in early cancer detection.

5 Mercy Hospital Cancer Program Analytic Case Diagnosis by AJCC Stage Stage refers to the extent of cancer spread throughout the body. Most cancers are assigned a stage from one to four, depending on the size and characteristics of the primary tumor, and the presence of spread to lymph nodes or other organs. Cancer stage is used by physicians to determine the best treatment options for an individual patient and his or her cancer. Early-stage cancers can often be treated more easily and comfortably than late-stage disease. Stage is also an important predictor of outcome, including the probability of survival and the risk of recurrence. Detecting cancer at an early stage is critically important to reducing cancer-related mortality. For example, stage I colon cancer has a five-year survival rate above 90%, while for stage IV colon cancer, that rate is about 11%. 50% 40% 30% 20% 10% Mercy Analytic Cases 2015 National Cancer Database Analytic Cases Comparison to most recent 5-year NCDB data % Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Mercy Breast Cancer Program Analytic Case Diagnosis by AJCC Stage Mercy Colon Cancer Program Analytic Case Diagnosis by AJCC Stage 50% 40% 30% 20% 10% 0% 50% 40% 30% 20% 10% 0% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Mercy Breast Cancer Program Analytic Cases 2015 National Breast Cancer Database Analytic Cases Comparison to most recent 5-year NCDB data Mercy Colon Cancer Program Analytic Cases 2015 National Colon Cancer Database Analytic Cases Comparison to most recent 5-year NCDB data

6 Putting Patients First Individualized, Patient-Focused Comprehensive Care The Mercy Hospital Cancer Program team is 100% dedicated to providing patients and their families with the most current personalized cancer care throughout their experience. Appointment coordination for all services including: Medical Oncology, Radiation Oncology, Surgical Oncology, Urology, Home Care, Rehabilitative /Support services and Palliative Care. Primary Nursing and Nurse Coordinators before during and after treatment Individualized Treatment Planning, Education and Goals Access to Registered Dieticians, Clinical Social Workers and Financial Counseling services. Multidisciplinary Cancer Care Services Mercy Hospital provides comprehensive, coordinated care for all types of cancer and blood disorders, including the following services: Benefits Coordinator Biotherapy Blood Disorder Management Blood Products Breast MRI Breast Ultrasound Chemotherapy Clinical Trials Colonoscopy CT Scan CT Scan Low Dose Lung Screening Diagnostic Radiology Digital Mammography Endoscopy Financial Advocates Hereditary Risk Assessment and Management Individualized New Patient Treatment Teaching Sessions Infusion Therapy: Chemotherapy, Biotherapy, Molecular Therapy, Supportive Blood Products and Therapeutic Phlebotomy Interventional Radiology: Full Spectrum of Diagnostic and Therapeutic Procedures Mammography Molecular Testing Molecular Therapy MRI Multidisciplinary Coordination of Care Nutritional Assessment and Management Ostomy and Wound Care Palliative Care Support Patient Navigator Patient resources / Lending Library Preparation for Surgery Primary Nursing in the Infusion / Treatment Suite Rehabilitative Services- Physical Therapy, Occupational Therapy, Speech Therapy, Lymphedema Specialists Supportive Care Surgical Breast Care Referral to Radiation Oncology Social Worker Services: Psychosocial and Emotional Support Surgical Oncology Survivorship Care Referral to Urology

7 Program Support Services Clinical Licensed Dietician Board-certified in Oncology Nutrition and Certified in Oncology Licensed Oncology-certified Clinical Social Worker Multidisciplinary Cancer Conference that meets weekly to review oncology cases prospectively to develop and review treatment planning Multidisciplinary Comfort Care Rounds meet weekly to review patient plan of care related to ancillary services, home care and supportive care needs and symptom management review Specialty Trained, Oncology-certified Nurses Understanding Your Potential Risk for Cancer The Hereditary Risk Assessment Program at Mercy Family history or genetic factors can increase an individual s risk for certain types of cancer- breast, ovarian and colorectal, for example. As part of Mercy s comprehensive and patientcentered care model, specialty-trained staff conduct individualized cancer risk assessments as well as genetic counseling and testing when indicated. Dr. Anna Niegowska, MD, has received specialty training for Comprehensive Cancer Risk Assessments A hereditary cancer risk assessment helps identify individuals and families who may be at risk of developing certain types of cancers based on their personal, family and social history. This information can help individuals and their healthcare providers take into consideration specific risk factors to guide decisions regarding disease prevention, screening tests and treatment decisions. Mercy s Hereditary Risk assessment program follows the National Comprehensive Cancer Network guidelines for testing, surveillance and medical management. I now have the information I need to monitor my own health and help my young adult children make decisions about their own genetic testing... I never felt pressured to make decisions, but was provided with available options. Mary, Mercy Cancer Patient

8 Breast Cancer Care at Mercy Suzanne Hoekstra, MD, FACS, is a Board-certified general surgeon with special training in breast surgery. She has served the needs of greater Portland for over six years and serves on medical missions to Haiti and other countries. Dr. Hoekstra has a Certificate in Mastery of Breast Surgery and is a member of the American Society of Breast Surgeons and the National Consortium of Breast Centers. She earned her MD at Southern Illinois University and trained in surgery at the University of Nebraska Medical Center. She is a Fellow of the American College of Surgeons. Mercy Breast Care Specialists of Maine is proud to report on a number of quality initiatives over the past year. We provide patients and their families the following services: Clinical breast examination and review of imaging Coordination of care, navigation and survivorship for patients diagnosed with breast cancer Evaluation of benign and malignant breast conditions Genetic evaluation for high-risk patients Non-cosmetic breast surgery Our program has been nationally accredited by the NAPBC since 2011, requiring compliance with 29 standards that hold our program to the highest level of evidence-based care. In addition, our surgeons participate in both the Mastery of Breast Surgery, a QCDR Registry that tracks 9 additional quality standards, as well as the Nipple-Sparing Mastectomy Registry (NSMR). The NSMR tracks women who have had a mastectomy with reconstruction and preserved their nipples. Another very important aspect of our program is risk assessment for hereditary cancer syndromes. Women receiving breast imaging or who have an appointment at The Breast Center are screened for potential genetic susceptibility to cancer. Appropriate patients are then counseled and tested in the oncology department by one of our physicians as well as our genetics nurse. For patients who test positive, we offer risk-reduction surgery. Suzanne A. Hoekstra, MD, FACS Director, Mercy Breast Care Specialists of Maine

9 Nipple-Sparing Mastectomy Registry (NSMR) We stay current with new surgical techniques. For example, one of the newer reconstructive techniques for mastectomy patients is called Nipple-sparing Mastectomy in which the nipple is preserved and the patient benefits from a more natural-appearing breast. Because of this, our practice has been actively enrolling patients in the National Nipple-Sparing Mastectomy Registry since As of December 2015, 89 patients have been enrolled from Mercy Breast Care Specialists of Maine out of 2000 nationwide. In 2016, posters were presented at both the ASBrS and the BC3 national meetings listing Dr. Hoekstra as a co-author. In addition, two journal articles have been submitted for publication. Surgical Management of Breast Cancer Patients 60% 50% 40% 30% Mercy Breast Cancer Program Analytic Cases 2015 National Cancer Database Analytic Cases % 10% 0% Partial Mastectomy or Lumpectomy Nipple/ Skin Sparing Mastectomy Total/Simple Mastectomy Modified Radical Mastectomy Surgery Nos No Surgery Comparison to most recent 5-year NCDB data Dealing with cancer and cancer risk is difficult enough; it is so helpful when the physicians and staff demonstrate true caring and offer genuine support. Mary, Mercy Cancer Patient

10 Colon Cancer Care at Mercy Karin Cole, MD, a Board-certified general surgeon and Fellowship-trained surgical oncologist, grew up in Rockport and graduated from Tufts University School of Medicine. She completed her general surgical residency at Abington, PA Memorial Hospital and a two-year fellowship in surgical oncology at the University of Pittsburgh in Dr. Cole is a Fellow of the American College of Surgeons and an Assistant Clinical Professor of Surgery at Tufts University School of Medicine. Her interests include colorectal cancer, upper gastrointestinal cancer surgery (including esophageal cancer) and minimally-invasive abdominal surgery. Colorectal cancer is one of the most common malignancies in the United States, and is a major focus of cancer care at Mercy. As with any cancer, the best first approach to the disease is prevention. Screening colonoscopy is a simple test that remains the standard of care for detecting colon polyps before they transform into cancer. This service is provided by Mercy s three gastroenterologists, Drs. Kleeman and Yu, and Dr. Catherine McCrann, who is one of only a handful of female gastroenterologists in Maine. Their practice, Mercy Gastroenterology at Casco Bay, also includes three dedicated and experienced nurse practitioners. When a colorectal cancer is diagnosed, the first course of treatment typically includes surgical removal of the affected area in the bowel. Recovery from this major operation has been significantly enhanced by the Fast Track program for colorectal surgery implemented at Mercy in May of The program includes pre-operative counseling, avoidance of bowel preparation prior to surgery, commitment to a minimally-invasive surgical approach, use of specialized anesthetic techniques for pain control and early return to eating and drinking after the operation. Use of these strategies has resulted in reduction in hospital length of stay (about half the national average for patients undergoing minimally-invasive partial colectomy), earlier return to work and an easier transition to additional cancer care for patients who need it. Karin Cole, MD Mercy Portland Surgical Associates

11 Cancer Programs Practice Profile Reports (CP3R) The Commission on Cancer measures compliance with current CoC quality reporting tools the Cancer Program Practice Profile Reports. We are proud that our program is exceeding or meeting all but one of the required performance expectations of the Commission on Cancer. Measures highlighted in green indicate that Mercy s performance was higher than the national average for all CoC accredited cancer programs. MERCY BREAST CANCER PROGRAM Accountability Measure CoC Benchmark Mercy Radiation therapy is administered within 1 year 90% 87% (365) days of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.* Combination chemotherapy is considered or 90% 100% administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage 1B-III hormone receptor negative breast cancer. Tamoxifen or third generation aromatase inhibitor 90% 94% considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB-III hormone receptor positive breast cancer. Radiation therapy is considered or administered following 90% 100% any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with > 4 positive regional lymph nodes. MERCY COLON CANCER PROGRAM Accountability Measure CoC Benchmark Mercy Adjuvant chemotherapy is considered or administered 90% 100% within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. At least 12 regional lymph nodes are removed and 85% 90% pathologically examined for resected colon cancer * We were slightly under the recommended performance rate for radiation therapy for women under the age of 70 receiving breast conservation surgery for breast cancer although the patients were offered this therapy. This was discussed in our Cancer Committee: some of the patients were almost 70 at diagnosis with low grade tumors and per NCCN guidelines they can safely opt out of the radiation therapy.

12 Mercy Hospital Cancer Program Mercy All About Women 195 Fore River Parkway, Suite 310 Portland, ME P Mercy Breast Care Specialists of Maine 195 Fore River Parkway, Suite 250 Portland, ME P Mercy Oncology-Hematology Center 195 Fore River Parkway, Suite 360 Portland, ME P Mercy Portland Surgical Associates 195 Fore River Parkway, Suite 420 Portland, ME P Mercy ENT Associates Ear, Nose and Throat Specialists 43 Baxter Boulevard Portland, ME P Mercy Gastroenterology at Casco Bay 25 Long Creek Drive South Portland, ME P Mercy Pulmonary and Critical Care 144 State Street Portland, ME P Fore River Urology 21 Donald B. Dean Drive South Portland, ME P mercyhospital.org/cancer