CANCER PROGRAM ANNUAL REPORT

2014 CANCER PROGRAM ANNUAL REPORT

2014 CANCER PROGRAM ANNUAL REPORT Prepared by Lynn M. Downey, MPH, RHIT, CTR Cancer Registrar/Clinical Trials Coordinator CONTENTS The Cancer Program Annual Report is a summary of the cancer experience at Holyoke Medical Center for 2014. The information used in this report is gathered from the Cancer Registry and activities of the Cancer Committee, which serve to improve the quality of cancer care. This report is provided as a source of reference to the hospital and its medical staff. 2 A Year in Review 4 Cancer Conferences 5 Cancer Registrar s Report 6 2014 Cancer Committee 8 Cancer Treatment at Holyoke Medical Center 12 Cancer Frequency at Holyoke Medical Center 13 Breast Cancer Study 16 References Holyoke Medical Center 575 Beech Street, Holyoke, MA 01040 413-534-2500

A YEAR IN REVIEW Zubeena Mateen, M.D. Director, Hematology/Oncology Chairman, Breast Cancer Committee The Cancer Committee is responsible for developing and implementing programs that evaluate cancer care at Holyoke Medical Center with respect to quality assurance and patient care. The committee organizes cancer screening sessions for various cancer sites, such as colon, prostate and skin. The committee also institutes programs to meet the standards of the American College of Surgeons Commission on Cancer. In 2014, Holyoke Medical Center s cancer program was surveyed by a representative of the American College of Surgeons, Dr. Peter Hopewood in May and received a full three-year accreditation with commendations in the areas of its clinical trials, cancer registrar education, public reporting of outcomes, following pathology protocols, oncology nursing care and accuracy of cancer data reporting. Holyoke Medical Center has been accredited by the American College of Surgeons for over thirty years and this is the highest rating the hospital has ever achieved in its history of affiliation. This accreditation is in addition to a full three-year reaccreditation for HMC s breast cancer program by the National Accreditation Program for Breast Centers (NAPBC) in 2013 which ensures that Holyoke Medical Center provides multidisciplinary, high quality patientcentered care for its breast cancer patients. HMC was the first accredited breast cancer center in Western Massachusetts. The maintenance of these accreditations requires a rigorous examination at the time of survey and in the months leading up to survey of all policies, procedures, programs and data of the HMC cancer program and its staff. In compliance with the college, Holyoke Medical Center started a breast cancer navigation program. A certified nurse navigator is responsible for coordinating care for breast cancer patients. In the future, navigation will be provided for other cancer diagnoses. A community needs assessment done for area hospitals including Holyoke Medical Center showed a high incidence and mortality rate for Hispanic breast and prostate cancer patients. This is an area of concern for Holyoke Medical Center since there is a significant Hispanic population serviced by the medical center. The cause of this problem may be related to social, financial and logistical problems of the affected population. In 2014, the cancer committee redesigned its quality indicators reported to the Patient Care Assessment committee to do ongoing monitoring of time between abnormal mammogram to biopsy, time from biopsy to surgery, outmigration of breast cancer patients, venous complications of patients with ports and no shows in the oncology department. Dr. Francis Martinez was appointed liaison to the American College of Surgeons. To meet the standards set forth by the Commission on Cancer, the hospital must review data submitted to the National Cancer Database and use benchmark reports. During 2014, the liaison reported on this data quarterly. In 2014, studies were done on relative five-year survival rates for breast cancer in general and for women of ethnicity. Breast cancer staging and treatment were also studied. A death certificate match was done between the cancer registry and the state/federal reporting authorities. 2

Outreach programs such as the Women s Health Fair was held in October, which was well attended. A men s health fair was also done. The navigators went into the greater Holyoke community to grocery stores and churches to promote cancer awareness. Lung cancer screening by low dose CT scan was discussed throughout the year. Dr. Steven Urbanski, Chief of Radiology, indicated that the American College of Radiology has recommended lung cancer screening. Plans are underway in 2015 to proceed with this program. A Survivor s Day luncheon was held in June and was very well attended. There are plans underway to expand the oncology unit. Another oncologist, Dr. Renuka Dulala was hired in September. A cancer survivorship program is scheduled to begin in 2015. The committee continues to coordinate educational opportunities for the medical staff and public with tumor and breast cancer conferences held monthly. In 2014, it was an exciting year for the Holyoke Medical Center s Breast Cancer Center. The committee studied breast cancer predictive markers and compared them to national standards. The ultrasound machine in the Women s Center is now accredited by the American College of Radiology to perform ultrasound guided breast biopsies. The Women s Center is now designated a Center of Excellence. vaccine. This has been an ongoing effort for five years. In 2014, the breast cancer committee worked on proceeding with physician participation in the Mastery of Breast Surgery program. Dr. Deborah Panitch has been entering her patients and will continue with assistance from the hospital registry. Hospitalwide, a transportation service was added due to a community needs assessment. Breast cancer screenings remain in place and are free to the public. The October women s health fair broadened its outreach to not only breast cancer but other women s health issues like osteoporosis, depression and menopause. The committee spent much time throughout the year on devising quality indicators concerning breast cancer timelines, between abnormal mammogram to biopsy and between biopsy to surgery. These were monitored quarterly throughout the year and showed improvements, but the process still has to be revised interdepartmentally. Breast cancer conferences are held the last Wednesday of the month and most new cases of breast cancer are presented. Plans are underway in the Oncology Department to start a survivorship program in 2015 with expansion of the department and each patient will receive a survivorship care plan which will guide them in follow up surveillance. The breast center participates in breast cancer clinical trials in cooperation with the University of Nebraska Medical Center s Breast Cancer Collaborative Registry (BCCR) which uses DNA in the hopes of the discovery of a breast cancer 3

CANCER CONFERENCES Thomas Gould, M.D. Co-Chairman, Cancer Committee Chief of Pathology Cancer conferences (Tumor conferences) have been held on a monthly basis during 2014. The conference is organized and moderated by the Department of Pathology. Its goal is to bring together a multidisciplinary group, including medical oncologists, radiologists, surgeons, radiation oncologists, pathologists, primary care physicians, oncology nurses, the cancer registrar and other specialists, to discuss the diagnosis and management of patients with malignancies. Over the course of each year, an attempt is made to include a wide variety of anatomic sites and to discuss both the common cancer types as well as unusual malignancies. The meeting is generally held on the second Friday of the month, and over the course of an hour, usually covers three cases. The clinical history is presented by the responsible physician or physicians, after which the relevant imaging findings are demonstrated by the radiologist. This is followed by a presentation of the morphologic findings by the pathologist. Following this, there is an open discussion of the patient s diagnostic evaluation and management, and recommendations are solicited from the members of the group regarding any additional suggestions they may have pertaining to evaluation and management. Cancer conferences have been well attended and well received and provide an important forum for arriving at decisions regarding patient diagnosis and treatment in an interdisciplinary setting. They also serve as a source of education for the medical staff and other members of the hospital team. As always, attending physicians are encouraged to notify a member of the Department of Pathology regarding suggested cases for presentation. Once again, it is my pleasure to personally thank all the members of the medical staff who have so willingly taken the time to prepare and present cases at this monthly conference. Additional thanks go to the Pathology Department staff and physicians whose support and involvement make this conference possible. Finally, a special thank you goes to Lynn Downey, who continues to work tirelessly behind the scenes to make this conference a success. Phyllis Parlengas is celebrating Just being alive! with her son, Michael, at the annual 2014 Cancer Survivor s Day luncheon. 4

The Holyoke Medical Center Cancer Registry continues to report close to 300 new diagnoses of malignancy each year. A reference date change was made to the registry in 2014 to begin cases diagnosed in 2005 in order to facilitate rapid reporting of cases to the National Cancer Database in the future. A current follow-up rate of 98% is maintained on all cases, with a 99% follow-up rate for cases diagnosed within the past five years. Cooperation of physicians and their office staff is of vital importance to the success of cancer follow-up and continuity of care. Their efforts are greatly appreciated. The Cancer Registry utilizes the Metriq software system to provide a broad range of cancer data, representing patients, diagnoses, treatment methods and outcome. With the advent of the electronic medical record and Webex sessions, learning software updates has been made easier, along with the retrieval of cancer data. The registrar also coordinates the breast cancer center program and breast cancer clinical trials in conjunction with the University of Nebraska s Breast Cancer Cooperative Registry (BCCR) which seeks to develop a breast cancer registry to include biological material which may be used in the future for the development of a breast cancer vaccine. The Registry saw many requests for information in 2014. These requests were from staff physicians, as well as external groups requesting participation in different studies. Registry information was utilized by administration in their efforts to assess patient care for improvements. Physicians and staff are urged to utilize the Registry s information for studies of their own interest at any time. The cancer registrar attended the North American Association of Cancer Registrars webinar in October on staging. The registrar completed a graduate degree in public health in 2014. CANCER REGISTRAR S REPORT Lynn M. Downey, MPH, RHIT, CTR Cancer Registrar/ Clinical Trials Coordinator Sherry Misek celebrates her mother, Debra Pirog, at the annual 2014 Cancer Survivor s Day luncheon 5

2014 Cancer Committee The Cancer Committee provides leadership for the Holyoke Medical Center Cancer Program. Individuals committed to the care, education and support of the cancer patient strive to provide optimal cancer care. *Robert Byrne, M.D., Hematology/Oncology *Lynn Downey, MPH, RHIT, CTR, Cancer Registrar/Clinical Trials Coordinator *Thomas Gould, M.D., Co-Chairman, Pathology Ann Jubinville, R.N., C.P.H.Q., Quality Improvement * James Keefe, R.N., V.P., Administration *Francis Martinez, M.D., General Surgery, ACOS Cancer Liaison *Zubeena Mateen, M.D., Chairman, Breast Cancer Committee, Hematology/Oncology Theresa McAndrew, R.D., Nutritional Services Additional members of the Breast Cancer Committee include: Bradford Gray, M.D., General Surgery Deborah Panitch, M.D., General Surgery Vinodray Shah, M.D., Reconstructive Surgery Jule Sherman, O.T., Occupational Therapy Dianne Walsh, R.T.R.M., Women s Center Helen Arnold, R.N., Oncology Nancy Almeyda, Women s Center Mark Sherman, M.D., Thoracic Surgery *Alan Stark, M.D., Chairman, Cancer Committee, Radiation Oncology (retired 8/14) *Scott Stylos, M.D., Pathology *Steven Urbanski, M.D., Radiology *Jolene Lambert, R.N., Oncology *Michael Yunes, M.D., Radiation Oncology *Laura O Connor, L.S.W., Oncology *Renuka Dulala, M.D., Oncology *indicates Breast Cancer Committee member 6

Left: Patricia Clayton writes that life after cancer is Survival with Gail Bergeron. Top right: Robert Mathieu celebrates The Sunshine with his wife. Bottom Right: Bernice Laramee (right) celebrates Cancer Survival and gives special thanks to the Holyoke Medical Center Oncology Department, Dr. Mateen and her staff, and especially Katryna a special nurse sent from heaven to help cancer patients. Bernice is photographed with her husband and nurse, Katryna. 7

Cancer Treatment at Holyoke Medical CANCER PROGRAM Holyoke Medical Center has maintained a cancer program since 1977 and currently utilizes a reference date of January 1, 2005 for its database. This has been managed according to the requirements set forth by the American College of Surgeons Commission on Cancer for a community hospital. Approval status affirms that the hospital provides a full range of services for the diagnosis and treatment of cancer. Massachusetts Oncology Services, which is a radiation therapy service, is located on the hospital campus and is accredited by the American College of Radiology. CLINICAL PROGRAM All cancer patients admitted to Holyoke Medical Center have access to consultative services by a member of the medical staff. This represents a variety of medical and surgical specialties, radiology, laboratory and other ancillary services, which provide optimal diagnostic and staging techniques. Inpatient and outpatient oncology services at Holyoke Medical Center are directed by oncologist, Zubeena Mateen, M.D.. Oncology referrals are made to other areas, such as Boston, New Haven, New York or the National Cancer Institute for experimental or newer types of cancer treatment. The hospital is affiliated with UMASS Medical Center in Worcester. The hospital s breast cancer center was the first center in Western Massachusetts accredited by the National Accreditation Program for Breast Centers (NAPBC). A new oncologist, Dr. Renuka Dulala was added to the oncology department in 2014. CLINICAL TRIALS The Adjuvant Online software program provides current information on cancer management, including treatment advances, clinical trials on each cancer, as well as physicians and organizations that provide care to cancer patients. The latest patient management guidelines are available for physicians on the National Comprehensive Cancer Network. The American Cancer Society provides a clinical trials matching program brochure in the information resource library located in the oncology department. The hospital participates in breast cancer clinical trials in cooperation with the University of Nebraska Medical Center. CANCER CONFERENCES Cancer conferences are generally held on the second Friday of each month. Breast cancer conferences are held on the last Wednesday of the month. Cancer conferences provide continuing medical education and are also available as a consultative service. Open discussions are encouraged among primary care physicians, pathologists, surgeons, radiation oncologists, radiologists and medical oncologists. 8

PROFESSIONAL DEVELOPMENT Programs are offered each year for continuing medical education and other related benefits to all members of the medical staff and other health care professionals. This ensures the constant access to new developments and updates in cancer care. This year s professional development included lectures on the following subjects: Pharmacology for Tobacco Use Dependence Therapy Options for HER-2 Positive Metastatic Breast Cancer: Case-Based Discussions Changes in Post-Mastectomy Radiation Breast Cancer Reconstruction Principles of Palliative Care A Practical Approach to Radiation Risks in Medical Imaging Metastatic Prostate Cancer Ductal Carcinoma In Situ Breast Cancer Adjuvant Endocrine Therapy for Breast Cancer Neoadjuvant Chemotherapy for Breast Cancer Surgical Margins in Breast Cancer Esophago-Gastric Carcinoma Triple Negative Breast Cancer Atypical Ductal/Lobular Hyperplasia of the Breast Male Breast Cancer Gene Expression Profiles PUBLIC EDUCATION SCREENINGS Cancer screenings allow for early detection of some types of cancer. Holyoke Medical Center is dedicated to this early detection. We provide annual public screening clinics to the general public and hospital employees for the following types of cancer during the months listed: March Colon Cancer Screening September Prostate Cancer Lecture June Skin Cancer Screening October Breast Cancer Screening HEALTH FAIRS A women s health fair is held each year in the lobby of Holyoke Medical Center featuring preventative information on breast cancer, scheduling of mammograms, skin care tips, pink carnation and rose sales, as well as many raffles with information on other women s health issues such as osteoporosis, menopause and depression. In 2014, the initiation of a men s health fair was done in June. Staff of Holyoke Medical Center make themselves available for other community events. In 2014, events were done at senior centers, grocery stores, churches and downtown health centers to distribute educational materials on cancer. Participation at health care expos like the Table Top Exposition was done in 2014. 9

BREAST CANCER AWARENESS Each October, Holyoke Medical Center promotes Breast Cancer Awareness month in several ways. Participants in the breast cancer screening are provided with written information, breast self-exam instructions, and a lecture on breast cancer by an oncologist and breast exams by a physician. Participants also have the opportunity to make an appointment for a mammogram. Breast cancer awareness is recognized throughout the month of October with events such as: Pink pancake breakfast Wear pink to work day Pink latex glove day Women s health fair Painting fundraiser Pink raffle baskets and flower sales AWARENESS THROUGH MEDIA Holyoke Medical Center is dedicated to providing information to the community and making the community aware of healthcare news that may help or affect its members. For this reason, multiple physicians provide interviews with the media on cancer whenever requested which appeared on television or in a written format. These interviews are then shared through social media outlets, such as Facebook. Pauline Smith celebrates six years cancer free with her husband, Reginald Smith Throughout 2014, interviews and articles included: HealthCare News, October 2013, Breast Cancer Navigation Business West, April 8, 2014, Yoga and Support Groups 22NEWS, June 2014, Coverage of the Annual Cancer Survivor s Luncheon HealthCare News, September 2014, Community Benefits and Educational programs 10

CANCER SUPPORT GROUPS Spanish Support Group This support group is geared toward Latina women recently diagnosed with breast cancer and for survivors of breast cancer. The group is bilingual. Cancer Support Group This support program is open to all cancer patients and their families and caregivers. Sponsored through Holyoke Medical Center s Oncology Department, this group meets monthly. The support groups offer many different topics during the year. Cancer Survivorship A cancer survivor recognition luncheon was held in June. A motivational speaker, Dr. Steven Sobel entertained the crowd. This is an annual event to celebrate cancer survivors. The luncheon included speakers from the hospital and community, some of whom are cancer survivors. American Cancer Society Each year Holyoke Medical Center participates in many events in association with the American Cancer Society including the Look Good, Feel Better program. Hospice Holyoke Medical Center has an affiliation with Holyoke VNA Hospice Life Care. Physicians are encouraged to recommend hospice services which can be initiated in as much as a six-month time frame. There are also patients who go on and off hospice periodically. Breast Cancer Center The hospital is accredited by the National Accreditation Program for Breast Centers. Accreditation ensures that a multidisciplinary, integrated and comprehensive breast care service is maintained at the hospital. This will also provide internal and external assessment of the breast center performance based on recognized standards to demonstrate a commitment to quality care. Frank Borrero, with his daughter, celebrates life after cancer! and gives thanks to the nurses and Dr. Mateen. He writes Dr. Mateen is the greatest doctor I have ever known! and says that life after cancer is being able to see my grandchildren, great-grandchildren, kids and life. 11

Cancer Frequency at Holyoke Medical Center Total cancer frequency at Holyoke Medical Center usually averages close to 300 new cases annually. The most common malignancy seen in 2013 was breast cancer at 27%, followed by lung cancer at 14% and colon cancer at 12%. It was noted that new colon cancer cases have decreased probably due to increase in screening colonoscopy. 2013 Frequency of Cancer by Primary Site (Analytic/Nonanalytic cases) 236/277 PRIMARY SITE # OF CASES PERCENTAGE Breast 74 26.70% Lung 40 14.40% Colorectal 33 11.90% Bladder 20 7.20% Prostate/Testis 18 6.40% Unknown primary/ Other Endometrium/ Cervix/Ovary/ Gynecological 18 6.40% 11 3.90% Hematological 11 3.90% Lymphoma 10 3.60% Head/Neck 10 3.60% Melanoma 7 2.50% Esophagus/ Stomach 6 2.10% Pancreas 5 1.80% Liver/Gallbladder 5 1.80% Kidney/Ureter 4 1.40% Thyroid 3 1% Mesothelioma 1 <1% HMC Oncology department members from left to right: Lynn Downey, Heather McMahon, Jolene Lambert, Helen Arnold, Katarzyna Swistak, Erin Hurlburt, Dr. Zubeena Mateen. Sarcoma 1 <1% TOTAL CASES 277 100% 12

BREAST CANCER STUDY The American Cancer Society estimated that in the United States 232,340 new cases of invasive breast cancer will be diagnosed in 2013 and 39,620 breast cancer deaths are expected to occur. A woman living in the United States has a 12.3% or 1-in-8 lifetime risk of being diagnosed with breast cancer. The relative five-year survival rate at Holyoke Medical Center for 326 cases of breast cancer diagnosed between 2005-2009 was 88%. The national five-year survival rate for breast cancer according to the American Cancer Society is 89%. HMC Breast Cancer Age at Diagnosis (63 cases) Patients 20 15 10 5 0 under 50 50-59 60-69 70-79 over 80 Age at Diagnosis In 2013, there were 63 new cases of breast cancer diagnosed. The largest age group was the 50-59 years of age. Don & Carol Beaulieu celebrate 53 years of being together and both being cancer free today HMC Breast Cancer 2013 Stage at Diagnosis (63 cases) 30 Patients 20 10 0 0 I II III IV Unknown Age at Diagnosis The largest stage group was Stage I. 13

HMC Breast Cancer Relative Five-Year Survival (326 cases Dx. 2005 2009) 2013 Breast Cancer Treatment (63 analytic cases) Percent 100 95 90 85 80 98 95 92 90 88 1 2 3 4 5 Years Surviving No Tx C C/H H R/H S S/C/H S/H HMC Breast Cancer Stage of Disease (326 cases diagnosed 2005-2009) No treatment Surgery/Chemotherapy/Hormonal 9% 3% 8% 21% Stage 0 21% Stage I 35% Chemotherapy Chemotherapy/Hormonal Hormonal Surgery/Hormonal Surgery/Radiation Surgery/Radiation/Chemotherapy Stage II 24% Radiation/Hormonal Surgery/Radiation/Chemotherapy/Hormonal 24% Stage III 9% Surgery Surgery/Radiation/Hormonal 35% Stage IV 3% Unknown 8% Surgery/Chemotherapy The largest treatment group is Surgery/Radiation/Hormonal Therapy The in-situ earliest stage group (Stage 0 ) was observed to be 21%. This is equivalent to the Massachusetts statistic of 25% and the national statistic of 20% 14

HMC Breast Cancer Initial Treatment (326 cases diagnosed 2005-2009) Chemotherapy alone <1% No treatment 3% Radiation alone <1% Surgery alone 22% Surgery/Chemotherapy 8% Surgery/Radiation 11% Surgery/Radiation/Chemotherapy Hormonal alone Radiation/Hormonal Surgery/Chemotherapy/Hormonal 5% 3% 1% 5% Surgery/Hormonal 9% Chemotherapy/Hormonal <1% Surgery/Radiation/Hormonal Surgery/Radiation/Chemotherapy/Hormonal 9% 22% 0% 7.5% 15% 22.5% Lynda Laury says that life after cancer is my husband of 35 years who is and was 100% there for me, and my grandchildren who are my life. The largest treatment group for breast cancer at Holyoke Medical Center is surgery alone or the combination of surgery/radiation/hormonal therapy. 15

References Desantis, C., Ma, J., Bryan, L., Jemal, A. (2014) Breast Cancer Statistics, 2013, CA: A Cancer Journal For Clinicians, American Cancer Society, 64: 52-62 Holyoke Medical Center Cancer Registry, Reference Date 2005 Manual For Staging of Cancer, American Joint Commission on Cancer, Seventh edition, 2010 16

575 Beech Street Holyoke, MA 01040-2296 Lucille Morin, with her husband, celebrates 10 years of survival and visiting Dr. Mateen. What a wonderful person.