MedStar Montgomery Medical Center Cancer Center 2014 Annual Report
2014 MedStar Montgomery Medical Center Cancer Center Committee Report Cancer Committee Chair s Report According to a recent report from the American Cancer Society, there are approximately 14.5 million cancer survivors in the U.S. today a number that is expected to grow to almost 19 million by 2024. The report notes that even though the rates of new cancer cases are decreasing, the number of cancer survivors is growing due, in part, to more effective treatments, as well as improvements in early detection. While this is wonderful news, it presents new challenges to cancer centers in terms of addressing the unique needs of cancer patients. The Cancer Center at MedStar Montgomery Medical Center is poised to meet these challenges. In 2014, we continued to flourish as part of the MedStar Georgetown Cancer Network. We expanded our expertise in terms of the kinds of cancers we diagnose and treat and now have eight physicians in our program, each with a different subspecialty. Our clinical research program has also grown with the addition of a research specialist and a nurse coordinator. And, with ever-increasing volumes in our Infusion Center, we have added an oncology pharmacist on site so patients can begin treatment as soon as possible after arrival. One of the most exciting developments of the past year was the grand opening of The Helen P. Denit Center for Radiation Therapy, thanks in large part to the efforts of the MGH Health Foundation. As more and more area residents have become aware of the advanced care we offer here, the demand for our services has grown. The newly expanded radiation center, which is nearly twice the size of the original facility, has better equipped us to respond to these growing demands in a timely fashion. As part of the expansion, the addition of state-of-the-art radiation technology the Elekta Infinity linear accelerator has increased our ability to care for more patients as well. Today, we can treat a much wider range of cancers more precisely and with fewer treatment sessions than in the past. We are also looking forward to the opening of our new Breast Imaging Center, which should be completed this fall. Patients will soon benefit from the latest technology, including a mammography system with digital tomosynthesis. This new breast imaging technique has been reported to produce clearer images of dense breast tissue and reduce the number of call backs for biopsies. We are excited to be able to offer high-quality breast imaging onsite and to have MedStar Georgetown University Hospital radiologists fellowshiptrained in breast imaging supervising this service for our patients. We are continuing to develop a lung cancer screening program at MedStar Montgomery Medical Center for patients who meet the criteria for low-dose computed tomography (LDCT) of the lungs. At MedStar Montgomery Medical Center, lung cancer was the most frequent cancer diagnosed and/ or treated in men and the second most frequent cancer diagnosed and/or treated in women behind breast cancer in 2013. On Feb. 5, 2015, the Centers for Medicare & Medicaid Services (CMS) released an historic final National Coverage Determination (NCD) permitting high-risk patients to receive annual LDCT scans without cost sharing. Highrisk patients are defined as those between the ages of 55 and 77 who smoked at least one pack of cigarettes per day for 30 years or have ceased tobacco use within the last 15 years, and who receive a written order from (continued on next page) 2
2014 MedStar Montgomery Medical Center Cancer Center Committee Report Cancer Committee Chair s Report (continued) a qualified practitioner. A visit for counseling and shared decision-making on the benefits and risks of lung cancer screening is also included in the coverage. We are working with MedStar Georgetown University Hospital radiologists to create a program for screening patients in our community. Finally, in 2014, we were proud to be granted another three-year accreditation with commendation, the highest level of approval, by the American College of Surgeons Commission on Cancer (CoC). Maintaining CoC accreditation, which we have had since 1986, is a tangible way for us to demonstrate our dedication to providing our patients with the very best in cancer care now and in the future. What was significant about this most recent accreditation process was the need to respond to new standards standards that have evolved to reflect the changing needs of cancer patients. These new standards call for cancer programs to enhance the care they provide by addressing specific patientcentered needs in three key areas: Patient navigation - to assist patients in overcoming barriers and accessing care Psychosocial screening - to identify patients in distress and help them cope Survivorship planning - to enable patients completing treatment to move on with their lives as a survivor We also strengthened our partnership with Hope Connections for Cancer Support, an organization that provides free programs to help cancer patients and their families deal with the emotional and physical impact of the disease, and had an oncology-specific social worker join our outpatient team. To meet these standards, we launched several new initiatives and expanded others, some of which you ll read about in this report. This includes the implementation of a survivorship program and ongoing psychosocial distress screening for our patients. We also strengthened our partnership with Hope Connections for Cancer Support, which provides free programs to help cancer patients and their families deal with the emotional and physical impact of the disease. Looking ahead, we will continue to evolve as part of the MedStar Health family. But we will always maintain our focus on providing the kind of care you have come to expect from us. For cancer patients at MedStar Montgomery Medical Center, this means the availability of a full range of medical services along with a multidisciplinary team approach that ensures patient-centered care for the best possible outcomes. Sincerely, Asma Dilawari, MD Medical Oncologist Chair, Cancer Committee 3
2014 MedStar Montgomery Medical Center Cancer Center Patient-Centered Care Ensuring the Delivery of Patient-Centered Care Delivering patient-centered care is critical to positive outcomes in the cancer setting where patients are often dealing with stress, uncertainty, complex information, and life-altering medical decisions. That s why, at MedStar Montgomery Medical Center, we strive to ensure the delivery of patientcentered care across the cancer care continuum. To that end, in 2014, as in prior years, we turned to our Multidisciplinary Quality Improvement Team to help us identify ways to improve the care we provide. This important committee reflects all aspects of our oncology program so that every department and discipline that a patient might encounter is represented. Following are a few examples of the quality improvement initiatives developed and implemented during the year that were based on this group s input. Infusion Nutrition Study Patients who maintain a good appetite while battling cancer are generally stronger, which results in better outcomes. The Infusion Nutrition Study was designed to identify cancer patients having problems with their food intake and provide them with complimentary dietary consults. Starting in January, patients new to the Infusion Center at MedStar Montgomery Medical Center were asked to complete a Nutritional Self Assessment and Referral Survey a new tool designed to capture specifics about each individual s nutritional habits. Based on their responses to questions about weight, symptoms affecting eating, food intake, and use of supplements, patients were assigned a nutritional score, which could range from zero to 20. The higher the score, the greater the need for nutritional counseling and support, as the chart illustrates. Percentage by Nutritional Needs Assessment Needs Score and Eligibility 80 60 40 20 40% 11% 0 0-2 3-10 11 and above all 3 and above Patient Survey Scores (score of three or more eligible for complimentary dietary consult) The use of the survey tool improved understanding among new infusion patients of the importance of good nutrition, with 76 percent completing it with minimal assistance from the nurses. Of these, 116 went on to receive dietary consultations, a dramatic increase over the 15 patients that received consults in 2013. Timely Breast Notification Study When a patient is facing a potential cancer diagnosis, there is nothing more agonizing than a long wait for biopsy results. To ensure the timely communication of results to individuals having breast biopsies, we (continued on next page) 49% 60% 4
2014 MedStar Montgomery Medical Center Cancer Center Patient-Centered Care Ensuring the Delivery of Patient-Centered Care (continued) established a goal for pathology to notify surgeons of the findings within 24 hours or less in 75 percent of the cases an ambitious goal that required a strong team commitment. The chart below illustrates the success of this initiative, which exceeded the goal of 75 percent by 6 percentage points overall and by 15 percentage points in the final quarter. Percent notified within 24 hours of less (goal including complex cases 75%) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter CY14 7/13 54% 11/11 100% 7/9 78% 10/10 100% 35/43 81% Reducing Pain During Sentinel Lymph Node Mapping Another initiative, started in 2013, focused on assessing and reducing pain among breast cancer patients during the sentinel lymph node mapping (SLNM) procedure. To ensure the application of numbing cream in a timely fashion prior to the procedure, a new process was implemented shifting the responsibility for applying it to the nuclear medicine technician onsite. This new process has resulted in all breast cancer patients undergoing SLNM rating breast injection pain as less than four on a 10 point scale, and it has now been adopted as the recommended presurgery routine. Medical Oncology Bed Assignment Process We also took steps during the year to ensure the best placement of oncology patients who are admitted to MedStar Montgomery Medical Center through the ED. After a review of the past three years of data, we developed protocols for helping to ensure that the ED physician and managing oncologist communicate as early as possible prior to admission when they recognize that an individual is an active cancer patient undergoing disease or treatment management. In addition, this process identified 3 West as the preferred placement for oncology patients with acute active cancer, where the greatest concentration of oncology and chemotherapy certified nurses can assist with their care. Other initiatives focused on ways to better coordinate care through communication tools, such as a Preliminary Plan of Care and a Breast Resource Notebook, which are provided to newly diagnosed breast patients when they meet to discuss their biopsy reports with their surgeons. At MedStar Montgomery Medical Center, we know that understanding and responding to the patient experience throughout the cancer journey is critical to successful outcomes. And delivering patient-centered care across the cancer care continuum is the best way to ensure that each and every patient receives the very best care possible. Debra Otani, RN, OCN, CBCN Cancer Care Navigator, Quality Improvements 5
2014 MedStar Montgomery Medical Center Cancer Center Enhancing the Community Enhancing the Community s Health and Well-being MedStar Montgomery Medical Center has a tradition of caring built on ensuring the good health of all area residents, especially those who face barriers to care. To that end, we dedicate each and every day to doing whatever we can to enhance the community s health and well-being. them with their discharge needs and help identify community resources. More importantly, the navigators work with patients to make sure they get the referrals they need, support them in scheduling clinic appointments, and educate them on ways to access care in non emergency settings. Through a comprehensive Community Health Needs Assessment (CHNA), a process conducted every three years that brings together hospital representatives, area leaders, public health experts, and other stakeholders, we ve been able to identify the health-related issues having the biggest impact on area residents. We ve used that information to prioritize how to best use our resources to address these issues. Among the most pressing health-related issues identified by our CHNA was the need to help area residents better understand cancer while improving access to cancer prevention and screening services. In response, we have continued to invest in community initiatives focused on cancer prevention and early detection. Emergency Department Primary Care Connect (ED/PC Connect) The goal of ED/PC Connect is to navigate uninsured, low-income individuals many of whom are at a higher risk for developing cancer to safety-net clinics providing primary care services. Patients who come to the MedStar Montgomery Medical Center s ED for services and lack a primary care provider meet with one of two bilingual health navigators who have the training and cultural knowledge to assist Since the project started in July 2009, hundreds of patients have been identified and referred to the Proyecto Salud Clinic on the hospital campus as well as several other area clinics. These patients are now receiving the kind of high-quality, coordinated care they need including preventive services such as cancer screenings on a regular basis. Women s Health Improvement Program (WHIP) One of MedStar Montgomery Medical Center s most successful community outreach initiatives, WHIP s goal is to increase the early detection of breast cancer by providing free, comprehensive, high-quality breast health services to uninsured, low-income women residing in Montgomery County. WHIP works by removing the barriers to care that many of these women face. These barriers range from cost to the inability to speak English to fear. Through WHIP, women ages 40 and above who are patients at Proyecto Salud Clinic on the hospital campus, receive women s health assessments, breast health education, referrals and care navigation as well as easily accessible, one-stop, coordinated breast testing. In 2014, a total of 176 screenings were performed, 34 of which were diagnostic. (continued on next page) 6
2014 MedStar Montgomery Medical Center Cancer Center Enhancing the Community Enhancing the Community s Health and Well-being (continued) Community Outreach MedStar Montgomery Medical Center participates in numerous outreach activities throughout the year to help raise awareness among young and old alike about cancer and how to prevent it. In 2014, these activities included: MedStar Montgomery Medical Center Cancer Symposium: This is a day-long session led by experts. The focus of the symposium was health, wellness and managing care during and after cancer treatment. Diseasespecific breakout sessions covered the latest therapies, available clinical trials, cancer care, and the integration of services. More than 150 individuals attended. Cervical Cancer Lecture: Held during Cervical Cancer Awareness Month, this lecture brought together a group of experts to help both mothers and daughters understand the importance of being proactive about cervical cancer screenings and vaccines. Participants discussed new cervical cancer screening guidelines and contraception options for teens. Keeping Your Colon Healthy: A free educational seminar presented by a colon and rectal surgeon and a gastroenterologist, this seminar taught participants about lowering the risk of developing colon cancer through a healthy lifestyle and screenings. The latest treatment options were also discussed. Cancer Support Services Cancer patients and families dealing with the stresses of cancer treatment and recovery need all the help they can get. That s why we offer programs such as Look Good Feel Better, which teaches women in active treatment how to enhance their appearance and feel better about themselves. We also partner with Hope Connections for Cancer Support, which provides free programs to help cancer patients and their families deal with the emotional and physical impact of the disease. Through Hope Connections, patients can connect with others as part of a Cancer Support Group or reduce stress by participating in a Gentle Yoga class. At MedStar Montgomery Medical Center, we recognize the essential role we play in helping those in the community reduce their risk of cancer through prevention and education. That s why our outreach goes far beyond the walls of our hospital. It s an essential component in the fight against cancer. Dairy Marroquin Community Benefits Outreach Coordinator 7
2014 MedStar Montgomery Medical Center Cancer Center Cancer Registry Report Cancer Registry Report In 2013, the MedStar Montgomery Medical Center Medical Center Cancer Registry accessioned 315 new analytic cancer diagnoses into the registry database. Breast was the overall most frequent primary site diagnosed and/ or treated at MedStar Montgomery Medical Center again in 2013. The most common cancer treated and/or diagnosed in men at MedStar Montgomery Medical Center in 2013 was lung cancer, and for women it was breast cancer followed by lung cancer. The Cancer Registry is responsible for collecting information on cancer that is diagnosed and/or treated at MedStar Montgomery Medical Center. This information is reported to the Maryland Cancer Registry, the American College of Surgeons Commission on Cancer (ACoS/CoC) and the National Cancer Data Base (NCDB). This data is used to analyze the efficacy of diagnostic methods and cancer treatments, public health planning and funding, and to conduct surveillance of cancer by public health officials and researchers to improve the care of cancer patients. Confidentiality and HIPPA regulations of patient identifying information and related medical data are strictly maintained. MedStar Montgomery Medical Center is enrolled in the NCDB s Rapid Quality Reporting System (RQRS). RQRS, a web-based, systematic data collection and reporting system, promotes and facilitates evidence-based care for patients at Commission on Cancer-accredited programs by actively monitoring and assessing compliance with National Quality Forum-endorsed quality of cancer care measures for breast and colorectal cancers. The MedStar Montgomery Medical Center Cancer Registry is staffed by a Certified Tumor Registrar (CTR). This individual has met all educational and work experience requirements to successfully complete the national certification examination administered by the National Cancer Registrars Association and maintains the CTR credential by annual continuing Most frequently diagnosed and/or treated cancers at MedStar Montgomery Medical Center in 2013 100 80 60 40 20 0 Breast 83 education. A CTR collects and manages cancer data effectively and professionally and ensures the quality of MedStar Montgomery Medical Center s oncology data. Quality control of the cancer registry data is further ensured by physician review of at least 10 percent of the new cases accessioned into the cancer registry annually. Lifetime follow up of patients is mandatory. This is conducted annually for each living patient in the database and the information is obtained through contact with physicians, other hospitals and cancer registries, and patients. This follow-up information ensures meaningful survival analysis. Katie Ronca, CTR Supervisor, Cancer Registry Operations 34 27 22 21 Lung Bladder Colon Pancreas Source: MedStar Montgomery Medical Center Cancer Registry, February 2015 8
Malignancies by Gender: Summary by Body System 2013 PRIMARY SITE TOTAL MALE FEMALE ORAL CAVITY AND PHARYNX 10 6 4 Tongue 2 2 0 Salivary Glands 2 2 0 Nasopharynx 2 0 2 Tonsil 2 1 1 Oropharynx 1 1 0 Hypopharynx 1 0 1 DIGESTIVE SYSTEM 65 28 37 Esophagus 3 2 1 Stomach 4 1 3 Small Intestine 2 0 2 Colon Excluding Rectum 22 8 14 Cecum 4 2 2 Ascending Colon 4 1 3 Transverse Colon 5 2 3 Descending Colon 3 0 3 Sigmoid Colon 4 1 3 Large Intestine, NOS 2 2 0 Rectum and Rectosigmoid 8 3 5 Rectosigmoid Junction 2 1 1 Rectum 6 2 4 Anus, Anal Canal and Anorectum 2 0 2 Liver and Intrahepatic Bile Duct 3 1 2 Liver 1 1 0 Intrahepatic Bile Duct 2 0 2 Pancreas 21 13 8 RESPIRATORY SYSTEM 39 23 16 Larnyx 5 4 1 Lung and Bronchus 34 19 15 SOFT TISSUE 3 1 2 Soft Tissue (including heart) 3 1 2 SKIN EXCLUDING BASAL and SQUAMOUS 1 0 1 Other Non-Epithelial Skin 1 0 1 BREAST 83 0 83 Breast 83 0 83 FEMALE GENITAL SYSTEM 10 0 10 Cervix Uteri 1 0 1 PRIMARY SITE TOTAL MALE FEMALE FEMALE GENITAL SYSTEM continued 10 0 10 Corpus and Uterus, NOS 7 0 7 Corpus Uteri 6 0 6 Uterus, NOS 1 0 1 Ovary 2 0 2 MALE GENITAL SYSTEM 18 18 0 Prostate 16 16 0 Testis 2 2 0 URINARY SYSTEM 33 22 11 Urinary Bladder 27 17 10 Kidney and Renal Pelvis 4 4 0 Ureter 2 1 1 BRAIN AND OTHER NERVOUS SYSTEM 5 2 3 Brain 3 2 1 Cranial Nerves Other Nervous System 2 0 2 ENDOCRINE SYSTEM 2 1 1 Thyroid 2 1 1 LYMPHOMA 18 10 8 Hodgkins Lymphoma 1 1 0 Non-Hodgkins Lymphoma 17 9 8 NHL - Nodal 14 6 8 NHL - Extranodal 3 3 0 MYELOMA 4 1 3 Myeloma 4 1 3 LEUKEMIA 8 4 4 Lymphocytic Leukemia 3 2 1 Myeloid and Monocytic Leukemia 5 2 3 Cecum 4 2 2 Ascending Colon 1 0 1 MESOTHELIOMA 1 1 0 Mesothelioma 1 1 0 MISCELLANEOUS 15 6 9 Miscellaneous 15 6 9 TOTAL 315 123 192 9 9
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