Cancer Program 2008 Annual Report (With 2007 Statistical Data)

Cancer Program 2008 Annual Report (With 2007 Statistical Data)

Cancer Program Western Maryland Health System Memorial Hospital & Braddock Hospital Cumberland, Maryland MISSION The mission of the Western Maryland Health System Cancer Program is to improve the health status and quality of life of the individuals and communities we serve through the development of programs for: screening, prevention, diagnosis, treatment, rehabilitation and cure of cancer, and to enhance the duration and quality of life of the people living with cancer. The Western Maryland Health System Regional Cancer Center strives to be the Regional leader in cancer care through the following activities and services: Superior quality, comprehensive, patient-focused cancer care provided across the continuum, including inpatient, outpatient, home health and hospice settings Education and training of health care professionals Clinical Research focused on cancer prevention, treatment, and control Patient support and community outreach services that promote cancer awareness, prevention and education among our patients and in our local community VISION The Western Maryland Health System Regional Cancer Center a partnership of patients, their families and health care professionals will be recognized as the Region s leader in cancer care. The Center will strive to develop its reputation as a provider of superior quality, patient-focused oncology services, emphasizing integrated, comprehensive care provided by an interdisciplinary team, motivated to meet the physical, emotional, and spiritual needs of its patients, with the goal of enhancing the duration and quality of life of cancer patients.

Chairman s Message The Western Maryland Health System s Regional Cancer Center continues to evolve and change to meet the needs of the citizens in the Tri-State area. We continue to offer support groups for our patients as well as their families to help in dealing with this devastating disease. They include Hand-in Hand Cancer Connection and programs sponsored by the American Cancer Society: I Can Cope, Look Good Feel Better, and Road to Recovery. Physician guest speakers from our group were provided for Senior Supper, sponsored by Senior Connection and other community programs. We take this opportunity to thank the Cancer Committee, our colleagues, and the cancer care team for their commitment to provide quality care and work toward our overall goal of decreasing morbidity and mortality of those diagnosed with cancer. We thank the patients and their families who have entrusted their care to us. We pledge to give our best always. We welcome any comments or suggestions to improve our services. Sincerely, Qamar Zaman, MD, WMHS Cancer Committee Chair Director of Medical Oncology

WMHS Cancer Experience 2007 The Cancer Registry data of the Western Maryland Health System Cancer Program represents the compilation of cancer data from the Memorial Hospital & Medical Center and Braddock Hospital. Seven hundred sixty cases of cancer were accessioned for 2007. These cases were diagnosed and/or treated at WMHS. 737 cases are analytic, initially diagnosed and/or treated at WMHS in 2007. Twenty-three patients received their entire first course of treatment elsewhere and received subsequent treatment at Western Maryland Health System. The WMHS Cancer Program is committed to serving the residents of the tri-state region. 60.3% of the cases were Allegany County, Maryland residents, 16.3% were Mineral County, West Virginia residents, 11.8% were Garrett County, Maryland residents; 3.7% were Bedford County, Pennsylvania residents; 3.4% were Hampshire County, West Virginia residents; 1.6% were Somerset County, Pennsylvania residents. The remaining 4.5% of cases are from other Maryland, West Virginia and Pennsylvania counties or other nearby states. County of Residence at Diagnosis ALLEGANY, MD 458 60.3% MINERAL, WV 124 16.3% GARRETT, MD 90 11.8% BEDFORD, PA 28 3.7% HAMPSHIRE, WV 26 3.4% SOMERSET, PA 12 1.6% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 30.0% 1.2% 2.0% Age at Diagnosis 8.6% 18.6% 27.5% 25.9% 14.7% 1.6% 0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ A nalyt ic C ases 2 0 0 7 % D iag no sed at Each St ag e The distribution of analytic cases is as follows. Breast was the most frequently diagnosed site representing 17.5% of the total number of cases, followed by lung at 17.2%, colorectal at 12.1%, and prostate at 10.2%. Race distribution showed that 98% of the cases were white, 1.5% of the cases were black and 0.5% were other races. 54.1% of the cases were female and 45.9% of the cases were male. 25.0% 20.0% 15.0% 25.3% 21.2% 15.6% 16.1% 11.6% 32.4 % of the analytic cases were diagnosed at an early stage (AJCC stage 0 or stage I). There were 23 cases without enough data to stage and 89 cases for which there is no AJCC staging. There were 12 benign central nervous system cases. 10.0% 5.0% 0.0% 7.2% 2.8% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 No Staging Not Staged

WESTERN MARYLAND HEALTH SYSTEM 2007 % of Analytic* Non- Analytic Primary Site Total % of Total Male Female Analytic ORAL CAVITY & PHARYNX 17 2.2% 11 6 17 2.3% 0 LIP 3 0.4% 2 1 3 0.4% 0 TONGUE 2 0.3% 2 0 2 0.3% 0 SALIVARY GLANDS 1 0.1% 0 1 1 0.1% 0 FLOOR OF MOUTH 2 0.3% 2 0 2 0.3% 0 GUM & OTHER MOUTH 2 0.3% 2 0 2 0.3% 0 NASOPHARYNX 1 0.1% 1 0 1 0.1% 0 TONSIL 4 0.5% 2 2 4 0.5% 0 OTHER ORAL CAV & PHARYNX 2 0.3% 0 2 2 0.3% 0 DIGESTIVE SYSTEM 130 17.1% 64 66 127 17.2% 3 ESOPHAGUS 8 1.1% 5 3 8 1.1% 0 STOMACH 5 0.7% 4 1 5 0.7% 0 SMALL INTESTINE 2 0.3% 2 0 2 0.3% 0 COLON, EXCL RECTUM 65 8.6% 27 38 62 8.4% 3 RECTUM & RECTOSIGMOID 27 3.6% 15 12 27 3.7% 0 ANUS,ANAL CANAL,ANORECT 3 0.4% 1 2 3 0.4% 0 INTRAHEPATIC BILE DUCT 1 0.10% 0 1 1 0.1% 0 OTHER BILIARY 3 0.40% 2 1 3 0.4% 0 PANCREAS 14 1.80% 7 7 14 1.9% 0 RETROPERITONEUM 2 0.30% 1 1 2 0.3% 0 RESPIRATORY SYSTEM 133 17.5% 80 53 132 17.9% 1 LARYNX 5 0.7% 3 2 5 0.7% 0 LUNG & BRONCHUS 128 16.8% 77 51 127 17.2% 1 SOFT TISSUE 4 0.5% 2 2 4 0.5% 0 SKIN EXCL BASAL & SQUAMOS 15 2.0% 6 9 13 1.8% 2 MELANOMAS SKIN 11 1.4% 5 6 9 1.2% 2 OTH NON-EPITH SKIN 4 0.5% 1 3 4 0.5% 0 BREAST 129 17.0% 2 127 129 17.5% 0 FEMALE GENITAL SYSTEM 47 6.2% 0 47 47 6.4% 0 CERVIX UTERI 9 1.2% 0 9 9 1.2% 0 CORPUS UTERI 21 2.8% 0 21 21 2.8% 0 OVARY 13 1.7% 0 13 13 1.7% 0 VULVA 4 0.5% 0 4 4 0.5% 0 MALE GENITAL SYSTEM 87 11.4% 87 0 80 10.9% 7 PROSTATE 82 10.8% 82 0 75 10.2% 7 TESTIS 5 0.7% 5 0 5 0.7% 0 URINARY SYSTEM 56 7.4% 34 22 55 7.5% 1 URINARY BLADDER 29 3.8% 19 10 29 3.9% 0 KIDNEY & RENAL PELVIS 25 3.3% 13 12 24 3.2% 1 URETER 2 0.3% 2 0 2 0.3% 0 EYE & ORBIT 2 0.3% 0 2 1 0.1% 1 BRAIN & NERVOUS SYSTEM 25 3.3% 10 15 24 3.3% 1 ENDOCRINE SYSTEM 18 2.4% 6 12 18 2.4% 0 LYMPHOMA 45 5.9% 22 23 44 6.0% 1 HODGKIN DISEASE 5 0.7% 3 2 4 0.5% 1 NON-HODGKIN LYMPHOMAS 40 5.3% 19 21 40 5.4% 0 MYELOMA 6 0.8% 0 6 6 0.8% 0 LEUKEMIA 18 2.4% 11 7 14 1.9% 4 MESOTHELIOMA 4 0.5% 3 1 3 0.4% 1 Unspecified/Ill-defined sites 24 3.2% 11 13 23 3.1% 1 TOTAL 760 100% 349 411 737 100.0% 23 * Percentage does not equal 100% due to rounding

WMHS Cancer Conference 2008 Cancer Conference, a multidisciplinary consultive forum for the medical staff and allied health professions to promote excellence in cancer care, is held weekly and teleconferenced between Memorial and Braddock Hospitals using video/teleconferencing equipment provided through a grant from the Maryland Cigarette Restitution Fund. Fifty conferences were held with an average attendance of 38. Physicians are able to present from either location with Pathology and Radiology presented from Braddock. One hundred fifty-four cases representing 33 different primary sites were discussed. All cases presented were prospective. WMHS Cancer Registry A cancer diagnosis touches one out three individuals in this country. More people than ever are winning the battle against the disease, thanks to research and continuing advances in medical technology. Information is one of the strongest allies in the fight. The Western Maryland Health System Cancer Registry is an important component of the Cancer Program designed to collect, manage, and analyze information on persons diagnosed with a malignant disease. This information is useful to WMHS for evaluating the quality of patient care, developing educational programs for health professionals and the community and planning future healthcare needs. The Reference Date for the shared cancer registry database of Memorial and Braddock Hospitals is 1/1/1997. 8,534 cases have been entered into the Cancer Registry database as of 12/31/2007. Numerous patients receive part of their initial course of treatment at each hospital and the shared database insures that cases are counted appropriately Seven hundred thirty-seven analytic and 23 non-analytic cancer patients were first cared for at WMHS in 2007. The registry is required to follow all living cases annually. The 2007 successful follow-up rate since the reference date of 1/1/1997 is 92.8% following 3,689 cases. For the last 5 years, the successful follow-up rate is 94%. To insures inclusion of data from the Western Maryland Heath System service area in national statistics, following an extensive editing process, Registry data is submitted to the National Cancer Data Base, as required for all Commission on Cancer programs. The WMHS Cancer Registry was recognized by the CoC for submitting data with no data quality errors in the data for years 2002 2007. Data is submitted quarterly to the Maryland Cancer Registry. Submitting data to these organizations allows WMHS to compare themselves to other health care organizations.

The registry staff includes Chris Roby, CTR, Cancer Registry Coordinator; Donna Huff, CTR; and Tammy Shaffer. They are members of the National Cancer Registry Association (NCRA). 2007 Site Distribution Private Referral Cases Submitted to the Maryland Cancer Registry For the Pathology Department at Western Maryland Health System Site Total Garrett PVH Hampshire Other Oral Cavity 2 0 0 0 2 Tonsil 1 1 0 0 0 Stomach 2 2 0 0 0 Small Intestine 1 1 0 0 0 Colon 8 8 0 0 0 Rectum 2 1 0 1 0 Hematopoietic 2 0 0 0 2 Skin 35 2 1 1 31 Lung 1 1 0 0 0 Soft Tissue 2 0 1 0 1 Breast 15 12 2 0 1 Cervix Uteri 2 2 0 0 0 Corpus Uteri 6 2 0 0 4 Prostate 38 0 0 0 38 Testis 1 0 0 0 1 Bladder 14 1 0 0 13 Lymph Nodes 1 1 0 0 0 Thyroid 2 2 0 0 0 Unknown 3 3 0 0 0 Total 138 39 4 2 93 The freestanding laboratory at WMHS is required by Maryland law to report all cancers diagnosed as private referrals to the Maryland Cancer Registry. One hundred thirtyeight cases that did not meet the criteria to be included with the WMHS data were reported. Prostate was the most frequently diagnosed primary site, followed by melanoma of the skin, breast and bladder.

National Cancer Data Base Review Background: The National Quality Forum (NQF) brought public and private payers together with consumers, researchers, and clinicians to broaden consensus on performance measures for breast and colorectal cancer. The Commission on Cancer has been actively engaged in this process. The CoC has instituted a facility feedback mechanism through this reporting venue, the electronic Quality Improvement Packet (e-quip) to promote awareness of the importance of charting and coding accuracy in line with evidence based practice guidelines. In light of the national movement towards Pay for Performance (P4P), these reports provide CoC-Approved programs with the ability to examine program-specific colorectal cancer care practices. e-quip for Breast, Colon, & Rectal Cancers Western Maryland Health System 2003-2005 Primary Site Breast Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1c N0 M0, or Stage II or III ERA and PRA negative breast cancer. Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c N0 M0, or Stage II or III ERA and/or PRA positive breast cancer. Colon Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. Rectum Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 of with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. Estimated Performance Rate 89.2% 92.6% 88.3% 86.7% 100% All cases (10) that did not meet the inclusion criteria were reviewed. The most frequent reason for not being included was that the patient or patient s family refused treatment. The reason for non-compliance with evidence based treatment guidelines was documented in all ten cases and resubmitted to the National Cancer Database on 6/2/2008.

WMHS Regional Cancer Center Contact Information Radiation Oncology 301-723-5538 I Can Cope 301-723-5894 Nutrition Services 301-723-4264 Screenings 301-759-9355 Oncology Pharmacist 301-723-6263 Social Services 301-723-5894 Patient Navigator 301-723-6380 Medical Oncology/Chemotherapy 301-723-6106 Look Good Feel Better & Hand in Hand Connection 301-723-6106 Pastoral Care & Counseling 301-723-5567 Cancer Registry 301-723-6293

Western Maryland Health System 2008 Cancer Committee Roy Chisholm, MD Cancer Liaison Physician Blanche Mavromatis, MD Alida Podrumar, MD Qamar Zaman, MD Medical Oncology Scott Watkins, MD Radiaton Oncology Robert Miller, MD Diagnostic Radiology Rohon Mullings, MD Pain Management Naimin Wei, MD, PhD Pathology Thomas Dowdell, FACHE Sr. VP /Chief Operating Officer Sandra Cassidy, MHA, RT (M)(QM) System Director Diagnostic Imaging Department Jeff O Neal Systems Director Behavorial Health Julie Hardy, RN, OCN, BS Operations Manager Regional Cancer Center Laura Perske, BS(R)(T) Chief Therapist Radiation Oncology Tenna Taylor, BS American Cancer Society Mark Kerns, MBA Analytic Facilitator Donna Huff, CTR Christine Roby, CTR Cancer Registry Nadine Wampler, RN, MSN, OCN Clinical Research Nurse Jennifer Hoover, RD Deborah James, RD Dietary Pamela Ackerman, RNC, BSN Home Health Linda Green, RN, CRNH Home Hospice Sarah Blocher, MS, OTR/L, CLT Lymphedema Clinic Terri Calvin, RN, BSN Nursing/Inpatient Oncology Patricia House, RN, OCN Nursing/Outpatient Oncology Cindy Shriver, RNC, OCN, BSN Nursing/Radiation Oncology Fran Weber, RN, MSN, CRNP Pain Management/Palliative Care Barbara Rossi Pastoral Care Brent Thornton, LGSW, OSW-C Patient Navigator Sandy Crabtree, B.C.O.P Pharmacy Julie Longenecker, LCSW-C, OSW-C Social Services Sue Willison, RN Wellness