Cancer Program Annual Report 20062007

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Cancer Program Annual Report2006-2007
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Contents
1. Cancer Program
2. Cancer Conferences
3. Annual Goals
4. Cancer Outreach Activities
5. Cancer Registry / Data
6. Clinical Protocols
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Introduction
Compassionate, Convenient, Comprehensive
Care.Close to Home. This is the message that we
as a multidisciplinary team have been working
toward getting into the Greene County community.
The Ruth G. McMillan Cancer Centers Cancer
Committee has been working toward increased
public awareness that a College of Surgeons
Accredited program exists right here in the midst
of their own backyard. Striving for care close
to home that meets the needs of the community and
meets the standards set by the governing body of
the American College of Surgeons Commission on
Cancer.
We are a program in its early years of
development and looking into the future of
specialization, technology and advanced care to
bring to the Greene County Community as we grow
along with the community.
A commitment to Risk Reduction, Early Detection
and Quality Care is the focus of the Cancer
Committee and its latest endeavors such as IMRT,
Breast Specific Gamma Imaging (BSGI), Care to
Share, Breast Care through the Ages educational
project.
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Introduction, cont.
Radiation Oncology Patient Satisfaction Surveys
reflect the care and support of the team effort
provided each and everyday. US Oncology team
members along with Radiation Oncology, Surgery,
Imaging, Research, Pathology, Laboratory, Cancer
Registry and multiple other team members and
support staff provide Greene county patients
Compassionate, Convenient, Comprehensive
care..Close to Home. We welcome you to take a
look at our 2006-2007 annual report to view some
of the highlights of special interest that we
have committed to working on during this time.
Mark Collins, M.D.
Justin G. Mills, M.D. Medical Oncologist
Radiation
Oncologist Chair, Oncology Service Line
Medical Director, Radiation Therapy Cancer
Liaison Physician
Terri VanZant, RN Oncology Services
Manager
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GMH Cancer Program
Risk Reduction
Early Detection
Quality Care
Detecting it at the earliest stage possible when
treatment can improve outcomes
Ensuring access to high quality treatment
Reducing the Rick for Cancer
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2006 Oncology Committee Members

• PI Medical Staff Coordinator Kitty Moorhead, RN
• Director Imaging ServicesMary Ann Hargrove,
  MA,CRA
• Director of Marketing Bob Jackson
• Cancer Registrar Kim Mills, BS, CTR
• Radiation Therapy TechDarlene McClure, CMD
  Julie Swartz, RT(R)(T)
• Radiation Therapy Medical Assistant Lisa Degler,
  CMA
• Social Services Kari Higgins, MSW, LSW
• Hospice Kathy Smith, MSN, RN, CRNH
• American Cancer Society Kay Finch
• CPSI (Ad Hoc) Susan Folkerth, MS
• Specialty Care Manager (Ad Hoc)
• Infection Control Practitioner (Ad Hoc)

• Chair/Medical Oncology Mark Collins, M.D.
• Cancer Liaison Physician Linda Bailey, M.D.
• Oncology Services Manager Terri Van Zant
• COO Tim Ols
• Surgery Linda Bailey, M.D.
• David Deutsch, M.D.
• Sanjoy Saha M.D.
  (Jan.-Aug 2007)
• Pathology Scott Arnold, M.D.
• Deborah Ward, M.D.
• Radiation Oncology Justin Mills, M.D.
• Radiology Richard Butler, M.D.
• Michael Caccamo, D.O.
  
• Protocol Nurse Nancy Hazlett, R.N.
• Radiation Therapy Nurse Laura Helsel, R.N.
• Breast Care Navigator
• Cyndi Merriman, RT(R)(M) (Jan.-Aug.
  2007)
• Director HIM Quality Services Sheila Harris

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2007 Oncology Committee Members

• Chair/Medical Oncology Mark Collins, M.D.
• Cancer Liaison Physician
• Sanjoy Saha, M.D. (May-Aug.
  2007)
• Mark Collins, M.D.(Sept.-)
• Oncology Services Manager Terri Van Zant
• COO Tim Ols
• Surgery Linda Bailey, M.D.
• David Deutsch, M.D.
• Christopher Madison, M.D.
  
• Sanjoy Saha M.D.
  (Jan.-Aug 2007)
• Pathology Scott Arnold, M.D.
• Deborah Ward, M.D.
• Radiation Oncology Justin Mills, M.D.
• Radiology Richard Butler, M.D.
• Michael Caccamo, D.O.
• Freddy Katai, M.D.
• Clinical Research Nurse Michelle Cox, R.N.,
• B.S. N. (Feb.-Mar. 2007)
  Cristy
• Morgan-Back, R.N., O.C. N.
  (July-)

• Director HIM Quality Services Sheila
• Harris
• PI Medical Staff Coordinator Kitty
• Moorhead, RN
• Director Imaging ServicesMary Ann
• Hargrove, MA,CRA
• Director of Marketing Bob Jackson,
• Ellie Wenzke
• Cancer Registrar Kim Mills, BS, CTR
• Radiation Therapy TechDarlene McClure,
• CMD Julie Swartz,
  RT(R)(T)
• Radiation Therapy Medical Assistant Lisa Degler,
  CMA
• Social Services Kari Higgins, MSW, LSW
• Hospice Kathy Smith, MSN, RN, CRNH
• American Cancer Society Kay Finch
• CPSI (Ad Hoc) Susan Folkerth, MS
• Medical Oncology ( Ad Hoc) Dee
• Mendenhall
• Specialty Care Manager (Ad Hoc)

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Oncology Team
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Cancer Conferences

• The Tumor Board Conference is a
  multi-disciplinary conference held monthly at
  Greene Memorial Hospital.
• Attendance is open to any physician or hospital
  staff member interested in the diagnosis and care
  of cancer patients.
• The goal of the conference is to benefit patients
  directly in a setting which provides physicians
  the best opportunity to consult with their peers
  in specialized areas of cancer treatment. Cases
  are chosen based on their complexity, unusual
  presentations, special requests and follow-up on
  previously presented cases. Each presentation
  includes medical and social history, physical
  findings, clinical course, staging and
  radiographic and pathologic interpretations.
• During 2006, 87 of the 45 cases were
  prospective and presented at a time when
  management of the patients treatment could be
  influenced by the discussion.
• Greene Memorial Hospitals Tumor Board
  Conferences are accredited by the Ohio Medical
  Association for up to 1.5 continuing medical
  education credits for physicians. CEUs are also
  available to nursing and allied health
  professionals

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2006 Sites Presented
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2007 Annual Goals

• Smoking Cessation Program
• Care to Share-Breast Care for the Ages
• Oncology QI Committee Conduct Reviews/Study
• Current Treatment practices re NCCN Guidelines
• Adopt and Implement The CEO Gold Standard
  Program
• New Technology Breast Specific Gamma Imaging

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New Technology Breast Specific Gamma
Imaging(BSGI)

• Functional imaging to complement mammography.

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Indications for BSGI

• Radiodense breast tissue difficult to image.
• Evaluation of indeterminate areas identified by
  mammography and/or Ultrasound.
• Post-surgical or post-therapeutic evaluation of
  mammographic tissue changes.
• Evaluation of multiple lesions or clusters of
  microcalcifications to aid in biopsy target
  selection.
• Palpable mass not demonstrated in mammogram or
  ultrasound.
• For use in patients where MRI is indicated, but
  not possible.

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Additional Indications

• Evaluating the axillary region for node status in
  breast cancer patients.
• Determining the extent of the primary lesion.
• Detecting multicentric and multifocal disease for
  treatment planning.
• Predicting chemotherapeutic response.
• Monitor primary tumor response to neoadjuvant
  chemotherapy.
• Screening high-risk population.

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2006-2007 Cancer Outreach Activities

• Large Scale Colonoscopy Ad Campaign
• Marketing and Education for BSGI
• GMH Cancer Support Group
• Look Good, Feel Better Program
• Health Fairs April 2007, October 2007
• ACS Patient Navigator Office
• BCCP Patient Referrals
• Bowl Over Cancer
• Colorectal Summit
• Circle of Victory
• Ohio Quits Smoking

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Cancer Registry

• A cancer registry is an information system
  designed for the collection, management and
  analysis of data on persons with the diagnosis of
  a malignant or neoplastic disease. The Cancer
  Registry of Greene Memorial Hospital, which
  operates under the supervision of the Oncology
  Service Line Committee, maintains a
  comprehensive database of all cancer cases
  diagnosed and/or treated at this facility since
  1985. Since January 1, 1985, the Cancer Registry
  has collected data on a total of 4,325 cases.
• Data collected for each patient includes
  demographic information, medical history,
  diagnostic findings, description of the cancer as
  to site, cell type and extent of disease, and the
  clinical course of treatment. Once a case is
  entered into the registry, there is lifetime
  follow-up of the patient. Annual follow-up
  information is obtained on all cases concerning
  treatment, recurrence and patient status.
  Follow-up data is valuable for tracking quality
  of care and treatment outcomes and for comparison
  to national standards and benchmarks. The
  Commission on Cancer mandates an 80 lifetime
  follow-up rate for an approved Cancer Program. In
  2006, the GMH Cancer Registry maintained a
  follow-up rate of 94 of all cases abstracted.
• The Greene Memorial Hospital Cancer Registry
  accessioned a total of 189 new patients into the
  registry in 2006. Of these, 150 were analytic,
  diagnosed and/or receiving the first course of
  treatment at GMH.

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Cancer Registry, cont.

• The Cancer Registry submits data to the National
  Cancer DataBase (NCDB) which provides a useful
  tool for benchmarking patient care and quality
  improvement efforts. Data is also submitted to
  the Ohio Cancer Incidence Surveillance System
  (OCISS) in compliance with House Bill 213, which
  made cancer a reportable disease in the state of
  Ohio as of January 1, 1992.
• Monthly Tumor Board Conferences are held to
  discuss the cancer care of our patients and give
  recommendations for continued optimal cancer
  care. The Cancer Registrar is responsible for
  coordinating the Tumor Board Conferences and
  recording the cases presented, disciplines
  represented and attendance. The registrar also
  coordinates the quarterly Oncology Service Line
  Committee meetings.
• In 2006, the Greene Memorial Hospital Cancer
  Registry was staffed by Kim Mills, BS, CTR. The
  Registry office is located on the second floor of
  the Vera T. Schneider Outpatient Building. The
  Registry office hours are 9 a.m. 500 p.m.,
  Monday through Friday. To request information
  from the database, or to request a case to be
  presented at the Tumor Board Conference, call
  [phone].
• Kim Mills, BS, CTR
• Oncology Data Registrar

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A NARRATIVE ANALYSIS OF BREAST CANCER DATA FROM
2006 RUTH MACMILLAN CANCER CENTERGREENE MEMORIAL
HOSPITAL, INC

• The recent history of breast cancer management at
  Greene Memorial Hospital has in many ways
  paralleled that of the history of breast cancer
  in this country in general.
• Dating back to 2650 B.C., the early Egyptians
  were the first to document breast cancer and
  treated the tumors by cautery of the diseased
  tissue. In 460 B.C., Hippocrates in Greece
  described a case report of breast cancer. There
  are many historical landmarks that could be
  referenced including the 1948 development of the
  modified radical mastectomy by Dr. Patey. It is
  revealing that through the first 65 years of the
  20th century, radical mastectomy was the
  treatment of choice for breast cancer. It wasn't
  until the 1960s when Dr. Bernard Fisher, among
  others, provided experimental evidence that
  contradicted the teachings of Dr. Halstead and
  Dr. Virchow. Breakthrough in chemotherapy came in
  1965 when Dr. Rosenberg discovered cisplatin,
  leading to the cure of testicular cancer and its
  use in other malignancies.
• It is very sobering that, as of 1975, the World
  Health Organization (WHO) survey showed that
  death rates from breast cancer had not declined
  since the 1900s. It was then realized that
  surgery alone was not the answer. In keeping with
  this, over the last 5 or 6 years, there has been
  a wonderfully collaborative effort made among the
  surgeons here at Greene Memorial Hospital,
  Radiation Oncology, and Medical Oncology in
  providing a multidiscipline approach to the
  management of breast cancer. This came about from
  the realization of the WHO survey and that
  patients are better served by input from all
  specialties combined to form a unified plan.

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A NARRATIVE ANALYSIS OF BREAST CANCER DATA, cont.

• The incidence of breast cancer is approximately 4
  times higher in North America and Northern Europe
  than in Asia and Africa, and it is the leading
  cause of death in women in the United States,
  representing about 1/3 of all new cancer cases.
  It is the second most common cause of cancer
  death in the United States, accounting for about
  15 of the cases, second only to lung cancer.
  Breast cancer rates increased by a little over 1
  per year between 1940 and 1980 this rate has
  been generally stable since the 1990s. It is
  especially sobering that breast cancer is the
  most common cause of death in women from cancer
  in ages 20 to 59 years of age. There has been a
  noticeably decreased mortality in young women,
  probably attributable to a combination of patient
  education, early diagnosis, and mammogram
  screening, as well increased use of systemic
  adjuvant therapy. The lifetime probability of
  developing breast cancer in this county is
  approximately 19 and is certainly age dependent.
  
• I would like to share our facility's experience
  with breast cancer in 2006 and compare this to
  the comparative data of the CIRF (Cancer
  Information Reference File) and the NCDB
  (National Cancer Data Base).
• In 2006, there were a total of 48 breast cancer
  cases, of which 41 were classified as analytic.
  In 2006, there were 189 cancer cases entered in
  the Registry, of which 150 were analytic (meaning
  the patients were diagnosed and received their
  first course of therapy at this institution). If
  you look at the distribution by age of the
  diagnosis of the cases at Greene Memorial
  Hospital and compare this to the NCDB, there is a
  trend toward suggesting our patient population is
  a little bit older, and there is a stark
  difference between analytic cases in our
  population beyond the age of 80 compared to the
  NCDB, raising the question of perhaps our elderly
  folks beyond the age of 80 are not being screened
  as aggressively as the NCDB patients.

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A NARRATIVE ANALYSIS OF BREAST CANCER DATA, cont

• Our percentage distribution by stage and
  diagnosis nicely parallels the CIRF and NCDB
  without any major variations from those data
  bases. The table that looks at the percentage
  distribution by first course of treatment is
  interesting and satisfying to me in that the
  percentage of patients that had surgery only at
  Greene Memorial Hospital was approximately 15
  versus almost 26 in the NCDB. As well, the
  percentage of patients that received surgery and
  chemotherapy or surgery, radiation, and
  chemotherapy was significantly higher in our data
  base compared to the larger data base. I think
  this reflects our concerted effort towards a more
  multidisciplinary input.
• A satisfying trend has been the decline in the
  mastectomy rate over the last 10 years at one
  point this exceeded 80 and now is approximately
  50 (based on the available data), which is more
  in line with the national data trends. There has
  been a concerted effort towards breast
  conservation stemming from the multidisciplined
  conversations with the patients before they have
  a definitive procedure. In this table, the total
  mastectomy rate is about 50.
• Survival data also nicely parallels that of the
  NCDB with 100 survival at 5 years for our
  stage 0 patients compared to 95 in the data
  base, and 66 survival based upon 9 patients
  compared with 56 in the NCDB. We only had 2
  patients with stage IV disease therefore, the
  data isn't really that meaningful with such small
  numbers. Also, stage I survival, based on 51
  patients, was 88, compared with 90, which is
  almost identical to the larger data base. Between
  1998 and 2000, based on 128 patients at Greene
  Memorial Hospital compared to the NCDB, the
  5-year survival was 82 compared to 83.

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A NARRATIVE ANALYSIS OF BREAST CANCER DATA, cont

• We will continue on our cooperative effort with
  our colleagues in an attempt to provide the best
  care for all of our patients, in particular our
  breast cancer patients. We strive to try to put
  patients on protocol as much as possible. I
  believe the national average for percentage of
  breast cancer patients going on protocol is about
  1 to 2, and we would like to get about 5 if we
  can. We have an active DCOP (Dayton Clinical
  Oncology Program), the availability of some US
  Oncology protocols as well, and a research nurse
  to help screen these patients for protocols.
• Prognostic factors are becoming more complex but
  still, despite an attempt to reinvent the lymph
  node, the lymph node is still the most important
  prognostic factor. Sentinel node procedures are
  very crucial in management. The second most
  important prognostic factor is the size of the
  tumor. Now we are in an age of gene profiling
  that is very exciting and is very promising in
  terms of being able to prognosticate more
  accurately and help better define risks and plan
  more appropriate therapy for our patients. For
  example, the development of Oncotype DX testing
  is very interesting and appears of value in
  patients who are node negative and receptor
  positive in trying to define patients who might
  benefit from more aggressive therapy. We are now
  using these tools also in an attempt to provide
  state-of-the-art care for our patients.
• Mark Collins, M.D.
• Medical Oncologist
• Chair, Oncology Service Line
• Medical Cancer Liaison Physician

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PRIMARY SITE TABLE 2006NEW CANCER CASES
ACCESSIONED FROM ALL SOURCES
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PRIMARY SITE TABLE 2006NEW CANCER CASES
ACCESSIONED FROM ALL SOURCES, cont.
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PRIMARY SITE TABLE 2006NEW CANCER CASES
ACCESSIONED FROM ALL SOURCES, cont.

• Analytic cases only in table above which
  includes Class of Case 0-first diagnosed at the
  reporting institution since registrys reference
  date (January1, 1985) and all first course of
  therapy elsewhere Class of Case1-First diagnosed
  at the reporting institution and all/part of
  first course of therapy at reporting institution
  Class of Case 2 First diagnosed elsewhere and
  treatment plan developed and documented and/or
  first course of therapy given at the reporting
  institution after the registry reference date.
• Thirty-nine non-analytic cases were accessioned
  into the registry and are not included in the
  table above. The non-analytic cases accessioned
  are Class of Case 3-First diagnosed and all of
  first course of therapy elsewhere Class of Case
  6-cases diagnosed and all the first course of
  treatment in a staff physicians office. GMH
  reports these cases for staff physicians as a
  courtesy in accordance to state law which
  requires all cancers to be reported to the state
  registry and Class of Case 7-Pathology report
  only.

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PRIMARY SITE TABLE 2006NEW CANCER CASES
ACCESSIONED FROM ALL SOURCES, cont.
The Greene Memorial Hospital Cancer Registry has
a total number of 4,325 cases in the database
with 189 cancer cases entered into the registry
in 2006. Of these, 150 were analytic, that is,
diagnosed and/or received their first course of
treatment at GMH. The first course of treatment
for the cancer patient can include surgery,
chemotherapy, radiation therapy or a combination
of these.
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AJCC Stage Distribution 2006-All Cancers
7
10
8
21
20
15
19
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AJCC Stage Distribution - All Cancers 1996-2006
Greene Memorial Hospital
Stage
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2006 Analytic Cases Compared to National (CIRF)
Data
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Analytic Cases Incidence of Cancer from
1996-2006
of Cases
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2006 Analytic Cases Compared to National (CIRF)
DataCancer Incidence in Males vs. Females ()
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2006 Analytic Breast Cancer Cases
Percentage Distribution by AJCC Stage at Diagnosis
Note NCDB-Ohio DX Year 2005 Community Hospital
Cancer Program
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2006 Analytic Breast Cancer Cases
Note NCDB-Ohio DX Year 2005 Community Hospital
Cancer Program
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2006 Analytic Breast Cancer Cases
Percentage Distribution by 1st Course of
Treatment
Note NCDB-Ohio DX Year 2005 Community Hospital
Cancer Program
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2006 Analytic Breast Cancer Cases
Percentage Distribution by Surgical Procedure
35
2006 Analytic Breast Cancer Cases
5 Year Observed Survival Rates by AJCC Stage
36
2006 Analytic Breast Cancer Cases
Five Year Observed Survival Rates

Years
GMH DX 1998-2000 (n128) NCDB DX 1998-2000
(n474,330)
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Quality Control

• Cancer Registry Abstracting
• AJCC Staging in the Medical Record
• Pathology Reports
• Radiation Oncology Chart Rounds

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Mechanism for Providing Clinical Protocol
Information to Patients

• Pathology reports with a diagnosis of cancer are
  tracked for the patients eligibility for an
  existing Clinical Trial through the Dayton
  Clinical Oncology Program.
• New consults/referrals in Medical Oncology are
  reviewed and tracked for eligibility.
• Information for an active protocol regarding a
  trial for which a patient may be eligible is
  attached to the chart. It is also noted on the
  chart if there is not an eligible protocol for
  that patient.
• The oncologist will review the protocol
  information and if approved, he will see the
  patient and discuss the protocol. The Cancer
  Research Nurse will discuss the protocol with the
  patient.
• The trial is discussed and written information is
  given to the patient to take and study. The
  Research Nurse will call the patient within 1-2
  business days to answer any questions and to
  determine the patients interest in
  participating. Information given to the patient
  will include, but not be limited to a consent for
  treatment, HIPAA authorization, brochures
  explaining the Dayton Clinical Oncology Program

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Mechanism for Providing Clinical Protocol
Information to Patients, cont.

• and the brochure Taking Part in Clinical
  Trials. Brochures on disease specific sites,
  nutrition, chemotherapy, radiation therapy, and
  Cancer Support groups are included.
• If the patient agrees to participate, the
  patient will meet with the Research Nurse to
  discuss and sign the consent, go over the
  treatment regimen and HIPAA authorization.
  Pre-studies will be ordered as indicated by the
  protocol and the patient will begin
  pre-randomization after the consent is signed and
  all questions have been answered by the
  oncologist and the Research Nurse.
• Note U.S. Oncology Protocols are also available
  to Greene Memorial Hospital patients and the U.S.
  Oncology Research Nurse manages the process
  similarly.
• Cristy Morgan-Back, R.N.
• Research Nurse

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Acknowledgements

• Data Sources
• Greene Memorial Hospital, Inc. Cancer
  Registry
•      IMPAC Medical Systems, Inc., 2007 Cancer
  Information Reference File (CIRF), National Data
  Set
•       NCDB, Commission on Cancer, ACoS Benchmark
  Reports Community Hospital Cancer Programs,
  Ohio, Diagnosis Year 2005
• NCDB, Commission on Cancer, ACoS Benchmark
  Reports, Observed Survival Rates All States, All
  Hospital Types, Diagnosis Years 1998 - 2000
• The Cancer program at Greene Memorial Hospital,
  Inc., would like to thank all the physicians,
  nurses, allied staff and volunteers for the
  service they performs in connection with the care
  of the cancer patients at our facility.
• A special thanks to those who serve as members
  of the GMH Oncology Service Line Committee and
  Tumor Board and those individuals who contribute
  their time, effort knowledge and talent to
  perform the duties needed.
• This Annual Report of the Greene Memorial
  Hospital Cancer Program is published to report on
  efforts made to continually improve the lives of
  members of our community.
• Published November 2007