2010 outcomes - cleveland clinic outcomes... · state-of-the-art radiation treatments external beam...

2010 OutcomesDepartment of Hematology and Oncology

To promote quality improvement, Cleveland Clinic Florida has created a series of Outcomes books similar to this one for many of its departments. Designed for a physician audience, the Outcomes books contain a summary of our surgical and medical trends and approaches, data on patient volumes and outcomes, and a review of new technologies and innovations.

Although we are unable to report all outcomes for all treatments provided at Cleveland Clinic Florida — omission of outcomes for a particular treatment does not necessarily mean we do not offer that treatment — our goal is to increase outcomes reporting each year. When outcomes for a specific treatment are unavailable, we often report process measures associated with improved outcomes. When process measures are unavailable, we may report volume measures; a volume/outcome relationship has been demonstrated for many treatments, particularly those involving surgical techniques.

In addition to our internal efforts to measure clinical quality, Cleveland Clinic Florida supports transparent public reporting of healthcare quality data and participates in the following public reporting initiatives:

• Joint Commission Performance Measurement Initiative (qualitycheck.org)

• Centers for Medicare & Medicaid (CMS) Hospital Compare (hospitalcompare.hhs.gov)

• Agency for Healthcare Administration (ahca.myflorida.com)

• Centers for Disease Control and Prevention (cdc.gov)

Our commitment to providing accurate, timely information about patient care also will help patients and referring physicians make informed healthcare decisions.

We hope you find these data valuable. To view all our Outcomes books, please visit our website at clevelandclinicflorida.org.

2010

Dear Colleague:

On behalf of Cleveland Clinic Florida, I am proud to present our 2010 Outcomes books. Each book is compiled by area of specialty to demonstrate our commitment to accountability, transparency and most of all, to outstanding patient care.

These books are designed to help you and your patients make informed decisions about treatments and referrals. We consider it a privilege to work in partnership with you to care for your patients, and we continuously challenge ourselves to improve and to achieve excellent outcomes on their behalf.

Each publication includes outcomes, volumes and other data, along with recent innovations and publications.

We hope you find the content informative.

Sincerely,

Bernie Fernandez, MD Chief Executive Officer Cleveland Clinic Florida

2 2010 Outcomes

2010

What’s InsideChairman’s Letter ____________________________________________ 4

Department Overview ________________________________________ 5

Quality and Outcome Measures _______________________________ 12

Patient Experience __________________________________________ 19

Selected Publications ________________________________________ 22

Clinical Research ____________________________________________ 23

Staff Listing ________________________________________________ 24

Referral Contact Information __________________________________ 25

Cleveland Clinic Florida Locations _____________________________ 26

About Cleveland Clinic Florida ________________________________ 27

Resources _________________________________________________ 28

3Department of Hematology and Oncology

Chairman’s Letter Department Overview

It is my pleasure to present this 2010 collection of outcomes from Cleveland Clinic Florida’s Department of Hematology and Medical Oncology. This compilation of quality and outcomes measurements is important to share with our patients, referring physicians and others who are interested in our medical and surgical activities.

The care of patients with cancer often involves the cooperation of a variety of physicians across multiple specialties. Cleveland Clinic Florida is designed to provide that type of comprehensive, compassionate team care with multiple specialists working together. Cleveland Clinic Florida also provides support services for patients and their families to help them during their family member’s illness.

We are dedicated to bringing our patients the best cancer care available and our research program provides our patients with access to National Cancer Institute-sponsored cancer treatment trials and up-to-date cancer management. Through this comprehensive organized clinical trial mechanism, along with pharmaceutical-sponsored studies, we are able to bring the latest cancer prevention and treatment research findings to our community.

We hope you find this outcomes summary useful and informative.

Sincerely,

Rogerio Lilenbaum, MD Chair, Cancer Institute

2010 Outcomes4


Chairman’s Letter Department Overview

The Hematology and Oncology Department at Cleveland Clinic Florida offers comprehensive cancer care services and performs extensive clinical research including participation in trials sponsored by the National Cancer Institute and selected trials of novel agents sponsored by pharmaceutical companies. The program includes seven specialists, four medical oncologists, two hematologists, and one radiation oncologist. We work in multidisciplinary teams in collaboration with surgeons, pathologists and radiologists to provide integrated and comprehensive oncology services.

Accreditation

In 2008, the Cleveland Clinic Florida cancer program received accreditation as a comprehensive cancer center from the Commission on Cancer (CoC). Established by the American College of Surgeons, the CoC sets standards for quality and multidisciplinary cancer patient care. Accredited institutions represent a broad-based network of comprehensive cancer programs that offer the entire spectrum of cancer control activities, from prevention to long-term follow-up. It is estimated that accredited programs annually diagnose and treat 70 to 80 percent of all new cancer cases.

The Cleveland Clinic Florida cancer program is among the top third of all accredited institutions in Florida who have received three-year approval with commendation by the CoC. Our facility is ranked highly in performance standards for:

• cancer outcomes analysis

• patient guidelines

• cancer clinical trial accrual

• cancer prevention and early detection

• cancer committee leadership

• overall cancer clinical management

• cancer clinical trial information

• cancer supportive services

2010 Outcomes6

Department Overview

• cancer prevention and early detection

• cancer community outreach

• cancer related education

Cleveland Clinic Florida also received accreditation from the National Accreditation Program for Breast Centers (NAPBC) in 2010. The NAPBC is the only national accreditation program to set criteria specifically for breast disease. It is a consortium of multidisciplinary organizations dedicated to ensuring high quality of care and outcomes for women with both benign breast disease and breast cancer. NAPBC accredited centers undergo a rigorous self-evaluation process to ensure that they provide quality comprehensive care for patients with breast diseases.

Centers accredited by the NAPBC are required to provide patients with (or have referred services to) the following measures:

• board-certified breast surgeons

• board-certified breast radiologists

• certified radiology equipment

• certified breast diagnostic radiographers

• board-certified breast pathologists

• board-certified medical oncologists

• board-certified radiation oncologists

• board-certified plastic reconstructive surgical services

• patient navigators

• genetic testing and counseling

• board-certified psychosocial support professionals

• interdisciplinary breast conferences

• patient education and support

• data management


Department Overview

• quality improvement programs

• palliative care

• research

• survivorship programs

• high-risk clinics

NAPBC accredited centers must demonstrate strict compliance with the practice standards established by the NAPBC for each measure. Cleveland Clinic Florida is only one of three centers in Florida to have received accreditation from the NAPBC. We are proud to have received this accreditation and are committed to provide the highest quality of care for patients with breast cancer.

Amyloidosis

We are listed by the National Organization for Rare Disorders as a center with expertise in amyloidosis. We are also a member of a national consortium working to bring early phase clinical trials to amyloid patients.

Services

Our cancer program services include:

• outpatient chemotherapy treatment

• inpatient chemotherapy treatment

• radiation treatment

• clinical research trials

• genetic testing and counseling

• psychosocial services

• prevention, education, early diagnosis

• rehabilitation

• end-of-life care

Department Overview

Multidisciplinary Conferences

Multidisciplinary care is the cornerstone of oncology. Comprehensive cancer care requires the participation and coordination of various specialties. We routinely meet with physicians from various specialties to present challenging cases, review imaging and pathology slides, and develop a comprehensive treatment plan for patients. Conferences held include:

Breast Tumor Board

• Genitourinary Tumor Board

• Gastrointestinal Tumor Board

• Hemato-Pathology Tumor Board

• Thoracic Tumor Board

Radiology

• PET scan, CT scan and MRI imaging

• Comprehensive breast imaging (digital mammogram, breast MRI, ultrasound, stereotactic guided biopsies)

• Radiofrequency ablation, transhepatic arterial chemoembolization

2010 Outcomes8


Department Overview

Chemotherapy Infusion Center

• Friendly, attentive and accommodating staff

• Experienced certified oncology nurses and pharmacists with twenty plus year experience

• Bright, spacious and comfortable

State-of-the-Art Radiation Treatments

External beam radiation therapy using the Varian Trilogy image-guided radiation therapy delivers real-time image guidance for the most accurate radiation delivery. This technology allows us to maximize the dose to the target cancer and minimize radiation damage to the critical normal structures. It also allows us to perform image-guided stereotactic central nervous system and body radiosurgery on previously radiated sites.

The versatile Trilogy system combines imaging and treatment technologies, and can be used to deliver the widest range of external beam radiotherapies: 3-D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy and intensity-modulated radiosurgery for cancer and neurosurgical treatments.

Advanced imaging capabilities built into the system allow therapists to position patients for treatment with submillimeter accuracy. A respiratory gating system compensates for any tumor movement that occurs as a patient breathes.

The Trilogy system can deliver radiotherapy doses at least 60 percent faster than conventional accelerators. This shortens the length of time patients need to spend undergoing treatment. In addition, the radiation beam is highly precise, allowing clinicians to deliver treatments with unprecedented accuracy.

Radiation treatment delivered by the Trilogy system also utilizes the Calypso 4D target localization system, also known as “GPS for the Body®.”

2010 Outcomes10

Department Overview

The Calypso® 4D Localization System™ with the implanted Beacon® electromagnetic transponders provides guidance to the clinician on the position and movement of the target during radiation therapy. Clinicians use the motion data provided by the Calypso system to guide radiation therapy setup and monitor the tumor position during treatment delivery. This technology allows continuous, real-time monitoring of the tumor and alerts the clinician when the target is outside of acceptable boundaries due to organ motion, thereby enabling corrections during treatment delivery. The implanted Beacon transponders and the Calypso System provide objective guidance through accurate submillimeter electromagnetic localization accuracy and additional nonionizing radiation doses are not needed.

Oncology Support Services

To facilitate patient and family adjustment to a cancer diagnosis, its treatment and rehabilitation, an oncology social worker is available to provide support with a variety of issues including psychological, financial or emotional concerns. Based on specific needs, a social worker can help a patient identify appropriate resources.

Services are also available to assist patients who are under-insured, have prescription drug coverage concerns or have home health needs including meals, nursing and medical equipment.

Cleveland Clinic Florida’s Cancer Program offers a variety of support groups including a breast cancer book club, blood cancer support group, and prostate cancer support group. We also have a patient and family support group that allows people facing cancer and their families to share experiences and concerns with others facing the disease. The support groups also offer education about cancer, treatment options and alternative services such as yoga classes and networking opportunities.

The oncology social worker can serve as a link between the patient and the health care system, and the community. Our goal is to provide a variety of services to aide in the long-term adjustment to a cancer diagnosis. We


Department Overview

are fortunate to have one of the best social workers in her field in Cara S. Kondaki, LCSW, ACSW, Licensed Clinical Social Worker-Oncology.

Cancer Support Groups

• Breast Cancer Book Club

• Prostate “Man to Man” Support Group with the American Cancer Society

• Look Good Feel Better with the American Cancer Society

• “Reel to Real” Blood Cancer Support Group With the Leukemia and Lymphoma Society

Surgical Procedures

Cleveland Clinic Florida oncologic surgeons provide the latest surgical treatments, including minimally invasive procedures that allow patients a fast recovery time and fewer days in the hospital.

Smoking Cessation Clinic

Staffed by trained respiratory therapists, this comprehensive clinic provides multiple consultations, support, medication and guidance to patients under the supervision of a pulmonary physician.

State-of-the-art techniques and latest medications are used to end nicotine addiction. The services are billed to insurance. Other forms of therapy such as psychotherapy and acupuncture are also available for those who prefer a non-medication approach.

2010 Outcomes12

Quality and Outcome Measures

Cancer Case Volumes

Number of Patients Seen by Year2008 – 2010

In 2010 there were 980 new cancer patient visits at Cleveland Clinic Florida. The most frequent cancer cases were colorectal, followed by prostate, then lung and breast.

2008 2009 2010

2008 2009 2010

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Quality Measures (2008 Data)

Cleveland Clinic Florida is an accredited institution of the Commission on Cancer (CoC) and reports cancer outcome statistics to the National Cancer Data Base (NCDB). NCDB is a nationwide database created by a joint program of the CoC and the American Cancer Society. More than 1,400 CoC-accredited cancer programs in the United States and Puerto Rico report their oncology outcomes to the NCDB. Approximately 70 percent of all newly diagnosed cases of cancer in the United States are submitted to the NCDB. This database can be used as a tool to compare statistics and performances of a cancer center with other centers in its region or in the nation. Data up to the year 2008 is available for analysis through the NCDB.

The most common types of cancer cases seen were prostate, colorectal and breast cancer.

Patients by Disease Subsite2008 – 2010

2010 Outcomes14

Radiation Treatment After Breast Conserving Surgery

Patients Under the Age Of 70 Diagnosed With Breast Cancer Who Received Radiation Therapy for Breast Conserving Surgery2008

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Cleveland Clinic Florida Florida Hospitals U.S. Hospitals

Percentage of patients under the age of 70 diagnosed with breast cancer in 2008 who received radiation therapy for

breast conserving surgery Percent

Radiation therapy given to patients undergoing breast conserving surgery reduces local breast cancer recurrence. A greater percentage of patients diagnosed with breast cancer in 2008 at Cleveland Clinic Florida received radiation therapy as a part of their breast conserving therapy compared to other CoC-accredited centers in Florida and the United States.


The National Cancer Data Base also provides comparative information on all the CoC-accredited institutions regarding adherence to standard practices for breast and colorectal cancer. Endorsed by the National Quality Forum, these standard practices are important quality measures that affect disease outcome.



Hormonal Treatment for Patients with Hormone Receptor Positive Breast Cancer

Patients with T1CN0M0 to Stage III Hormone Receptor Positive Breast Cancer in Whom Tamoxifen or Aromatase Inhibitor Was Considered or Administered2008

0 10 20 30 40 50 60 70 80 90

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Race of patients with breast cancer diagnosed in 2008

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Percentage of patients with T1cN0M0 to stage III hormone receptor positive breast cancer diagnosed in 2008 in whom tamoxifen or

aromatase inhibitor was considered or administered Percent

Hormonal therapy, tamoxifen or an aromatase inhibitor, given to patients with hormone receptor positive breast cancer improves survival. A higher percentage of patients with hormone receptor positive breast cancer diagnosed in 2008 received or were considered for hormone therapy at Cleveland Clinic Florida.

2010 Outcomes16

Number of Lymph Nodes Examined from Colon Cancer Surgery

Patients with Resected Colon Cancer Who Had at Least 12 or More Lymph Nodes Removed and Examined2008

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Percentage of patients with resected colon cancer diagnosed in 2008 who had at least 12 or more lymph nodes removed and examined Percent

For patients undergoing colon cancer surgery, studies have found that the number of lymph nodes removed by the surgeons and evaluated by the pathologists improves not only the staging but also survival. Patient survival increases when 12 or more lymph nodes are examined. At Cleveland Clinic Florida, a higher percentage of patients undergoing surgery for colon cancer in 2008 had at least 12 lymph nodes examined compared to other institutions in Florida or the United States. The average number of lymph nodes examined at Cleveland Clinic Florida that year was 29.




Adjuvant Chemotherapy for Stage III Colon Cancer

Patients with Stage III Colon Cancer In Whom Adjuvant Chemotherapy Was Considered or Administered2008

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Percentage of patients with stage III colon cancer diagnosed in 2008 in whom adjuvant chemotherapy was considered or administered

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Race of patients with colon cancer diagnosed in 2008

White

Black

Hispanic

Others

Percent

Chemotherapy given after surgery (adjuvant chemotherapy) for stage III colon cancer has been shown to improve overall survival. In 2008, more than 80 percent of patients with stage III colon cancer were treated or considered for adjuvant chemotherapy at Cleveland Clinic Florida. This was superior to other centers in the state of Florida and the United States.

2010 Outcomes18

Radiation for Rectal Cancer

Patients with Stage IIB/C to III Rectal Cancer In Whom Radiation Therapy is Considered or Administered2008

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Percentage of patients with stage IIb/c to III rectal cancer diagnosed in 2008 in whom radiation therapy is considered or administered

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Race of patients with rectal cancer diagnosed in 2008

White

Black

Hispanic

Others

Percent

Radiation for locally advanced rectal cancer given before or after surgery has been shown to reduce local recurrence. Compared to other centers in Florida or the nation, Cleveland Clinic Florida has a higher percentage of patients diagnosed with stage II-III rectal cancer who received or were considered for radiation as part of their treatment.

Patient ExperienceQuality and Outcome Measures


We ask our patients about their experiences and satisfaction with the services provided by our staff. Although our patients are already indicating we provide excellent care, we are committed to continuous improvement.

Below are the most recent results of the feedback that our patients have given to our department.

Source: Press Ganey, a national hospital survey vendor

Overall Rating of Outpatient Care and Services During Outpatient Visit (N = 127)2010

OncologyOverall Rating of Outpatient Care and Services During Outpatient Visit2010

Rating of Outpatient Care Provider 2010

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Patient ExperienceQuality and Outcome Measures

2010 Outcomes20

Rating of Outpatient Care Provider (N = 127)2010

OncologyOverall Rating of Outpatient Care and Services During Outpatient Visit2010

Rating of Outpatient Care Provider 2010

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Likelihood of Recommending Outpatient Care Provider (N = 127)2010

Likelihood of Recommending Outpatient Care Provider 2010

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Patient Experience


Patient Experience

Inpatient

With the support of the Centers for Medicare & Medicaid Services (CMS) and its partner organizations, the first national standard patient experience hospital survey (HCAHPS) was implemented in late 2006. Results collected for reporting are available at hospitalcompare.hhs.gov.

% respondents choosing 'definitely yes'

73% 80%

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Rate Hospital Would Recommend

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Discharge Information

Doctor Communication

Nurse Communication

Pain Management

Room Clean Communication New Medications

Responsiveness to Needs

Quiet at Night

HCAHPS Domains of Care (N = 1750)2010

HCAHPS Overall Assessment (N = 1750)2010

% respondents choosing 'definitely yes'

73% 80%

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Discharge Information

Doctor Communication

Nurse Communication

Pain Management

Room Clean Communication New Medications

Responsiveness to Needs

Quiet at Night


% “always”(Options: always, usually, sometimes, never)


% 9 or 10 (0-10 scale)

% “definitely yes”

2010 Outcomes22

Bastos BR, Hatoum GF, Walker GR, Tolba K, Takita C, Gomez J., et al. Efficacy and toxicity of chemoradiotherapy with carboplatin and irinotecan followed by consolidation docetaxel for unresectable stage III non-small cell lung cancer. J.Thorac.Oncol. 2010;(5):533-539.

Berho M, Oviedo M, Stone E, Chen C, Nogueras J, Weiss E., et al. The correlation between tumour regression grade and lymph node status after chemoradiation in rectal cancer. Colorectal Dis 2009;(11):254-258.

Selected Publications Clinical Research


Selected Publications Clinical Research

The cancer program at Cleveland Clinic Florida is dedicated to bringing patients the best cancer care available. Our program includes clinical trials sponsored by the National Cancer Institute (NCI) as well as pharmaceutical-sponsored clinical trials.

Cleveland Clinic Florida is part of a community-based cancer research program established by the NCI. The aim of the program is to provide cancer patients with access to NCI-sponsored cancer treatment trials and up-to-date cancer management. Through this comprehensive organized clinical trial mechanism we can bring the latest cancer prevention and treatment research findings to our community.

• Our pharmaceutical-sponsored studies as well as the NCI studies are chosen carefully in order to offer expanded treatment options to patients in our community and also to those who do not have access to clinical trials in their communities.

• We have active clinical trials in breast, lung, colon, prostate, kidney, head and neck, bone metastasis, lymphoma and multiple myeloma. For a list of our current studies, please refer to our web page at clevelandclinicflorida.org, then click on clinical research.

2010 Outcomes24

Rogerio Lilenbaum, MD Chair, Cancer Institute

Elizabeth R. Stone, MD

Chieh-Lin Fu, MD

Christopher T. Chen, MD

James Hoffman, MD

Bruno R. Bastos, MD

Tim Nguyen, MD

Staff Listing Referral Contact Information


Staff Listing Referral Contact Information

General Patient Referral

24/7 hospital transfer or physician consults 954.689.5150

General Patient Information

Toll-free: 877.463.2010

Referring Physician Center

For help with service issues, information about clinical specialists and services, details about CME opportunities and more: 954.659.5162 [email protected]

Global Patient Services

Patient Services Center 954.659.5080 Toll-free: 877.463.2010 [email protected]

Cleveland Clinic Florida Locations

Weston Campus

2950 Cleveland Clinic Blvd. Weston, FL 33331 Clinic: 954.659.5000 Hospital: 954.689.5000

Weston Family Health Center

1825 North Corporate Lakes Blvd. Weston, FL 33326 954.349.1111

West Palm Beach

CityPlace Tower 525 Okeechobee Blvd. West Palm Beach, FL 33401 Toll-free: 877.463.2010

Krupa Center

3250 Meridian Parkway Weston, FL 33331 954.659.5000

About Cleveland Clinic Florida

2010 Outcomes26


Cleveland Clinic Florida Locations About Cleveland Clinic Florida

Cleveland Clinic Florida, the Florida campus of the world-renowned Cleveland Clinic, is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Weston and West Palm Beach, Cleveland Clinic Florida has nearly 200 physicians with expertise in 35 specialties and subspecialties working collaboratively to achieve excellent results for patients. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital, which was named one of the nation’s 100 Top Hospitals® by Thomson Reuters in 2010.

Our West Palm Beach location extends our reach, enabling us to serve the Palm Beach County community. In addition to clinical care, our services include and infusion suite, pulmonary function testing and procedure room, as well as diagnostic imaging suites.

Cleveland Clinic Florida has been named one of the nation’s 100 Top Hospitals® for cardiovascular care for the last four years (2007, 2008, 2009, 2010) by Thomson Reuters. In 2010, it was named one of America’s Best Hospitals for gastroenterology and diabetes/endocrinology by U.S. News & World Report.

Cleveland Clinic Florida is an integral part of Cleveland Clinic in Cleveland, Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Established in 1988, Cleveland Clinic Florida has been committed to improvements in patient care and enhancements in medical education for more than 20 years.

2010 Outcomes28

Resources

eCleveland Clinic

eCleveland Clinic uses state-of-the-art digital information systems to offer several services, including remote second medical opinions to patients around the world; personalized medical record access for patients; patient treatment progress for referring physicians; and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.

DrConnect

Weather you are referring from near or far, DrConnect can streamline communication from Cleveland Clinic physicians to your office. This online tool offers you secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit eclevelandclinic.org or email [email protected].

MyConsult

MyConsult Remote Second Medical Opinion is a secure online service providing specialist consultations and remote second opinions for more than 1,000 life-threatening and life-altering diagnoses. The MyConsult service is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit eclevelandclinic.org/myconsult, email eclevelandclinic.org, or call 800.223.2273, ext. 43223.

MyChart

This secure online tool connects patients to their own health information from the privacy of their home any time, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to GoogleTM Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice. To establish a MyChart account, visit clevelandclinic.org/mychart.

Resources

Continuing Medical Education (CME) Opportunities

Cleveland Clinic Florida is dedicated to advancing medical knowledge through continuing education. Our CME program provides educational opportunities of a high quality and a wide variety to physicians, nurses, and other healthcare professionals. Our mission is to develop educational programs of an appropriate scope and depth to satisfy the need for knowledge and skill development of the learner.

CME activities include didactic lectures, live surgery presentations, hands-on workshops and audience participation. Interactivity between faculty and participants is emphasized. All activities are designed to maintain, develop or increase knowledge, competence or professional performance with the intended result of improving patient care and reducing disease impact.

For a program schedule and more information, visit: clevelandclinic.org/florida and click on “Education” at the top of the page.

Department of Hematology and Oncology 29

2950 Cleveland Clinic Boulevard n Weston, FL 33331 n clevelandclinicflorida.org

Every life deserves world class care.

2010 outcomes - cleveland clinic outcomes... · state-of-the-art radiation treatments external beam...

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