2012 cancer program annual report - baptist health

2012 Cancer Program Annual Report

BaptistHealthMadisonville.com 2

Dr. Justin Sedlak Chairman

2012 has been a challenging, yet exciting, year as we completed the

merger to become Baptist Health Madisonville. We are excited to

become a part of the Baptist Health Cancer Network, as we continue

to provide high quality care to residents of Western Kentucky. Baptist

Health is a leader in cancer care, treating the largest number of new

cancer cases of any health system in Kentucky. In fact, one in five new

patients in Kentucky is treated at a Baptist facility.

From early detection programs, advanced diagnostic testing, multi-disciplinary surgical, chemotherapy and radiation therapy treatment options to numerous support programs, the Cancer Program truly provides comprehensive care close to home. We would like to thank Dr. Muhammed Siddique and Dr. Suresh Devineni for their commit-ment to the Cancer Program for the past three years. Both physi-cians left the Merle M. Mahr Cancer Center within the past year to explore other opportunities. Tracy Hagan, APRN, AOCNP, joined the oncology practice in March, and has been a refreshing addition to the cancer care team. We look forward to Dr. Ali Kanbar joining us in December.

There have been numerous changes to the American College of Sur-geons Commission on Cancer Standards to enhance patient centered functions and define performance criteria in quality measurement and patient outcomes. At Baptist Health Madisonville, we are evolving to meet these new challenges with the addition of patient navigation programs and psychosocial distress screenings. The program contin-ues to ensure that the evaluation and treatment of patients follows the most recent evidence-based national treatment guidelines. Dr. William Logan and members of the Quality Care Team recently performed an in depth study reviewing adherence to national guidelines for the treatment of head and neck cancer patients at Baptist Health Madisonville. The results of this study are out-lined in the 2012 Cancer Program Annual Report.

New CANCeR CASeS 2011 – MAJoR SiteS

Site Local Kentucky National

Lung – (SC & NSC) 19.5% 16.7% 13.8%

Colorectal 12.7% 10.2% 8.8%

Breast, female & male 11.1% 15% 14.4%

Bladder 6% 3.9% 4.3%

Prostate 5.4% 9.9% 15%

l National estimated new cancer sites by American Cancer Society “Facts & Figures” 2011

l 2011 Regional Medical Center and Kentucky figures are actual to date

l Kentucky information obtained from the Kentucky Cancer Registry


Dr. Darren Chapman Cancer Liaison Physician

The cancer program has been continuously accredited by the Ameri-can College of Surgeon’s Commission on Cancer (ACoS, CoC) since 1976. Since 80 percent of all cancer patients are diagnosed and treated at ACoS accredited programs, this participation allows our cancer program to compare our experiences and trends with that of the nations through the data submissions to the National Cancer Data Base and participation in the Cancer Program Practice Profile Reports (CP3R). Our performance has far exceeded the national benchmarks for both breast and colorectal cancer treatment.

In a recent review of Baptist Health Madisonville performance rates for 2010, 100 percent of breast cases were in concordance with all measures in the summary compared to 91.7 percent statewide and 87.9 percent for all CoC approved programs. 100 percent of stage III rectal cancers were in concordance compared to 95.5 percent statewide and 90.7 percent for all CoC approved pro-grams. 100 percent of Stage III colon cancer cases were in concordance with the measures reviewed compared to 90.7 percent statewide and 89.1 percent for all CoC approved programs. The measure of 12 lymph nodes pathologically examined for all resected colon cancers was 88.2 percent compared to 87.7 percent statewide and 86.5 percent for all CoC programs reporting. Each colon cancer case that did not meet the anticipated measure of 12 lymph nodes pathologically sampled was reviewed inde-pendently and found to have been treated with adequate resection and lymph node dissection.

Overall survival outcomes for our program have continuously benchmarked above state and national averages. The cancer committee recognizes that this is in large measure due to the prospective multidisciplinary approach to cancer care. Cancer Conferences (Tumor Board Conference) are held twice per month in the Joseph R. Miller Auditorium. This team approach brings together Medical and Radiation Oncologists, surgeons, Radiologists, Pathologists, residents and other clinical experts to discuss and formulate the best treatment options for cancer patients. This approach leads to care based on best practice and adherence to national treatment guidelines. In 2011, 36 patient focused tumor board conferences were held presenting 134 prospective can-cer cases. Staging and national treatment guidelines were discussed on each applicable case. There was 100 percent attendance of medical and radiation oncology as well as pathology, diagnostic radiology, and surgery, exceeding the goals set by the cancer program.

Our cancer program is deeply committed to not only treating cancer, but also to preventing cancer by educating the public about the disease. This includes improving access to medical care, creating education and screening programs, and establishing partnerships with communities. Screening and prevention programs offered during the past year included breast, prostate and colorectal cancers. Based on a community assessment earlier this year, our focus continues to be on prevention of smoking and tobacco use. We look forward to 2013 as we become a smoke and tobacco-free campus, and continue to focus on Patient Navi-gation, Cancer Survivorship, and overall Patient Centered Care.


william A. Logan, MD, FACS Head and Neck cancer (H&N Ca) cases account for about 4 percent of all malignancies. Sites included in the grouping of “Head and Neck” include lip, oral cavity, pharynx, larynx, nose, paranasal sinuses, and salivary glands.

Squamous cell (SCC) is by far the most common head and neck can-cer, and tobacco use, both oral and smoked, substantially increases the risk of developing SCC of the head and neck. Review of cases of H&N Ca in our study showed that tobacco use was present in 88 percent of all cases from all sites. We also noted that alcohol use was present in 70 percent of these cases.

Appropriate treatment of H&N Ca depends on an accurate diagnostic work-up, including a comprehensive head and neck exam, biopsy to confirm histology, and imaging studies to determine the stage and extent of disease.

Treatment options include, when technically feasible, surgical resec-tion, often with regional lymphadenectomy, curative intent radio-therapy, and concurrent chemotherapy and radiotherapy. In more advanced disease, radiation therapy, either with or without chemo-therapy (depending on stage and extent of disease), may also be used in combination with surgery, either pre-operatively or postoperatively. National Comprehensive Cancer Network (NCCN) guidelines give di-rection as to what options are appropriate given the stage of disease, and these guidelines are used in our institution.

A study of Head and Neck Cancer cases at our institution was conducted due to an apparent increase in diagnosed cases in our area over the past three years. Although this type of cancer is less common than some of the other tobacco related malignancies, it is impacted by tobacco use, which is a significant problem in our three counties service area. Alcohol abuse also can impact these types of cancers. Based on a Community Assessment completed in January of 2012, tobacco use is a significant problem in the three counties studied which include Hopkins, Webster and Muhlenberg counties. Compared with other counties in Kentucky, we noted that Muhlenberg County is above the state average in tobacco use, specifically smoking.

Forty-one cases were reviewed, which included patients treated at Regional Medical Center (now Baptist Health Madisonville) during 2010 and/or 2011. Each patient had some form of Head or Neck cancer. The most prevalent at twenty-nine percent was

26.325

31

27.8

Hopkins

Percentage of Adult Smokers

Webster Muhlenberg State

88%

Merle M. Mahr Cancer CenterHead and Neck Cancer 2010-2011

Tobacco Use/hx Alcohol/hx

70%

100

90

80

70

60

50

40

30

20

10

0

35/40

28/40

40 Cases1 Case - No Data


cancers of the oropharynx (base of tongue, floor of mouth, soft palate, tonsils). Other anatomical locations were as follows: Glot-tic larynx – 17 percent, Lip – 15 percent, Oral Cavity – 15 percent. The remainder were supraglottic, nasopharynx, salivary glands and maxillary sinus. Five percent were recurrences.

The NCCN guidelines for Head and Neck Cancer were used as criteria to measure compliance with standard of care. For pa-tients with Head and Neck Cancer referred to and followed at the Merle M. Mahr Cancer Center, we wanted to determine if the NCCN guidelines for treatment modality were followed. Three patients received treatment elsewhere, and one expired prior to treatment, so we excluded these from the study. Of the remaining 37, we found that all were treated following NCCN guidelines.

2 5%Recurrent

Lip

Supra Glottic

Glottic Larynx

oropharynx

Nasopharynx

Salivary Glands

oral Cavity

Maxillary Sinus

5%

5%

2%

15%

7%

17%

15%

29%

6

3

7

12

2

2

6

1

Merle M. Mahr Cancer CenterHead and Neck Cancer Primary Category Site 2010-2011

Merle M. Mahr Cancer CenterHead and Neck Cancer treatment Followed by NCCN Guidelines 2010-2011

100%

Excludes1 - exp3 - unable to determine

81%

Merle M. Mahr Cancer CenterHead and Neck Cancer 2010-2011

Pt Completed Treatment

Break in Treatment

59%

100

90

80

70

60

50

40

30

20

10

0

33/41

24/41

41 Cases

5% 2/41

Pt Expired During Treatment


Head and Neck Cancer Study Summary Areas of opportunities include an increased emphasis on pre-treatment evaluation of speech, swallowing, hearing, and overall nutritional status. One of our goals for 2013 is to implement a Cancer Rehabilitation program to further support the patient in meeting these needs.

Our overall survival at five years was 65.7 percent compared to NCDB at 53.4 percent. We recog-nize this was a small sample size.

tobacco-Free Campus The adverse health effects from cigarette smoking and tobacco use account for nearly one of every five deaths each year in the United States. Motivated by a commitment to protect and promote the health and safety of our employees and the community at large, as well as by a Joint Commission requirement for accreditation, the former Trover Health System Board of Directors and the Regional Medical Center Medical Executive Committee approved the health system’s decision to adopt a tobacco-free policy, effective January 1, 2013. This initiative has been recommended and encouraged by the Cancer Committee for several years. We are pleased to see this implemented.

the Cooper/Clayton Program - A 13-week program that combines nicotine patches, gum or lozenges with counseling and social support to maximize success and minimize the potential of relapse has been offered to employees and the community. In ad-dition to community education, Baptist Health has committed to reimburse 10 weeks of nicotine replacement products for its employees and one other individual who attend a Cooper Clayton Smoking Cessation class or Freedom from Smoking class.

Additionally, the Merle M. Mahr Cancer Center has participated in several community education events to provide the commu-nity with the facts about tobacco use.

100

90

80

70

60

50

40

30

20

10

00 12 24 36 48 60

% S

uRv

ivA

L

MoNtHS PASt DiAGNoSiS

BHM

NCDB

Head and Neck Cancer overall Survival 2003-2005BHM compared to NCDB


2011 Cancer Registry Summary Cancer registrars are highly trained data information specialists who collect and code patient-level data for cancer registries. Cancer data information collection is coordinated by Stacy Littlepage, CTR, at the Merle M. Mahr Cancer Center. Essential information is provided to state and national cancer registries to assist cancer programs to accurately determine cancer patient populations, measure outcomes of treatment and survival, and formulate plans for improvement.

The cancer registry database is a computerized data center which provides a broad range of demographic, diagnostic, thera-peutic and lifetime follow-up information about cancer patients at Baptist Health Madisonville, Merle M. Mahr Cancer Center, and Baptist Health Medical Associates. The networked computer system in the registry allows for direct data entry supporting the paperless system. Data from the registry enables the medical staff, as well as other healthcare professionals, to analyze the results of their efforts.

The cancer registry has accessioned over 14,300 cases since its inception in 1973. In 2011, approximately 370 new cancer cases were accessioned into the cancer registry database. The cancer registry staff is continually following an average of 7,500 pa-tients on an annual basis with a success rate of 92 percent. The cancer registry is part of the Kentucky Cancer Registry’s Cancer Patient Data Management System (CPDMS.net) using a modern data encryption system with patient confidentiality and data security a top priority. Our cancer registry continually exceeds all expectations of data quality as evidenced by audits performed by the state, SEER and NCDB.

The cancer registry staff would like to thank all of the health care professionals involved in the care of our cancer patients. Their dedication, empathy and compassion are the basis for the quality care that is provided by our program. If any further data or graphics are required, please feel free to contact the Cancer Registry at 270.825.5820 or by e-mail at [email protected].

Stacy Littlepage, CtR Cancer Registry Coordinator


BAPtiSt HeALtH MADiSoNviLLe CANCeR iNCiDeNCe

Site 2006 2007 2008 2009 2010 2011

Lip 1 2 2 1 2 4

Tongue 0 1 1 4 5 2

Salivary glands 0 1 0 0 0 2

Gum & hard palate 0 1 0 1 2 1

Floor of mouth 2 0 0 1 3 0

Buccal mucosa 0 0 1 0 1 2

Oropharynx 4 3 10 1 3 8

Nasopharynx 2 0 2 0 1 0

Hypopharynx 1 0 1 1 0 0

Other oral cavity 0 1 0 2 2 1

Esophagus 8 10 8 14 6 4

Stomach 6 4 3 3 5 2

Small Intestine 1 2 1 1 2 2

Colon 34 37 42 48 34 30

Rectum/Anus 18 18 10 19 20 17

Liver 0 2 5 3 1 6

Gallbladder 2 1 0 2 3 2

Pancreas 7 8 11 5 10 6

Other digestive tract 0 1 0 1 0 1

Nasal cavities,sinuses,ear 0 1 0 0 1 0

Larynx 7 9 3 7 6 10

Trachea,bronchus,lung-small cell 11 20 13 23 18 7

Trachea,bronchus,lung-NSC 75 97 74 75 80 65

Other respiratory 1 3 1 1 2 0

Bone 1 0 0 0 0 0

Connective & soft tissue 1 2 2 3 2 3

Malignant melanoma 12 19 13 24 16 16

Other skin 1 2 0 2 0 0

Breast, female & male 55 74 62 69 59 41

Cervix 4 7 6 4 4 4

Endometrium (corpus uteri) 10 11 12 13 13 9

Ovary 9 3 3 2 5 5

Other female genital organs 9 8 8 7 7 4

Prostate 36 36 34 17 21 20

Testis 0 2 1 1 4 4

Other male genital organs 0 0 1 0 0 1

Bladder 15 18 15 14 21 22

Kidney 9 14 18 15 12 11

Other urinary organs 8 4 3 3 0 3

Eye 0 0 0 0 0 1

Brain 7 4 1 3 2 0

Thyroid 6 3 3 5 11 10

Other endocrine 1 0 0 0 0 0

Hodgkin's 2 1 3 1 2 0

Non-Hodgkin's Lymphomas 19 25 20 15 17 16

Plasma cell tumors 7 6 7 11 7 2

Lymphocytic leukemias 14 8 5 4 4 7

Myeloid leukemias 5 4 4 1 5 9

Other leukemias 1 0 0 1 0 0

Myeloproliferative & myelodysplasia 16 19 15 10 8 3

Other hematopoietic diseases 0 0 0 1 0 1

Unknown primary 9 6 8 5 5 3

Benign/borderline brain,cns 4 0 1 1 0 2

Total 441 498 433 445 432 369

2011 CASe FRequeNCy RePoRt

Site Total Cases

RMC Percent

State Percent

Trachea,bronchus,lung-NSC/SC 72 19.5% 16.7%

Colorectal 47 12.7% 10.2%

Breast, female & male 41 11.1% 15.0%

Bladder 22 6.0% 3.9%

Prostate 20 5.4% 9.9%

Non-Hodgkin's Lymphomas 16 4.3% 3.3%

Malignant melanoma 16 4.3% 5.3%

Kidney 11 3.0% 3.3%

Larynx 10 2.7% 1.2%

Thyroid 10 2.7% 2.6%

Endometrium (corpus uteri) 9 2.4% 2.6%

Myeloid leukemias 9 2.4% 1.2%

Oropharynx 8 2.2% 0.9%

Lymphocytic leukemias 7 1.9% 1.2%

Liver 6 1.6% 1.2%

Pancreas 6 1.6% 2.1%

Ovary 5 1.4% 1.1%

Testis 4 1.1% 0.4%

Esophagus 4 1.1% 0.9%

Cervix 4 1.1% 0.8%

Other female genital organs 4 1.1% 1.4%

Lip 4 1.1% 0.2%

Unknown primary 3 0.8% 1.4%

Connective & soft tissue 3 0.8% 0.5%

Other urinary organs 3 0.8% 0.6%

Myeloproliferative & myelodysplasia 3 0.8% 1.3%

Plasma cell tumors 2 0.5% 1.0%

Benign/borderline brain,cns 2 0.5% 3.0%

Tongue 2 0.5% 0.7%

Small Intestine 2 0.5% 0.5%

Gallbladder 2 0.5% 0.5%

Stomach 2 0.5% 1.1%

Salivary glands 2 0.5% 0.2%

Buccal mucosa 2 0.5% 0.1%

Other hematopoietic diseases 1 0.3% 0.1%

Other digestive tract 1 0.3% 0.3%

Gum & hard palate 1 0.3% 0.2%

Eye 1 0.3% 0.1%

Other male genital organs 1 0.3% 0.2%

Other oral cavity 1 0.3% 0.1%

Total 369


Clinical Services At the Merle M. Mahr Cancer Center, patients can receive their outpatient care in one setting, including Physician practice, Chemotherapy and Infusion Services, and Radiation Therapy. We like to call it a “One Stop Shop.” Inpatient cancer care and che-motherapy is provided at Baptist Health on 3 West, where the nurses are specially trained to provide this type of care.

imaging Services are available adjacent to the Merle M. Mahr Cancer Center, which creates convenience for our patients. Services include:

l CTl Pet/CTl MRI

The Breast Suite services include:

l Digital Mammographyl Stereotactic Breast Biopsyl Ultrasound Biopsy.

Radiation oncology includes an experienced and dedicated team trained to provide radiation therapy in a warm, family-like setting. Dr. Satish Shah leads the Radiation team, which includes a Certified Medical Physicist, Certified Medical Dosimetrist, Registered Radiation Therapists, and Radiation Nurses.

A Quality Assurance program is in place to ensure safe, high quality care for all patients. Weekly conferences are held with the team to discuss patient care.

Radiation Services include:

l Varian 21 EX Linear Acceleratorl Siemens Oncor Linear Acceleratorl Dedicated CT Simulationl Intensity Modulated Radiation Therapyl Low Dose Brachytherapy

infusion Services are available for a wide array of needs including, but not limited to:

l Chemotherapyl Biotherapyl Blood Transfusionl IV Antibioticsl IV Medications for Crohns Disease, Rheumatoid Arthritis, Osteoporosis, and many other indications

This care is provided by chemotherapy certified Nurses, most of whom are nationally certified by the Oncology Nurses Society.


Supportive Care Patient Navigation, Cancer Survivorship, and Distress Management are three of the top initiatives we are pursuing to provide our patients with care that is centered around them and their needs.

Additional support services include:

American Cancer Society The Merle M. Mahr Cancer Center, in collaboration with the American Cancer Society, provides patients with additional access to supportive care. At the time of diagnosis, throughout the course of treatment and even after treatment is completed, individu-als diagnosed with cancer and their caregivers have a wide range of needs. The American Cancer Society understands these needs and offers information, support, and resource referrals to cancer patients, survivors, and caregivers during their cancer experience. Help is available 24 hours a day by calling 1.800.227.2345.

information Packets – Upon referral, the ACS will send a specific packet of information on a cancer diagnosis, which in-cludes booklets about treatment and answers to common questions, as well as available resources. ACS provides patients with vital information for understanding their cancer, managing their lives through treatment and recovery, and finding the emotional support they need.

The Look Good Feel Better program is a community-based, free, national service that teaches female cancer patients beauty techniques to help restore their appearance and self-image during chemotherapy and radiation treatments. Volun-teer beauty professionals lead small groups, usually consisting of six to 10 women, through practical, hands-on experience. Women learn about makeup techniques, skincare, nail care, and options related to hair loss such as wigs, turbans, and scarves. Each group program participant receives a free kit of cosmetics for use during and after the workshop.

Reach to Recovery is a one-on-one support program for breast cancer patients. Volunteers are at least one-year post treatment and are trained by the American Cancer Society. These volunteers provide support to breast cancer patients throughout treatment and are matched to the patient by age and surgery type. A pillow and kit of information are pro-vided, specific to the patients’ surgery type.

Road to Recovery is an American Cancer Society program that provides cancer patients with free transportation to and from medical facilities for treatment. Volunteer drivers help keep them on their regular treatment schedule.

Dietician on Call – The American Cancer Society Dietitian on Call program provides free nutrition counseling by regis-tered oncology dietitians and is offered by phone to cancer patients and survivors before, during, and after treatment. Di-etitians may assist with: Management of treatment side-effects, like nausea, poor appetite, constipation, diarrhea, altered taste, or weight loss; achieving a healthier weight after treatment is finished; and information about nutrition and physical activity to lower the risk of cancer recurrence.

Clinical trial Matching Services – The American Cancer Society Clinical Trials Matching Service helps patients, their families, and health care workers find cancer clinical trials most appropriate to a patient’s medical and personal situation, thereby increasing enrollment. They are also able to identify and help remove barriers that prevent patients from partici-pating in clinical trials.


Kentucky Cancer ProgramThe Kentucky Cancer Program partners with the Merle M. Mahr Cancer Center to provide prevention and early detection ser-vices and support to the community and patients. Joan Lang serves as the community outreach coordinator to the cancer com-mittee and participates in studies to better understand the nature of cancer in our area. KCP furnishes staffing, public awareness and educational materials to screenings and produces the Pathfinder resource for patients.

Support GroupsThe General Cancer Support Group meets the first Wednesday of each month at 3 p.m., at the First Christian Church in Madisonville.

Grief Camps for Children – Camp Butterfly is an annual grief camp for children aged 5-13 years. It is held each September at the hospice house. Camp Butterfly is an opportunity for these children to see that loss touches people in all walks of life. The camp is staffed by Baptist Health Hospice staff and trained volunteers, as well as social workers and counselors. Throughout the day, there are sessions on feelings associated with loss, and fun activities planned. The day is finished off with a memorial service and a butterfly release.

Shelley Coffman Patient Resource CenterThe Shelly Coffman Patient Resource Center is a free resource available to cancer patients.

l Access to the Internet with bookmarked Web sites related to cancer care and resources to help patients’ research disease and treatment.

l Books l Educational brochures l Wigsl Turbans l Bras and other prosthetics

Baptist Health Madisonville

2012 Cancer Committee MembersChairman Justin Sedlak, MD

Diagnostic Radiologist Neal Rosner, MD

General Surgery/ Cancer Liaison Physician Darren Chapman, MD

Radiation oncologist Satish Shah, MD

eNt Surgeon William A. Logan, MD

Pathology Richard Bauer, MD

Cancer Program Administrator Diana Jackson, BSN, RN, OCN

oncology Nurse (inpatient) Faith Hancock, RN

oncology Nurse Practitioner Tracy Hagan, MSN, RN, AOCNP

Clinical Social worker/ Patient Rep Judy Blue, CSW

Cancer Registry Coordinator Stacy Littlepage, CTR, Registry Coordinator

quality improvement Coordinator Denise Dunn, BSN, RN, CPHQ

Clinical trial Research Associate Jenifer Miller, RN, OCN

Radiation oncology Shari Walker, RT(T)

Chaplain Rev. Bill McCann

Pharmacy Margo Ashby, PharmD Director

Reg. Coordinator Ky. Cancer Program Joan Lang, MBA

Community outreach CoordinatorACS Representative Heather Blair

Ad Hoc MembersHospice Manager Michelle Byrd, BSN, RN

Case Management Sherri Wilson, RN

Family Practice Residency Faculty William Crump, MD

oncology Dietician Sheila Baker, RD

Cardiothoracic Surgery T. Mark Stanfield, MD

vP of Nursing Stacey Beaven, MHA, RN, NE-BC

2012 cancer program annual report - baptist health

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