2017 annual repotr...2016 cancer screening summaries 2016 cancer screening summaries skin cancer...

2 0 1 7 A n n u A l R e p o R t

“we are able to offer the newest radiation therapy technology available.”

1

Our partnership with the Methodist Estabrook Cancer Center continues

in 2016. We have engaged the MECC Radiation Oncology Physician practice in providing care in the Methodist Jennie Edmundson Cancer Center Radiation Oncology Department. This partnership provides a standardized approach to radiation therapy across the Health System assuring excellent outcomes for our patients

With the addition of our new Linear accelerator in 2015 and a new pulmonologist in the Methodist Physicians Clinic the MJE cancer program implemented a low dose CT lung screening program and a Lung Mass Clinic in 2016. These additions to our program will assist us in providing a multidisciplinary

approach to lung cancer diagnosis and treatment with a focus on earlier intervention. New diagnostic tools – Endoscopic Bronchoscopy Ultrasound and Super Dimensional Navigation Bronchoscopy enable us to achieve earlier diagnosis of smaller lung lesions.

With the commissioning of the new Varian TrueBeam linear accelerator in 2016 we are able to offer the newest radiation therapy technology available.

This allows the team to treat patients who previously would have traveled into Omaha for their therapy.

Reducing commute time and distance is essential to this population. The combination of daily treatment and travel can exhaust many patients.

A n n u A l R e p o R t

Donna Hubbell, BSN MHAVP Patient Safety and QualityCancer Program Administrator

M E T H O D I S T J E N N I E E D M U N D S O N C A N C E R C E N T E R

2 0 1 7 A n n u A l R e p o R tm j e c A n c e R c e n t e R 32

Breast 86Lung/Bronchus-Non Small Cell 45Colon 28Prostate 27Bladder 12Hemeretic 11Lung/Bronchus-Small Cell 10Rectum & Rectosigmoid 8Kidney And Renal Pelvis 8Non-Hodgkin's Lymphoma 7Unknown Or Ill-Defined 7Other Nervous System 6Pancreas 5Melanoma Of Skin 5Esophagus 4Corpus Uteri 4Tongue 3Anus, Anal Canal, Anorectum 3Myeloma 3Thyroid 3Other Endocrine 3Tonsil 2Small Intestine 2Larynx 2Brain 2Salivary Glands, Major 1Stomach 1

Site Group TotalCases

2016 cAses Accessioned

Liver 1Bile Ducts 1Peritoneum, Omentum, Mesentary 1Soft Tissue 1Other Skin Cancers 1Cervix Uteri 1

ALL SITES 304

Site Group Total Cases

2016 cAses Accessioned (continued)


Stage 0 (in situ) 20 6.6%

Stage I 92 30.3%Stage II 51 16.8%Stage III 50 16.4%Stage IV 57 18.8%Not Applicable 32 10.5%Unknown 2 0.7%

ToTAL 304 100%

AJcc stAge At diAgnosistop ten cAnceRs (All sites) 2016

0

10

20

30

40

50

60

70

80

100

90

Bladd

er

Non-H

odgk

in's

Lym

phom

a

Panc

reas

Melano

ma

Prosta

te

Hemer

etic

Kidne

y &

Re

nal P

elvis

Colore

ctal

Lung

& B

ronc

hus

Brea

st

Stage Cases % of Cases

Breast 86 34.1%Lung & Bronchus 55 21.8%Colorectal 36 14.3%Prostate 27 10.7%Bladder 12 4.8%Hemeretic 11 4.4%

Kidney & Renal Pelvis 8 3.2%Non-Hodgkin's Lymphoma 7 2.8%Pancreas 5 2.0%Melanoma 5 2.0%

ToTAL 252 100.1%

Cases % of CasesCancer SiteStage Cases % of Cases

30.3%

16.8%

16.4%18.8%

10.5%

6.6%

0.7%86

36

27

12 11

55


pAtient Age At diAgnosis

10 - 19 1 0.8% 0 0.0%20 - 29 3 2.4% 4 2.2%40 - 49 5 4.1% 11 6.1%50 - 59 10 8.1% 27 14.9%60 - 69 46 37.4% 55 30.4%70 - 79 40 32.5% 42 23.2%80 - 89 17 13.8% 36 19.9%90 - 99 1 0.8% 6 3.3%

ToTALS 123 100% 181 100%

Age at Diagnosis Male % of Male Female % of Females

90-99

10-19

80-89

70-79

60-69

50-59

40-49

20-29

0

10

20

30

40

50

60

Male

Female

OUT OF STATE

Nebraska 2.3% (7)

2016 southwest iowA cAnceR RefeRRAls to mJe

H A R R I S O N

MONON A C R AW F O R D C A R R O L L

MON TGOM E R Y A DAM S

P OT TAWAT TAM I E C A S S

M I L L S

AU D U B ONS H E L B Y

PAG E TAY LO RF R EMON T

0 0.3% (1) 0.7% (2)

2.3% (7)

53% (161)

14.1% (43)

4.9% (15)

3.9% (12)

3% (9)

0

1% (3)

8.2% (25)

5.3% (16)

1%(3)


2016 mJe distRibution of mAJoR pRimARy sites

Breast (Female)

Lung/ Bronchus

Colon/ Rectum Prostate Bladder

MJE 28.3% 18.1% 11.8% 9.0% 3.9%

ACS - Iowa 13.5% 14.2% 8.8% 9.8% 4.9%

ACS - US 14.6% 13.3% 8.0% 10.7% 4.6%

Prostate BladderColonLung/Bronchus

Breast(Female)

0%

5%

10%

15%

20%

25%

30%

MJE

ACS - IA (Projected)

ACS - US (Projected)

Acos ncdb cp3R 2016 meAsuRes

oncology Metric MJEExpected

Performance Rate

The ACoS Commission on Cancer has defined eleven Cancer Program Practice Profile Reports (CP3R) that must be evaluated in 2015 for accreditation.

BCSRT – Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.

93.80%>=90% or upper bound

of 95%**(82 - 100)

HT – Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or Stage IB-III hormone receptor positive breast cancer.

96.00%>=90% or upper bound

of 95%**(88.3 – 100)

MASTRT – Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >=4 positive regional lymph nodes.

100% >=90% or upper bound of 95%

MAC – Combination chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB – III hormone receptor negative breast cancer .

100% Not Applicable

ACT – Adjuvant chemotherapy is recommended 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.

(no cases qualified) Not Applicable

nBx – Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer. 100% >=80% or upper bound

of 95%

12RLN – At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. 100% >=85% or upper bound

of 95%

RECRTCT – Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is recommended; for patients under the age of 80 receiving resection for rectal cancer.

100% >=85% or upper bound of 95%

G15RLN – At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer.

(no cases qualified)

>=80% or upper bound of 95%

LNoSurg – Surgery is not the first course of treatment for cN2, M0 lung cases 50% >=85% or upper bound of 95% (0 - 100)

LCT – Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC.

(no cases qualified)

>=85% or upper bound of 95%

*All measures meet or exceed the defined Confidence Interval, given the number of cases classified for the measures by the NCDB.**Program’s Calculated Performance Rate (95%) from CoC National Cancer Database (NCDB)


8

4

33

6

Binational Health Week All Care “Flu & Poo” Event - October27 Participants across all events

2016 cAnceR scReening summARies 2016 cAnceR scReening summARies

Skin Cancer Screening - June142 Participants / 52 Abnormal Results

Normal

AbnormalNormal

Abnormal

Normal

Normal

Abnormal

Abnormal

Colorectal Screening - March 23 Volunteer Participants / 0 Abnormal Results

Head & Neck Cancer Screening - April 35 Participants / 10 Abnormal Results

Prostate Cancer Screening - September10 Participants / 3 Abnormal Results:

7

3

Binational Health Week Women’s Event/Breast Screening - October22 Participants across all events / 6 Abnormal Results – followed by PCP

Methodist Physician’s Clinic /Glenwood Breast Cancer Screening - October 5 Participants / 0 Abnormal

Normal

Abnormal

23 5

25

10

46

32

90

23

11

13

22

6

Screening Mammograms

Diagnostic Mammograms (Negative)

Ultrasounds (Negative)

HIV Tests (Negative)

STI Tests Chlamydia & Gonorrhea (Negative)

Flu Shots

Glucose Tests

Fecal Occult Blood Test Kits

Normal

Basal Cell Carcinoma

Melanoma

Squamous Cell Carcinoma

Other Abnormal1


Patient Navigation Process Driven by Community Needs Assessment Address health care disparities and barriers to care of patients. The barriers identified are: improve resident’s health status; increase their life spans, and elevate their overall quality of life; to reduce the health disparities among residents; and to increase accessibility to preventive services for all community residents.

I. Cancer Prevention Program / Education – Cancer prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the chance of developing cancer. When applicable, pre and post evaluation scores are obtained (i.e. Brief Symptom Inventory 18 and Perceived Health Status).

January 5, 2016 “Exercise During and After Cancer Treatment” – Wings of Hope Young Women’s Breast Cancer Support Group / M. Bartels (10 attended). Discussed benefits of exercise, components of a well-rounded exercise program, tips to get started, as well as modifications for pain or for lymphedema. Provided examples of exercises, which may be beneficial for lymphedema.

March 13, 2016 “HouseCalls” - KMA Radio Program with Dr. Warner / M. Bartels – Discussion of lymphedema, lymphedema treatment, compression garments, etc. broadcasted to residents of southwest, Iowa.

March 31, 2016 Glenwood Women’s Health Symposium “Colorectal Cancer Diagnosis & Care” / Dr. A. Tran (125 attended). Participants will learn about colonoscopy screening guidelines and colorectal cancer diagnoses and treatment options. Upon completion of program the participant will be able to: discuss importance of colon cancer screenings, colorectal diagnoses, interventions, and treatment options

March 31, 2016 Glenwood Women’s Health Symposium “Breast Health Discussion” / Dr. M. Zlomke (125 attended). Participants will learn about a variety of breast health issues. Upon completion of this program, participants will be able to: discuss mammogram guidelines, identify the risk factors for breast cancer, describe benign breast disease, symptoms and findings, discuss the importance of individualized breast cancer treatment, list the basics of hereditary breast cancer, and explain the benefits of a Certified Cancer Center.

2016 community outReAch Activity summARy(stAndARd 1.8, 3.1, 4.1, & 4.2) (nApbc 2.15 & 4.1)

September 15, 2016 “Physical Therapy for Cancer Patients” – Methodist PTA Program / M. Bartels (25 educated). Discussed Physical Therapy treatment considerations for breast cancer patients - which included education on the Lymphatic system, what lymphedema is, and treatment options for this condition.

September 27, 2016 “Refuel for Health & Energy” – Wings of Hope A Time to Heal Program / C. Reeder (13 attended). Focused on the role of nutrition in healing, present good nutritional strategies for cancer patients, and offered ideas for quick and easy meals with high nutritional content.

October 3, 2016 “Getting to Know Your Oncologist” – Wings of Hope Annual Dinner / Drs. Parker & Warner (28 educated). Discussed the importance of forming a relationship with your oncologist to enhance communication throughout the treatment process.

October 18, 2016 “Renewing My Body, Regaining My Strength” – Wings of Hope A Time to Heal / M. Bartels (13 attended). Focused on how to rehabilitate the body after cancer treatment to improve muscle strength and endurance, and choosing an exercise program that is right for the individual. Information about coping with common physical side effects of treatment such as lymphedema is also discussed.

October 25, 2016 “Adventures / Misadventures in Supplement Jungle”– Wings of Hope A Time to Heal / M. Ryan (13 attended). Focused on navigating the ocean of information on vitamins, nutritional supplements, and herbal remedies marketed to breast cancer patients. Information given about how to choose supplements that are research-based, compatible with other medications, and safe for cancer survivors.

2016 community outReAch Activity summARy


II. Cancer Prevention Program Smoking Cessation - Methodist Jennie Edmundson provides a cancer prevention program targeted to meet the needs of the community designed to reduce the incidence of tobacco use and related sequelae. This prevention program was chosen due to the prevalence of tobacco usage in Pottawattamie and surrounding counties. According to the IA Department of Public Health (2015), the tobacco related disease burden is as follows:

Tobacco Related Disease Burden (age-adjusted rate / 100,000 population)

County Cancer Death Rate

Adult Cigarette Smoking

Prevalence %

Youth any Tobacco Use Prevalence %

Cass 173.6 15.0 19.8

Crawford 146.8 13.0 27.6

Fremont 183.6 17.0 7.1

Harrison 161.6 22.0 29.6

Mills 180.1 28.0 18.0

Montgomery 170.4 24.0 22.9

Page 193.0 16.0 22.5

Pottawattamie 180.3 22.0 17.4

Shelby 137.9 21.0 21.7

State of Iowa 167.7 18.5 18.1

The MJE Family Resource Center (FRC), has developed an educational packet that includes a list of community smoking cessation resources, and the following information:

• American Cancer Society - When Smokers Quit: Benefits of Quitting, Set Yourself Free, Deciding How to Quit, A Smoker’s Guide, Smart Move! A Stop Smoking Guide

• Quitline Iowa – When You’re Ready to Quit Smoking, We’re Here

• Krames - Why Do You Smoke?, The Health Effects of Smoking, Smoking Cessation Programs, Planning to Quit Smoking, When Smokers–Benefits of Quitting Set Yourself Free–Deciding How to Quit: A Smokers Guide


In 2016, the FRC nurse received a total of 1,266 requests for educational information on smoking cessation which decreased 36.0% (due to data extraction), from 1,974 in 2015. Of these 1,266 requests, 100% are generated when a patient presents to the hospital and is identified as a smoker through the admitting process, a physician’s order, or self- referral. Smoking cessation educational packets are also distributed at hospital cancer screening events and health fairs. All those who receive smoking cessation information are encouraged to contact Quitline IA. According to Quitline Iowa, the counts of registered participants are as follows:

Quitline Iowa Registered Participants FY 2015

County Registered Participants

Cass 71

Crawford 30

Fremont 24

Harrison 66

Mills 48

Monona 39

Montgomery 52

Page 86

Pottawattamie 407

Shelby 30

State of Iowa 9,661

Effectiveness: MJE data shows that 116 / 1,266 or 9% of identified patients actually sign the fax referral request to Quitline Iowa after smoking cessation education by the FRC nurse. Of these referrals, 61 / 116 or 53% have accepted services by Quitline Iowa.

According to the Iowa BRFSS 2013-2014 (retrieved from idph.gov, p. 31) the Quitline Iowa program of registered participants reports that 60% of current smokers have attempted to quit smoking in the past 12 months. A key finding reported is that 19% of the registered users have not smoked cigarettes, or used other tobacco products in the past 30 days and have successfully quit.



III. Cancer Screenings- Methodist Jennie Edmundson provides Cancer Screenings for 5 different anatomic sites annually. These sites correspond to the top incidence of cancers reported at our institution. The cancer screenings follow NCCN and other guidelines appropriate to the specific site screened (i.e. American Society of Colon and Rectal Surgeons, American Academy of Dermatology, American College of Obstetrics and Gynecology, and American Urological Association). Cancer screenings are intended to address the access to care barrier, and decrease the number of patients diagnosed with late-stage disease by detecting the cancer at an earlier stage.

Participants at these events are provided with educational information specific to the cancer type (i.e. healthy diet, exercise, tobacco cessation, sun protection, and self-health awareness).

Effectiveness: Overall, 264 patients participated in these cancer screening events with 6 cancers identified, which are now seeking care for their disease. This is decreased 21% from 2015, with 335 participants and 6 cancers identified. There were a total of 71 abnormal findings identified. These cancer screening participants were notified by letter of any abnormal findings, and were then followed with a phone call to encourage the patient to seek additional medical care.

Cancer screening participants are encouraged to complete an evaluation summary to assess screening usefulness and effectiveness. 190 / 237 or 80% completed the evaluation forms and 99% responded favorably that the cancer screenings were excellent, well organized, met a community service need, and provided access to care.

IV. Fundraisers / Health Fairs / Races – Methodist Jennie Edmundson participates in many community outreach activities to provide educational and promotional material to participants. The purpose is to encourage participants to become proactive with their health care needs and raise awareness of the services the hospital has to offer. Information includes breast education, healthy lifestyle choices, and smoking cessation materials.


1ST QUARTER

• River City Expo - Breast Health Center Booth

• Wings of Hope (WOH) Winter Fundraiser

• Omaha Boat, Sports & Travel Show - BHC Booth

• Glenwood Women’s Health Symposium

2ND QUARTER

• IWCC Health Fair

• WOH Spa Day

• Jenyi for Jennie Volleyball Tournament

• The Center’s Health Fair

• Council Bluffs Pride Parade

• Mills & Pottawattamie County Relay for Life

• The Bald & The Brave Challenge

• Spring into Summer Health Fair

• Wheels of Courage

• Bikers for Boobies



3RD QUARTER

• WOH Glow Ball Golf Tournament

• BHC Educational Booth at Leach Camper Sales

• Spirit of Courage Weekend

• Wellness Bash

• WOH Patient / Caregiver Focus Groups

• Community Education Foundation Fair

• WOH A Time to Heal

• BCBS Safe & Healthy Expo s

• WOH Walk

• IWCC Pink-out Football Game

• St. Albert Pink-out Football Game

4TH QUARTER

• WOH Annual Dinner

• IWCC Pink-out Soccer Games

• IWCC Pink-out Football Game

• Gubernatorial Signing for Breast Cancer Awareness Month

• MJE Council Bluffs Pink Out & Mayoral Proclamation

• MJE Pinkercise

• Wash Away Breast Cancer

• Great American Smokeout


Jean Thomsen, MDChairman*Pathologist*

Kathryn BartzClinical Research Representative*

Rick BlodgettVolunteer Chaplain

Scott Bomgaars, MDFamily Practice

Becky BusseyPhysical Therapist

Annabel Galva, MDDiagnostic Radiologist*

Roger Holland, MD / Nicole Nolan, MDRadiation Oncologist

Donna HubbellCancer Program AdministratorQuality Improvement Coordinator*

Sakeer Hussain, MD / Stacy Parker-Brueggemann, MDMedical Oncologist

Tammy JohnsonBreast Health Nurse Navigator

Michelle KaufmanCommunity Outreach Coordinator*

Deb Kinney / Jodi LudingtonCancer Conference Coordinator*

Barbara KricsfeldOncology Nurse / Radiation Oncology

Carol KroftCancer Registry Quality Coordinator*

Mary Jo MattheisOncology Nurse

Carol ReederDietitian

Melanie RyanPharmacist

Brent Wakefield, MDUrologist

Dee WicksPsychosocial Services Coordinator*

Michael Zlomke, MDCancer Liaison Physician*

2016 cAnceR committee membeRs

*designates individuals or positions that are required by the American College of Surgeons Cancer accreditation program.

2017 annual repotr...2016 cancer screening summaries 2016 cancer screening summaries skin cancer...

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