Baptist Health Cancer Care1 Trillium Way

Corbin, KY 40701606.523.1934

Annual Report

2017

BAPTIST HEALTH CANCER CARE 2017 Annual Report

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Contents

Intro Letter .................................................................................................................................................................... 3

Clinical Research ........................................................................................................................................................... 4

Quality Improvement Initiatives ................................................................................................................................... 6

Cancer Patient Support Services ................................................................................................................................. 34

Outreach Programs ..................................................................................................................................................... 37

Awards & Accreditations ............................................................................................................................................ 41

2017 Cancer Committee Members ............................................................................................................................. 42

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Intro Letter Baptist Health Corbin’s Cancer Center is dedicated to providing top quality, compassionate, comprehensive, integrated and personalized care to our patients. We offer a full range of services, including: cancer screening, diagnostic and therapeutic procedures, genetic counseling and testing, laboratory services, surgical interventions, diagnostic and therapeutic endoscopy, clinical research participation, education, nurse navigation, nutritional counseling, social services, financial counseling, and mental health services. We offer support group services, physical therapy and lymphedema services. We offer integrated health services including oncology massage and therapeutic touch. We offer palliative medicine services and advance care planning. We have a strong oncology pharmacy staff and OCN - certified infusion nurses to assure safe and effective as well as comfortable delivery of care. In 2016, we updated our Electronic Medical Record so that all care and records would be easily accessible and available to providers of care both within and outside our system as well as directly to our patients. We also built a new cancer center aimed at providing a safe and comfortable care environment. We are dedicated to providing both clinically excellent and up-to-date care, as well as a compassionate care team and comfortable environment of care to our patients. Our high standards of care have been recognized by numerous different entities. Our medical oncology center received a Press Ganey Guardian of Excellence award for reaching the 95th percentile for patient experience in 2016. Additionally, Baptist Health Corbin is one of 153 hospitals internationally to have received the Pathway to Excellence designation from the American Nurses Credentialing Center. This award recognizes a healthcare organization’s commitment to creating a positive nursing environment leading to safe and excellent patient care. We are pleased to offer close coordination with cardiac services necessary to support our patients and were honored to learn that Baptist Health Corbin has received the Mission: Lifeline Bronze Receiving Quality Achievement award from the American Heart Association for quality improvement measures. With our EMR update, we were a repeat honoree, being included in the nation’s “Most Wired” hospital systems according to the American Hospital Association’s Health Forum. Our hospital is pleased to have received the following accreditations as we strive to provide excellent care: ISO 9001 Certification, College of American Pathologists (laboratory), American Association of Blood Banks (blood bank), Commission on Accreditation of Rehabilitation Facilities (Physical Rehabilitation Center) and Chest Pain Center Accreditation. At Baptist Health Corbin, we go out of our way to treat our patients the way we would want our own family members to be treated. We strive to educate and support our patients to feel empowered and involved in their own care. We work to help our patients and their families to feel educated, comfortable and cared for and we continually push forward to make sure our patients receive the best care available anywhere. This year’s annual report is focused on improving the timeliness of care to our patients, recognizing that all of our care is ultimately aimed at providing our patients with more time. Specifically, we are focusing on improving the timeliness of laboratory turn around, which we found affects almost all of our patients. We have been working closely with our clinical and laboratory staff, using both work improvements as well as physical improvements to our facility to improve our patient experience by helping with shorter wait times for laboratory results. Our Baptist Health Corbin Cancer Care team is working today to ensure a brighter tomorrow for our patients and their families. We are pleased to work on continual improvement as both the Art and Science of Medicine advance to provide care our community with top notch, up-to-date, integrated and comfortable cancer care for our friends, families, communities and neighbors.

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Clinical Research The Corbin Oncology Research department has made tremendous strides over the past couple of months beginning in 2017. A new Research Coordinator, specific to Corbin was introduced. Currently there are four patients enrolled in three different treatment trials. Physicians and staff are meeting frequently to discuss the enrollment updates, potential new trials, and any updates to current trials that are open. Our program is currently researching new trials relative to the Corbin Oncology patient population. We hope to continue our enrollment increases as the year continues. Standard: 2% (7 cases) Clinical Trial Activity for Calendar Year 2016

Total Patient Count: 13

• Screen Failed: 9 • Off Trial-Withdrawn: 1 • Off Trial-Completed: 1 • Off Treatment-Survival Only: 1 • Lost to Follow-Up: 1 • Enrolled: 0

2016 Total #

Number Prevention Trials 0

Number Screening Trials 0

Number Treatment Trials 11

Number Quality of Life Trials 1

Number Other ?

2016 Total %

Quarterly Overall Accrual 0 0 Projected Analytic Caseload 350 350 Projected Percent Accrual 4.00% 4.00% Qtr. Overall Analytic Caseload

Qtr. Overall Percent Accrued 0% 0%

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Clinical Trial Activity for Calendar Year to date 2017 Standard: 2% (7 cases)

Total Patient Count: 24

• Screening: 4 • Screen Failed: 13 • Off Trial-Withdrawn: 1 • Off Trial-Completed: 0 • Off Treatment-Survival Only: 0 • Lost to Follow-Up: 0 • Expired: 2 • Enrolled: 4

2017 Total #

Number Prevention Trials 0

Number Screening Trials 0

Number Treatment Trials 11

Number Quality of Life Trials 1

Number Other ?

January - March

2016

April - June 2016

July - September

2016

October - December

2016

2016 Total %

Quarterly Overall Accrual 3 1 - - 4 4 Projected Analytic Caseload 350 350 350 350 350 350 Projected Percent Accrual 4.00% 4% 4.00% 4.00% 4.00% 4.00% Qtr. Overall Analytic Caseload

Qtr. Overall Percent Accrued 0.9% 0.3% - - 1.1% 1.1%

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Quality Improvement Initiatives Reducing Lab Turn around Times for Oncology Patients Green Belt Process Excellence Story

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Cancer Patient Support Services GENETIC COUNSELING The Genetic Counselling program was introduced as part of a commitment to provide high-quality comprehensive care. The program provides services in not only Cancer Genetics, but also Prenatal Genetics, Cardiac Genetics and General Genetics. The Hereditary Cancer Program was developed because many people with a family history of cancer worry that they or a loved one will develop cancer. Our genetic counselors analyze and discuss the patient’s risk or developing cancer. They also discuss what the patient can do to lower the risk of developing cancer and increase the chance of early detection if cancer does occur. SURVIVORSHIP SERVICES As patients complete their treatment they may have many questions about what lies ahead. Survivorship services include providing patients with treatment summaries, providing ongoing care of survivors and their caregivers, describing preventive measures to help the patient stay healthy, scheduling follow up visits and tests and referring patients to appropriate services, if necessary, to address late effects of treatment. PASTORAL CARE We recognize that we have needs beyond our physical selves. Our pastoral care staff is ordained ministers and are available upon request for patients and family members who have spiritual needs such as, discernment, sacramental needs, prayer and pastoral counseling. All faith traditions are respected and welcomed. CLINICAL RESEARCH The Research Program at Baptist Health participates in numerous research trials in a variety of clinical areas such as Oncology, Pulmonology and Cardiology. More than 40 physicians currently serve as investigators or co-investigators across the system. Clinical trials provide patients with yet another option to the patients’ treatment. Participation in clinical trials is voluntary and our staff is available to answer questions at any time. BREAST CANCER NAVIGATION SERVICES The nurse navigator meets with newly diagnosed breast cancer patients to provide educational material about his/her cancer and works with the patient to help them and their family better understand the type of cancer they are facing. The nurse navigator schedules and coordinates upcoming appointments. She meets with the patient and family at the time of surgery and follows them throughout treatment. The navigator encourages the patient during treatment, serves as a resource for and provides a support group for all survivors. SUPPORT GROUPS Our staff facilitates support groups and educational programs for patients and families affected by cancer. The opportunities to share and learn from others are offered on site. In addition to support groups open to all cancer types, specialized groups are also offered to breast cancer survivors. INFUSION CENTER The 22-chair chemotherapy suite offers a comfortable, safe and therapeutic environment for receiving outpatient therapy. The center is staffed with highly trained oncology and chemotherapy certified nurses.

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SOCIAL SERVICES Our social workers provide individuals, families and groups with the emotional support, guidance and counseling needed to cope with chronic, acute or terminal illnesses. Services include advising patients and caregivers, providing patient education and counseling, and making referrals for appropriate services. May also provide care and case management or interventions designed to promote health, prevent disease and address barriers to access to healthcare. FINANCIAL COUNSELING SERVICES Our financial counselor helps the patient navigate thru the financial stressors incurred with a cancer diagnosis. She reviews the hospital charges, patient’s insurance status and their financial resources. If resources are insufficient, the counselor identifies additional assistance for which the patient may be eligible. The counselor may also determine that the patient is eligible for reduced fees or free services under federal or state medical assistance programs. She may also work with the billing department to arrange a payment plan. NUTRITION SERVICES Individualized medical nutrition therapy is available to patients, families and caregivers to ensure optimal nutritional health at home. The clinical nutrition department is staffed with all masters-prepared registered dietitians. The clinical dietetics staff works closely with each patient’s healthcare team to provide comprehensive care, with the goal of keeping patients strong, maintaining muscle mass, promoting healing, treating nutritional deficiencies and minimizing complications and side effects of treatments and disease process. Our dietitians’ primary goal is to promote quality of life before, during and after cancer diagnosis and treatment through individual medical nutrition therapy PHARMACY SERVICES Pharmacy provides many services to our oncology patients. An oncology pharmacist is staffed each day to provide any needs for our patients: compounding chemotherapy doses, counseling on chemotherapy and supportive medications, physician consultation, etc. Pharmacy also has financial patient services available to assist with either copayment or replacement of medications. A retail pharmacy is on site and available to fill any supportive medications with option of delivery to the patient in the oncology clinic. For oral chemotherapy and specialty medications, patients are enrolled in our specialty pharmacy to assist in managing/obtaining these medications. A pharmacist is available at any time to address any pharmacy related issue. INTEGRATIVE HEALTH SERVICES We have available integrative health services that can encourage patients and reduce the side effects of conventional cancer care. This includes massage therapy, healing touch, guided imagery and aromatherapy. MASSAGE THERAPY An oncology massage is a customized massage session designed to meet your unique needs as you go through cancer treatment or if you have had treatment in the past. Sessions may include a hand massage during treatment or a session scheduled in our massage therapy suite located inside our hospital. Your massage plan will aim to help relieve the short- and long-term side effects. Oncology massage is provided by a licensed massage therapist who has received training in cancer and cancer treatment. General benefits: Reduced stress, improved sleep, reduced fluid accumulation, eased constipation, increased alertness and mental clarity, reduced anxiety, less nausea and reduced pain.

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HEALING TOUCH Healing Touch (HT) is a non-invasive form of gentle touch and energy work. By promoting deep relaxation, HT can improve overall sense of well-being and the ability to cope with challenging life events. Individual HT sessions lasting between 30-45 minutes are tailored to your individual needs. The individual will lie fully clothed on a bed, chair or massage table while the provider gently places their hands slightly above or on the individual. People frequently report feeling deeply relaxed and peaceful during and after the session. GUIDED IMAGERY Guided imagery is a gentle but powerful technique that focuses and directs the imagination in proactive, positive ways. The effectiveness of guided imagery has been increasingly established by research findings that demonstrate its positive impact on health, specifically to reduce the aversive effects of chemotherapy and radiation therapy, especially nausea, depression, soreness and fatigue. Guided imagery tracks can be customized with music and positive affirmations can be listened during or after treatment. AROMATHERAPY Aromatherapy is the use of essential oils from plants as a therapy to promote physical and emotional well-being. Aromatherapy can help relieve certain physiological and emotional symptoms including Stress, Anxiety, and Difficulty sleeping. To administer the essential oil, a small amount is placed on a cotton ball, which is waved gently about 6 to 8 inches in front of your nose while you inhale deeply. Our Massage Therapist is trained in Clinical Aromatherapy.

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Outreach Programs Cancer screening programs help detect cancers at an early stage, which improves the likelihood of increased survival and decreased morbidity.

Lung Cancer Screening

Lung cancer is the number one cause of cancer-related deaths in the U.S. and in Kentucky. The American Cancer Society estimates that the lifetime risk of developing invasive lung cancer is 1 in 13 for men and 1 in 16 for women. However, recent research shows that more than 80% of lung cancers may be cured if detected early.

Baptist Health Corbin offers a quick, painless way to detect lung cancer early with its Lung Cancer Screening program, designed to identify potential lung issues before they become problematic. If a malignant tumor is found while it is still small, there is a better chance that it can be removed before the disease spreads to other areas of the body.

CT lung cancer screenings are recommended for those who:

• are 55-80 years old, • are heavy smokers (a pack a day for 30 years) or have quit smoking within the last 15 years • have no signs, symptoms, or personal history of lung cancer.

CT lung screening is a noninvasive, painless procedure that uses low-dose X-rays to screen the lungs for cancer. There is no preparation for this scan and it normally takes less than 15 minutes to complete. Kentucky has one of the highest rates of lung cancer in the nation. In the National Lung Screening Trial, a recent study of more than 53,000 heavy smokers revealed that getting CT scans every year for three years reduced lung cancer deaths by 20%. The following statistics are low dose CT screenings for 2017. The Nurse Navigator follows all positive scans.

Month # of Scans January 2017 11 February 2017 22 March 2017 20 April 2017 21 May 2017 10 June 2017 18 July 2017 15 August 2017 14 September 2017 19 October 2017 24 November 2017 19 December 2017 19

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Mammography

Baptist Health Corbin has a dedicated breast care center that serves Southeastern Kentucky and Northern Tennessee.

The latest technology in digital mammography, 3-dimensional breast imaging with tomosynthesis is available. It provides a clear and accurate view of the breast that allows physicians to effectively pinpoint the size, shape and location of any abnormalities. Breast tomosynthesis uses high-powered computing to convert digital breast images into a stack of very thin layers or “slices”- building what is essentially a 3-dimensional mammogram.

Breast MRI is used to detect breast cancer or abnormalities of the breast by capturing multiple images that are combined to generate a detailed image for diagnosis.

The CAD (Computerized Aided Detection) system assists the Radiologist by seeking out and highlighting areas that need to be given a closer look. The CAD system digitizes a mammogram and analyzes it.

Stereotactic breast biopsy is a safe and relatively painless non-deforming and cost effective alternative to biopsy surgery to a patient with an abnormal mammogram. Baptist Health Breast Care Corbin performed 4,725 screening procedures in 2016.

Colorectal Screening

The risk of colorectal cancer increases dramatically with age. Ninety percent of all colorectal cancers are diagnosed in persons over the age of 50. There is no single cause of colorectal cancer and nearly all begin as noncancerous polyps that slowly develop into cancer. Early stage colorectal cancer does not typically have symptoms. Symptoms of advanced colorectal cancer may include:

• Rectal bleeding • Blood in stool • Change in bowel habits • Cramping pain in the lower abdomen • Decreased appetite • Weight loss

The following screening guidelines are recommended for most adults:

• Age 50 or over: Everyone age 50 and over should have a colonoscopy. If no polyps are found, the colonoscopy should be repeated every 10 years.

• Colorectal polyps: If colorectal polyps are identified at any age, screening should be repeated within 3-5 years.

• Family history of colorectal cancer: If you have a family history of colorectal cancer, please consider visiting our genetic counselor to discuss your cancer risks because you may need to begin screening at an earlier age.

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Screening methods: • Flexible sigmoidoscopy • Colonoscopy • Double contrast barium enema • Fecal occult blood test

During the month of March, which is Colon Cancer Awareness month, materials were displayed in the hospital lobby with information about colon cancer and the importance of screening. The staff from BHMG Gastroenterology assembled packets about colonoscopies and distributed them to area health providers to encourage screening of patients. There is a colorectal cancer risk assessment available on the Baptist Health Corbin website to estimate personal risk of developing colon and rectal cancer in addition to other resources. Skin Cancer

Skin cancer is the most common cancer in the United States. Basal cell carcinoma is the most common form of skin cancer. More than 4 million cases are diagnosed in the U.S. each year. Squamous cell carcinoma is the second most common form of skin cancer. More than 1 million cases are diagnosed in the U.S. each year. Melanoma is the least common but also the most deadly skin cancer, accounting for only about 1% of all cases, but the vast majority of skin cancer deaths. In 2017, it is estimated that there will be 87,110 new case of melanoma in the United States and 9,730 deaths from the disease.

Educational materials and sunscreen were distributed to individuals at an informational booth organized by the Nurse Navigator and the Clinical Manager of Oncology on June 29, 2017 to promote awareness of skin cancer. A DermaScan machine owned by the Kentucky Cancer Program was loaned to the hospital for the day and 187 people were screened.

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Awards & Accreditations Press Ganey Guardian of Excellence Award Baptist Health Cancer Care was honored to receive the 2016 Press Ganey Guardian of Excellence Award for Patient Experience. The Guardian of Excellence Award honors organizations who have achieved the 95th percentile or higher for the composite Overall Rating based on the standard Press Ganey Quarterly Reports during the course of the award year (May-April). Client peer groups are determined based on the information in the demographic profile. To be eligible, clients must participate in one of the targeted award peer groups (listed below), meet minimum n guidelines* based upon the targeted peer group and be actively surveying for the entire reporting period. Data are reviewed from standard quarterly reports delivered between May 2015 – April 2016. Esurvey adjustments and phone calibrations are applied to all data where appropriate. Baptist Health Cancer Care opened in 2012. We are fortunate to have skilled and compassionate physicians who provide leadership by example. The chemotherapy suite is staffed by trained oncology and chemotherapy certified nurses. To obtain the Press Ganey Guardian of Excellence Award requires a committed team and we are fortunate to have a highly trained and caring team of caregivers. Cancer is often a difficult journey. We recognize that each patient is an individual and our goal is to make this journey a positive patient experience Pathway to Excellence designation In August 2017, Baptist Health Corbin achieved Pathway to Excellence designation by the American Nurses Credentialing Center. The Pathway to Excellence designation identifies the elements of interprofessional work environments where nurses can flourish and feel empowered. The designation substantiates nursing job satisfaction at Baptist Health Corbin and identifies it as one of the best places to work. Sherrie Mays, MSN, RN, Vice President, Chief of Nursing stated, “This designation reflects the great nursing care that our staff provides to our patients. I am so proud of their accomplishment.” The Pathway to Excellence designation is granted based on the confirmed presence of the six Pathway to Excellence Practice Standards: 1. Shared decision-making 2. Leadership 3. Safety 4. Quality 5. Well-being 6. Professional development For an organization to earn the Pathway to Excellence distinction, it must successfully undergo a thorough review process that documents foundational quality initiatives in creating a positive work environment — as defined by nurses and supported by research. These initiatives must be integrated in the facility’s practices, policies and culture. Nurses in the organization validate the presence of the criteria in the organization through participation in a completely voluntary and confidential online survey. As a Pathway to Excellence designated organization, Baptist Health Corbin is committed to creating an environment where nurses excel and feel valued as integral members of interprofessional health care teams. This designation confirms to the public that nurses working at Baptist Health Corbin know their efforts are supported. The honor encourages other nurses to join their colleagues in this desirable and nurturing environment. The Pathway to Excellence designation is perfectly suited to and desired by health care organizations around the world.

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2017 Cancer Committee Members Abigail Byrnes, MD Committee Chair Hematology/Oncology Joey Bargo, MD Radiologist Freida Belcher, RT(R), CTR Cancer Registrar Joshua Bowling, RPh Pharmacy Supervisor Joyce Brown, RN Breast Cancer Navigator Sara Campbell, MS, CGC Genetics Counselor Allison Christian, BS, MPH Research Coordinator Elvis Donaldson, MD GYN Oncology Lisa Gomez, RN OCN Oncology Clinical Manager Debbie Hardin Director of Marketing (Alternate) Eryn Harmon, RN Palliative Care Chris Holcomb Executive Director of Behavioral Health Aaron House, MD General Surgery

Phillip Johnson Chaplain Manager Christine Meece, MD Pathology Barbara Michna, MD General Surgery (Alternate) Anthony Powers Vice President of Out-Patient Services Lee Richardson Director of Foundation Community Health Services Debbie Scarberry, MA, RDN, LD, CDE, MLDE Dietetics Clinical Manager Pamela Taylor, MA, BSW Social Services Alice Tremaine, MDiv, BCC Regional Advance Care Planning Coordinator Alternate) Crystal Ward, RN Director of Rehabilitation Julie Waters ACS Representative Michael White, MD Hematology/Oncology Helen Wilson, RN Executive Director of Quality Swati Yalamanchi, MD Hematology/ Oncology