cancer annual report - final

8/3/2019 Cancer Annual Report - FINAL

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Faulkner Hospitals Cancer Program

Annual Report 2010


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Faulkner Hospitals Cancer Program | Annual Report 2010

2

It has been another produc-

tive year at Faulkner Hospital

with regard to cancer care.

We have chosen prostate

cancer as our focus this year,

particularly because of the

rapid changes in this field.

Faulkner Hospital has always

had a robust prostate cancer

screening and treatment

program and this has grown

with the addition of the new-

est generation DaVinci robot.

We have expanded clinicalservices with traditional open

surgical procedures and robotic prostatectomy. Working with

our Dana Faber colleagues we are also able to refer appropri-

ate patients for the latest technology in radiation therapy for

prostate cancer when indicated. This is a field with exciting

changes and advances and Faulkner Hospital continues to in-

vest in improving the services we offer.

This year was our scheduled site visit from the American Col-

lege of Surgeons. Our surveyors were impressed not only

with the volume of cancer care provided but also the compre-

hensive nature of the care in each service line and the commit-

ment of the providers, the members of the Cancer Committee

and hospital leadership. We were again certified by the Amer-

ican College of Surgeons as an Accredited Cancer Program.

Finally, a number of members of the Cancer Committee and

Medical Staff are participating in a state wide project looking

at best practices in mastectomy and implant based recon-

struction. I am co-chairing the state wide commission. Alex

Kauffman, RN (cancer committee), Dr. Yoon Chun (Plastic

Surgery), Dr. Stephanie Caterson (Plastic Surgery), Dr. CharlesHergrueter (Chief of Plastic Surgery) and Dr. Pardon Kenney

(Chief of Surgery) are all participating in the statewide com-

mission to improve outcomes, not just for patients in our own

institution but across the Commonwealth.

These are just a few of the exciting activities in cancer care at

Faulkner Hospital. Please look through our Annual Report to

learn more about the work were involved in and feel free to

contact me if you are interested in an educational forum being

offered on any of these topics.

Summary of Faulkner Hospitals Cancer Program

MARGARET M. DUGGAN,

MD, FACS

CHAIR CANCER COMMITTEE

About Faulkner Hospital

Faulkner Hospital is a 150 bed, non-profit, community teaching hospital located in southwest Boston.

Founded in 1900, Faulkner Hospital offers comprehensive medical, surgical and psychiatric care as

well as emergency, ambulatory and diagnostic services.


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Faulkner Hospital has been an Accredited Cancer Program

governed by the American College of Surgeons, Commis-

sion on Cancer since 1980. An essential component of the

program is the Cancer Registry which maintains a data base

on all cancer patients diagnosed or treated at Faulkner Hos-

pital. The current registry is comprised of one full-time and

one part-time CTR and one part-time registry clerk. Registry

personnel coordinate the collection, management and analy-

sis of data, as well as lifetime medical follow up which pro-

vides information for epidemiological, clinical, and research

studies and for educational purposes.

In 2009, the registry accessioned 1,370 analytic cases and treat-

ed an additional 60 cases that were recurrences or non-analyt-ic, totaling 1,430 new cancer patients added to our data base.

The Registry contributes data to the National Cancer Data

Base, Massachusetts Cancer Registry and Harvard School for

Public Health. This data is utilized for incidence monitoring,

cancer prevention and awareness, identifying high-risk popu-

lations and to help improve and standardize care across the

country.

The AJCC TNM (Tumor, Nodes, Metastases) staging system

is used to describe the extent of the spread of cancer and is a

valuable indicator of prognosis and survival. Figure 1 repre-

sents stage at diagnosis for all sites as compared to NCDB data

for 2009.

Figure 2 reflects the top ten most frequently seen cancers at

Faulkner Hospital and compares their frequency to the Ameri-

can Cancer Society estimate of new cases for 2009.

Overall, the cancer program has continued to expand and

work cooperatively with other departments in the hospital to

improve patient care and satisfaction. Faulkner Hospital offers

the highest quality cancer care and being accredited by the

American College of Surgeons is one important way in which

we demonstrate our commitment to that promise.

Cancer Registry Activity Report

Comparison AJCC Stage at Diagnosis FAULKNERNCDB

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 No Stage Unk

35%

30%

25%

20%

15%

10%

5%

0%

Site Frequency FAULKNERNCDB

Colon Rectum Bron/Lung Hem/Retic Skin Breast Prostate Bladder Thyroid Lymph Node

80%

70%

60%

50%

40%

30%

20%

10%

0%


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From 2003-2009, 653 cases of prostate cancer were diagnosed and/or treated at Faulkner Hospital; in

the latter part of this time period, the number of cases treated increased markedly (from 75 cases in

2007 to 258 cases in 2009, in association with the advent of robotic prostatectomy).

A detailed analysis of the 258 cases diagnosed in 2009 shows that the median age of Faulkner

Hospital prostate cancer patients is almost a decade younger than the national average, suggesting

successful early detection. The stage distribution at Faulkner further supports this conclusion, with

the vast majority of patients at Faulkner presenting in Stage II (typically curable disease). Indeed,

the vast majority (83 percent) of Faulkner patients are treated surgically, rather than by radiation or

hormonal therapy, and Stage II patients at Faulkner enjoy a 90 percent five-year survival, in keeping

with the national norm.

Analysis of Prostate Cancer Cases 2003-2009Tad J. Wieczorek, MD, FCAP

Women trust the breast care program at Faulkner Hospital because theres nothing routine about the

care and attention we provide. We combine our highly regarded services with the resources and expertise

of Dana-Farber/Brigham and Womens Cancer Center.

As a leader in all aspects of breast care, we not only provide you with comprehensive care and

personalized service, but offer peace of mind that comes from knowing youre getting the very best

care, close to you.

Whether its time for your annual mammogram, or youre concerned about your risk factors,

or you need leading-edge treatment for breast cancer, turn to the names you trust for breast care,

working together to care for you.

For more information, or to schedule an appointment, please call 617-983-7500.

www.faulknerhospital.org

Three of the many expert breast health care physicians at the breast care

program at Faulkner Hospital, left to right, Dr. Yoon Chun, Plastic Surgery;

Dr. Peggy Duggan, Breast Surgery; and Dr. Shara Oken, Mammography.

Dana-Farber/Brigham and Womens Cancer Center at Faulkner Hospital.

Theres no such thingas routine breast care.


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Under 20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

FAULKNER

NCDBComparison of Age at Diagnosis

45%

40%

35%

30%

20%

25%

15%

10%

5%

0%

Prostate Cancer

300

250

200

150

100

50

NumberofNew

Cases

2005 2005 2007 2008 2009

Year

Comparison of Treatment FAULKNERNCDB

Surgery Radiation Rad/Hormone Hormone Other No 1st Course

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Comparison of Stage at Diagnosis FAULKNERNCDB

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unk

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

2003-2009 National Prostate Survival Rate

120%

100%

80%

60%

40%

20%

0%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 9

0 1 2 3 4 5

Years

2003-2009 Faulkner Hospital Survival Rate.

100%

80%

60%

40%

20%

0%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 9

0 1 2 3 4 5

Years


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Prostate Cancer is the most common cancer diagnosis in men.

The incidence increases with age the treatment approach will

depend on the extent of disease, patient age and other co-mor-bidities. Faulkner Hospital has developed a comprehensive

program to address the needs of our patients with prostate

cancer, including the pre-operative and post-operative recov-

ery issues specific to theses cases.

Like many other cancers, prostate cancer can be treated by

multiple modalities. As seen in our report, the vast majority

of our cases are treated primarily by surgery. However, some

patients benefit from radiation therapy as their primary mo-

dality and depending on a patients age, co-morbid conditions

and stage of disease watchful waiting and hormonal therapy

could also be employed.

The back bone of Faulkner Hospital comprehensive prostate

cancer program is excellence in surgical services. Our urolo-

gists perform a high volume of radical prostatectomies, both

traditional open and robotic approaches. In 2009 the number

of prostatectomies rose to 258 which is three times the number

just two years earlier. The majority of cases are performed

by Dr. Robert Eyre, Associate Professor of Surgery (Urology),

Dr. James Hu, Assistant Professor of Surgery (Urology), and

Dr. Steven Chang, Instructor in Surgery (Urology) at Harvard

Medical School.

When radiation is the preferred approach, we have an ac-

tive collaboration with the radiation oncology departments

at Brigham and Womens Hospital for patients who choose

brachytherapy or radiation therapy for curative or palliative

treatment. Under the leadership of Dr. Anthony DAmico the

department is internationally renowned for their extensive

research in prostate cancer. See the Frequently Asked Ques-

tions regarding prostate seeds by Dr. Paul Nguyen, also of the

BWH/DFCC. This collaboration allows patients who chose to

have their prostate cancer care at Faulkner access to excellence

and innovation in surgery, radiation and systemic treatments.

The strength of the program is the breadth and depth of the

experience and knowledge of the clinicians in the program.

Our major contributing surgeons are described below. Each

brings a unique area of interest to the program, making pros-

tate cancer care at Faulkner Hospital an example of excellence

in service, caring and outcomes. Each surgeon has developed

a patient focused practice where education and training, as

well as academic involvement, are a critical piece of the entire

patient experience

Dr. Eyre has given several presentations over the past year to

a variety of civic organizations about prostate cancer. He also

gave the Presidential Address at the annual meeting of theNew England Section of the American Urological Association

in 2008 about technical modifications he has made over his

career to the open radical prostatectomy to reduce intraopera-

tive blood loss, shorten length of stay, reduce the time of post-

operative catheterization, reduce post-operative narcotic re-

quirement, and to achieve early continence. He currently has

three studies underway where he is utilizing date from his last

300 consecutive open prostatectomies that he has performed.

He is comparing the differences in reported margin positivity

between different institutional pathology departments with a

single surgeon experience. He is also looking at outcomes of

patients over the age of 70 who undergo open radical prostate-ctomy, as well as outcomes of men with Gleason grade 4+3 or

higher who undergo radical prostatectomy.

Dr. Eyre has an interest in the surgical management of post-

prostatectomy incontinence. He has reported his experience

with the male sling at the annual meeting of the New England

Section of the American Urological Association and at the an-

nual meeting of the Massachusetts chapter of the American

College of Surgeons.

Dr. Hu is internationally known for his

groundbreaking research comparing roboticprostatectomy to open prostatectomy using

a SEER database of Medicare patients. He

has published extensively on various aspects

of prostate cancer, including 16 papers either

out or in press for 2010. In 2010, 138 robotic-

assisted laparoscopic radical prostatectomies

were performed at Faulkner Hospital. The

overall positive margin rate was 12.5 percent and the median

length of stay was 1 day, which measures favorably with

published series. A complete list of Dr Hus publications is

available on the Faulkner Hospital website (www.Faulkner-

Hospital.org).

Dr. Chang has published articles this year on the utility of

ultrasensitive PSA in post-radical prostatectomy surveillance

of men, on the effect of common medications on serum PSA

in the cohort of men being screened for prostate cancer, and

about the factors that impact baseline preference for PSA test-

ing. His references cam also be found on Faulkner Hospitals

website.

Dr. Eyre and Dr. Paul Church provide a full range of treatment

options for post-prostatectomy sexual dysfunction. Each has

30 years of experience with penile prosthesis surgery.

Faulkner Hospitals comprehensive prostate cancer program

Dr. James Hu


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What is prostate brachytherapy?

It is the implantation of tiny permanent radioactive seeds

in the prostate through needles placed in the perineum. The

radioactivity kills tumor cells in the prostate and eventually

the seeds become inert within a year. At the DFCI/BWH, it is

performed under general anesthesia with robotic assistance

and real-time intraoperative planning. Patients go home the

next day with minimal discomfort and are often able to return

to work a few days later.

Who is eligible for brachytherapy?

Low-risk prostate cancer now represents the majority of

prostate cancers diagnosed in the United States. Patients with

low-risk disease (i.e. disease that does not occupy more than

half of one lobe on digital rectal examination, with Gleason

score 6 or less and PSA less than 10) are excellent candidates

for brachytherapy, and select patients with favorable

intermediate-risk disease (Gleason 3+4=7 with PSA60cc) and that the anatomy is suitable for brachytherapy.

Are the outcomes as good as other treatments?

With follow-up data extending out to 15 years, the PSA

control outcomes for brachytherapy appear to be equivalent to

surgery for low-risk disease and select patients with favorable

intermediate-risk disease.

What are the most common side effects?

The main short-term symptoms are urinary frequency

and urgency which can be managed with medications and

generally improves after 2 months. In the long-term, some

men may develop erectile dysfunction which often responds

to oral phosphodiesterase inhibitors. Significant long-term

rectal bleeding is uncommon.

Is the radioactivity a hazard to others?

The vast majority of the radiation is deposited within the

prostate with extremely minimal radiation outside the body.Radiation detectors attached to spouses have shown that the

total lifetime radiation exposure to the spouse as a result of

their partners brachytherapy is less than what we receive

in a single roundtrip flight from Boston to California. As a

precaution, patients are advised to avoid very close contact

with pregnant women or placing infants on their lap for 2

months after the procedure.

How do I get a patient evaluated for brachytherapy?

They should be referred to Dr. Paul

Nguyen who is the Director of Prostate

Brachytherapy and lectures nationally

on the subject. Contact the DFCI referral

hotline (877) 441-DFCI (441-3324), or email

[email protected].

FAQs about Prostate Brachytherapy:

An Excellent Treatment Option for Low-Risk Prostate Cancer


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If there was a surgeon with eyes

that could see with the clarity of a high-

powered microscope and hands that

could move with the precisions of a robot,

would you choose that surgeon for your

procedure? At Faulkner Hospital you can.

Faulkner Hospital offers the newest da

Vinci robotic surgery system to help

surgeons perform minimally invasive

procedures such as prostatectomy,

hysterectomy and certain forms

of general surgery.

For more information please

call .

If there was a surgeo

that could see with the c

powered microscope an

could move with the prec

would you choose that sur

rocedure? At Faulkner H

Faulkner Hospital offer

Vinci robotic surger

surgeons perform m

procedures such

hysterectomy a

f general surg

For more in o

all

With the da Vinci

robotic surgery system, they can.

| Prostate surgery |

| Gynecologic surgery |

| General surgery |

1153 Centre Street, Boston, Massachusetts 02130

www.FaulknerHospital.org


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Faulkner Hospitals Surgical Quality programs have ensured

that surgical patients undergoing cancer surgery are receiving

quality care through numerous ongoing programs. In 2010

Faulkner Hospital has been recognized by two national

organizations, American College of Surgeons (ACS) and

University Health Consortium (UHC) as a top provider in

several surgical quality care initiatives.

The ACS National Surgical Quality Improvement Program

(ACS NSQIP) is the first nationally validated, risk-adjusted,

outcomes-based program to measure and improve the

quality of surgical care. The program employs a prospective,

peer controlled, validated database to quantify 30-day risk-

adjusted surgical outcomes, which allows valid comparison of

outcomes among all hospitals in the program. The American

College of Surgeons noted Faulkner Hospital as an exemplary

provider in preventing surgical site infections (SSI). A SSI is

an infection that occurs after surgery in the part of the body

where the surgery took place. An exemplary rating means

that Faulkner Hospital is a national leader in preventing

surgical sites infections. Faulkner Hospital has earned this

honor for the past 3 annual reports.

The University Health System Consortium (UHC) is an

alliance of more than 100 academic medical centers and nearly

200 of their affiliate hospitals, representing more than 90

percent of the nations nonprofit academic medical centers. Its

products and services help members measure and improve

clinical performance...UHC has noted Faulkner Hospital

as a top 10 provider in several Surgical Care Improvement

Programs (SCIP). Areas where Faulkner Hospital is a leader

in surgical care are in use of the appropriate antibiotic prior to

surgery, Deep Vein Thrombosis (DVT) prevention, and the use

of Beta Blockers to prevent cardiac injury.

Finally, Surgical Quality Program is the adoption of the World

Health Organization (WHO) checklist. The implementation

of this checklist is designed to help ensure that surgical teams

are able to implement the checklist consistently. By following

a few critical steps, health care professionals can minimize the

most common and avoidable risks endangering the lives and

well-being of surgical patients.

Faulkner Hospital is committed in providing quality care

for the oncological patients to promoting smooth and

complication free recovery from lifesaving cancer surgery.

Any questions regarding surgical quality, contact Alexandra

Koffman, RN, MSN, Surgical Quality Program Manager.

Surgical Quality Programs for the Surgical Oncological Patients

Skin Cancer Screening

2010 marks the American Academy of Dermatologys 25th anniversary of the National Skin Cancer Screening Pro-

gram. Dr. Eva Balash, along with Faulkner Hospitals Community Health & Benefits program, has participated in

this campaign since the inception. Although many doctors have participated through the years, Dr. Balashs prac-

tice, Boston Family Dermatology, offers the free program to the community every spring. When questioned about

her driving motivation to keep hosting the free screening, Dr. Balash responded, It is very important to provide

a screening service to people who may not otherwise see a doctor. I have had the profound experience of being

able to detect potential problems early on in many patients at the free screenings, and have helped them fromdeveloping more serious conditions. Dr. Balash screened twenty four patients in the spring of 2010.

Community Outreach Programs

Faulkners early detection health screening programs were created in response to information received through

continual communication and collaboration with community residents, service providers, and advisory groups, as

well as through the review of health status indicators. In 2009, Faulkners cancer related screenings served 232

participants, all of whom received the services free of charge thanks to physicians, nurses, clinical specialists, tech-

nicians, and health educators who donated their time and expertise. Such screenings include: cervical cancer, skin

cancer, colorectal cancer, and breast cancer.


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Approximately 184,000 women are diagnosed with breast

cancer each year in the United States, and 90% of these

women will live at least 5 years. Improvements in immediate

treatment outcomes have led to an increased focus on

morbidity among survivors. The Journal of Breast Cancer

Research and Treatment, 2008, published an article by Lee

et al. which attempts to capture the prevalence of residual

functional impairments following surgery. They conducted a

systematic review of 32 studies which focused on prevalence

and severity of upper limb problems following surgery

and radiation for breast cancer. The review found shoulder

restrictions, upper limb weakness, lymphedema, pain, and

reduced quality of life are commonly reported outcomes of

surgery and radiation for early breast cancer for months toyears following surgery.

The Faulkner Breast Centre and the Faulkner Rehabilitation

Services Department have recently joined forces to create a

new post-op program for breast surgery patients which offers

the initiation of physical therapy immediately following

mastectomy, axillary lymph node dissection, and/or breast

reconstruction. It has been designed with input from breast

surgeons, plastic surgeons, and our nursing colleagues at

Faulkner Hospital, as well as research on inpatient physical

therapy programs at Brigham and Womens Hospital,Memorial Sloan Kettering Cancer Center and University of

North Carolina Hospital.

Immediately following breast surgery, patients are faced with

pain, post-op drains, sensory deficits, and postural changes

due to protective guarding. Often they lack knowledge of

safe range of motion exercises, receive conflicting information

regarding activity precautions, and remain unaware of

lymphedema risk reduction strategies. Upper extremity

weakness, pain, lymphedema and decreased range of motion

in the shoulder are common impairments associated with

breast surgery and sentinel lymph node biopsy or axillary

lymph node dissection. These symptoms can range from mild

to severe and may become chronic, with a profound effect on a

patients quality of life.

The Rehabilitation Services Outpatient Department at

Faulkner currently treats post-op breast surgery patients

referred anywhere from weeks to months after surgery with

complaints of continued pain, scar adhesions, limited shoulder

range of motion and functional limitations. The patient will

work with a physical or occupational therapist to help regain

range of motion, decrease scar adhesions, manage swelling

and initiate an exercise program to guide the patient towards

their prior level of function. The department also offers

lymphedema treatment for patients who develop lymphedema

in their upper extremity secondary to lymph node dissection

and/or radiation. Patients referred to outpatient therapy

will often report lack of information, immediate anxiety post-

operatively and delayed initiation of range of motion exercisesfollowing surgery.

This new program was developed with the aim of decreasing

pain, soft tissue restrictions and shoulder impairments

associated with delayed initiation of motion. It recommends

initiation of physical therapy for breast patients during their

inpatient stay when prescribed by the surgeon to ease patient

anxiety and provide patients with information regarding

gentle range of motion exercises and gradual return to prior

level of function. The purpose of the physical therapy visit

will be to educate patient on short term precautions, reviewgentle active motion exercises and deep breathing techniques,

discuss gradual return to activities, and review lymphedema

risk reduction strategies. Patients will be given verbal and

written instructions consistent with updated information

listed in the Faulkner Hospitals A Guide to Breast Surgery

which patients receive prior to surgery. The program is

currently under final stages of development and will be

available later this fall. Program will be provided to patients

with surgeon referral.

Initiating Physical Therapy Immediately Following Breast Surgery


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Committee Chair

Margaret Duggan, MD

Matthew Blom

American Cancer Society

M. Madeleine Glennon, CTR

Cancer Registry

Eileen Joyce, LICSW

Social Work

Alex Koffman, RN, MSN

Quality Improvement

Edward Liston-Kraft, PhD

Professional and Clinical Services

Harvey Mamon, MD, PhD

Radiation Oncology

Stacey Miller, CHES

Community Health & Benefits

Dan Morganstern, MD

Oncology

Faina Nakhlis, MD

Surgery

Janet OConnor

Oncology Coordinator

Shara Oken, MD

Radiology

Rosemary Ryan, MD

VNA Care Network, INC.

Debra Torosian, MA, RHIA

Health Information Services

James Warth, MA

Oncology

Tad Wieczorek, MD

Pathology

Faulkner Hospitals Cancer Committee Membership

Breast MRIs done at Faulkner Hospital now available system-wide

Faulkner Hospitals Department of Radiology recently

announced that breast MRIs performed at the Sagoff Centre are

accessible on the Picture Archive and Communication System

(PACS). Referring physicians throughout the entire Partners

network can view images taken at Faulkner Hospital without

needing to request film.

PACS solves many of the limitations that were associated with

film, says Brian McIntosh, Director of Radiology. While film

could only be available in one place at a time, which could

result in delayed patient care, PACS allows patient studies to be

viewed from any referring physician on a Partners computer.

While PACS enables increased efficiency for physicians,the system also benefits the patient. Those patients whose

images are stored on PACS no longer need to contact Faulkner

Hospitals Image Service Center to request a CD of their scans

if they are being seen by a Partners physician. By eliminating

this step, it is more convenient for our patients. Its one less

thing they have to worry about, adds McIntosh.

Dr. Parisa Lotfi reviews a breast MRI recently performed atFaulkner Hospitals Sagoff Breast Imaging and Diagnostic Centre.

Breast MRI appointments are available six days a week and

include evening and weekend hours at Faulkner Hospitals

Sagoff Breast Imaging and Diagnostic Centre.


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1153 Centre Street

Boston, Massachusetts 02130

Telephone: 617-983-7000

www.FaulknerHospital.org

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