cancer committee - queen's · 2018. 4. 19. · 1 cancer committee annual report 2016 cancer...

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CancerCommittee

A N N U A L R E P O R T 2 0 1 6

THE QUEEN’S MISSION

To fulfill the intent of Queen Emma and

King Kamehameha IV to provide in perpe-

tuity quality health care services to improve

the well-being of Native Hawaiians and all

of the people of Hawai‘i.

THE QUEEN’S VISION

To be the preeminent health care system of the Pacific, pro-viding superior patient care that is continually advanced through education and research.

Through our stewardship and dedication, we embrace these values in our Philosophy of Care, Lokomaika‘i, or inner health.

We believe that all people will be cared for with dignity and respect in an environment which is sensitive to each person’s beliefs, values, and culture. Each team mem-ber, patient, and family is committed to a collaborative approach in providing an environment that will promote healing of mind, body, and spirit. Our philosophy is extend-ed in a place of harmony as guided by the vision and ide-als of our founders.

SHARED VALUES (C.A.R.E.)

Compassion guides our actions

Aloha inspires us in all that we do

Respect and understanding are essential for the dignity of all

Excellence is our quest

GUIDING PRINCIPLE

One team committed to the best patient C.A.R.E. for our community.

Our Shared Values and Guiding Principle are a set of beliefs and behaviors that honor the intent of our founders, Queen Emma and King Kamehameha IV, and guide the performance of our organization. Sustaining the royal vision is an ongo-ing cycle that began with our founders. Guided also by our mission and vision, The Queen’s Health System’s Board of Trustees and management use Ka ‘lke Pono to align our efforts. Ka ‘lke Pono (striving to perfect the vision) is a con-tinuous process that integrates strategic, business, and financial planning. Our commitment to a mission-driven, per-formance-focused culture allows us to continuously improve, growing ever stronger as we strive to fulfill the extraordinary responsibility of sustaining the royal vision.

1859: The Queen’s Hospital founded by King Kamehameha IV & Queen Emma

1878: Oldest cancer case on record

1970: First oncology unit at Queen’s

1972: Acquired first linear accelerator to treat tumors

1974: Accredited by the Commission on Cancer

1976: Comprehensive Cancer Care Program

1977: Oncology Unit Opens

1979: QMC/University of Hawai‘i Cancer Research Center collaboration

1981: 48-bed inpatient oncology unit opens

1994: Accredited by the American College of Radiology

1997: First in U.S. with 32-ring PET scanner; First PET in Hawai‘i

2004: Molokai General Hospital Cancer Care established

2006: Patient Navigation Program established

2007: Acquired 64-ring PET-CT Scanner; Queen’s Cancer Center Opens

2008: Oncology Research Department created

2009: First hospital survivorship program in Hawai‘i; National Accreditation for Breast Centers—first in Hawai‘i

2010: QMC selected by National Cancer Institute Cancer Centers Program

2013: Quality Oncology Practice Initiative Certification

2014: NCI Community Oncology Research Program (NCORP) subgrant; first Comprehensive Cancer Biorepository in Hawaii

2015: North Hawai‘i Community Hospital Cancer Center established; affiliation with MD Anderson Cancer Network®

2016: QMC – West O‘ahu Infusion Center opens in preparation for Cancer Center opening in 2017

1942: Deep Roentgen therapy machine installed

1949: First tumor board

1960: Acquired two million volt x-ray machine to shrink tumors; Oncology Data Registry established

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1931: Cancer Clinic established for outpatients

TABLE OF CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Summary Of Oncology Data Registry Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Summary of 2016 Cases - The Queen’s Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Newly Diagnosed Cancer Cases Reported in the State of Hawai‘i, 2012 - 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Classification of Newly Diagnosed Cases - 2012 - 2016, The Queen’s Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Place of Residence at Diagnosis - 2016, The Queen’s Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Age & Gender Distribution at Diagnosis - 2016, The Queen’s Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Top 10 Cancer Sites Reported at The Queen’s Medical Center & the State of Hawai‘i . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

5 Leading Cancer Sites by Gender, The Queen’s Medical Center vs. the State of Hawai‘i . . . . . . . . . . . . . . . . . . . . . . . .10

Distribution by Ethnicity, The Queen’s Medical Center vs. the State of Hawai‘i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

The Queen’s Cancer Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Multidisciplinary Care Clinics: A Team Approach to Cancer Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Inpatient Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Patient Navigation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Cancer Survivorship Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Queen’s Head and Neck Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Pain & Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Pharmacy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Oncology Research Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Queen’s Pathology, Molecular Diagnostics Laboratory & Biorepository . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Hospital Ministry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Comprehensive Genetics Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Imaging Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Social Work Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Queen’s Women’s Health Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Community Outreach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Food & Nutrition Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Cancer Committee Annual Report 2016 21 Cancer Committee Annual Report 2016

PREFACE

The Queen’s Medical Center Cancer Committee thanks the Queen’s Board of Trustees and Art Ushi-jima, President & CEO of The Queen’s Health Sys-

tems, for their unwavering support of our oncology pro-gram . While we are delighted to gain local and national accolades for our accomplishments, none of this would have been possible without the support of our leadership .

The process of taking this cancer program to the next level began many years ago when the Queen’s Board of Trust-ees approved the building of the Queen’s Cancer Center . This dream soon became reality, shaped by Mr . Ushijima’s desire to integrate the concepts of The Queen’s Health Systems’ five-year plan, Ka ‘lke Pono (striving to perfect the vision), into the Queen’s Cancer Center .

QMC has established itself as the provider of choice for oncology patients in the State of Hawai‘i . Additionally, QMC is the employer of choice for the majority of oncology nurs-es, health professionals, and support staff . In keeping with the request of the Board of Trustees, QMC has escalated its oncology research efforts and increased the number of patients who participate in clinical trials .

Our philosophy is extended in a place of harmony as guid-ed by our founders, King Kamehameha IV and Queen Emma . The Queen’s Medical Center embraces a hospi-tal-wide philosophy of care called Lokomaika‘i, or “inner health .” The purpose of Lokomaika‘i is to create a healing environment that promotes and fosters partnerships with patients, their families, and health care teams throughout the organization . Another aspect of Lokomaika‘i is to build a values-based organization centered on compassion, alo-ha, respect, and excellence . The ultimate goal is to incor-porate the vision and ideals of the Queen’s Mission and Vision with the latest medical practices and the healing of the mind, body, and spirit .

The oncology service line and the Cancer Committee here-by expresses our most sincere appreciation to Mr . Ushijima and the Board of Trustees for believing in our dreams and providing the support needed to create this world-class oncology program .

On behalf of The Queen’s Medical Center (QMC) and the oncology service line, we are honored to update our community on the continued develop-

ment and evolution of the Queen’s Cancer Center, which is inspired by our founders, Queen Emma and King Kame-hameha IV . We strive to provide complete cancer care of the highest quality—from cancer screening and treat-ment to survivorship and beyond—in both inpatient and outpatient settings . Our comprehensive health care team includes outstanding physicians, nurses, nurse navigators, lay navigators, case managers, a survivorship team, medi-cal assistants, social workers, and other key patient service staff .

The Queen’s Cancer Center’s quality metrics are equal to and often greater than national benchmarks . We continu-ally measure ourselves against national benchmarks and take every opportunity to institute quality improvement pro-grams . This constant quest for excellence has resulted in nationally recognized accreditations, and in 2015, led QMC to become a certified member of MD Anderson Cancer Network® . The network is a program of MD Anderson Can-cer Center, which is the nation’s top-ranked cancer center .

MD Anderson’s mission is to eliminate cancer not only

INTRODUCTION

1 Chair of the Cancer Committee Paul T. Morris, MD, FACS

2 Chief of Oncology, Queen’s Cancer Center Clayton Chong, MD, MPH

3 Surgical Oncology Program Director Shane Y. Morita, MD, MS, PhD, FACS

4 Medical Director, Radiation Oncology Pi Ju Christina Liu, MD

5 Vice President of Patient Care Darlena Chadwick, MSN, MBA, FACHE

6 Director of Oncology AnnaLyn Ogata, MBA, RN, BSN

By The Leaders of The Queen’s Cancer Center

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in the U .S ., but across the world . To fulfill its mission, MD Anderson has established relationships with local mission-aligned community hospitals to provide high quality care to patients within their own communities . As Queen’s is committed to providing quality cancer care within the State of Hawai‘i, QMC sought to enhance its program through access to the expertise and pioneering evidence-based guidelines of MD Anderson . Our relationship with the network holds us to the highest standards, and provides access to treatment plans, best practices, and disease-spe-cific guidelines . In addition, there are routine discussions on challenging cases with MD Anderson’s cancer experts through physician to physician consultations . This access, matched with QMC’s established excellence in cancer care, serves to further improve the likelihood of positive outcomes for our cancer patients, right here in Hawai‘i .

To initiate QMC’s affiliation in 2015, MD Anderson Physi-cians Network® reviewed all chemotherapy infusion sites, the radiation department, the inpatient oncology floor, and pharmacy . The site recommendations and changes were implemented to meet MD Anderson Cancer Center’s stan-

Continued on next page

Cancer Committee Annual Report 2016 4

dards of practice . Initiated by a recommendation from MD Anderson Physician Network, our team implemented a quality improvement initiative pertaining to our nursing clin-ical practice and the optimization of full use of our Person-al Protective Equipment (PPE) when caring for our cancer patients receiving chemotherapy . This recommendation led to a quality improvement initiative that allowed us to continue our mission to keep our nurses and patients safe by using day-to-day supplies such as gloves, gowns, and eye or face protection .

The official collaboration between The Queen’s Medical Center and MD Anderson Cancer Network was launched, and our certified physicians gained access to resources such as the ability to consult via telephone with physician experts in MD Anderson’s “peer-to-peer” program to dis-cuss challenging cases . The program enables patient cas-es to be reviewed by respected experts in the field, result-ing in feedback with valuable treatment advice . Through the network affiliation, patients have the knowledge that their individual case has been carefully scrutinized, result-ing in their ability to confidently move forward with therapy . This resource has become very popular with our physicians and patients, with over 60 telephone consults ranging from a wide variety of cases from the top four disease sites (breast, colon, lung, and prostate), as well as gastrointesti-nal (GI), genitourinary, thoracic, and hematology . Our affili-ation has allowed QMC multidisciplinary teams to access video conferenced tumor boards for gastrointestinal and breast cases, with 31 and 49 cases presented respectively . This continued face-to-face experience with MD Anderson physicians has allowed Queen’s practitioners to build an outstanding collegial relationship . Our MD Anderson Can-cer Network certified physicians may also request expedit-ed referrals to MD Anderson in Houston, Texas, for certain complex cases .

Currently, there are 11 medical oncologists, 4 radiation oncologists, 15 surgeons and 2 gynecologist oncologists who have been certified to participate in MDAPN . Addition-ally, we have 6 new surgeons who focus on complex head and neck, and melanoma cases .

In 2016, our certified physicians went through another rigor-ous audit, including data collection, which is the foundation of the Concordance Study Process . Parties from QMC and MD Anderson Physicians Network participate in search-ing for retrospective QMC cases dated from May 2014 to August 2015 with the top four disease sites (breast, lung, colorectal, and prostate) . The evaluation categories were

based on diagnostic evaluation; staging accuracy; evi-dence of multidisciplinary planning when indicated; ther-apy delivered compared to MD Anderson Cancer Center guidelines; and quality indicators specific for each tumor .

To maintain certification, QMC oncology physicians must participate in peer reviews . This is an ongoing educational process with collegial interactions in a non-punitive setting in which our physicians are given a report from MD Ander-son Physicians Network faculty with comments and feed-back . There is no expectation that a physician will hold treatment or revise treatment plans for a patient based on recommendations from MD Anderson . These recommen-dations are made for educational purposes with the intent that the physician will incorporate recommendations into their practice as appropriate .

COMMISSION ON CANCER ACCREDITATION

3 Cancer Committee Annual Report 2016

CONTINUED QUALITY ONCOLOGY PRACTICE INITIATIVE CERTIFICATION

The Queen’s Cancer Center—including the medical oncolo-gy providers at the Queen’s Cancer Center and the Queen’s Physicians Office Building offices of OnCare Hawai‘i—con-tinue to be certified by the Quality Oncology Practice Initia-tive (QOPI) . An affiliate of the American Society of Clinical Oncology, QOPI is a voluntary program designed to help hematology-oncology practices evaluate the quality of care they provide to patients . Through the certification pro-cess, practices demonstrate their commitment to quality cancer care for patients and payers by achieving set qual-ity measure scores, safety standards, and on-site surveys . Data are collected and compared to more than 100 quality measures determined by published care recommendations and expert opinion . In 2015, the Queen’s Cancer Center successfully underwent a QOPI 3-year recertification site survey that evaluated our outpatient chemotherapy nursing staff, facilities, and processes .

INTRODUCTION (CONTINUED)

The Queen’s Cancer Center continues to maintain its accreditation with the American College of Surgeons Com-mission on Cancer (CoC), the only multidisciplinary accredi-tation program for cancer programs in the United States . Maintaining our CoC accreditation allows the Queen’s Can-cer Center to be rated on comprehensive standards that guide treatment, ensuring the highest quality patient-cen-tered cancer care . Our CoC program requires continuous reporting to benchmark performance and improve out-comes . In 2014, the Queen’s Cancer Center received the CoC’s Outstanding Achievement Award, which recognizes the exceptional level of cancer care provided to the com-munity . Only 7% of CoC hospitals receive this award . The next re-accreditation survey will occur in Fall of 2017 .

RE-ACCREDITATION BY THE AMERICAN COLLEGE OF RADIOLOGY

Having fulfilled all quality and patient safety standards, the Radiation Oncology Department at QMC is the only radia-tion facility in Hawai‘i that is fully accredited by the American College of Radiology (ACR) . The Radiation Oncology Depart-ment received full re-accreditation by the ACR in 2015 .

NATIONAL CANCER INSTITUTE’S COMMUNITY ONCOLOGY RESEARCH PROGRAM

QMC and the University of Hawai‘i Cancer Center (UHCC) maintain a sustained partnership through the National Cancer Institute’s (NCI) Community Oncology Research Program (NCORP) . NCORP’s overall goal is to bring can-cer clinical trials to individuals in their own communities . QMC is the Cancer Care Delivery Research component of the University of Hawai‘i’s overall Minority/Underserved NCORP research grant, which is one of 12 such grants nationwide . NCORP builds on the NCI’s previous commu-nity programs, which Queen’s was a part from 2010-2014 via the NCI Community Cancer Centers Program . The NCI’s collaboration with UHCC and QMC effectively brings researchers and community-based physicians together to conduct high-quality clinical studies for Hawai‘i’s cancer patients .

ACCREDITATION DESIGNATION BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS

QMC’s Breast Center continues to be fully accredited by the National Accreditation Program for Breast Centers (NAPBC), a coalition of professional organizations dedicat-ed to providing the most efficient and current breast care using scientific evidence . The NAPBC board is comprised of leadership from many medical disciplines, and upholds nationally recognized quality performance measures for breast cancer treatment . Queen’s is the only hospital in Hawai‘i that has been accredited by the NAPBC . Queen’s is also designated as a Breast Imaging Center of Excellence by the American College of Radiology .

5 Cancer Committee Annual Report 2016 Cancer Committee Annual Report 2016 6

Sex AJCC Stage Distribution at Time of DiagnosisPrimary Site Total (%) M F Stg 0 Stg I Stg II Stg III Stg IV N/A* Unk

SUMMARY OF 2016 CASES – THE QUEEN’S MEDICAL CENTER

DURING THE YEAR 2016, The Queen’s Medical Center (QMC) was the principal facility that established the initial diagnosis and/or performed the treatment for a total of 2525 patients. This was a nearly 2.5% increase in compari-son to the previous year of 2,465 patients. In 2015, there were 8,065 analytic cancer cases in Hawai’i, and QMC is the institution that manages the most oncology cases in the state.

SUMMARY OF ONCOLOGY DATA REGISTRY TRENDS

ORAL CAVITY & PHARYNX 124 (4.9%) 80 44 0 17 24 13 59 2 9Lip 4 (0.2%) 3 1 0 0 1 1 1 0 1Tongue 45 (1.8%) 25 20 0 13 4 6 18 0 4Salivary Glands 13 (0.5%) 11 2 0 0 6 1 3 1 2Floor of Mouth 2 (0.1%) 1 1 0 0 1 0 1 0 0Gum & Other Mouth 21 (0.8%) 9 12 0 4 6 1 10 0 0Nasopharynx 7 (0.3%) 3 4 0 0 2 0 5 0 0Tonsil 20 (0.8%) 18 2 0 0 3 3 13 0 1Oropharynx 4 (0.2%) 3 1 0 0 0 0 3 0 1Hypopharynx 7 (0.3%) 7 0 0 0 1 1 5 0 0Other Oral Cavity & Pharynx 1 (0.0%) 0 1 0 0 0 0 0 1 0DIGESTIVE SYSTEM 492 (19.5%) 285 207 3 79 93 111 107 44 55Esophagus 25 (1.0%) 22 3 0 2 4 6 5 0 8Stomach 53 (2.1%) 27 26 0 14 10 3 11 4 11Small Intestine 11 (0.4%) 6 5 0 0 2 3 0 4 2Colon Excluding Rectum 110 (4.4%) 68 42 0 14 28 37 21 2 8 Cecum 22 14 8 0 2 6 9 5 0 0 Appendix 4 2 2 0 0 1 0 0 1 2 Ascending Colon 19 12 7 0 3 4 9 2 0 1 Hepatic Flexure 2 1 1 0 0 1 1 0 0 0 Transverse Colon 9 5 4 0 1 3 2 1 1 1 Splenic Flexure 4 3 1 0 0 2 1 1 0 0 Descending Colon 9 7 2 0 1 1 3 3 0 1 Sigmoid Colon 37 21 16 0 6 10 12 6 0 3 Large Intestine, NOS 4 3 1 0 1 0 0 3 0 0Rectum & Rectosigmoid 92 (3.6%) 52 40 0 10 19 28 13 9 13 Rectosigmoid Junction 26 12 14 0 4 4 13 2 1 2 Rectum 66 40 26 0 6 15 15 11 8 11Anus, Anal Canal & Anorectum 6 (0.2%) 5 1 1 0 0 2 1 1 1Liver & Intrahepatic Bile Duct 78 (3.1%) 41 37 0 27 10 17 12 4 8 Liver 63 36 27 0 23 9 15 5 4 7 Intrahepatic Bile Duct 15 5 10 0 4 1 2 7 0 1Gallbladder 8 (0.3%) 3 5 1 0 0 0 6 1 0Other Biliary 14 (0.6%) 7 7 0 4 3 1 2 1 3Pancreas 82 (3.2%) 47 35 1 8 16 12 36 8 1Retroperitoneum 3 (0.1%) 3 0 0 0 1 1 0 1 0Peritoneum, Omentum & Mesentery 3 (0.1%) 1 2 0 0 0 1 0 2 0Other Digestive Organs 7 (0.3%) 3 4 0 0 0 0 0 7 0RESPIRATORY SYSTEM 278 (11.0%) 181 97 5 72 19 47 119 3 13Nose, Nasal Cavity & Middle Ear 8 (0.3%) 5 3 0 1 1 2 3 0 1Larynx 24 (1.0%) 20 4 2 5 2 5 6 0 4Lung & Bronchus 244 (9.7%) 154 90 3 66 16 40 110 1 8Pleura 1 (0.0%) 1 0 0 0 0 0 0 1 0Trachea, Mediastinum & Other Respiratory Organs 1 (0.0%) 1 0 0 0 0 0 0 1 0BONES & JOINTS 2 (0.1%) 0 2 0 1 1 0 0 0 0Bones & Joints 2 (0.1%) 0 2 0 1 1 0 0 0 0SOFT TISSUE 21 (0.8%) 15 6 0 5 3 9 1 1 2Soft Tissue (including Heart) 21 (0.8%) 15 6 0 5 3 9 1 1 2SKIN EXCLUDING BASAL & SQUAMOUS 66 (2.6%) 36 30 5 37 10 8 3 1 2Melanoma – Skin 61 (2.4%) 34 27 5 36 9 7 3 0 1Other Non-Epithelial Skin 5 (0.2%) 2 3 0 1 1 1 0 1 1BREAST 487 (19.3%) 2 485 91 199 135 34 21 1 6Breast 487 (19.3%) 2 485 91 199 135 34 21 1 6

Sex AJCC Stage Distribution at Time of DiagnosisPrimary Site Total (%) M F Stg 0 Stg I Stg II Stg III Stg IV N/A* Unk FEMALE GENITAL SYSTEM 204 (8.1%) 0 204 1 100 5 37 25 8 28Cervix Uteri 18 (0.7%) 0 18 0 5 1 4 4 0 4Corpus & Uterus, NOS 140 (5.5%) 0 140 0 82 3 16 16 6 17 Corpus Uteri 139 0 139 0 82 3 16 15 6 17 Uterus, NOS 1 0 1 0 0 0 0 1 0 0Ovary 30 (1.2%) 0 30 0 9 1 12 4 1 3Vagina 1 (0.0%) 0 1 0 1 0 0 0 0 0Vulva 6 (0.2%) 0 6 1 3 0 0 0 0 2Other Female Genital Organs 9 (0.4%) 0 9 0 0 0 5 1 1 2MALE GENITAL SYSTEM 278 (11.0%) 278 0 0 14 149 77 17 2 19Prostate 262 (10.4%) 262 0 0 13 149 76 15 0 9Testis 13 (0.5%) 13 0 0 1 0 1 0 1 10Penis 1 (0.0%) 1 0 0 0 0 0 1 0 0Other Male Genital Organs 2 (0.1%) 2 0 0 0 0 0 1 1 0URINARY SYSTEM 230 (9.1%) 173 57 46 77 13 22 23 3 46Urinary Bladder 87 (3.4%) 72 15 40 17 9 5 8 0 8Kidney & Renal Pelvis 135 (5.3%) 95 40 5 60 3 17 15 0 35Ureter 4 (0.2%) 3 1 1 0 1 0 0 0 2Other Urinary Organs 4 (0.2%) 3 1 0 0 0 0 0 3 1EYE & ORBIT 2 (0.1%) 1 1 0 0 0 0 0 2 0Eye & Orbit 2 (0.1%) 1 1 0 0 0 0 0 2 0BRAIN & OTHER NERVOUS SYSTEM 60 (2.4%) 24 36 0 0 0 0 0 60 0Brain 27 (1.1%) 15 12 0 0 0 0 0 27 0Cranial Nerves Other Nervous System 33 (1.3%) 9 24 0 0 0 0 0 33 0ENDOCRINE SYSTEM 111 (4.4%) 30 81 0 51 7 9 12 20 12Thyroid 90 (3.6%) 21 69 0 51 7 9 12 0 11Other Endocrine including Thymus 21 (0.8%) 9 12 0 0 0 0 0 20 1LYMPHOMA 81 (3.2%) 45 36 0 20 15 14 24 2 6Hodgkin Lymphoma 5 (0.2%) 4 1 0 1 2 1 1 0 0Non-Hodgkin Lymphoma 76 (3.0%) 41 35 0 19 13 13 23 2 6 NHL - Nodal 42 24 18 0 3 7 12 18 0 2 NHL - Extranodal 34 17 17 0 16 6 1 5 2 4MYELOMA 10 (0.4%) 6 4 0 0 0 0 0 10 0Myeloma 10 (0.4%) 6 4 0 0 0 0 0 10 0LEUKEMIA 45 (1.8%) 28 17 0 0 0 0 0 45 0Lymphocytic Leukemia 15 (0.6%) 10 5 0 0 0 0 0 15 0 Acute Lymphocytic Leukemia 8 6 2 0 0 0 0 0 8 0 Chronic Lymphocytic Leukemia 5 2 3 0 0 0 0 0 5 0 Other Lymphocytic Leukemia 2 2 0 0 0 0 0 0 2 0Myeloid & Monocytic Leukemia 28 (1.1%) 17 11 0 0 0 0 0 28 0 Acute Myeloid Leukemia 25 15 10 0 0 0 0 0 25 0 Acute Monocytic Leukemia 2 1 1 0 0 0 0 0 2 0 Chronic Myeloid Leukemia 1 1 0 0 0 0 0 0 1 0Other Leukemia 2 (0.1%) 1 1 0 0 0 0 0 2 0KAPOSI SARCOMA 1 (0.0%) 1 0 0 0 0 0 0 1 0Kaposi Sarcoma 1 (0.0%) 1 0 0 0 0 0 0 1 0MISCELLANEOUS 33 (1.3%) 24 9 0 0 0 0 0 33 0Miscellaneous 33 (1.3%) 24 9 0 0 0 0 0 33 0 TOTAL 2,525 1,209 1,316 151 672 474 381 411 238 198

*N/A= not applicable; no AJCC staging scheme for site/histology combination


NEWLY DIAGNOSED CANCER CASES REPORTED IN THE STATE OF HAWAI‘I, 2012 – 2015*

Number of Analytic Cases Reported by QMC, 2012 - 2016

CLASSIFICATION OF NEWLY DIAGNOSED CASES 2012 - 2016, THE QUEEN’S MEDICAL CENTER

Patients who had their diagnosis and treatment at QMC (Class of Case 10-14) numbered 1,623, which accounted for 64.3% of total analytical cases.

Patients who received a diagnosis of cancer from another center but were subsequently treated at QMC (Class of Case 20-22) account-ed for 29.72% of the analytical case distribution. Only 6.1% of patients diagnosed with cancer at QMC elected to have their care performed else-where or chose no treatment at all. This under-scores the premise that QMC is the provider of choice for many cancer patients in Hawai‘i. The low rate of patients electing to have their care managed elsewhere is a testament to QMC’s reputable oncology program.

PLACE OF RESIDENCE AT DIAGNOSIS – 2016, THE QUEEN’S MEDIAL CENTER

In 2016, there was no significant change in the distribution of residence for patients who received their oncolog-ic care at QMC as compared to the prior year. The overwhelming majority of patients (81.4%) live on the island of O‘ahu; 17.3% of patients who received their cancer care at QMC were neighbor island residents.

AGE & GENDER DISTRIBUTION AT DIAGNOSIS – 2016, THE QUEEN’S MEDICAL CENTER

Place of Residence Number Percent at Diagnosis of Cases Cases

O‘ahu 2055 81.4%

Hawai‘i 288 11.4%

Maui 72 2.9%

Kaua‘i 41 1.6%

Molokai 31 1.2%

Pacific Basin 18 0.7%

Mainland/USA 10 0.54%

Foreign 6 0.2%

Lana‘i 4 0.2%

Total 2525 100.0%

The majority of patients diagnosed with cancer were between the ages of 50 years to 79 years. However, nearly 14% were less than 50 years old, which emphasizes that this condition can afflict young individuals. Additionally, about 13% were greater than 80 years old, which demonstrates that it can also burden the elderly population.

SUMMARY OF ONCOLOGY DATA REGISTRY TRENDS (CONTINUED)


Caucasian 2615 32.4%

Japanese 1579 19.6%

Filipino 1136 14.1%

Hawaiian/Part Hawaiian 1118 13.9%

Chinese 431 5.3%

Pacific Islander 266 3.3%

Korean 144 1.8%

Other 776 9.6%

Unknown 0 0.0%

Total 7856 100.0%

TOP 10 CANCER SITES REPORTED AT THE QUEENS’ MEDICAL CENTER & THE STATE OF HAWAI‘I 5 LEADING CANCER SITES BY GENDER, QMC VS. THE STATE OF HAWAI‘I

With respect to cancers reported at QMC and the state, the most common cases included breast, lung, and prostate. In reviewing the stage classification, a significant proportion of patients with cancers of the lung (45%) and pancreas (44%) managed at QMC exhibited stage IV disease.

*2015 data for the State of Hawai‘i are incomplete, and 2016 data for the State of Hawai‘i was not available during the prep-aration of this report.

Note: Data excludes basal and squamous cell skin cancers.

*2015 data for the State of Hawai‘i are incomplete, and 2016 data for the State of Hawai‘i was not available during the preparation of this report.

Note: Data excludes basal and squamous cell skin cancers.

QMC MALE/FEMALE 5 LEADING SITES, 2016

Breast 35.7% Prostate 19.4%

Lung 8.4% Melanoma (Skin) 12.5%

Corpus Uteri 6.2% Lung 11.6%

Melanoma (Skin) 6.0% Colon 5.4%

Colon 5.1% Urinary Bladder 5.1%

Female Male

STATE OF HAWAI‘I MALE/FEMALE 5 LEADING SITES, 2015*

Breast 36.9% Prostate 21.7%

Corpus Uteri 10.6% Lung 12.7%

Lung 8.0% Kidney/Renal Pelvis 7.9%

Thyroid Gland 5.2% Oral Cavity/Pharynx 6.6%

Oral Cavity/Pharynx 3.3% Urinary Bladder 6.0%

Female Male

DISTRIBUTION OF ETHNICITY, THE QUEEN’S MEDICAL CENTER VS. THE STATE OF HAWAI‘I

Caucasians were the most common group affected. With regard to the state, it is compelling that near-ly 5% of cancer patients managed at QMC were Pacific Islanders, as opposed to only 3.3% of can-cer patients within Hawai‘i. This emphasizes the fact that QMC not only serves Hawai‘i, but the Pacific Basin as well. QMC also continues to care for Native Hawaiians, who comprised 14.6 % of all cancer patients treated in 2016.

Race No. Cases % Cases

QMC DISTRIBUTION BY RACE, 2016

Caucasian 621 24.6%

Japanese 600 23.8%

Filipino 417 16.5%

Hawaiian/Part Hawaiian 368 14.6%

Chinese 260 10.3%

Pacific Islander 123 4.9%

Korean 64 2.5%

Other 72 2.9%

Unknown 0 0.0%

Total 2525 100.0%

Race No. Cases % Cases

STATE OF HAWAI‘I DISTRIBUTION BY RACE, 2015*

*2015 data for the State of Hawai‘i are

incomplete, and 2016 data were not available during the preparation

of this report.

Top 10 Cancer Sites Reported at QMC in 2016

Top 10 Cancer Sites Reported in the State of Hawai‘i in 2015*

SUMMARY OF ONCOLOGY DATA REGISTRY TRENDS (CONTINUED)

Cancer Committee Annual Report 2016 12

The Queen’sCancer Center

When the Queen’s Cancer Cen-ter (QCC) was established in the fall of 2007, it brought the people

of Hawai‘i a comprehensive, multidisciplinary cancer treatment and research center with a mission to provide superior cancer care . As Hawai‘i’s premier cancer treatment facility, we continue to demonstrate our commitment to uphold the highest standards . Consistent-ly ranking among the best of its kind in the nation, the QCC has earned accreditation and the Outstanding Achievement Award from the Commission on Cancer (CoC) since 2011 .

Today, the QCC is a part of an elite network of hospitals

Today, the QCC is a part of an elite network of hospitals that offer quality, leading edge, research based cancer care at community hospitals close to home to improve the health care of disparate communities . Fully integrated with oncol-ogy services, the QCC provides advances in cancer treat-ments, such as in chemotherapy, biotherapy, radiation ther-apy, and surgery .

Aggressively treating all types of cancer, the QCC offers advanced technology combined with patient-centered, mul-tidisciplinary care in a comfortable place of healing . Virtually every aspect of cancer diagnosis, treatment planning, and treatment is physically brought together, minimizing the need for patients and their caregivers to make outpatient visits to different providers, or to travel to the mainland for treatment .

QCC physicians and staff are experienced, knowledgeable, and caring individuals who are active in the community beyond their work . Working together as one team in one location, they deliver integrated care that is tailored to each patient’s individ-ual needs . They are focused on providing care, support, and guidance to patients throughout their journey . Medical treat-ments are fully integrated with oncology services, which may include medical, surgical, and radiation oncologists, as well as registered nurses, clinical coordinators, patient navigators, licensed social workers, registered dietitians, pain manage-ment practitioners, physical therapists, and spiritual care pro-viders . Our staff also includes multidisciplinary specialists, such as cardiothoracic surgeons, head and neck surgeons, gyne-cological oncologists, endocrinologists, and others . Able to respond to all medical emergencies, the QCC is backed by a hospital-based full code team and crisis nurse .

The QCC strives to ensure that treatment and cancer care coordination is as convenient and stress-free as possible . Our

pledge is to put patients first by providing care focused on each individual’s needs and offering a full array of expert ser-vices to promote healing at all levels—body, mind and spirit .

The QCC has a nationally-recognized, award-winning patient navigation program . Patient navigators serve as guides to help patients through the confusing and often overwhelming nature of having cancer, from diagnosis to treatment to survivorship . Patient navigation works hand-in-hand with many collaborative services, including social work, genetic counseling, psychiatry, nutrition, spiritual guidance, rehabilitation, and education on cancer care . Care during and after treatments is covered as well . After cancer treatments have been completed, the QCC’s Survi-vorship Program continues to help patients with manage-ment and monitoring .

Initiatives at the QCC in 2016• Since 2015, The Queen’s Medical Center has been a cer-

tified member of MD Anderson Cancer Network®, a pro-gram of MD Anderson Cancer Center, which is ranked the leading cancer center in the nation . The affiliation gives Queen’s health professionals access to best prac-tices, innovative treatment plans, and evidence-based guidelines . The goal is to allow Queen’s physicians who are certified by the Network to care for cancer patients at home in Hawai‘i with the support of family and friends . This access, combined with Queen’s established excel-lence in cancer care, serves to further improve the like-lihood of positive outcomes for our cancer patients . Patient cases are reviewed by respected experts in individual fields, resulting in feedback with valuable treatment advice . Network affiliation gives patients the confidence to move forward with their therapy with the knowledge that their individual case has been care-fully scrutinized . Through the Network, Queen’s certi-fied physicians may also request expedited referrals to The University of Texas MD Anderson Cancer Center in Houston, Texas, for complex cases . Since 2016, MD Anderson affiliation has continued to benefit our cancer patients significantly .

• A quality study was conducted to investigate nurse to patient acuity to ensure that the QCC scheduled nursing staff in the most efficient manner to appropriately meet the needs of all types of cancer patients while maintain-ing high quality care . The team developed an acuity rat-ing tool to quantify patients’ treatments for each day, for each nurse . The tool allowed the team to achieve its two goals of reducing the need for overtime and maintaining a lower acuity score per nurse .

INTEGRATED ONCOLOGY SERVICES

Left: The Queen’s Medical Center’s two certified pet therapy dogs, Ipo and Yoda. Ipo is in Orthopedics, and Yoda (right) serves in the QCC.

• A quality study was conducted to address patient-reported difficulty with ‘wayfinding’ at QMC . Led by the Wayfinding Committee, the aim was to standardize and simplify the way we communicate directions to patients and visitors to ease their journey to the QCC . As a result, new maps, signage, and direction sets were created for this quality initiative .

• As part of a quality improvement initiative, our team imple-mented the use of Patient Prompt . Patient Prompt is a cloud-based communication platform between providers and patients that delivers courtesy appointment remind-ers using email, voicemail, and text messages . The goal of Patient Prompt is to reduce the number of no-shows and cancellations, and for patients to confirm appointments .

Diagnostics• Diagnostic Imaging Services• Diagnostic Laboratory Services• Expert Pathology Services, including Molecular Pathology

Cancer Treatment• Advanced Radiology• Advanced Surgical & Medical Oncology• Outpatient Chemotherapy, Treatment & Cancer Care• Clinical Trials

Navigation, Counseling & Support• Patient Navigation Services• Psychiatric Services• Licensed Social Work• Nutritional Counseling• Genetic Counseling• Smoking Cessation Referrals• Spiritual Care• Cancer Survivorship Program• Patient & Family Support Groups• Certified Pet Therapy Dog • Community Resource Referrals

Rehabilitation• Physical, Occupational & Speech Therapies• Specialized Physical Therapy for breast cancer & lymphede-

ma patients

Education• Patient & Community Education

Research• Cancer Registry• Cancer Research Services

Other Services• Pain & Palliative Care • Complementary & Alternative Medicine (e.g., Acupuncture,

Healing Touch, Massage)

11 Cancer Committee Annual Report 2016


The diagnosis and management of cancer is com-plex . It requires the expertise of many highly trained individuals . Multidisciplinary Care (MDC) clinics at

the Queen’s Cancer Center (QCC) optimize care for can-cer patients by bringing together a team of experts in cas-es where prior treatments have been unsuccessful, clarifi-cation of roles is needed, or in other complex cases . The result is faster access to treatment and referral servic-es, improved care coordination, less duplication of medi-cal tests, less travel for treatment planning, and a greater opportunity to hear about clinical trials .

A Multidisciplinary Care clinic brings together health pro-fessionals with the necessary skills to consider a patient’s treatment and care options . The team considers all of the patient’s medical, physical, and support care needs . Together, they develop the best individualized care and treatment plan using National Comprehensive Cancer Net-work (NCCN) guidelines .

Patients receive appropriate and consistent information from all members of the team, who are also aware of per-sonal choices . Patients have access to support services, which include patient navigation, social workers, financial assistance, and participation in Queen’s Survivorship and Pain & Palliative Care programs .

Multidisciplinary Care Clinic Team• Medical Oncologist: A physician with expertise in the

diagnosis and management of cancer . A medical oncol-ogist can prescribe chemotherapy, immunotherapy, and targeted therapy to treat cancer, and is usually the pri-mary doctor taking care of cancer-related problems .

• Radiation Oncologist: A physician who uses radiation to treat cancer . Examples of radiation therapy are exter-nal beam radiation, brachytherapy, stereotactic body radiation, and radioimmunotherapy .

• Surgical Oncologist: A physician who specializes in treating cancer with surgery .

• Pathologist: Although patients may never meet a pathol-ogist, these physicians play an essential role by making accurate diagnoses of cancer through evaluating blood and tissue samples . This is a critical step, because fur-ther treatment of cancer depends on the diagnosis .

• Other Physician Specialists: Depending on the complexity of the cancer or the treatment plan, physicians who spe-cialize in other areas may contribute to care . Examples include specialists who treat infections or other medical issues . Others may specialize in the gastrointes-tinal system, the nervous system, respira-tory tract, or other areas of the body .

• Chemotherapy Nurse: A registered nurse who plays an important role in a patient’s overall care . Most chemother-apy nurses are certified in oncology, which means they have completed spe-cial training and are experienced in tak-ing care of cancer patients .

• Oncology Nurse Navigator: A regis-tered nurse with oncology-specific clini-cal knowledge who helps patients, fami-lies, and caregivers overcome health care system barriers . Nurse navigators provide education and resources to facil-itate informed decision making and time-ly access to quality cancer care .

• Clinical Oncology Programs Coordinator: A registered nurse with oncology-spe-cific clinical knowledge who coordinates peer-to-peer telephone consults between MD Anderson Cancer Center physicians and QCC’s MD Anderson network certified physicians . This nurse expe-dites MD Anderson patient referrals to The University of Texas MD Anderson Cancer Center in Houston, Texas .

• Patient Navigator Associate: Patient navigators help patients, family members, and caregivers coordinate appointments and services and also assist with practical issues, such as childcare during treatment . Other servic-es include housing and coordination of transportation to and from the airport for those who do not live on O‘ahu .

• Social Worker: A social worker assesses the impact of cancer diagnoses on patients, families, and caregivers . They address issues related to coping, adjustment to the diagnosis, disease progression, and end-of-life care

needs . Social workers also give counsel on advance health care directives and make referrals to community resources as needed .

• Physical and Occupational Therapists: These thera-pists help patients regain strength so that they can per-form basic functions at home .

• Speech-Language Pathologist: A speech-language pathologist assists with speaking and swallowing issues .

• Clinical Research Nurse: A clinical research nurse helps enroll patients in available clinical trials . They provide information about the latest trends and clinical trials available in Hawai‘i for specific cancers .

• Dietitian: Nutrition is an important part of cancer treat-ment . Eating the right kinds of food before, during, and after treatment can help patients feel better and stay stronger . A registered dietitian is one of the best sourc-es of information about diet .

MULTIDISCIPLINARY CARE CLINICS: A TEAM APPROACH TO CANCER CARE


The mission of the Queen’s Radiation Oncology Department is to uphold the highest standards in cancer treatment with the most advanced technolo-

gies while providing high quality patient care through pro-fessionalism and treating each patient as ‘ohana, or family .

As Hawai‘i’s premier radiation oncology facility, the Queen’s Radiation Oncology Department is the only one in the state accredited by the American College of Radiology (ACR) . Only 15% of radiation oncology facilities in the U .S . carry this distinction, which gives patients the assurance that the treatments they receive are safe and accurate .

The largest and most comprehensive radiation facility in Hawai‘i and the Pacific Basin, Queen’s Radiation Oncolo-gy offers the most advanced technologies and equipment .

Additionally, all treatments are based on peer-reviewed, evidence-based protocols and National Comprehensive Cancer Network (NCCN) guidelines .

In 2015, the Queen’s Cancer Center became a certified member of MD Anderson Cancer Network®, a program of MD Anderson Cancer Center, which is ranked the leading cancer center in the United States . This affiliation required a rigorous evaluation of our radiation oncology program, and site recommendations and changes were made to meet MD Anderson standards of care . MD Anderson’s Physician’s Network® board also certified all 4 of our radiation oncolo-gists after reviewing their patient chart documentation .

Being a certified member of the network combines the exceptional cancer care Queen’s offers to the people of Hawai‘i with the expertise of one of the world’s leading can-cer centers . The affiliation gives Queen’s health profession-als access to best practices, innovative treatment plans, and evidence-based guidelines, as well as the ability to consult with physicians in peer-to-peer consultations . Patient cases can be reviewed by respected experts in individual fields, resulting in feedback with valuable treatment advice .

In 2016, based on a previous year’s quality study, the QCC implemented a patient care quality improvement standard (Commission on Cancer, Standard 4 .8) in which 100% of breast conservation patients, regardless of age, are consid-ered for hypofractionation . This is based on the American Society for Radiation Oncology (ASTRO)/Choosing Wisely® recommendation: Don’t initiate whole breast radiotherapy as part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without consider-ing shorter treatment schedules . To improve the rates of “short course” offerings to patients regardless of age, it is now a standard procedure for QCC team members to dis-cuss shorter treatment options at weekly Radiation Oncol-ogy case reviews . Additionally, new physicians are oriented to QCC departmental standards .

The Queen’s Radiation Oncology ProgramThe Queen’s Radiation Oncology program provides care to cancer patients at all ages, and performs both curative and palliative radiation treatments . Over 90% of radiation treatments are delivered to outpatients, most of whom are ambulatory and self-supportive . Inpatients who require intensive monitoring or other services also receive radia-tion treatments .

A radiation oncologist consults with each patient upon referral from the attending or primary care physician . A reg-istered nurse interviews the patient and completes a com-prehensive evaluation that includes the patient’s medical

history, reason for treatment or diagnosis, treatment, and side effects education . Psychosocial and/or physical concerns are also addressed .

A treatment recommendation is discussed with the patient . After a specific course of treatment is agreed upon by the patient and the radiation oncologist, the patient undergoes treatment planning . In this step, the medi-cal physicist and dosimetrist will provide treatment planning sup-port to the physician .

Precise radiation treatments are delivered by certified radiation therapists prescribed by and under the direction and super-vision of a radiation oncolo-gist . During the course of radi-ation treatments, each patient is seen once each week to be evaluated for any treatment-related side effects, and for any other questions or concerns that the patient may have . The entire team also helps moni-tor each patient with regard to symptom management .

If any issues arise outside the scope of the immediate team, the patient is referred to an appropriate health pro-fessional, such as a dietitian, social worker, pain manage-ment physician, and/or a patient navigator . After the com-pletion of the treatment course, the patient is scheduled for periodic follow-ups with the radiation oncologist to help monitor treatment outcomes .

In addition to standard treatments, patients are diligently screened to determine eligibility for enrollment in leading-edge radiation clinical trials, some of which are only avail-able at Queen’s .


RADIATION ONCOLOGY

Left: In 1960, a two-million volt General Electric X-ray machine was installed at Queen’s to shrink tumors. Requiring an open space two sto-ries high, there were only 12 such machines in existence at the time.

L-R: Gene-Fu Liu, MD, Vince Verdepreado, Nora Kimura, RN, and Rosemary Kimbrel of Queen’s Radiation Oncology team with the Elekta Infinity


At The Queen’s Medical Cen-ter Inpatient Oncology Unit, cancer patients who need

hospital care receive the person-alized care of a community hospi-tal combined with the advances of a respected teaching medical cen-ter . Our 48-bed private room unit on the 7th floor of The Queen’s Medi-cal Center (QMC) provides a com-plete continuum of care with full access to specialized clinical ser-vices, rehabilitative therapies, and support services that aid in the treatment of and recovery from can-cer . As the only hospital in the State of Hawai‘i with Magnet Recogni-tion,® QMC’s oncology program combines advanced diagnostic and treatment technologies with a dedicated, multidisciplinary team of cancer experts who carefully coor-dinate each patient’s care to ensure that treatment is highly individual-ized, progressive, and comprehen-sive .

During a patient’s stay at the hos-pital, daily multidisciplinary rounds are conducted to com-municate, collaborate, and coordinate efficient and effec-tive transitions of care . All nurses are specialty-trained in chemotherapy administration, and have expert knowledge of the different types of cancer and symptom management . An increasing number of the unit’s registered nurses are acquiring national certification in oncology, demonstrating dedication and commitment to providing the best cancer care .

The Inpatient Oncology Unit places a great emphasis in continually improving the quality-of-care provided to patients . For example, a quality study was conducted to improve staff response time to patient call lights . As a result, our team implemented a “no pass zone” to reduce response time . Staff are trained to not pass an illuminated call light and to address the issue before ‘passing’ . Staff also

increased the frequency of checking in with their patients every hour . As a result of a previous year’s quality study, the unit also implemented a quality improvement initiative focused on suicide risk assessment of oncology patients .

QMC’s oncology staff is also dedicated to supporting com-munity efforts that raise awareness and funds for cancer programs, such as annual participation in the Honolulu Marathon to benefit the Leukemia and Lymphoma Soci-ety; the American Cancer Society’s Relay For Life; the Mak-ing Strides Against Breast Cancer Walk; and the Susan G . Komen Race for the Cure . The staff also supports Oncol-ogy on Canvas and the American Cancer Society’s “I Can Cope” classes for oncology patients and their families . An Artist in Residence Program also offers cancer patients, caregivers, and staff the opportunity to explore their own creativity to help cope with the challenges of cancer .

RADIATION ONCOLOGY (CONTINUED)

QUEEN’S RADIATION ONCOLOGY TECHNOLOGIES & THERAPIES

The Radiation Oncology Department offers an extensive range of advanced treatment technologies and treatments, many of which can be found nowhere else Hawai‘i . Safe and accurate radiation treatments are given with the use of ionizing radiation equipment (linear accelerators) and radio-active sources . All equipment and sources are inspected, tested, and calibrated regularly by board-certified medical physicists . Collaborative approaches to treatment ensures unsurpassed clinical care in the delivery of radiation treat-ments to our patients . Technologies and treatments include:

• Three external beam radiation therapy treatment machines which provide a variety of effective ways to deliver radiation treatment protocols depending on each patient’s individual case:

Elekta Infinity. The only one of its kind in Hawai‘i, the QCC’s Elekta Infinity provides leading edge technology with enhanced patient safety features . Designed with proven, 7th generation digital technology, the Elekta Infinity redefines treatment position, speed, and control to give superior radiation treatments . Some of the fea-tures of this system include built-in 3D CT imaging, real time motion tracking, and 5mm multi-leaf collimator . A very unique capability of the Elekta Infinity is volumetric intensity modulated arc therapy (VMAT) . VMAT allows the radiation beam to be continuously shaped around a tumor like shrink wrapping for better accuracy and faster treatment times . VMAT also requires significantly lower doses of radiation for effective treatments .

TomoTherapy HiArt. Unique in Hawai‘i, the TomoTherapy HiArt system combines an advanced form of intensity modulated radiation therapy (IMRT) with CT scanning for image-guided radiation therapy (IGRT) . This system pro-vides unprecedented accuracy in treating tumors effec-tively while dramatically reducing toxicity to surrounding healthy tissues .

Dual-Energy Varian Multi-Leaf 2100. A radiation treat-ment machine capable of a wide range of photon and electron energies, and varying sizes of treatment fields that can attack cancerous tumors at different depths and locations within the body .

• Other specialized treatments include:

Radionics XKnife for Stereotactic Radiosurgery (SRS)

Stereotactic body radiation therapy (SBRT) using TomoTherapy HiArt

Accelerated partial breast irradiation (APBI)

Variseed prostate seed implants (PSI)

Philips high dose rate (HDR) brachytherapy for gyne-cologic, prostate, and other malignancies

• Multiple treatment planning systems include:

Philips Big Bore CT Simulator designed specifically for radiation oncology with the latest in radiation treatment planning, including 4D gating, which enables the most accurate treatment of tumors that move with breathing, particularly in the lung, liver, and breast

ADAC Pinnacle for IMRT and 3D teletherapy

Varian Brachyvision for High Dose Rate (HDR) brachytherapy

RayStation, a newly acquired treatment planning sys-tem that offers groundbreaking enhancements for spe-cific treatment planning protocols .

Variseed prostate seed treatment planning

Elekta Infinity

TomoTherapy

Philips Big Bore CT Simulator

INPATIENT ONCOLOGY


Having a cancer diagnosis and getting through treatment can be overwhelming, and navigating through the com-plex health care system is often confusing . The goal of the Queen’s Cancer Center Patient Navigation Program is to guide and help patients through this difficult journey . Hav-ing served over 8,000 patients since 2006, the award-winning Patient Navigation Program has become a service that patients, families, medical staff, and the community has come to rely on and trust . The Queen’s Cancer Center is unique in that it is staffed by both clinical nurse navigators and ‘lay’ navigators (i .e ., patient navigator associates) that work together to coordinate a seamless continuity of care .

Clinical nurse navigators are registered nurses with oncol-ogy-specific clinical knowledge . Nurse navigators provide education and resources to facilitate informed decision-making and timely access to quality cancer care . Some of the services nurse navigators provide include:

• Educating patients/families regarding disease, treatment, side effects, and adverse reactions

• Initiating and completing patient treatment summary plans

• Participate in tumor board conferences

Patient navigator associates are warm, compassionate, empathetic, and culturally competent . They use their years

The Queen’s Medical Center (QMC) Cancer Survivor-ship Program is the first adult, hospital-based sur-vivorship program in Hawai‘i . Begun in 2009, the

goal of the program is to improve the quality-of-life of can-cer survivors by assisting with their transition after active treatment is complete . The Cancer Survivorship Program helps coordinate follow-up care and cancer surveillance by providing the patient with a comprehensive, individualized survivorship care plan, which includes a treatment summa-ry, follow-up plan, and education regarding potential later effects from cancer treatment . The program is staffed by an oncology certified RN (OCN) and a survivorship associate on the hospital campus .

In 2016, the Commission on Cancer (CoC) required that at least 25% of eligible patients receive a survivorship care plan . The Survivorship Program provided 401 patients with survivorship care plans, which represented 28 .9% of eli-gible patients . Beginning in 2017, at least 50% of eligible patients are required to receive a survivorship care plan,

Efforts to improve delivery of survivorship care plans (SCP) to more eligible patients included the following:• Incorporated SCP into Queen’s CARE*Link electronic

medical records with implementation of Beacon module

• Expanded screening efforts to identify more oncol-ogy surgical patients by partnering with Queen’s MD Anderson certified physicians

• Mailed SCPs and provided phone consults to patients who decline in-person consults

• Provided survivorship visits with physician follow-up appointments

• Visited North Hawai‘i Community Hospital monthly for survivorship consults

Other highlights in 2016 include:• Submitted an NIH R21 grant application: Evaluating

Survivorship Care Plan Efficacy in Hawai‘i’s Adult Cancer Survivors

• Contributed members of the 2016 Hawai‘i Cancer Plan as members of the Quality of Life Action Team

• Assisted the Hawai‘i Comprehensive Cancer Control Coalition in coordinating Journey Together focus group meetings on neighbor islands

• Hosted the annual Cancer Survivorship Celebration

of expertise to provide cancer patients with seamless coor-dination of services and to connect them to the right people and programs . Some of the many services patient navigator associates provide for patients and their caregivers are to:

• Coordinate appointments

• Coordinate transportation, travel, and lodging

• Facilitate access to financial assistance

• Facilitate access to community resources

• Facilitate access to support groups and classes

• Provide and link to educational materials

• Facilitate access to interpreter services

• Facilitate referrals to other support team members

The patient navigation team provides individualized assis-tance to patients, families, and caregivers to help them tra-verse the complexities of the cancer care delivery system .

Highlights in 2016 Include:• Integration of Patient Navigation Program at North Hawai‘i

Community Hospital (NHCH) and QMC – West O‘ahu

• Continued collaboration with MD Anderson Cancer Center

• 1,254 new patients assisted by Patient Navigation Program

PATIENT NAVIGATION PROGRAM CANCER SURVIVORSHIP PROGRAM

Queen’s Cancer Center Patient Navigator Associates and Social Workers

TOTAL NUMBER OF PATIENTS RECEIVING SURVI-VORSHIP CARE PLANS(JAN 1 – DEC 31, 2016): 401

Ethnicity Number Percentage

Japanese 100 24.9%

Caucasian 97 24.2%

Filipino 50 12.5%

Chinese 47 11.7%

Native Hawaiian 44 11.0%

Other 63 15.7%

Cancer Site

Breast 123 30.67%

Gynecologic malignancies 75 18.70%

Head and Neck 58 14.46%

Lung 40 9.98%

Prostate 23 5.74%

Melanoma 14 3.49%

Colorectal 12 2.99%

Other 56 13.97%

Island

O’ahu 371 92.5%

Hawai‘i 24 6.0%

Molokai 2 0.5%

Kaua‘i 2 0.5%

Maui 2 0.5%

Gender

Female 271 76.0%

Male 130 24.0%


The care of people living with cancer continues to be a major focus of The Queen’s Medical Center Pain and Palliative Care Department . Available at the request

of a patient’s medical, radiation, or surgical oncologist, Pain and Palliative Care clinicians work with patients and family members to prevent and relieve the pain, symptoms, and stress related to their illness, and to provide an added layer of support . The goal is to promote the best possible quality-of-life throughout the course of cancer treatment . The Pain and Palliative Care Department was the first in Hawai‘i to be awarded The Joint Commission’s Certificate of Distinc-tion for Advanced Certification in Palliative Care . In 2016, the Pain and Palliative Care received more than a thousand requests for consultation throughout The Queen’s Medical Center . Of these requests, nearly half were for oncology patients, with growing numbers served in our outpatient program located in the Queen’s Cancer Center .

Head and neck cancers are devastating . Even with today’s advanced procedures, the surgery neces-sary to remove tumors can leave significant cos-

metic deformity, as well as functional problems, such as facial paralysis, or issues with speech and swallowing . The goal of the Queen’s Head and Neck Institute is to not only erad-icate head and neck cancers, but to return people to their life before diagnosis through advanced and often extensive reconstructive surgery . The Head and Neck Institute’s goal of restoring quality-of-life before surgery is a type of advanced cancer care that goes beyond most institutions .

Focusing on patients with malignant and benign tumors, the Head and Neck Institute is a Queen’s Cancer Center special-ty clinic that delivers the best possible care using a multidisci-plinary approach . The team includes head and neck specialty surgeons, radiation oncologists, medical oncologists, neuro-radiologists, dentists, pain and palliative specialists, a coun-selor, and a social worker . Inpatient and outpatient nurses are also a part of the team, as well as speech pathologists, physi-cal therapists, and dietitians . All team members specialize in head and neck cancer treatment and dedicate their work solely to the Head and Neck Institute .

Patients are usually referred by their primary care physi-cian or other specialty physician . A full outpatient evalua-tion normally takes three to five business days, depend-ing on the amount of testing and consultation needed to assess the patient’s condition and to recommend a special-ly designed treatment plan . All new cancer patients are pre-sented to a multidisciplinary Head and Neck Tumor Board that includes specialists in head and neck surgery, radia-tion oncology, medical oncology, dentistry, speech pathol-ogy, and research . Treatments may include advanced tech-nology robotic and minimally invasive surgical techniques, XKnife stereotactic radiosurgery, and the most current tar-geted therapies, as well as clinical trials . Treatment may involve non-surgical options for many patients, including radiation therapy and/or chemotherapy .

QUEEN’S HEAD AND NECK INSTITUTE PAIN & PALLIATIVE CARE

• Oral cavity• Pharynx• Larynx• Thyroid & parathyroid• Salivary glands• Skin cancers, including melanoma• Nasal cavity & paranasal sinuses• Skull base (including pituitary gland)• Ear & temporal bone• Neck• Acoustic neuroma (vestibular schwannoma)• Sarcomas of the head & neck

Other conditions treated

• Head & neck issues from tumors elsewhere in the body• Longstanding facial nerve paralysis

MAJOR TYPES OF TUMORS TREATED

Head and neck surgeons Daniel Alam, MD, and Christo-pher Klem, MD

Kiyota A, Bell CL, Masaki K, Fischberg DJ: “What’s the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.” Hawaii J Med Public Health 2016; 75(8):235-41.

2016 PUBLICATION

The Pain & Palliative Care team


Staffed by oncology research nurses, research asso-ciates, and other clinical research professionals, the Queen’s Oncology Research Department provides

a wide range of support services for patients, physicians, and Queen’s Cancer Center staff to participate in clini-cal research . Cancer clinical research trials offer patients access to cutting-edge therapies, while helping research-ers find better ways to prevent and treat the disease . Clini-cal trials offer patients the opportunity to take advantage of all kinds of new therapies, including new drugs or new ways to use existing drugs, types of surgeries, radiation thera-pies, and new ways to combine different cancer treatments . Some studies evaluate cutting-edge therapies while oth-ers compare two different treatments to determine which is better . All standard cancer treatments used today are avail-able because years ago, patients agreed to participate in clinical trials that proved those treatments worked .

Queen’s Pharmacy Services plays a vital role in the treatment of cancer patients . Queen’s clinical pharmacists function as intermediaries between

patients and physicians, and are specifically assigned to care for cancer patients, verifying all medication orders, including chemotherapy .

A pharmacist counsels each patient who takes certain high risk medications, such as oral chemotherapy, and monitors patient compliance . Counseling includes explaining medica-tions and how they work, how much and how often to take them, and what the patient can do to manage side effects .

Clinical pharmacists collaborate daily with physicians, nurses, case managers, and social workers to help with the management of patients from admission through dis-charge . They help to optimize therapy by adjusting medi-cations to the patient’s clinical response . Pharmacists also provide antibiotic monitoring and intravenous nutrition .

Pharmacy Services assists with implementing research pro-tocols through The Queen’s Medical Center or the Univer-sity of Hawai‘i Cancer Center, and has instituted protocols that include growth factor support, management of nausea and vomiting, chemoembolization, and high-dose metho-trexate administration .

The Oncology Research Department pre-screens and recruits patients, and coordinates clinical trials in compli-ance with Good Clinical Practice (GCP), an international eth-ical and scientific quality standard for the conduct, record-ing, and reporting of clinical trials involving the participation of human subjects . Compliance with GCP provides assur-ance that the rights, safety, and well-being of trial subjects are protected, and that the clinical trial data is credible .

Clinical trials are classified based on four clinical phas-es (I-IV) of new drug or new treatment development . The Queen’s Cancer Center’s clinical trial portfolio includes studies from all four phases .

PHARMACY SERVICES ONCOLOGY RESEARCH DEPARTMENT

PHARMACY SERVICES provides inpatient and discharge medications for the entire medical cen-ter, with pharmacists available 24 hours a day, 7 days a week. Pharmacists verify the correct medi-cation, dose, and schedule for each patient, and are a drug information resource for physicians, nurses, and patients.

Clinical Trials Team



PATHOLOGY

The Queen’s Pathology Department provides comprehensive anatomic

pathology services to patients for all four Queen’s hospitals (The Queen’s Medical Center – Punchbowl, The Queen’s Medi-cal Center – West O‘ahu, Molo-kai General Hospital, and North Hawai‘i Community Hospital), and for other sites in the Pacific region .

The largest, most comprehensive surgical diagnostic service in the State of Hawai‘i, Queen’s Pathol-ogy processes over 40,000 sur-gical specimens and 10,000 cytology (non-GYNs) per year, including specimens from Guam, Saipan, and Micronesia . Queen’s Pathology is home to 16 pathol-ogists representing hematopathology, dermatopathology, GYN, breast, head and neck, oral, urologic, ophthalmologic, GI and hepatobiliary, cytology, neuropathology, renal, and molecular genetic pathology subspecialities .

With over 60 medical students rotating through Queen’s Pathology each year, the department represents one of the critical educational cores of the University of Hawai‘i John A . Burns School of Medicine . It also serves as the home base of the Pathology Residency Training Program, which is the only ACGME-accredited program in Hawai‘i that emphasizes cancer diagnostics and management .

MOLECULAR DIAGNOSTICS LABORATORY

Molecular diagnostics is a technique used to analyze bio-logical markers in an individual’s complete set of genetic instructions, or genome . By identifying certain biomark-ers, we can predict which subgroups of patients are likely to respond to specific anti-cancer drugs . As Hawai‘i’s only personalized medicine program, the Molecular Diagnostics Laboratory performs over 15,000 tests per year, providing cancer genomic profiling for hereditary cancer screening, targeted therapy, and clinical trials selection .

The Molecular Diagnostics Laboratory offers innovative techniques to define gene expression within cells and tis-sues, including next-generation sequencing, fluorescence in situ hybridization (FISH), cytogenomics, laser capture microdissection, and hyperspectral imaging . There is an active operating agreement with MD Anderson’s Genomic Technology program where two pathology fellows a year visit our laboratory to be trained in advanced diagnostics .

COMPREHENSIVE CANCER BIOREPOSITORY

The first of its kind in Hawai‘i, The Queen’s Medical Center Comprehensive Cancer Biorepository is the primary tissue storage and inventory management system for Queen’s and the University of Hawai‘i Cancer Center . The facil-ity collects and stores frozen samples for clinical transla-tional research . The Biorepository has a strategic partner-ship with the ‘Imi Hale Native Hawaiian Cancer Network to facilitate ethical engagement of Hawai‘i’s Native Hawaiian population for health disparity research . The Bioreposito-ry is the first in the nation to feature a post-operative con-sent process and secondary re-consent for all approved research projects . To date, over 4,000 samples have been collected from almost 700 donors .

Phase I: Studies that test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects . The staff and facilities to conduct both inpatient and outpa-tient Phase I clinical trials are available at Queen’s .

Phase II: Studies in which a new drug or treatment is giv-en to a larger group of people of a few hundred to test its effectiveness and further evaluate its safety in the dosage range established from Phase I trials .

Phase III: Multi-institution studies in which the new drug or treatment is given to thousands of people to confirm effec-tiveness compared to currently available standard treat-ments . This phase also monitors side effects and assess-es the risk/benefit relationship for the intended use of the drug or treatment, which supports FDA-approval to market the drug or treatment .

Phase IV: Studies done after a drug or treatment has mar-keting approval . These studies, also known as post-market-ing studies, are often required as a condition of approval by the FDA to provide additional long-term safety and effi-cacy data . Phase IV clinical trials may also be conducted to increase awareness of a new drug among physicians, or to compare the drug or treatment to other marketed products .

Through its partnership with the Hawai‘i Cancer Consor-tium (HCC), the Oncology Research Department has a leadership role in fostering a community-wide, coordinated effort to improve cancer care in the State of Hawai‘i . We are fully engaged in the selection process, launch, and con-duct of clinical trials that our physician researchers deter-mine are relevant for our local population .

The Oncology Research Department continues to work closely with HCC members to develop centralized proce-dures and shared processes to improve the efficiency of the clinical trials process .

The implementation of the OnCore Clinical Trials Manage-ment System (CTMS) continues to move forward . The mod-ules that are currently well supported by HCC are Regulatory, Protocol, and Subject Management . Work is ongoing to acti-vate additional modules to take full advantage of the CTMS .

The Queen’s Cancer Center continues with year three of the University of Hawai‘i Cancer Center’s National Cancer Institute Community Oncology Research Program (NCORP) grant . The overall mission of the five-year grant is to bring cancer prevention, control, screening/post-treatment sur-veillance, treatment, and imaging trials—as well as health-related quality-of-life and cancer care delivery research tri-als to individuals in their own communities .

Additionally, QMC is the Cancer Care Delivery Research (CCDR) site for the Minority/Underserved for NCORP, which provides scientific and administrative oversight for CCDR in Hawai‘i . CCDR-specific clinical trials examine how social fac-tors, financing, organizations, health technologies, health care providers, and individual behavior affects cancer outcomes .

Through its partnership with

the Hawai‘i Cancer Consortium

(HCC), the Oncology Research

Department has a leadership role

in fostering a community-wide,

coordinated effort to improve

cancer care in the State of Hawai‘i.

ONCOLOGY RESEARCH DEPARTMENT (CONTINUED)

PATHOLOGY, MOLECULAR DIAGNOSTICS LABORATORY & BIOREPOSITORY

MAJOR TYPES OF TUMORS TREATED

In 2016, The Queen’s Medical Center portfolio of clinical research studies (treatment and non-treatment) included the disease sites below. Over-all patient accrual to clinical trials was 14.3% with respect to QMC’s 2015 total analytic cases.

• Brain (Glioma)• Breast• Gastrointestinal (Colorectal, Esophagus, Esoph-

ageal Gastric Junction, Liver, Pancreas)• Genitourinary (Prostate, Bladder, Renal)• Gynecologic (Cervical, Vulva, Endometrial, Ova-

ry, Fallopian, Peritoneal)• Head & Neck• Hematologic (Non-Hodgkin’s Lymphoma, Leu-

kemia, Myeloma)• Lung• Melanoma• Sarcoma• Symptom Management• Thyroid

Molecular Diagnostics Laboratory team members


ed to collaborate in the selection of group themes, including such topics as feeding one’s spirit, anger, authenticity, forgive-ness, hope, joy, love, and peace . All cancer survivors and their loved ones are welcome to attend .

The Hospital Ministry Department provides spiritual and emotional care support to patients, their loved ones, and the Queen’s health care team 24 hours a

day, 7 days a week . While religion is one way that “spiritual-ity” is expressed, the term is much broader, addressing the ways that people connect to the divine, to self, and to oth-ers to create meaning in their lives .

Upon request, interfaith hospital chaplains facilitate spirituality groups for cancer survivors and their loved ones . These ses-sions offer an opportunity for individuals facing similar circum-stances to connect and share personal journeys and sources of spiritual strength . The spirituality group is designed to be a safe place for everyone to explore, process, and share . Differ-ences are honored and respected . Participants are also invit-

Queen’s Imaging Services offers many types of advanced imaging technologies to diagnose dis-

eases and develop therapy plans . All pro-cedures are performed by registered and certified technologists and interpreted by board-certified radiologists . Imaging Ser-vices has the broadest range of radiology and ultrasound services at The Queen’s Medical Center (QMC), as well as various imaging capabilities at The Queen’s Med-ical Center – West O‘ahu, the Queen’s Health Care Centers – Hawai‘i Kai, and the Physicians Office Buildings 2, 3, and West – O‘ahu .

Imaging Services provides lung cancer screenings with low dose CT scans of the chest for patients with high risk of lung cancer due to significant smoking history . Research has shown an approximately 20% reduction in mortality from lung cancer due to early detection .

Recently, Queen’s Nuclear Medicine acquired a SPECT/CT system . Obtaining functional SPECT and anatomic CT data together improves the ability to find lesions, reduces false

positives, and clarifies questionable lesions by better local-ization compared to SPECT alone . SPECT/CT is also supe-rior in the assessment of endocrine and neuroendocrine tumors . The system is better in tumor localization and char-acterization, leading to a decrease in the number of ambig-uous findings . In addition, SPECT/CT has been very ben-eficial in ruling out metastatic disease bone scans, and in determining the location of sentinel lymph nodes to tumors in lymphoscintigraphy (study of the lymphatic system) .

HOSPITAL MINISTRY IMAGING SERVICES

COMPREHENSIVE GENETICS CENTER

Staffed by a team of two genetic counselors and a patient services coordinator, the Queen’s Compre-hensive Genetics Center offers genetic counseling for

individuals and families with histories of cancer to determine if there is a hereditary basis for cancer and to assess risk . Genet-ic counselors offer guidance on appropriate genetic screen-ing and testing; coordination of testing when recommended; and interpretation of results . They help patients understand and adapt to the medical, psychological, and familial implica-tions of genetic contributions to cancer . Genetic education and counseling allows individuals to consider various medical uncertainties, diagnoses, or medical management based on test results . Individuals are also better able to weigh the risks, benefits, and limitations of genetic testing .

Genetic counselors review all cases presented at Queen’s Multidisciplinary Oncologic Treatment Planning and Research Conferences (tumor boards) to identify patients who may ben-efit from genetic counseling and/or genetic testing . Patholo-gy reports are also reviewed to identify cases appropriate for genetics referral, based primarily upon abnormal immunohis-tochemistry results of new cancer specimens that are sug-gestive of an underlying hereditary syndrome .

Genetic counselors hold a monthly support group for indi-viduals who have a BRCA gene mutation, which may pro-duce hereditary breast-ovarian cancer syndrome in affect-ed individuals . The support group is open to all patients with a BRCA mutation .

In 2016, the Queen’s Comprehensive Genetics Center had 704 individual cancer genetic counseling/risk assessment patient visits, including patients with a personal and/or fam-ily history of cancer .

Our Genetic Counselors began offering genetic counsel-ing at North Hawai‘i Community Hospital (NHCH), located in Waimea on Hawai‘i Island in fall 2015 . Monthly Genetic Counseling clinics are provided at NHCH . There were 31 individual genetic counseling sessions provided at NHCH during the 2016 calendar year .

Through these and other efforts, the Queen’s Genetics Center continues to work toward increased community and physician awareness of the genetics services available to cancer patients .

Approximately 5-10% of cancers are associated with a hereditary cancer syndrome.

IMAGING TECHNOLOGIES

64-Slice CT Scanners. Queen’s CT scanners are low dose and high diagnostic quality. They produce scans of all anatomical areas of the body, and are also used for CT-guided interventional procedures.

Short-bore 1.5 Tesla MRI (2) & Short-bore 3 Tesla MRI (1). QMC has advanced MRI techonologies that offer the clearest imaging capabilities available today. QMC also has an advanced technology coil geometry breast MRI system that works with a 1.5T MRI scanner to provide physicians with enhanced quality images of breast tissue for more accurate diagnoses and inter-vention. The breast MRI program is accredited by the American College of Radiology.

PET/CT Scanner. QMC houses a PET/CT scanner at the Ham-amatsu/Queen’s PET Imaging Center, a joint venture between Hamamatsu Photonics and Queen’s located in the hospital. Because of their short half-life, radiopharmaceuticals used in PET scanning are manufactured at Queen’s. A tumor’s size, shape, mass, and location can be imaged by the CT scanner, while the PET shows where and how rapidly it is growing.

Biplane & Single Plane Angiography/Interventional Imag-ing Suites. These systems are used to perform various types of diagnostic and interventional procedures, such as chemo-embolization, radiofrequency (RF) ablation, and Y-90 thera-py. The equipment includes flat panel technology that sup-ports the integration of angiography images with CT and MRI images during procedures, and 3D images that assist radiol-ogists in diagnoses and therapy plans.

Coil geometry breast MRI system with 1.5 Tesla MRI

The Rev. Al Miles (left) performs a blessing for the Queen’s Cancer Center’s 10th anniversary


With a staff of master-level licensed social workers, Queen’s Social Work Services provides counsel-ing for patients diagnosed with cancer . The staff

helps answer questions, as well as addresses feelings, including loneliness, sadness, and anxiety . Social work-ers help plan for the future, provide education, and access community resources .

As creative problem solvers, the staff works as a team with physicians, nurses, navigators, psychiatrists, and other medical professionals to address the whole person, not just the diagnosis of cancer .

Continuing & New Initiatives• Continued collaboration with social workers in the

Emergency, inpatient, and outpatient departments to provide continuity-of-care and to increase patient satisfaction .

• As psychological, social, financial, and behavioral issues may interfere with a patient’s treatment plan and adversely affect treatment outcomes, social workers provide Distress Thermometer assessment, counseling, and referrals, and collaborate with the Queen’s Cancer Center team to give integrated, high-quality care . In 2016,

there was a 23% increase in new patients screened at the Queen’s – Punchbowl Cancer Center . This increase is partially attributed to improved efficiency in collection, referral, and tracking of the Distress Screening data .

• A full-time Social Worker was added to the Head and Neck Institute to meet the needs of the increased num-bers of new patients .

• Collaborated with the staff at North Hawai‘i Community Hospital and Queen’s – West ‘Oahu . The Cancer Center provided education on the Commission on Cancer and Psychosocial Distress Screening Standards, and initiat-ed Distress Screening for their facilities .

Meeting Community NeedsFacilitated a 4-week CLIMB (Children’s Lives Include Moments of Bravery) Program designed to help children of cancer patients cope with the emotional stress the disease can cause in families . Developed and facilitated a separate parent group that met simultaneously . Participants of the group reported that they enjoyed and benefitted from this program .

• Facilitated monthly Caregiver, Breast Cancer, and Lung Cancer support groups .

SOCIAL WORK SERVICES

CLINICAL SOCIAL WORK SERVICES

• Assessment, diagnosis, planning, and treatment of patient and family psychosocial needs

• Brief therapy for newly diagnosed patients and families with adjustment to illness issues

• Brief therapy for patients experiencing progres-sion of disease

• Community resource linkage• Crisis intervention• Substance abuse counseling• Grief/bereavement therapy• Advance care planning

THE QUEEN’S WOMEN’S HEALTH CENTER

The Queen’s Women’s Health Center (WHC) offers a full spectrum of clinical, diagnostic, and therapeutic services for women of all ages in a beautiful setting .

Breast health screening, education, outreach, and patient navigation services are our specialties . Services include mammography, breast ultrasound, stereotactic and ultra-sound guided biopsies, bone density testing, physical therapy, prenatal screening, and wellness services such as massages, facials, and acupuncture .

The WHC has earned the only National Accreditation Pro-grams for Breast Centers accreditation in Hawai‘i by the American College of Radiology for mammography, ste-reotactic breast biopsy, and breast ultrasound/ultrasound biopsy . The WHC has also been awarded National Breast Cancer Foundation grant funds for the past seven years, and Breast and Cervical Cancer Control Program grant funds for nine years .

MammographyEarly detection is the best defense against breast cancer . At the Women’s Health Center, digital mammography is avail-able in 2D and 3D . Our 3D digital mammogram technology, or Tomosynthesis, is an advanced technology screening and diagnostic tool designed for early breast cancer detec-tion that can be done at the same time as 2D mammog-raphy . The 3D mammography technology provides a bet-ter way to find breast cancer when tumors are smaller and can be treated with simpler procedures with greater suc-cess . Tomosynthesis has improved cancer detection rates by 27%, with a 40% increase in invasive cancer detection .

With Tomosynthesis, 16 images are taken through an arc from different angles, versus four in traditional 2D mam-mography . While 2D mammography images can be confus-ing when different layers of tissue overlap, Tomosynthesis images can be viewed separately or put together as a 3D reconstruction of the breast tissue . It is especially effective for examining dense breast tissue prevalent in many eth-nic groups in Hawai‘i . The advanced technology also uses about half the amount of radiation of other mammography machines . Tomosynthesis 3D mammography is available at the following Queen’s facilities on the island of O‘ahu:

• The Queen’s Medical Center – Punchbowl, Women’s Health Center

• Physicians Office Building 3 Imaging

• The Queen’s Medical Center – West O‘ahu

• Queen’s Health Care Centers – Hawai‘i Kai

WHC Patient Navigation ProgramThe WHC’s Patient Navigator Program was a first in Hawai‘i and is still a service found at few other health care facilities .

Patient navigator associates assist patients from abnormal mammogram to diagnosis . They are trained to provide sup-port for clinical needs while also giving emotional support if an abnormality is detected on a routine mammogram .

The program provides services for patients who require: • Additional imaging services resulting from an initial

screening mammogram;

Mammography Screening by Location, 2016

DigitalScreening

3DScreening*


QMC Punchbowl CampusWomen’s Health Center 16,556 6,708

QMC Punchbowl CampusPOB 3 Imaging 1,376 627

QMC – West O‘ahu 4,783 1,046

Total 22,715 8,381

*We have seen an increase in requests by patients and physi-cian for 3D Tomosynthesis studies even though insurance is not yet reimbursing for this exam as of yet .


• One-on-one meetings when a biopsy is recommended;

• Pre-biopsy and post-biopsy support; and

• Scheduling of follow-up appointments .

There are three patient navigator associ-ates at the WHC . The first is assigned to patients at the onset of an abnormal mam-mogram . The patient navigator associ-ate contacts the patient to schedule a diagnostic mammogram appointment and evaluates the needs of the patient to include financial assistance, emotional support, and transportation services . The navigation process continues if a breast biopsy is recom-mended . If there is a cancer finding from a breast biopsy, the second patient navigator associate assists and guides the patient from treatment to survivorship . The patient naviga-tor associate works with the patient throughout treatment, meeting them when they arrive, giving them support when needed, and answering questions about the process . The third patient navigator associate is responsible for communi-ty outreach, educating girls and women about breast health, and matching eligible women with facilities to schedule their annual mammograms .

Physical TherapyWomen’s Health Physical Therapy is offered to improve quality-of-life for all women . WHC physical therapists have specialized training to perform comprehensive examina-tions, identify problem areas, and formulate a treatment plan to reduce pain, maximize function, and enable patients to manage these issues at home . Cancer-related treat-ments include:• Breast cancer rehabilitation for pain, weakness, and

tightness; and

• Lymphedema treatments for swelling after breast can-cer treatment .

2016 Breast Program Report• The WHC’s Breast Program received its third re-certi-

fication by the American College of Surgeons’ National Accreditation Program for Breast Centers (NAPBC) in April 2015 . Under the guidance of the Cancer Committee, the Breast Program Leadership Committee oversees and coordinates 27 highly specific standards that must be met to earn and maintain national accreditation . The Queen’s Medical Center’s commitment to these quality standards of care ensures the highest quality of care for patients .

• A weekly interdisciplinary breast cancer conference focuses on treatment planning for newly diagnosed and recurrent breast cancer patients, providing a forum to discuss recent advances in breast cancer care, clinical trial availability, comprehensive updates, and to gen-erate consensus in the community regarding quality breast cancer care using National Comprehensive Care Network guidelines . Participation is designed for all prac-titioners involved in the care of patients, including prima-

ry care physicians, breast radiolo-gists, pathologists, patient navi-gators, breast surgeons, plastic surgeons, medical oncologists, radiation oncologists, nurses, mammographers, sonographers, pharmacists, social workers, clini-cal research staff, pain specialists, geneticists, physical therapists, and cancer registrars .

• As a result of The Queen’s Medical Center becoming a cer-tified member of MD Anderson

Cancer Network®, a program of MD Anderson Cancer Center . Since 2015, the WHC has had multidisciplinary team access to video conferenced tumor boards for breast cancer cases . Participants from MD Anderson are specialists in breast surgery, medical oncology, and radiation oncology . Many recommendations from MD Anderson regarding best practices and new protocols in breast cancer treatments have provided Queen’s phy-sicians with additional treatment plans to consider for our patients . The network affiliation also gives Queen’s physicians access to resources, such as the ability to consult with physicians in peer-to-peer consultations . Patient cases can be reviewed by respected experts, resulting in feedback with valuable treatment advice . Through the network, Queen’s certified physicians may also request expedited referrals to The University of Texas MD Anderson Cancer Center in Houston, Texas, for complex cases .

THE QUEEN’S WOMEN’S HEALTH CENTER (CONTINUED)

SERVICES PROVIDED ON O‘AHU (Data from January – December 2016)

No. of AverageStages of Patients Time Elapsed StageServices Measured Served Between Stages Measured

Mammograms 18,688 Self-or MD-Referred

Abnormal Results 1,375 1-2 Days From Screening to Diagnostic Mammogram

Biopsy/Work-up 1,018 3 Days From Abnormal Results to Biopsy

Diagnosis of 256 2 Days From BiopsyMalignancy to Diagnosis

• The WHC continues its participation with the Breast and Cervical Cancer Control Program (BCCCP), which pro-vides services for underinsured and uninsured women at no cost to them . Over 64 women are given mammo-grams each year to ensure that they don’t go without one due to a lack of health insurance coverage or finan-cial issues . Services are provided by a patient naviga-tor associate at all sites on O‘ahu and on the Island of Molokai and Lanai .

• A challenge we have encountered is getting women to get their annual mammogram . It is common for a wom-an with insurance to put off making her annual mam-mogram screening appointment . We continue to reach these women at community health fairs and encourage them to schedule and appointment . Our goal is to make the experience as easy and painless as possible .

As the needs of the community grow, the Queen’s Breast Program will grow with it to serve all of the women of Hawai‘i .

Erin Capps, MD, of the Women’s Health, Queen’s – West O‘ahu.

Each year, prevention and early-detection/screening programs are offered by the Queen’s Cancer Center (QCC) . They are based on community needs and are

monitored to ensure that the services provided best serve both patients and the community .

The QCC’s outreach activities are developed based on American Cancer Society cancer awareness calendar guidelines . Events are planned to target specific cancer types and identify community needs . Programs offered by the American Cancer Society are incorporated into educa-tional classes, and evidence-based guidelines are used for cancer prevention .

These events are designed to help the community under-stand the importance of cancer awareness and preven-tion . Brochures and resource materials are provided by the American Cancer Society, Cancer Care, and other certified organizations, and are used as tools to educate the pub-lic . Cancer patients and family members are encouraged to participate in art classes, support groups, and educa-tional offerings to help them with the various aspects of coping with a cancer diagnosis . Patients are made aware of educational classes and support groups through staff, QCC website, newspaper ads, flyers, and a quarterly cal-

endar of events . The QCC also educates the public about the importance of screening and prevention at community events and conferences throughout the year .

Colon Cancer Awareness EventsThe American Cancer Society’s cancer awareness calen-dar marks March as colon cancer awareness month . This annual event educates people about the importance of colon health, targeting mainly people age 50 or older . In 2016, QMC hosted two events, one of which was a first to be offered at Queen’s – West O‘ahu .

COMMUNITY OUTREACH


Colon cancer screening at QMC


In partnership with Sodexo, Queen’s Food & Nutrition Services delivers quality meal service and clinical nutri-tion care services to patients . Queen’s upholds strict

food quality and sanitation standards, such as the Gold Check program and Hazard Analysis Critical Control Points (HACCP) . All Queen’s food services personnel must also pass training on food preparation methods, safety and sani-tation, and on hospital food service issues, such as special diets for patients .

Food & Nutrition Services provides a registered dietitian (RD) for all patients on Queen’s inpatient oncology unit . An RD is available to help with appetite changes, weight loss, and other complications . They obtain patient food prefer-ences; provide nutrition education for those who require special diets; and consult and work with pharmacists, nurs-es, case managers, and physicians to provide optimal nutri-tion for cancer patients . Patients are also referred from Radi-ation Oncology, the Queen’s Cancer Center, and the Head and Neck Institute for individualized nutrition counseling .

An RD also: • Provides monthly group classes for patients seeking

information on dealing with the side effects of cancer treatment

• Sees patients who want more information on an individ-ual basis

• Conducts classes on healthy eating to prevent cancer

• Holds classes for those who have completed treatment and wish to improve their diets

• Co-facilitates a monthly cancer support group

• Attends other support groups as requested .

Oncology inpatients and those receiving extended treat-ments at the Queen’s Cancer Center can order meals through Sodexo’s At Your Request™ Room Service by calling the Concierge Center between 6:30 am and 6:30 pm . Room Service is particularly suited for patients with decreased appetites, as small meals can be ordered multiple times throughout the day . Menu items can be ordered at any time, such as a breakfast entree at dinner or soup at breakfast, depending on whatever a patient desires at the time . The menu has been revised to include local favorites and glu-ten-free items . The goal of Food & Nutrition Services is to provide flexible, patient-centered care through this program .

Other noteworthy features and developments in Food & Nutrition Services include:• The oncology clinical dietitian services both inpatient

and outpatient areas for greater continuity .

• A regular clinical nutrition satisfaction survey is conduct-ed for oncology areas . Favorable feedback and com-ments received from patients indicate a high demand for services in the Queen’s Cancer Center and Radiation Oncology areas .

• Nutrition consult referrals from patient navigators contin-ued to increase in 2016 .

• Monthly nutrition classes for cancer patients have tran-sitioned to a standardized, curriculum-based “I Can Cope” nutrition class . The class is offered to the public and taught by Queen’s RDs who have completed “I Can Cope” training modules .

Educational booths were staffed by Queen’s GI Services, Oncology, and Endoscopy departments . Information and materials provided on awareness and prevention follow guidelines from the American Society of Gastroenterol-ogy (SGEA) and the Society of Gastroenterology of Nurs-ing (SGNA) . Health care professionals encourage people to schedule a colonoscopy at age 50, and talk to their doctor if they have a family history of colon cancer .

Queen’s – Punchbowl had an estimated 350 people in atten-dance; Queen’s – West O‘ahu had 53 . Participant evaluations indicated that conducting the event at Queen’s – West O‘ahu was helpful, and a significant number noted that they want to see more of these events at this location . As Queen’s – West O‘ahu and its surrounding community grows, we predict that attendance at community outreach events will increase, and that we will be able to reach more people with awareness and prevention education on colon cancer .

Skin Cancer Screening EventsAnnual skin cancer screening events have been held at the Queen’s – Punchbowl campus for the past 6 years . In 2016, skin screenings were also offered at Queen’s – West O‘ahu and at Molokai General Hospital . Using guidelines from the American Academy of Dermatology, dermatologists volun-teered to offer free screenings at all three locations . Copies of screening forms were sent to patients’ PCPs for follow-up for all abnormal findings .

Head & Neck Cancer Screening EventOral screening was performed by physicians from The Queen’s Head and Neck Cancer Institute and dentists from the Queen’s Dental Clinic . Screening forms and guidelines used were from the Head and Neck Cancer Alliance . At the 2016 screening event, there were 84 patients screened, 19 of whom had abnormal findings . Screening forms were sent to the patients’ PCPs . Calls were made to ensure that they were received and a follow-up appointment was made to discuss the findings with the patient .

Other Community Activities & Educational Classes• I Can Cope – Nutrition Before and After Cancer

Treatment

• Look Good Feel Better Educational Class

• Cancer Survivorship Celebration: Annual “Celebration of Life” event for cancer survivors and their caregivers .

• PaintFest America: A national event hosted by the Foundation for Hospital Art .

• Healing Through Art: An art program for cancer patients that meets twice monthly .

• Oncology on Canvas: This annual event brings together cancer patients and their caregivers to enjoy a fun day of painting .

Support Groups• Breast Cancer: A forum for women to discuss and share

issues related to breast cancer .

• BRCA+: A place to find support for those with a BRCA gene mutation and meet others who have experienced or may be experiencing the same situation and have the same questions .

• Caregivers: Addresses the needs of caregivers and gives them the resources to help them keep a balanced lifestyle while caring for a loved one .

• Lung Cancer: Survivors share and help one another cope with the difficulties the disease can cause .

• Head & Neck: Warriors help newly diagnosed patients who are battling cancer of the brain, mouth, throat, thy-roid, and esophagus .

• CLIMB (Children’s Lives Include Moments of Bravery): A program designed to help children of cancer patients cope with the emotional stress this disease can cause in families .

COMMUNITY OUTREACH (CONTINUED)

FOOD & NUTRITION SERVICES

2016 Skin ScreeningNo. of People Screened

Abnormal Findings

QMC Punchbowl Campus 88 26 30%

QMC – West O‘ahu 35 13 37%

Molokai General Hospital 17 7 41%

%

Executive Chef Walter Kaneshiro with an At Your Request Meal.

The Queen’s Medical Center is a 501(c)(3) corporation

1301 Punchbowl Street Honolulu, Hawai‘i 96813

Phone: 808-691-1000

cancer committee - queen's · 2018. 4. 19. · 1 cancer committee annual report 2016 cancer...

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