StatenIslandUniversityHospitalNorthwellHealthExecutiveSummary2017

Completed November2018

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TABLEOFCONTENTS

CancerCommitteeMembership 3

CancerCommitteeChairReport 4-7

SurgicalOncologyReport 8-9

PediatricOncologyReport 10-12

RadiationOncologyReport 13-15

RadiologyReport 16-17

HematologicNurseNavigatorReport 18-19

BreastHealthNavigatorReport 20-21

GastrointestinalNurseNavigatorReport 22-23

Head/NeckNavigatorReport 24-25

LungNavigatorReport 26-27

RehabilitationReport 28-31

CancerRegistryReport 32-34

OncologyResearchReport 35-36

UniversityHospice 37-39

CancerEducationandPreventionReport 40-41

CommunityOutreachYearEndSummary 42-48

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2017CancerCommitteeMembershipPatriciaM.Altschuler,BSN,RN,HeadandNeckNavigator

LisaCarolan,RN,MHA,PIManager

NancyCaserta,RN,OCN,BreastHealthNavigator

RaimondaClark,RN,MA,M.ED,AssociateExecutiveDirector,OncologyServices

CynaraCoomer,MD,CancerLiaisonPhysician

ClaudineDeMarco,RN,MSN,GastrointestinalNurseNavigator

FrankForte,MD,Director,PalliativeCareMedicine

KerryGillespie,DirectorComplimentaryMedicine

NoraGoldberg,Manager,OccupationalTherapy

LauraLongo,RN,BSN,NPDirector,PatientCareServices,AmbulatoryOncology

MicheleLotito,HealthInformationManagement

LouiseMadrigal,RN,BSN,OCN,CRC,ManagerClinicalResearch

PaulaMcAvoy,RN,MPS,OCNAdmDirector,UniversityHospiceOncology

AveryMiller,MS,CGC,GeneticCounselor

LaurenMoore,AmericanCancerSociety

LynneOpitz,MD,AssociateChair,Pathology

AntonioPicon,MD,SurgicalOncology

HeatherPolizzi,BSN,RN,HematologicMalignanciesNavigator

DeirdreQuirk,CTR,RHIACancerRegistryCoordinator

MariaRapuzzi,RN,BreastHealthNavigator

CarolynSimone,LCSW,Manager,CommunityEducationandMarketing

TerenigTerjanian,MD,Chairman,CancerCommittee

DeniseTorsney,RN,NurseManager,3B

PennyTroiano,MSW,LCSW,OCW-C,OncologySocialWorker

SarahVaiselbuh,MD,PediatricOncology

JudyValitutto,RN,LungNavigator

PhilipVigneri,DO,Chairman,RadiationOncology3

TerenigTerjanian,MDChair,CancerCommittee

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CancerCommitteeChairReport

Cancermanagementcontinuestobeoneofthemajortargetsofhealthcarerealities.Itisestimatedthat,thisyearmorethan1,700,000millionpeoplewillbediagnosedwithcancer.Morethan600,00willdiefromthedisease.Inadditiontotheobligationofprovidinghighqualitycancercaretoourcommunity,theCancerCenterduty includesparticipatingincancerresearchtoachievethefinalgoalofacureforeverykindofcancer.Progresshasbeenmadeoverthelastthirtyfiveyearswithanexplosionofnewandeffectivetreatmentsachievingnotonlybettersurvival,butalsoasignificantnumberofcures.

TheCancerCenterwasestablishedin1991inordertorespondtotheneedsoftheStatenIslandcommunity,andtoavoidtheburdenofcommutingtoNewYorkCityfortheircare.Forthatreason,acomprehensivecancercareprogramincludingallaspectsofthemanagementofmalignantdisorderswascreated.AlloftheareasofcancertreatmentsareavailableatStatenIslandUniversityHospitalNorthwellHealth.Surgery,chemotherapy,radiationtherapy,immunotherapy,nutritionalandpsycho-socialservices,patienteducation,cancerscreening,physiotherapy,rehabilitation,palliativecareprogram,hospiceandcommunityoutreach.(Pleaseseeseparatereportsfortheabovementionedprograms).

Alloftheseprovidedthroughacoordinatedmultidisciplinaryapproach,usingthemostupdatedinformationavailable,consistentwithnationalguidelinerecommendationsinadedicatedenvironmentthatuniteshighqualitycareofanacademicandwellrespectedinstitutionwiththecomfort,convenience,personaltouchanddedicationofprivateinstitutionsorpractices.Forallofthesereasons,thecancerprogramwasaccreditedforanotherthreeyearswithcommendationfora3rd timeinarowin2017bytheAmericanCollegeofSurgeonsCommissiononCancer.Thisisanhonorreservedtoonlyabout75institutions outofoverathousand Ourprogramisdueforanothersurvey in2020. Wehopetoachievethesamehighlevelofaccreditationwithcommendation.

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Themultidisciplinaryapproachisattheheartofthecancerprogram.Theintentionisnotonlytreatment,buttodosoinarelaxingenvironmentwithallofthenecessaryancillaryandsubspecialtyservicesavailable,suchasgynecologicandurologiconcologicconsultations andfollowupprovidedonsite,althoughtheCancerCenterhasbeenprincipallythehomeoftheMedicalOncologydivisionsince1991.Thecenterdoesnotdiscriminatebasedoninsurancecoverage.Alloncologicandhematologicpatientsaretreatedwithout distinctionbetween“clinic”and“private”patients.Thenumberofpatientsvisitsatthecenterisover30,000peryear.Atpresent,thereareplanstomovethelocationoftheCancerCenterandexpandittoaccommodatethe increasingnumberofpatientssincethepresentfacilityhasreachednearsaturationlevels.Asexpected,therehavebeenpersonnelchangesattheattendingphysicians’level.Theprogramhiredanewhematologist-oncologistDr.Sokoloff joinedourteaminearly2017.Wearelookingfora7th oncologistfor2018.

FeaturesoftheCancerCenterandprogramincludethefollowing:

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• Extensivechemotherapytreatmentcenterofferingthelatestmodalitieswitha alloftherecentlyavailabledrugsinadditiontothetraditionaltreatmentsunderthesupervisionoftheattendingphysiciansandoncologycertifiednurses.

• FullyequippedRadiationOncologyprogram

• PalliativeCareservicesandaHospiceprogram

• DedicatedservicesforPediatricHematologyandOncologyunderthedirectionofDr.SarahVaiselbuh

• Fourconsultationandtenexaminationroomswithasixteenchairoutpatientchemotherapyunit

• Inpatientoncologyunit

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• On-sitelaboratoryservices

• Dedicatedoncologypharmacy

• CancerInformationLine

• NutritionalServices

• NurseNavigatorprograms

• Geneticcounseling

• SocialServicesprogramtoassistpatientsandfamilieswithfinancialassistanceandcounseling

• Support groupsandpatienteducationprograms

• UptodateradiologicservicesPET-CT,CATscan,MRI,nuclearimaging,digitalmammogramunitinadditiontostandardxrays

• BloodBankunitwithcytophoresisandplasmapheresiscapabilities

• CancerRegistryData

• Hematology-Oncologyresearchprogramwiththeappropriatedesignatedpersonnel

• Academicactivities(lectures,conferences,journalclubs)intheconferencecenter

• ComplementaryMedicineservices

• ACGME-approvedHematology-Oncologyfellowshipprogramhousingamultiheadmicroscope

AntonioPicon,MDSurgicalOncology

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SurgicalOncologyReport2017

1. Wewillenforcepathologyslidereviewfromoutside institutions foralloncological cases.2. AspertheCommissiononCancermeasure,wewillmonitor thetrendforadequatelymphadenectomy incoloncancerresections.3. Wewillincreasethenumber ofgastrointestinaloncologyandsofttissuetumorcasespresentedatourmedical-surgicalweeklytumorconferencemeetings.4. Wewillcreateamultidisciplinary gastrointestinalconferencethatcanbeusedtodiscussadditionalGIoncology casesoutsideourregulartumor conference.5. SurgicalattendanceatTumorConferencein2017wasover90%.TheCancerCommitteesettherequiredattendancetobe80%.Everyeffortwillbemadetokeepthesurgicalattendanceatthehighestlevel.

Goals20181. IncreasethenumberofSurgicalOncologycasesin2018.2. Toincorporatethenursenavigatorroleintoothersurgical

disciplines.3. Consolidatetheroleofthemultidisciplinary GIconference.4. Increasethenumberofsurgicaloncologycases,prospectiveand

retrospective,presentedattumorconference.

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SarahVaiselbuh,MDChair,PediatricOncologyServices

TheDivisionofPediatricHematology/Oncologyprovidesclinicalservicesforchildrenwithcancersaswellasbenignblooddisorders.Focusonoutpatientchemotherapy(insteadofhospitalization)isauniquefeatureoftheChildren’sCancerCenteratSIUHthataimsatincreasingthequalityoflifeofbothchildandparentsalike,sincethechildrencanreturnhomeintheeveningtothefamiliarityoftheirownbedroom.

ThePediatricHematology/OncologydivisionhasdevelopedpoliciesandproceduresfullyintegratedwithNorthwellstandardsofcare.Wetrainedmid-levelproviderswhoaretheliaisonbetween inpatientandoutpatientnursingstaff.Theyprovidetrainingprogramsforpediatricnursessotheygainconfidenceintheclinicalmanagementofoncologypatients.Asacorerotationofthepediatric residencyprogram,ourfacultyisdailyinvolvedinmentoringandguidanceofrotatingresidents.ToimpacttheacademicproductivityoftheDepartmentofPediatricsandresidenttraineesatSIUH,Dr.Romanosplaysakeyroleasco-chairoftheresearchandscholarshipcommittee.Dr.Vaiselbuhistheprincipalinvestigator(PI)ofherlaboratoryinbasicscienceinexosomesinleukemiaresearchatFeinsteinInstituteofMedicalResearch.Inaddition,she isthePIonaclinicalphaseIIItrialthatevaluatestheefficiencyofaninvestigationalantibodyinpatientswithsicklecellcrisis.Bothattendingphysicianshavehadmultipleabstractsacceptedforposterand/ororalpresentationsatregionalandnationalmeetingsandareactivelyinvolvedinmentoringjuniorfacultyandhousestaff.

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WeinitiatedProjectS.M.I.L.E.– apainawarenessandcomfortprogramforchildrenofallagesafflictedbydisease.Theresidentsarebeingtrainedinpainawarenessandcomfortkitsarebeingdistributedtohelpdistractchildrenduringpainfulproceduressuchasneedlesticks.Ourdivision isalsohometotheHistioCareprogram– aspecialtyprogramforchildrenandadultsaffectedbyHistiocyticDisorders.WecurrentlyareaparticipatingsiteoftheInternationalRegistryforRareHistiocyticDisorders(IRHDR)andamemberingoodstandingoftheNorthAmericanConsortiumforHistiocytosis.

CancerCommitteesettheacquiredattendanceat80%.ThePediatricHematologyOncologyattendancelevelhasbeenpersistentlyat80%orabove.

Goalsfor2018:

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• Expandtheprimarycarereferralbasebyuseoftheambulatoryelectronichealthrecordconsultationnotestoimproverapidcommunicationwithreferringphysicians

• PatientenrollmentonLCHIVprotocol(internationalprotocolfortreatmentofLangherhansCellHistiocytosis)

• DevelopresearchcollaborationstoenhancepatientenrollmentforclinicalcancertrialsacrossNorthwellHealthCancerServices

P.Vigneri,DOChair,RadiationMedicineTreatmentServices

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CONSULTATIONS:Volumeremainsinazone,withasmallgaininout-patients.

PARTIALBREASTIRRADIATION(PBI)- GiventheconcernsraisedbyrecurrencesintheTARGITtrial,areviewwasdoneofourcohort. Resultsfoundonerecurrencein98cases(2013-2015). Overall,volumewasconsistent in2017.

PatientstreatedwithIORT- 25PatientstreatedwithSAVIcatheter- 25TotalpatientstreatedwithPBI- 50

2011 2012 2103 2014 2015 2016 201733 32 38 61 54 40 50

PBICASESPERYEAR

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2011 2012 2013 2014 2015 2016 2017

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SBRT(FOCUSEDTREATMENT)FORSTAGEILUNGCANCERSBRTformedicallyinoperableStageILungCancercontinuedtogainacceptance.Allpatientswerediscussedatthemultidisciplinarythoracicconference.

RESEARCH: Theintraoperativebrachytherapy(IORT)caseswerereviewedgivenconcernsfromtheTARGITtrialofrecurrencerisk.In90patientstreatedfrom2013-2016therewere2localrecurrences,whichiswellwithinnationalguidelines(5%at5years).

EricTrenkmann,MDDirector,BreastImagingCenter

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INTRODUCTION: In2017therewereseveraltechnologicadvancesandupgradesintheBreastImagingCenter,aswellasfurtherstaffdevelopment.

TECHNOLOGY: In2017wepurchasedanewultrasoundmachine,anddidsoftwareupgradesonthe2existingunits.Ultrasoundhasbeeninincreaseddemandasasupplementalscreeningforpatientswithdensebreasts.

ENVIRONMENTOFCARE: In2017wecontinuedto improvetheaestheticsoftheBreastCentertohelpimprovethepatientexperience.

CLINICALVOLUMES:TheBreastCenterperformed17,117screeningmammograms,4,811diagnosticmammograms,5,134breastultrasounds,and969interventionalbreastprocedures.244breastcancerdiagnosesweremade,103ofwhichwerescreendetected.

2017AUDITANDBENCHMARKS:RESULT BENCHMARK

CALLBACKRATE11.15%5-12%SCREEN-DETECTEDCANCERRATE5.17/1000>2.5/1000PPV15.27%3-8%PPV332.7%20-40%

GOALSFOR2018:

Installationofour2nd &3rd TomosynthesisMammographyUnitsInstallationofour4th UltrasoundUnitCreatemoreschedulingavailabilityforpatientsneedingsamedayscreeningmammography/sonographyWehavenew,integratedclinicalsystems/applicationswithintheNorthwellHealthservicelineBeginofferingSaturdayappointmentsfordiagnosticimaging

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HematologicMalignanciesPatientNurseNavigator

HeatherPolizzi,BSN,RN

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Nursenavigatorsprovidedirectpatientcareandcomprehensivecoordinationofcareforpatientsandtheirfamilies/caregiverstoeliminatebarrierstotimelycareandfacilitateflowthroughthesystem,increasepatientandprovidersatisfaction,maintainpointofcontactwithprovidersandserveasthefirstpointofcontactforpatientsandfamilies.TheNurseNavigatorassistsincoordinationofmultidisciplinarycarefrominitialscreening,finaldiagnosisandsurvivorship.Navigatorsareresponsibleforeducating,coordinating,facilitating,andparticipatinginallpatientcare.NurseNavigatorscollaboratewithallmembersofthehealthcareteamtomakesureeachpatientisgettingthebestcareandsupport theyneedthroughouttheircancertreatment.

Centralpointofcontactforallnavigatedpatients;includinginteractionwithmedical,nursing,ancillaryservices.

Provideseducationtopatients,families,andsignificantothers;actsasaninformationresourcetohealthcareprofessionals,patientsandthepublic.

Collectandreportdatafrompatientonbarriers,healthcare,priortreatments.

Trackordercompletionandfollowup.Monitorpatientcompliancewithpatienttreatmentplan.

Assistwithreferralstooutsideresourcesandcarecoordinationasneeded.

Mayattendandreferpatientstotumorconference;followupwithrecommendations.

Collaborateswithmedicalproviders,patientcarestaffandclinicmanagementintheplanningandimplementationofpatienteducation.

Followupandassessallpatientspostcancertreatmentandcontinuetomonitorforany/alllongtermsideeffectsandpsychosocialissues.Referpatientstothepropersupportteamwhenneeded.

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NancyCaserta,RNMariaRapuzzi,RN

BreastHealthNavigatorReport

TheNurseNavigatorsatStatenIslandUniversityHospitalactaspersonaladvocatesfornewlydiagnosedbreastcancerpatients.Ournursenavigatorsprovidetheirpatientswithcounselingservicessopatientscaneffectivelycopewiththe impactofbreastcancerandsubsequent lifestylechangesthatoccurasaresultoftheirillness.

Nursenavigatorswillassisttheirpatientswiththefollowing:

Organizingappointmentsandnavigatingthroughthehealthcaresystem

Providenecessaryeducationandinformationonavailableoptions,informeddecisionmakingprocess,andrealisticgoalsettinginordertoempowerthepatientandtheirfamilytoactivelyparticipateintheirplanofcare

Providesupportandeducationalmaterials

Answerquestions regardingpatient’supcomingtreatmentplans

Collaboratewithpatientsandtheirfamilies

Providingsupport topreandpostsurgicalpatientsduringhospitalization

Facilitatetheweeklymultidisciplinaryconferences

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ClaudineDemarco,RN

GastrointestinalNurseNavigatorReport

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TheNurseNavigatorpromotestimelyqualitycareviapersonalguidancethroughthehealthcarecontinuum. Theprimarygoalofthenavigatoristodecreasethebarrierstocare.

TheNurseNavigatorwillassistthepatientwiththefollowing:

Orientspatientstothecancercaresystem

Coordinationofappointments, proceduresandtestingwithnecessarysubspecialtiesinatimelymanner

Collaborationwiththemultidisciplinaryteampreandpostoperativesupport

Providespatientandfamilyeducationrelatedtodiagnosis,treatment,chemotherapyprotocols,clinicaltrials,communityresourcesandsurvivorship

Developsandfacilitatessurvivorshipplans

Advocatesonthepatients’behalf

AdditionalActivities:

ParticipatedinthehospitalbasedbiannualOncologyCoreCurriculumbypresentingtheNavigationandGastrointestinalcontent

ActivememberoftheOncologyNursingSocietyandtheAcademyofNurseandpatientnavigators

ObtainedAONNCertification:OncologyNurseNavigatorCertifiedGeneralist

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PatriciaM.Altschuler,BSN,RN

Head&NeckNavigatorReport

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TheroleoftheOncologyNurseNavigatorusesamultidisciplinary approachtoprovidetimelypatientcarefromthebeginningofacancerdiagnosisthroughsurvivorship.TheNurseNavigatorisresponsible foreducating, coordinating,facilitating,andparticipatinginallpatientcare.NurseNavigatorscollaboratewithallmembersofthehealthcareteamtomakesureeachpatientisgettingthebestcareandsupporttheyneedthroughouttheircancer treatment.Uponcompletionofcancer treatment,NurseNavigatorscreatesurvivorshipcareplansforeachpatient,whichincludesabriefsummaryofthecaretheyreceived,aswellaslongtermsideeffects,followupappointmentsandcontactinformation.Acopyofthistreatmentplanisthensenttotheirprimarymedicalphysiciantofurtherfacilitatecollaboration inmedical care.

Collaborateandcoordinatepatientcare inatimelymannerfromdiagnosisthroughcompletionofcancer treatment

Educatepatientsandtheirfamiliesonallcancer treatments,sideeffectsandconcernsbefore,duringandaftertreatment

ParticipateinmonthlyCMEapprovedHeadandNeckconference tofacilitateamultidisciplinary planofcareforeachpatient

Followupandassessallpatientspostcancer treatmentandcontinuetomonitorforanylongtermsideeffects,aswellasanypsychosocialissues.Referpatientstothepropersupportteamwhenneeded(nutrition,socialworkers,financial,etc.)

Providesurvivorshiptreatmentplanstoallpatientsandtheirprimarycarephysicianstofacilitatecollaborationthroughoutthehealthcare team

TakepartinyearlyHeadandNeckcancer screeningsandcontinuetoencourageandsupportallnewlydiagnosedpatientsingettingthetreatmenttheyneed

Encourageallpatientsandtheir familymembers toparticipate inongoingsupportgroups,whichhelpstoovercomefearsandconcernsbefore,duringandaftertreatment

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JudyValitutto,RN

LungNavigatorReport

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TheLungCancerNavigatorguidesthepatienttothemostimportantinformationandresourcesforwheretheyareintheirlungcancerjourney.Thisincludesthenewlydiagnosedpatient,patientswhohavecompletedtreatment,lungcancercaregivers,andforpeoplewhoarecurrentlyintreatment.

Coordinationofcareforappointmentssuchasmedical,cardiology,interventionalradiology,radiationandpulmonaryappointments.

Provideeducationtopatientswhowillbereceivingchemotherapyand/orimmunotherapy.

Assistthepatient,familyandcaregiverswhohavequestionsregardingfinancialassistance,socialworkintervention,supportgroupsandsmokingcessations.

CoordinatesThoracicConferencewiththemultipledisciplinaryteam.(Pulmonary,Surgery,Oncology,InterventionalRadiology,andRadiation)

CoordinationwiththeCaseManagementteamforpatientswhoarehospitalizedincludingdiscussionofthedischargeplan.

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NoraGoldbergDepartmentofRehabilitationMedicineCancerReport

SpeechTherapy

Approximately20patientsamonthfordysphagiaconsultation.

CollaboratesconsistentlywithENTformoreadvancedsurgicalandreconstructiveproceduresonindividualswithheadandneckcancer.

Ongoingeducationwithnursingstaffinmanagingpost-surgicalheadandneckcancerpatients.

Ongoingassessment/treatment fordietmodificationandsafefeedingstrategieson3Binpatientoncologyunit.

Improvedawarenessthroughoutthehospitalforpatientswithheadandneckrelatedcancersandtheirneedfordysphagiaand/orvoiceservices.

Collaboratedwithadministration,patientsafety,qualityriskmanagement,and ENTindevelopingaplantobetteridentifyandadequatelycarefortotallaryngectomies.

AssistingENTindevelopingeducational toolsfornursing/medicalstaffand todevelopasimulationlabinCenterforAmbulatorySurgery.

InstrumentalassessmentstoincludeModifiedBariumSwallowStudies(MBS)andFiberopticEndoscopicEvaluationofSwallowing(FEES)forawidervarietyofoncologicalpatients.

WorkingalongsidePalliativeCareteamforadvancedillnesspatients.

Ongoingcollaborationamongspeechdepartment,respiratorytherapy,pulmonaryandstaffdevelopmentregardingeducationofstaffforvoiceprosthesisandtracheostomycare.

Participated incontinuingeducationcoursesfortechniquesusedwithpatientsdiagnosedwithheadandneckcancer.

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SpeechTherapy

Utilizingemailingamongteammembersaboutpre-treatmentpatientstoshareSpeechLanguagePathologyrecommendations.

Optimizingtheuseofthenursingnavigatorforearlyidentification forpatients’pre-treatmentinterventions(i.e.education,exerciseprogram,dietmodification).SpeechLanguagePathologyfollowupaspatientmovesthroughindividual careplan.

Oralcancer screeningsforthecommunity.

Participation inmonthlytumorboardforheadandneckcancer.

Oral,Head&NeckCancer supportgroupheldmonthly.

Additional Outpatientservices

Createdsocialmediaforumsforcommunicationwithinthecommunityregardingsurvivorship.

Participated incontinuingeducationcoursefortechniquesusedwithpatientswithheadandneckcancer.

ReferralfromcommunitySpeechLanguagePathologyforModifiedBariumSwallowStudies(MBS).

Useofasharedtrackingsystemforpatientswithheadandneckcancer.

Increasedpatientsatisfaction,reducedweightloss,reducedtreatmentinterruptions,andpostchemotherapyradiationtherapyoutcomeswithmorestandardizedprophylacticPEG placement.

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OccupationalTherapy

OTtreated66patientsintheUpperExtremityLymphedemaProgram.Weprovided336visits.Thissignificantlyexceeds171visitsfor38patientsprovidedin2016.

WearereceivingmorereferralsfromspecialistswithinSIUH(ComprehensiveBreastCenter,OutpatientOncologyServicesandRadiationOncology)aswellasoutsideoftheNorthwellHealthSystem.

EstablishedaprofessionalrelationshipwithNursePractitionersatNYU.

PediatricRehabilitation

Twopatientswerereferred toOutpatientservice.

Oneofthesepatientswasnotrecommendedforongoingservices. Thesecondchildevaluatedduringthe2nd quarterwasreferredforOTandPTservices,butwasre-hospitalizedandservices couldnotbeprovided.

PhysicalTherapy

Provided200visitstopatientswithLowerExtremityLymphedema.

293visitswereprovidedtopatientsonHospiceService.

Neuropsychology

OnepatientwasreferredandseenforNeuropsychologyevaluationin2017.

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DeirdreQuirk,CTRCancerRegistryCoordinator

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CancerRegistryReportTheCancerRegistryisadatabaseestablished toimprovecancercare throughthecollection,maintenance,analysisandproductionofreportsfromoncologydata.TheentiredatabaseincludesallcancercasesdiagnosedandtreatedatStatenIslandUniversityNorthwellHealthsince theregistry’sreferencedateof2002.Securitymeasuresforinsuringconfidentialityofdataarestrictlyfollowed.

TheCancerRegistryfrequentlyprovidesoncologydataforclinical studies,nursenavigatorsandthegeneticcounseloraswellasforthepurposeofbothshorttermandlongtermplanningfortheinstitution.Italsoservesasareviewofhospitalutilizationandqualityofcancercare.Toinsurecompleteandaccuratedataabstractingandreporting,theregistrystaffandtheCancerCommitteechairmanperformanongoingqualitycontrolandreviewofcompletedcancercases.

TheCancerRegistryisalsoresponsible formaintaininga90%fiveyearfollowuprateonalleligible cancerpatients,arequirementoftheAmericanCollegeofSurgeons,CommissiononCancer. An80%followuprateforalleligible patientsisalsorequired.Completeandaccurateinformationisessential forcompliancewiththestandardsoftheCommissiononCancerandtoprovidehighqualitysurvivaldata.

In2017,thefivemajorcancer sites(analyticcases)treatedherewere:

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Primary Site Total Percentage

Breast 275 19.43%

BronchusandLung 188 13.29%

HematopoieticReticuloendothelial System

101 7.14%

Bladder 96 6.78%

Colon 90 6.36%

AllOther Sites 665 47%

Total 1,415 100%

In2017,1,746newcancercaseswereaddedtoourcurrentCancerRegistrydatabase.Ofthenew,1,746casesaccessioned,1,415wereanalytic(newlydiagnosedand/ortreatedatStatenIslandUniversityHospitalNorthwellHealth)and331werenonanalyticcases(previouslydiagnosedandtreatedelsewherebuttreatedatSIUHforrecurrentorpersistentdisease).DistributionofcasesbyAJCCStageincludesunknownstagepatientsinitially diagnosedatSIUHbutthereisnotenoughinformationforaccuratestagingandnotapplicable (NA)cancersthatdonothaveAJCCstagingsuchasbonemarrowandbrain.

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Stage TotalCases %ofTotalCasesStage0 133 9%Stage1 328 23%Stage2 174 12%Stage3 105 8%Stage4 256 18%NA 242 17%Unknown 177 13%TotalCases 1,415 100%

Stage09%

Stage123%

Stage212%

Stage38%

Stage418%

NA17%

Unknown13%

2017AnalyticCaseStageDistribution

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MelissaPanzo,RNOncologyResearchReport

TheDepartmentofResearchwithinMedicalOncologycontinuestocollaboratewiththepatientcareteamtoenrollpatientsintooncologyrelatedtrials.Wecontinuetoofferourpatientpopulationaccesstoclinicaltrialsthroughcooperativegroupaffiliations,industrysponsored studiesandinternalinvestigatorinitiatedresearch.

OurOncologistsmaintainactiveNationalCancerInstituteInvestigatoridentificationnumbersandparticipateasmembersofourOncologyClinicalInvestigationsCommittee(OCIC)whichservesasaforumfordiscussingnewstudies,enrollment/screeningstatisticsandotherimportantresearchdevelopments.WeareproudtoreportthatourResearchCoordinator,ResearchNurseandManagerofClinicalResearchmaintaincertificationwiththeAssociationofClinicalResearchProfessionals(ACRP).

In2018theOCICmeetingwillberenamedtheResearchTransitionMeeting,thismeetingwillhavethesamegoalsastheOCIC.

Atotalof1,415analyticalcaseswerereportedtotheDepartmentofResearchfor2017.Enrolling6%ofouranalyticcasesforaccreditationequatesto85enrollments.Enrolling8%ofouranalyticalcasesforcommendationequatesto113enrollments.

Ourtotalenrollmentfor2017is196,meetingcommendationstatusfortheyear.

TheDepartmentofResearchwithinMedicalOncologycontinuestocollaboratewiththepatientcareteam,toenrollpatientsintooncologyrelatedclinicaltrials.

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PaulaMcAvoy,RNPalliativeCare

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MissionStatementThemissionofUniversityHospiceistomeettheneedsofterminallyillpatients,theirfamiliesandlovedones,byprovidingcomprehensivepalliativecarefocusingonphysical,social,emotionalandspiritualsupport.

ScopeofServiceUniversityHospiceislicensedtoprovidepalliativecareforterminallyillpatientsandtheirfamiliesinStatenIsland,Brooklyn&Queens.An8bedhospiceresidentialfacilityisavailableonthecampusofEgerRehabilitationCenter.

PatientCareStatisticsTotalReferrals 1,235TotalAdmission 556AverageLengthofStay 59MedianLengthofStay 18

*QualityImprovementactivitiesutilizeHCAHPSfamilysurveydata.

*Collectionof7NationalQualityForummeasuresrequiredbyCMScontinues. In2017CMSaddedanalysisofvisitsinthe last3and6daysoflife.FirstpublicreportingofNationalQualityForumscoresbeganinthesummerof2017.

*Effortstoimproveaccesstovolunteerservicescontinuedwithsmallincrementalincreasesover2016.

*EmergencyPreparedness- ParticipationinlargescaleDOHdrillandanalysisofall2017actualevents.PolicyandpracticeupdatedtoincludenewCMSregulation.ActiveshooterdrillcompletedfortheAddeoResidence.

*InfectionControl- Focusin2017onincreasingratesofinfluenzavaccinesamongHHA.“Secretshopper”handhygieneobservationsbeganin2017inadditiontoannualstaffvisitswithexcellentcompliance.

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MissionStatementThemissionofthein/patientpalliativecareserviceistomeetthephysical,social,emotionalandspiritualneedsofpatientswithanadvancedillness.Theseneedsareassessedandaddressedthroughaconsultingserviceconsistingofphysicians,nursepractitioners,nursessocialworkersandpastoralcarestaff.

Totalnewin/PtConsults-1222TotalVisits—3736

*ContinuationofAdvancedIllnessinitiativeswithPalliativeCarecurrentlyinICUrolledout in2016toCCUandEmergencyRoomin2017.AllpatientsassessedbyPalliativeCareteamforpotentialHospiceservices.

Plan2018

*ObtainHospiceEMR

*IncreaseHospiceserviceavailabilityinBrooklyn

*IncreasePalliativeCareservicepenetrationincludingsubmissionofaproposaltobringpalliativecareservicestotheSouthCampus

*Continueinitiativesinemergencypreparedness,fallprevention,infectioncontrolsurveillanceand“endoflife”education

*DSRIPinitiativescontinuetofocusonintegratingpalliativecareintoStatenIslandLongTermCareFacilities

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CarolynSimone,LCSWPracticeManagerCommunityOutreachCoordinator

CancerEducationandPreventionReportCommunityOutreachYearEndSummary

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CANCEREDUCATIONANDPREVENTIONREPORT2017

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TheCancerEducationdepartment iscommittedtoearlycancerdetectionbyprovidingfreescreeningsandeducationalseminars tothecommunity.Screeningsarescheduledforbreast,skin,headandneck,andcolorectalcancer. Educational seminarsandhealthfairsarescheduledtoprovideeducationandawarenesstothecommunity.

TheCancerEducationdepartmentworkswiththeAmericanCancerSocietytoprovidecommunityawarenessandcancerpreventionwitheducationallecturesandactivities suchas:MakingStridesAgainstBreastCancer,StatenIslandQuits,andLookGood…FeelBetter. Inaddition,theCancerEducationdepartmentworkswithTheLeukemia&LymphomaSocietyandparticipatesintheirannualLighttheNightWalk.

Tohelpwiththeemotionalneedsofourpatients,CancerServicesprovidesmonthlysupportgroupsforbreastcancer,ayoungadultbreastcancersupportgroup,oral,headandneck,ageneralcancer supportgroupandacaregiver supportgroup.

TheCancerEducationdepartmenthasa“Cancer InformationLine”availabletothepublictocallandobtaininformationonourservices,brochures,andaboutupcomingevents.Thetelephonenumberis718-226-8888.Inaddition,wepostacalendarofupcomingeventsontheSIUHwebsite.

Throughouttheyear,weparticipated inlocalandnationaleventstorecognizesurvivorsofcancer. ThemaineventheldyearlyistheNationalCancerSurvivorsDay,adayofrecognition forallsurvivorsofcancerandtheirfamilies.

2017SIUHScreeningsandPreventionPrograms

CANCERSERVICESPROGRAM

TheCancerServicesProgramofStatenIsland,whichisacooperativeendeavorwithNYSDOHtoprovidefreebreast,cervical andcolorectal cancer screening totheunder-insuredanduninsuredpopulationonStatenIsland.Additionallythisprogramprovidesallthediagnosticworkuprelated toanabnormalfindingandnavigationintotheMedicaidCancerTreatmentProgramforeligible individualsdiagnosedwithbreast,cervical, colonorprostatecancer.Weprovidecommunityeducationonthesecancersandalsopartakeinactivities specific tocervical, colonandbreastcancerawarenessmonths.WeworkwiththeDOHonMainStreetsGoBlueinMarchtoincreasecoloncancer screeningsandawareness.IncooperationwithSIUHwedistributeFITkitsduringMarchtoanyoneapplicable (averageriskclients).Wealsohaveaspecial freecolonoscopyprogramthatwerunincooperationwiththeNYCDOH.Wehavebeenfundedannuallytoprovide80freecolonoscopies.

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BreastCancerScreenings

CommunityNeed - Breastcancer isoneofthehighestcancersinthecommunity.Evidence isfoundintheNewYorkStateDOHCancerRegistryandSIUHtumorregistryfrequencyreport.ThisscreeningiseffectivebecausewehaveahighnumberofbreastcancerdiagnosesinRichmondCounty.Nationalguidelines andEvidencebasedinterventions followedareAmericanCancerSociety,NCCNandNCI.Inaddition,thesescreeningsareeffectivebecausetheyaredetectingbreastcanceratanearlier stage,thus,decreasing thenumberofpatientswithlate-stagedisease.679womenhadbreastcancer screenings.Clinicalbreastexams,screeningmammograms,bilateralandunilateraldiagnosticmammograms,breastultrasoundsandbiopsieswereperformedtotaling1,221and6breastcancerdiagnosesweremade.

Followupprocess

Clients foundtohaveanabnormalfinding(breast,cervical orcolorectal)arecontactedwithin72businesshourstoprovidecasemanagementservices toaddressanybarriers thatcouldpreventordelaytheir (patients)seekingcare.ThekeycomponentstoourCaseManagementisassessment,planning,coordinationandresourcedevelopment.ClientsarecalledbyCMwithin72hours(preferablyaftertheMDhasspokenwiththeclient)andtheroleoftheCMisexplained totheclient. Abarrierassessmentisperformedandaclientcareplanformulated.Barriers identifiedaredocumentedaswellasthestepsperformedtoresolve.Clientsareassistedwithappointmentremindercallswhichareplacedtoclients1-2dayspriortoappointment.Abarrierassessmentisagainprovidedatthattime.Ifaclient isfoundtohaveapre-cancerousorcancerdiagnosistheyarereferredimmediately totheDQE(designatedqualifiedentry)toevaluateandstartapplication fortheNYSMedicaidCancerTreatmentProgram(MCTP).Clientsnoteligible arereferred totheslidingscale (clientswhoarenotdocumentedarenoteligible forMCTPbutareeligible forslidingscale).

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MCTPisaMedicaidprogramforeligible personswhoarefoundtobeinneedoftreatmentforbreast,cervical, colonorprostatecancer (andsomepre-cancerousconditionsneedingtreatment)Onceaclient isenrolled theyreceive fullMedicaidcoverageforaninitial enrollmentperiodasdeterminedbythetypeofcancerbeingtreated.Recertification isyearly,iftheclient isstillinneedoftreatment.

ColonScreenings

CommunityNeed - Colorectalcancer isoneofthehighestcancersinthecommunity.Evidence isfoundintheNewYorkStateDepartmentofHealthCancerRegistryandSIUHtumorboardfrequencyreport.Thisscreeningiseffectivebecausewehaveahighincidence inRichmondCountyanditcandecrease latestagedisease. NationalguidelinesandEvidencebasedinterventionsfollowedareAmericanCancerSociety,NationalComprehensiveCancerNetwork,andNationalCancerInstitute.42fitkitsweredistributedwithinstructionforaverageriskclients.Outof42kits,39werenegativeand3werepositive.Colonoscopieswereperformedonthe3positivefitkits,2colonoscopieswerenegativeand1hadahyperplasticpolyp.TheCancerServicesProgramDirectornotifieseachclientoftheirresults.Ifthereisanegativefinding,eachclient isnotifiedoftheirresultsviamail.Ifthere isapositivefinding,eachclient isnotifiedoftheirresultsviaphone,referral isgivenandpatientisfollowedthroughtodiagnosis.

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1/1/17-12/31/17ProcedureCountandResultsBreast Cervical ColorectalTOTALBREASTSCREENED TOTALCERVICALSCREENED TOTALCOLORECTALSCREENED TOTALSCREENED

679 124 42 701CLIENTS198ClinicalBreastExams 123Pevlic/PapExams 42FITKitsDevolped593ScreeningMammograms 114HRHPVtests 39Negative65BilateralDiagnosticMammograms 8GYNConsults 3Positive151UnilateralDiagnosticMammograms5ColposcopywithBiopsyandEcc 3GIConsults179BreastUltrasound 1Colonoscopy12StereotacticBiopsy 2Colonoscopywithbiopsy18CoreBiopsy1FNA4ExcisionalBiopsy27SurgicalBreastConsultsResults Results Results3InvasiveBreastCancer 3CIN1 2Negative1LobularCarcinomainsitu 1CIN11 1HyperplasticPolyp2DuctalCarcinoma

SKINCANCERSCREENING

NameofActivity:FREESKINCANCERSCREENINGTypeofcancer

Meetingdateneedwasdiscussed(MM/DD/YYYY)

TypeofActivity (PreorScr)

Guidelinesusedtodesignactivity)

DateofActivity(MM/DD/YYYY)

Participants(targetaudience, #inattendance)

Outcomes/Follow-upprocessforparticipantsw/positive findings(Screeningonly)

Effectiveness ofActivity(value,lessonslearned,recommendations forimprovements)

Skin Feb,7th,2017

FREESKINCANCERSCREEN

AmericanAcademyofDermatology

TUESJUNE27TH,2017

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NORMALFINDINGS•24ABNOMALFINDINGS•3

Thedermatologistinformed thepatientsoftheresultsimmediatelyfollowing theexamination.Ifthereisanabnormal finding,thedermatologist maderecommendations forfollowupandareferralwasmade.Theserecommendationsinclude, butarenotlimited to,areferral toadermatologist withorwithout biopsy.Patientsweregivenalistofdermatologists andinstructed toscheduleanappointment with thedermatologist oftheirchoice forfollow-up.

Participants areabletoaccessthesefreeservicesbecauseitisadvertisedinthecommunity.Thescreening wasusefultothecommunitybasedonthepositivefeedbackfromtheparticipants. Itisaneffectivescreeningbecausethereisaneedforthisscreeninginthecommunity.According todatefromtheNYStateCancerregistryandSIUHcancerregistryreport, thereisanincreaseinthediagnosisforskincancer, aswellasanincreaseinlatestagedisease.

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HEADANDNECKSCREENING

NameofActivity:FREEHEADANDNECKSCREENINGTypeofcancer

Meetingdateneedwasdiscussed(MM/DD/YYYY)

TypeofActivity (PreorScr)

DateofActivity(MM/DD/YYY

Participants(targetaudience,#inattendance)

Outcomes/Follow-upprocessforparticipantsw/positive findings(Screeningonly)

Effectiveness ofActivity (value,lessonslearned, recommendations forimprovements)

HeadandNeck

Feb,7th,2017

FREEHEADANDNECKSCREEN

TUESNOV14TH,2017

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NORMALFINDINGS•8ABNORMALINDINGS•4

TheENTphysicianinformedthepatientsoftheresultsimmediatelyfollowing theexamination.Iffurtherevaluationwasneeded,thephysicianmaderecommendations forfollowup.Therecommendation include,butarenotlimitedto, areferral toanENTphysicianwithorwithout biopsy.Iffurther evaluationwasneeded, anappointmentwasmadeimmediatelyatthescreening.

Headandneckscreeningsareeffectivebecauseitprovidesearlydetection ofheadandneckcancer.Participants areabletoaccessthesefreeservicesbecauseitisadvertisedinthecommunity.Thescreeningwasusefultothecommunitybasedonthepositivefeedbackfromtheparticipants. Nexttime,wewill include asurveyforourscreening.

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COLORECTALSEMINARNameofActivity:ColorectalSeminar

Typeofcancer

Meetingdateneed

wasdiscussed

(MM/DD/YYYY)

TypeofActivity (PreorScr)

Guidelinesusedtodesignactivity

DateofActivity(MM/DD/YYYY)

Participants(target

audience, #inattendance)

Effectiveness ofActivity (value,lessonslearned,recommendations

forimprovements)

Colon 2/7/2017

Content includedfactsaboutColonCancerScreening forprevention andearlydetection andpreventivenutrition.

NCCN 3/29/17 25

Anevaluationtool wasgiventoeachattendeeaftertheseminar.Theevaluationindicated thattheylearnedabouttheimportance ofscreeningforColon Cancer, andthatthepresentation gavethemtheknowledgeandsupport tomakehealthydecisionsabouttheirlifestyle.Inaddition, attendeeslearnedhowtoaccessandobtainareferral forafreecolonoscopy.Fitkitswerealsoavailable.

ALBANIANCOMMUNITY HEALTHFAIR/COLONCANCERPREVENTION

NameofActivity:AlbanianCommunityHealthFair/Colon CancerPrevention

Typeofcancer

Meetingdateneedwasdiscussed(MM/DD/YYYY)

TypeofActivity (PreorScr)

Guidelinesusedtodesignactivity

DateofActivity(MM/DD/YYYY)

Participants(targetaudience, #inattendance)

Effectiveness ofActivity (value,lessonslearned,recommendationsforimprovements)

Colon 2/7/2017 AlbanianCommunityHealthFair/Colon CancerPrevention

NCCN 3/25/17 75TherewasacommunityneedtoreachouttotheAlbanianCommunity.Positivefeedbackwasreported fromtheattendees.