T H E
C A N C E R
C E N T E R
STATISTICAL REPORT
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WELCOME We are pleased to present the Lehigh Valley Health Network (LVHN) cancer program’s 2015 annual report featuring LVHN’s 2014 cancer data as well as information about our cancer care services. Cancer
care programs offered by LVHN include prevention, detection, diagnosis, genetics, patient navigation, nutritional services, social and psychological support, rehabilitation, clinical trials, multidisciplinary and coordinated care, surgery, radiation, chemotherapy and hemophilia care. EXPANDING CANCER CARE IN THE HAZLETON AREA
During 2015, LVHN expanded cancer care and treatment access to patients in the Greater Hazleton area with the October 1 opening of our newest cancer center, Lehigh Valley Health Network (LVHN) Cancer Center–Hazleton (384 Airport Beltway). The cancer center offers residents of northeast Pennsylvania close-to-home cancer care including appointments with hematology oncology providers; chemotherapy and therapeutic infusions; transfusion services; therapeutic phlebotomies and injections; an on-site blood draw station; pharmacy services, as well as nutritional counseling for patients. TOGETHER. AGAINST CANCER.
In August 2015, LVHN and Memorial Sloan Kettering (MSK) Cancer Center announced a collaborative relationship that will provide LVHN cancer patients with unprecedented access to early-phase cancer trials, building on the already-robust cancer clinical trials program offered by LVHN. Memorial Sloan Kettering, the world’s oldest and largest private cancer center, and LVHN will begin offering our patients access to these studies in early 2016. Patients and their providers will discuss the studies that offer the most potential while minimizing side effects from treatment.
OUR MISSION
We ease our community’s cancer burden by preventing cancer, by finding cancer early, by providing comprehensive diagnostic, consultative, treatment, support and survivorship services, and by educating health care professionals and residents of the communities we serve about advances in cancer care.
ABOUT THE COVER
Messages of love, hope and courage written by patients, family and friends have been placed on a traveling display taken to community events. Multicolored ribbons representing all cancer types and chronic illness accompany the inspiring notes.
Cancer care programs offered by LVHN rehabilitation
surgery
detection radiation social and psychological support multidisciplinary and coordinated care
2 LEHIGH VALLEY HEALTH NETWORK
LVHN CANCER CASE INFORMATION The LVHN cancer program offers a range of cancer services in convenient, patient-focused locations, including the John and Dorothy Morgan Cancer Center at Lehigh Valley Hospital (LVH)–Cedar Crest, the Cancer Center at LVH–Muhlenberg and the Health Center at Bangor. Patient care also is provided through Lehigh Valley Physician
Group practice offices in Allentown, Bethlehem, Hazleton, Bangor and Lehighton. Breast Health Services is offered in eight locations throughout the region. The faculty of the cancer program is composed of physicians who are cancer care specialists and board-certified in their fields. In calendar year 2014, the cancer program saw more than 3,300 new cancer patients. Inpatient oncology admissions were 4,269 in fiscal year ending June 30, 2015. Outpatient volumes comprised 7,172 unique patients for radiation procedures and 36,512 infusion visits.
TOP FIVE MOST PREVALENT SITES OF CANCERS TREATED AT LVHN 2,000
1,500
Breast
1,000
479
505
427
405
364
394
418
275
284
279
272
236
164
179
423
Lung Colon/Rectal Prostate
500
Bladder Corpus Uteri Skin
0
FY 2011
3,305
New cancer patient analytic cases
patient navigation
266
nutritional services
clinical trials
261
205
202
165 FY 2012
FY 2013
FY 2014
4,269 36,512
Inpatient oncology admissions
diagnosis
Infusion visits
chemotherapy and hemophilia care prevention
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genetics
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CANCER STAGING AND INCIDENCE TERMINOLOGY Cancer diagnosis, staging, incidence and treatment have a language of their own. Here are some commonly used terms and resources for more information: American Joint Committee on Cancer (AJCC) staging: A classification system used for describing the extent of disease progression based on the evaluation of the tumor size/invasion (T), nodal status (N) and metastasis (M) at the time of diagnosis. AJCC staging is important in determining treatment plans. Analytic cancer case: Cases for which the facility provided the initial diagnosis of cancer and/or for which the facility contributed to all or part of the first course of treatment. Collaborative staging: Cancer stage historically has been collected using three different staging systems: AJCC (TNM), Surveillance, Epidemiology and End Results (SEER), Extent of Disease (EOD) and Summary Stage (SS). Collaborative staging is a unified data collection system designed to provide a common data set to meet the needs of all three staging systems and provide a comprehensive system to improve data quality by standardizing rules for timing, clinical and pathological assessments, and compatibility across all systems for all cancer sites. National Cancer Database (NCDB): The NCDB is a joint project of the American Cancer Society and the Commission on Cancer. This database collects information on cancer cases diagnosed and/or treated at hospitals throughout the country. This non-patient-identified information is used to present scientifically reviewed descriptions of patient diagnosis, treatment and outcomes. The most recent data from NCDB is on cases newly diagnosed in 2013.
TOTAL ANNUAL ANALYTIC CASES 3,305
3,300
3,190
1
Elk
3,081
3,100
2,887
2,900
2,918
2,809 2,700
1
2,696
Westmoreland
2,632
2,500 2007
4 LEHIGH VALLEY HEALTH NETWORK
2008
2009
2010
2011
2012
2013
2014
1
Cameron
INCIDENCE BY COUNTY OF RESIDENCE Lehigh Valley Health Network provides cancer care for patients in our community and serves as a tertiary referral center. In 2014
COUNTY OF RESIDENCE
alone, we provided diagnostic care, second opinion recommendations and treatment to more than 3,300 patients from 33 Pennsylvania counties. In addition, 59 patients came to our cancer program from communities across the United States.
2012
2013
2014
ADAMS
5
4
0
BEAVER
0
1
0
BERKS
196
213
236
BLAIR
0
1
0
BRADFORD
2
1
0
BUCKS
60
52
48
CAMERON
0
0
1
CARBON
191
185
193
CHESTER
4
2
2
COLUMBIA
2
1
2
CUMBERLAND
1
0
0
DAUPHIN
2
1
5
DELAWARE
1
1
0
ELK
0
0
1
LACKAWANNA
51
33
23
LANCASTER
1
1
0
LEBANON
1
2
0
1,426
1,515
1,616
LUZERNE
77
97
115
LYCOMING
3
2
5
MONROE
124
122
129
MONTGOMERY
106
85
83
NORTHAMPTON
LEHIGH
4 Susquehanna 2 Wyoming
5
Lycoming
2
Northumberland
23
Pike
129 Monroe
193
125
1,616 236
637
Northampton
Lehigh
Berks
2 Chester
613
663
637
NORTHUMBERLAND
0
1
3
PHILADELPHIA
0
5
3
PIKE
7
5
6
130
121
125
SUSQUEHANNA
7
2
4
TIOGA
1
1
0
WAYNE
15
5
6
WESTMORELAND
0
0
1
WYOMING
3
1
2
YORK
1
1
0
OUT OF STATE
51
66
59
3,081
3,190
3,305
SCHUYLKILL
Carbon
Schuylkill
5 Dauphin
6
Lackawanna
115 Luzerne
Columbia
3
6 Wayne
83
48
Bucks
Montgomery
3 Philadelphia
TOTAL
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2014 ANALYTIC CASES BY PRIMARY BODY SITE THIS CHART NOTES THE PRIMARY BODY SITE INVOLVED IN EACH PATIENT’S CANCER DIAGNOSIS. PRIMARY SITE
TOTAL
HEAD AND NECK
56
DIGESTIVE ORGANS
PRIMARY SITE
TOTAL
MALE GENITAL ORGANS
274
585
PENIS
ESOPHAGUS
36
PROSTATE GLAND
STOMACH
63
SMALL INTESTINE
19
COLON
188
KIDNEY
116
RECTOSIGMOID JUNCTION
20
KIDNEY, RENAL PELVIS
15
RECTUM
58
URETER
9
ANUS AND ANAL CANAL
21
URINARY BLADDER
LIVER AND BILE DUCTS
47
OTHER AND UNSPECIFIED URINARY ORGANS
GALLBLADDER
3
6 261
TESTIS
7
URINARY TRACT ORGANS
346
202
CENTRAL NERVOUS SYSTEM
4 158
OTHER BILIARY TRACT
22
MENINGES
70
PANCREAS
101
BRAIN
68
OTHER NERVOUS SYSTEM
20
OTHER DIGESTIVE ORGANS
7
ENDOCRINE GLANDS
134
RESPIRATORY ORGANS
435
BRONCHUS AND LUNG
423
THYROID GLAND
116
THYMUS
4
ADRENAL GLAND
1
HEART MEDIASTINUM PLEURA
8
OTHER ENDOCRINE GLANDS
17
MUSCULOSKELETAL SITES
26
BLOOD AND BONE MARROW
171
SKIN
149
OTHER
5
RETROPERITONEUM AND PERITONEUM ILL-DEFINED SITES
BREAST
479
LYMPH NODES
FEMALE GENITAL ORGANS
277
UNKNOWN PRIMARY
VULVA
22
VAGINA
4
CERVIX UTERI
24
CORPUS UTERI
175
UTERUS (NOT OTHERWISE SPECIFIED-NOS)
2
OVARY
41
OTHER FEMALE GENITAL ORGANS
8
PLACENTA
1
6 LEHIGH VALLEY HEALTH NETWORK
4 1
3,305 Analytic cases
147 63
PRIMARY BODY SITES: FIVE MOST FREQUENTLY TREATED AT LVHN
BREAST CANCER INCIDENCE OF BREAST CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
2
19
63
129
126
86
47
7
479
(N)
BREAST CANCER TREATMENT BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
SURGERY ONLY
33
27
14
8
SURGERY AND RADIATION
28
24
7
1
SURGERY AND CHEMOTHERAPY
0
5
19
9
1
Stage 3
Stage UNK
TOTAL
1
1
84
0
0
60
0
34
Stage 4
SURGERY, RADIATION AND CHEMOTHERAPY
0
14
11
3
1
0
29
SURGERY, RADATION AND HORMONE THERAPY
13
68
19
1
3
0
104
SURGERY AND HORMONE THERAPY
6
22
14
4
1
0
47
SURGERY, RADIATION, CHEMOTHERAPY AND HORMONE THERAPY
0
3
13
3
0
0
19
SURGERY, CHEMOTHERAPY AND HORMONE THERAPY
0
0
4
3
0
0
7
OTHER SPECIFIED THERAPY
1
14
39
8
17
0
79
NO FIRST-COURSE TREATMENT
1
6
2
1
5
1
16
TOTAL
82
183
112
41
29
2
479
LUNG CANCER INCIDENCE OF LUNG CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
0
0
16
63
129
130
73
72
423
(N)
LUNG CANCER TREATMENT BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
Stage 3
SURGERY ONLY
1
63
5
7
2
0
1
0
79
RADIATION ONLY
0
21
0
8
21
1
0
0
51
SURGERY AND CHEMOTHERAPY
0
8
10
9
3
0
0
0
30
RADIATION AND CHEMOTHERAPY
0
1
6
32
44
0
1
0
84
CHEMOTHERAPY ONLY
0
1
0
5
40
1
0
0
47
SURGERY, RADIATION AND CHEMOTHERAPY
0
Stage 4
Stage NA Stage OC Stage UNK
TOTAL
1
6
7
1
1
0
0
16
CHEMOTHERAPY AND HORMONE THERAPY
0
0
0
1
0
0
0
1
CHEMOTHERAPY AND BRM
0
0
1
4
0
0
0
5
OTHER SPECIFIED THERAPY
0
0
0
4
13
0
0
1
18
NO FIRST-COURSE RX
0
12
0
25
52
0
2
1
92
TOTAL
1
107
27
98
181
3
4
2
423
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COLON AND RECTAL CANCER INCIDENCE OF COLON CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
0
4
8
39
46
52
48
11
208
(N)
COLON CANCER BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Stage UNK
TOTAL
SURGERY ONLY
9
26
49
18
8
3
113
SURGERY AND CHEMOTHERAPY
0
0
7
30
14
0
51
CHEMOTHERAPY ONLY
0
0
0
0
13
0
13
SURGERY, RADIATION AND CHEMOTHERAPY
0
0
2
1
2
0
5
RADIATION THERAPY ONLY
0
0
0
0
1
0
1
OTHER SPECIFIED THERAPY
0
0
0
0
2
0
2
NO FIRST-COURSE TREATMENT
0
0
0
1
12
10
23
TOTAL
9
26
58
50
52
13
208
INCIDENCE OF RECTAL CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS (N)
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
3
7
11
10
20
6
1
58
RECTAL CANCER TREATMENT BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
TOTAL
SURGERY ONLY
2
10
0
1
0
13
SURGERY AND CHEMOTHERAPY
0
0
0
2
1
3
RADIATION AND CHEMOTHERAPY
0
0
3
0
2
5
CHEMOTHERAPY ONLY
0
0
0
0
3
3
SURGERY, RADIATION AND CHEMOTHERAPY
1
3
8
15
3
30
OTHER SPECIFIED THERAPY
1
0
0
0
0
1
NO FIRST-COURSE TREATMENT
0
0
1
1
1
3
TOTAL
4
13
12
19
10
58
8 LEHIGH VALLEY HEALTH NETWORK
PROSTATE CANCER INCIDENCE OF PROSTATE CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
0
0
6
71
110
55
17
2
261
(N)
PROSTATE CANCER TREATMENT BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
TOTAL
SURGERY ONLY
6
87
17
1
0
111
RADIATION ONLY
0
20
0
0
0
20
SURGERY AND HORMONE THERAPY
0
3
1
1
1
9
SURGERY, RADIATION AND HORMONE THERAPY
0
4
0
3
0
8
SURGERY AND HORMONE
0
50
2
1
0
55
SURGERY AND RADIATION
0
1
1
1
0
3
HORMONE THERAPY ONLY
0
3
0
13
0
16
OTHER SPECIFIED THERAPY
0
1
0
5
0
6
NO FIRST-COURSE TREATMENT
0
30
0
2
1
33
TOTAL
6
199
21
33
2
261
BLADDER INCIDENCE OF BLADDER CANCER BY AGE AT DIAGNOSIS LVHN 2014 AGE AT DIAGNOSIS (N)
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TOTAL
0
4
9
29
45
59
47
9
202
Stage UNK
TOTAL
URINARY BLADDER CANCER TREATMENT BY STAGE AT DIAGNOSIS FIRST COURSE
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
SURGERY ONLY
55
15
14
3
1
0
88
SURGERY AND CHEMOTHERAPY
39
11
8
1
4
1
64
SURGERY AND IMMUNOTHERAPY
15
5
0
0
0
0
20
SURGERY, CHEMOTHERAPY AND IMMUNOTHERAPY
8
3
0
0
0
0
11
SURGERY, CHEMOTHERAPY AND RADATION THERAPY
0
0
2
1
3
0
6
SURGERY AND RADIATION THERAPY
2
0
3
1
1
0
7
CHEMOTHERAPY ONLY
1
0
0
0
0
0
1
OTHER SPECIFIED THERAPY
1
0
0
0
0
0
1
NO FIRST-COURSE TREATMENT TOTAL
0
0
0
0
3
1
4
121
34
27
6
12
2
202
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INNOVATIONS AND IMPACT Year after year, the cancer program at Lehigh Valley Health Network continues to grow. Not only have we
experienced steady growth in the number of patients for whom we provide care, we also have become a leader in our area offering specialized procedures and treatments. Our areas of specializations include clinical trials, robotic surgery, liver and pancreatic surgeries, thyroid surgery and stereotactic radiosurgery among others.
CLINICAL TRIALS
OUR PROGRAM IS ABLE TO OFFER
Offering our patients excellence in cancer care and access to the latest and most promising therapies is the mission of Lehigh Valley Health Network’s clinical trials program. Our dedicated clinical trials staff helps ensure we follow the strictest of clinical trial protocols and deliver clear results, while providing compassionate care for our patients. Enhancing our already-robust and well-respected program further, LVHN was invited to join the Memorial Sloan Kettering (MSK) Cancer Alliance. Beginning in 2016, LVHN cancer patients will work with their LVHN provider to determine if an early-phase MSK cancer clinical trial is right for them. In addition to potentially improving lifespan or quality of life, the LVHN/MSK clinical trials collaboration will help advance cancer treatment knowledge to benefit all patients. We are proud of our relationship with Memorial Sloan Kettering, and are equally pleased to continue National Cancer Institute-sponsored clinical trials and innovative immunotherapy trials.
STUDIES THAT PROVIDE EARLY ACCESS TO
2015 ACTIVE CLINICAL TRIALS 8 Symptoms management/blood trials 2 Expanded-access trials P H A SE 2
TREATMENTS AND THERAPIES:
Phase 2 – Study to measure the effectiveness of therapy;
available at limited number of centers Phase 3 – Larger study to measure effectiveness Having access to clinical trial medicines in a phase 2 study provides the latest advancements in cancer care to our patients close to home. IMMUNOTHERAPY SUCCESSES AT LVHN
For the past three years, Lehigh Valley Health Network has been involved in the early-phase testing and latephase testing of the revolutionary immunotherapy drug (Nivolumab/Opdivo®). The Food and Drug Administration ultimately approved this innovative immune treatment for advanced melanoma, lung cancer and kidney cancer. More than 50 local patients have taken part in these high-impact clinical trials, and among them, 11 patients have been rendered completely disease free from stage 4 cancer. Many more have benefited by either delaying progression or preventing recurrence of their cancer. Immunotherapy trials remain a large area of focus for our cancer program due to the tremendous promise and our proven expertise. We are involved in immunotherapy trials for glioblastoma, head and neck cancer, gastroesophageal cancer, Hodgkin disease, in addition to new trials in lung cancer and melanoma.
2 Pediatric trials 4 Adult trials P H A SE 3
22 Pediatric trials 36 Adult trials
74
Total active clinical trials 24 Pediatric trials 50 Adult trials
10 LEHIGH VALLEY HEALTH NETWORK
464
Clinical trial participants in 2014
3 Robots
30+ Physicians trained in robotics
9
Specialties
ROBOTIC SURGERY PROGRAM
At LVHN, our robotic surgery program features one of the nation’s largest teams skilled in using da Vinci® Si HD Surgical Systems. Each robotic system offers high-definition, 3-D views of the surgery site coupled with precise instrument control. Using this tool, our surgeons can perform complex and delicate surgeries, such as gynecologic and fertility-sparing surgery, urologic, thoracic, colon-rectal, as well as other surgeries. Robotic surgery usually involves three to five small incisions. For some conditions, Lehigh Valley Health Network now offers da Vinci® Single Site® Surgery, where the surgeon operates through a single small incision of less than 1 inch long.
BENEFITS OF ROBOTIC SURGERY MAY INCLUDE:
Smaller incisions Less pain, scarring and recovery time Shorter hospital stay Lower risk for infection Less blood loss and fewer transfusions Quicker return to normal activities
5,000+ Procedures
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1,300
Number of patients assisted by patient navigators in 2015
PATIENT NAVIGATION Patient navigators follow patients from diagnosis through treatment completion. These specialized care
team members offer each patient emotional support, help the patient communicate with his or her physicians, and provide guidance for decision-making about his or her care. Navigators direct patients to support services and community resources to assist them with treatment-related supplies, financial concerns and transportation. They serve as a single point of access and help coordinate all members of the patient’s health care team. When treatment is complete, the navigators guide the patients to survivorship services as appropriate. At LVHN, we have six patient navigators, two of whom are bilingual in Spanish to help meet the cultural needs of our patients.
referral to the ear, nose and throat (ENT) tumor board. Multiple interventions were implemented: Navigator organized a multidisciplinary case conference that meets twice monthly with a speech therapist, radiation and medical oncology nurses, dietitian, social worker, counselor and bilingual nurse navigator to better coordinate patient care. ENT tumor board meets monthly (instead of quarterly). Accelerated access to dental care. Oral screening outreach events now held annually. (2014 oral screening resulted in 13 cases requiring follow-up review.) Patients receive post-treatment survey to determine their satisfaction with care and follow-up. SINCE IMPLEMENTING INTERVENTIONS
STUDY: PATIENT NAVIGATION IMPROVES
Support service referrals for head and neck cancer
HEAD AND NECK CANCER PATIENT
patients has doubled:
EXPERIENCE
A patient navigator-initiated survey of LVHN staff and providers revealed that head and neck cancer patients had many unmet needs. These needs ranged from nutritional services to speech therapy as well as for greater access and
• 134 (July–September 2013) • 268 (January–March 2014) The number of patients diagnosed with malignancies
presented at ENT tumor board increased from 16 to 58 annually.
LVHN ONCOLOGY NURSES IMPROVE PATIENT SKIN COMFORT Radiation oncology nurses provide care throughout the course of radiation treatments and educate patients about expected side effects and interventions. One of those side effects is radiodermatitis,
a painful skin condition experienced by an estimated 95 percent of radiation therapy patients. In an evidence-based comparison study, LVHN radiation oncology nurses compared the effectiveness of the standard of care for radiodermatitis, Beta-Val cream, a steroid topical agent vs. a non-prescription topical product called calendula lotion. Calendula lotion was selected based on other institutions’ research that showed it was likely to be an effective intervention. LVHN breast cancer patients who received radiation therapy were offered the option of using calendula lotion purchased as an over-the-counter product or a prescription for Beta-Val cream.
12 LEHIGH VALLEY HEALTH NETWORK
Out of 63 patients, 47 patients used the lotion as recommended. Out of the 47 patients using calendula, 29 patients were prescribed Beta-Val due to either noncompliance with recommended use or advanced skin toxicity. Beta-Val was avoided in 18 out of 63 patients. SINCE THE STUDY
New treatment patients receiving a Beta-Val prescription: 2012, 32 percent 2013, 20 percent 2014, 18 percent These results indicate that not only have Beta-Val prescriptions been avoided with use of calendula lotion, but also calendula lotion may delay the use of Beta-Val in patients who develop radiodermatitis. This could also decrease the financial costs associated with the prescription medications.
WHEN YOU’RE 27 AND HAVE CANCER… A cancer diagnosis is difficult regardless of your age. For adolescents and young adults
(AYA) who face a diagnosis of leukemia, lymphoma or a brain tumor, there’s a heightened awareness of “future” and “future planning.” LVHN cancer program team members know AYA patients have concerns that cover many areas: How will I go to school? What if I want to have a child someday? Who can help me or my family get through this?
FOR OUR 15–29-YEAR-OLD CANCER PATIENTS WE OFFER:
1
AYA multidisciplinary tumor board – This teen and
young adult-focused tumor board meets each month to discuss cases and plan care (including psychosocial management) for newly diagnosed AYA patients. Participating care providers include pediatric and adult oncologists, radiation oncologist, surgical oncologist, fertility specialist, pathology, radiology, oncology nursing and social workers/counselors. Fertility preservation – Fighting cancer exposes your body to powerful treatments, some potentially causing infertility. As part of our care for the teen to young adult age group, we educate patients (and family members) about options for fertility preservation.We work with a fertility specialist who is available for consultation prior to the start of cancer treatment and who can implement fertility-preserving options for you. Care for nonmedical needs – This experience can challenge the strongest of people. Our pediatric and adult nurses and social workers will help you and your family with any counseling/psychosocial management needs you may have. This team also developed a resource list of community services, nonprofit organizations and other resources that may help AYA patients with nonmedical needs.
COMING IN 2016 Grant-funded patient navigator for AYA patients will join our team
2
3
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RADIATION ONCOLOGY Radiation therapy may play a crucial role in your cancer care. At Lehigh Valley Health Network, you have the
security of knowing you are receiving care from experienced physicians, nurses, therapists and other professionals who are specialists in their fields and who have helped thousands of patients confront cancer. Radiation oncology at the LVHN Cancer Center offers patients the availability of the finest state-of-the-art technology and techniques. Radiation oncology facilities at LVHN include: Linear accelerators (six) Stereotactic body radiotherapy (SBRT) Gamma Knife® radiosurgery Intensity-modulated radiation therapy (IMRT) CT simulators (two)
Brachytherapy – high dose and low dose 3-D treatment planning Image-guided radiation therapy (IGRT) Respiratory gating RapidArc technology
OUR PROGRAM ALSO OFFERS THE LATEST IN TREATMENT PROTOCOLS AND TECHNOLOGIES, INCLUDING:
Metal artifact-reduction software (MAR): LVHN is among a few select cancer centers in the United States – and the
only hospital in northeastern Pennsylvania – offering a special type of CT scan, used for preparing radiation therapy treatments, that reduces the undesirable display of artifacts in the CT images produced by metal in the body. Metal artifacts are caused by objects like dental fillings, joint replacement implants, screws, metal plates or pins that are commonly used for back, spinal or bone procedures. When you have a traditional CT scan, which is a type of X-ray, metal artifacts can appear as white and black streaks on the image. These streaks may obscure part of your internal anatomy, making it more challenging to develop the radiation treatment plan. However, at LVHN, if you have metal objects in the area to be treated, you can have your simulation CT scans performed with the GE Optima580RT CT scanner. This device features revolutionary software that reduces the streaks created by metal objects and helps ensure treatment plans are made with the best visualization possible. Prone breast radiation therapy: Prone breast radiation therapy is performed with the patient lying face down on a special table, which allows the breast to fall away from the chest wall. This positioning reduces the radiation doses to the heart and lungs, and is especially helpful for women with large breasts. Pediatric radiation oncology: Children and adolescents with a malignancy have a unique set of needs. For patients requiring radiation therapy, the Children’s Hospital at Lehigh Valley Hospital offers benefits specific to pediatric patients, beginning with our full-time physicists and dosimetrists who develop custom radiation treatment plans for children. Our professional staff also ensures patients and their families understand the child’s treatment. We follow a structured, child-friendly education program (using iPad®s and even crafts) to orient patients and parents to radiation oncology technology and treatment. The child-friendly experience extends to the children’s area of the radiation oncology department where walls are decorated with a mural created by the Baum School of Art, Allentown. CT simulation: For computed tomography (CT) simulation, LVHN uses the latest technology including large bore, 16-slice imaging, laser patient positioning, a metal artifact-reduction image reconstruction mode and respiratory gated CT image acquisition, when needed. Dose painting: Intensity-modulated radiotherapy (IMRT) and RapidArc® treatments can be performed using a dose painting technique in almost all areas in the body. With dose painting, the treatment area is highly customized. A focused area (the tumor) receives a “boosted” dose of radiation while the remaining targeted area receives a lower dose. This can result in a lower overall radiation exposure. For instance, instead of treating the large field for 25 fractions and the cone down (focused area) for 15 fractions, we may give 30 fractions total. But within those 30 fractions we are treating the large field and giving additional dose to the cone down in the same fraction. TrueBeam™ with linear accelerator 4 (LINAC 4): TrueBeam offers stereotactic radiosurgery (SRS) capabilities and delivers ultra-precise image-guided radiation therapy, using real-time X-ray imaging to more precisely target cancer lesions. We are able to target the treatment precisely with only minimal effect on adjacent healthy tissue. Optical surface monitoring is new on LINAC 4, which allows us to set and monitor patient position during radiation treatment. LINAC 4 also gives us better portal images that are used to verify patient position. The multileaf collimator (MLC) is the Varian Millennium 120 leaf version. This advanced MLC provides detailed radiation beam shaping that is patient-specific. 14 LEHIGH VALLEY HEALTH NETWORK
TUMOR REGISTRY A cancer registry is an information system designed for the collection, management and analysis of data on persons with the diagnosis of a malignant or neoplastic disease (cancer). At LVHN, the cancer
registrars ensure that timely, accurate and complete data are maintained on all types of cancer diagnosed and/or treated within our facility. The data is then used to inform a wide variety of public health decisions and provide rich information for cancer diagnosis and treatment education. This data has been an especially importatnt source of foundational information as we build our partnership with the Memorial Sloan Kettering Alliance. The cancer data management department captures a complete summary of patient history, diagnosis, treatment and status for every cancer patient seen at LVHN. The data is used to evaluate patient outcome, quality of life, calculate survival rates, report cancer incidence as required by the PA Cancer Registry and the National Cancer Database, and evaluate effectiveness of treatment modalities in an effort to improve the quality of care we deliver. As part of our commitment to long-term care and education, we offer lifetime patient follow-up to gather data that benefits our patients now and into the future.
1,515 29,413 Patient cases reviewed at a multidisciplinary tumor board in 2014
Patients followed for life
13 SITE-SPECIFIC TUMOR BOARDS
Adolescent and young adult Breast Colon-rectal Combined tumor board Ear-nose-throat Endocrine Gynecology Hepatobiliary LVH–Muhlenberg general tumor board Neurology Pulmonary Skin and soft tissue Urology TUMOR BOARD MEMBERS
Medical oncologist Surgical oncologist Diagnostic radiologist Pathologist Radiation oncologist Genetic counselor Support counselor Palliative care provider Nurse navigator Tumor registrar and many more…
MULTIDISCIPLINARY CLINICS (MDC) When you are faced with a cancer diagnosis, it is important to understand your options. At Lehigh Valley Health
Network, we offer a multidisciplinary team approach to your care. This means you will have access to doctors and support staff who understand the many aspects of your disease and can provide you with the information you need to make important decisions. All of your oncology team members are coordinated through an MDC where one appointment can be used as a primary meeting for treatment discussions or as a second opinion service. A nurse navigator will coordinate your appointments and stay with you through treatment completion. MULTIDISCIPLINARY CLINICS OFFERED BY LVHN
Breast Genetics Prostate
Survivor PLACE Thoracic Upper gastrointestinal
1,355
Patients seen in MDC clinics in fiscal year 2015
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INFUSION SERVICES Patients who require intravenous (IV) therapy for oncology or non-oncology disorders may receive their care at one of our three convenient and comfortable infusion locations: Health Center at Bangor infusion services Multipurpose area infusion services at the John and Dorothy
16%
Non-oncology infusions
Morgan Cancer Center at Lehigh Valley Hospital (LVH)–Cedar Crest Multipurpose satellite infusion services at Lehigh Valley Hospital–
Muhlenberg Health Center at Bangor: 12 infusion bays LVH–Cedar Crest: 38 infusion bays LVH–Muhlenberg: 24 infusion bays
2014 INFUSION ENCOUNTERS
36,512
84%
Oncology infusions
Infusion encounters in 2014
BREAST HEALTH SERVICES (BHS) Breast Health Services of Lehigh Valley Health Network offers women a caring environment for breast screening and diagnostic studies provided by staff members who excel in their profession. Among our designations: Accredited by the National Accreditation Program for Breast Centers (NAPBC) Designated Breast Center of Excellence by the American College of Radiology (ACR) “Certified Quality Breast Center” by the National Quality Measures for Breast Centers (NQMBC) 3-D DIGITAL TOMOSYNTHESIS
Women with dense breast tissue may wish to have a mammogram done using 3-D digital tomosynthesis. This technology provides clear 3-D images of breast tissue by showing results in very thin cross-section images. Provides improved view so doctors can more effectively pinpoint any abnormalities Reduces the false-positive rate of screening mammograms To bring you even more comprehensive care, LVHN’s Breast Health Services now utilizes technology from Hologic that eliminates the need for additional X-ray exposure to acquire a 2-D image. C-View™ (by Hologic) creates a traditional 2-D image from 3-D data points. This change eliminates the need for extra 2-D X-ray exposure to capture the same image. BENEFITS OF 3-D MAMMOGRAPHY WITH C-VIEW™:
Less time under compression Reduced radiation exposure Increased diagnosis accuracy
Reduced recall rates Faster exam time Better patient experience
BHS at LVH–Muhlenberg was the first in the region to offer this technology in September 2012. We now offer 3-D tomosynthesis at three BHS locations: LVH–Muhlenberg, LVH–Cedar Crest and Breast Health Services Trexlertown.
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57,398 Mammograms in 2014
10,026
3-D tomosynthesis exams in 2014
MAMMOTHON RESULTS Lehigh Valley Health Network offered 12 straight hours for walk-in mammograms in October
at four different locations on four dates. No appointment or prescription was necessary. Health Center at Moselem Springs Health Center at Bethlehem Township Health Center at Bangor Health Center at Bath TOTAL
19 36 16 46
117
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154
CANCER SUPPORT SERVICES
Patient visits our licensed counselors had with cancer patients or their families
COUNSELING SERVICES
PALLIATIVE CARE
A cancer diagnosis can create strong feelings of grief, sadness, anger or fear. Our licensed counselors with an expertise in cancer care are available to help patients, their families and caregivers cope with the diagnosis in an effort to help feel less distressed. Counselors can make visits to the doctor’s office or treatment area. They are also available by appointment.
While most cancers are not inherited, family and personal medical histories are important to identify people at higher risk for certain cancers. Three board-certified genetic counselors and a medical oncologist are available to meet with patients and families to discuss benefits of genetic testing and perform a personalized cancer risk assessment. The genetic counselors provide an in-depth review of results, counsel patients and family members on implications, and provide comprehensive treatment and surveillance recommendations.
Managing one complex illness such as congestive heart failure (CHF) is difficult. If you have two or more complex illnesses, such as CHF and cancer, then additional medical assistance is often needed. That’s where palliative care can help. The word “palliate” means to comfort, and at LVHN a team called OACIS (optimizing advanced complex illness support) provides comfort and care. The OACIS team includes doctors, nurse practitioners, social workers, clergy and community groups. How it’s different from hospice care – Hospice care provides services for people at the end of life. Palliative care is for anyone facing one or more serious illnesses, at any stage of illness. That said, if you are facing a terminal illness, OACIS can assist you with completing advance directives and will work closely with hospice as needed. We also can help you through the difficult decisions in managing your illness, associated pain and symptoms. How to access OACIS – Ask your doctor for a palliative medicine consultation so he or she can refer you to OACIS care: In your home through our home-based consult service As a patient in one of LVHN’s hospitals By making an appointment at the OACIS outpatient clinic
FINANCIAL COORDINATION
CANCER REHABILITATION
The LVHN cancer program provides five financial coordinators to assist patients in reducing financial barriers to care. They answer questions related to precertification requirements, health insurance and medical bills. Financial coordinators also connect patients with support agencies to assist them in receiving free or reducedcost services and medical supplies if they qualify. Financial coordinators assisted 109 patients in obtaining $3.1 million dollars in free or reduced-cost oral medications in fiscal year 2015. Assisted over 800 patients with other services.
If you are suffering from fatigue, weakness, balance problems, lymphedema or other symptoms related to your condition and treatment, our specially educated rehabilitation therapists can help provide relief or recommend steps you can take to improve your symptoms.
FINALITY BELL
The finality bell is a symbol of cancer survivorship and a source of hope. LVHN has three, donated by patients, so fellow survivors can ring the bell as a way to celebrate their final day of cancer treatment. CANCER RISK AND GENETIC ASSESSMENT
NUTRITION COUNSELING
Three oncology-certified registered dietitians are available to meet with patients and families to assess nutritional needs and determine appropriate nutritional goals and strategies during treatment as well as during survivorship. Our dietitians provided 2,296 visits in fiscal year 2015.
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SURVIVORSHIP CARE PLAN
Patients who have completed their first course of cancer treatment will receive a comprehensive care summary and follow-up plan. The care plan is provided by the physician managing their oncology treatment and includes input from other treatment providers. The care plan contains information regarding care they received, disease characteristics and follow-up recommendations. The purpose is to ensure a process of providing a “survivorship care plan” as a standard of care for patients at the end of cancer treatment.
COMMUNITY OUTREACH Lehigh Valley Health Network works with community organizations such as the American Cancer Society, Lymphoma & Leukemia Society, the Mark J. Young, MD, Community Health and Wellness Center, the Allentown Health Bureau, Cancer Support Community of the Greater Lehigh Valley and other community entities to accomplish outreach activities.
Prevention, along with early detection and screening programs, are offered to residents of our area utilizing nationally accepted evidence-based guidelines and interventions.
35%
Increase in referrals to cancer risk program in 2015
COMMUNITY HEALTH ASSESSMENT IDENTIFIES TOP NEEDS IN CITY
Free CANCER SCREENINGS
Breast: 467 mammograms Cervical: 381 Pap tests Skin: 123 skin exams Oral: 80 oral exams 2015 EDUCATION AND PREVENTION WORKSHOPS
Nutritional Education Series Kinnon Breast Cancer Survivor Workshop Latino Cancer Survivor Education Series The Legacy Program for Cancer Survivors LVHN Health Fair Night at Coca-Cola Park Catch Them Early – Importance of Skin Cancer
Detection I Pink I Can – Advances in Breast Cancer Detection 12-hour Mammothon – walk-in mammogram screenings Cancer Screening Education programs Frankly Speaking About Cancer I Pink I Can:Women’s Health Awareness Melanoma Survivor Workshop No Evidence of Disease – Gynecologic Cancer Awareness event
NEIGHBORHOOD
Allentown Promise Neighborhood (APN) – a subsidiary of United Way of the Greater Lehigh Valley – is an 84-square-block area of the city of Allentown bordered by Martin Luther King Boulevard to the south; Tilghman Street to the north; Jordan Creek to the east and 12th Street to the west. The APN mission includes nine promises to ensure residents of the neighborhood have access to education, employment and health care. PRELIMINARY ANALYSIS OF DISPARITIES DEMONSTRATES
Poverty rate: 39.58% Uninsured rate: 21.19% Head of household receiving cancer screening: 21% Breast and prostate incidence rates higher than state
and national rates Only a small percentage of women who access the
Allentown Health Bureau’s free mammogram and Pap program return for screening in the future Transportation is a key issue LVHN will join other local community programs in providing outreach to serve this unmet promise.
319 733 318 751
Patient visits from counseling services
New genetics patients counseled in fiscal year 2015
Cancer support referrals
Cancer support encounters with cancer patients
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OUR AWARDS, CERTIFICATIONS AND ACCREDITATIONS NATIONAL ACCREDITATION PROGRAM
BLUE DISTINCTION CENTER FOR COMPLEX
FOR BREAST CENTERS (NAPBC)
AND RARE CANCERS
Lehigh Valley Health Network’s Breast Health Services is accredited by the National Accreditation Program for Breast Centers (NAPBC).
Highmark Blue Shield has named Lehigh Valley Hospital–Cedar Crest as a Blue Distinction Center for Complex and Rare Cancers, focusing on complex inpatient and surgical care.
COEMIG™ DESIGNATION
COMMISSION ON CANCER
Eight of our doctors also have earned COEMIG™ designation from the AAGL (American Association of Gynecologic Laparoscopists), whose mission is advancing minimally invasive gynecology worldwide.
Continuously since 2005, Lehigh Valley Health Network has been an accredited cancer program through the American College of Surgeons Commission on Cancer® (CoC), a designation only granted when a facility voluntarily commits to provide the best in cancer diagnosis and treatment, while also complying with standards established by the CoC.
ACR FOR RADIATION ONCOLOGY SEAL OF ACCREDITATION
Lehigh Valley Hospital–Cedar Crest and Lehigh Valley Hospital–Muhlenberg have been awarded the ACR and the American Society for Radiation Oncology (ASTRO) seal of accreditation. AMERICAN COLLEGE OF RADIOLOGY (ACR) FOR BREAST MAMMOGRAPHY
Lehigh Valley Health Network has earned accreditation from the American College of Radiology (ACR) for breast mammography.
AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO) QOPI® CERTIFICATION PROGRAM (QCP™)
Hematology-Oncology Associates of Allentown, Bethlehem and Bangor, a practice of Lehigh Valley Physician Group, actively participates in the American Society of Clinical Oncology (ASCO) QOPI® Certification Program (QCP™) and has been continuously certified since 2011. NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)
BREAST IMAGING CENTER OF EXCELLENCE
LVHN Breast Health Services is also designated as a Breast Imaging Center of Excellence by the ACR.
Hematology-Oncology Associates (HOA) at Lehigh Valley Hospital–Cedar Crest and Lehigh Valley Hospital–Muhlenberg has been recognized by the National Committee for Quality Assurance (NCQA) for three years.
U.S. NEWS & WORLD REPORT
NATIONAL CANCER INSTITUTE’S
Each year, U.S. News & World Report ranks hospitals according to patient satisfaction, patient outcome and access to leading-edge care across many specialties. In cancer care, U.S. News & World Report recognizes Lehigh Valley Hospital as “high performing” in recognition of our qualified staff, patient access to advanced technologies and patient survival.
COMMUNITY CANCER CENTERS
20 LEHIGH VALLEY HEALTH NETWORK
PROGRAM (NCCCP)
Lehigh Valley Health Network’s Cancer Center was one of 21 sites in the United States selected to be part of the National Cancer Institute’s Community Cancer Centers Program (NCCCP) (April 2010 to June 2014).
PUBLICATIONS AND POSTERS AUTHORED BY OUR ONCOLOGY TEAM Anemia and the need for intravenous iron infusion after roux-en-y gastric bypass. Kotkiewcz, A, Donaldson, K, Dye,C, Rogers, AM, Mauger, D, Kong, L., Eyster, ME., Clinical Medicine Insights: Blood Disorders 2015:8 9-17. Peripheral primitive neurectodermal tumor of the dura in a 51-year old woman following intensive treatment for breast cancer. Cole M; Parajuli S; Laske D; Goldstein L; Morrison T; Mukherjee A; Tumelty K; Tetzlaff E; von Mehren M; Inniss S., The American Journal of Case Reports. 15:294-9, 2014. Assessing the development of multidisciplinary care: Experience of the National Cancer Institute community cancer centers program. Friedman EF, Chawla N, Morris PT, Castro KM, Carrigan AC, Prabhu Das I, Clauser SB. Journal of Oncology Practice Jan 1, 2015:e36-e43; published online on October 21, 2014. Primary dural lymphoblastic B-cell lymphoma: a rare subtype of aggressive dural lymphoma. Saraceni, C., Agostino, N., Gheiith, S., Journal of Hematopathology (2015, August) pp 1-5 doi 10.1007/ s12308-015-0257-0 Benefits and risks of contralateral prophylactic mastectomy in women undergoing treatment for sporadic unilateral breast cancer: A decision analysis. Lester-Coll, NH, Lee, JM, Gogineni,K, Hwang, WT, Schwartz, JS, Prosnitz, RG. The Journal Breast Cancer Research and Treatment, July 2015, Volume 152, Issue 1, pp 217-226. Promyelocytic sarcoma present with spinal cord compression and treated successfully with surgical debulking and the PETHEMA regimen for acute promyelocytic leukemia. Cornfield, D., Gheith, S., Barron, L. Case Reports in Clinical Pathology, 2015, Vol. 2, No. 3. doi: 10.5430/crcp.v2n3p12 Central nervous system cancers. Nabors LB; Ammirati M; Bierman PJ; Brem H; Butowski N; Chamberlain MC; DeAngelis LM; Fenstermaker RA; Friedman A; Gilbert MR; Hesser D; Holdhoff M; Junck L; Lawson R; Loeffler JS; Maor MH; Moots PL; Morrison T; Mrugala MM; Newton HB; Portnow J; Raizer JJ; Recht L; Shrieve DC; Sills AK Jr; Tran D; Tran N; Vrionis FD; Wen PY; McMillian N; Ho M., Journal of the National Comprehensive Cancer Network. 11(9):111451, 2013 Sep 1.UI: 24029126 A review of the symptomatic management of malignant gliomas in adults. Shah U; Morrison T. Journal of the National Comprehensive Cancer Network. 11(4):424-9, 2013 Apr 1. UI: 23584345
Clinical characteristics and treatment-related biomarkers associated with response to high-dose interleukin-2 in metastatic melanoma and renal cell carcinoma: Retrospective analysis of an academic community hospital’s experience. Saraceni, C., Agostino, N., Weiss, M. J., Harris, K., & Nair, S. SpringerPlus,(2015) 4, 118. doi:10.1186/s40064-015-0890-1 Advancing value-based cancer care: Lessons from four community-based health systems. O’Brien, DM, Chadwick, DD, Flaks,JA, Holstien, B, Weinhold, KJ., American College of Healthcare Executives: Congress on Healthcare Leadership, 2015 Cystic brain metastases in NSCLC harboring the EML4-ALK translocation after treatment with crizontinib. Saraceni, C.; Li, PM; Gainor, JF., Stopyra,GA; Friedman, EL, Journal of Thoracic Oncology, (2015 July) Volume 10 - Issue 7 - p 1116–1117,doi: 10.1097/JTO.0000000000000409 Identifying barriers to weight management in cancer survivors. Brennan, J., Gilboy, J., Levine, E., & Koplin, K. Poster presented at: Lehigh Valley Health Network Research Day, Allentown, PA (October 29, 2013) and Pennsylvania Academy of Nutrition and Dietetics annual meeting in Bethlehem, PA (April 25th, 2014) Influence of the implantation site on the sensitivity of patient pancreatic tumor xenografts to Apo2L/TRAIL therapy. Sharma R1, Buitrago S, Pitoniak R, Gibbs JF, Curtin L, Seshadri M, Repasky EA, Hylander BL. Pancreas. 2014 Mar; 43(2): 298–305. doi: 10.1097/ MPA.0000000000000099 Development and utilization of an acuity scale for oncology patient navigation. Roman-Rosado, R., Beaupre, L., Sevedge, K., Zubia, J., Chicas, M., McHugh, D., Morrone, D. & Kichline, T. Poster presented at the Academy of Oncology Nurse & Patient Navigators Fifth Annual Navigation and Survivorship Conference, Orlando, FL(2014, September, 18-21). MiR-205 and MiR-375 microRNA assays to distinguish squamous cell carcinoma from adenocarcinoma in lung cancer biopsies. Patnaik S, Mallick R, Kannisto E, Sharma R, Bshara W, Yendamuri S, Dhillon SS. Journal of Thoracic Oncology: 2015 Mar;10(3):446-53. doi: 10.1097/JTO.0000000000000423. Surgery during pregnancy, end-stage renal disease and immunocompromising hematologic disorders. Khubchandani, IT. Presentation (Visiting Professor) at Agostino Gemelli Hospital, Rome Italy Sept 13-14, 2015
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22 LEHIGH VALLEY HEALTH NETWORK
CONTACT US
If you have a question about Lehigh Valley Health Network services or the cancer program, please call 610-402-CARE.
OUR LOCATIONS THE LVHN CANCER PROGRAM OFFERS A RANGE OF SERVICES IN CONVENIENT PATIENT-FOCUSED LOCATIONS.
LVHN Cancer Center–Cedar Crest LVHN Cancer Center–Muhlenberg LVHN Cancer Center–Hazleton Health Center at Bangor
We also provide patient care at Lehigh Valley Physician Group practice offices in Allentown, Bangor, Bethlehem, Hazleton and Lehighton. BREAST HEALTH SERVICES LOCATIONS
Breast Health Services – 17th Street, Allentown Breast Health Services – LVH–Cedar Crest Breast Health Services – LVH–Muhlenberg Health Center at Bangor Health Center at Bath Health Center at Bethlehem Township Health Center at Moselem Springs Health Center at Trexlertown OVERNIGHT ACCOMMODATION FOR PATIENTS AND GUESTS
The Hackerman-Patz House at Lehigh Valley Hopsital–Cedar Crest is a convenient and affordable alternative to a hotel or daily trips to and from a distant home. Whether you are receiving care here or your loved one is a patient at our hospital, the Hackerman-Patz House offers you comfortable accommodations and a supportive environment that allows you to focus on healing. Financial assistance is available. Reserve your room at the Hackerman-Patz House.
Call 610-402-9500 or visit LVHN.org/familylodge.