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2016 Cancer Report


COMMITTEE MEMBERS Brian Mathews, MD Hematology/Oncology Cancer Committee Chair

Jennifer Vann, DNP, CRNO Akashai Janak, MD Palliative Care

Harry James McCarty, MD Radiation Oncology Cancer Liaison Physician

Emily Pauli, BMSm PharmD, Rph Clinical Research Coordinator

Rachel Kruspe, MD Hematology/Oncology Cancer Liaison Physician Elizabeth Falkenberg, MD John Gleason, MD Radiation Oncology Marshall Schreeder, MD Hematology/Oncology Frank Honkanen, MD Aimee League, MD Pathology Christian Scales, MD Libby Shadinger, MD Diagnostic Radiology Richard Richardson, MD General Surgery Tyler Kirby, MD Gynecology Oncology Jeff Walker, MD Critical Care/Trauma/General Surgeon Gregory Thomas, MD Cardiothoracic Surgery Mohamad Younes, MD Hematology/Oncology Michael Brown, MD Joseph Pettus, MD Urology Karen Adams, RN, BSN Cancer Program Manager Community Outreach Coordinator Jonathan Bunn, PharmD Amanda Ouzts, PharmD Oncology Pharmacy Janet Elledge-Nauman, RN Quality Management Coordinator Kristina Johnson Lee Shaw Hospice Family Care 2

James Kelly Todd Ziegler Karen Hislop Therapy and Rehab Services Sandra Cross, RN Breast Center Lennox Marr, RN, BSN, MSN Oncology Inpatient Unit Director Anna Lisa Weigel American Cancer Society Ruth Smith, MSN,RN,AOCNS Inpatient Clinical Nurse Specialist Michele Engelhardt, RN Outpatient Chemotherapy Infusion Unit Patty Stutts, LCSW Suzanne Marks RN Social Services/Psychosocial Services Coordinator Crystal McVey, RDLR/Vilmali Demerin, RD, CSO, LD Clinical Nutrition Stacey Hill, CRNP TVGO Rod Crutcher Chaplain Heather Whorton, RN Community Outreach Cindy Johnson, CTR, Cancer Registry Quality Coordinator Judy Crawford, Cancer Conference Coordinator Katherine Wolfson, CTR Carol Spahn Susan Elam RN,BSN Karen Hixson Cancer Registry


CANCER CONFERENCE Huntsville Hospital offers a weekly multidisciplinary cancer conference to provide consultative services for patients treatment planning and to provide education to physicians and other allied health professionals. Physician representatives from surgery, medical oncology, radiation oncology, diagnostic radiology, pathology and a variety of other medical specialties may attend and participate in cancer conferences. Monitoring of the following criteria is required for compliance with the American College of Surgeons Commission on Cancer standards: – Cancer conference frequency – Multidisciplinary attendance – Total number of case presentations – Percentage of prospective cases – Discussion of stage, prognostic indicators and treatment planning using evidence-based treatment guidelines – Options and eligibility for clinical trial enrollment – Adherence to cancer conference policies Additional Huntsville Hospital conferences include chest conference and hemoncology conference. A weekly multidisciplinary breast cancer conference was started in 2016. The number of annual cases presented is to be proportional to the annual analytic caseload and should represent the case mix. All major cancer sites are discussed each year. The ACS Commission on Cancer requires that 15% of the annual analytic caseload be presented at cancer conference. In 2016, 440 cases were presented.

CANCER REGISTRY ACTIVITIES The Huntsville Hospital Cancer Registry is an information data base system for the collection, management and analysis of cancer patient data. The cancer registry participates in a nationwide effort to compile data on the diagnosis and treatment of all types of cancers. The American College of Surgeons Commission on Cancer requires a minimum 80% follow-up rate to be maintained for all analytic cases from the cancer registry reference date of l987, and a minimum 90% follow-up rate for all analytic cases diagnosed within the last five years. At present, the cancer registry operates with a 94% and 95% follow-up rate, respectively. The cancer registry has collected more than 38,000 cases since its reference date. 2,027 new analytic cases were abstracted and entered in the registry in 2015.

2015 CANCER REGISTRY DATA AJCC Stage by Sex at Diagnosis 400 350 300 250 200 150 100 50 0 0

5

Hematopoietic

III

IV

UNK

N/A

400

28

350 300

Bone 2

Liver 7

250

Breast 163

Lung 72

200

Brain/CNS

5

Lymphoma

16

150

Colon/Rectal

19

Prostate 15

100

Connective Tissue

5

Skin/Melanoma 17

Gastric 5

Thymus 2

GYN 25

Thyroid 6

Head & Neck

Other 16

32

II

Age by Sex at Diagnosis

2016 CANCER CONFERENCE CASES Urinary System

I

50 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79

Male

Female

TOTAL 440

3


PRIMARY SITE TABLE PRIMARY SITE Oral Cavity Lip Tongue Oropharynx Hypopharynx Other Digestive System Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other Respiratory System Nasal/Sinus Larynx Lung/Bronchus Other Blood & Bone Marrow Leukemia Multiple Myeloma Other Bone Connective/Soft Tissue Skin Melanoma Other Breast Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other Male Genital Prostate Testis Other Urinary System Bladder Kidney/Renal Other Brain & CNS Brain (benign) Brain (malignant) Other

4

MALE

FEMALE

5 10 1 0 11

1 5 0 0 7

15 15 65 38 3 12 19 12

0 9 62 22 4 9 13 16

0 9 197 5

2 1 133 0

31 19 11 0 8

Endocrine Thyroid Other Lymphatic System Hodgkin’s Disease Non Hodgkin’s Unknown Primary Other/Ill-defined TOTAL

12 6

33 3

4 46 8 6 855

5 32 13 6 1,172

Race at Diagnosis Race White Black Other TOTAL

Number of Cases 1,719 239 69 2,027

Alabama County of Residence at Diagnosis County

Number of Cases

Baldwin

0

20 13 6 2 1

Blount

2

Calhoun

2

Cherokee

2

Colbert

23

Cullman

7

49 3 5

30 2 447

Dale

1

Dekalb

39

Etowah

5

0 0 0 0 0

22 102 52 9 2

Franklin

7

Jackson

127

Jefferson

1

Lamar

0

Lauderdale

39

106 6 2

0 0 0

Lawrence

24

Lee

1

Lowdes

0

47 55 1

15 27 2

Madison

1125

0 13 24

Montgomery

0 12 7

Limestone

213

Marion

3

Marshall

155 0

Morgan

144

Shelby

1

Tuscaloosa

1

Wintson

2 Total

1923


Out of State Residence at Diagnosis State Florida Georgia Illinois Pennsylvania Tennessee TOTAL

Number of Cases 1 2 1 2 99 104

2015 Estimated US Cancer Cases* Primary Site Males Prostate Lung/Bronchus Colon & Rectum Urinary Bladder Non-Hodgkin’s Lymphoma Melanoma Kidney and Renal Pelvis Oral Cavity & Pharynx Leukemia Pancreas All Sites

Primary Site Females Breast Lung/Bronchus Colon & Rectum Non-Hodgkin’s Lymphoma Melanoma Kidney and Renal Pelvis Ovary Leukemia Urinary Bladder All Sites

Number of Cases 220,800 115,610 69,090 56,320 39,850 42,670 38,270 14,610 30,900 24,840 848,200

Number of Cases 231,840 105,590 63,610 32,000 31,200 23,290 21,290 23,370 17,680 810,170

* Excludes basal and squamous cell skin cancers

and in situ cancers except urinary bladder. Source: American Cancer Society Facts & Figures 2015.

Treatment Distribution Treatment Modality Surgery

Number of Cases 677

Surgery/Chemo

489

Chemo

170

Chemo/Radiation

139

None

138

Surgery/Chemo/Radiation

114

Surgery/Radiation/Hormones

113

Surgery/Hormones

100

Surgery/Radiation

68

Radiation

47

Chemo/Immu

42

Surg/Chemo/Rad/Hormones

41

Surgery/Chemo/Hormones

28

Chemo/Hormones/Immu

19

Surg/Chemo/Immu

17

Chemo/Hormones

14

Surg/Chemo/Rad/Immu

14

Surgery/Immu

14

Surg/Chemo/Hormones/Immu

12

Chemo/Rad/Immu

11

Hormones

11

Surg/Chemo/Rad/Hor/Immu

10

Immunotherapy

7

Chemo/Tram

6

Chemo/Rad/Hormones

4

Surgery/Rad/Immu

3

Hormones/Immu

3

Radiation/Hormones

3

Surgery/Tran

2

Chemo/Other

2

Other

2

Chemo/Radiation/Tran

1

Surgery/Hormones/Immu

1

Radiation/Hormones/Immu

1

Chemo/Rad/Hormones/Immu

1

Chemo/Rad/Hor/Immu/Tran

1

Chem/Hor/Tran

1

Radiation/Immu

1

TOTAL

2,027

5


2015 HUNTSVILLE HOSPITAL CANCER CASES DIAGNOSED *NATIONAL COMPARISON OF SELECTED CANCER SITES

*Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2015

HUNTSVILLE HOSPITAL PRIMARY SITE

NATIONAL

CASES

PERCENT

CASES

PERCENT

CASES

PERCENT

BREAST

452

22.3%

3,680

14.1%

234,190

14.1%

LUNG

330

16.3%

4,150

15.9%

221,200

13.3%

COLORECTAL

187

9.2%

2,150

8.2%

132,700

8.0% 13.3%

Prostate

106

5.2%

3,590

13.7%

220,800

BLADDER

89

4.4%

1,000

3.8%

74,000

4.5%

NH LYMPHOMA

78

3.8%

1,020

3.9%

71,850

4.3%

CORPUS UTERI

102

5.0%

660

2.5%

54,870

3.3%

MELANOMA

79

3.9%

1,380

5.3%

73,870

4.5%

LEUKEMIA

519

2.5%

730

2.8%

54,270

3.3%

CERVIX

22

1.1%

230

0.9%

12,900

0.8%

ALL OTHERS

531

26.2%

7,560

28.9%

507,000

30.6%

2,027

100.0%

26,150

100.0%

1,658,370

100.4%

TOTAL CASES

6

ALABAMA


Radiologist Roderick Zalamea, MD, reviews images of a lung tumor.

TO Catch a Killer Lung cancer has long been the leading cause of cancer death for both men and women in Alabama, but Huntsville Hospital is determined to help change that.

pulmonary nodules and identify possible early lung cancer. By using low-dose CT screening in combination with smoking cessation physicians can dramatically improve lung cancer survival.

“It’s deadlier than breast, prostate and colon cancers combined,” said Roderick M. Zalamea, MD, a radiologist on Huntsville Hospital’s medical staff. “The main reason for that is lack of early diagnosis and treatment.”

Medicare and most private health insurance plans will cover the screening cost for current and former heavy smokers over 55 who do not have any symptoms of lung cancer. Talk with your physician to schedule a screening.

Through Huntsville Hospital’s lung cancer screening program, the hospital is working to reduce mortality rates by detecting the disease in the earliest stages – before a person even has symptoms. The screening test involves a low-dose CT (Computed Tomography) scan of the chest. Offered at both the downtown Medical Mall and Heart Center, the scan is superior to a standard X-ray at providing detailed images of any abnormalities within the chest. “Low-dose” means the test uses a lower level of radiation than a regular chest CT. The scan is akin to a 3D X-ray that allows physicians to detect very small

LUNG CANCER

“It’s deadlier than breast, prostate and colon cancers combined.” Roderick M. Zalamea, MD

In 2016, screenings done through Huntsville Hospital detected seven cases of lung cancer and one unrelated cancer in people who were not showing any signs of disease.

Many lung cancer victims don’t exhibit symptoms until the disease has spread to other parts of the body. At that point, treatment is much more difficult. Dr. Zalamea said the five-year survival rate for lung cancer patients is 15 percent to 20 percent, compared to 90 percent-plus for people with breast cancer and prostate cancer. The American Cancer Society estimates lung cancer killed 158,080 people nationwide in 2016, including 3,260 Alabamians. Several years ago Huntsville Hospital helped form the Southeast Lung Alliance to raise awareness about the importance of low-dose CT screenings. Cardiothoracic surgeon Evan Cohen, MD, and oncologist Marshall Schreeder, MD, co-chair the group. “Our goal is very simple: To diagnose lung cancer sooner and expedite getting those patients into treatment,” said Karen Adams, RN, manager of Huntsville Hospital’s Cancer Program.

To schedule a screening, call (256) 539-0457. 7


2016 Screening Program In 2016, Huntsville Hospital and The Heart Center performed 230 Low-dose screening CTs. Seven lung cancers were diagnosed from these scans and 1 non-lung cancer case was discovered. Five of the seven lung cancer cases were diagnosed at an earlier stage which improves survival.

LDCT Screening Volume 2016

Smoking Status 2016

40

80

35

70

30

60

25

50

20

40

15

30

10

20

5

10

0

0 Jan

Feb Mar April May June July Aug Sept Oct Nov Dec

Current Smoker

Former Smoker Male

Non Smoker Female

Diagnosed Cancers 2016

Lung Cancer by Stages 2016

8

4

7

3.5

6

3

5

2.5

4

2

3

1.5

2

1

1

0.5

0

0 Lung Other

IA IB IIA IIB IIIA IIIB IV

2016 Prevention Program In 2016, Huntsville Hospital’s Cancer Program in conjunction with the Center for Lung Heath offered 4 free smoking cessation clinics in the month of November. Additionally, the Center for Lung Health offers the American Lung Association’s Freedom from Smoking Program® year round. Quitting smoking lowers the risk of lung cancer as well as other smoking related illnesses such as heart disease, stroke, pulmonary diseases and peripheral vascular disease.

8


The wonderful donors, staff and volunteers made 2016 one of the more memorable years at Hospice Family Care. Together we connected with our community and supported families in their darkest moments. As our mission states we exist to provide excellent compassionate end of life care for those touched by illness, grief, and loss. Year in review 28 full time employees, 14 part time Served 365 patients –199 women and 166 men Made 14,695 patient visits Broke ground on the inpatient hospice facility at Redstone Village Provided a new home for the Caring House Volunteers 65 Volunteers 2,538 hours Driving 8,000 miles Net cost savings of $11,404.69 351 Patient family visits 57 Visits to sing hymns 630 Bereavement calls 161 Office support visits 170 Caring House support visits Bereavement Annual Service of Remembrance for loved ones lost Theology Panel event for inter-denominations to discuss faith and spiritual beliefs to train staff 124 groups this year

Attended National Hospice & Palliative Care Organization Intensives 2 New Certified Hospice & Palliative Care Administrator Certifications 1 End of Life Nursing Education Consortium Trainer 1 Pediatric End of Life Nursing Education Consortium Trainer First Skills Fair at UAH Additional support Provided additional ancillary therapies of: Massage Therapy – 62 massages Music Therapy – 77 therapy sessions 449.95 hours of Child Life Specialty to our patients with children in the homes 2 patients on all expense paid beach trips! Caroling to our patients Training by National Children’s Advocacy Center Care Transition Coordinator in ED Caring House New Location – 203 Longwood Drive Celebrated Christmas with Carols, Cupcakes & Cocoa

Grief Camps supporting more than 50 children

Celebrated National Children’s Grief awareness day

Community Outreach

Served 424 children since September!

Attended more than 100 community outreach events Educated more than 75 physician offices Partnered with Post Acute Care Partners to create Huntsville Hospital At Home Services Education Institute Educated 560 individuals and offered 31 classes Attended Alabama Hospice & Palliative Care Organization

New inpatient hospice facility taking shape Construction is under way on Madison County’s first inpatient hospice facility. The $10 million structure at Redstone Village is on track to open in the fall of 2017. Operated by Hospice Family Care, it will have 15 private suites where patients with terminal illnesses can spend their final days in a home-like setting surrounded by family.

9


Doris Bailey holds a framed American flag honoring her late husband, Charles Bailey.

The promise of Hope A Huntsville Hospital plan to open North Alabama’s first inpatient hospice unit has special meaning to Doris Bailey.

Hospice employees arranged a hospital bed for Charles and put it at the foot of his wife’s bed, allowing him to spend his final days in a familiar setting surrounded by the people he loved most. His daughter Dodi Gaines was at his side when he died.

Bailey, who lives in the Monrovia community, credits Huntsville Hospital’s Hospice Family Care with allowing her husband to die peacefully and with dignity in his own bedroom. Charles Bailey, 76, a retired Army systems analyst, suffered “I don’t know what I would have done without hospice,” says from stomach cancer. Doris Bailey. “They weren’t only our caregivers; they became like family to us.” “He was at the point of no return” when the family reached out to Hospice Family Care, Doris Bailey says. “They set up everything in the house for us and let us know they were at our disposal whenever we needed them, 24/7.”

10

While Bailey says home-based hospice care was the right choice for her husband, she enthusiastically supports the idea of inpatient hospice care for terminally ill patients who no longer can be cared for at home and who require constant medical supervision.


Region’s first inpatient hospice unit promises ‘peace and comfort’ to terminally ill patients, families.

Huntsville Hospital, Hospice Family Care and Redstone Village are teaming up to build the region’s first inpatient hospice facility on the campus of Redstone Village, a retirement community in south Huntsville. Scheduled to break ground this spring, the $10 million, 30,000-square-foot structure will offer 15 private rooms with all the comforts of home. Each room will have sleeping accommodations for two family members. Plans also call for family living areas, work areas, a kitchen, patios with views of the nearby woods and mountain, and a non-denominational chapel. Round the clock care and comfort will be provided by a specially-trained medical director, nurses, technicians and spiritual counselor. “A community the size of Huntsville should have a facility dedicated to inpatient, end-of-life care,” says Jeff Samz, Huntsville Hospital’s chief operating officer. “Our goal is to create a world-class model where end-of-life care is delivered with privacy and dignity for the patients, and where their families can be present and involved in the care.”

Huntsville Hospital estimates more than 300 hospital patients a year would benefit from inpatient hospice care. Currently, there are only 40 inpatient hospice beds statewide – none within an hour of Huntsville. The Huntsville Hospital Foundation, the nonprofit fundraising arm of Huntsville Hospital, recently launched a $7 million capital campaign to cover the bulk of the costs to build, furnish and equip the inpatient hospice facility. Bailey says inpatient hospice care would be a godsend for many families in the Huntsville area. She has a close friend whose husband is battling stomach cancer. The couple does not have any family in Alabama, and the woman is “at a loss” how to care for her husband as his condition worsens. “She’s been asking me about hospice,” Bailey says, “and she could really benefit from an inpatient hospice. I would even volunteer my time at a place like that. “Hospice Family Care was so good to me,” she says, “and I’d love to give back.”

If you would like to donate to the inpatient hospice project, call Huntsville Hospital Foundation President Candy Burnett at (256) 265-8077 or email candy.burnett@hhsys.org. You can also make a contribution online at huntsvillehospitalfoundation.org. All donations to the foundation are tax deductible.

11


Big HOPE in a small house Hospice program is changing the dynamics of childhood grief. Not long after their infant daughter was born with a serious genetic disorder, Jeremy and Hallie Kenny reached out to Hospice Family Care. The Madison couple knew they would need hospice nursing help for baby Mae. And they wanted to get older daughter Alice involved with The Caring House, Hospice Family Care’s grief support program for children and teens.

When Mae died at home in March 2016, Alice was not caught off guard. That day, she drew pictures of heaven and released a balloon into the sky for Mae.

Hallie Kenny had tried to explain to five-year-old Alice that Mae had been diagnosed with Trisomy 18, a chromosomal defect.

“As we watched it go up and up,” said O’Leary, “she was smiling and waving at her sister in heaven.”

“But it was hard for me to find the right words,” she said, “and I was so consumed with Mae’s care that I worried Alice wasn’t getting enough attention. To have The Caring House staff come in and give their full focus to Alice was just … amazing.

A safe place

Kim O’ Leary, a child life specialist with The Caring House, visited the Kenny home numerous times to help Alice understand – in developmentally appropriate terms – what was happening with her baby sister. Alice was given the opportunity to touch and feel real medical equipment just like the equipment used in Mae’s care. That experience made those unfamiliar objects less threatening.

There’s a Volcano Room where children are encouraged to release emotions in a safe setting. There’s a play room where they can act out images stuck in their mind from a hospital room or funeral. There’s a well-stocked art room where they can express feelings in paint and Magic Marker.

“Young children can’t grasp the specifics of a chromosomal disorder,” said O’Leary, “so you try to work with what they can physically see and understand.” 12

She used exercise to help Alice see that her own health was not affected by Mae’s illness. While Mae needed supplemental oxygen to breathe, Alice could run and do jumping jacks with ease.

In late August, The Caring House program moved from the Hospice Family Care business office to a restored 1950s bungalow on Longwood Drive in Huntsville’s Medical District.

On a recent visit, Alice drew a sidewalk chalk portrait of Mae wearing a lavender hair bow.


The first fundraising event to benefit The Caring House, hosted by the Huntsville Hospital Foundation, will be the BMW Brunch on Sunday, Nov. 20, at Century BMW in Huntsville. Alice Kenny draws a sidewalk chalk portrait of Mae on The Caring House porch. At right, Hospice Family Care Executive Director Kristina Johnson and Business Development Manager Lee Shaw.

For more information on that event or to make a donation to The Caring House, please call (256) 265-8077. For online donations, visit huntsvillehospitalfoundation.org.

‘To the next level’ “I think this great space is really going to take The Caring House program to the next level,” said Lee Shaw, Hospice Family Care’s business development manager. “It’s much more inviting than the office we were in before, and it’s also larger so we can accommodate more children and teenagers.” Hospice Family Care is part of the Huntsville Hospital Health System, and many hospital employees rolled up their sleeves to make The Caring House a reality. Huntsville Hospital Foundation President Candy Burnett volunteered her interior decorating talents. Madison Hospital President Mary Lynne Wright, who is also a master gardener, designed the landscaping. “When you think of the name ‘Caring House,’ this house fits that picture,” said Hallie Kenny. “They had an incredible setup before, but it was in an office building. Now when you walk up and see the white picket fence and the colorful front door, it gives you a feeling of calmness.” The teal front door is The Caring House’s most eye-catching feature, but it wasn’t chosen just for the curb appeal: Teal is the color associated with childhood grief awareness. All the difference When Mae was born on Oct. 14, 2015, doctors at Huntsville Hospital for Women & Children noticed her feet were curved – a possible sign of a chromosomal abnormality. The test results came back a week later: Mae had Trisomy 18. The Kennys were told their infant daughter was unlikely to live past her first birthday.

While Hospice Family Care nurses taught the couple how to use the feeding tubes and bottled oxygen that Mae required, O’Leary gave Alice information about Mae’s illness and tried to prepare her for the inevitable. “Instead of Mae’s condition being some big scary thing, Alice knew what to call it and how it worked,” said Hallie Kenny. “That was so important.” After Mae died, Alice joined The Caring House’s bereavement support group for children who have lost a parent, sibling, grandparent or other loved one. The meetings, led by Hospice Family Care grief support specialists, take place at The Caring House. The program is also offered at 28 public schools across Madison County. “There’s so much value in that peer support and knowing that you’re not the only child dealing with death,” said O’Leary. “It’s a safe place for them to share things about their loved one and to learn from others. Children have all the same emotions about death as adults do, but they may not always know how to express it in the healthiest way.” Hallie Kenny said she realized how much Mae’s illness was weighing on Alice when Alice asked for a medical-themed Doc McStuffins birthday party. “Kids have these huge feelings about death,” she said. “To have someone come in and listen to Alice talk about her sister at her own pace made all the difference.” 13


101 Sivley Road, Huntsville, AL 35801 (256) 265-1000 | huntsvillehospital.org

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