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Center for Cancer Care 1330 Coshocton Road Mount Vernon Ohio 43050 www.KCH.org

2016 Annual Cancer Report 2015 Data Collection

1330 Coshocton Road Mount Vernon OH 43050 740 393 5551 www.KCH.org


The Center for Cancer Care 1330 Coshocton Road Mount Vernon Ohio 43050 740.393.5551 www.KCH.org

2016 Annual Cancer Report 2015 Data Collection

Husain Rasheed, MD Cancer Committee Chairman Amy Murnen, MD Cancer Liaison Physician Diana Endsley, RN, OCN Director, The Center for Cancer Care Sandy Petros, BS, MT (ASCP), CTR Oncology Data Specialist  Bobbi Mickley, RN Patient Navigator Becky Dangelo, MSN, RN, CNOR, CN-BN Breast Health Navigator Barb Stiltner, RT (T) Community Outreach Coordinator Katy Breeze, BSN, RN Clinical Research Coordinator


table of contents Section 1 - 1.1

A Word from Bruce D. White, CEO

1.2 A Word From... Husain Rasheed, MD, Cancer Committee Chair 1.3 Cancer Liaison Physician Overview Report Amy Murnen, MD, FACS, Cancer Liaison Physician Section 2 2.1 Center for Cancer Care Service Report Diana Endsley, RN, OCN, Director of Center for Cancer Care Section 3 - 3.1 Center for Cancer Care Registry Report Sandy Petros, BS, MT (ASCP), CTR, Oncology Data Specialist Section 4 - 4.1 Patient Navigator Report Bobbi Mickley, RN, Patient Navigator Section 5 - 5.1 Breast Health Navigator Report Becky Dangelo, MSN, RN, CNOR, CN-BN, Breast Health Navigator Section 6 - 6.1 Community Outreach Report Barb Stiltner, RT (T), Community Outreach Coordinator Section 6 - 7.1 Clinical Research Report Katy Breeze, BSN, RN, Clinical Research Coordinator Section 6 - 8.1 Photo Highlights 2015-2016 Cancer Awareness and Breast Cancer Awareness Events


Our Cancer Committee Team

REQUIRED PHYSICIAN MEMBERS Medical Oncologist

HUSAIN RASHEED, MD Cancer Committee Chair

Radiation Oncologist

THOMAS PEDRICK, MD

Cancer Liaison Physician AMY MURNEN, MD General Surgeon

LAUREN MCDOWELL-JACOBS, MD

Diagnostic Radiologist

ROBERT KONSTAN, MD

Pathologist  

TISHA FARRELL, DO

REQUIRED NON-PHYSICIAN MEMBERS DIANA ENDSLEY, RN,OCN Cancer Program Administrator SANDY KOLLAR, MSM-HCA, RN Vice President Quality, Quality Improvement Coordinator ADONYAH WHIPPLE, BSN, RN, CHPN Palliative Care Representative SANDY PETROS, BS, MT (ASCP), CTR CTR & Cancer Registry Quality Control Coordinator LINDSAY KARAS, LSW, MSW Psychosocial Services Coordinator BOBBI MICKLEY, RN Patient Navigator & Cancer Conference Coordinator BARB STILTNER, RT (T), Community Outreach Coordinator AMY SHOEWALTER, BSN, RN, OCN, Oncology Nurse KATY BREEZE, BSN, RN, Clinical Research Nurse & Clinical Trials Coordinator

RECOMMENDED MEMBERS BECKY DANGELO, MSN, RN, CNOR, BHN Breast Health Navigator KELLY BAILEY, RD, LD DEANA RAGER Laboratory SEAN CULL, RPH Pharmacy DEB LINK, MS, PT Rehabilitation and Wellness ANN STYER, MSM-HCA, RT (CT), (M) Diagnostic Imaging MEGAN SEXTON American Cancer Society MIKE WHITAKER Knox County Health Department BRUCE BEHNER Chief Operating Officer PEGGY SEVERNS, RN Surgical Clinical Reviewer DEB SHOBE, BSN, RN Peri-Operative Services


1.1

A word from... Bruce D. White

Chief Executive Officer I am very pleased to provide the 2016 Cancer Report from The Center for Cancer Care at Knox Community Hospital. As you review this report you will find statistical and narrative accounts of all cancer cases diagnosed and/or treated at our Center in 2015. The Center for Cancer Care has maintained accreditation from The Commission on Cancer (CoC) since achieving that recognition in 2010. This accreditation is granted only to facilities that have voluntarily committed to providing the very best in cancer diagnosis and treatment according to strict CoC standards. Recognition by The Commission on Cancer is significant because it emphasizes the highest possible care for the most important individual of all—the patient. I am extremely proud of the care provided by the oncologists, surgeons, physicians, dieticians, pathologists, pharmacists, phlebotomists, radiologists, nurses, therapists, and all other support personnel who make up our team. Perhaps most importantly, this team not only excels at caring for our patients, they also care about them. The uniquely compassionate care provided for patients in our community at the Center for Cancer Care is due to an extraordinary team of people with a wide variety of professional and clinical skills who also happen to care deeply. It is this dedication to clinical quality with a real personal and human touch that makes this team at Knox Community Hospital so very special. We believe that the patients of the Center for Cancer Care at Knox Community Hospital—our friends, our families, and our neighbors—deserve nothing less.


1.2

A word from... Husain Rasheed, MD

Cancer Committee Chair THE CENTER FOR CANCER CARE Medical Oncology Dear friends, We are happy to present our annual cancer report for 2016. Cancer care is changing rapidly. The most meaningful changes in the clinic are happening from the emergence of two new types of cancer therapies: Immunotherapy and molecularly-targeted therapy. Immunotherapy primes or induces a person’s immune system to attack his or her cancer. Three new immunotherapy drugs (“checkpoint inhibitors”) have been approved by the FDA in the last year or so for the treatment of common cancers such as metastatic melanoma, lung cancer, head and neck cancers, kidney cancer, bladder cancer and lymphoma. These immunotherapy drugs have proven to be more effective than chemotherapy in the appropriate settings and, very importantly, have significantly less side effects than chemotherapy. We are now routinely using these drugs in our clinic and have quite a few patients on them. The emergence of these drugs is causing a shift away from chemotherapy. There are newer forms of immunotherapy on the horizon where a cancer patient’s own immune cells are removed and genetically engineered to target the cancer and then infused back to the patient to kill the cancer. A patient of mine with Non-Hodgkin’s Lymphoma whose cancer had relapsed after multiple lines of chemotherapy treatments recently underwent one such treatment with“ CAR-T cell immunotherapy” on a clinical study and has had a complete remission. Molecularly-targeted therapy consists of “smart drugs” that target a certain genetic or molecular change in the cancer. For example, when we now see a newly diagnosed patient with metastatic lung adenocarcinoma, we routinely test for certain mutations in the cancer. There are currently three “actionable mutations” (EGFR, ALK, ROS) for which we have FDA approved “smart drugs” that target these mutations and result in better control of the cancer and longer survival with less side effects compared to standard chemotherapy. Newer drugs for different mutations are being studied. We are also learning that patients can develop new mutations in their cancer that makes them grow and no longer respond to the smart drug.


1.3

For example, certain lung cancer patients with EGFR mutation will develop a new mutation, T790M mutation, causing their cancer to grow. Detecting this new mutation is critical because we now have a new smart drug that targets this new mutation and brings the cancer back under control. To detect this new mutation we would need to do a needle biopsy of the cancer again. Fortunately, a new technique is emerging called a “Liquid Biopsy”. Instead of doing a needle biopsy of the tumor again, we can now obtain the information with a simple blood draw by capturing and analyzing tumor DNA circulating in the patient’s blood! As cancer care is changing rapidly, it is becoming more complex and costly. We are happy to say that at KCH we have been staying abreast Source: https://www.cancer.gov/about-cancer/treatment/clinical-trials/nci-supported/nci-match with these new developments. We are fortunate to be able to offer these new drugs and diagnostic tools to our patients at KCH. Our cancer navigators work hard to obtain these new medications for our patients through various complex grants and programs when, not infrequently, insurance coverage is a problem. The financial costs of the evolving diagnostic tools and new therapies are considerable and will be a challenge going forward. How much does a new drug impact a person’s disease and the quality and quantity of their life? A basic “value assessment” of a new drug or diagnostic tool will allow for profitable but sensible and rational payment strategies to contain costs. I am grateful to the outstanding KCH Administrative team, the KCH Board, dedicated Physicians, NPs, PAs, Nurses, and all the staff and volunteers at KCH for their support and help in the care of the cancer patients in our community. Most of all we, at the Center for Cancer Care, are grateful to our patients for entrusting their care to us.


1.4

Amy Murnen, MD THE CENTER FOR CANCER CARE Cancer Liaison Physician Report Knox Community Hospital is dedicated to provide patient-centered quality cancer care in our community. Our Center for Cancer Care has been accredited by The Commission on Cancer (CoC) since 2010. In order to become an accredited program, our cancer program is required to meet each and every standard set forth by the CoC. Our Center for Cancer Care continues to meet, and at times exceeds the expectations set by these many standards. This year has been my third full year volunteering as Knox Community Hospital’s Cancer Liaison Physician (CLP). As the CLP, I have the responsibility to review our monthly outcomes data for our patients who receive treatment in our Center for Cancer Care. We now have the ability to look at current data to make sure our patients are receiving the appropriate treatments in a timely manner. I also sit on our Cancer Committee and report our outcomes data to this committee on a quarterly basis. We have a dedicated team that joins together to create our Cancer Committee. The Cancer Committee is made up of our oncologist, Dr. Husain Rasheed, MD, who is the committee chairperson, as well as our radiation oncologist, radiologist, pathologist, surgeons, primary care physicians, oncology nurses, patient navigators, nutritionists, social worker, and many others involved in the cancer patients’ care. We meet quarterly to ensure that our Center for Cancer Care is meeting all of the expectations set by the CoC and that our patients receive quality cancer care. As the CLP for Knox Community Hospital, I continue to be impressed with the quality of care our patients receive at The Center for Cancer Care. I can assure our community that we continue to give our patients quality cancer care that meets and often exceeds National Standards set by the Commission on Cancer. Our Center for Cancer Care provides high quality care for our community close to home.


2.1

Medical Oncology Diana Endsley, RN, OCN, Director THE CENTER FOR CANCER CARE Service Report Husain Rasheed, MD

Board-Certified in Medical Oncology and Internal Medicine

We offer an array of resources to our patients which include: • Laboratory Services • Diagnostic Imaging • Breast Health Navigator • Patient Navigator • Rehabilitation & Wellness • Lymphedema Therapy • Occupational Therapy • Physical Therapy • Speech Therapy • Massage Therapy

• • • • • • • • • • • • • • •

Dietitian Services Pain Management Palliative Care Pharmacists Social Services Wound/Ostomy Services American Cancer Society Cancer Support Group Breast Cancer Support Group Men’s Cancer Support Group Young Women’s Breast Cancer Support Group Community Health Resource Center Education Financial Counseling Pre-certification Services

Our Center & Staff Knox Community Hospital’s Center for Cancer care is located in the Knox Medical Pavilion. We provide medical oncology, hematology and radiation therapy services to assist patients and their loved ones from the time of diagnosis to survival and end of life. Medical Oncology/ Hematology is provided by Dr. Husain Rasheed, who is board certified in Medical Oncology and Internal Medicine. This year we added Laura Eichenlaub, CNP to our Medical Oncology and Hematology Department. Radiation Oncology services are provided by board-certified physicians from Riverside Radiation Oncology group, Drs. Mark Crnkovich, Megan DeHaan, Praveen Dubey, and Thomas Pedrick. August 2014 was the addition of Riverside Radiology to interpret diagnostic imaging at Knox Community. A physician with Riverside Radiology is Dr. Robert Konstan who specializes in interpreting breast images.

Radiation Oncology

Mark Crnkovich, MD (Radiation Oncology)

Tom Pedrick, MD (Radiation Oncology)

Praveen Dubey, MD (Radiation Oncology)

Megan DeHaan, MD (Radiation Oncology)

Department of Specialty Care, General Surgery

Michael Heuman, MD

Board-Certified General Surgery

Hydi Laidlaw-Smith, DO Board-Certified General Surgery

Lauren McDowell-Jacobs, MD Board-Certified General Surgery

(continued next page)


2.2

Eleven registered nurses (nine oncology/chemotherapy certified), 3 registered radiation therapists, registered radiation oncology nurse, registered and certified nurse Breast Health Navigator, registered nurse Patient Navigator, an Oncology Data Specialist and 2 secretarial support staff provide patient care. Our facility offers an array of resources to our patients which include: • Chemo and Bio Therapies • Palliative Care with supportive care • Pharmacists • Laboratory Services • Social Services • Radium 223 Treatments • Wound/Ostomy Services • Diagnostic Imaging • American Cancer Society • Breast Health Navigator • Cancer Support Group • Patient Navigator • Breast Cancer Support Group • Rehabilitation & Wellness • Men’s Cancer Support Group • Lymphedema Therapy • Young Women’s Breast Cancer Support Group • Occupational Therapy • Community Health Resource Center • Physical Therapy • Education • Speech Therapy • Financial Counseling • Massage Therapy • Pre-certification Services • Dietitian Services • Pain Management Since 2010 The Center for Cancer Care continues to be accredited by the Commission on Cancer (CoC). Established in 1922 by the American College of Surgeons the CoC sets standards to ensure organizations are dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care. Patients who obtain care at a COC accredited cancer program receive the following benefits: • • • • • • • • • •

Quality care close to home Comprehensive care offering a range of state-of-the-art services and equipment A multi-disciplinary, team approach to coordinate the best cancer treatment options available Access to cancer-related information and education Access to patient-centered services such as navigation Options for genetic assessment and counseling and palliative care services Ongoing monitoring and improvement of care Assessment of treatment planning centered on evidence-based national treatment guidelines Information about clinical trials and new treatment options A cancer registry that collects data on cancer type, stage, treatments results and offers lifelong follow-up (continued next page)


2.3

In accordance with our National Accreditation and Standards from the CoC we annually set goals that will benefit our program and especially the patients. 2016 goals included the addition of a satellite pharmacy in the Knox Medical Pavilion (KMP). The Center for Cancer Care is located on the Ground Floor in the KMP. Historically, chemotherapy and other medications for administration to our patients have been prepared by the KCH Pharmacy located in Knox Community Hospital. Having a satellite pharmacy in the KMP increases the timeliness for communication, focuses on cancer treatment medications, and is in close proximity for the delivery of those medications. There is also the availability of a pharmacist to directly address patient concerns and questions. The Pharmacy on the Ground Floor of the KMP became operational in November 2016. Knox Community Hospital continues to be a member of the National Cancer Institute Community Oncology Research Program (NCORP). NCORP consists of three major components: Research Bases, Community Sites, and Minority/Underserved Community Sites. The main goal of NCORP is to bring quality clinical trials to the communities where individuals reside and includes cancer delivery research, cancer control, screening, prevention, treatment, and imaging. The membership was previously with Columbus Community Clinical Oncology Program (CCOP). Clinical trials investigate new ways to treat diseases like cancer. Newly developed medications, combinations of existing and new medications or different ways of giving existing medication are some of the ways clinical trials help to improve the prevention, detection and treatment of cancer. Types of clinical trials include: • Treatment Trials test new treatments (like a new cancer drug, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy). • Prevention Trials test new approaches, such as medicines, vitamins, minerals, or other supplements that doctors believe may lower the risk of a certain type of cancer. These trials look for the best way to prevent cancer in people who have never had cancer or to prevent cancer from coming back or a new cancer occurring in people who have already had cancer. • Screening Trials test the best way to find cancer, especially in its early stages. • Quality of Life Trials (also called Supportive Care Trials) explore ways to improve comfort and quality of life for cancer patients. Treatment planning decisions are made utilizing national guidelines and evidence based practice as well as the individual patient’s needs. Delivery of treatment is provided by highly skilled staff from The Center for Cancer Care who are dedicated to provide excellent service and compassion to our patients and their loved ones.


3.1

Sandy Petros, BS, MT (ASCP), CTR THE CENTER FOR CANCER CARE Registry Report The Cancer Registry began at Knox Community Hospital in 2006 and now has ten years of data comprising 2351 analytic cases. In addition to sending this data to the National Cancer Data Base (NCDB), KCH data is also sent to the Ohio Department of Health, Ohio Cancer Incidence Surveillance System (OCISS). OCISS is funded by the Center for Disease Control’s (CDC) National Program of Cancer Registries (NPCR) to collect population based cancer incidence data under Public Law 102-515. Source (http://www.cdc.gov/cancer/npcr/npcrpdfs/publaw.pdf)

KCH works in collaboration with the Knox County Health Department to help fulfill one of NPCR’s goals which is to monitor the burden of disease and to implement cancer prevention and control programs. The current collaboration consists of a Tobacco Cessation Program which is being funded by an investment from United Way of Knox County through the Public Health Partnership of Ohio. The program is being led by Mike Whitaker who is a certified tobacco treatment specialist with the health department. Tobacco-related diseases are the most preventable cause of death worldwide and tobacco is a major cause of lung cancer, one of the top five cancers at KCH. In addition to lung cancer, tobacco use is also known to cause cancers of the oral cavity and pharynx, esophagus, stomach, colorectum, liver, pancreas, larynx, uterus, cervix, ovary, bladder and kidney, and is also a contributing factor in myeloid leukemia. We’re optimistic that the Tobacco Cessation Program will continue with its success.


3.2

Registry Report Primary Site of Cancers at KCH in 2015 by Stage The primary site tabulation displays all cancer sites in 2015 by AJCC stage and sex. Table 1

Total

Sex

AJCC Stage Group

Male

Female

0

I

II

III

IV

Unknown

N/R*

Total

247

122

125

22

62

28

46

61

13

15

Oral Cavity

11

10

1

2

1

0

2

6

0

0

Tongue

5

5

0

0

1

0

0

4

0

0

Oropharynx

2

2

0

0

0

0

0

2

0

0

Other

4

3

1

2

0

0

2

0

0

0

48

24

24

0

7

8

13

17

3

0

Esophagus

2

2

0

0

0

0

0

2

0

0

Stomach

2

0

2

0

0

0

0

2

0

0

Colon

17

6

11

0

3

2

7

2

3

0

Rectum

8

7

1

0

1

0

4

3

0

0

Anus/Anal Canal

2

0

2

0

0

0

2

0

0

0

Liver

1

1

0

0

0

0

0

1

0

0

Pancreas

12

5

7

0

2

3

0

7

0

0

Other

4

3

1

0

1

3

0

0

0

0

52

33

19

1

6

3

15

24

2

1

Larynx

6

4

2

1

0

0

2

1

2

0

Other

1

0

1

0

0

0

0

0

0

1

Lung/Bronchus - Sm Cell

10

4

6

0

0

0

1

9

0

0

Lung/Bronchus - Non Sm Cell

30

23

7

0

4

3

10

13

0

0

Other Lung/Bronchus

5

2

3

0

2

0

2

1

0

0

Digestive System

Respiratory System

N/R*=not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown. (continued next page)


3.3

Registry Report PRIMARY SITE OF CANCERS AT KCH IN 2015 BY STAGE Table 1 continued...

Total

Sex

AJCC Stage Group

Male

Female

0

I

II

III

IV

Unknown

N/R*

247

122

125

22

62

28

46

61

13

15

8

5

3

0

0

0

1

0

0

7

Leukemia

5

4

1

0

0

0

1

0

0

4

Other

3

1

2

0

0

0

0

0

0

3

4

2

2

0

4

0

0

0

0

0

4

2

2

0

4

0

0

0

0

0

Breast

45

0

45

10

20

9

3

3

0

0

Female Genital

11

0

11

0

2

0

4

0

5

0

Cervix Uteri

1

0

1

0

0

0

1

0

0

0

Corpus Uteri

6

0

6

0

1

0

0

0

5

0

Ovary

2

0

2

0

1

0

1

0

0

0

Vulva

2

0

2

0

0

0

2

0

0

0

23

23

0

0

12

7

2

2

0

0

23

23

0

0

12

7

2

2

0

0

15

12

3

9

4

0

0

2

0

0

Bladder

10

8

2

7

2

0

0

1

0

0

Kidney/Renal

4

3

1

1

2

0

0

1

0

0

Other

1

1

0

1

0

0

0

0

0

0

Brain & CNS

4

1

3

0

0

0

0

0

3

1

Brain (Benign)

3

1

2

0

0

0

0

0

3

0

Brain (Malignant)

1

0

1

0

0

0

0

0

0

1

Endocrine

6

2

4

0

6

0

0

0

0

0

Thyroid

6

2

4

0

6

0

0

0

0

0

12

7

5

0

0

1

4

6

0

1

12

7

5

0

0

1

4

6

0

1

Unknown Primary

3

2

1

0

0

0

0

0

0

3

Other/Ill-Defined

5

1

4

0

0

0

2

1

0

2

Total Blood & Bone Marrow

Skin Melanoma

Male Genital Prostate Urinary System

Lymphatic System Non-Hodgkin

N/R*=not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown.


3.4

Registry Report

The top five cancer sites at KCH are lung, breast, colorectal, prostate and oropharyngeal. These five sites comprise 63.6% of the total analytic cases diagnosed and/or treated at our facility. Chart 1a

20

18.2%

18.2%

Bronchus & Lung Breast

15

9.3%

10

Colorectal

10.9%

Prostate

6.9%

Oropharynx

5

0

These same five sites comprise 52.3% of the total estimated analytic cases by the American Cancer Society (ACS). *American Cancer Society Facts & figures 2016. Chart 1b

14.6%

15

13.3%

12

6 3 0

Breast

10.7%

9

8.0% 5.7%

Bronchus & Lung

Colorectal Prostate Oropharynx


3.5

Registry Report

Cancer is primarily a disease of older people. Over 60% of all cases of cancer are diagnosed after age 65 years.

Chart 2a

40 35 30 25 20 15 10 5 0

KCH Age at Diagnosis by Gender

Male

30-39

Chart 2b

40-49

Female

50-59

60-69

70-79

80-89

Age-Adjusted SEER Incidence Rates, By Age, All Sites, All Races, Both Sexes, 1975-2013 (SEER 9)

3000 2500

Rate per 100,000

90-99

2000 1500 1000 500 0 YEAR OF DIAGNOSIS Ages < 20

Ages 20-49

Ages 50-64

Ages 65-74

Ages 75+


3.6

Registry Report

Since the majority of cancer patients in the United States are treated in community settings, the National Quality Forum (NQF) endorsed quality measures developed in joint effort between the ACoS, the National Comprehensive Cancer Network (NCCN), and the American Society of Clinical Oncology. The KCH Cancer Committee ensures that all cancer patients are treated according to these measures and ensures quality care close to home. The Cancer Committee reviews the quality of care annually. Since KCH does not perform major lung surgery, not all of these measures apply. These measures were the following: At least 10 regional lymph nodes are removed and pathologically examined for AJCC stage IA, IB, and IIB resected Non-Small Cell Lung Cancer (NSCLC). N/A Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC. 2/2 100% Surgery is not the first course of treatment for cN2, M0 lung cases. 4/4 100% A table of the years 2011-2015 is included below: Table 2

LN0-Surg-Surgery is not the first course of treatment for cN2, M0 lung cases (Quality Improvement) Performance rates and reported cases

2011

2012

2013

2014

2015

all

Estimated performance rates

100%

100%

100%

100%

100%

100%

3/3

3/3

4/4

2/2

4/4

16/16

Cases eligible for measure (Denominator) [Comp]

3

3

4

2

4

16

â&#x20AC;˘

Concordant, treatment administered [Comp]

3

3

4

2

4

16

â&#x20AC;˘

Non-concordant [nRx]

0

0

0

0

0

0

Cases not eligible due to incomplete tumor characteristics [I]

0

0

0

0

0

0

Cases not eligible for consideration for the measure [NE]

27

20

38

39

41

165

Total number of lung cancer cases reported to NCDB

30

23

42

41

45

181

Performance rate Numerator/Denominator

(continued next page)


3.7

Registry Report

Table 2 continued...

10RLN- At least 10 regional lymph nodes are removed and pathologically examined for AJCC stage IA, IB, IIA, and IIB resected NSCLC (Surveillance) 2011

2012

2013

2014

2015

all

no data

no data

no data

no data

no data

no data

0/0

0/0

0/0

0/0

0/0

0/0

0

0

0

0

0

0

30

23

42

41

45

181

Performance rates and reported cases Estimated performance rates Performance rate Numerator/Denominator Cases eligible for measure Concordant, treatment administered

LCT-Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC (Quality Improvement). Performance Rates and Reported Cases Estimated Performance Rates

2011

2012

no data

100%

2013

2014

2015

all

no data no data

100%

100%

Administered

no data

100%

no data no data

100%

100%

Considered, not administered

no data

0%

no data no data

0%

0%

0/0

1/1

0/0

0/0

2/2

3/3

Performance Rate Numerator/Denominator •

Administered

0

1

0

0

0

3

Considered, not administered

0

0

0

0

0

0

0

1

0

0

2

3

Cases eligible for the measure (Denominator) [Comp]+[Consid]+[fRx] •

Concordant, treatment administered [Comp]

0

1

0

0

2

3

Concordant, treatment considered not administered [Consid]

0

0

0

0

0

0

Nonconcordant [rRx]

0

0

0

0

0

0

Cases not eligible for consideration for the measure [NE]

30

22

42

41

43

178

Total number of lung cancer cases reported to NCDB

30

23

42

41

45

181

The lung quality measures at KCH are well within expected performance rates.


3.8

Registry Report

Knox Community Hospital continues to provide cancer care close to home as 84% of the oncology patients are from Knox County. 4%

RICHLAND

2%

MORROW

84% KNOX

6%

COSHOCTON

4%

Other


4.1

Bobbi Mickley, RN, Patient Navigator THE CENTER FOR CANCER CARE Patient Navigator Report Since 2011, the Patient Navigation service has played an integral part in meeting the criteria set forth by the Commission on Cancer, but more importantly meeting the needs of our patients. In 2015, I joined the staff of the Center for Cancer Care as the patient navigator. Many questions accompany a cancer diagnosis which often includes questions about treatment, side effects, support services. As the Cancer Navigator and being a registered nurse, I connect patients with resources, arrange appointments, provide education and coordinate other services patients may need such as wigs, transportation and financial assistance. Emotional support and questions are answered every step of the way with guidance and reassurance provided to our patients and family members so they can focus on their optimal health of fighting their disease. I also provide education within the community on cancer, promoting prevention to reduce risk of increasing knowledge to recognize the symptoms of cancer. In April of 2016, I implemented a community program called “Strollin’ for the Colon” along with the assistance of registered dietitians, Dina Herald and Kelly Bailey and exercise physiologist, Lyndsay DePolo, we were able to provide education on Colon Cancer, Nutrition and Exercise tips for our participants. Screening programs have also played an important part in cancer prevention and treatment. We currently provide screening programs for Colon Cancer and Head and Neck Cancer for the community. Screening participants are notified of a positive finding detected from the screening and provided recommendations for follow-up with their healthcare provider.


5.1

Becky Dangelo, MSN, RN, CNOR, CN-BN THE CENTER FOR CANCER CARE Breast Health Navigator Report While lung cancer is the leading cause of death among both men and women, breast cancer is the second-leading cause of death cancer among women. In a womanâ&#x20AC;&#x2122;s lifetime there is a one in eight chance of being diagnosed with breast cancer. In 2016 it has been reported that 240,000 new cases of breast cancer have been diagnosed in the United States. Although breast cancer is the most commonly diagnosed cancer there has been great advances in the early detection of breast cancer and in prevention of cancer deaths. Through the efforts of the Foundation for Knox Community Hospital, which plays an integral role in the provision of the latest technology available, 3D digital (tomosynthesis) mammography became available in 2016. The 3D imaging provides the ability for improved imaging for dense breast tissue and improved detection of suspicious lesions as thin layers of tissues are visible separately providing more accurate delineation of the inner breast structures without shadowing and distortion. Tomosynthesis benefits also include increased comfort during imaging and there are fewer call backs for additional breast imaging. When breast cancer is diagnosed the treatment is personalized for each individual. Hormone receptors that can be targeted for treatment are estrogen receptor (ER) and progesterone receptor (PR). Her 2 neu (human epidermal growth factor receptor 2) is a protein that appears on the surface of some breast cancer cells. For women who are identified with ER/PR receptors, or Her 2 neu positive breast cancer, treatment is provided to block these receptors or protein which would prevent the growth signals from occurring in tumor cells. A treatment combination for hormone positive breast cancer would include surgery, radiation, chemotherapy, if indicated in some patients, and antiestrogen treatment. To prevent a breast cancer recurrence estrogen blockers, such as Anastrozole or Tamoxifen, would be initiated for a five to ten year course. Herceptin was FDA approved in 1998 for the treatment of Her 2 neu positive breast cancers. This medication blocks cancer cells ability to receive signals that informs the cells to grow. Pertuzumab and Tykerb are medications that also prevent uncontrolled cell growth in Her 2 neu positive type tumors. Our goal is for cancer prevention and early detection. With the advances that have been made in the past couple decades for early detection and treatment more birthdays have been celebrated and people are happy to be able to celebrate another birthday. Aspects of a cancer diagnosis such as emotional issues, financial concerns and treatment side effects still exist however, assistance can be provided to address these concerns / issues which promote the willingness for the survivor to fight and to have a healthier life and prolonged survivorship.


5.2

2016 ACCOMPLISHMENTS The Mother, Daughter, Sister and Friends Project (MDSFP) was provided grant funding through Susan G. Komen Columbus for the 2016-2017 grant year. This project provides assistance for those 40/older who were/are uninsured or under insured; 40/under at risk who were/are under insured and those 40/under with an area of concern or suspicious breast mass. This project continues to not only address needs for screening mammograms but diagnostic needs (i.e. diagnostic mammograms, ultrasounds and biopsies) as well. Survivorship assistance continues to be provided as identified and as included in the grant proposal. During the initial six months of the grant period there were 20 screening mammograms and a total of 73 diagnostic services provided. There were 6 breast cancers diagnosed during this period with all six women progressing through the continuum of care. Each person provided with navigation, education and assistance through the project related their appreciation of assistance and care. Effective July 1, 2016 the Ohio Department of Health Region 5 Breast and Cervical Cancer Project (BCCP) office closed. Knox County was designated to be in the Central Region of BCCP which is located in Licking County and is a great asset to women. The BCCP program provides no-cost breast and cervical cancer screenings and diagnostic testing to qualified individuals. Women who are enrolled in the BCCP program and are diagnosed with breast cancer are eligible for a special version of Medicaid and receive full Medicaid benefits throughout treatment. The BCCP case managers are consulted by the BHN, for each potential woman, for determination of qualifying for assistance through this program. Upon meeting the qualifications, a case manager from BCCP contacts the woman to provide navigation as needed via BCCP available services. Should a woman not qualify for BCCP, assistance is provided through the MDSFP. The Breast Cancer Support Group continues to meet monthly. Women share their personal journey and experiences which promotes growth for the woman and for the group. These women refer to themselves as “members of a sisterhood” that they enjoy being a part of and of being able to support each other as well as to receive support. The Young Survivors Breast Cancer Support Group is for women in their 20’s to age 45. These women have the opportunity to share and ask questions that may impact them at this age as younger women may be confronted with various concerns/issues than older women. As the facilitator the goal is to provide education, engage and empower all women from the time of diagnosis throughout treatment and ongoing survivorship. The promotion of emotional, physical and spiritual health is provided for optimal well-being throughout the journey and as a part of support group meetings.


5.3

LOOK GOOD FEEL BETTER PROGRAM An American Cancer Society (ACS) program provided free once a month for any woman receiving cancer treatment. A make-up kit is provided to each woman with the facilitator being a licensed cosmetologist and trained by the American Cancer Society for this program. Women are instructed how to apply make-up, how to wear scarves and hats and how to look good and feel better about themselves. Women who attend this program always remark what a good time they had, that they laughed and learned new tricks to help them feel better as well as look good. How a woman looks can affect how she feels and this program improves a woman’s self-image as she is undergoing treatment. This is a collaborative effort of the ACS, the National Cosmetology Association, and the Cosmetic and Toiletry and Fragrance Association. The Look Good Feel Better Program is held monthly at Knox Community Hospital. Programs and education provided by the Breast Health Navigator during 2016 include: MARCH 2016: “Healthy People Healthy Community” at the Gay Street Methodist Church. Attendance: 18. There were 40 Colorectal Screening Kits distributed at the Hot Meals dinner. A Hispanic Outreach program was presented by the BHN and Adriana de la Pena, Program Coordinator – Latino Breast Health Project (Ohio Health) to women from the Knox County Hispanic community. Attendance: 14 MAY 2016: The ABCs of Breast Health presented to the Newark Road Church of Christ Women’s Group. Attendance: 14 Breast health information / education provided at the Women’s Healthy Happy Hour organized by, and in collaboration with, the Knox County Health Department. Attendance: 75 JUNE 2016: Breast health information / education provided at a health fair held at New Hope Industries. Attendance: 30 JULY 2016: Breast health information / education provided at the Knox County Fair.

AUGUST 2016: The ABCs of Breast Health presented to the Brandon Church Women’s Group. Attendance: 15 SEPTEMBER 2016: Breast health information / education provided at the Tomato Show in Fredericktown. OCTOBER 2016 Breast health information / education provided at the 10th Annual Breast Health Awareness Event. Attendance: 110 Of note: Certification was obtained in 2015 as a Certified Navigator-Breast Nurse (CN-BN) from the National Consortium of Breast Centers, Inc.


5.4

LOOK GOOD FEEL BETTER PROGRAM

SCREENING MAMMOGRAM 300

2.0

250 1.5

200

JAN FEB MARCH APRIL

150

1.0

MAY 100 JUNE

0.5

50 0

0.0

JULY AUG SEPT

DIAGNOSTIC MAMMOGRAM

BREAST CANCER SUPPORT GROUP

120

60

100

50

80

40

60

30

40

20

20

10

0

0

YOUNG SURVIVORS BREAST CANCER SUPPORT GROUP: Note: YS Group has decided to meet 2 - 3 times/year due to family schedules 2016ï&#x192;&#x153;

May: 4 December: 3

OCT NOV


6.1

Barb Stiltner, RT (T) THE CENTER FOR CANCER CARE Community Outreach Coordinator Report COMMUNITY OUTREACH

(Commission on Cancer Standard 1.8)

The Center for Cancer Care at Knox Community Hospital realizes the importance of screening and prevention of cancer. Focusing on those cancers that are most predominant in our community assists us with our goal of reaching the majority of our population to help keep them healthy by education in the prevention of cancer and early detection that may identify a cancer at a curable stage. In accordance with our dedication to the community we have held several screening and prevention activities in 2016.

PREVENTION

(Commission on Cancer Standard 4.1)

COLORECTAL CANCER | Program: Strollin’ for the Colon According to the American Cancer Society, colorectal cancer is identified as one of the top 5 cancers in Knox County. Lifestyle behaviors that result in an increased risk for colorectal cancer due to obesity include poor eating habits and a lack of physical activity. In January and February 2016 a sub-committee met to discuss the possibility of providing a program in the community to educate the public on the impact of lifestyle choices influencing their risk for colorectal cancer. During their March 2016 Meeting the Cancer Committee discussed the sub-committees recommendations along with the America Cancer Society’s and Colon Cancer Alliance’s guidelines on risks for colorectal cancer. Discussion also centered around the Knox County Health Department’s Community Needs Assessment which identified Knox County residents as choosing unhealthy foods and having a lack of exercise. It was agreed by the committee that ‘Strollin for the Colon’ was a worthwhile program. The program would include colorectal cancer information, healthy eating tips by a registered dietitian, and physical activity motivation by an exercise physiologist.

Learn more about Cancer Prevention! Center for Cancer Care www.KCH.org

Strollin'

FOR THE COLON

Join Us for a Light Snack and a Walk! September 9, 2016 Kiwanis Pavilion at Foundation Park 10:30 am - 12:30 pm Information presented will include: • Healthy Eating for Cancer Prevention • Diet and Exercise Working Together KCH Patient Navigator, Bobbi Mickley, from the Center for Cancer Care will give a brief overview on colo-rectal cancer. Dietitians Dina Herald and Kelly Bailey will provide information on nutrition, diet and exercise and conducting the walk. The Center for Rehabilitation will share information on exercise and cancer prevention tips.


6.2

Community Outreach Program Report

The program was held on September 9, 2016 at Ariel Foundation Park. Local participants and Knox Community Hospital employees enjoyed healthy snacks prepared by Knox Community Hospitalâ&#x20AC;&#x2122;s Food and Nutrition Department while listening to Knox Community Hospital dietitians explain the nutritive value of foods and what to avoid. The Center for Cancer Care Patient Navigator provided an overview of colorectal cancer. After learning how physical activity helps decrease the risk for obesity and colorectal cancer, those in attendance took a stroll around the park. Participants completed pre- and post-program questionnaires that identified their knowledge of colorectal cancer risk factors. Participants agreed that their knowledge base of the information provided was improved. Phone calls to participants one month after the program revealed that 2 consulted with their primary care provider and then joined a formalized exercise program. One person started walking and made positive dietary changes. Two of the participantâ&#x20AC;&#x2122;s spouses also made positive diet revisions and began evening walks. One participant continues to be active in Tai Chi but also made changes in eating habits. During the registration process, one participant did not provide the contact information necessary for follow-up. During the December 2016 Cancer Committee Meeting the committee agreed that this program was worthwhile to the community and should be offered in 2017.

PREVENTION CANCERS OF THE LUNG, ORAL CAVITY, PHARYNX, ESOPHAGUS, | Program: Smoking Cessation STOMACH, COLORECTUM, LIVER, PANCREAS, LARYNX, UTERUS, CERVIX, OVARY, BLADDER, KIDNEY, AND MYELOID LEUKEMIA. The Cancer Committee sub-committee identified issues of alcohol abuse and smoking/tobacco as two of the five major issues in Knox County according to the Knox County Health Department (KCHD) Community Needs Assessment. These are major risk factors for oral, head, and neck cancer. Mike Whitaker, a Certified Tobacco Treatment Specialist from KCHD, met in August with KCH employees to discuss setting up a tobacco cessation program at KCH. The programs are designed according to the Mayo Clinic method and were held on Tuesdays and Thursdays and used cancer information provided by the American Cancer Society. Funding was provided by the United Way and KCH publicized the classes and printed up the tobacco information packet. Eight people attended the classes which started in October and after six weeks; seven people were successful in quitting their smoking habit. The Cancer Committee reviewed this information in December and decided to renew and re-energize this effort in 2017.


6.3

Community Outreach Program Report SCREENING

(Commission on Cancer Standard 4.2)

COLORECTAL CANCER | Program: Colorectal Cancer Screening As identified by the American Cancer Society (ACS) colorectal cancer is one of the 5 most diagnosed cancers in Ohio and Knox County. Depending on the location of the tumor in the colon, colorectal cancer may go undetected for a long period of time resulting in the finding of late-stage disease on diagnosis. The ACS screening guidelines for colorectal cancer include having a fecal immunochemical test (FIT) annually, Guaiac-based fecal occult blood test (gFOBT) annually, or a Stool DNA Test every 3 years. Sub-committee meetings held in January and February 2016 focused on the best way to provide screening for colorectal cancer to the vast majority of our community. At the March 2016 Cancer Committee Meeting discussion was held regarding the need for screening and decided the community would benefit. The screening was already underway as March is colorectal cancer awareness month. Colorectal screening kits were offered February 29th through April 1st, 2016. Kits were available at physician offices, Urgent Care, KCH ER, KCH Registration, KCH Laboratory, and Wellness and Rehabilitation. Kits were also handed out at various community meetings. The program was highlighted in the Mount Vernon News, WQIO Radio Station, and Knox Pages. The testing modality offered in the kit was the FIT method. The kits also included screening guidelines, risk factors, prevention, and symptoms of colorectal cancer from the ACS. Of the kits distributed, a total of 247 specimens were submitted for testing. Of the 247 submitted specimens, 47 (19%) tested positive for blood. Participants received a letter in the mail with their result (positive or negative) along with information about what they should do for follow-up and contact information for additional questions. Upon follow-up with participants receiving a positive result we found that 37 had scheduled an appointment with their primary care physician, 7 were planning to schedule an appointment, and 3 participants did not provide detailed contact information. Of the 37 with follow-up, 19 had colonoscopies with findings within normal limits or benign polyps; 6 persons had colonoscopies outside of our facility (results were not available); 8 had follow-up that didnâ&#x20AC;&#x2122;t require further action; and 4 were not able to be reached. At the December 2016 meeting the Cancer Committee discussed the distribution, kit contents, participation, and follow-up information. It was noted that the number of participants increased from 113 in 2015 to 247 in 2016. Due to the fact that a number of the screenings led to the excision of polyps that have the potential to become cancerous a decision by the committee was made that the program was successful and to provide it again in 2017.


6.4

Community Outreach Program Report SCREENING ORAL, HEAD AND NECK CANCERS | Program: Oral, Head, and Neck Screenings Sub-committees met in February and March 2016 to discuss the possibility of screening for Oral, Head, and Neck Cancers. In March 2016 the sub-committee findings were discussed at the Cancer Committee Meeting. The committee members took into consideration the findings of the Knox County Health Departmentâ&#x20AC;&#x2122;s Community Needs Assessment identifying that smoking related deaths in Knox County are higher than Ohio and the United States averages. Additional findings of the Community Needs Assessment were that poverty in Knox County impacts 13.2% of our population resulting in decreased access to medical care. The Cancer Committee using the Community Needs Assessment, American Cancer Society Guidelines, and national guidelines from the Oral, Head and Neck Alliance agreed that a screening would benefit our community. Screening for Oral, Head and Neck Cancer was held May 2, 2016. There were 55 participants screened by Suzanne Helming, D.O. and Britney McCollough, CNP. Educational materials from the Oral, Head, and Neck Alliance outlining the risk factors, symptoms, and how to perform a selfassessment were distributed to all participants. Participants completed a questionnaire, as well as a pre- and post-exam that also asked if they had a better understanding of these cancers. Of the 55 persons screened, 6 were identified for follow-up. Of the 6, 1 had a dental consult resulting in no adverse outcome; 1 consulted with an ENT and was then referred to a dermatologist. The ENT performed a biopsy. The patient was diagnosed with Hodgkinâ&#x20AC;&#x2122;s lymphoma and is currently in treatment; the remaining 3 participants did not choose to have follow-up even though they were strongly encouraged to do so. The number of participants that took advantage of the screening increased from 46 in 2015 to 55 in 2016. During their December 2016 meeting the Cancer Committee Meeting agreed that this was a beneficial service and recommended to increase the number of providers performing the screening in 2017 from 2 to 3. Recommendations were also made to follow-up with the participants, at a later date after the screening, to determine if the educational literature made a positive impact in promoting a healthy lifestyle.

SCREENING LOW DOSE CT LUNG CANCER SCREENING A service initially offered in 2015 saw an increase in participation in 2016. Low Dose CT screening for lung cancer was offered. In 2016 there were 129 screenings performed. The CT must be ordered by a physician and certain criteria, including smoking status (past and present), must be met. Community members interested in this service should contact their primary care physician to determine the necessity of screening.


7.1

Katy Breeze, BSN, RN THE CENTER FOR CANCER CARE Clinical Research Coordinator Report CLINICAL RESEARCH TRIALS

(Commission on Cancer Standard 1.9)

Clinical trials have been offered by referral or on site by The Center for Cancer Care for many years. Our ongoing participation with the NCI Community Oncology Research Program (NCORP) allows us to provide clinical trials that were previously only available at larger facilities. These clinical research trials advance science and ensure that patient care approaches the highest possible level of quality (Commission on Cancer 2016). As of December 13, 2016 the types of trials that our patients participated in were:

1.

Clinical Trial

a.

RESIST: IDH1 Peptide Vaccine for Recurrent Grade II Glioma at Duke University Hospital: 1 patient

b. CART-T Study at Moffitt Cancer Center Tampa, Florida: For Follicular Lymphoma: 1 patient

2.

Bio-Repository/Bio-Bank Studies:

a.

Fol. 3576: Functional Genomic and Bio-marker analysis in small cell lung cancer: 2 patients

b.

Fol. 3464: Bio-marker Analysis in Triple Negative Breast, Colorectal, Lung and Bladder Cancer Patients: 2 patients

3.

Genetic Studies

a.

OCCPI: Ohio Colorectal Cancer Prevention Initiative Universal Screening for Lynch Syndrome: 7 patients


8.1

Photo Highlights 2015 Cancer Survivor Event

Cancer Center Staff Handing out Survivor T-Shirts

Donna Hartley, Television Personality

Live music from members of the community

Bruce Behner, COO, Dr. Rasheed, Dr. McDowell-Jacobs, Dr. Konstan and Bruce D. White, CEO

Donna Hartley with Center for Cancer Care Staff

Sandy Petros, handing out survivorship beads

Nancy Karam, Survivor Story Speaker

Buildings Services at KCH offers a shuttle service and a pink carnation to each survivor, each year.

Cheri Butcher and Jeff Scott (Marketing/ Development) share recent growths to breast health in Knox County.


8.2

Photo Highlights Continued... 2015 Breast Cancer Awareness Event

Group Photo of Our Breast Cancer Survivor Attendees

Speaker/Breast Cancer Survivor, Leslie Mouton, ABC News Anchor, San Antonio, TX

Center for Cancer Care Director, Diana Endsley and staff

Husain Rasheed, MD - KCH Medical Oncologist

Door Prize Time!

Tammy Lemley, Breast Cancer Survivor

Robert Konstan, MD, KCH Radiologists


8.3

Photo Highlights Continued... 2016 Cancer Survivor Event

Group Photo of Cancer Center Staff with Guest Speaker Chris Speilman

Group Photo of Survivor Speakers with Guest Speaker Chris Speilman

CEO, Bruce D. White with wife, Kathy are shuttled to the entrance by our shuttle service for the event.

Jan Legg, retired nurse and cancer survivor signing the tree of life.

Long time OSU fan, Jan Legg scores a big hug from Chris Speilman.

Robert Konstan, MD, Radiology

Following a powerful speech from one of our speakers.

Cancer Center director, Diana Endsley with Ashley Wittel, who was recognized for Community Support of our Patients.

Building Services attends each of our events to offer shuttle services and a flower honoring patients.


8.4

Photo Highlights Continued... 2016 Breast Cancer Awareness Event

Group Photo of Center for Cancer Care Staff

Husain Rasheed, MD, Medical Oncologist Cancer Liaison and survivor, Amy Murnen, MD with her staff and Becky Dangelo.

Lauren McDowell-Jacobs, MD General Surgeon

Laura Eichenlaub, CNP recently joined the Cancer Center.

Jodi Giffin, crocheted the pink ribbons seen to the right for KCH cancer patients.

Dr. Goodrich (MOCC) and his wife going PINK!

Janet Grohe with daughter Jackie who is a survivor.

Kathy Wade, Patient Advocate


Center for Cancer Care 1330 Coshocton Road Mount Vernon Ohio 43050 www.KCH.org


2016 Cancer Report [2015 Data]