Sl cancer center annual report 2016 single 3

S T. L U K E ’ S C A N C E R C E N T E R

2016 Annual Report and Outcomes

ACTIVITIES AND ACHIEVEMENTS St. Luke’s University Health Network’s Integrated Network Cancer Program offers a comprehensive range of services, delivered by a dedicated team of professionals using the latest technology. It is committed to providing our patients with exceptional care tailored to their individual needs.

We are pleased to present to you the 2016 Cancer Program Annual Report, recognizing the hard work and many achievements of the St. Luke’s Cancer Team.

In addition to reviewing this 2016 annual report, we encourage you to visit our St. Luke’s Cancer Center website to familiarize yourself with all of our cancer-related programs and services.

2016 Highlights and Accomplishments Accreditation: Our Integrated Network Cancer Program earned another full three-year Accreditation with Commendation during our most recent Commission on Cancer (CoC) Survey in October 2016.

The results of our survey showed commendation compliance in five standards and compliance with all additional standards; no deficiencies were identified.

American College of Surgeons’ Commission on Cancer (CoC) accreditation is a voluntary accreditation that signifies a facility’s commitment to deliver quality cancer care. The CoC publishes Cancer Program Standards which encompass all aspects of patient care. Retaining this accreditation requires the facility to undergo a survey process every three years for evaluation of compliance with defined standards.

2

St. Luke’s Cancer Center

Clinical Trials: The St. Luke’s University Health Network Clinical Trials Office is the clinical and administrative shared resource for the conduct and management of sponsored clinical research across SLUHN, consisting of a robust and knowledgeable team with specific roles dedicated to each function of clinical trials and research.

The St Luke’s Oncology Clinical Trials team offers studies that are sponsored by industry pharmaceutical companies, government-sponsored studies through NCI’s National Clinical Trials Network (NCTN), such as ECOG-ACRIN and NRG, as well as investigator-initiated trials (IITs) originating at St. Luke’s, some of which are multi-site trials with St. Luke’s serving as the lead coordinating center. Our staff provides patients with the most up-to-date information on treatments that are available to them, as we believe in putting the patient first by ensuring that we present all available treatment options, including participation in a clinical trial.

• In 2016, seven percent of our patients were enrolled in clinical trials with lung studies being the number one enrollment.

• In 2016, we increased the number of trials activated and decreased the amount of time to activate trials.

In addtion, our trial portfolio expanded across therapeutic clinical areas.

• St. Luke’s immunotherapy program includes treatment of melanoma, lung cancer, head and neck cancer, bladder cancer, kidney cancer, stomach cancer, breast cancer, pancreatic cancer, prostate cancer, ovarian cancer and multiple myeloma.

• Our lung studies were the number one enrollment in 2016.

• St Luke’s Oncology Clinical Trials offer patients a variety of clinical research trials, quality service, education and support across the continuum of care of the patient.

2016 Annual Report and Outcomes

3

ACTIVITIES AND ACHIEVEMENTS cont.

Enhancements to Patient Care: • Multidisciplinary comprehensive cancer conferences took place throughout 2016, encompassing all campuses. Tumor Board/Cancer Conferences provide a forum in which experts from varied oncology disciplines are able to collaboratively discuss the clinical stage of disease, the different treatment options recognized by national treatment guidelines, as well as available clinical trials when applicable.

Cases presented throughout the year are determined by incidence volume and tracked statistically to assure all sites are covered, or unusual or rare cancers are discussed. In addition to Tumor Board, cancer case discussion also takes place at regularly scheduled site-specific working groups.

• Twenty-two percent of analytic cases were discussed at tumor conferences and average physician attendance of required disciplines exceeded benchmark.

• The NCCN-endorsed distress thermometer (DT) was administered to patients at all designated cancer care sites affiliated with each of the campuses. Patients are screened at least once during a pivotal visit, such as newly diagnosed patients coming in for their first medical oncology appointment, first chemotherapy treatment and at first radiation therapy treatment. Results are reviewed and patients with moderate or severe distress are connected to cancer support staff for follow-up and intervention.

Throughout 2016, St. Luke’s consistently performed above the statewide and US norms.

• In March 2016, SLUHN entered into a formal agreement with Abington Reproductive Medicine to market and promote a joint oncofertility program. Tara Budinetz, DO, is the physician from Abington Reproductive Medicine who will lead this initiative. Dr. Budinetz is a native of the Lehigh Valley. Her special interests include female and male fertility, in vitro fertilization (IVF and ICSI), and fertility preservation/egg freezing.

• A formal agreement with the Temple Bone Marrow Transplant Program was finalized and Dr. Henry Fung began seeing patients at the Anderson Campus in September 2016.

• Two clinical education specialists have been integrated into the cancer service line to support clinical education.

• A GI patient navigator was added to our clinical support services to enhance care to patients with gastrointestinal cancers.

4

St. Luke’s Cancer Center

Performance Improvement Initiatives: • Reduced colon cancer surgical site infection rates and hysterectomy surgical site infection rates through the use of evidence-based guidelines and bundles; • Implemented a unified process across the Network for CADD pump safety; • Improved the percent of chemotherapy orders received in the infusion center more than 48 hours in advance of the patient’s appointment; • Reduced same day cancellation rate/no shows by 11 percent over a 6-month period by assessing reasons and deriving plans to mitigate the reasons for cancellations; • Mapped out breast cancer pathways and established metrics for monitoring.

2016 Annual Report and Outcomes

5

ACTIVITIES AND ACHIEVEMENTS cont.

Technology: • When a woman is diagnosed with breast cancer, radiation therapy is frequently part of the treatment plan for those receiving breast-conserving surgery or mastectomy to reduce the chance of cancer recurrence. However, because the left side of the heart is in close proximity to the breast, the heart may be subject to some radiation exposure. St. Luke’s offers cardiac-sparing radiation therapy for left-sided breast cancer patients meeting criteria because of state-of-the-art technologies that are available: Optimal Surface Monitoring System (OSMS @ St. Luke’s Anderson Campus) and ORPM Respiratory Gating (St. Luke’s University Hospital – Bethlehem). The highly precise tracking systems are fully integrated with the movement of the patient as they receive radiation therapy. This technique helps minimize the toxicities of radiation to the heart.

• Radiation Oncology participates in the national database, RO-ILS: Radiation Oncology Incident Learning System™. The mission of RO-ILS™ is to facilitate safer and higher quality care in radiation oncology by providing a mechanism for shared learning in a secure and non-punitive environment.

We believe in putting the patient first by ensuring that we present all available treatment options.

• Radiation Oncology entered into an agreement with VARIAN Medical Systems to serve as an official reference site to other health care institutions. The most recent addition of Optical Surface Monitoring System (OSMS) has allowed us to lead the way for frameless radiosurgery, which we have performed at our Anderson Campus since February 2015.

• Progeny, family history software for genetic counseling, was implemented February 1, 2016. This new software was purchased with a generous donation from the Women’s 5K and will replace the family history and personal history questionnaires that were sent to patients prior to their genetic counseling appointment. Patients are now sent an email with a secure, personalized link which is allowing them to complete their family history through an online portal.

Patient Support: • The Allentown Infusion Center is now the third infusion center in the Network to provide “Chemo Bags” to new patients upon their first visit to the infusion center. The Chemo Bags are donated by a non-profit organization which started by a local cancer survivor who wanted to “give back” to patients undergoing chemotherapy. The Chemo Bags are filled with various items for patient comfort, such as lap blankets, hats, hand lotion, puzzle books, etc.

6

St. Luke’s Cancer Center

• LAFF (Life Always Facing Forward), a volunteer mentoring program connecting women cancer survivors with women newly diagnosed with cancer, implemented in 2016, was founded by two cancer survivors, Ali Glaser and Sheri Frinzi.

• Nearly 1,500 cancer survivors and their guests attended Tony Orlando’s Great American Christmas Show to celebrate their battle against cancer. Held at the Sands Event Center, the event was supported through philanthropic funds from The Sands Event Center, Tony Orlando, the Auxiliary of St. Luke’s, Boutique at the Rink, the Circle of Hope and the Regina Patient and Family Support Endowment.

Awards/Quality: • The New Jersey State Cancer Registry awarded St. Luke’s Warren Campus with the “Bronze Award for Excellence in Timely and Complete Cancer Case Reporting” for the 2014 accession year. Only nine hospitals in the State of New Jersey met the rigorous criteria for any of the registry awards.

• St. Luke’s participated in the ACCC Financial Advisory Network (FAN) Process Improvement Learning Lab Workshop. The goal of FAN was to evaluate the quality and sophistication of financial advocacy services that providers offer to cancer patients by developing comprehensive tools, resources and networking opportunities.

2016 Annual Report and Outcomes

7

ACTIVITIES AND ACHIEVEMENTS cont.

Improvements in Access to Care: • Focus on Health Equity • A partnership was established with the HCM Foundation to reduce the financial burden of accessing cancer screening/treatment.

• St. Luke’s Cancer Compassion Fund continued to help underserved patients receiving care through St. Luke’s Cancer Centers. The fund continues to support patients who need financial assistance with medications, mortgage or rent payments, and paying utility bills.

•O ncology specialist physicians changed patient appointment schedules to better accommodate patients during non-traditional hours.

Communications: • St. Luke’s Cancer Connection is distributed and posted to St. Luke’s website quarterly to help patients connect with St. Luke’s cancer programs and services and introduce them to caregivers from St. Luke’s Cancer Center team.

• A digital “Share A Ribbon” awareness campaign was launched in September 2016 that engages patients and family members affected by cancer and encourages them to share a ribbon to show support and spread awareness and hope in the fight against cancer.

We are committed to providing our patients with exceptional care tailored to their individual needs.

8

St. Luke’s Cancer Center

2016 — CANCER COMMITTEE MEMBERS Our optimal clinical outcomes are due to the collective efforts of the Cancer Committee and the medical staff. The Cancer Committee is composed of representatives of primary and specialty care physicians, as well as team members from administrative and supportive services involved in the care of our cancer patients.

This multidisciplinary committee of dedicated professionals meets five times a year to provide leadership in evaluating, monitoring, and coordinating cancer-related activities and programs throughout SLUHN. Lee B. Riley, MD, PhD INCP Committee Chair Surgical Oncology Darius Desai, MD Cancer Liaison Physician Surgical Oncology Sanjiv Agarwala, MD Medical Oncology David Anderson, MD Pathology Ric Baxter, MD Palliative Care Neil Belman, DO Medical Oncology William Burfeind, MD Thoracic Surgery Bonnie Coyle, MD, MS Community Health and Preventive Medicine Nimisha Deb, MD Radiation Oncology Edward Gilkey, MD VP, Medical Affairs Warren Campus Hugh Moulding, MD Neurosurgery Subhash Proothi, MD Medical Oncology Laurie Sebastiano, MD Radiology John Smith, MD Medical Oncology

Thomas J. Tachovsky, MD Oncology Quality Oversight Nicholas Taylor, MD Gynecologic Oncology David Yen, MD Otolaryngology Cheryl Belman, RN, OCN Neuro-Oncology Nursing Mary Brophy, MT Cancer Data Associate Debra Bubba, MSN, RN Administrative Director, OSL Donna Bydlon, RN, OCN Oncology Nursing Rose Cabral, RN, OCN & Tracy Butryn, MS, CCRP, CHRC Clinical Trials Beth Ciliberti, RDN, LDN, CSO Oncology Nutrition Debbie Cooper, RD Nutrition Services Elizabeth Gregg, RN Oncology Nursing John Flenner, MEd Cancer Counselor Kathleen A. Hedges, CTR Cancer Registry Manager Kathleen Katchur, MPH Community Health and Preventive Medicine

Kristen Maggipinto, RN Med-Surg Nursing Anderson Campus Linda Moller, RNC Hospice Erin Moskel American Cancer Society Kathy Nunemacher, RN, CPN, CPHQ Quality Resources Joseph Pinto VP, Network Operations Robyn Plesniarski Manager, Radiation Oncology Ashli Stuppino Manager, Radiation Oncology Susan Ross & Kate Raymond Communication and Marketing Jen Sinclair Cancer Support Community Andrea Smith, MS, CGC, LGC Genetic Counselor Brian Waldron, R.Ph Pharmacy Mari Wahlgren, MSPT, ATC, CLT-UE Rehabilitation Brenda West, RHIT, CTR Cancer Data Registrar

2016 Annual Report and Outcomes

9

ST. LUKE’S SCREENING, PREVENTION AND COMMUNITY OUTREACH Skin Cancer Screening Date

Location

Outcome

May 10, 2016

St. Luke’s Quakertown

May 11, 2016

St. Luke’s Bethlehem

9 screened—2 normal; 4 referred for biopsy; 3 biopsy recommended 31 screened—20 normal; 11 biopsy recommended

May 12, 2016

St. Luke’s Allentown

20 screened—4 normal; 12 referred for biopsy; 4 biopsy recommended

Colorectal Cancer Screening Event

Event Date

South Bethlehem Health Awareness Day

November 20, 2016

FIT Kits Distributed 16

FIT Kits Returned 6

+ FIT Results 2

Cancers Detected 0

• Launched Network-wide quality improvement project to improve colorectal cancer screening rates in our resident-based family practice and internal medicine clinics

Breast Cancer Screening – Lehigh Coalition for Cancer Control (LCCC) clients seen at SLUHN Dates

Women Total Screened Mammos

January to 29 March 2016

10

April to June 2016

31

July to September 2016 October to December 2016 CY 2016

28

40

128

St. Luke’s Cancer Center

26 (12 screening, 14 diagnostic) 29 (20 screening, 9 diagnostic) 27 (12 screening, 15 diagnostic) 38 (19 screening, 19 diagnostic) 120 (63 screening, 57 diagnostic)

Breast Returning Recommended Total Total Cancers for Add’l Biopsies CBEs Ultrasounds Detected Testing 1 17 4 3 1

0

12

2

1

1

1

17

2

1

1

1

18

2

0

0

3

64

10

5

3

Cervical Cancer Screening – LCCC clients seen at SLUHN

Women Receiving Pap Tests

January to March 16

April to June 2016

July to October to CY 2016 September December Total 2016 2016

15

22

22

12

71

Bethlehem Health Bureau Partnership – Healthy Woman Program women seen at SLUHN Dates

Women Screened

Breast Biopsies

Diagnostic Testing of Breast

Breast cancers Diagnostic detected Testing of Cervix

CY 2016

108

10

56

0

17

Low-dose CT Lung Cancer Screening Receiving Lung CT Screen

July to September 2016

October to December 2016

171

216

2016 Annual Report and Outcomes

11

ST. LUKE’S SCREENING, PREVENTION AND COMMUNITY OUTREACH cont.

Cancer Prevention Initiatives As a non-profit health institution, St. Luke’s University Health Network must conduct a Community Health Needs Assessment (CHNA) every three years, as mandated by the 2010 Affordable Care Act. This CHNA is used to identify priority health areas and to formulate strategic implementation plans for addressing identified health needs. In 2016, St. Luke’s University Health Network concurrently conducted both the network CHNA and a cancer center community needs assessment (CNA) using analogous processes. Both needs assessments were conducted by our Department of Community Health and Preventive Medicine, which has expertise in population health, evaluation, and assessment.

Our 2016 network CHNA process included a network-wide CHNA as well as CHNAs for each of our 10 campuses, allowing us to identify the specific needs of our unique campus service area’s populations.

Through the network CHNA process, St. Luke’s University Health Network identified these five priority areas: 1. Improving access to care and reducing health disparities 2. Promoting healthy lifestyles and reducing chronic disease 3. Improving mental and behavioral health 4. Improving child and adolescent health 5. Improving elder health.

Cancer is considered to be a chronic disease; therefore it is included under the health priority area of promoting healthy lifestyles and reducing chronic disease. Network-wide efforts have been underway to address the health priority area of promoting healthy lifestyles and reducing chronic disease. The full CHNA report, as well updates on the priority areas, may be found at slhn.org/Conditions-Services/ Community-Health/Community-Health-Needs-Assessment.

Education/Professional Presentations January •L ee Riley, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish Radio on Jan. 19, 2016, addressing the topic of “Breast Cancer.”

February • Israel Zighelboim, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on Feb. 27, 2016, addressing the topic of “Cervical Cancer.”

March •L ee Riley, MD, Tricia Kelly, MD, David Anderson, MD, Sanjiv Agarwala, MD, and Tracy Butryn appeared on PBS Cancer HealthNow TV program on targeted therapies and clinical trials on Mar. 14, 2015, on local WFMZ Channel 69.

•D arius Desai, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on Mar. 12, 2016, addressing the topic of “Pancreatic Cancer.”

• Subhash Proothi, MD, Medical Oncology, presented on breast cancer to Luthercrest residents in Allentown.

• S anjiv Agarwala, MD, chief of medical oncology, chaired the 12th annual New York Melanoma Conference which had 300 attendees. Dr. Agarwala presented lectures on melanoma brain metastasis and intralesional therapies.

12

St. Luke’s Cancer Center

Network-wide efforts have been underway to address the health priority area of promoting healthy lifestyles and reducing chronic disease.

April • Sanjiv Agarwala, MD, was a guest on “Talk with Your Doctor” on local WFMZ Channel 69 on Apr. 25, 2016, addressing the topic of “Skin Protection.”

•A Breakthrough Over Breakfast, “Updates in Breast Cancer Treatments,” was held in Monroe County. The program discussed the next generation of breast cancer care with Lee Riley, MD, Hikaru Nakajima, MD, and David Andolino, MD. • Medical Oncologists presented several Temple Medical Student lectures on topics including hematology review, acute leukemia, anticoagulation therapy and myelodysplastic syndromes, Hodgkin’s and Non-Hodgkin’s lymphoma, coagulation, platelet disorders and white cell disorders.

June • S anjiv Agarwala, MD, served as chair and moderator for the 2016 American Society of Clinical Oncology (ASCO) Conference in Chicago, Illinois (June 3-7, 2016). In addition, Dr. Agarwala presented an overview on melanoma at the conference.

• S anjiv Agarwala, MD, presented “Your Skin and Cancer—What Everyone Needs to Know” at Sanofi Pasteur in Swiftwater, PA, on June 10, 2016, to over 20 attendees.

July •T ricia Kelly, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on July 9, 2016, addressing the topic of “Yoga.”

• S anjiv Agarwala, MD, presented “Your Skin and Cancer –What Everyone Needs to Know” to PPL employees comprising of supervisors, safety team members and line workers on July 28, 2016.

• Israel Zighelboim, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on July 30, 2016, addressing the topic of “Abnormal Vaginal Bleeding.”

August • Sanjiv Agarwala, MD, and Andrea Smith, MS, CDC, LGC, presented on “Immunotherapy and Cancer A Whole New World” at both St. Luke’s Allentown and St. Luke’s Anderson Campuses for the St. Luke’s Physician Group PCP Group meeting. The meeting discussed the basics of the immune system and how it relates to cancer, the mechanism by which immunotherapy is able to use the immune system to fight cancer cells, and an overview of current breakthroughs in immunotherapy and integration into clinical practice.

• William Burfeind, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on Aug. 27, 2016, addressing the topic of “Lung Cancer.”

2016 Annual Report and Outcomes

13

ST. LUKE’S SCREENING, PREVENTION AND COMMUNITY OUTREACH cont.

September •A yaz Matin, MD, Daniel Eyvazzadeh, MD, and other SLUHN staff distributed educational materials and spoke to attendees about colorectal cancer screening and prevention at the HCM Foundation Saucon Rail Trail 10k on Sept. 5, 2016.

•A n annual oncology symposium “Immunotherapy: the New Face of Cancer Treatment” was hosted on Saturday, Sept. 17, 2016, with nearly 100 attendees.

•F rank Tamarkin, MD, Zachariah Goldsmith, MD, and Zachary Piotrowski, MD, were guests on “Talk with Your Doctor” on local WFMZ Channel 69 on Sept. 19, 2016, addressing the topic of “Controversies in Urology.”

• Alison Fowler, radiation oncology therapist, presented “Left Breast Deep Inspiration Breath Hold Technique Utilizing OSMS” at the American Society of Radiation Therapy Conference on Sept. 26, 2016.

October •A dinner program was held for primary care providers in the Warren County region on Oct. 26, 2016, which focused on “What’s New and Exciting in Breast Cancer & Women’s Imaging.” Speakers included Joe Russo, MD, Joe Bucich, MD, and Lee Riley, MD. •L ee Riley, MD, network chairman, Department of Oncology, and Donna Bydlon, BSN, RN, OCN, presented on a panel discussion sponsored by the Lehigh Valley Business Coalition on Health Care in October 2016. The panel discussion was on “Balancing Work & Cancer: How Employers Can Help” and included representatives from Lehigh Valley Hospital and Reading Medical Center. The event was attended by approximately 50 community business members.

•T ricia Kelly, MD, spoke to the ENCORE group at the Allentown YMCA on breast health awareness.

Fifty people were in attendance.

•K athleen Katchur, MPH, presented “Aligning cancer specific needs assessment to network needs assessment to attain measurable implementation goals” at the American Public Health Association’s Annual Meeting.

November •D arius Desai, MD, was a guest on “Hablando con su Doctor” on La Ola Spanish radio on Nov. 12, 2016, addressing the topic of “Colon Cancer.”

• Over 70 people attended a Breakthroughs over Breakfast which focused on womens’ cancers (breast, ovarian, cervical and endometrial) from Berks and Lehigh Counties. The physician panel was composed of Tara Budinetz, DO (reproductive endocrinology); Nimisha Deb, MD (radiation oncology); Tricia Kelly , MD (breast surgical oncology); Lino Miele, MD (plastic/reconstructive surgery); Hikaru Nakajima, MD (hematologist/oncologist); Joseph Russo, MD (radiologist, women’s imaging) and Israel Zighelboim, MD (gynecologic oncologist). The event was streamed live on Facebook (first time this technology was used).

14

St. Luke’s Cancer Center

Awareness •C arbon-Tamaqua ACS Telethon was held at Penn’s Peak on Apr. 11-12, 2016.

•V isions of Hope exhibit debuted at St. Luke’s Allentown Campus in April —art exhibition created by a local artist and cancer survivor.

• In May, Dr. Lee Riley hosted Circle of Hope Society, a Society of caring individuals that was established to secure philanthropic funds to support patients and family members during their cancer journey at his home.

•A CS Relay for Life Tamaqua was held on June 17-18, 2016.

• S ands Bethlehem Casino Wellness Fair was held on July 22, 2016 (470 Sands employees attended).

•N utrition Tip of the Week email “7 Cancer Tips for your Diet” was sent out on Sept. 9, 2016, to all SLUHN employees.

•P BS 39 Story featuring a St. Luke’s melanoma survivor aired on Sept. 20, 2016.

• St. Luke’s Blue Ribbon Race, held on Sept. 25, 2016, raised nearly $17,000 for local prostate cancer patients.

•W omen’s 5k Expo (information provided on Prevention, Clinical Trials, Treatment, Support Services) was held on Sept. 30, 2016.

Support Services We offer multiple support groups including breast, prostate, all cancers and mindfulness.

Support Group Type

Dates Met

Prostate Cancer Support

Feb. 2, Mar. 1, Apr. 5, May 3, June 7, July 5, Aug. 2

Journey of Hope

Jan. 12, Feb. 9, Mar. 14, Apr. 11, May 9, June 8, July 13, Aug. 10

Look Good, Feel Better Program: A free, public service support program that helps people with cancer deal with the appearance side effects of cancer treatment.

Program

Dates Met

Look Good, Feel Better

May 9, Aug. 8

Mindfulness Group—Began in July 2016: Teaches techniques to let go of worries and learn to exist in the present moment. Helps to relax and empower patients dealing with the stresses of cancer.

2016 Annual Report and Outcomes

15

CANCER DATA MANAGEMENT & STATISTICS The Cancer Registry is the data collection component of our Cancer Program. It is a depository of confidential patient information that provides the whole picture of the patients’ disease. The Network Cancer Registry is staffed by a team of data specialists trained as Certified Tumor Registrars (CTRs) and Cancer Data Associates. They collect information about the occurrence (incidence) of cancer, types of cancer, locations within the body, extent of cancer at the time of diagnosis (disease stage) and types of treatment patients receive. Cancer Registry data provides hospital administrators with statistics for research, education and strategic planning.

Data for all cancer cases diagnosed or treated within the Network is reported to a central statewide cancer registry. Data collected by state cancer registries enables public health professionals to better understand and address the cancer burden.

Reliable registry data is fundamental to a variety of research efforts, including those aimed at evaluating effectiveness of cancer prevention, control or treatment programs. In recent years, higher education and certification standards for Cancer Registrars were mandated to ensure the accuracy of the collected data.

Cancer Registry data goes through electronic edits as well as quality review processes.

Each patient in the database is followed annually in order to acquire necessary information on disease recurrence, subsequent treatment and survival data that is vital for continued patient care. Our current follow-up rate is 92 percent, which exceeds the established benchmark mandated by the Commission on Cancer (CoC) and attests to the continued teamwork approach to patient care at St. Luke’s.

Following are some cancer statistics for our Network:

Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report Class of Status Case Total (%) M F Analy NA Alive Exp 67 (2.2%) 48 19 59 8 45 22 1 (0.0%) 1 0 1 0 1 0 27 (0.9%) 17 10 23 4 18 9 8 (0.3%) 6 2 7 1 5 3 4 (0.1%) 3 1 4 0 2 2 7 (0.2%) 5 2 7 0 6 1 4 (0.1%) 2 2 3 1 4 0 7 (0.2%) 6 1 6 1 5 2 3 (0.1%) 3 0 2 1 1 2 6 (0.2%) 5 1 6 0 3 3 532 (17.2%) 283 249 483 49 299 233 32 (1.0%) 23 9 29 3 16 16 42 (1.4%) 28 14 35 7 20 22 Sex

Primary Site Oral Cavity & Pharynx Lip Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Digestive System Esophagus Stomach

Stage Distribution* 0 I 3 11 0 0 2 5 0 0 0 3 1 3 0 0 0 0 0 0 0 0 70 94 9 2 3 10

II 2 0 0 2 0 0 0 0 0 0 90 4 6

III IV 88 Unk 4 34 0 5 0 1 0 0 2 13 0 1 1 4 0 0 0 0 0 1 0 2 0 1 1 2 0 0 0 6 0 0 0 2 0 0 0 4 0 2 93 105 13 18 6 8 0 0 4 11 0 1 *Analytic Cases Only

16

St. Luke’s Cancer Center

Class of Case

Sex Primary Site

Total (%)

M

F

Small Intestine 18 (0.6%) 9 9 Colon Excluding Rectum 205 (6.6%) 96 109 Cecum 43 16 27 Appendix 14 3 11 Ascending Colon 38 18 20 Hepatic Flexure 11 4 7 Transverse Colon 25 18 7 Splenic Flexure 4 0 4 Descending Colon 8 6 2 Sigmoid Colon 44 25 19 Large Intestine, NOS 18 6 12 Rectum & Rectosigmoid 73 (2.4%) 43 30 Rectosigmoid Junction 16 11 5 Rectum 57 32 25 Anus, Anal Canal 16 (0.5%) 5 11 & Anorectum Liver & Intrahepatic 37 (1.2%) 25 12 Bile Duct Liver 28 23 5 Intrahepatic Bile Duct 9 2 7 Gallbladder 3 (0.1%) 0 3 Other Biliary 20 (0.6%) 14 6 Pancreas 73 (2.4%) 37 36 Peritoneum, Omentum 8 (0.3%) 1 7 & Mesentery Other Digestive Organs 5 (0.2%) 2 3 Respiratory System 426 (13.8%) 209 217 Nose, Nasal Cavity 5 (0.2%) 2 3 & Middle Ear Larynx 30 (1.0%) 26 4 387 (12.5%) 180 207 Lung & Bronchus Pleura 1 (0.0%) 0 1 Trachea, Mediastinum & 3 (0.1%) 1 2 Other Respiratory Organs Bones & Joints 2 (0.1%) 1 1 Bones & Joints 2 (0.1%) 1 1

Status

Stage Distribution*

Analy NA Alive Exp 0

I

II

III

IV

88 Unk

16 193 43 13 36 10 24 4 8 40 15 64 15 49

2 12 0 1 2 1 1 0 0 4 3 9 1 8

12 145 31 13 32 7 14 2 5 33 8 53 10 43

6 60 12 1 6 4 11 2 3 11 10 20 6 14

1 4 44 36 8 7 1 9 9 6 2 1 7 4 0 1 2 1 14 6 1 1 10 14 1 6 9 8

6 34 8 2 6 3 3 1 1 5 5 14 5 9

2 38 12 0 11 3 4 1 1 4 2 18 1 17

2 34 8 1 3 1 4 1 3 9 4 5 1 4

0 2 0 0 0 0 1 0 0 0 1 0 0 0

1 5 0 0 1 0 1 0 0 2 1 3 1 2

15

1

13

3

2

4

1

6

1

0

1

33

4

11

26

0

9

6

3

11

3

1

24 9 2 19 65

4 0 1 1 8

8 3 2 4 18

20 6 1 16 55

0 0 0 0 1

8 1 1 4 10

5 1 0 2 17

3 0 1 1 7

5 6 0 4 29

2 1 0 3 0

1 0 0 5 1

8

0

3

5

0

0

0

7

0

1

0

4 408

1 18

0 0 61 168

4 4

0 9

4

1

1

0

0

28 372 1

2 15 0

0 9 60 159 0 0

1 0 1

0 9 0

3

0

1

2

0

1

0

0

0

2

0

2 2

0 0

2 2

0 0

0 0

0 0

0 0

0 0

0 0

1 1

1 1

2 3 187 239 4

1

23 7 159 228 0 1

0 5 0 3 2 0

0 0 126 35 2

1

9 6 114 28 0 0

0

*Analytic Cases Only 2016 Annual Report and Outcomes

17

CANCER DATA MANAGEMENT & STATISTICS cont.

Class of Case

Sex Primary Site Soft Tissue Soft Tissue (including Heart) Skin excluding Basal & Squamous Melanoma – Skin Other Non-Epithelial Skin Breast Breast Female Genital System Cervix Uteri Corpus & Uterus, NOS Corpus Uteri Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Male Genital System Prostate Testis Penis Urinary System Urinary Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs Eye & Orbit Eye & Orbit Brain & Other Nervous System Brain Cranial Nerves Other Nervous System Endocrine System Thyroid

Status

Stage Distribution*

Total (%)

M

F

Analy NA Alive Exp 0

I

II

III

IV

88 Unk

11 (0.4%) 11 (0.4%)

10 10

1 1

11 11

0 0

5 5

6 6

0 0

5 5

3 3

0 0

1 1

1 1

1 1

223 (7.2%)

144

79

153

70

187

36

16 66

24

24

17

3

3

211 (6.8%) 137 74 12 (0.4%) 7 5 419 (13.6%) 7 412 419 (13.6%) 7 412 214 (6.9%) 0 214 26 (0.8%) 0 26 120 (3.9%) 0 120 118 0 118 2 0 2 35 (1.1%) 0 35 4 (0.1%) 0 4 21 (0.7%) 0 21

144 9 392 392 183 23 116 114 2 28 0 10

67 3 27 27 31 3 4 4 0 7 4 11

180 7 371 371 167 15 98 98 0 26 3 18

31 5 48 48 47 11 22 20 2 9 1 3

16 0 79 79 1 0 0 0 0 0 0 1

65 1 150 150 101 11 80 80 0 6 0 4

23 1 93 93 14 5 4 4 0 3 0 2

23 1 33 33 39 5 17 16 1 12 0 2

14 3 32 32 25 2 13 12 1 7 0 1

0 3 1 1 1 0 0 0 0 0 0 0

3 0 4 4 2 0 2 2 0 0 0 0

8 (0.3%)

0

8

6

2

7

1

0

0

0

3

2

1

0

289 (9.4%) 272 (8.8%) 14 (0.5%) 3 (0.1%) 284 (9.2%) 173 (5.6%) 99 (3.2%) 8 (0.3%) 4 (0.1%) 4 (0.1%) 4 (0.1%)

289 272 14 3 196 138 51 4 3 2 2

0 0 0 0 88 35 48 4 1 2 2

212 195 14 3 259 153 95 8 3 0 0

77 77 0 0 25 20 4 0 1 4 4

259 242 14 3 219 131 77 7 4 1 1

30 30 0 0 65 42 22 1 0 3 3

0 0 0 0 84 74 4 5 1 0 0

53 39 14 0 114 51 61 1 1 0 0

122 120 0 2 22 14 7 1 0 0 0

20 19 0 1 15 4 11 0 0 0 0

17 17 0 0 18 6 11 1 0 0 0

0 0 0 0 1 0 0 0 1 0 0

0 0 0 0 5 4 1 0 0 0 0

124 (4.0%)

43

81

117

7

88

36

0

0

0

0

0

117

0

38 (1.2%)

20

18

36

2

16

22

0

0

0

0

0

36

0

86 (2.8%)

23

63

81

5

72

14

0

0

0

0

0

81

0

171 (5.5%) 148 (4.8%)

42 31

129 117

165 142

6 6

159 140

12 8

0 0

92 92

12 12

18 18

13 13

23 0

7 7

*Analytic Cases Only 18

St. Luke’s Cancer Center

Class of Case

Sex Primary Site Other Endocrine including Thymus Lymphoma Hodgkin Lymphoma Non-Hodgkin Lymphoma NHL - Nodal NHL - Extranodal Myeloma Myeloma Leukemia Lymphocytic Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia Other Myeloid/ Monocytic Leukemia Other Leukemia Other Acute Leukemia Aleukemic, Subleukemic & NOS Mesothelioma Mesothelioma Kaposi Sarcoma Kaposi Sarcoma Miscellaneous Miscellaneous Total

Status

Total (%)

M

F

23 (0.7%)

11

12

23

0

19

4

114 (3.7%) 11 (0.4%) 103 (3.3%) 68 35 53 (1.7%) 53 (1.7%) 66 (2.1%) 29 (0.9%)

64 7 57 41 16 23 23 41 19

50 4 46 27 19 30 30 25 10

100 11 89 60 29 43 43 44 12

14 0 14 8 6 10 10 22 17

89 11 78 52 26 35 35 34 23

4

2

2

4

0

23

15

8

6

2

2

0

34 (1.1%)

21

24

Stage Distribution*

Analy NA Alive Exp 0

I

II

III

IV

88 Unk

0

0

0

0

0

23

0

25 0 25 16 9 18 18 32 6

0 0 0 0 0 0 0 0 0

27 2 25 12 13 0 0 0 0

10 1 9 6 3 0 0 0 0

29 5 24 22 2 0 0 0 0

28 3 25 15 10 0 0 0 0

1 0 1 0 1 43 43 44 12

5 0 5 5 0 0 0 0 0

1

3

0

0

0

0

0

4

0

17

21

2

0

0

0

0

0

6

0

2

0

1

1

0

0

0

0

0

2

0

13

30

4

9

25

0

0

0

0

0

30

0

14

10

23

1

4

20

0

0

0

0

0

23

0

1

0

1

1

0

0

1

0

0

0

0

0

1

0

8

6

2

5

3

4

4

0

0

0

0

0

5

0

1

1

0

1

0

1

0

0

0

0

0

0

1

0

3 (0.1%) 2

1 0

2 2

2 1

1 1

2 1

1 1

0 0

0 0

0 0

0 0

0 0

2 1

0 0

1

1

0

1

0

1

0

0

0

0

0

0

1

0

3 3 0 0 52 52 907

0 0 0 0 0 0 258

0 0 0 0 0 0 839

1 1 0 0 0 0 428

0 0 0 0 0 0 336

1 1 0 0 0 0 459

0 0 1 1 72 72 326

0 0 0 0 0 0 60

3 (0.1%) 0 3 2 1 0 3 (0.1%) 0 3 2 1 0 1 (0.0%) 1 0 1 0 1 1 (0.0%) 1 0 1 0 1 87 (2.8%) 50 37 72 15 35 87 (2.8%) 50 37 72 15 35 3,090 1,453 1,637 2,706 384 2,183

*Analytic Cases Only 2016 Annual Report and Outcomes

19

COUNTY OF RESIDENCE AT DIAGNOSIS FOR CY2015 ANALYTIC CASES 9.68%

7.67%

PA — Northampton PA — Lehigh

5.86%

NJ — Warren

3.95%

23.11%

PA — Monroe

3.53% 7.46%

6.11% 0.91% 0.39%

PA — Bucks PA — Carbon

Other Other PA Counties Other NJ Counties Out of State

PA — Schuylkill

Other NJ Counties 38.74%

Other PA Counties County at Diagnosis PA — Montgomery PA — Berks PA — Luzerne PA — Pike PA — Adams PA — Tioga PA — Wayne PA — Lackawanna PA — Lebanon PA — Lycoming PA — Centre PA — Cumberland PA — Dauphin PA — Sullivan PA — York Total

20

St. Luke’s Cancer Center

Percent 3.01% 1.17% 0.81% 0.49% 0.10% 0.10% 0.10% 0.06% 0.06% 0.06%

Count 93 36 25 15 3 3 3 2 2 2

0.03% 0.03% 0.03% 0.03% 0.03% 6.11%

1 1 1 1 1 189

County at Diagnosis NJ — Hunterdon NJ — Atlantic NJ — Middlesex NJ — Ocean NJ — Union NJ — Burlington NJ — Hudson NJ — Mercer NJ — Salem NJ — Somerset Total

Percent 0.52% 0.06% 0.06% 0.06% 0.06% 0.03% 0.03% 0.03% 0.03% 0.03% 0.91%

Count 16 2 2 2 2 1 1 1 1 1 29

Percent 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.39%

Count 1 1 1 1 1 1 1 1 1 1 1 1 1 13

Out of State County at Diagnosis CT — Hartford FL — Charlotte FL — Orange FL — Palm Beach KS ­— Sedgwick NC — Bladen NY ­­— New York NY ­­— Ontario NY ­­— Suffolk PR — Maunabo TN — Knox VA — Arlington VA — Fairfax Total

CANCER CASES BY YEAR 3,500

2,878

3,000

Number of Cancer Cases by Calendar 2,742 Year 2,625 3,500 3,000

2,625

2,500

348

2,742 378

2,500

348

2,000 2,878

3,000

392 1,500

2,000

1,000

1,500

500 2,277

1,000

2,364

2,486

0

432

378

2011

2012

2013

432

3,090 384

3,090 384

Analytic Cases:

2,277

2,364

2,486

2,568 2011

2,706 2012

2013

2014

2015

500 0

392

3,000

SLUHN 2,706 in the diagnosis 2,568was involved and/or treatment of the patient during their initial diagnosis of cancer.

Non-Analytic Cases: 2014 who were 2015 initially diagnosed Patients and treated elsewhere and came to SLUHN for management of recurrent or persistent disease.

Top 6 Most Prevalent Sites of Cancers Treated (Calendar Year) 600

Breast Volume

500

Lung Volume

400

ColoRectal Volume

300

Prostate Volume

200

Melanoma Volume

100

Thyroid Volume

0

2012

2013

2014

2015

Age at Diagnosis of Cancer Cases by Site (Calendar Year) 160 140 120

Breast Volume

100 80

Lung Volume

60

ColoRectal Volume

40

Prostate Volume

20 0

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

2016 Annual Report and Outcomes

21

CLINICAL PERFORMANCE DATA The ACoS Commission on Cancer provides tools to accredited facilities to help them improve the quality of their patient care. Two of those tools are the Rapid Quality Reporting System (RQRS) and Cancer Program Practice Profile Reports (CP3R).

RQRS provides real-time tracking of treatments recommended by evidence-based standards. RQRS helps facilities evaluate the timeliness of cancer treatment given at their facilities. Participation in RQRS is voluntary and SLUHN chooses to participate because of our commitment to quality patient care.

CP3R accountability and quality measures, endorsed by the National Quality Forum (NQF), are used by facilities to monitor the use of evidence-based guidelines. SLUHN has a higher rate of eligible patients receiving recommended treatments than national benchmarks (rate for all CoC accredited facilities).

The tables below contain the most recent data obtained from the National Cancer Database (NCDB), Cancer Program Practice Profile Reports (CP3R), along with comparative data from the Pennsylvania Health Care Quality Alliance (PHCQA). Data are updated annually.

Breast Cancer Radiation therapy following breast-conserving surgery Radiation therapy is administered within one year of diagnosis for women under age 70 receiving breast-conserving surgery (a lumpectomy instead of a mastectomy).

SLUHN’s compliance with this standard is at 90 percent which is the Commission on Cancer (CoC) benchmark for this measure.

100

90%

95%

93%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Hormone modification therapy for breast cancer Hormone modification therapy is considered or administered within one year of diagnosis for women with AJCC T1c, or stage IB - III hormone receptor positive breast cancer.

100

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 96 percent and the US rate of 92 percent.

40

St. Luke’s Cancer Center

96%

93%

90%

80 60

20 0

22

100%

SLUHN

PA Rate

US Rate CoC Standard

Combination chemotherapy for breast cancer Combination chemotherapy is considered or administered within four months of diagnosis for women under age 70 with AJCC T1c, or Stage IB - III hormone receptor negative breast cancer.

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 95 percent and the US rate of 93 percent.

100%

100

95%

93%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Colon Cancer Adjuvant chemotherapy within four months of surgery Adjuvant chemotherapy is considered or administered within four months of diagnosis for patients under the age of 80 with AJCC Stage III lymph node positive colon cancer.

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 95 percent and the national rate of 89 percent.

100

100%

95%

89%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Number of lymph nodes excised during surgery At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

SLUHN’s compliance with this standard was at 100 percent compared to the PA state rate of 95 percent and the national rate of 89 percent.

100

96%

91%

80

89%

80%

60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

2016 Annual Report and Outcomes

23