2008 Cancer Program Annual Report
Chairman’s Report As Chairman of the St. Tammany Parish Hospital (STPH) and Mary Bird Perkins Cancer Center (MBP) Cancer Committee, I am pleased to present highlights of the 2008 Cancer Program Annual Report. The Cancer Committee of STPH and MBP provides leadership in ensuring the provision of quality patient care through cancer-related activities that benefit not only patients and their families but also our community. As an approved Cancer Program by the American College of Surgeons (ACoS) Commission on Cancer (CoC), our mission is to ensure that residents have access to a full range of medical services, a multidisciplinary approach to patient care and programs that impact survival and quality of life. These programs focus on prevention and early diagnosis, pretreatment evaluation, staging, optimal treatment, rehabilitation, surveillance for recurrent disease, support services and end-of-life care. To learn more about the Commission on Cancer, the benefits of having an approved cancer program near you or to view cancer program standards, visit http://www.facs.org/cancer/publicapproval.html.
Jack Saux, M.D.
The Cancer Committee was active in numerous aspects of cancer control activities provided to patients, caregivers, health professionals and the community.
•• Members expanded the scope of community based screenings in West St.
Tammany and Washington Parishes with over 1,100 participants at screenings for breast, skin, colorectal and prostate cancers;
•• Over 1,200 patients and caregivers attended the educational opportunities
made available, including support groups, genetic risk assessment clinics, stress management, lymphedema prevention and other classes;
•• Cancer Survivors Day was redesigned as a roundtable format allowing
participants to receive more personalized knowledge from one of our many expert speakers.
Over 800 physicians and allied health professionals attended cancer-related professional education programs on a variety of topics.
•• Enhancing end of life care was a priority with over 50 allied health professionals completing programs held in 2007. In addition, three staff members obtained ELNEC (End-of-Life Nursing Education Consortium) certification.
Clinical care was also a focus.
•• The opening of the 7-bay STPH Outpatient Infusion Suite Center specifically for chemotherapy, blood and supportive therapy procedures;
•• Diagnostic and treatment tools were improved at both facilities; •• Surgical precision was enhanced with the acquisition of the DaVinci Surgical
Robotic System that allows minimally invasive surgeries for appropriate patients; and
•• The Committee worked proactively with hematology oncology physicians to
develop standardized chemotherapy order sets for hospital administration of commonly used cancer treatment protocols. The goals were to improve patient safety, eliminate potential medication errors and promote evidence based care.
Numerous other quality improvement initiatives were completed, including a study evaluating the management and outcomes of patients with Non-Hodgkin’s lymphoma. The results of this study are included in this report.
Jack E. Saux III, M.D. Cancer Committee Chair
2008 MBP/STPH Cancer Program Annual Report
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Our mission: To provide the highest quality cancer care and to meet the needs of the community with education seminars, support groups and health screenings.
2007 Cancer Committee Jack Saux, M.D. Hematology/Oncology Cancer Committee Chairman Greg Henkelmann, M.D. Radiation Oncology Cancer Liaison Physician Tumor Conference Coordinator Donna Berbling, RN, BSN Director of Hospice, STPH Debbie B. Fascio RT (R) (M) Assistant Department Head Imaging Services, STPH Robert Capitelli, M.D. Sr. Vice President, Chief Medical Officer, STPH Chryl Corizzo, RN, BSN, OCN Cancer Program Director, STPH Quality Improvement Coordinator, STPH Renea Duffin, MPA Executive Director, CARE Network, MBP Community Outreach Coordinator, MBP
Darlene Melancon, RN Certified Breast Health Navigator Breast Center, STPH Debra Miller, RN, OCN Cancer Resource Nurse, STPH Community Outreach Coordinator, STPH David Oubre, M.D. Hematology Oncology Ty Ovella, M.D. Radiology Teresa Palombo, RN, BSN, ET Department Head Medical Oncology Unit, STPH Juanita Schenck, LCSW Case Management, STPH Mary Clare Spansel Health Initiatives Representative, ACS
Terry Freeman, CTR Cancer Data Specialist, MBP
Susan Stahl Tumor Registrar, STPH
Vickie Hall, LPN, RT (T) Director, MBP Covington
Teena Strand-Parker, RN Department Head Ambulatory Care, Pre-op, Infusion Suite, STPH
Judy Limbaugh, M.D. Pathology CAPS Protocols Coordinator, STPH Nicole Magee, CTR Cancer Registry Director, MBP Registry Quality Control Coordinator, MBP Patricia Maltese, RT, MHA Department Head, Imaging Services, STPH Susan May, RN, BS Department Head Case Management, STPH
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Kathy McWhorter, RN, MSN Director of Nursing, STPH
2008 MBP/STPH Cancer Program Annual Report
Brenda Truxillo, RN, LRT (T) Vice President, Radiation Oncology Services, MBP Quality Improvement Coordinator, MBP John Verhulst, M.D. General Surgery Registry Quality Control Coordinator, STPH Beverly Villemuer, CTR Certified Tumor Registrar, STPH Jo Watkins, RPh Clinical Pharmacy Coordinator, STPH
Cancer Liaison Physician’s Report The Cancer Liaison Physician Program was established in 1963 by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). As an ACoS multidisciplinary program, the CoC is committed to decreasing morbidity and mortality from cancer through education, setting standards and monitoring of quality of care. Cancer Liaison Physicians (CLP) serve as links between the CoC and the hospitals they represent, manage clinically-related cancer activities within their local institutions and partner with local community agencies, such as the American Cancer Society (ACS), to accomplish community outreach goals regarding education, early detection and prevention of cancer. As the CLP, I have been involved in implementing quality initiatives, encouraging the use of NCDB data as an institutional benchmark, promoting our staff’s compliance with CoC treatment guidelines, accurate staging, quality control of registry data and patient’s enrollment in clinical trials — all of which contribute to our CoC survey preparation.
Gregory C. Henkelmann, M.D.
During 2007-2008, the CoC defined five priority areas for CLP activity that include advocacy, quality improvement, ACS partnership, clinical trials and comprehensive cancer control. The CoC recommended implementation of one or more objectives or activities from any area that would result in a positive change within our cancer program. This year, we have worked diligently to follow the commission’s directive in several areas: 1. We are pleased to welcome ACS representatives to our quarterly cancer committee meetings. Their participation has resulted in a more coordinated, community-wide effort to provide education, treatment and support services to the community. In addition, the committee has increased its involvement in ACS in community outreach activities, its referral of patients to ACS services and its participation in the annual Relay for Life fundraiser. 2. We have held several training sessions to help medical professionals maximize their use of the National Cancer Data Base’s (NCDB) e-QuIP, data which evaluates and benchmarks the management of patients treated for breast and colorectal cancers at the local level. Information gleaned from national data inspired the cancer committee to begin a discussion of Stage III colon cancer and adjuvant chemotherapy and to develop an action plan to better address node sampling in Stage II and III patients. 3. We have increased the enrollment of patients in clinical trials. I continue to look forward to working with local and national organizations to facilitate communication and collaboration in the years ahead.
Sincerely,
Gregory C. Henkelmann, M.D.
2008 MBP/STPH Cancer Program Annual Report
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Together, Mary Bird Perkins Cancer Center and St. Tammany Parish Hospital coordinate the entire continuum of cancer care. Our comprehensive cancer program has been accredited with commendation since 2003 by the American College of Surgeons -- the gold standard for outstanding cancer programs. Approval is given only to those facilities that have voluntarily committed to provide the highest level of quality cancer care and undergo a rigorous evaluation process. The comprehensive cancer program is the only approved cancer program in West St. Tammany Parish. The cancer program of Mary Bird Perkins and St. Tammany Parish Hospital offers patients the most advanced comprehensive cancer program in the region with a steadfast dedication to finding cancer and fighting it with our extensive resources and unique clinical expertise. Mary Bird Perkins has been solely dedicated to fighting cancer for over 35 years, serving 18 parishes in Southeast Louisiana. Mary Bird Perkins has a variety of the best of class radiation therapy options. This means we can treat the most simple cancer cases to the most complex cases – without accepting the limitations of a one size fits all solution. Unique to MBP is its nationally-competitive medical physics program with Louisiana State
Mary Bird Perkins Cancer Center
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2008 MBP/STPH Cancer Program Annual Report
University, one of only 14 accredited graduate level programs in the country. MBP is home to the largest and most experienced medical physics team in Louisiana, including eleven medical physicists and nine dosimetrists. Residents choose STPH, the leading provider of comprehensive medical care on the Northshore, more than any other health care resource. As the only approved community hospital cancer program in West St. Tammany Parish accredited by the American College of Surgeons, STPH delivers to patients on the Northshore the highest quality care available. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, the STPH system delivers the very latest technology, the most accomplished specialists and highly personalized, caring staff to ensure patients and their families receive world-class health care close to home. The comprehensive cancer program of Mary Bird Perkins and St. Tammany Parish Hospital provides free cancer screenings throughout the year including prostate, breast, skin and colorectal cancer screenings. These events provide diagnostic and educational services to underserved and uninsured populations on the Northshore. In 2007 over 1,100 community residents were screened for breast, colorectal, prostate or skin cancer. In addition, smoking cessation programs are offered to assist those looking to quit.
Stph Is Excited to Announce a New Program to Assist in Cancer Recovery
STPH and MBP were proud to sponsor the 8th annual Cancer Survivor Day (CSD) Celebration. This year’s breakfast and educational event was entitled “Living Through and After a Cancer Diagnosis: A Celebration of Life.” CSD is celebrated in June in communities all over the country with the specific purpose of acknowledging the over 12 million cancer survivors, their caregivers and the health professionals who care for and support them through treatment. This year’s program offered a unique opportunity to sit in roundtable groups, discuss specific topics with speakers knowledgeable in their area of practice and ask questions in a small group setting. Many topics were suggested by cancer survivors and include items such as nutrition and weight management, exercise as part of cancer treatment, dealing with the long term effects of cancer treatment, pain and symptom control, and coping with the fear of cancer recurrence. Over 120 attendees were present at this very successful program. Much appreciation goes to additional program sponsors: Holiday Inn Hotel, Leonard C. Thomas HOS Foundation, Ponchartrain Hematology Oncology and The Louisiana Breast Cancer Task Force.
Exercise can have a profound effect on your ability to tolerate treatments and to recover from the physical and emotional effects of treatment. Fatigue, changes in sleep patterns, pain and anxiety are but a few of the symptoms that individuals with cancer face during and post cancer treatment, as are concerns over how to protect against cancer recurrence. St. Tammany Parish Hospital is proud to partner with the West St. Tammany YMCA to offer an evidence-based exercise and wellness program exclusively for individuals close to completing cancer treatment or in cancer recovery. This nationally recognized eight week program (twice a week) incorporates personalized activity in a supervised environment based on individual capabilities. Health and wellness topics of importance to cancer survivors are also included in each session. CancerFit® evaluation and treatment does require a physician order. Learn more about this new program proven to reduce the side effects of cancer & treatment while building strength, energy and endurance. Call 898-4581 or email ccorizzo@stph.org for more details.
St. Tammany Parish Hospital 2008 MBP/STPH Cancer Program Annual Report
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Integrated Supportive and Continuing Care Services Diagnostic Services Pathology Laboratory
•
Radiology
•
CT Scanner, Ultrasound, Nuclear Medicine, MRI
•
Breast Center Mammography, bone density, stereotactic needle biopsy
•
Ultrasound, Dedicated Radiologists; specialty in breast disease
•
Treatment Services Inpatient Medical Oncology Unit/Outpatient Infusion Suite
•
Radiation Therapy
•
External Beam Radiotherapy
•
Intensity Modulated Radiation Therapy (IMRT)
•
Radiation Treatment Planning
•
Image Fusion
•
Medical Physics/Dosimetry
•
Surgery/DaVinci Robotic Surgical System
•
Supportive/Rehabilitative Services Cardiac/Pulmonary Rehabilitation
•
Enterostomal/Wound Therapy
•
Home Health/Hospice
•
Nutritional Services
•
Pastoral Care/Clergy Community Support
•
Physical/Occupational/Speech Therapy
•
Certified Lymphedema Therapy
•
Social Services/Case Management
•
•
Cancer Screenings
•
•
Cancer Resource Center
•
•
Community Outreach and Education
Education for Health Professionals Continuing Medical Education
•
Continuing Nursing/Allied Health Education
•
Multidisciplinary Tumor Conferences
•
Elder Services
•
Genetic Cancer Risk Assessment & Counseling Program
•
Lymphedema Prevention Clinics & Seminars
• • • •
Patient Library (www.librarything.com/catalog/stphcrc)
•
Pain Management
•
•
Speakers Bureau
•
•
Research Clinical Research
•
Cancer Registry
•
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2008 MBP/STPH Cancer Program Annual Report
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A Brief Discussion of Non-Hodgkin’s Lymphoma Overview: In 2008, an estimated 66,120 Americans will be diagnosed with non-Hodgkin’s lymphoma, (NHL) and 19,160 patients will die from this malignancy of the immune system. David Oubre, M.D. NHL is the 5th leading site of new cancer cases in men and women each year. NHL represents a heterogeneous group of lymphoproliferative malignancies originating from lymphocytes that have differing patterns of behavior and responses to treatment. B cell lymphomas compromise about 80-85% and T-cell lymphomas 15-20% of all NHL cases. NHL and Hodgkin’s Disease usually originate in lymphoid tissues and can spread to the liver, lungs, bone and bone marrow or other organs. NHL is much less predictable than Hodgkin’s Disease and has a far greater tendency to disseminate to extranodal sites. The prognosis depends on the histologic type, stage and treatment. NHL is classified into indolent (or low grade) and aggressive prognostic groups (Table 1). The most common aggressive type is diffuse large B-cell lymphoma, marked by rapidly growing tumors in the lymph nodes, spleen, liver, bone marrow or other organs. By contrast, many of the indolent tumors are follicular, characterized by cells that slowly grow to form nodules, or follicles. Most aggressive and highly aggressive lymphomas respond well to chemotherapy, and many are curable.
Table 1: Common Subtypes of Lymphoma Based on Growth Patterns Slow-growing (indolent)
There are many risk factors that contribute to the development of NHL. Infectious causes include Human Immunodeficiency Virus, Epstein-Barr virus, Helicobacter pylori, human T-cell leukemia/lymphoma virus type 1 and Hepatitis C or any virus that compromises the immune system. A weakened immune system, from a genetic condition or organ transplant anti-rejection medicines, can also be a risk factor for NHL. Although NHL can occur in young people, it is more prevalent in those ages 60 and older, and the chance of developing this disease increases with age. Researchers are investigating whether obesity, exposure to herbicides, hair dyes manufactured before 1980 or certain other chemicals may increase the risk of this disease. Initial symptoms of NHL are dependent on where it develops on the body. Common symptoms include swollen, painless lymph nodes in the neck, armpits or groin; persistent weakness or fatigue; coughing, trouble breathing or chest pain; pain, swelling or a feeling of fullness in the abdomen. In addition to symptoms caused by the local effects of cancer, NHL can produce vague “B” symptoms (Table 2) which can sometimes be associated with a worse outlook. The definitive diagnostic tests require a physical exam, blood count and chest x-ray, and an excisional or incisional lymph node biopsy. A fine needle aspiration usually cannot remove an adequate enough specimen. Because of the many NHL subtypes, immunophenotypic analysis (flow cytometry, immunohistochemistry) is critical in determining the proper diagnosis and choice of treatment. Identification of specific chromosomal translocations is essential in some subtypes and requires additional molecular cytogenetic analysis. Other tests needed in staging include bone marrow biopsy, CT scan, MRI, ultrasound, spinal tap or PET scan to determine the extent of the cancer.
• Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma • Follicular Lymphoma • MALT Lymphoma • Splenic Marginal Zone Lymphoma • Nodal Marginal Zone Lymphoma • Mycosis Fungoides (cutaneous T cell lymphoma)
Aggressive
• Diffuse Large B-Cell Lymphoma • Mantle Cell Lymphoma *
Highly Aggressive
• Burkitt’s Lymphoma • Lymphoblastic Lymphoma • AIDS-Related Lymphoma • Peripheral T-cell Lymphoma
* Although mantle cell lymphoma is not very fast growing, it responds poorly to standard treatment.
• Sezary Syndrome (cutaneous T cell lymphoma)
Reference: NCCN Non-Hodgkin’s Clinical Practice Guidelines, NHL, version 3.2008
2008 MBP/STPH Cancer Program Annual Report
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Staging of NHL Staging is a process to determine the extent of cancer spread and is useful in helping to determine appropriate treatment and prognosis. The staging system most often used to describe the spread of NHL in adults is called the Ann Arbor Staging System (Table 2). The addition of “B” is added to denote the presence of B symptoms.
Table 2: The Ann Arbor Staging System Stage
Description
Standard Treatment by Stage
I
NHL is in a single lymph node group, such as the neck, groin or underarm.
Radiation and/or chemotherapy and/or immunotherapy
II
NHL is in multiple lymph nodes group on the same side of diaphragm.
III
NHL is in multiple lymph node groups on both sides of the diaphragm.
IV
NHL is wide-spread in an organ or organs, skin or bone marrow.
A/B symptoms
Radiation to treat modes causing symptoms, chemotherapy, immunotherapy. Consider clinical trial
B symptoms: weight loss >10%, fever, drenching night sweats
Reference: NCCN Non-Hodgkin’s Clinical Practice Guidelines, NHL, version 3.2008
In recent years much progress has been made in the treatment of NHL. Treatment options are dependent on the type of lymphoma, its stage (Table 2) and the International Prognostic Index (IPI). The IPI (Table 3) consists of five factors that assist in predicting patient outcome in aggressive NHL. No two patients are treated exactly alike, and standard treatment options are tailored to a patient’s unique situation.
Table 3: International Prognostic Index Table Prognostic Factor
Favorable Value
Unfavorable Value
Age
Below 60
Above 60
Stage
I and II
III or IV
Extranodal cancer
Absence of NHL outside of lymph nodes
Presence of NHL outside of lymph nodes
Performance status
Able to function normally
Needing a lot of help with daily activities
Serum LDH
Lab value is normal
Lab value is elevated
Referen
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ce: NCCN Non-Hodgkin’s Clinical Practice Guidelines, NHL, version 3.2008
2008 MBP/STPH Cancer Program Annual Report
Types of Treatment Surgery is often used to obtain tissue samples for diagnosis, but because NHL is considered a systemic disease, it is rarely used as treatment. Exceptions would be if the NHL were isolated to an organ outside the lymphatic system. External beam radiation is often a primary treatment for early stage NHL (I or II) but is more often combined with chemotherapy or to relieve symptoms caused by NHL. Chemotherapy is usually the primary treatment in advanced NHL. Rituximab, a monoclonal antibody against B lymphocytes, has substantially improved the effectiveness of chemotherapy. There is much research on the use of immunotherapy, natural substances used by the immune system to fight the cancer. When these options fail, stem cell transplant or clinical trials may be a consideration for patients with aggressive NHL cancer. Asymptomatic patients with indolent forms of advanced NHL may defer treatment until the disease causes symptoms. When treatment is deferred, the clinical course varies. Careful observation is essential, so intervention can be initiated immediately as the disease process accelerates. Many patients have a prolonged indolent course. Others have a rapid progression of the disease that evolves into more aggressive NHL and requires immediate treatment. Radiation techniques differ somewhat from those used in the treatment of Hodgkin’s Disease. The dose of radiation therapy usually varies from 25 Gy to 50 Gy and is dependent on the type and stage of NHL, overall condition of the patient and goal of therapy (curative or palliative). The associated morbidity of the treatment must be considered as well. The majority of patients who receive radiation are usually treated on only one side of the diaphragm. Localized presentations of extranodal NHL are often treated with involved-field techniques with significant (>50 percent) success. Long Term Survival Patients with indolent NHL have a relatively good prognosis with a median survival of up to ten years with early stage disease. While these patients are not curable in advanced clinical stages, patients with Stage I and II indolent NHL may be treated successfully with radiation therapy alone. Aggressive NHL has a shorter natural history. Remarkably, many patients with aggressive disease — 30 to 80 percent — can be cured with an intensive combination chemotherapy regimen. In fact, with the treatments now available, overall survival at five years is approximately 50 to 60 percent for aggressive NHL.
In aggressive NHL, the overwhelming majority of relapses occur in the first two years after therapy. While indolent NHL is responsive to radiation therapy and chemotherapy, a continuous rate of recurrence is typical in advanced stages. Patients who experience a recurrence and maintain a low-grade histology can often be effectively retreated. Patients who present with or convert to aggressive forms of NHL may sustain complete remissions with combination chemotherapy regimens or aggressive consolidation with marrow or stem cell support. The STPH/MBP Experience: The STPH/MBP Cancer Committee compared patterns of treatment and outcomes (survival) of NHL patients diagnosed and/or treated at STPH and MBP with current information listed in the National Cancer Data Base (NCDB) Benchmark Report. The NCDB is a joint program of the Commission on Cancer (CoC) and the American Cancer Society and is a nationwide oncology outcomes database for more than 1,400 COC Approved Cancer Programs in the United States and Puerto Rico. Some 75% of all newly diagnosed cases of cancer in the United States are captured at the institutional level and reported to the NCDB annually. Submission is required to maintain cancer program approval status. The NCDB, begun in 1989, now contains approximately 20 million records from hospital cancer registries across the United States. These data are used to explore trends in cancer care, create regional and state benchmarks for participating hospitals, and to serve as the basis for quality improvement at the institutional level. An overview (Table 4) is presented of patients diagnosed and/or treated at STPH during the years 2000-2004 and cases specifically diagnosed and treated at STPH/MBP during the years 1998-2005. The data does not demonstrate significant variations in the demographic data of patients seen locally. Minor variances are seen in the histologic type of NHL diagnosed, specifically a higher percentage of large cell, diffuse NHL cases. Patients diagnosed at STPH or STPH/MBP tended to be diagnosed with an earlier stage of NHL (NCDB 39% vs. STPH 49% vs. STPH/MBP 50%) and there were fewer patients with an unknown stage.
2008 MBP/STPH Cancer Program Annual Report
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Table 4. Non-Hodgkin’s Lymphoma Statistical Overview/Comparison NCDB/STPH (2000-2004) Benchmark Comparison Report with Patients Treated Only at STPH/MBP (1999-2005)*
GENDER
AGE AT DIAGNOSIS
RACE
INSURANCE
HISTOLOGY
AJCC MIXED STAGE
TREATMENT
SURGERY TYPE
RADIATION THERAPY
SYSTEMIC THERAPY
NCDB (%) 2000-2004 data n=175,646
STPH (%) 2000-2004 data n=81
STPH/MBP (%) 1998-2005 data n=135
Male
53.14
48.15
51.2
Female
46.86
51.85
48.8
16-29
2.6
#
3.0
30-39
5.0
3.7
3.7
40-49
10.5
7.4
8.1
50-59
16.8
14.8
17.0
60-69
20.7
21.0
18.5
70-79
25.5
23.5
28.9
80-89
16.6
29.6
20.0
90+
1.6
#
0.7
White
83.2
93.8
96.3
Black
7.3
3.7
3.7
Hispanic
4.9
2.5
#
Private Insurance
15.6
6.2
4.0
Managed Care
23.5
28.4
28.1
Medicaid
4.5
4.9
2.9
Medicare
13.2
4.9
4.4
Medicare w/ Supplement
32.2
46.9
55.6
Not Insured
3.2
1.2
1.0
Insurance Status Unknown
5.1
7.4
4.0
Malignant Lymphoma, NOS
6.7
4.9
6.9
Malignant Lymphoma, Non-Hodgkin’s, NOS
8.4
1.2
2.3
Small Lymphocytic Malignant Lymphoma, NOS Lymphocytic, Intermediate Differentiation, Diffuse Malignant NHL Large Cell, Diffuse Malignant Lymphoma, NOS
6.3
8.6
7.6
3.7
6.2
6.9
36.3
40.7
43.5
Mixed Small Cleaved and Large Cell, Follicular Lymphoma
4.2
3.7
6.1
Small Cleaved Cell, Follicular Lymphoma
5.4
6.2
6.1
Large Cell, Follicular Malignant Lymphoma, NOS
3.1
6.2
6.1
Monocytoid B-Cell Lymphoma
6.2
7.4
6.9
Other Specified Types
12.8
14.8
7.6
I
25.4
25.9
27.4
II
13.9
23.5
23.0
III
12.6
21.0
21.5
IV
27.4
25.9
25.9
Unknown
20.8
3.7
2.2
Surgery Only
9.8
9.9
9.6
Radiation Only
5.1
1.2
2.2
Surgery/Chemotherapy
5.9
4.9
11.1
Radiation/Chemotherapy
4.7
8.6
12.6
Surgery/Radiation/Chemotherapy
19.5
35.8
10.4
Chemotherapy/Hormone Therapy
6.9
3.7
6.7
Other Specified Therapy
20.7
9.9
26.7
No First Course Treatment
18.9
25.9
20.7
No Surgery of Primary Site
70.6
79.0
68.9
Surgery, NOS
28.4
21.0
31.1
No Radiation
79.1
85.2
74.8
Beam Radiation
20.6
12.4
24.2
Radioisotopes
0.1
1.2
#
Radiation Therapy, NOS
0.3
1.2
1.0
No Systemic Therapy
37.2
40.7
38.4
Chemotherapy Alone
32.1
51.9
47.9
Immunotherapy Alone
2.5
2.5
1.4
Chemotherapy/Hormone Therapy
12.2
3.7
10.9
Chemotherapy/Immunotherapy
5.7
1.2
1.4
* may not equal 100% due to rounding errors; ony comparable NCDB data displayed # No comparison data NOS = Not Otherwise Specified
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2008 MBP/STPH Cancer Program Annual Report
Patients treated at STPH and MBP had no significant variances in treatment compared with NCDB, though a trend toward more combination treatment with chemotherapy with or without radiation treatment was noted in the STPH/MBP data. Valid comparisons in survival are difficult to make because of sample sizes, but appear to be comparable to the NCDB data.
Table 5: Observed Survival Rate Comparisons (%) for Non-Hodgkin’s Lymphoma Cancer Cases Between NCDB, STPH and Those Treated Only at STPH/MBP*
AJCC Stage Overall Survival
NCDB (%) 1996-2000 n=139,608
STPH (%) 1996-2000 n=49
STPH/MBP (%) 1998-2005 n=30
45
40
54
AJCC: American Joint Commission on Cancer * Low volume of STPH/MBP did not allow for stratification of rates by stage, only overall survival
Discussion: Because immunostaining techniques are so valuable in the proper diagnosis of NHL, the Cancer Committee worked with the pathology department to obtain immunostaining equipment within the STPH Laboratory. Because testing can now be done at STPH, time to a NHL diagnosis has improved significantly, allowing physicians to complete diagnostic work-up and initiate appropriate treatment more quickly. There are many advances in both the diagnosis and treatment of NHL. The Cancer Committee saw a need to educate health care professionals, patients and interested members of our community about current trends in NHL incidence, management and survival. The result was a well attended community and professional program cosponsored with the Leukemia and Lymphoma Society.
Most recently, committee members have worked collaboratively with the Leukemia and Lymphoma Society as well as the International Myeloma Foundation to facilitate the formation of the Northshore Blood Cancer Support Group. This group will meet the needs of patients/support persons with a diagnosis of NHL and other blood cancers such as multiple myeloma, leukemia and myelodysplastic syndrome. For more information on this or other support groups, contact the STPH Cancer Resource Center at 898.4581. Copies of the NCCN Clinical Practice Guidelines for physicians or patient guidelines for treatment are also available by calling the Resource Center or by visiting www.nccn.org. Additional resources include the American Cancer Society (1-800-ACS-2345 or www.cancer.org) and the Leukemia and Lymphoma Society (1-800-955-4572 or www.leukemia-lymphoma.org).
– David Oubre, M.D., Hematology Oncology
2008 MBP/STPH Cancer Program Annual Report
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MBP Cancer Registry Summary
ACS Estimated Top 5 Sites 2007 Compared with MBP Covington cases accessioned in 2007
The Cancer Registry is an integral component of the Commission on Cancer approved program and plays a vital role in the success of the program. The Registry collects and analyzes demographic, diagnostic, treatment and staging data on cancer patients treated at Mary Bird Perkins (MBP) in Covington.
% TOP MALE CANCER SITES-2007 40
37
35 30
29 ACS MBP
25 20 15
15
16
10
10
8
7
5
3
4
3
0 Prostate
Lung & Bronchus
Colon & Rectum
Urinary/Bladder
NHL
% TOP FEMALE CANCER SITES-2007
50 45
45 40
Of the 289 newly accessioned cases in 2007, 231 were analytic and 58 were non-analytic*. The top five sites treated were breast, prostate, lung, colorectal and cervix.
ACS MBP
35 30 26 25 19
20 15
15
11 10
8
8 6
5 0
Breast
The MBP Cancer Registry reference date is 1998, and it contains data on 2,190 cancer cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry. High importance is placed on data quality using these guidelines, and a sample of the cases is reviewed by a radiation oncologist for quality assurance. Once part of the registry database, these cases are followed for the life of the patient. The MBP Cancer Registry maintains a follow-up rate averaging 95 percent, exceeding the ACoS minimum standard of 90 percent.
Lung & Bronchus Colon & Rectum
Uterine Corpus
4
NHL
3
The Registry maintains cancer data that is available for use by clinical and administrative staff at MBP. All information collected is kept confidential in accordance with HIPAA regulations. During 2007, the registry received requests for statistical reports including analytic studies, annual statistics, research activities and quality management studies. The registry participated in the National Cancer Data Base (NCDB) Annual Call for Data and the Breast e-QuIP study. In addition, the registry participated in the Facility Information Profile System (FIPS) initiative on the American Cancer Society’s Web site www.cancer.org. *Analytic cases are those diagnosed and/or receiving all or part of the first course of therapy at MBP.
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2008 MBP/STPH Cancer Program Annual Report
MBP 2007 DISTRIBUTION SITE TABLE SITE
TOTAL
GROUP
CASES
A
N/A
M
F
0
I
II
III
IV
NA
UNK
289 2 2 5 69 31 2 4 8 1 14 2 2 2 19 11 4 2 1 1 13 4 9 58 55 3 13 1 2 5 5 58 9 44 5 4 3 1 4 4 7 3 4
394 1 1 5 55 28 2 3 6 1 14 2 0 0 15 10 3 0 1 1 11 4 7 43 40 3 11 1 2 4 4 49 8 37 4 1 0 1 3 4 5 3 2
58 1 1 0 14 3 0 1 2 0 0 0 2 2 4 1 1 2 0 0 2 0 2 15 15 0 2 0 0 1 1 9 1 7 1 3 3 0 1 0 2 0 2
135 0 0 3 0 18 0 1 7 0 8 2 0 0 0 0 0 0 0 0 6 2 4 58 55 3 11 1 1 4 5 26 5 19 2 3 2 1 1 3 6 3 3
154 2 2 2 69 13 2 3 1 1 6 0 2 2 19 11 4 2 1 1 7 2 5 0 0 0 2 0 1 1 0 32 4 25 3 1 1 0 3 1 1 0 1
10 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 1 0 0 0 0 0 0 0 0 0
93 0 0 0 23 1 0 0 0 0 1 0 0 0 4 3 1 0 0 0 5 1 4 12 9 3 1 0 1 0 0 10 1 9 0 1 0 1 2 0 0 0 0
115 0 0 0 15 13 1 2 2 1 6 1 0 0 3 3 0 0 0 0 5 2 3 23 23 0 2 1 0 0 1 3 1 2 0 0 0 0 0 0 1 1 0
79 0 0 0 7 8 0 1 2 0 5 0 0 0 5 3 1 0 0 1 0 0 0 2 2 0 4 0 0 2 2 17 2 13 2 0 0 0 0 0 0 0 0
73 0 0 0 3 4 1 0 1 0 1 1 0 0 2 1 0 0 1 0 1 1 0 6 6 0 3 0 0 2 1 15 3 10 2 0 0 0 0 0 4 2 2
17 1 1 5 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 0 1 4 0 0 0
7 0 0 0 1 2 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0
ALL SITES BLOOD/BONE MARROW
Myeloma BRAIN BREAST DIGESTIVE SYSTEM
Anus, Anal Canal, Anorectum Colon Esophagus Pancreas Rectum & Rectosigmoid Stomach ENDOCRINE
Thyroid FEMALE GENITAL
Cervix Uteri Corpus Uteri Ovary Vagina Vulva LYMPHATIC SYSTEM
Hodgkin’s Disease Non-Hodgkin’s Lymphoma** MALE GENITAL
Prostate Testis ORAL CAVITY/PHARYNX
Hypopharynx Nasal Cavity, Sinus, Ear
Tongue Tonsil RESPIRATORY/INTRATHORACIC
Larynx Lung/Bronchus, Non-Small Cell Lung/Bronchus, Small Cell SKIN
Melanoma of Skin Other Skin Cancer SOFT TISSUE UNKNOWN OR ILL-DEFINED URINARY TRACT
Bladder Kidney & Renal Pelvis
CLASS
Note: AJCC Stage-Analytic Cases only *Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.
Sex
AJCC STAGE AT DIAGNOSIS*
Abbreviations: M=Male; F=Female; A=Analytical; N/A=NonAnalytical; Unk=Unknown; NA=Not Applicable; AJCC=American Joint Commission on Cancer
2008 MBP/STPH Cancer Program Annual Report
13
STPH Cancer Registry Summary “Whether you live in a large city, a small town, or a rural community, quality cancer care can be found…close to home…for you and your loved ones. The Commission on Cancer offers the only national accreditation program for hospitals, freestanding treatment facilities, and health care network cancer programs in the US and Puerto Rico.”1 The St. Tammany Parish Hospital (STPH) Cancer Registry is an integral part of the Commission on Cancer Approved Cancer Program and functions under the Cancer Committee to collect data on cancer type, stage, and treatment results, and offers lifelong patient follow-up. These cases are reported, as required and per HIPAA standards, to the American College of Surgeons, (ACoS), the Louisiana Cancer Registry (LTR), the National Cancer Data Base (NCDB) and the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute. When combined with other cancer cases nationally, researchers are able to identify trends in cancer incidence and mortality, as well as patterns in diagnosis, treatment, and survival. The Registry recommends the American College of Surgeons, National Cancer Database, website for “Public Access to Cancer Data” at http://www.facs. org/cancer/ncdb/publicaccess.html to view local, state, and national comparisons of cancer registry data. In 2007 the Registry abstracted 636 new cancer cases (487 analytical/149 non-analytical). The 2007 analytical cases (38% male and 62% female) had a median age of 66 years (same for males and females). The majority of patients (82%) were diagnosed with local or regional disease and 91% were diagnosed and treated or treated only at % TOP MALE CANCER SITES-2007 % TOP MALE CANCER SITES-2007 35 our facility (class 1 and 2) demonstrating confidence in 35 30 29 29 the ability to access quality cancer care close to home. 30 ACS* 25 20
ACS* STPH STPH
25 20
15
15
10
10
10 10
18 18 15 15
12 12 10 10
7
10 10 7
46
6
Since our reference date of January 1993, 5,342 total cases have been entered into the Registry with 2,311 requiring follow-up. The current follow-up rates are within the ACoS follow-up benchmark.
Overall, breast cancer continues to be the major site diagnosed and treated at STPH. A trend also reflected in comparisons with expected Prostate Lung Lung Colorectal Colorectal BladderLymphoma Lymphoma Prostate Bladder 2007 (ACS) national trends2 for females; lung, colorectal, kidney and lymphoma were consistent with national estimates. Prostate cancer continues to rank highest nationally in men, but is seldom diagnosed % TOP FEMALE CANCER SITES-2007 % TOP FEMALE CANCER SITES-2007 in the hospital setting. Other common cancers in males are lung, 40 39 39 colorectal, bladder and lymphoma. Survival rates shown for these 35 30 major sites compare to the National Cancer Data Base3 and also the 26 26 ACS* 25 ACS* American Cancer Society’s2 survival rates. With the exception of STPH 20 STPH lung cancer, survival rates for both males and females are similar. 15 15 13 15 5
5
4
0
0
40 35 30 25 20 15
13
11 11 9 9
The Cancer Registry participated in performance improvement activities and served as a valuable data resource providing reports 0 0 on selected information to physicians at monthly tumor conferences, Breast Lung Colorectal Kidney Lymphoma Breast Lung Colorectal Kidney Lymphoma hospital-wide departments, and even outside sources. The Registry also has added to the software an electronic case-finding program to SURVIVAL RATES COMPARISON OF STPH MAJOR CANCER SITES TO: SURVIVAL RATES COMPARISON OF STPH MAJOR CANCER SITES TO: facilitate in its operations. Full-time Staff National Cancer Data Base (NCDB)-All Community Hospital Cancer Programs-1998-1999 National Cancer Data Base (NCDB)-All Community Hospital Cancer Programs-1998-1999 remains active members and also has American Cancer Society (ACS)-Nationwide Facilities-1996-2002 American Cancer Society (ACS)-Nationwide Facilities-1996-2002 been elected to serve as officers of the 100 100 100 100 Louisiana Cancer Registry Association. 10
10
5
5
3
89 90 89 90
79 80 79 80
34
4
4
44
4
NCDB* NCDB* STPH STPH ACS** ACS**
65 66 65 66 54 54 49 49
71 71 66 66 60 60
80 80 77 77
82 82 80 80
57 57 57 57
52 52
Beverly F. Villemuer, C.T.R., Cancer Registrar, St. Tammany Parish Hospital President, Louisiana Cancer Registry Association: 2008-2009 Excerpts from the American College of Surgeons CoC-Approved Cancer Programs July 28, 2008 ad in “U.S. News & World Report;” “America’s Best Hospitals, Exclusive Ranking.” 1
from the American Cancer Society, Cancer Facts & Figures, 2007 2
from the American College Of SurgeonsCOC data links website.www.facs.org. 3
16 16 13 13 10 10 6 6
14
Breast Breast
Lung Lung
Colon Colon
Rectum Rectum
Prostate Prostate
2008 MBP/STPH Cancer Program Annual Report
Bladder Bladder
STPH 2007 DISTRIBUTION SITE TABLE SITE
TOTAL
GROUP ALL SITES
CASES 636
A 487
N/A 149
M 255
F 381
0 71
I 120
II 71
III 82
IV 72
39 15 16 8 4 151 128 1 1 58 8 4 9 5 12 17 2 11 11 46 6 9 10 11 2 5 3 36 4 32 29 3 24 2 6 1 1 1 1 1 1 4 89 4 74 11 25 21 4 1 8 59 24 33 1 1
30 12 14 4 4 122 97 0 1 45 3 3 7 4 9 15 2 8 10 35 5 9 7 6 1 4 3 23 3 20 21 2 17 2 1 0 0 1 0 0 0 3 70 2 58 10 14 14 0 1 7 49 20 27 1 1
9 3 2 4 0 29 31 1 0 13 5 1 2 1 3 2 0 3 1 11 1 0 3 5 1 1 0 13 1 12 8 1 7 0 5 1 1 0 1 1 1 1 19 2 16 1 11 7 4 0 1 10 4 6 0 0
21 6 10 5 1 0 76 0 1 32 8 1 8 3 5 10 1 7 1 0 0 0 0 0 0 0 0 18 3 15 29 3 24 2 5 1 1 0 1 1 1 0 43 1 38 4 17 14 3 0 4 40 19 20 0 1
18 9 6 3 3 151 52 1 0 26 0 3 1 2 7 7 1 4 10 46 6 9 10 11 2 5 3 18 1 17 0 0 0 0 1 0 0 1 0 0 0 4 46 3 36 7 8 7 1 1 4 19 5 13 1 0
0 0 0 0 0 21 16 0 0 14 0 0 0 0 0 2 0 0 0 13 1 9 0 0 0 3 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 0 2 0 4 4 0 0 0 14 12 2 0 0
0 0 0 0 0 53 15 0 0 5 0 2 1 0 1 4 1 1 6 4 1 0 3 0 0 0 0 2 0 2 2 0 1 1 1 0 0 1 0 0 0 0 9 0 9 0 7 7 0 0 0 22 3 19 0 0
0 0 0 0 0 24 18 0 0 11 0 1 1 0 2 3 0 0 0 2 1 0 1 0 0 0 0 3 0 3 12 1 10 1 0 0 0 0 0 0 0 0 5 0 4 1 2 2 0 0 0 5 3 1 1 0
0 0 0 0 0 11 17 0 0 9 1 0 3 0 0 3 0 1 1 9 1 0 2 3 1 0 2 9 3 6 3 0 3 0 0 0 0 0 0 0 0 0 29 1 24 4 1 1 0 1 0 1 0 0 0 1
0 0 0 0 0 6 17 0 0 5 2 0 0 0 3 3 1 3 3 5 0 0 1 2 0 1 1 9 0 9 2 0 2 0 0 0 0 0 0 0 0 0 23 1 17 5 0 0 0 0 0 7 2 5 0 0
BLOOD/BONE MARROW Leukemia Myeloma Other Hematopoietic BRAIN BREAST DIGESTIVE SYSTEM Anus, Anal Canal, Anorectum Bile Ducts Colon Esophagus Gallbladder Liver Other Digestive Pancreas Rectum & Rectosigmoid Small Intestine Stomach ENDOCRINE-THYROID FEMALE GENITAL Cervix Uteri Cervix In Situ Ca Corpus Uteri Ovary Vagina Vulva Other Female Genital LYMPHATIC SYSTEM Hodgkin’s Disease Non-Hodgkin’s Lymphoma** MALE GENITAL Penis Prostate Testis ORAL CAVITY/PHARYNX Hypopharynx Lip Nasal Cavity, Sinus, Ear Salivary Glands, Major Tongue Tonsil PERITONEUM, OMENTUM, MESENT RESPIRATORY/INTRATHORACIC Larynx Lung/Bronchus, Non-Small Cell Lung/Bronchus, Small Cell SKIN Melanoma of Skin Other Skin Cancer SOFT TISSUE UNKNOWN OR ILL-DEFINED URINARY TRACT Bladder Kidney and Renal Pelvis Ureter Other Urinary
Note: AJCC Stage-Analytic Cases only *Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.
CLASS
SEX
AJCC STAGE AT DIAGNOSIS* NA UNK 53 18 30 12 14 4 4 0 7 0 0 0 0 0 0 4 0 0 0 3 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 7 0 0 0 0 0
0 0 0 0 0 7 7 0 1 1 0 0 2 0 3 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0
Abbreviations: M=Male; F=Female; A=Analytical; N/A=Non-Analytical; Unk=Unknown; NA=Not Applicable; AJCC=American Joint Commission on Cancer
2008 MBP/STPH Cancer Program Annual Report
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COMMUNITY SUPPORT GROUPS AND ACTIVITIES ADULT/CHILDREN’S BEREAVEMENT GROUPS For those in the community who have experienced loss from the death of a loved one. Groups are held in short day or evening sessions (871-5976).
LUNCH AND LEARN EDUCATIONAL PROGRAMS Offered routinely throughout the year on a variety of topics for individuals diagnosed with cancer, their families, friends and caregivers who support them (898-4481).
BETTER BREATHERS SUPPORT GROUP For adults with lung disease and their caregivers interested in better living (898-3785).
LYMPHEDEMA PREVENTION CLINICS One-on-one assessments with a certified lymphedema therapist are offered free of charge periodically throughout the year to cancer survivors who have had lymph nodes removed (1-888-616-4687).
BREAST CANCER SUPPORT GROUP Support and education for individuals diagnosed with breast cancer. Groups meet on the second Tuesday of every month (612-2111). CANCER SURVIVORS DAY Held in June, this program provides support and recognition to individuals within our community diagnosed with cancer and their caregivers to celebrate survivorship (898-4581). CANCER CONNECTION NEWSLETTER Bi-monthly newsletter provides information on cancer related support, education and rehabilitative services across the Northshore for individuals/families going through a cancer diagnosis (898-4581). CANCER CONNECTION SUPPORT GROUP For individuals, family members and friends who are challenged by a cancer diagnosis. It provides an atmosphere for expressing thoughts, feelings and expectations. Groups meet on the third Wednesday of every month (898-4581).
NORTHSHORE BLOOD CANCER SUPPORT GROUP For individuals, family members and caregivers with leukemia, lymphoma, myeloma or myelodysplastic syndrome. Co-sponsored by the Leukemia and Lymphoma Society and the International Myeloma Foundation. Groups meet the second Saturday of every month (898-4581). REACH TO RECOVERY Specially trained, breast cancer survivor volunteers provide one-on-one support and personally respond to concerns of those facing breast cancer diagnosis, treatment, recurrence or recovery (898-4581). SMOKING CESSATION When combined with other smoking cessation efforts, structured classes can greatly increase the chances of quitting for good. Classes scheduled routinely (898-4581).
CANCERFIT EXERCISE AND WELLNESS PROGRAM Designed for individuals completing cancer treatment or in cancer recovery. Incorporates a supervised, personalized fitness program activity with health and wellness education (898-4581). CARING FOR THE CAREGIVER SUPPORT GROUP Specifically for cancer caregivers to share hope and support in caring for loved ones. Groups meet the second Thursday of every month (871-5974). GENETIC CANCER RISK ASSESSMENT & COUNSELING PROGRAM Provides genetic counseling and screening services at no cost to individuals at high risk for cancer development to help patients and their families make informed decisions about their medical options, including screening for early detection, ways to reduce personal risk and genetic testing. Co-sponsored by St. Tammany Parish Hospital, Mary Bird Perkins Cancer Center and the Leonard C. Thomas HOS Foundation (898-4581). HOSPICE VOLUNTEER TRAINING For those interested in becoming a Hospice volunteer to have training in direct patient care, office support, bereavement care, community education or fundraising events (871-5976). LOOK GOOD, FEEL BETTER Offers skin, nail and hair care tips that can enhance appearance and improve self-image while undergoing cancer treatment. Our professionals will help you with a 12-step make-up guide, choosing and caring for a wig and dealing with skin changes. Cosmetics provided. Held bimonthly (898-4481).
WIG RESOURCE CENTER This community service program offers wigs, turbans, hats and scarves at no cost to women undergoing cancer treatment. Our private fitting area is located in the Cancer Resource Center (898-4481).
Co-sponsored by ACS and STPH
16
2008 MBP/STPH Cancer Program Annual Report
2008 MBP/STPH Cancer Program Annual Report
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39 Starbrush Circle Covington, LA 70433 www.marybird.org
1202 South Tyler Street Covington, LA 70433 www.stph.org