Cancerservices annualreport 8707pages

2016 Cancer Services

Annual Repor t

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Introduction 5

Cancer Program Practice Profile Repor ts (CP3R) 6

Cancer Committee Membership 7

Primary Site Table 8

CT Simulator 9

Financial Navigator 10

Infusion Center 11

Colon Cancer Screening Kit Giveaway 12

For Additional Information 14

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Introduction

Introduction I’m pleased to introduce Regional West Medical Center’s 2016 Cancer Services annual report. Regional West’s cancer program offers compassionate care with the latest in screening, diagnosis, treatment, and support services working together to ensure the best possible outcome for our patients.

In 2016, Regional West saw 455 newly diagnosed cancer patients and is one of the region’s leading facilities for cancer care. The demand for cancer services is strong in our area, and will only rise as our population ages. Our continued commitment to enhanced patient care is a direct reflection of this need.

According to the National Cancer Institute, cancer prevention, screening, and early detection represent the best opportunities to defend against cancer.

Regional West activities this past year that focused on cancer awareness, prevention, and screening include: • The distribution of free colon cancer screening kits.

• Regional West’s Boxer Rebellion 5k run/walk to raise colon cancer awareness.

• Educational seminars highlighting breast cancer and prostate cancer risks and prevention.

Vincent Bjorling, MD Co-Chairman Cancer Committee

Cancer detection, treatment, and support continue to be a vital focus of Cancer Services as we seek to combine the latest technology available with the compassionate, human aspect of care that’s so vital to anyone facing a cancer battle. This year saw the addition of a CT simulator in the Cancer Treatment Center, plus the opening of Regional West’s new Infusion Center. Free programs like Camp Hope, Look Good…Feel Better, and a Cancer Survivors’ Day picnic are an important component of the services that Regional West provides to our patients.

Each and every member of Regional West’s Cancer Services team considers it a privilege to care for patients who choose Regional West as a partner on their cancer journey. I’m honored to work with this talented, dedicated group of professionals to provide patient-centered, individualized, compassionate care.

If you would like information about cancer services, support programs, and activities for cancer survivors and their loved ones, call Regional West Physicians Clinic-Oncology at 308.630.2101, the Cancer Treatment Center-Scottsbluff at 308.630.1348, or the Dorwart Cancer Care CenterSidney at 308.254.9192.

Sincerely, Vince Bjorling, MD Co-Chairman, Cancer Committee Regional West| |rwhs.org rwhs.org Regional West Medical Center | 5| 5

Cancer Program Practice Profile Reports (CP3R)

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Standard 4.4 Accountability Measures The Commission on Cancer (CoC) requires accredited cancer programs to treat cancer patients according to nationally accepted accountability measures indicated by the CoC quality reporting tools. The web-based Cancer Program Practice Profile Reports (CP3R) offer local providers comparative information to assess adherence to and consideration of standard of care therapies for major cancers.

This reporting tool provides a platform from which to promote continuous practice improvement to improve quality of patient care at the local level, and also permits hospitals to compare their care for these patients relative to that of other providers.

Below is the summary CP3R performance grid for the breast cancer measures. Breast cancer patients can be assured that they will receive care at Regional West Medical Center that is consistent with nationally recognized standards.

American College of Surgeons, Cancer Program Practice Profile (CP3R) Reports, Breast Cancer Diagnosed 2011 to 2014 Estimated Performance Rates ( % ) Select Measures

Measure

CoC Std / %

2011

2012

2013

2014

Radiation is administered within one year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability).

BCSRT

4.4 / 90%

94.10

100.00

100.00

92.90

Tamoxifen or third generation aromatase inhibitor is recommended or administered within one year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer (Accountability).

HT

4.4 / 90%

100.00

96.00

95.20

96.30

Radiation therapy is recommended or administered following any mastectomy within one year (365 days) of diagnosis of breast cancer for women with >= 4 positive lymph nodes (Accountability).

MASTRT

4.4 / 90%

66.70

no data

0.00

100.00

Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer (Quality Improvement).

nBx

4.5 / 80%

96.90

97.60

93.30

97.70

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2016 Cancer Committee Membership Required Physician Members

(Designated alternate members are italicized)

Cancer Committee Chair/CoChair • Vincent Bjorling, MD • Jason Walsh, MD, FACS

Quality Management • Margo Ferguson, MT (ASCP) • Jeannie Miller, BSN, RN

Cancer Liaison Physician • Gitesh Chheda, MD • Jason Walsh, MD, FACS

Oncology Nursing • Sue Schoeneman, MSN, ACNP-BC, AOCNP • Kim Croft, RN, BSN

Medical Oncology • Vincent Bjorling, MD • Regine Leconte, MD

Community Outreach Coordinator • Paulette Schnell, MSN, RN • Deborah Keener, BSN, RN

Radiation Oncology • Mark Hartman, MD

Clinical Research Coordinator • Michele Lambert, OCN, BSN

Pathology • Peter Schilke, MD, FCAP • Randall Williams, MD, FASCP

Ad Hoc Program Members

Diagnostic Radiology • Gitesh Chheda, MD • Jason Swink, MD Surgery • Jason Walsh, MD, FACS • Jason LaTowsky, MD Palliative Care Services • Connie Beehler, MD, MS, FAAHPM • Deborah Moore, GNP-BC

Required Non-Physician Members Cancer Program Administrator • Jeff Kriewald, B.S. RT(R)(T)

• John Mentgen, FACHE President/CEO Regional West Health Services • Lisa Scheppers, MD, FACP Chief Medical Officer • Connie Rupp, MSN, RN Vice President Patient Care Services/ Chief Nursing Officer • John Kabalin, MD, Urology • Kelsey Kriewald, Pharm.D, RPH, Director, Pharmacy • Nichole Griffith, PT, DPT, Rehab Services • Karen Johnson, RD, CSO, LMNT, Food Service • Jill Koch, American Cancer Society Representative • Amy Potts/Tobie Copp, Medical Staff Office

Certified Tumor Registrar • Cindy, Keller, CTR • JoAnn Cervantes, CTR Social Worker • Carol Diffendaffer, PMHP, PMSW, OCW-C • Jennifer Hiltgen, BSW Regional West| |rwhs.org rwhs.org Regional West Medical Center | 7| 7

Regional West Medical Center

2016 Cancer Cases by Anatomic Site Primary Site

Buccal Cavity/Pharynx Major Salivary Gland Floor of mouth Tonsil Hypopharynx Pharynx, other buccal ca.

Digestive System Esophagus Stomach Small intestine Colon, excluding rectum Rectum and rectosigmoid Anus/anal canal Liver Gallbladder Other biliary Pancreas Peritoneum Other digestive organs Respiratory/System Larynx Lung, bronchus Trachea pleura and other Bones and joints Skin (exc. basal and sq. ca) Melanoma of the skin Other skin cancers Breast Female Genital system Cervix uteri Corpus uteri Ovary Vulva Male Genital Prostate Testis Penis Urinary system Urinary bladder Kidney and renal pelvis Ureter/other urinary organs Brain/other nervous system Endocrine system Thyroid gland Other endocrine Lymphatic system Hodgkin’s disease Non-Hodgkin’s disease Multiple Myeloma Blood/Leukemia Other, ill-defined and unk.

ALL Cases (includes non-analytic) 7 1 1 3 1 1 73 7 6 2 23 13 1 3 1 2 9 1 5 52 3 48 1 1 30 29 1 66 43 2 33 4 4 73 70 2 1 38 22 14 2 16 12 7 5 19 1 18 5 12 8

Analytic Cases

Sex

6 0 1 3 1 1 72 7 6 2 23 12 1 3 1 2 9 1 5 49 3 45 1 1 29 28 1 60 41 2 32 4 3 50 48 2 0 33 20 12 1 5 7 7 5 18 1 17 5 12 8

4 0 0 3 1 0 47 7 4 2 13 11 0 2 1 2 3 0 2 28 3 24 1 0 15 14 1 0 0 0 0 0 0 50 48 2 0 20 13 7 0 2 2 2 0 8 1 7 3 6 6

2 0 1 0 0 1 25 0 2 0 10 1 1 1 0 0 6 1 3 21 0 21 0 1 14 14 0 60 41 2 32 4 3 0 0 0 0 13 7 5 1 3 5 5 0 10 0 10 2 6 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 8 8 0 9 0 0 0 0 0 0 0 0 0 14 13 0 1 N/A 0 0 N/A 0 0 0 N/A N/A 0

0 0 1 0 0 0 5 1 1 0 2 0 0 0 0 0 1 0 0 7 1 6 0 0 11 11 0 22 22 1 19 1 1 7 5 2 0 11 5 6 0 N/A 1 1 N/A 2 0 2 N/A N/A 0

0 0 0 0 0 0 16 1 2 0 4 6 0 1 0 0 2 0 0 2 0 2 0 1 3 3 0 19 2 0 2 0 0 27 27 0 0 3 1 2 0 N/A 1 1 N/A 4 1 3 N/A N/A 0

0 0 1 0 0 0 21 4 0 1 11 2 1 0 0 0 2 0 0 11 1 9 1 0 1 1 0 7 6 0 5 0 1 6 6 0 0 3 1 2 0 N/A 2 2 N/A 1 0 1 N/A N/A 0

5 0 1 3 1 0 18 0 2 1 5 3 0 1 1 0 4 1 0 26 0 26 0 0 4 4 0 3 5 1 0 3 1 10 10 0 0 2 0 2 0 N/A 3 3 N/A 9 0 9 N/A N/A 1

1 0 0 0 0 1 12 1 1 0 1 1 0 1 0 2 0 0 5 2 0 2 0 0 2 1 1 0 6 0 6 0 0 0 0 0 0 0 0 0 0 5 0 0 5 2 0 2 5 12 7

All Sites Combined

455

396

191

205

32

88

78

58

86

54

M

Best AJCC Stage F

Stage 0

Stage I

Stage II

Stage III

Stage IV

Not Staged

*Analytic – Initially diagnosed at Regional West Medical Center, and all or part of first course of therapy at Regional West or case diagnosed elsewhere and all or part of first course of therapy at Regional West.**Non-analytic case – Initially diagnosed and treated elsewhere, referred to Regional West for recurrence or subsequent therapy and physician office cases. AJCC Stage Grouping T, N, and M categories describe the anatomic extent of disease Stage groupings gather cases into homogeneous categories to facilitate analysis.

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CT Simulator Quality Improvement Located in Regional West’s Cancer Treatment Center, the Philips Big Bore CT simulator is the newest tool used for cancer treatment at Regional West. The 2016 purchase was made possible through Regional West Foundation’s Campaign for Continuing Excellence.

With the simulator located in the Cancer Treatment Center, cancer patients no longer have to travel across the hospital to use a regular CT scanner.

“One of the advantages of having this technology is that we know we are providing the best and most accurate treatment available to our patients, all conveniently located right in our treatment center,” said Jeff Kriewald, Cancer Treatment Center director.

treatment planning by pinpointing the exact location, shape, and size of the tumor to be treated prior to radiation therapy. It is the most accurate process available to localize and define a tumor, and has the ability to reconstruct a patient’s tumor in 3-dimension, and in some cases, in 4-dimension.

“The scanner’s added benefits help us develop more comprehensive and detailed treatment plans for patients with all types of cancer,” said radiation oncologist Mark Hartman, MD. “The freedom to place patients in different orientations helps us improve targeting of cancerous tumors while simultaneously minimizing any negative side effects.”

CT simulation is one of the latest advances in the preparation for the treatment of cancer. The new CT simulator dramatically increases the precision of

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Fin nancial Navigator

troduction

A Patient Centered Solution

Standard 4.5 Quality Improvement Measures This past year, Regional West introduced the services of a financial navigator for patients who need assistance in estimating insurance-covered and out-of-pocket expenses before starting cancer treatment. The service is provided at no cost for patients who receive cancer treatment at Regional West.

plan has been established, Osthoff meets with the patient to complete paperwork, obtain financial information, and provide a printout of where the patient stands with his or her insurance deductible.

Co-pay cards are provided to all patients and an explanation is given as to what happens financially once they begin treatment.

The financial navigation service is a comprehensive program designed to reduce patients’ out-of-pocket financial burden, increase reimbursement to the hospital, and enrich our patients’ care experience.

After all, for many patients, the physical, emotional, and psychological toll of illness is compounded by concerns and questions about paying for treatment.

The service is designed to alleviate some of those concerns and uncertainty so patients can concentrate on managing their care and healing.

Financial navigation services include: • Investigating eligibility for a host of financial support.

As an integral member of the multidisciplinary cancer care team, Janel Osthoff, Regional West’s financial navigator, follows patients from the beginning of treatment until completion – and beyond, if necessary.

Services offered As a liaison between the patient, provider, other Janel Osthoff clinic departments, and Regional West the patient’s insurance Financial Navigator carrier, Osthoff coordinates the financial details surrounding care so our patients are free to concentrate on treatment and living their daily lives.

The financial navigator’s job begins when the patient meets with his or her oncology physician to discuss diagnosis and a treatment plan. Once a treatment

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• Providing assistance for enrolling in eligible programs, including the premium assistance program, foundation funding, co-pay assistance initiatives, and medications available through pharmaceutical companies free of charge for the uninsured.

• Submitting reimbursement requests on behalf of patients.

• Obtaining prior authorization for the patient’s planned treatment.

• Following the patient’s account to make sure any reimbursement funds are applied correctly.

For more information about Regional West’s financial navigator services, contact Janel Osthoff at 308.630.3725 or Janel.Osthoff@rwhs.org.

Infusion Center Quality Improvement When Regional West’s new Infusion Center opened in July 2016, the goal was to make infusion care as easy, comfortable, and convenient as possible. The previous infusion area had been in use since 1999, and was crowded and outdated. The new center was designed to provide patients with safe, healing, individualized care best suited to their particular needs, while allowing them to maintain an active lifestyle.

What is infusion therapy?

Infusion therapy, also known as intravenous or IV administration, refers to delivering medication and/or nutrition directly into the veins. Regional West’s Infusion Center offers infusion therapy for chemotherapy, Crohn’s disease, rheumatoid arthritis, and multiple sclerosis, and also offers port flush and port maintenance services.

Choosing to receive infusion therapy at Regional West’s Infusion Center means: • Being able to spend more time with family and friends at home and less time in the hospital.

• Lower medical costs because care is delivered in a clinic setting versus a hospital stay.

• Receiving therapy in a beautiful suite designed with patient comfort in mind.

How does infusion therapy work?

Once a patient’s provider orders the infused medication, members of the Infusion Center team authorize the procedure, visit with the patient’s insurance company, and work with the patient to schedule an appointment for the initial infusion.

When patients arrive for their first infusion, they work with the team to develop an infusion schedule that best fits their schedule and needs.

The team takes care of sending subsequent infusion records to the patient’s providers.

Infusion Center team The Infusion Center team includes highly qualified and trained infusion nurses and onsite pharmacists.

Because the pharmacists prepare the infusions in the clinic, this translates to less waiting time for patients.

In another timesaving measure, the infusion nurses prepare any needed blood draws right in the clinic if patients have a port, eliminating the need for trips to the lab. This means less wait time, decreased treatment time, and more time for patients to pursue everyday activities. The team works hard to make the infusion experience as seamless and hassle-free as possible.

A serene environment The center’s warm, soothing environment and thoughtful amenities were designed to provide reassurance and a sense of comfort the minute patients step through the door: • A choice of private, semi-private, or open areas to receive therapy.

• A coffee and snack bar.

• Spacious restrooms within the center designed for efficient movement of patients with IVs. • Readily available educational materials.

• Access to private cable television.

• Comfortable recliner chairs.

• A relaxing lounge area for family members and/or support person. They are also welcome to be with patients as they receive treatment.

If you have questions or would like more information, contact the Infusion Center at 308.630.3762.

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Colon Cancer Screening Kit Giveaway Prevention/screening programs According to the US Centers for Disease Control and Prevention, colorectal cancer is the second leading cause of cancer deaths among Americans, behind lung cancer, yet one-third of adults do not undergo proper screening.

past 10 years, beginning each March. In 2016, over 360 kits were requested, and the goal is to distribute over 400 kits in 2017. FOBT are available free of charge to Scotts Bluff County residents ages 50 to 75.

The risk of developing colorectal cancer begins to increase after the age of 40 and rises sharply over the age of 50. On average, the lifetime risk of developing colorectal cancer is approximately five percent, or about one in 20 individuals.

According to Paulette Schnell, MSN, Regional West’s Community Health Director, the test is simple, private, and painless. She has a personal stake in urging early screenings; her father passed away from colon cancer just a few months ago.

The good news? Colon cancer is highly treatable if caught early, and screening methods like colonoscopies and Fecal Occult Blood Tests (FOBT) are the best line of defense in early detection. Early detection may prevent polyps from becoming cancerous and can jumpstart early treatment when it is most effective.

When colorectal cancer is found early and treated, the five-year survival rate is 85 to 90 percent.

“There are over 50,000 deaths a year in the US from colon cancer, and that’s far too many,” she said. “Early detection is the key to survival.”

Colon cancer often starts with no symptoms. Screening can reveal the presence of microscopic or invisible blood in the stool, or feces. This Paulette Schnell, MSN blood can be a sign of a problem in Regional West the digestive system, such as a Community Health Director growth or polyp, or from cancer in the colon or rectum. Screening should Regional West Community Health, in partnership take place even if individuals do not have a history with the Scotts Bluff County Health Department of colorectal cancer, a previous history of colon and the state of Nebraska, has been giving away free cancer, or any other malignancy. colon cancer screening kits to area residents for the

What can you do to reduce your risk • Be physically active for 30 minutes or more a day, at least five days a week.

• Eat more fruits, vegetables, and whole grains.

• Eat less red meat.

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“There are over 50,000 deaths a year in the US from colon cancer, and that’s far too many.

Early detection is the key to survival.” -Paulette Schnell

state lab in a postage-paid envelope that’s included in the kit. The samples are analyzed, and results sent to both the participant and to Regional West. If there are abnormalities, individuals are contacted to come in for further testing.

“The bottom line is that colon cancer is very preventable if people can get screened and find pre-cancerous polyps and early-stage cancers before they grow and spread,” said Schnell.

How do the kits work?

The kits are simple and painless to use, and are shipped directly to an individual’s home. The test is a three-day process, and participants are asked to refrain from eating red meat during those three days, since blood in the meat could show up as blood in the test. Each day, participants save a small stool sample smear using materials provided in the kit.

After three days they send all three samples to the

Enrollment forms for FOBT home testing kits and information about colorectal cancer are available by contacting Deb Keener, RN, Regional West’s Colon Cancer Program nurse, at 308.630.1580 or by calling 308.436.6636. Additional information about the Nebraska Colon Cancer Screening Program through the Nebraska Department of Health and Human Services is available from the Nebraska Colon Cancer Screening Program at 800.532.2227 or www.dhhs.ne.gov/crc.

of colorectal cancer?

• Eat fewer processed foods.

• Don’t smoke. If you do smoke, quit.

• Limit alcohol consumption to no more than one drink a day for women, and two drinks a day for men.

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Fo

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Call: Write:

308.630.2421

Regional West Medical Center Cancer Treatment Center 3911 Avenue B, Suite G100 Scottsbluff, NE 69361 Attention: Cindy Keller, CTR Cancer Registry Coordinator

Email: Cindy.Keller@rwhs.org Web:

Access the report at rwhs.org

2016 annual report published October 2017 Teresa Clark, Editor

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