2014 Cancer Services Report
Providing Advanced Medicine, Promising Extraordinary Care
Message from Leadership I am pleased to present the 2014 Rush-Copley Cancer Care Center Annual Report. In this year’s Annual Report, you’ll find an overview of our programs and services, some of the highlights of the year, statistics from our cancer registry and a special report on breast cancer. This past year was an exciting one for our center. The Cancer Care Institute was awarded the Illinois Department of Public Health (IDPH) Carolyn Adams Ticket for the Cure Grant and a Susan G. Komen Grant. These two grants will allow the center to provide education, navigation, resources and support services to low-income and minority breast cancer survivors. The Cancer Care Center also has an ongoing Coleman Foundation grant that provides similar benefits to all cancer survivors. The programs and services offered as a result of these grants are part of a commitment to provide extraordinary care to our patients and the community. Another example of Rush-Copley’s commitment to its mission of providing advanced medicine with quality outcomes and extraordinary care is the radiation oncology expansion project. In 2013, construction crews broke ground to expand the Cancer Care Center on the main hospital campus. This expansion included the addition of a second state-of-the-art linear accelerator, Varian TrueBeam, that will provide more precise, higher dose treatment options in shorter time frames. This new treatment option was made available to patients at the end of 2014. As the leading provider of health services in the greater Fox Valley area Rush-Copley will continue to look for opportunities to improve our Cancer Care program and strive to provide a warm, compassionate environment for our patients. Sincerely,
Judi Bonomi, RN, MS, MSN, OCN, NE-BC Director, Rush-Copley Cancer Care Institute
Rush-Copley Cancer Care Center Annual Report
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Table of Contents 1
Message from Leadership
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Rush-Copley Cancer Care Center Overview
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Waterford Place
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2014 Highlights
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Cancer Registry Report and Analytic Data
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Breast Cancer Report
16 - 17 18
Oncology and NAPBC Committee References
Rush-Copley Cancer Care Center
Clinical excellence, compassionate care and a collaborative approach to fighting cancer is what distinguishes Rush-Copley’s Cancer Care Institute from other cancer programs in the region. Our team includes medical and radiation oncologists, surgeons and nurses working in conjunction with their colleagues in pathology, radiology and other clinical specialties to provide patients with the most advanced diagnostic and treatment technologies available, access to clinical trials and dynamic patient-clinician relationships. This comprehensive care is further enhanced by a full complement of support services including nutrition counseling, genetic counseling and testing, palliative care, social work, physical rehabilitation, complementary medicine and behavioral health.
Advanced Detection and Diagnosis Accurate diagnosis is a crucial element in developing a cancer treatment plan. That’s why Rush-Copley has made a significant investment in state-of-the-art diagnostic testing, imaging and pathology technologies. Rush-Copley’s Breast Imaging Program has been recognized as a Breast Imaging Center of Excellence by the American College of Radiology for outstanding mammography, ultrasound and MRI breast services.
Personalized Medicine Cancer is a complex disease and often requires a multifaceted treatment approach that can include surgery, chemotherapy, radiation or a combination of therapies. At Rush-Copley, each patient has their own multidisciplinary team of cancer experts who work to develop a personalized treatment plan based on cancer type and stage, and tailored to meet the patient’s personal needs and goals. Treatment plans are designed to not only fight disease but to control symptoms, manage pain and help cope with the emotional stress caused by cancer.
Advanced Technology Patients at Rush-Copley have access to some of the most innovative and advanced diagnostic imaging and treatment tools including high resolution breast ultrasound, CT-PET, MRI imaging and guided biopsy, digital stereotactic biopsy system, brachytherapy, image-guided radiation therapy, intensity modulated radiation therapy, rapidarc, stereotactic radiosurgery and stereotactic body radiation therapy. By offering patients the most accurately targeted and least invasive methods of diagnosis and treatment, we are able to help patients achieve the best possible outcomes.
Rush-Copley Cancer Care Center Annual Report
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Cancer Care Center Nurses Our oncology nurses are an integral component of our program. They have a wealth of experience and knowledge about cancer, cancer treatment and side effects and are sensitive to the needs of our patients. At Rush-Copley, our nurses work in outpatient offices and inpatient units as direct care providers, research nurses, advanced practice nurses, nurse navigators and other roles. They also work in our community coordinating education, outreach and screening programs.
Specialized Support Patient care at Rush-Copley extends beyond the most advanced treatment options for cancer. Each patient also gains access to support and complementary services to help manage life during treatment and recovery.
destructive behavior. At Rush-Copley, we understand that “getting better� means helping our patients learn the skills needed to cope with the psychological stress that may experience before, during and after their treatment. Together, our team works with patients, their family members and their treatment team to get the care needed to begin the healing process and restore hope for the future.
Cancer Genetics Program Some families have a hereditary, or genetic, factor that can greatly increase their chances of developing cancer. Identifying these families and educating them about available cancer screenings, risk reduction and prevention options can significantly reduce their risk for some types of cancer. Our genetics program provides risk assessment, genetic counseling and testing, and referral to a genetics specialist, if appropriate.
Nutritional services are provided by certified dietitians who have extensive experience counseling patients. Our dietitians work closely with our clinicians to identify problems and assist patients who may have special dietary needs and weight issues. They are also actively involved in community education initiatives throughout the year. Social services, post-surgical rehabilitation, lymphedema prevention and treatment, and pastoral care are further examples of Rush-Copley resources designed to help patients cope with their disease and how it affects their life. Each of these areas serves as an integral part of the comprehensive cancer care team.
Behavioral Health Program Cancer may be one of the most difficult challenges a person can face. Along with the physical illness, many individuals may feel overwhelmed by a range of emotions that without treatment can lead to social withdrawal, neglect of care, and in severe cases, self4
Rush-Copley Cancer Care Center Annual Report
Inpatient Care
Outreach, Screening and Education
While most cancer care is provided in the outpatient setting, some patients may need to be admitted to Rush-Copley’s inpatient oncology unit for complex chemotherapy treatment, intensive symptom management, multiple blood transfusions and IV antibiotic therapy and for patients going through treatments for leukemia, which may require extended stays. Through thoughtful design and continuous quality improvement efforts, the inpatient oncology unit supports our vision of truly comprehensive cancer care and gives cancer patients and their families a space that is supportive and healing.
Each year Rush-Copley hosts a wide variety of patient, community and professional education programs and participates in communitysponsored events throughout the Fox Valley region. In partnership with Susan G. Komen for the Cure, Rush-Copley has actively been working in the community to increase minority and lowincome women’s access to breast cancer education, screenings, navigation and support services.
Clinical Research Our clinicians are committed to finding and translating promising research into new and better options for the prevention, diagnosis and treatment of cancer. Our ongoing clinical trials are directed toward the evaluation of cancer risk, screening and prevention, new approaches and treatment options, and quality of life issues. Rush-Copley invites eligible patients to participate in clinical trials and contribute to the development of new medical knowledge. Patients at Rush-Copley have access to NCIsponsored, pharmaceutical-sponsored and investigator-initiated studies with the goal of improving the treatment of cancer.
In addition, Rush-Copley physicians, nurses and outreach staff conduct free or low-cost screenings and any necessary follow-up care for those who may not have the resources or access to these services. In many cases, these services provide a true lifeline of caring to the community we serve.
Recognized for Outstanding Cancer Care Rush-Copley Cancer Care Institute is respected both regionally and nationally for excellence. The center is accredited by the American College of Surgeons’ Commission on Cancer as a Comprehensive Community Cancer Program, the highest level a community program can achieve.
Rush-Copley Cancer Care Center Annual Report
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Waterford Place Center – Patient Spotlight In the course of most lives, few things can create more stress and isolation than a cancer diagnosis. Having a support system and resources available can make a huge difference as was the case in Peggy’s situation.
remove financial costs as an additional source of stress for those confronting cancer. Waterford Place becomes a true community in which every participant can tap any and all resources they feel can help them live life to the fullest.
In 1998, Peggy was diagnosed with Carcinoma INSITU (meaning contained) to the breast. She underwent a mastectomy with same day reconstruction. On the day she was to be released from the hospital, the surgeon informed her that the cancer had spread to her lymph nodes. Further surgery was required along with chemotherapy and radiation therapy. All of these obstacles caused a stressful and difficult time for Peggy and her family.
The availability of these types of services can have a huge impact on someone diagnosed with cancer.
As medical science has advanced, researchers have discovered that stress and isolation can affect a patient physically – significantly influencing the course of the disease. Increasingly, emotional support is valued as an essential component of treatment for all cancer patients and their families. These findings are the basis for the development of Waterford Place, Rush-Copley’s Cancer support center. Quite simply, Waterford Place unities participants, family members, caregivers and volunteers into a community centered on helping all those affected by cancer to lead their best life. It is where help meets hope. Almost all of the Center’s leading edge psychological support, education and information services will be provided free of charge. Without service fees, and facing a future of increasing challenge, the center relies substantially on philanthropy – contributions from a caring and grateful community, who prize Waterford Place as the resource, advocate and friend it becomes for so many in time of need.
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In the case of Peggy, she was living in New York during this challenging time in her life and no one ever suggested a support group or a cancer resource center. Upon moving to the Fox Valley, and before her second diagnosis, her primary care physician suggested that she join the Breast Cancer Support Group at Rush-Copley. “This was one of the best pieces of advice I have ever received,” said Peggy. Peggy’s second diagnosis of breast cancer was in September 2006. It was a second primary with a mastectomy again with positive lymph nodes and, once again, chemotherapy, radiation therapy and a year of Herceptin. The surgery and all follow-up treatment was performed at Rush-Copley. This time around Peggy had a resource in Rush-Copley’s Breast Cancer Support Group, which she now co-leads, and found a resource center, where she and other members of the support group benefited from their massage therapy, counseling, art workshops, yoga and classes. “These services have made a tremendous impact on these women, but Geneva is a far drive for many of the people in Fox Valley, ” said Peggy. “And during treatment this commute is sometimes impossible. We so need a support center here in Aurora to help our community deal with this devastating disease.”
Rush-Copley Cancer Care Center Annual Report
Waterford Place will offer classes, workshops and speakers covering every topic from the latest treatment options to managing side effects to navigating insurance issues. Nutritional counseling and fitness programs offer nutrition and exercise opportunities to nourish both body and mind. Family programs help loved ones learn about cancer and express their feelings in a supportive atmosphere. Support groups for specific cancer types and general information and guidance are offered on managing every cancer diagnosis. Meditation groups and art and music therapy sessions help participants examine and express emotions and reduce stress levels.
Waterford Place is meant to feel like a home, a place of peace, restoration and healing. Far from the institutional feel of a cancer support center retrofitted from a clinical facility or a building in an office park, the center welcomes participants with comfort, warmth, and caring. “Those not affected by cancer seem to think that once your treatment (chemo or radiation) is over that you should be just fine and able to put this whole experience behind you,” says Peggy. “But it doesn’t happen that way. For some people it is never over.” For more information about supporting Waterford Place please contact Alex Pope at 630-978-4946 or alex.pope@rushcopley.com.
Access and proximately to these services are critically important and Waterford Place is the closest such resource in Southern Kane and Kendall Counties.
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2014 Highlights
This past year has been an exciting one for Rush-Copley’s Cancer Care Institute. Two
physicians have been added to the Radiation Oncology team, a new state-of-the-art linear accelerator is in place for
treatment, completion of a center expansion project, expanded support services, provided innovative education
programs for clinicians, patients and the community and improved workflow operations have positioned the program for
future growth. 8
Rush-Copley Cancer Care Center Annual Report
Lung Cancer Screening Program Lung Cancer is the leading cause of cancer death in the United States with the majority diagnosed in later stages. That’s why prevention and early detection are the best ways to reduce risks associated with lung cancer. In January of 2014, the Cancer Care Center was awarded a lung cancer screening grant. This grant allows Rush-Copley to offer a low-dose lung CT screening for people at risk for lung cancer. Low-dose lung CT screening has shown a 20 percent reduction in lung cancer deaths for high-risk individuals. Rush-Copley follows the National Comprehensive Cancer Network guidelines for lung cancer screening. All individuals interested in this screening will receive a consultation with a nurse navigator to explain the exam and determine if they meet the NCCN guidelines. After qualifying the individual is scheduled for a low-dose CT scan read by a board-certified radiologist. The nurse navigator then follows up with the patient once the results are available.
Grant Funding The Cancer Care Center was awarded the Illinois Department of Public Health (IDPH) Carolyn Adams Ticket for the Cure grant and a Susan G. Komen grant in 2014. The IDPH Grant allows the Institute to offer support and navigation services to breast cancer survivors. This includes care plans, in-person visits, follow-up phone calls, care coordination and general education. The Susan G. Komen grant provides the Institute with funding for a community outreach coordinator and two nurse navigators that offer education and services to low-income and minority breast cancer survivors. Additionally, this grant allows the Institute to provide transportation services and medication assistance to this patient population. The programs and services offered as a result of
these grants are part of a commitment to provide extraordinary care to our patients and the community.
Physician Recruitment In 2014, Rush-Copley welcomed two radiation oncologists and two specialists to the team. Sea Chen, M.D., Ph.D., a board-certified radiation oncologist, joined the center in February. Dr. Chen received his medical degree from Indiana University School of Medicine in Indianapolis, Indiana. His expertise includes LDR Brachytherapy, Stereotactic Radiosugery (SRS) and Stereotactic Body Radiotherapy (SBRT). Ying Zhang, M.D., a board-certified radiation oncologist, joined the center in September. Dr. Zhang received his medical degree from the Feinberg School of Medicine, Northwestern University, Chicago, Illinois. His expertise includes HDR/LDR gynecological brachytherapy and SRS. Suzanne Bergen, M.D., specializes in gynecological oncology or cancers of the female reproductive organs. Dr. Bergen takes a comprehensive approach to her patient’s care – focusing on treatment, follow-up and survivorship. Tochukwu Okwuosa, M.D., specializes in cardiology and cardio-oncology. Dr. Okwuosa provides care to patients in varying stages of cancer treatment who are at risk for heart disease. Dr. Okwuosa will hold a monthly clinic as part of a collaboration between Rush University Medical Center, Fox Valley Cardiovascular Consults and Rush-Copley.
National Accreditation Program for Breast Centers As a part of our continuing effort to improve the standards of care for patients Rush-Copley has applied for the American College of Surgeons NAPBC accreditation.
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Cancer Registry Report Rush-Copley’s Cancer Registry Department supports the activities of the Oncology Committee and the Cancer Care Institute. The Registry staff oversees the collection, quality assurance, lifetime follow-up and analysis of data from patients diagnosed with cancer who receive all or part of their care at Rush-Copley and those other deemed reportable. The Registry provides vital statistics and information to clinicians and researchers as well as local, state and national cancer databases and cancer-related organizations. This contribution of information advances the body of knowledge in the field of cancer and ultimately has a positive impact on cancer patient care. The world of a Cancer Registrar is ever changing, and so are the guidelines that registrars use to conduct accurate data abstracting. Cancer centers report specifics of diagnosis, stage of disease, medical history, patient demographics, laboratory data, tissue diagnosis and medical, radiation and surgical methods of treatment for
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each cancer diagnosed at the facility. The data is used to observe cancer trends and provide a research base for studies into the possible causes of cancer with the goal of reducing cancer death and illness. Registry data also serves as an ongoing resource to the Oncology Committee in determining the most effective allocation of resources, for developing community education and outreach initiatives as well as monitoring program quality. For Rush-Copley’s data to be comparable to those collected at other programs around the country, the registrars adhere to data rules established by the collecting and credentialing organizations. Keeping up with these changes can be challenging, but Rush-Copley Registrars understand the significance of their work and are experts in their field.
Rush-Copley Cancer Care Center Annual Report
Primary Site Distribution Rush-Copley 2013 Analytical Cases SITE
Total Analytical % Anal. Stage Stage Stage Stage Stage Cases Cases Cases 0 1 2 3 4
Unkn
Breast
276
273
34%
73
92
65
25
6
11
Colorectal
90
89
11%
33
19
14
14
9
0
Lung & Bronchus
80
75
9%
0
6
5
22
39
3
Endocrine System
63
62
8%
0
37
4
3
2
1
Other Digestive
54
50
6%
1
5
10
13
18
2
Female Genital System
50
44
6%
1
24
3
7
6
1
Prostate
50
39
5%
0
10
22
5
2
0
Brain & CNS
29
28
4%
0
0
0
0
0
0
Lymphoma
25
23
3%
0
7
6
4
1
5
Urinary System
25
20
3%
7
5
5
1
2
0
Skin (excluding basal & squamous)
20
19
2%
2
8
1
3
3
1
Oral Cavity & Pharynx
21
18
2%
0
4
2
3
9
0
Leukemia
13
12
2%
0
0
0
0
0
0
Myeloma
9
9
1%
0
0
0
0
0
0
Larynx
7
6
1%
0
0
4
1
1
0
Soft Tissue
3
2
0%
0
0
0
0
2
0
Testis
1
1
0%
0
0
1
0
0
0
Bone and Joint
1
0
0%
0
0
0
0
0
0
Eye and Orbit
1
0
0%
0
0
0
0
0
0
Miscellaneous (Benign Bloods)
25
24
3%
0
0
0
0
0
0
Total
843
794
100%
117
217
142
101
100
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Rush-Copley Cancer Care Center Annual Report
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B r e a s t C a n c e r R e p o r t : Review of Diagnosis, Treatment and Survival at Rush-Copley Nancy E. Whereatt, MD INTRODUCTION Breast cancer is the most common female cancer in the United States, the second most common cause of cancer death in women, and the main cause of death in women ages 45 to 55. About one in eight (12 percent) women in the U.S. will develop invasive breast cancer during their lifetime. According to American Cancer Society data from 2014, about 232,670 new cases of invasive breast cancer will be diagnosed in women. Approximately 62,750 new cases of carcinoma in situ (CIS), early stage breast cancer, will be diagnosed and about 40,000 women will die from breast cancer.
RISK FACTORS A risk factor is anything that affects the chance of getting a disease, such as cancer. Some risk factors, like age, genetics or race, can’t be changed. Others are related to environmental factors. Still others can be related to personal behaviors, such as smoking, drinking, and nutrition. Some of these factors can influence risk more than others and the risk of breast cancer can change over time, due to aging or lifestyle. Nearly eight out of ten breast cancers occur in women older than age 50. A woman who is 70 is almost twice as likely to develop breast cancer as a woman who is 50. As mentioned above, race and ethnicity can play a role in developing breast cancer. Overall, white women are slightly more likely to develop breast cancer than African-American women, but African-American women are more likely to die of this cancer. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.
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Genetics can also play a role in developing breast cancer. Approximately fifteen percent of breast cancer cases are thought to be hereditary, meaning that they are a direct result of gene defects (mutations) inherited from a parent. One known cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. In women with a mutated copy of either gene there is a high risk of developing breast cancer. The average risk of developing breast cancer with a BRCA1 mutation is in the range of 44 to 78 percent while the risk for a BRCA2 mutation is in the range of 31 to 56 percent.
SCREENING When found and treated early, breast cancer is often curable. The most important component of early detection for women age 40 and older is having a mammogram every year. Recent evidence has confirmed that mammograms offer substantial benefit for women greater than 40 years of age. Women younger than 40 with a family history of breast cancer may need to begin screening earlier. Improved mammography has lead to detection of smaller tumors therefore improving outcomes. Digital mammography and 3D tomosynthesis are the latest improvements in imaging technology. They offer enhanced views of the breast tissues and greatly improves the radiologist’s ability to find smaller cancers. Women in their 20s and 30s should have a clinical breast exam (CBE) as part of their regular health checkups at least every three years. Starting at age 40, women should have a CBE performed every year. A breast self-exam is an option for women starting in their 20s.
Rush-Copley Cancer Care Center Annual Report
Performing regular self -exams allows women to become familiar with the look and feel so that lumps, thickness or changes can be identified. Recommendations may vary for women at high risk for breast cancer. Risk assessment is based on various models and clinical factors. Those with BRCA1 or BRCA2 gene mutation, should get a breast MRI and mammogram every year, alternating every 6 month intervals.
DIAGNOSIS Diagnosing breast cancer has traditionally begun with either a clinical finding or an abnormality seen on routine screening mammography. Once an abnormality is indentified on a mammogram further imaging is performed with an ultrasound of the breast or, in some cases, a breast MRI. In order to confirm a diagnosis, physicians need a sample of the breast tissue. The process for obtaining a sample depends on the size and location of the abnormality in the breast. An ultrasound guided or digital stereotactic biopsy can be performed using a needle to get a small piece of the tissue. A surgical biopsy can also be preformed to remove all or part of the lump and surrounding tissue.
STAGING The stage describes the extent of the cancer in the body. It is based upon whether the cancer is invasive or non-invasive, the size of the tumor, how many lymph nodes are involved, or if it has spread to other parts of the body. The cancer’s stage is one of the most important factors in determining prognosis and treatment. This is done using the TNM classification. T is the primary tumor size (T0-T4); N is the lymph node involvement (N0-N3); and M means the tumor has metastasized or spread to other parts of the body. Generally, the smaller the tumor, and the less lymph nodes, the better the prognosis and overall survival. Staging also involves the use of CT scans, PET scans and other imaging as recommended by the oncologist. Based on 2013
data, Rush-Copley diagnosed 273 new cases of breast cancer which is a 35 percent increase since 2011. The National Cancer Database (NCDB) statistics on diagnosis by stage for 2011 show that 63 percent were diagnosed in the early stages (I, II) of the disease. Considering the importance that staging plays in prognosis and treatment this is great sign. Refer to figure 1 below for detailed breakdown of staging for Rush-Copley, Illinois and the United States. Stage
RushCopley
Illinois
US
0
20%
21%
20%
I
38%
42%
42%
II
25%
22%
24%
III
9%
9%
8%
IV
5%
4%
4%
Unknown
3%
2%
2%
Figure 1. Breast Cancer diagnoses by stage at Rush-Copley compared to Illinois and U.S. from the NCDB 2011
In addition to stage, age is another important factor in determining the course of treatment for breast cancer. The NCDB statistics on diagnosis by age group for 2011, figure 2 below, show that 56 percent of the patients diagnosed at RushCopley were between 30 and 59 years of age compared to 43 percent for the United States for the same age group. Age RushGroup Copley Under 20 0% 20-29 1% 30-39 6% 40-49 25% 50-59 25% 60-69 24% 70-79 14% 80-89 4% 90+ 1%
Illinois
US
0% 0% 3% 17% 25% 26% 17% 9% 1%
0% 0% 3% 16% 24% 27% 18% 9% 1%
Figure 2. Breast Cancer diagnoses by age group at Rush-Copley compared to Illinois and U.S. from the NCDB 2011
Rush-Copley Cancer Care Center Annual Report
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Treatment decisions for breast cancer are made by the patient and the physician after consideration of the optimal treatment available for the stage and biological characteristics of the cancer, the patient’s age and preferences, and the risks and benefits associated with each treatment protocol. Most patients with breast cancer will have some type of surgery. Surgery is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy, and/or target therapy.
determine if the disease has spread beyond the breast. More women are now choosing to have a mastectomy as the first treatment option and often with a contralateral prophylactic mastectomy. Reconstruction is offered as an option in virtually 100 percent of patients opting for mastectomy. At Rush-Copley, as well as nationally, the mastectomy rate is rising. This rise in incidence seems to be patient driven, as more options are now available. These patients are having risk assessment, genetic counseling, BRCA testing and are then able to decrease their risk of recurrence with more extensive initial surgery.
SURGERY
RADIATION THERAPY
The primary goals of breast cancer surgery are to remove the cancer from the breast and to determine the stage of the disease. Surgical treatment involves breast-conserving surgery (BCS) or mastectomy. BCS is also known as partial mastectomy, quadrantectomy, and lumpectomy. In BCS only the cancerous tissue plus a rim of normal tissue are removed. Simple or total mastectomy includes removal of the entire breast. Modified radical mastectomy includes removal of the entire breast and lymph nodes under the arm, but does not include removal of the underlying chest wall muscle as with radical mastectomy. Radical mastectomy is no longer done. Both BCS and mastectomy are usually accompanied by a sentinel node biopsy removing regional lymph nodes from the armpit to
Radiation therapy is the use of high-energy beams or particles to kill cancer cells. Radiation may be used after surgery to destroy cancer cells remaining in the breast, chest wall or underarm area. Radiation can also be used to treat the symptoms of advanced breast cancer, especially if it has spread to the central nervous system or bones. It may be administered internally or externally and some patients are treated with both types in combination. The way radiation therapy is given depends on the type, stage, and location of the tumor, in addition to the doctor and patient preference. External beam radiation therapy is the standard form of radiation and is focused from the machine –
TREATMENT
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Rush-Copley Cancer Care Center Annual Report
outside the body on the area affected by cancer. Internal radiation therapy, known as brachytherapy, is a form of accelerated partial breast irradiation which uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
of the treatment options showing that the standard of care is similar across the state. Upon case review of 25 patients by Rush-Copley physicians, it was determined that 100 percent of those patients are receiving the correct course of treatment as defined within the NCCN guidelines.
FIVE–YEAR ANALYSIS SYSTEMIC THERAPY Systemic therapy is treatment that travels through the bloodstream and affects all parts of the body, not just the cancer. It includes chemotherapy, hormone therapy and targeted therapy, all of which work in different forms. Chemotherapy drugs attack cells that grow quickly. Hormone therapy drugs work by either blocking the body’s natural hormones or lowering the hormone levels, which can promote cancer growth. Targeted therapy drugs attack specific parts of cancer cells. Systemic treatment can be given to a patient before surgery, neoadjuvant therapy, or after surgery, adjuvant therapy. Neoadjuvant therapy is used to shrink the tumor enough to make surgical removal possible or allow for less extensive surgery. Adjuvant therapy is used to kill any undetected tumor cells that were left behind during surgery or that have migrated to other parts of the body. Figure 3 below illustrates the treatment modalities at Rush-Copley compared to other hospitals in the state. Rush-Copley is within 5 percent on each
Fortunately, the outcomes for patients diagnosed with breast cancer are quite good compared to many other cancers. The survival rates at RushCopley are favorable. This could be a result of increased patient awareness, education, screening measures, earlier diagnosis and advanced treatment options.
RushCopley
Stage 0
Stage I
Stage II
Stage III
Stage IV
98%
97%
92%
76%
33%
Figure 4. Observed 5-year survival Breast Cancer at Rush-Copley
CONCLUSIONS The statistics throughout this breast cancer report are a clear indicator that Rush-Copley is providing its patients with a full continuum of care, including education, screenings, diagnosis and treatment, as well as social and spiritual issues.
RushIllinois Copley Surgery Only 8% 13% Surgery & Radiation 6% 9% Surgery & Chemo 5% 6% Surgery, Radiation & Chemo 14% 9% Surgery, Radiation & Hormone 31% 26% Surgery & Hormone 8% 12% Surgery, Radiation, Chemo & Hormone 13% 12% Surgery, Chemo & Hormone 7% 4% Other Specified Therapy 7% 6% No 1st Course Rx 0% 3% First Course Treatment
Figure 3. First Course Treatment of Breast Cancer at Rush-Copley and for Illinois from the NCDB 2011
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Rush-Copley Cancer Care Center Annual Report
Oncology Committee Oncology Committee is a designated multidisciplinary body for the administrative oversight, development and review of cancer care services at Rush-Copley. Members include physician representatives from diagnostic and treatment specialties along with representatives from supporting services involved with the care of patients with cancer.
Physician and Ex-Officio Members of Oncology Committee Kaushik Patel, MD
Hematology/Medical Oncology, Chairman
Salitha Reddy, MD
Radiation Oncology, Vice-Chair
Kurian Abraham, MD
Pathology, Cancer Liaison Physician
Syed Akbar, MD
Diagnostic Radiology
Suzanne Bergen, MD
Gynecologic Oncology Surgeon
Alice Danielle, MD
Palliative Medicine
Ted Kulczycki, MD
Internal Medicine
Joseph Meschi, MD
Hematology/Medical Oncology
Ho Myong, MD
Hematology/Medical Oncology
Craig Szafranski, MD
General Surgery
Non-Physician Members of Oncology Committee Judi Bonomi, RN, MS, MSN, OCN, NE-BC
Director, Inpatient Nursing and Cancer Care Center
Mary Shilkaitis, RN, MS, MBA
Vice President, Patient Care Services & Chief Nursing Officer
Jeff Coleman, RN, MSN, CMSRN, CNML
Clinical Manager, CCC, Quality Coordinator
Ryan Alvarez, MS
Business Manager, CCC, Community Outreach Coordinator
Laura Rollins, LSW
Oncology Social Worker, Psychosocial Services Coordinator
Marianna Arroyo
Community Health Outreach Coordinator
Amanda Baker, CCRP
Clinical Research
Stephanie Beam, PharmD
Pharmacy
Vickie Burdick, RHIT, CTR
Tumor Registry
Jennifer King, RN, MSN, OCN
Oncology Nursing
Ashley Lach
American Cancer Society Representative
Prema Ramakrishnan, RHIT, CTR
Tumor Registry
Jillian Smallwood
Living Well Representative
Mira Vujovic, APN, MSN, CBCN
Breast Care Navigator and Genetics Counselor
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Breast Program Leadership Committee Breast Program Leadership Committee is a designated multidisciplinary body committed to improving the quality of breast health care by coordinating the best care and treatment options available at RushCopley. Members include physician representatives from diagnostic and treatment specialties along with representatives from supporting services involved with the care of patients with breast cancer.
Physicians and Breast Program Leadership Team Committee Members Kurian Abraham, MD
Pathology, Cancer Liaison Physician
Mohsen Anwar, MD
Imaging Services
Ho Myong, MD
Hematology/Medical Oncology
Salitha Reddy, MD
Radiation Oncology
Nancy Whereatt, MD
Surgeon
Judi Bonomi, RN, MS, MSN, OCN, NE-BC
Director, Inpatient Nursing and Cancer Care Center (CCC)
Allen Bloom, MD
Surgeon
Beatrice Klade, MD
Surgeon
Joseph Meschi, MD
Hematology/Medical Oncology
Kaushik Patel, MD
Hematology/Medical Oncology
Non-Physician Breast Program Committee Members Mary Shilkaitis, RN, MS, MBA
Vice President, Patient Care Services & Chief Nursing Officer
Ryan Alvarez, MS
Business Manager, CCC, Community Outreach Coordinator
Jeff Coleman, RN, MSN, CMSRN, CNML
Clinical Manager, CCC, Quality Coordinator
Marianna Arroyo
Community Health Outreach Coordinator
Amanda Baker, CCRP
Clinical Research
Vickie Burdick, RHIT, CTR
Tumor Registry
Michelle DeHass
Nurse Navigator, Midwest Center for Advanced Imaging
Tisha Hailey
Manager, Therapy Services
Gloria Hall
Director, Midwest Center for Advanced Imaging
Julie Kwait
Therapy Services
Tom Markuszewski
Director, Imaging Services
Prema Ramakrishnan, RHIT, CTR
Tumor Registry
Laura Rollins, LSW
Oncology Social Worker, Psychosocial Services Coordinator
Mira Vujovic, APN, MSN, CBCN
Breast Care Navigator and Genetics Counselor
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References American Cancer Society. Breast Cancer Facts and Figures, 2013 – 2014. Web. 25 November 2014. American Cancer Society. What are key statistics about breast cancer?, n.d. Web. 25 November 2014. American Cancer Society. What are the risk factors for breast cancer?, n.d. Web. 25 November 2014. American College of Surgeons Commission on Cancer. National Cancer Database Benchmark Reports, 2014. Web. 3 November 2014.
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