UnityPoint Health St. Luke's Cancer Care Annual Report 2012

ST. LUKE’S

Cancer Care ANNUAL REPORT 2012

A broad spectrum of quality care

Table of Contents

1 Advances in

breast cancer

2-3 St. Luke’s Breast

and Bone Health

4 Cancer Risk

Assessment Services

5 Specialty Support Services

6 Caring for the community

7 St. Luke’s Cancer Committee

8-9 Data analysis of

breast cancer

m Message fro

Leadership

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Center, the clin ve developed th the community e’ in w er ps hi ad rs le a ne e m co be The part d an s to expand helped us grow to look for way am te ip patients have sh er unity for more n lead h our physicia g to our comm it in w id y ov el pr os cl en k eir families. e’ve be we wor patients and th cancer care w At St. Luke’s, er ng nc vi ca sa r efo lif es e ic on th oud of our serv and improve up e extremely pr ar er with them. e nc W ca s. t ar ns ai ye ag t gh fi e than 129 th d to continuing We look forwar

Dr. Warren ologist, Medical Onc d Oncology an y og PCI Hematol ctor and Medical Dire ee Chair, itt m om Cancer C r Care ce an St. Luke’s C

Dr. Brimmer eon, en G eral Surg ialists ec Sp al PCI Surgic Physician, n so ai Li r ce Can cer Care St. Luke’s Can

ter Kimberly Ives Cancer Care ’s ke Lu .

St , Director

Collaboration with Helen G. Nassif Community Cancer Center In 2011, a group of local cancer experts from multiple specialties formed the Helen G. Nassif Community Cancer Center. The collaboration brought together more than 200 doctors from Physicians’ Clinic of Iowa, P.C., independent providers and St. Luke’s to improve cancer care in our community by better coordinating resources and services that support cancer patients and their loved ones. As a result of this collaboration, providers have adopted evidence-based pathways to standardize cancer care, improved coordination between specialties and made providing supportive services to patients a priority.

The Helen G. Nassif Community Cancer Center has become the “hub” of supportive services for St. Luke’s, area providers and the community. It is a connecting link for coordination of care and is open to all providers in the community.

Advances in breast cancer CLINICAL TRIALS

Connie Rabe is the first patient in Cedar Rapids to receive the newest technology available to breast cancer patients. Called intraoperative electron radiation therapy (IOERT), this treatment combines surgery with an initial dose of radiation precisely focused on the area where most breast cancers recur.

“I feel so fortunate it was available to me,” said Rabe. “When they say the word ‘cancer,’ you pretty much don’t remember anything else they say. I was glad Wendy Young,

my care coordinator, helped me navigate the steps I needed to take. She explained I might be a candidate for IOERT. I hadn’t heard about this new technology, but she explained I would receive three weeks of radiation versus six weeks – because of that – she had my attention.”

IOERT is used during lumpectomy surgery.

After the patient’s surgeon removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy

“ In one procedure, a woman can have a cancer operation, radiation to the tumor bed and maintain optimal appearance and symmetry with the other breast. IOERT is a concise, convenient and cost-effective treatment. This is true innovation.”

Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon

tissue from unnecessary radiation. In one to two minutes, patients receive radiation equal to five to seven daily radiation treatments.

After the surgery, patients require three weeks of follow-up daily radiation treatments rather than the usual six weeks.

“In one procedure, a woman can have a cancer operation, radiation to the tumor bed and maintain optimal appearance and symmetry with the other breast,” said Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon. “IOERT is a concise, convenient and cost-effective treatment. This is true innovation.”

Rabe’s lumpectomy was performed by Dr. Brimmer. The surgery and IOERT treatment were an outpatient procedure that took about two hours. Rabe was able to go home shortly afterward and was back to traveling and her usual activities after just three weeks of external beam radiation. “The shortened follow-up treatment allows women to get back to their daily commitments much sooner,” Dr. Brimmer explained.

“I think IOERT is a huge advancement in the treatment of breast cancer and we’re so fortunate it’s available in eastern Iowa,” Rabe said.

St. Luke’s began offering ioert in the fall of 2012

for early stage breast cancer patients through an international clinical trial.

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ST. LUKE’S

Cancer care coordinators In 2012, an essential part of St. Luke’s Cancer Services growth came from implementing the latest technology and collaborating with the Helen G. Nassif Community Cancer Center to expand our care coordination program.

St. Luke’s care coordinators work with every patient diagnosed with cancer.

Care coordination team pictured L to R standing: Mona Cook, Andrea Watson.

Seated: Dawn DeMean, Wendy Young and Emi Chapman

St. Luke’s Breast and Bone Health St. Luke’s Breast and Bone Health takes pride in leading efforts in our community for early detection of breast cancer, diagnostic services, individualized care and educating women about their health.

Breast and Bone Health care coordinators Registered nurses with oncology experience coordinate care for every patient diagnosed with breast cancer. Called care coordinators, these specially trained nurses are also certified breast care nurses (CBCN) through the Oncology Nursing Society. Each care coordinator possesses the clinical expertise patients require, but also understands the cancer journey, enabling them to help patients through emotionally difficult experiences. They help connect patients and their families with resources available to them at St. Luke’s and in our community.

This service is available at no cost to everyone in the community.

Patients who require additional follow-up after an abnormal screening also receive assistance from care coordinators who help

Kristi Thomson, manager St. Luke’s Breast and Bone Health

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them navigate the many different disciplines to complete their work-up and care. In 2012, St. Luke’s care coordinators provided education and care for over 300 patients.

Patient satisfaction Patients’ rating of their experience with St. Luke’s Breast and Bone Health is at the forefront of the management team every day.

We listen to our patients and use their feedback to enhance our programs and improve the quality of care we provide.

2012 Press Ganey survey results St. Luke’s Breast and Bone Health received an overall patient satisfaction survey score in the upper five percent of facilities reporting.

Press Ganey surveys patients about their healthcare experience for providers across the country.

Time elapsed

Expert staff – degrees and certifications Breast and Bone Health is led by a radiologic technologist with primary certification in radiography and advanced-level certification in mammography, bone densitometry and quality management and a Bachelor of Science in Health Care Administration.

between discovery of an abnormality during a diagnostic mammogram to performing a needle or core biopsy to determine whether it is cancerous or benign.

Technologists have advanced level certifications in the services they perform, for example, mammography and bone densitometry certifications through the American Registry of Radiologic Technologists (ARRT) or International Society of Clinical Densitometry (ISCD).

Nurses have their Bachelor of Science in Nursing (BSN), and three care coordinators are also Certified Breast Care Navigators (CBCN) through the Oncology Nursing Society.

Raising standards for patient care St. Luke’s Breast and Bone Health is a Certified Quality Breast Center in the National Quality Measures for Breast Centers (NQMBC), which measures and compares facility performance between like facilities. St. Luke’s is striving to improve and exceed the bench-marked 75 percentile ranking. Our goal for 2013 is to be named a Certified Quality Breast Center of Excellence by the NQMBC. “St. Luke’s Breast and Bone Health is an active participant in the quality assurance initiatives set forth by the NQMBC. With national standards to compare our local results, we are implementing studies to show our current strengths in providing care to women with breast cancer and to determine the areas where we can improve, in both the delivery and quality of care to our patients, throughout the spectrum of treatment, from the initial detection of breast cancer until treatment is complete. By comparing ourselves against national standards, we can affirm the great care patients receive in the fight against breast cancer. That care will continue to improve in the years to come.”

St. Luke’s National average

2.66 days 2.95 days 2010 – 2012 data provided by the National Quality Measures for Breast Centers (NQMBC)

Breast cancer patients diagnosed at St. Luke’s receive the

appropriate chemotherapy 100 percent of the time.

Stephen Burke, MD, Radiology Consultants of Iowa, PLC

St. Luke’s National CoC approved programs of patients

100%

91.7% of patients

The Commission on Cancer (CoC), a program of the American College of Surgeons, is a consortium of professional organizations dedicated to improving survival rates and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive, quality care.

The cancer program at St. Luke’s Hospital earned a three-year accreditation with commendation from the CoC of the American College of Surgeons in 2010.

“Truly outstanding staff – their caring and personal demeanor made a very difficult situation easier to handle.”

St. Luke’s Breast and Bone Health patient

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Cancer Risk Assessment SERVICES

Heredity can play an important role in the development of cancer. Medical research has increased our understanding of the link between genetics and cancer. With the discovery of the BRCA genes, we have been able to provide genetic testing for patients at an increased risk for breast and ovarian cancer. This genetic testing can be a powerful tool in cancer prevention and helps determine the most appropriate treatment for those diagnosed with breast cancer. Providing patients with an individualized cancer risk assessment, including counseling, education, testing, referrals and ongoing support is an innovative way the Helen G. Nassif Community Cancer Center shows commitment to their patients. There is a cost for the blood test, which some insurance companies may cover. Genetic counseling services are free.

“Cancer and Genetic Risk Assessment Counseling provides patients and their families with the education they need to make informed decisions about their healthcare. Working closely with a patient’s healthcare provider, a prevention plan is tailored specifically to each individual based on their family’s cancer history. For those patients diagnosed with a genetic mutation, more extensive education is provided about options for prevention and surveillance.”

Julie Thompson, ARNP-BC, Cancer and Genetic Risk Assessment Helen G. Nassif Community Cancer Center of Iowa

Genetic testing increases cancer knowledge “I tested positive for the BRCA1 genetic mutation,” said 27-year-old Amy White, who has had five members of her family on her dad’s side diagnosed with either breast or ovarian cancer. She decided to pursue genetic testing recently after she learned her 40-year-old cousin was diagnosed with breast cancer and tested positive for the BRCA1 gene mutation. “I wanted to be proactive so I would be able to take preventative steps to hopefully keep cancer at bay,” White explained.

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Women who carry either the BRCA1 or BRCA2 gene mutation have an 85 percent lifetime risk of developing breast cancer and a 25 – 45 percent risk for ovarian cancer. Many individuals with the gene mutation choose to remove their breasts and ovaries before receiving a cancer diagnosis to greatly reduce their risks. White, at 26, wasn’t ready for the cancer-sparing surgeries. However, she took immediate steps to develop a care plan with her doctor, Lisa Hess, MD, OB-GYN Associates, which included annual mammograms and other

tests, such as an MRI and pelvic ultrasound to look for ovarian and breast cancer.

White and her husband, Andy, have two children, Kynzley, 3, and Kohen, 2. With her positive test, White’s children have a 50/50 chance of also carrying the gene mutation. She said, “When the time comes, I anticipate having both of our kids go through genetic testing – when they are older.”

The White family at their rural Independence home with the John Deere tractor they painted pink and white to raise awareness of breast cancer.

SPECIALTY

Support Services To help patients and their families navigate the often difficult cancer journey, St. Luke’s collaborates with the Helen G. Nassif Community Cancer Center and other community organizations to provide support services to patients, caregivers and family members.

Many of these cancer support groups and services are provided at no charge, some are provided for a small fee and others may be covered by insurance. These services consist of the Cook Cancer Wellness Program, support groups including a secure/private Facebook group for cancer survivors and a variety of educational workshops and programs.

• Mind-body skills group • Body image & sexuality group • Family and individual counseling • Sexuality and body image counseling • Caregiver resources • Lymphedema management • Massage therapy • Art therapy • Music therapy • Group exercise classes – Zumba, Tai Chi, Pilates, Yoga

• Complementary therapies • Reiki • Cooking demonstrations • Cancer Connections newsletter • Patient and caregiver mentor program • LiveStrong Cancer Transitions workshop • Cancer Really Sucks (in partnership with Gems of Hope) • What About Us? Children’s support group (in partnership with Gems of Hope)

Pictured clockwise L to R: Julie Thompson, Matt Schmitz, Beth Beckettand Nancy Hagensick.

Wellness Program With progress in diagnosing certain cancers at an earlier stage and improvements in treatment, the number of cancer survivors continues to climb. These survivors are in need of additional services that help them tackle treatment-related side effects and adjust to a new personal health altered by a diagnosis of cancer. In response to these needs, St. Luke’s Hospital launched the Cook Cancer Wellness Program in 2009. It provides multiple services to cancer survivors and addresses quality-oflife issues in an individualized way.

Use of the St. Luke’s Cook Cancer Wellness Program is free to any cancer patient in the community and doesn’t end when the patient stops treatment. It’s intended to be available to individuals for as long as they need it – even if that means years after their last treatment.

In collaboration with the Helen G. Nassif Community Cancer Center, specialized staff are available to work with cancer survivors, including a program coordinator to

help survivors identify needs post cancer, a social worker, an exercise specialist who works with individuals to devise an exercise and wellness plan and a dietitian to assist patients and survivors with choosing healthy foods. Also cancer wellness massage is available to patients and survivors dealing with prolonged pain from treatment and a risk assessment advisor is available to work with individuals to determine additional cancer risks.

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CARING FOR THE

Community St. Luke’s works to ensure there are programs in our community that provide services and promote health and healing in response to identified community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge, or relieve the burden on government or other community efforts.

St. Luke’s community support includes education, charity care, subsidized health services, community health improvement activities and more. Here’s a look at a few programs St. Luke’s Cancer Care makes available to Cedar Rapids and the surrounding community.

Bras for the Cause is a nonprofit organization that raises funds for mammograms and cervical screenings and promotes women’s health and wellness education.

Photos L to R: Breast Cancer Awareness “Bat” Boat; “Pink in the Rink”; Breast Health Summit

Photojeania, Inc.

Free Mammography Day

Breast Health Summit

Bras for the Cause

St. Luke’s Breast and Bone Health provided no-cost mammography screening to 29 uninsured or underinsured women over the age of 40 on March 19.

Three of the women received additional imaging and follow-up.

For the first time in Cedar Rapids, last March over 100 women gathered to focus on education, risk prevention and detection of breast cancer in African American women.

The conference was held at the African American Museum and was organized with assistance through the Iowa Cancer Consortium, Iowa Department of Public Health and many community partners, including St. Luke’s Cancer Care and Breast and Bone Health.

Carousel Motors, a major contributor to the Bras for the Cause organization, chose St. Luke’s to receive $10,000 in Bras for the Cause donations.

The money will be used primarily for screening mammography for the uninsured and underinsured. St. Luke’s Breast and Bone Health, in collaboration with St. Luke’s Foundation, is planning a screening event in June 2013 to provide approximately 57 screenings to women who otherwise would not receive recommended breast screenings.

“Pink in the Rink” St. Luke’s Breast and Bone Health and Cancer Care partnered with the Cedar Rapids Roughriders Hockey organization to promote breast cancer awareness on September 19. Over $2,300 was raised for the Spirit Fund through ticket sales – with the Rough Riders donating $2 of every ticket sold – and a silent auction.

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Breast Cancer Awareness “Bat” Boat St. Luke’s Breast and Bone Health and Cancer Care once again sponsored the Breast Cancer Awareness “Bat” Boat, an offshore racing boat with a “batwing” design. The boat helps promote breast cancer awareness and education in the community when it appears at events such as the Uptown Marion Market and Cedar Rapids’ St. Patrick’s Day and Holiday DeLight parades.

ST. LUKE’S HOSPITAL

Cancer Committee Program leadership

Thomas Warren, MD Chair PCI Medical Oncologist

Robert Brimmer, MD Cancer Liaison Physician (CLP) PCI General Surgery

Physician Members James Bell, MD St. Luke’s Palliative Care & Hospice Stephen Burke, MD Radiologist, RCI

J. David Cowden, MD Pulmonologist Respiratory and Critical Care Asociates Wook Lee, MD Radiation Oncologist Radiation Oncology of Cedar Rapids

Ruth Macke, MD Pathologist, Cedar Valley Pathology Jasmine Nabi, MD Medical Oncologist Oncology Associates

Members Kimberly Ivester Cancer Program Administrator Emi Chapman Cancer Care Coordinator Community Outreach Coordinator Mona Cook Oncology Nurse Cancer Conference Coordinator Denise Abel Oncology Nurse, Manager Inpatient Oncology & Hospice Units Nancy Hagensick Social Worker, Psychosocial Services Coordinator

Rhonada Weber Certified Tumor Registrar, Quality Control of Registry Data Coordinator Sherrie Justice Performance Improvement Professional, Quality Improvement Coordinator Maureen McEvoy Palliative Care, Spiritual Care

Carmen Kinrade Director, St. Luke’s Nursing Services Pat Thies St. Luke’s Pharmacy Director Christy Thurman American Cancer Society Michelle Niermann St. Luke’s Administration

Julie Thompson Cancer & Genetic Risk Assessment Beth Beckett Nutrition/Dietary Specialist 7

Data analysis

OF BREAST CANCER

Breast cancer is the most frequently diagnosed cancer in women, excluding skin cancer.

The American Cancer Society estimated that 226,870 new cases of invasive breast cancer occurred in the United States in 2012 and 39,510 women died of the disease.

Breast cancer ranks second as a cause of cancer death in women (after lung cancer).

Breast cancer was the most frequently diagnosed cancer at St. Luke’s in 2012.

Although some breast cancers are extremely aggressive and spread quickly, most tend to grow slowly and are present for years before they can be felt. Therefore, it is important for women to follow recommended screening guidelines for detecting breast cancer at an early stage, before symptoms develop. Breast cancer typically produces no symptoms when the tumor is small and most treatable.

The optimal treatment for breast cancer depends on how advanced the tumor is at diagnosis. Staging of the cancer is the process used to determine how large the tumor is, whether lymph nodes are involved and if the tumor has spread to other organs.

Generally, the smaller the stage, the better the prognosis of the cancer. In the 2010-2012 data included in this report, 407 breast cancer cases were treated and abstracted into the St. Luke’s Cancer Care registry. As shown, over 87 percent of breast cancer patients diagnosed at St. Luke’s are diagnosed in an early stage when treatment is optimal. In fact, more stage 0 and stage I diagnoses were identified at St. Luke’s than other comprehensive hospitals in the ACS division of the Midwest.

To support early diagnosis in our community, St. Luke’s Breast and Bone Health proudly collaborates with the Care For Yourself program and Bras for the Cause to provide breast cancer screening to uninsured and underinsured women in Cedar Rapids and surrounding communities. St. Luke’s also supports the community through education on the importance of breast cancer prevention and screening.

In 2012, St. Luke’s introduced several advances focusing on the diagnosis, treatment and care of breast cancer patients. Molecular breast imaging (MBI) was successfully introduced by nuclear medicine to help find small breast cancers in very dense breast tissue. St. Luke’s also formed a Breast Care Committee in 2012 to help sharpen the focus on breast cancer.

Multiple highly specialized, experienced and dedicated physicians work in collaboration with the experts at St. Luke’s Breast and Bone Health to ensure optimal quality and precision are practiced across the continuum of breast cancer care. This team also focuses on the clinical and psychosocial needs of the patient, her family and her caregivers.

St. Luke’s is the only hospital in Iowa and one of three in the Midwest to offer intraoperative electron radiation therapy (IOERT) using a mobile electron generator. IOERT is available to treat early stage breast cancer patients, decreasing side effects and dramatically minimizing the duration of radiation therapy. The unique opportunity to complete both surgical care and the initial radiation therapy simultaneously promotes breast preservation and avoids unnecessary mastectomies.

We are supremely confident our efforts, in conjunction with highly dedicated personnel and unique equipment, such as IOERT, will improve the number of women diagnosed at an early stage and advance the innovative care provided to women looking for stateof-the-art breast cancer care.

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From 2010-2012, breast cancer cases

407

were treated and abstracted into the St. Luke’s Cancer Care registry.

Over

87%

of breast cancer patients diagnosed at St. Luke’s are

diagnosed at an early stage.

More St. Luke’s patients were diagnosed with breast cancer at stage 0 and stage 1 than those diagnosed at the other similar-sized hospitals in the Midwest, from 2010-2012.

In 2012, molecular breast imaging (MBI) was successfully introduced to help find small breast cancers in very dense breast tissue.

Stage of breast cancer diagnosed 2010 to 2012

46%

50%

42%

St. Luke’s

40% 30% 20%

21%

21% 18%

26% 8% 8%

10%

0

Stage I

Like-sized hospitals in Midwest

Stage II

Stage III

3% 3%

1% 2%

Stage IV

Unkown

Percentage of patients diagosed with breast cancer according to stage at diagnosis.

Top cancer sites

Breast cancer surgical treatment at St. Luke’s

Seen at St. Luke’s – 2012

Primary Site Total Male Female Breast

113 0 113

Prostate

108 108 0

Lung/Bronchus 88 47

41

Female Genital

76

76

Melanoma

70 45 25

Blood & Bone Marrow

64

Colon

45 18 27

Bladder

47 31 16

0

31

Kidney/Renal 30 20 10 Brain & CNS

25

Thyroid

24 8 16

Unknown Primary

17 8 9

All other sites

All Sites

126

81

346 patients with Stage 0 – 111A breast cancer

Mastectomy

48%

33

Lymphoma 37 23 14 3

2010 to 2012

Lumpectomy

52%

22

45

870 423 447

The most recent publication of mastectomy rates from the Surveillance, Epidemiology and End Results (SEER) database shows a 38.4% national mastectomy rate in 2008 for early stage breast cancer patients.

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