2015 Annual Report by Yuma Regional Medical Center

2015 ANNUAL REPORT

The Best Care Close to Home

The Dream Continues

Providing care beyond medicine means more than always working to bring the latest in cancer care and treatment to patients. It means going above and beyond “medicine” to treat all aspects of the patient during their journey. In this report, you’ll read about our progress from the past year and all the ways we’re making cancer care as convenient, effective and comfortable as possible.

The new year will bring even greater benefits to the Yuma community. The center plans to focus on partnering with community physicians, as well as adding a nurse practitioner. Collaborating with local physician practices will help patients access the benefits of the Cancer Center and to assist in cancer screenings and prevention.

Highlights include lung cancer screening, expanded supportive care offerings, team-focused linear accelerator treatment, and community involvement through a unique Art Heals exhibit and a partnership with Arizona Western College.

“We’re very excited about this,” Dean said. “It’s hard for doctors to make sure all their patients are getting screened.”

Expanded clinical trials, an evolving oncology pharmacy and the addition of lymphedema treatment offer even more benefits.

From Our Journey to Yours

Relationships built with these practices also will be beneficial to patients after their cancer care, as they transition back to primary care and longterm wellness.

The center already is attracting more patients with its comprehensive offerings. New patient consults have increased by more than 20 percent, Dean reported.

The nurse practitioner will aid in helping the Cancer Center offer same-day appointments and in providing follow-up care with patients post treatment.

A “Dream Big” initiative in 2012 ignited the possibility of a comprehensive cancer center for Yuma residents. Yuma Regional Medical Center’s passionate pursuit of this dream has resulted in the kind of cancer care Yumans deserve: A single point of contact for all aspects of cancer care from diagnosis to survivorship.

In addition, the center plans to expand its lung cancer screening program and to make its professional/community cancer symposium a two-day event that integrates cardiology and orthopedic specialties. Dr. Brenda Earnst, a medical oncologist from the Mayo Clinic fellowship program, will join the center in July 2015.

Today, after our first full year in the new Yuma Regional Cancer Center, we reflect on how that journey has opened up new roads in our commitment to provide care beyond medicine.

Yuma Regional Cancer Center remains committed to offering patients the best possible cancer care and treatment – for those currently on their cancer journeys and for cancer journeys not yet begun.

“Patients and their caregivers overall have been very excited about the new facility,” said Dean Putt, Cancer Center Administrative Director. “Winter visitors who returned to a brand new building in full operation last fall were ecstatic and very impressed with the changes.”

One location. One team. One focus. Providing you with the best possible cancer care close to home.

They’ve appreciated access to a social worker, dietitian, palliative care, lymphedema therapy and cancer resource center all in one building, he noted.

Supporting Patients Beyond Chemotherapy and Radiation

A Life Planning team, led by a cancer center social worker, adds another layer of support by addressing end-of-life wishes, goals and concerns of advanced cancer patients. “Life planning is really about identifying how you want your life to be if things don’t go as well as you wish,” Dr. Elnadry said.

When Yuma Regional Cancer Center set out to bring comprehensive cancer care to the Yuma community, it made sure to address all aspects of treatment and healing – emotional, physical and spiritual. Through supportive care services, the center offers care beyond medicine through pain and symptom management (or palliative care) and a variety of complementary therapies to assist patients throughout their journey.

Supportive care at the Cancer Center also includes complementary therapies such as massage and acupuncture both free to patients thanks to generous grant funding from the Foundation of the Yuma Regional Medical Center McDaniel Fund. Additional support therapies such as nutrition, art and meditation also are being developed.

A weekly palliative care clinic mainly serves patients with stage 3 and 4 cancers. Dr. Jeanne Elnadry, Director of Palliative Care, meets with patients to discuss their needs and concerns and then maps out a plan for reducing treatment side effects and cancer related symptoms.

While Dr. Elnadry has dreams for the clinic to do even more, she’s pleased with progress thus far. “It’s pretty unusual for a community cancer center to have a robust program like this. It’s all starting to come together.”

Partnering to Bring More Healing Services to Patients “My anxiety has really toned down since I’ve been able to get a massage every week.” “I’m amazed that a massage is helping me sleep so much better!”

“Studies have shown that patients who take advantage of supportive care have better coping skills, improved mood levels, get better sleep and are able to tolerate their treatments with more ease,” Kate noted.

These comments are heard over and over again at the Cancer Center from patients who’ve experienced these comfort sessions, said Kate Turpin, Professor/ Coordinator, Massage Therapy and Healthcare Programs at Arizona Western College. Kate manages an educational partnership with Yuma Regional Cancer Center that brings supportive care services such as massage therapy and Reiki to the center.

Acupuncture treatments also are provided by Elyse Tera of Acupuncture of Yuma, an independent contractor licensed by the State of Arizona. These services are offered at the center at low or no cost through the McDaniel fund and donation programs. A lecture series called the Vitality Series also is part of the mix and provides health-related experiential learning opportunities for patients, staff and family caregivers twice a week at the center. Sessions include such topics as yoga, meditation, food as medicine and many others.

Seeking early palliative care can extend life for some patients, noted Dr. Elnadry. A 2010 study reports that lung cancer patients who received early palliative care lived almost three months longer than those who did not and enjoyed a higher quality of life.

Yuma Regional Medical Center has partnered with Arizona Western College for many years in varied healthcare programs. Bringing supportive care into the Cancer Center was a natural extension of that partnership, Kate explained.

Within the last year, the clinic has increased its value to patients by adding more services. A new program focuses on the specific treatment- and cancer-related symptoms of head and neck cancer patients. Patients in crisis can now receive pain medications during their clinic visit rather than having to wait for their prescription. Patients also have access to a chaplain resident, who provides spiritual care, including healing touch and guided imagery. Dr. Elnadry stressed the importance of the center’s interdisciplinary approach to patient support, describing a patient who arrived at the clinic with a pain level of 9 and left with a pain level of 2. The patient received pain medication, healing touch and support from a social worker. “It’s often not just the cancer itself,” she explained. Transportation, family and anxiety issues can affect healing as well. “All that distress can affect pain.”

The Healing Power of Art

Grateful for the small things in life In addition to the welcoming collage of flower canvases by cancer survivor Lora Dana (see her story on opposite page), the Art Heals exhibit displays on other floors of the Cancer Center photographic works by local photographer Ty Cook and a collection of stunning Southwestern landscapes donated by the family of the late artist Louis Benesch. All of the art has a local tie. To maximize the project’s impact, the Cancer Center has tapped community art experts such as retired art teacher Tom Rushin and Martha Palomino, interim director of the Yuma Fine Arts Association. Martha offered her services without hesitation. “I have some background with art therapy and when I received a call, I thought, ‘Wow, this is something I’d like to do.’” She brings expertise in organizing art exhibits and connecting with the arts community. “I’ve mentioned this to several artists, and not one has said they don’t want to participate.”

Take the elevator up to the second floor of the Yuma Regional Cancer Center, and you’ll witness bursts of beauty and color as the elevator doors open. More than a dozen canvases with large, bold flowers reminiscent of artist Georgia O’Keeffe captivate the eyes and elicit a happy, calming effect. It’s what patients see every day they come for chemotherapy treatments. “When we asked the people of Yuma their dream for a community cancer center, many responses were not about clinical things. People wanted an environment that was healing,” says Machele Headington, Vice President of Marketing and Support Services. She oversees the Cancer Center’s Art Heals exhibit, an effort that embraces care beyond medicine through a holistic approach to healing. “Our mission is to create restorative and calming environments for patients, visitors and staff by integrating the arts and visual esthetics into the healing process,” Machele says.

“Art washes away from the soul the dust of everyday life.” ~ Pablo Picasso A team of cancer patients will make the final decision on what art will be displayed. “Having patients choose the art is a fabulous idea. They’ll see something we aren’t able to see,” Martha says. “I’m hoping eventually we can get the cancer patients to do some artwork themselves and to learn about art — beginning drawing, painting or even art therapy.” With three displays already up, the Art Heals exhibit will officially open this spring, adding more exhibits and an audio tour. “Cancer is a really scary time for patients and families,” Machele says. “If there’s anything we can do to add something bright in their day, it’s important that we do that. It amazes me how beautifully this has come together.”

No matter how tough life gets, Lora Dana believes in being positive. “There’s a saying that ‘Cancer isn’t a gift, but it shows you what the gifts in life are,’” she says. When severe lower stomach pain prompted her to see her doctor in 2010, Lora learned she had stage IV ovarian cancer. That diagnosis began a year of surgery followed by relentless chemotherapy treatments. The third-generation Yuman, mother of three and grandmother of 13 says, “You’re glad to have your feet hit the ground every morning after that.”

“My experience has made me slow down and smell the roses on the way.” As she battled hair loss, blood transfusions and bouts of nausea, her daughter gave her some paints and canvases for therapy. She had little art experience and was indifferent at first. When she started putting paint to canvas, however, it transformed her. “Expressing with paint releases a lot of what you’re holding inside. Painting makes you forget everything around you. It was the best therapy. I found a way to help me heal,” Lora explains. Her subjects are happy ones: flowers and whimsical dogs and cows, all in bold, bright colors. She was proud and extraordinarily pleased when Yuma Regional Cancer Center asked to display her works in the center’s Art Heals exhibit (see story on opposite page). “If my work puts a smile on people’s faces, that makes me feel good,” Lora says. “It’s such a stressful time when you go into a treatment facility. It’s usually so sterile looking, and often you’re waiting and waiting. The medicine can only work on the disease. Art Heals is a treatment for the soul.” “When you come so close to death, you have an appreciation of the small things in life. There are lots of things to be thankful for. My experience has made me slow down and smell the roses on the way.”

Cancer Registry Yuma Regional Cancer Center maintains a detailed cancer

YRMC CANCER CENTER CASES DIAGNOSED *NATIONAL COMPARISON OF SELECTED CANCER SITES *Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2014

registry to document important information about cancer BREAST

NATIONAL

CASES

PERCENT

CASES

PERCENT

CASES

PERCENT

18.2%

4,520

13.8%

235,030

14.1%

COLON

7.4%

2,560

7.8%

96,830

5.8%

is then used to study cancer trends and to identify poten-

CORPUS UTERI

4.6%

910

2.8%

52,630

3.2%

tial opportunities for early detection and/or treatment. The

LUNG BRONCHUS

18.5%

4,280

13.0%

224,210

13.5%

PROSTATE

6.2%

4,390

13.4%

233,000

14.0%

URINARY BLADDER

6.9%

1,490

4.5%

74,690

4.5%

ALL OTHERS

165

38.1%

14,680

44.7%

749,150

45.0%

TOTAL CASES

433

100.0%

32,830

100.0%

1,665,540

100.0%

* YRMC data is a partial data from January 2014 - Oct 2014

2014 CANCER CASES DIAGNOSED * YRMC data is a partial data from January 2014 - Oct 2014

140

111

120 80

100

80 60

S ER

LO TH

UM AL

RE CT

RU S BO NE MA RR OW LY MP HN OD ES UN KP RI MA RY

ST AT E

UT E

BLO OD &

AR UR IN

ON C

PR O

CO LO N

their medical expertise.

cases to determine the best course of treatment based on

board, groups of physicians who meet to review patient

cancer registry also coordinates the activities of the tumor

ARIZONA

they developed cancer and other critical factors. This data

“As we were designing the Cancer Center, our planning committee visited other centers across the country and found that many had gardens. We tested the idea here, and it was well-received. Patients and families remark on its beauty and peacefulness.”

they have, the treatments they receive, the age at which

“It’s very much part of the healing process at the Cancer Center to provide a place of respite from the often exhausting aspects of treatment,” says Wayne Steffey, Executive Director of the Foundation.

PRIMARY SITE

LU N

A soothing Serenity Garden with water features, desert plants, tranquil pathways and private seating areas opened in spring 2015 to bring the healing power of nature to patients, families and staff of the Yuma Regional Cancer Center. The Serenity Garden offers visitors a sense of calm and hope and a place for body, mind and spirit to rest and realign. A generous gift of $1.3 million from the Foundation of Yuma Regional Medical Center brought the garden to life.

patients in the community, including the types of cancer

Peace Flourishes in Serenity Garden

YRMC DATA*

Meet Vonni Dunn Her recommended course of action was 25 radiation treatments. Vonni and her husband were planning to leave Wisconsin for their winter in Yuma and she decided the sunny, mild climate might be a comfort while she underwent treatment.

After a social work career spent helping troubled children and disabled adults in her native Wisconsin, Vonni Dunn enjoys the RV life with her husband and her Shih Tzu, Ella. Officially residents of South Dakota, they travel the U.S., making friends and memories along the way. For the winter, they like to head to a Yuma RV park for some sunshine, relaxation and camaraderie.

“It makes you feel better when the sun is shining”

But this year, Vonni came with a different agenda. Each year, more than 50,000 women are diagnosed with uterine cancer. In September 2015, Vonni became one of them.

Compassionate Care Beyond Technology: The Linear Accelerator Team High-energy radiation has been used to treat cancer since late in the 19th century and is still a mainstay of treatment for many forms of cancer. More than half of cancer patients receive some form of radiation treatment.

“I had some vaginal bleeding and I was postmenopausal, so I looked online and it said that could be a symptom of cancer,” Vonni recalled. “I had a physical planned with my doctor, so I told her about it, and she sent me to the gynecologist, who did a biopsy. That’s when the cancer was discovered.”

At her first visit, Vonni noticed the attractive landscaping, design and décor. But she was more impressed with Dr. Takesuye and the staff. It was obvious that he had read her reports, and he and his nurse, Durana Havins, made sure she knew what to expect. They explained possible side effects and how best to handle them, and let her know she could call any time she had questions or concerns. Vonni did have some common side effects, but she managed them with medication and by following recommendations such as eating smaller, more frequent meals. She says her faith and the care beyond medicine that she found at the Cancer Center helped her stay positive.

in their home state but who winter in Arizona. These individuals are very strong, and they won’t let cancer interfere with their day-to-day plans. So we tailor the treatment plan for each patient based on their diagnosis, needs and desired schedule.”

Most external beam radiation therapy is administered using a linear accelerator, a device that can direct radiation treatment to any area of the body. The linear accelerator at the Cancer Center is used many times each day and is the highest quality available, but the in-house team behind the technology is what makes all the difference. Together, the team ensures each patient receives care beyond medicine. “The majority of our staff has deep roots in the community,” said Dr. Robert Takesuye, the Cancer Center’s radiation oncologist. “Many of our patients are friends, family or acquaintances, so we have a personal investment in providing the best care. We also get a significant number of patients who are diagnosed

Vonni again turned to the internet and was pleased to find the advanced care she needed right in Yuma at Yuma Regional Cancer Center. She chose to see Dr. Robert Takesuye, and her doctor made the referral.

“I can’t say enough good things about Dr. Takesuye and the staff,” she said. “They really have been very kind and compassionate.”

The first step after referral is a one-hour consultation, followed by a computed tomography (CT) scan to help tailor the treatment plan. A 30-minute appointment on the first day of treatment provides time for the team to meet with the patient and family, let them know what to expect from treatment, talk to them about any possible side effects and address any questions or concerns.

In mid-December, Vonni was nearing the end of her treatments, but she wasn’t putting her life on hold. She and her husband were making plans to travel to San Diego to see their beloved Wisconsin Badgers in the Holiday Bowl, and her spirits were high.

“When the patient is knowledgeable about the upcoming experience, it helps to relieve anxiety,” Dr. Takesuye said. “Our common goal is to give the patient the most pleasant experience possible during this very stressful time.”

“I feel that the radiation will be very successful,” she said. “I really feel that the cancer will be gone and I’ll be on the road to a full recovery.”

Early Detection Saves Lives: Lung Cancer Screening Program Lung cancer is one of the most common cancers treated at Yuma Regional Cancer Center and across the U.S., and progress in fighting the disease is promising. Unfortunately, many lung cancers are not detected until they have already begun to spread. Early detection can greatly increase a patient’s chances of survival, and lung cancer screening for qualified patients is now available to Yuma residents at the Cancer Center.

Bringing Specialized Knowledge to Cancer Care For Oncology Pharmacist Ramesh “Tony” Neerpat, the complex, potent medicines he and his staff prepare for cancer patients “are extending people’s lives and quality of life. That’s what drives me.” He thrives on the challenge of meticulously preparing the right medications, promptly. “Everything we do has a sense of urgency—always with safety in mind.” Tony’s 15 years of experience in oncology pharmacy give him a level of expertise with cancer drugs that a general pharmacist can’t duplicate. “Knowing the regimens and protocols for many different cancers and how to decipher those is a daunting task. For each patient, we may be using two to five drugs, and we have to know maximum and minimum doses, the rate at which to give the drugs, the order of drugs, their compatibility and how they should be administered,” he said. He also has an arsenal of medicines for chemotherapy side effects such as nausea and diarrhea.

The oncology pharmacy is located just steps away from the infusion center where patients receive chemotherapy treatments at Yuma Regional Cancer Center. Its proximity to patients and caregivers enhances communication between pharmacists, oncologists and nurses. For Tony, providing care beyond medicine means doing what’s right for every patient. It’s laughing and joking to keep people’s spirits up. It’s also keeping hard-to-get medicines stocked so patients get exactly what they need. He’s excited about a new wave of oral chemotherapy agents and is seeking government permission to dispense those drugs from the Cancer Center pharmacy to enhance patient convenience and safety. “Having chemotherapy they can take at home by mouth will be easier for patients but more responsibility. We’ll need to monitor them more closely and provide more education and counseling.”

“I love what we’re doing here, and I’m excited about the impact we’re making. The Cancer Center provides the best care in town. It’s a great place to be.” 12

The Cancer Center’s lung cancer screening program aims to keep the process as simple and convenient as possible. The first step is talking to your doctor and being honest about your smoking history. If your doctor finds you meet the guidelines for screening, you’ll be referred to our outpatient imaging center. The imaging process is quick, noninvasive, painless and low-risk, and can detect lesions as small as half a centimeter, while they are still highly treatable and may not yet be cancerous. One of the Cancer Center’s specialists will review you images closely, and if nothing is found, you’ll receive yearly reminders to come back for continued screening. If a lesion is found but is highly unlikely to be cancerous, you’ll need to return in six months for a follow-up screening to be sure the lesion hasn’t grown or changed. If a high-risk lesion is found, your referring doctor will be notified right away, and you will be referred to an oncologist, a cancer specialist who can help you evaluate your options and choose the best course of action, which will most likely involve surgery to remove the lesion. All the services needed for treatment are available close to home at Yuma Regional Medical Center.

“It’s easy, it’s quick and it can save your life.” The Cancer Center will be reaching out to primary care physicians and pulmonologists in the area to encourage them to refer qualified patients for lung cancer screening, and hopes to help educate the public about the importance and benefits of screening. “The key is to let these patients know, if they are in the age group and have been smoking since they were in their 20s or even earlier, that they really should get in to see their doctor and get screened,” said Dr. Thomas Cain, a radiologist with Yuma Regional Medical Center. “It’s easy, it’s quick and it can save your life.”

In February 2015, Medicare began offering coverage for a yearly lung cancer screening for high-risk patients using low-dose computed tomography (CT), and the screening is also one of the minimum essential benefits required under the Affordable Care Act. Eligible patients include those who: • Are age 55-77, and either currently smoke or have quit smoking within the last 15 years. • Have a tobacco-smoking history of at least 30 “pack years” (an average of one pack a day for 30 years, two packs a day for 15 years, and so forth). • Have a written order from a physician or qualified practitioner that meets certain requirements.

Lymphedema Services Close to Home

Applying New Knowledge to Fight Cancer: Clinical Research Program

For people who develop lymphedema following cancer surgery, Yuma Regional Cancer Center began offering lymphedema treatment services in June 2015. Lymphedema is a condition in which lymph fluids build up in certain areas of the body, causing pain that ranges from aching to intense. It is common with cancers involving removal of lymph nodes, such as breast, head and neck cancers.

When you’re fighting cancer, you want as many options as possible. Taking part in a clinical trial may offer the chance to be among the first to benefit from promising new treatments. Many of today’s standard treatment protocols began as clinical trials and are now saving thousands of lives.

“People who were unable to travel didn’t receive care at all...” On the Cancer Center’s second floor, two physical therapists and a physical therapy assistant, all certified in lymphedema therapy, work with patients to manage pain through light massage, exercise programs, compression of swollen areas using bandages or garments, and other techniques. “Before we offered this service, patients had to travel great distances, several days a week, to receive lymphedema care,” said Physical Therapist and Certified Lymphedema Therapist Melissa Lea. “People who were unable to travel didn’t receive care at all. When Yumans looking for lymphedema services find that we offer care here, they are thrilled and so grateful not to have to travel for this treatment.” Offering lymphedema treatment is one more way the Cancer Center is fulfilling its promise of offering care beyond medicine to the Yuma community. In June 2016 the rehab team plans to expand services to include speech and language therapy to address changes in communication and swallowing as a result of head and neck cancer.

Yuma Regional Cancer Center’s growing Clinical Research Program began in 2013 and is committed to bringing clinical trials of innovative new therapies to the Yuma area. The program is one of only eight in Arizona to be accredited by the American College of Surgeons Commission on Cancer. Currently, 13 studies are ongoing and three more are pending approval. Qualified patients can take part in these studies without having to travel to a distant city. Several of the trials involve new types of immunotherapy that can help trigger the body’s immune system to fight cancer. One immunotherapy treatment currently being studied at the Cancer Center is showing success against head and neck cancer, with one patient’s tumor shrinking significantly. The same drug is showing progress against metastatic (spreading) lung cancer, one of the most commonly treated cancers at the Cancer Center. The Cancer Center is also currently enrolling for trials testing new treatments for: • Breast cancer that has spread to the bone • Triple negative breast cancer • Pancreatic cancer, using monoclonal antibodies, molecules that are engineered to attach to specific defects in cancer cells A trial soon to begin will focus on breast cancer neutropenia (a low white blood cell count). Several supportive care observational studies are ongoing for prostate cancer, blood cancers and polycythemia vera, a bone marrow disorder that causes too many red blood cells to be produced. Bringing novel, promising treatments closer to home is part of our commitment to care beyond medicine. Our clinicians, researchers and study participants are also contributing to an ever-growing body of knowledge that is already saving countless lives — and may one day lead to a cure.