Download The Cancer Center 2015 Annual Report With

The Cancer Center 2015 Annual Report
With statistical data from 2014
Chairman’s Report
We are excited that work has begun on a new infusion suite at the Cancer Center which we anticipate
will open next year. With a new design concept, this will provide us with an updated facility to better
serve our patients who need intravenous and related therapies. Our newly installed true beam linear
accelerator is fully operational and together, we are well positioned through collaboration, to provide
modern, combined-modality cancer treatment to our patients in a community setting.
The cancer program at Phoenixville continues to be accredited through the American College of
Surgeons and through the National Accreditation Program for Breast Centers, ensuring that quality
review and performance measures are provided to our patients and available to their treating
physicians. In addition, we continue with collaborative relationships the American Cancer Society and
the Abramson Cancer Center of the University of Pennsylvania with whom, we provide clinical research
and a genetic risk screening program.
Thanks to a grant from the Phoenixville Health Care Foundation and with donations from individuals, we
continue to emphasize quality of life concerns by providing complimentary Reiki, massage and spiritual
supportive care to our patients. This grant also allows for us to provide assistance to selected patients
facing financial hardship through our Patient Assistance Fund.
My personal thanks to all my colleagues and to our staff for the dedicated hard work and expertise that
allows us to provide high-quality cancer care to our community.
Christopher Holroyde, MD
Cancer Center Medical Director
Clinical Research and Quality Improvement
This past year efforts continued on many areas to improve our efforts to provide the best care possible.
Quality improvement efforts involved most areas of the Cancer Center. The area with the most effort
was participating successfully in the QOPI program of the American Society of Clinical Oncology. This is
premier national and international organization monitoring and establishing good practice guidelines in
oncology. Efforts will continue in the next year in this area.
The Cancer Center continues to bring new treatments to the Phoenixville area. Through an affiliation
with The Abramson Cancer Center at the University of Pennsylvania phase I, II, and III studies are
available. Last year studies for ovarian, breast, colon and lung cancer were opened looking at initial
treatments and maintenance treatments. Maintenance treatments have long been a goal to lengthen
remissions and improve ones quality of life. There are now chemotherapy agents that have a side
effect profile that can be used for extended treatment times and there are early phase studies showing
these medicines can be of benefit. Longer studies with a larger group of individuals graciously agreeing
to participate is how these needed treatments will be found.
The Cancer Center continues to participate in National Cancer Institute sponsored studies. One of the
Cancer Center’s missions is to continue to offer the latest treatments.
As new studies open up to accrual, participation will be offered here in Phoenixville.
Carl Sharer, DO
Survivorship for the Cancer Center at Phoenixville Hospital
The Survivorship Program at Phoenixville Hospital’s Cancer Center is a collaborative process between
the medical oncology, radiation oncology and surgical oncology staff members. The process involves a
succinct and clear treatment summary and follow-up plan that is easy for the patient to comprehend
and follow. The written document is provided to the patient and primary care physician. The plan is
communicated to the patient during the 3 month counseling and/or a follow up visit once the patient
has completed active treatment.
The survivorship program at Phoenixville Hospital meets the 2015 Commission on Cancer Standard 3.3
and is focused on a select group of patients who have been treated with curative intent with cancer
from all disease sites.
In early 2014, a pilot was performed using “survivorship software” including Lance Armstrong, Journey
Forward and American Society of Clinical Oncology (ASCO). Once all three formats were trialed, the
ASCO format was chosen for use by both medical and radiation oncology. Our focus for the first year is
all the breast cancer patients, which are roughly one third of our total volume. Educational materials
will be given to patients including the National Cancer Institutes’ Facing Forward – Life after Cancer,
information about exercise, nutrition, and symptom management as needed. A letter will be sent to the
primary care physician with a copy of the treatment summary print out.
We feel prepared to meet the 2015 requirement with the work and processes we have put into place.
Victoria Korkus, CRNP
2014 Long – Term Study: Colon Cancer
Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer
death in both men and women in the US. The American Cancer Society estimates that 136,830 people
will be diagnosed with colorectal cancer and 50,310 will die from the disease in 2014.
The existing knowledge about cancer prevention and recommended screening tests may account for a
4% per year decrease in incidence for both men and women from 2008 to 2010. Screening has the
potential to prevent colorectal cancer because it can detect and remove precancerous polyps.
The following study looked at colon cancer patients treated at Phoenixville Hospital in 2014. We
compared our data with the National Cancer Data Base as well as Phoenixville Hospital colon patients
from 2010.
All patients were first diagnosed and/or received all or part of the first course of treatment at
Phoenixville Hospital. We diagnosed 34 patients with colon cancer in 2014. Adenocarcinoma NOS was
the most common histology with 17 cases, or 50%. Other histology included adenocarcinoma in
adenomatous polyps, adenocarcinoma in tubulovillous adenoma, and mucinous adenocarcinoma.
Age at presentation:
More than half of the patients were between 50 and 69 years old at diagnosis with almost twice as
many men as women which align with the data presented in the American Cancer Society Colorectal
Cancer Facts & Figures 2014 – 2016 report.
Sex / Age Distribution for Phoenixville Hospital 2010 - 2014
7
6
5
4
Male
3
Female
2
1
0
50 - 59 60 - 69 70 - 79 80 - 89 90 - 99
Sex by stage – 2010 - 2014 Colon Cancer at Phoenixville Hospital
25
20
15
Male
Female
10
5
0
0
I
II
III
IV
UNK
At Phoenixville Hospital over the last 5 years, men were diagnosed more with Stage 0 and 1 colon
cancers than women. Women were diagnosed more often with Stage 2 or 3 colon cancer and men
again with a larger percentage for Stage 4.
Five year Survival by Stage – 2010 – 2014 Phoenixville Hospital Colon Cancer
SURVIVAL CHART
100
0
YEAR 5
20
YEAR 4
40
2010-ANALYTICCASES
YEAR 3
STAGE 4 CASES
YEAR 2
60
YEAR 1
STAGE 3 CASES
80
BEGI…
STAGE 2 CASES
In general, the relative survival rate for colorectal cancer is 65% at 5 years. Only 40% of colorectal
patients are diagnosed with localized-stage disease. Survival declines to 13% for patients diagnosed
with distant stages. According to American Cancer Society surveillance research, the 5 year relative
survival rate has increased from 51% to 65% for colon cancer since the mid 1970’s. The five year
Phoenixville Hospital survival graph clearly demonstrates and supports that early stage at diagnosis
confers a better long-term prognosis for all stages except Stage 4.
AJCC Stage by treatment combinations
2014-Colon cases
SUMMARY AJCC STAGE GROUP
Surgery
Surgery/Chemo
None
Chemo
All Others
NBR
NBR
NBR
NBR
NBR
0
1
2
3
4
ANY OTHERS
2
7
5
6
0
2
0
0
2
6
0
0
0
0
0
0
0
2
0
0
0
0
0
2
0
0
0
0
0
0
OVERALL TOTALS
22
8
2
2
0
CONTROLLING VARIABLES
0 is SUMMARY AJCC STAGE GROUP 0
1 is SUMMARY AJCC STAGE GROUP 1
2 is SUMMARY AJCC STAGE GROUP
2A,2B,2C
3 is SUMMARY AJCC STAGE GROUP
3A,3B,3C
4 is SUMMARY AJCC STAGE GROUP 4
14
12
Series1
10
Series2
8
Series3
Series4
6
Series5
4
Series6
2
Surgery
0
1
2
3
4
5
6
American College of Surgeons Commission on Cancer
National Cancer Data Base (NCDB) Hospital Comparison Benchmark Reports
Hospital comparison reports are available from the NCDB for years 2000 to 2013. Various comparisons
can be made by primary site, hospital type, location, and diagnosis year.
Below is a sample of hospital comparison benchmark reports on colon cancer for all Community Cancer
Program Hospitals in Pennsylvania. This data is taken from 19 similar sized hospitals for comparison.
This is a valuable tool for assessing our diagnostic and therapeutic efforts as more data from additional
years are added to the data base.
Incidence of Colon Cancer by Age
Phoenixville Hospital diagnosed a larger percentage of patients in the 50 – 59 and 70 - 79 age brackets
than the comparison group, and significantly fewer in the 60 – 69 and 80 – 89 year age groups. In the
age groups less than 50 years old and over 89 years old, there seemed to be no difference with
comparison group hospitals.
Colon Cancer Stage by Sex
In comparing Phoenixville Hospital to 20 other Community Cancer Program hospitals, most stages
parallel our findings. Men are diagnosed at a greater number for stages 0, 1, and 4. Women are
diagnosed more frequently than men at stage 3 for Phoenixville, but not in the comparison hospitals.
Both graphs support a similar result for stage 2 colon cancer.
Phoenixville Hospital colon cancer cases stage at diagnosis were seen to be higher than similar hospitals
in Pennsylvania for stages 1, 2, and 3. Cases were slightly lower at Phoenixville for stage 0 and almost
half of stage 4 presentations. Unknown staging was comparable in all hospitals.
First course of treatment for Phoenixville Hospital compared with other Pennsylvania Community
Cancer Program Hospitals is very similar in the surgery only and chemotherapy only treatment arms.
Patients receiving both surgery and chemotherapy were 13% higher at Phoenixville Hospital compared
with other hospitals. Other hospitals reported almost 9% of patients receiving no first course of
treatment while at Phoenixville there were no patients reported for this category.
Conclusion
A review of the NCDB Comparison Reports for Colon Cancer found the gender distribution of cases to be
similar in comparison to similar hospitals in Pennsylvania. Age distribution was dissimilar with
Phoenixville having many more patients in the 50 to 59 and 70 to 79 age categories. Stage at
presentation parallel other hospitals for Stages 0, 1, and 4. Stage at presentation was similar for all
stages except Stage 4 where there were almost half as many as the comparison hospitals.
Community Health Education and Outreach Department continue to provide the community with
education and resources for colon screening importance and opportunities. Employee education within
Phoenixville Hospital system is available at employee health fairs and publications featuring health
stories throughout the year.