Download Community Memorial Hospital Cancer Program 2012 Annual Report

Community Memorial Hospital
Cancer Program
2012 Annual Report
CMH Cancer Program 2012 Annual Report
Mission
To Heal, Comfort and Promote Health
for the Communities We Serve.
Vision
To be the regional
health system of choice for patients,
physicians and employees
by providing the latest treatments.
To be a valued community treasure.
Value
Integrity, Excellence,
Caring and Transparency.
Page 2
CMH Cancer Program 2012 Annual Report
Message from the Cancer Committee Chair
Being diagnosed with cancer can be frightening and overwhelming, and deciding where to seek treatment can
be difficult. The goal of patient care services at Community Memorial Hospital (CMH) is to provide appropriate
individualized and coordinated care throughout the patient’s treatment. The physical, psychosocial and spiritual needs
of patients and their families are fulfilled by a variety of health care professionals, consisting of physicians, nurses,
pharmacists, dietitians, social workers, rehabilitation services, to name a few. The team at CMH has been working hard
to have a positive impact on healthcare in our community.
We continue to strive to improve our services. In 2012 we received a grant from the Avon Foundation for a
Breast Cancer Navigator program. With these funds we were able to hire a Nurse Navigator part time and increase the
availability of our social worker. We hope to continue to grow this program and add Navigation services for other
types of cancer.
The Cancer Resource Center continues to be a valuable part of our Cancer Program. Located in the Coastal
Community Cancer Center, additional services were added in 2012 including weekly Tai-Chi and Yoga Therapy. A
comprehensive overview of the services offered at the CRC
is listed on page 17 of this report.
Our Cancer Program was originally accredited by
the American College of Surgeons Commission on Cancer
in 2008 and we have elected to maintain our
accreditation . The quality standards established by the
Commission on Cancer ensure:
• Comprehensive care including a complete
range of state-of-the-art services and equipment
• A multidisciplinary team approach to coordinate
the best available treatment options
• Information about ongoing cancer clinical trials
and new treatment options
• Access to prevention and early detection
programs, cancer education, and support services
• A cancer registry that offers lifelong patient follow-up
• Ongoing monitoring and improvements in cancer care AND
• Quality care, close to home
Our physicians and staff remain dedicated to providing state of the art comprehensive cancer care in Ventura
County. In this Annual Report, we will give a detailed report of those services and Dr Beaghler will discuss the
highlights of Urologic Cancers at CMH.
Lynn Kong, MD
Cancer Committee Chairman
Page 3
CMH Cancer Program 2012 Annual Report
Overview of Community Memorial Hospital
What originated in 1902 as a single hospital serving its neighbors has today grown into an expansive healthcare
system that touches the lives of individuals throughout Ventura County, California and beyond.
Community Memorial Health System, established in 2005 when Community Memorial Hospital in Ventura
merged with Ojai Valley Community Hospital, is comprised of these two hospitals along with eleven family-practice
health centers serving various communities within Ventura County.
Our health system is a community-owned, not for profit organization. As such, we are not backed by a
corporate or government entity, nor do we answer to shareholders. Rather, we depend on—and answer to—the
communities we serve.
Guiding us on this esteemed mission is a volunteer and diverse Board of Trustees that represents a cross
section of leaders in our community, and who govern Community Memorial Health System with a focus aimed on what
is best for our citizenry.
In 2012, CMHS had over 400,000 patient visits. CMH is an eight story, 242 bed state-of-the-art facility which
provides a vast array of medical services and programs. We have 530 physicians on staff and over 2,000 employees
and are one of Ventura County’s largest employers. CMH also has 400 volunteers. CMH is the regional leader in
cardiac care with the lowest coronary artery bypass graft mortality rate in the county, as well as one of the lowest in
the country, and has received the Blue Cross/Blue Shield award of Distinction for cardiac care. CMH has the busiest
orthopedic program in the county. The Cancer Program is the only accredited program in Western Ventura county.
CMH is also a Primary Stroke Center and the leading birth facility in Ventura county with 2,481 births in 2012. Our
Emergency Department , which is the designated critical heart patient receiving center, had over 41,000 visits in 2012.
CMH has the region’s leading surgical robotics program with over 800 procedures accomplished by the end of 2012 and
has the most experienced daVinci surgeons in Ventura county. CMH also has an outstanding Palliative Care Program
dedicated to helping patients and their loved ones cope with serious illness. This team includes Palliative Care
physicians, Palliative Care nurses, Social Workers and a Chaplain. CMH has an outstanding wound care center including
hyperbaric medicine. The Breast Center has been designated as a Breast Imaging Center of Excellence by the American
College of Radiology and CMH is also an accredited bariatric center.
CMH is accredited by Det Norske Veritas (DNV)
and undergoes survey by this organization annually.
DNV has extensive worldwide healthcare experience
and has a reputation for quality and integrity in
certification. CMH has been voted #1 by the community consistently for the last decade in the Consumer
Choice and Ventura County Star polls.
Page 4
CMH Cancer Program 2012 Annual Report
Overview of the CMH Cancer Program
The CMH Cancer Program has been accredited by the American College of Surgeons (AC0S) Commission on
Cancer (CoC) since 2008. Accreditation ensures that cancer patients at CMH receive the highest quality of care. The
goal of the cancer program at Community Memorial Hospital is to provide high quality services to both the patient and
their family. Our greatest asset is the compassionate, personalized care afforded our cancer patients.
Quality cancer care is a team effort. The spectrum of cancer care at Community Memorial Hospital is monitored by the
cancer committee, a group of physicians and departmental representatives involved directly or indirectly in the
treatment of cancer patients. The committee ensures that consultative services are available to all cancer patients and
their families.
Patient-oriented multidisciplinary cancer conferences are held weekly. Current case treatment and management
options are discussed during these conferences, affording the cancer patient with a broad spectrum of comprehensive
specialty input. The Cancer Registry maintains a database of the cancer patient’s history, diagnosis, stage, and
treatments for all patients diagnosed and/or treated at CMH. Treatment outcomes and survival statistics are
maintained by conducting lifelong annual follow-up on all cases. The Cancer Registry data generates accurate and
meaningful information to be used by the cancer committee, medical staff and hospital administration to improve
quality care.
Community Memorial Hospital has long been committed to assisting
cancer patients from diagnosis through recovery. Helping enhance the
level of services provided, CMH is extremely proud to provide a wide
range of services within the Cancer Program. Many of these services
are provided at the CMH Cancer Resource Center.
In January 2011, the CMH Cancer Program moved into its permanent
home , the Cancer Resource Center, within the Coastal Communities
Cancer Center. This improved accessibility to the cancer program for
cancer patients and their families. The Cancer Resource Center
partners with the American Cancer Society, the Cancer Support
Community and local physicians to provide free programs, education,
and support to cancer patients and their families.
Some of the free services provided at the Cancer Resource Center are:
cancer related publications, research assistance, a licensed social
worker , a cancer patient nurse navigator, spiritual care services, complementary therapies such as Reiki, Reflexology and Feldenkrais, Yoga and Tai Chi classes, art therapy, a wig and hat
bank, nutrition consults and classes, as well as many site specific and general cancer support groups for both patient
and caregivers. Please refer to the table on the page 17 for details of the Cancer Resource Center offerings in 2012.
Kathleen Horton, CTR
CMH Cancer Program Manager
Page 5
CMH Cancer Program 2012 Annual Report
Cancer Registry Report 2012
The American Cancer Society Cancer Facts & Figures 2012 estimated that over 1.6 million new cancer cases will
be diagnosed in 2012 in the United States. Of those cancer cases, an estimated 165,810 will be diagnosed in California.
At Community Memorial Hospital, during 2012, a total of 1008 cancer cases were entered into the cancer
registry’s database. This is up from 995 cases in 2011.
Annual CMH Cancer Caseload-Trend Over Time
1010
1008
1008
1005
Number
of Cases
1000
995
995
990
985
2010
2011
Year
2012
Of those 1008 cases, 829 were newly diagnosed and/or treated cancer cases. The remaining 179 cases ere
previously diagnosed and/or treated elsewhere but came to CMH for subsequent care.
TopTen
Ten Sites
Sites at
Top
atCMH
CMH2012
2012
3%
3%
3%
20%
5%
Breast
Prostate
Lung
Melanoma
5%
Bladder
Colorectal
6%
Corpus uteri
Thyroid
Ovary
7%
19%
8%
Page 6
Non-hodgkin lymphoma
CMH Cancer Program 2012 Annual Report
Cancer Registry Report 2012
The top ten sites of cancer in 2012 at Community Memorial Hospital include: breast (20%), prostate (19%) lung
-both small cell and non-small cell (8%), melanoma (7%), bladder (6%), colorectal (5%), thyroid (3%), ovary (3%) and
non-Hodgkin lymphoma (3%).
The patient population at CMH is slightly older when compared to the National Cancer Database.
Age at Diagnosis—CMH Compared to National Cancer Database
With a reference date of January 1, 2006 the Community Memorial Hospital (CMH) Cancer Registry data base
now has seven years of complete data. This data includes information about the diagnostic work-up, primary site of
origin, stage of disease at diagnosis, first course treatment and survival of all CMH cancer cases. The Cancer Registry
data is available to CMH physicians to evaluate the effectiveness of early diagnosis, treatment and survival. Staff
physicians are encouraged to access the data available in the Cancer Registry. Requests for data can be made by calling
(805) 652-5459.
The statistical data provided to our medical staff and hospital administrators is used for cancer program
development, evaluation of patient outcomes and assessment of patient services. The cancer registry data is also
required to be reported to the American College of Surgeons National Cancer Data Base, the California Cancer Registry
and the National Cancer Institute’s SEER Registry.
Chris Wilborn, CTR
Cancer Registrar
Page 7
CMH Cancer Program 2012 Annual Report
Cancer Registry Report 2012
Comparison of 2012 Major Site Distribution
Primary Site
Community
Memorial
California
United States
Breast
20%
15%
14%
Prostate
19%
14%
15%
Lung
8%
11%
14%
Melanoma
7%
6%
5%
Urinary Bladder
6%
4%
4%
Colorectal
5%
9%
9%
Definitions
The CMH Cancer Registry collects data on all analytic
and non-analytic cases with the exception of basal
and squamous cell cancers of the skin.
Analytic Cases
 Patients who were diagnosed and initially
treated at CMH.
 Patients who were diagnosed at CMH but
received their first course of treatment
elsewhere.
 Patients whose cancers were diagnosed
elsewhere, but who received all or part of
their first course of treatment at CMH.
Non-Analytic Cases
 Patients whose cancers were diagnosed and
initially treated elsewhere and were referred
to CMH for disease persistence or recurrence.
 Patients whose cancers were diagnosed and
initially treated elsewhere and were referred
to CMH for care of either persistent,
recurrent or metastatic cancer.
AJCC Staging
American Joint Commission on Cancer (AJCC) TNM
(Tumor, Nodes, Metastasis) Staging and Classification
system is a method for measuring the extent of
disease, usually at the time of diagnosis. Clinical and
pathologic staging are both used as appropriate
based on the type of cancer.
Page 8
CMH Cancer Program 2012 Annual Report
2012 Site Table
Site
ALL SITES
LIP
TONGUE
SALIVARY GLANDS, MAJOR
GUM
MOUTH, OTHER & NOS
TONSIL
HYPOPHARYNX
ESOPHAGUS
STOMACH
SMALL INTESTINE
COLON
RECTUM & RECTOSIGMOID
ANUS,ANAL CANAL,ANORECTUM
LIVER
GALLBLADDER
BILE DUCTS
PANCREAS
PERITONEUM,OMENTUM,MESENT
LARYNX
LUNG/BRONCHUS-SMALL CELL
LUNG/BRONCHUS-NON SM CELL
PLEURA
LEUKEMIA
MYELOMA
OTHER HEMATOPOIETIC
SOFT TISSUE
MELANOMA OF SKIN
OTHER SKIN CA
BREAST
CERVIX UTERI
CORPUS UTERI
OVARY
VAGINA
VULVA
PROSTATE
TESTIS
BLADDER
KIDNEY AND RENAL PELVIS
OTHER URINARY
EYE
BRAIN
OTHER NERVOUS SYSTEM
THYROID
OTHER ENDOCRINE
HODGKIN'S DISEASE
NON-HODGKIN'S LYMPHOMA
UNKNOWN OR ILL-DEFINED
Total
Class
Sex
Cases Analytic NonAn
1008
829
179
2
3
2
1
2
2
1
6
5
1
34
21
5
9
2
6
22
2
3
14
66
2
22
6
13
8
71
4
201
13
47
26
6
11
187
3
60
17
1
1
10
16
28
3
2
26
15
2
3
2
1
2
2
1
3
3
1
33
18
5
7
1
4
14
2
3
12
57
1
18
4
8
6
70
4
191
12
45
17
4
8
113
3
53
13
1
1
8
11
26
2
1
22
11
0
0
0
0
0
0
0
3
2
0
1
3
0
2
1
2
8
0
0
2
9
1
4
2
5
2
1
0
10
1
2
9
2
3
74
0
7
4
0
0
2
5
2
1
1
4
4
M
497
F
511
2
2
2
0
1
1
1
4
3
0
22
15
3
6
1
2
13
0
2
8
30
2
11
3
4
2
47
3
1
0
0
0
0
0
187
3
48
15
0
0
5
2
16
3
0
18
9
0
1
0
1
1
1
0
2
2
1
12
6
2
3
1
4
9
2
1
6
36
0
11
3
9
6
24
1
200
13
47
26
6
11
0
0
12
2
1
1
5
14
12
0
2
8
6
Page 9
Stage
Stage 0 Stage I Stage II Stage III Stage IV
87
213
197
119
97
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
0
39
0
0
0
1
3
0
0
26
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
6
2
0
5
0
0
0
0
2
1
12
1
0
0
0
0
35
1
77
6
25
4
0
1
0
0
13
8
0
0
0
0
10
0
0
3
0
2
0
0
1
0
0
0
0
0
1
9
4
0
0
0
0
5
0
0
1
3
0
0
0
0
2
14
0
42
2
7
1
0
1
89
0
4
0
0
0
0
0
2
0
1
6
0
0
0
1
0
0
1
0
2
0
0
10
11
2
1
0
1
0
0
1
2
14
0
1
0
0
0
4
2
17
4
5
9
0
3
16
0
2
2
0
0
0
0
3
0
0
5
0
0
2
1
0
1
1
0
1
2
0
5
1
0
0
1
1
8
0
0
8
26
0
0
0
0
1
1
1
7
0
2
3
3
0
5
0
2
3
0
0
0
0
4
0
0
7
0
N/A
69
Unk
47
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
17
4
8
0
0
0
0
0
4
0
0
0
0
0
0
0
1
1
8
11
0
2
0
0
11
0
0
0
0
1
0
0
0
1
0
2
0
3
1
0
2
1
0
0
0
2
0
0
0
0
3
0
0
9
0
2
0
0
0
3
3
6
0
0
0
0
0
7
0
0
1
0
CMH Cancer Program 2012 Annual Report
Cancer Conferences 2012
The CMH Cancer Conference (Tumor Board) is held every Wednesday of the month at noon in the CMH Board
room. During cancer conference, patient’s cancer cases are discussed, enabling the physicians coordinating the
patient’s treatment to gain input from a number of healthcare professionals representing a variety of specialties. The
discussions include: interdisciplinary patient management options based on current standard of care; references to the
national guidelines; results of completed clinical trials; and availability of open clinical trials. Recommendations
relevant to the patient’s care are thoroughly evaluated before a treatment plan is created.
During the year 2012, a total of 203 cases were
presented at Cancer Conference which comprised a wide range
of cancer diagnoses. This total represents approximately 20%
of CMH’s annual caseload.
In 2012, there were also two educational conferences
held. On October 31, 2012, Christy Russell, M.D., Associate
Professor of Medicine and Co-Director of the Norris Breast
Center at the University of Southern California Los Angeles,
spoke on ER Positive Breast Cancer: New Pathways to Improved
Outcomes. On November 21, 2012, Harry P. Erba, M.D., PhD.,
from the University of Alabama at Birmingham, presented
Community Oncology Clinical Debates: Chronic Myelogenous
Leukemia. The two debates presented were: ‘How Do You
Choose the Optimal Frontline Therapy for Patients with CML?’
and ‘How Should the Relapsed/Refractory CML Patient Be
Treated?’
The table on the following page shows the number of cases by site that were presented to the CMH Cancer Conference
in 2012.
Jeffrey Rodnick, M.D.
James Woodburn, III, M.D.
Cancer Conference Coordinators
Page 10
CMH Cancer Program 2012 Annual Report
Cancer Conferences 2012
2012 Cancer Conference Case Summary
Primary Site
Number of Cases Presented
Breast
Skin
Soft Tissue
Colon/appendix
Uterus
Prostate
Lung
Bladder
Rectum/Anus
Kidney
Vocal cord/epiglottis
Unknown site
Lymphoma
Ovary
Cervix
Esophagus
Thyroid
Tongue
Pancreas
Stomach
Bone marrow
Lip
Pharynx
Vulva
Total Cases Presented
63
44
15
10
9
8
7
7
7
4
4
4
3
3
3
2
2
2
1
1
1
1
1
1
203
Page 11
CMH Cancer Program 2012 Annual Report
Oncology Nursing
Cancer nurses are required to maintain a balance of high touch in a highly technical environment. They take
the best of what we know in cancer care to manage common physical problems like pain, fatigue, nausea and mouth
sores. They understand the experience of uncertainty and suffering and provide care to address the emotional,
spiritual and cultural context of cancer and its impact on the human spirit. The joy in their work comes from engaging
with their patients and their families to preserve function, optimize life quality, and maintain high quality of life in spite
of a cancer diagnosis. They make sure that patients and families find their voice and that their voice is heard as
treatment decisions are made. As integrators of care,
cancer nurses work the health system to find resources to
make sure that patients and their families get the best
care possible.
At CMH, our inpatient oncology unit consists of a
highly skilled nursing staff that have advanced training in
the care of those experiencing oncologic illnesses and end
-of-life issues. Many registered nurses on the Oncology
nursing floor complete the Oncology Nursing Society’s
Chemotherapy and Biotherapy Provider course and are
clinically validated annually. We are proud to have a
number of our staff certified in both oncology and
palliative care. This reflects our staff’s commitment to
excellence and continuing education. Our nursing staff
continues to provide an environment that is calm and
healing. Our goal is to continually meet the highest
standards of patient care, improving patient outcomes by
reducing length of stay, and increasing patient and family
satisfaction as well as staff satisfaction.
Florence Roach, R.N.
Director, Oncology Nursing
Page 12
CMH Cancer Program 2012 Annual Report
Oncology Social Services
At the CMH Cancer Program we recognize that a diagnosis of cancer may feel overwhelming and be farreaching. Therefore, along with physicians and nurses, we provide psychosocial services to help with the emotional and
psychological needs of patients, their caregivers and loved ones, during this challenging time.
What affects a person physically, also affects them emotionally, intellectually, spiritually, sexually and socially.
Receiving a cancer diagnosis can also impact an individual's sense of self or identity.
As the CMH Cancer Resource Center’s Oncology
Social Worker, I assist cancer patients and their loved ones
by:
Discussing the emotional challenges of dealing with a
potentially life-limiting illness.
Guiding patients and their family members through the
healthcare system.
Directing patients to available resources, including
financial assistance programs and support groups.
Helping patients devise a system to keep track of their
appointments, medical information and medical bills.
Providing information on having important conversations
with physicians, family and friends.
Assisting in the adjustment to life after treatment.
Providing information on, and the completion of ,
Advance Health Care Directives, such as a Durable Power of
Attorney for Healthcare, POLST or Five Wishes.
Providing a screening tool for measuring distress. A tool
to identifying areas of concern and resources and information
to address those concerns.
In 2012, I was available 8 hours a week to assist cancer patients at the Cancer Resource Center. During that
time I provided services to 97 cancer patients and their family members. In 2012 we were granted funds from the
Avon Foundation which allowed my hours to be increased to 16 per week in 2013.
Jody Giacopuzzi, LCSW
Cancer Program Social Worker
Page 13
CMH Cancer Program 2012 Annual Report
Rehabilitation Services
The Lymphedema Program is serving patients with primary and secondary lymphedema of all ages.
Secondary lymphedema is commonly associated with cancer surgery involving lymph node dissection as well as
radiation therapy. The lymph system’s circulation is disrupted and lymph fluid accumulates in the region of the associated lymph node removal/radiation site which presents as swelling. Symptoms include fullness, heaviness, discomfort,
and lack of mobility in the affected area due to the enlargement of extremities.
The most common patient group the program sees is women with post mastectomy lymphedema.
Lymphedema can occur in the upper quadrant of the affected side and can be successfully managed with Complete
Decongestive Therapy.
Primary lymphedemas and other edemas, e.g. due to
venous stasis with associated wounds, venous insufficiency,
morbid obesity, and immobility are equally successfully treated
with Complete Decongestive Therapy and the Lymphedema
Program has seen an increasing number of patients with such
diagnoses.
Risk reduction, prevention, education, and increasing the
awareness of lymphedema remain high priorities of the
Lymphedema Program. The monthly screening clinic and support
group serve to reach out and inform patients and their families
and give hope that successful management is indeed possible
with early and consistent intervention.
The Lymphedema Program is a partnership of the
Rehabilitation Department and the Cancer Resource Center.
Besides screening for and treating lymphedema it is able to
provide oncology rehabilitation services to restore health and
wellness to patients with cancer and beyond.
Claudia Steele-Major, PT, CT-LANA
Lymphedema Therapist
Rehabilitation Services
Page 14
CMH Cancer Program 2012 Annual Report
Palliative Care Services
As the future of healthcare remains uncertain, the principle of patient and family support during serious illness
is not. Palliative Care throughout the course of illness and treatment involves addressing physical, intellectual,
emotional, social and spiritual needs. It improves autonomy, access to information, and choice. Palliative Care can be
provided simultaneously with any other treatments and may begin early in the course of a serious or chronic disease.
The Palliative Care team saw the first patients in 2008. We have since grown into a robust, interdisciplinary
service that consulted over 500 pts in 2012. Our team includes board certified members in each of their respective
fields. PCMD Pankratz has been our full time physician and Medical Director since 2010. PCRNs Diana Jaquez and Laura
Fitts provide clinical oversight of the daily needs and education for our staff, patients and families, while MSW Janine
Coronado and LCSW Cathy Dorsey assist our clients in exploring their social, financial and emotional needs as they
affect their medical treatment plan and QOL. Reverend Curtiss Hotchkiss is essential to Palliative Care as he explores
the spiritual nature of the patient and families journey which often is a significant barrier to acceptance. This team
along with MD James Hornstein and MD Tara Snow has provided excellence in patient centered oversight.
As our service has matured since 2008 we no longer primarily consult
with patients and families to discuss and coordinate end of life care. 56 % of
patients seen by the Palliative Care services had discharge plans which did not
involve hospice or end-of-life care. While it is a difficult time for patients and
families, when surveyed, they report a 98% satisfaction score with their
Palliative Care experience, in addition to continuing a 95% physician
satisfaction score.
In order to address the palliative care needs of our community outside
the hospital an outpatient palliative care clinic has been developed and
implemented. It represents collaboration of the Community Memorial Health
System, the Palliative Care Team, Pulmonology group and the Cancer Clinic as
it continues to expand services to patients from the time of diagnosis to the
completion of treatment.
Looking to align the needs of the community with the strategic plan of the hospital, we plan integration of PCS
into the ED and ICU utilizing national guidelines by initiating PC triggers for early identification of appropriate PC
patients. As we expand our services to outpatients, we continue to improve access to Palliative Care within the hospital
and our community.
Charles Pankratz, M.D.
Diana Jaquez, RN, MSN, OCN
Palliative Care Services
Page 15
CMH Cancer Program 2012 Annual Report
Community Outreach
Community outreach is one of our main priorities. The CMH Cancer Program provides cancer education for the
community as well as cancer screening events. The CMH Cancer Resource Center provides ongoing patient and family
support with their educational programs, complementary therapies and wellness programs. See the table on the
following page for information on the services and number of patients served in 2012.
In 2012, lectures were provided to the general public on End of Life Care (by Dr James Hornstein), End of Life
Ethics (Hospice Foundation of Americans Living with Grief Program), Skin Cancer (by Dr Arthur Flynn), and Advances in
Diagnostic Imaging (by Dr Irwin Grossman). CMH continues to offer cancer screening for breast, prostate, cervix, skin
and colorectal cancers through the outpatient department of the hospital and the Centers for Family Health. Breast
and cervical cancer screening are provided through the CMH Healthy Women’s Program and are conducted bi-monthly
from January through October. In 2012, 172 women participated in the screening programs. Of those 172 patients ,
one patient was diagnosed with breast cancer. In June, 85 people joined us in celebrating Cancer Survivors Day. A few
photos from the event are included below.
Our Annual Cancer Symposium in October which focused on “Surviving and Thriving” was very well received.
Topics and speakers were:
David Letterman-like Top Ten Rules for Cancer Survivorship—Rosemary McIntyre, M.D.
Developing Your Own Survivorship Care Plan—Kathryn Burnham, PA-C
Creating Your Supportive Village—Jody Giacopuzzi, LCSW
Survivorship and Rehabilitation: A New Normal—Claudia Steele-Major, PR, CT-LANA
Nurturing Your Spirit with a Cancer Diagnosis— Reverend Curtis Hotchkiss
Thriving with Good Nutrition—Laura Fuld, RD
Palliative Care Model: When Your Loved One is Diagnosed with Cancer—Charles Pankratz, M.D. and Diana
Jaquez, RN, MSN, OCN
Thomas Fogel, M.D.
Cancer Liaison Physician
Community Outreach Coordinator
Page 16
CMH Cancer Program 2012 Annual Report
Cancer Resource Center 2012 Statistics
2012 - Patients Served
Patient Information and Referrals
Telephone Requests
Walk In Requests
Other Patient Assistance
Social Services
Wig/Hat Bank
Spanish speaking only (calls, walk-ins, on on one)
Support Groups/Programs
Man to Man
Men & Cancer - A Discussion Group
Breast Cancer Support Group
Wednesday General Cancer Support Group
Thursday General Cancer Support Group
Lymphedema Support Group
SPOHNC Support Group
Women's Cancer Support Group
Family Night for Children with Cancer and Their Family
Yoga
Tai Chi For Health Program
Yoga Therapy
Feldenkrais
Reiki
Reiki Circle
Guided Meditation
Reflexology
Medical Hypnotherapy
Creativity Central art class
Frankly Speaking: Coping with the Cost of Care
Mindfulness Based Stress Reduction Class
Social Services presentations
Registered Dietition Services
National Cancer Survivor's Day celebration
Annual Cancer Symposium
ACS - Look Good Feel Better
Auxiliary Member Workshop
The Healing Garden Workshop
Holiday Gift Tag Making Class
Total
unk
699
169
97
156
14
102
1
318
131
134
45
37
3
263
429
36
8
83
554
132
43
45
9
34
6
51
17
3
70
118
12
14
4
4
3841
Page 17
CMH Cancer Program 2012 Annual Report
CMH Genitourinary Cancers, 2006-2012
Community Memorial Hospital has one of the most progressive and state of the art programs for the diagnosis
and treatment of urologic cancers. These are divided into the four most common types of genitourinary tumors (GU),
which are prostate, bladder, kidney and testicular cancer. In addition to state of the art imaging, these cancers are
often treated with expertise of surgeons, medical, and radiation oncologists.
From a surgical prospective, we have had an active and growing Robotics program. Since 2004 we have had
the Da Vinci Robot (Intuitive Co). Recently, we upgraded this to the latest system, the Si, which has allowed us to do
prostate, kidney and other cases in a less invasive fashion with lower complications and earlier hospital discharges than
traditional open surgery.
Prostate Cancer
Prostate cancer represents the most commonly diagnosed forms of GU cancer. In 2012, 238,590 cases of
prostate cancer were diagnosed in the U.S. 29,720 men died from prostate cancer. Prostate cancer is the most
common cancer among men (after skin cancer), but often can be treated successfully. More than 2 million men in the
US are prostate cancer survivors.
In the last six years at CMH, a total of 889
cases of prostate cancer were recorded between
2006-12. The majority of these cancers cancers, 860
of 889, are adenocarcinoma of the prostate. Peak
age at diagnosis was between 60-69 (365 of 889),
and the majority of diagnosed cases were Clinical
Stage II (615 of 889). This is very consistent with
national averages.
CMH Prostate Cancer Cases
Shown by Stage and Type of Treatment, 2006-2012
Stage I
Stage II
Stage III
Stage IV
Not Staged
TOTAL
No treatment
16
225
12
9
91
271
Total/Radical Prostatectomy Only
21
161
55
0
2
239
TURP Only
32
29
0
3
1
65
Cryoprostatectomy Only
2
85
15
0
0
102
Radiation (RT) Only
5
43
2
0
0
50
Chemo Only
0
1
0
1
0
2
Hormone Only
0
18
12
12
1
43
Endocrine Only
0
0
0
0
1
1
Unproven Only
0
0
1
0
0
1
Surgery & RT
0
6
14
0
0
20
Surgery & Chemo
0
0
0
1
0
1
Surgery & Hormone
0
32
10
6
3
51
A variety of treatment approaches have
been applied for the treatment of these
patients. These include surgical removal of the
prostate with the majority of these cases being done
using Robotic Assisted Radical
Prostatectomy. Many patients had transurethral
resection of the prostate (TURP) done for urinary
obstruction and have been diagnosed with incidental findings of prostate cancer. Radiation treatment, either with
IMRT or brachytherapy (in which radioactive seeds are placed into the prostate), also represents a common
treatment for prostate cancer. In addition, adjuvant radiation has been combined with either hormone treatment or
surgery in certain clinical situations. Prostate cancer is unique in that in certain clinical situations it does not require
treatment, so in many cases it is not treated. Please see figure 1 which breaks down the stage and form of treatment
for prostate cancer.
Surgery & Biologic
0
0
1
0
0
1
RT & Hormone
2
13
6
4
2
27
Chemo & Hormone
0
1
0
1
0
2
Surgery & RT & Hormone
2
1
5
2
0
10
Surgery & Hormone & E ndocrine
0
0
0
2
0
2
RT & Hormone & Endocrine
0
0
0
1
0
1
TOTAL
80
615
133
42
19
889
Figure 1
Finally, it should be stated that many of these cancers have been successfully treated using a multimodality
approach, which includes urologists, radiation and medical oncologists. Chemotherapeutic treatment for late stage
disease plays, and will continue to play, a more significant role in the future treatment of prostate cancer. Please refer
to figure 2 for the Actuarial Survival for patients with prostate cancer stage by stage in our community.
Page 18
CMH Cancer Program 2012 Annual Report
CMH Genitourinary Cancers, 2006-2012
Observed Five Year Survival for all CMH Prostate Cancer Cases
by Stage at Diagnosis, 2006-2012
100
90
80
Percent
70
60
All Stages
Stage I
Stage II
Stage III
Stage IV
50
40
30
20
10
0
0
1
2
3
4
5
Years after Diagnosis
Figure 2
Bladder Cancer
Bladder cancer represents the second most common type of GU cancer treated. In the United States it is
estimated that 72,570 new cases of bladder cancer will be made in 2013. A total of 15,210 people will die from bladder
cancer. The majority of these cases are transitional cell carcinoma, which is derived from the lining of the bladder.
Rare forms are squamous cell carcinoma and adenocarcinoma of the bladder.
Bladder cancer is caused by exposure to cigarette smoke and various industrial chemicals. It is estimated that
cigarette smoking alone has been estimated to cause 50% of bladder cancers in the United States.
Bladder cancer is diagnosed most commonly in the process of evaluation of hematuria (blood in the urine).
Often the diagnosis is made cystoscopically. Initial treatment and staging requires surgery. This is done endoscopically
by doing a TURBT (transurethral resection of bladder tumor).
Fortunately, this often is curative as the majority of
bladder cancers are stage Ta superficial transitional cell
AJCC Mixed Stage at Diagnosis for all CMH Bladder Cancer Cases
carcinoma. See figure 3.
2006-2012
13.3
3.9
43.9
5.1
Stage 0
Stage I
Stage II
Stage III
Stage IV
Not Staged
11
22.7
Figure 3
Bladder cancer can often be treated with resection
and in many cases active surveillance. More advanced
disease may require instillation of an immunotherapeutic
agent called BCG or a chemotherapeutic agent. Intravesical
therapy is an important technique, which decreases
recurrence of bladder cancer. Advanced cases can be
treated with complete removal of the bladder.
Chemotherapy can be used combined with surgery and, in
cases where the patient is not a surgical candidate,
combined with radiation.
Page 19
CMH Cancer Program 2012 Annual Report
CMH Genitourinary Cancers, 2006-2012
Observed Five Year Survival for all CMH Bladder Cancer Cases
by Stage at Diagnosis, 2006-2012
In advanced bladder cancer, like prostate cancer, a
multimodality approach is often required.
100
90
80
Percent
70
All Stages
Stage 0
Stage I
Stage II
Stage III
Stage IV
60
50
40
30
20
Survival of bladder cancer depends on the stage and
grade of cancer. Fortunately, the majority of cases are
diagnosed early. See figure 4.
10
0
0
1
2
3
4
5
Years after Diagnosis
Figure 4
Kidney Cancer
Cancer of the kidney is most often renal cell carcinoma, which makes up the majority of renal cancers of the
lining of the kidney and collecting system. It is rare and makes up less than 5% of renal tumors. In the United States
renal cancer is estimated to occur in 65,150 patients in 2013. Deaths due to renal cancer are estimated to be 13,680 in
the same year.
Since 2004, we have had an advanced Robotic program. We now have the capability of doing partial
nephrectomies laparoscopically, using the da Vinci Robot. This allows the surgeon to remove only the tumor,
preserving the majority of the kidney. In the past, Renal Cell Carcinoma meant removal of the entire involved kidney.
Now we can remove the tumor, achieving equivalent oncologic outcomes, but preserving renal function. We have one
of the most active programs (Robotic Assisted Partial Nephrectomies) for any community hospital of our size in
Southern California.
CMH Kidney and Renal Pelvis Cancer Cases
Shown by Surgical Procedure, 2006-2012
The majority of kidney tumors are treated surgically.
See figure 5. However, both medical and radiation oncology
has an ever expanding role in the treatment of kidney cancer.
More effective chemotherapy is having an impact on patient
survival, especially in late state disease. See figure 6 for
Actuarial Survival from kidney cancer.
38.2%
60
50
30
20
58.8%
2.9%
8%
10
3.1%
1.6%
Observed Five Year Survival for all CMH Kidney and Renal
Pelvis Cancer Cases by Stage at Diagnosis, 2006-2012
1.6%
100
0
No
treatment
Surgery
Only
Chemo
Only
Radiation
Only
Surgery +
Chemo
Surgery + Surgery +
Radiation Radiation +
Chemo
90
80
Figure 5
70
Percent
Percent
40
All Stages
Stage 0
Stage I
Stage II
Stage III
Stage IV
60
50
40
30
20
10
0
0
1
2
3
Years after Diagnosis
Figure 6
Page 20
4
5
CMH Cancer Program 2012 Annual Report
CMH Genitourinary Cancers, 2006-2012
Testicular Cancer
Testicular cancer is a rare form of cancer that has an annual incidence of 7500-8,000 per year in the United States. It is
the most common cancer in males aged 20-39 years.
Observed Five Year Survival for all CMH Testicular Cancer Cases
by Stage at Diagnosis, 2006-2012
100
90
80
70
Percent
The treatment of testicular cancer represents one of
modern medicines triumphs over disease. Testicular
cancer has one of the highest cure rates of all
cancers: a five year survival rate of over 90% overall,
and nearly 100% if Stage 1, confined to the testicle.
This is due to a multimodality approach, which
includes surgery, chemotherapy and radiation. See
Figure 7 for the Actuarial Survival from testicular
cancer 2006-2012.
60
All Stages
Stage I
Stage II
Stage III
Stage IV
50
40
30
20
10
Testicular cancer is not a uniform type. The most
common form is Seminoma. The other tumors are
classified as non-seminomatous tumors such as
mixed germ cell tumors, embryonal cell tumors,
teratocarcinoma, lymphomas, and nonseminomatous
germ cell tumors. See Figure 8.
0
0
1
2
3
4
5
Years after Diagnosis
Figure 7
Treatment is dependent on tumor cell classification. Most tumors are Seminoma which is treated with surgery and
radiation. Chemotherapy plays an important role in high stage disease. Nonseminomatous tumor is treated with
surgery and chemotherapy in most cases.
Conclusion
CMH Testicular Cancer Cases Shown by Histology
2006-2012
25
Leydig Cell Malig
CMH has an active and multidisciplinary program for
the diagnosis and treatment of urologic malignancies.
We have developed state of the art programs for the
treatment of these diseases. In 2013 we will continue
to push the frontiers of treatment and continue to
develop the best treatment protocols for our
patients.
Non-Seminomatous
Germ Cell
Diffuse Large B-cell
Lymphoma
Marc Beaghler, M.D., MPH
Medical Director of Robotic surgery
Seminoma
20
Mixed Germ Cell Tumor
20
Embryonal Carcinoma
15
Teratocarcinoma
10
5
5
0
3
2
1
1
1
Number of Cases
Figure 8
Page 21
CMH Cancer Program 2012 Annual Report
CMH Physicians
Local physicians who diagnose and treat genitourinary cancers:
Urologists
Marc Beaghler, M.D.
Cedric Emery, M.D.
Stephen Feinberg, M.D.
Seyed Khoddami, M.D.
William Klope, M.D.
Paul Silverman, M.D.
Roy Sugasawara, M.D.
Radiation Oncologists
Thomas Fogel, M.D.
Jeffrey Rodnick, M.D.
Medical Oncologists
Kevin Chang, M.D.
Chirag Dalsania, M.D.
Ann Kelley, M.D.
Lynn Kong, M.D.
Austin Ma, M.D.
David Massiello, M.D.
Rosemary McIntyre, M.D.
Rashmi Menon, M.D.
Kooros Parsa, M.D.
Todd Yates, D.O.
Page 22
CMH Cancer Program 2012 Annual Report
Patient Resources
All Cancer Sites
American Society of Clinical Oncology—cancer.net
American Society for Radiation Oncology—astro.org
Lance Armstrong Foundation—livestrong.org
Cancer Information Service of the National Cancer Institure—cancer.gov
National Comprehensive Cancer Network—nccn.org
National Coalition for Cancer Survivorship—canceradvocacy.org
Cancer Support Community—cancersupportcommunity.org
American Cancer Society—cancer.org
American Association for Cancer Research—aacr.org
Cancer Care—cancercare.org
Cancer Legal Resource Center—disabilityrightslegalcenter.org/cancer-legal-resource-center
Partnership for Prescription Assistance—pparx.org
Prostate Cancer
Prostate Cancer Foundation—pcf.org
Us TOO International Prostate Cancer Education and Support Network—ustoo.org
Prostate Cancer Research Institute— prostate-cancer.org
Prostate.com— prostate.com
The Prostate Institute of America—pioa.org
American Urological Association Foundation—urologyhealth.org
Kidney Cancer
Kidney Cancer Association—kidneycancer.org
National Cancer Institute—cancer.gov/cancertopics/types/kidney
Cancer Care—cancercare.org/diagnosis/kidney_cancer
Bladder Cancer
National Cancer Institute—cancer.gov/cancertopics/types/bladder
Cancer Care—cancercare.org/diagnosis/bladder_cancer
American Cancer Society—cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-additional
Testicular Cancer
Testicular C ancer Resource Center—tcrc.acor.org
National Cancer Institute—cancer.gov/cancertopics/types/testicular
National Library of Medicine—nlm.nih.gov/medlineplus/testicularcancer.html
Please see cmhshealth.org/distinction/cancerprogram/resources.html for additional resources.
Page 23
CMH Cancer Program 2012 Annual Report
Cancer Committee
The CMH Cancer Committee is comprised of physicians from various specialties, allied healthcare professionals and
supportive services professionals. The Committee meets bi-monthly to assess, plan and implement cancer related
programs and activities for our community.
The multidisciplinary Cancer Committee is composed of both medical staff members and hospital personnel with a full
range of specialty skill sets invoked in the diagnosis, treatment, rehabilitation and support of cancer patients. The
committee is responsible for reviewing and maintaining the standards of care for cancer patients at Community
Memorial Hospital to meet the accreditation requirements of the American College of Surgeons.
Members of the 2012 Cancer Committee:
Gene Day, Pharm.D.
Pharmacy
Lynn Kong, M.D.
Chair, Cancer Committee
Hematology/Oncology
Cindy DeMotte
VP, Quality Services
Thomas Fogel, M.D.
Cancer Liaison Physician
Radiation Oncology
Kevin Chang, M.D., Ph.D.
Hematology/Oncology
Erwin Clahassey, M.D.
Pathology
Ivan Hayward, M.D.
Radiology
James Hornstein, M.D.
Family Practice
Geoffrey Loman, M.D.
Family Practice
Laura Fuld, R.D.
Dietary/Nutrition
Jody Giacopuzzi, LCSW
Social Services, Cancer Program
Lyndsay Heitmann-Avery, LCSW
Social Services
Kathleen Horton, RTT, CTR
Cancer Program
Reverend Curtis Hotchkiss, M.D.
Spiritual Services
Diana Jaquez, R.N., MSN, OCN
Palliative Care Services
Charles Pankratz, M.D.
Palliative Care Services
Bobbie McCaffrey, R.N.
VP, Nursing
Jeffrey Rodnick, M.D.
Radiation Oncology
James Woodburn, M.D.
General Surgery
Florence Roach, R.N.
Oncology Nursing
Claudia Steele-Major, PT, CT-LANA
Rehabilitation Services
Chris Wilborn, CTR
Cancer Registry
Page 24
CMH Cancer Program 2012 Annual Report
Our Partners in Cancer Care
Page 25
Community Memorial Health System
147 North Brent Street
Ventura, CA 93003
(805) 652-5011
www.cmhshealth.org
CMH Cancer Resource Center
2900 Loma Vista Road, #105
Ventura, CA 93003
(805) 652-5459
www.cmhshealth.org/cancer