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2016 Cancer Annual Report – 2015 data The Froedtert & the Medical College of Wisconsin Kraemer Cancer Center at St. Joseph’s Hospital Campus MK12166316 Kraemer Cancer Center Cancer Annual Report – 2015 data Table of Contents Welcome................................................................................................................ 3 Cancer Committee. . .................................................................................. 5 Cancer Registry Report............................................................................ 7 Cancer Conferences.. ............................................................................... 9 Cancer Care Team.................................................................................... 10 Cancer-Related Services.......................................................................... 11 Primary Sites.. .......................................................................................... 13 Glossary................................................................................................... 16 Skin Cancer Screening ............................................................................ 17 Photo on cover: Froedtert & the Medical College of Wisconsin Small Stones Wellness Center supports the healing process by helping cancer patients enhance their appearance, boost self-esteem and promote optimal health and well-being. Small Stones provides carefully selected products and resources, wigs and other hair coverings and educational classes. Professional staff offer their guidance and expertise. Learn more: froedtert.com/cancer/small-stones The Froedtert & the Medical College of Wisconsin Cancer Network delivers a coordinated system of high-quality cancer care anchored by the specialty expertise of Medical College of Wisconsin physicians and the extensive resources of eastern Wisconsin’s only academic medical center. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 2 Kraemer Cancer Center Cancer Annual Report – 2015 data Welcome We proudly present the 2016 cancer annual report for the Froedtert & the Medical College of Wisconsin Kraemer Cancer Center at St. Joseph’s Hospital campus, a member of the Froedtert & MCW Cancer Network. Highlighted in this report are resources and services available at St. Joseph’s Hospital. We also examine the overall statistics of newly diagnosed cancer patients benchmarked against state and national data. Our energetic cancer care team continues to grow rapidly, strengthening current programs as well as new offerings. We are excited by the breadth and quality of support and services now available to the residents of Washington County and surrounding areas. Colin Mooney, MD The following highlights advances and achievements over the past year at the Kraemer Cancer Center. • National recognition for quality care at St. Joseph’s Hospital continues. e maintained accreditation through the Commission on Cancer and National Accreditation Program for o W Breast Centers and have upcoming surveys in 2017. e initial application for accreditation by the Quality Oncology Practice Initiative of American Society o Th of Clinical Oncology has been submitted. o The Joint Commission survey was successful. • New cancer experts have joined the team, enhancing cancer care. o Clinical pharmacist Becky Stark delivers coordinated care to physicians in clinic and supports patients receiving oral chemotherapeutics. Her addition completes a 2016 Commission on Cancer goal. o Financial counselor Kyle Gaesslin navigates patients through the cost of cancer care. o Survivorship coordinator Chawndel Nelson gives patients a summary of care delivered and a roadmap of post-treatment care. • A new inpatient palliative care program was implemented with plans for outpatient integration. • Clinical trial enrollment has expanded significantly. • Tissue banking consent is available to expand clinical research in our community. • .Screening events for skin and prostate cancer were held May 25, 2016, and Nov. 1, 2016, respectively. • Community outreach continued with promotion of colon cancer awareness, screening and education at the Celebrate Families Resource Fair held Feb. 14, 2016. • Efforts toward prevention continue with upcoming events focusing on cervical, breast and colon cancers. • Radiation oncology achieved tier-one status for staff engagement. • Implementation of a new clinic check-in process now allows tracking of wait times for patients to firstchemotherapy-drug to exam and optimizes patient movement through the cancer center. • Quality improvement efforts focused on developing a new scheduling process for patients receiving chemotherapy to maximize valuable infusion space throughout the day. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 3 Kraemer Cancer Center Cancer Annual Report – 2015 data • Fertility preservation is the subject of a new study for eligible breast cancer patients going through treatment. • .Early lung cancer detection was the focus of a screening study to evaluate eligible individuals using computed tomography (CT) scans, which will be the foundation of a new community CT lung cancer screening program. • .Th e Centers for Medicare and Medicaid Services (CMS) accepted the Kraemer Cancer Center as an official participant in the Oncology Care Model. Colin Mooney, MD Colin Mooney, MD Hematologist/Oncologist Chair, Cancer Committee Medical Director, Hematology and Oncology Froedtert & MCW St. Joseph’s Hospital 414-805-0505 • 866-680-0505 • froedtert.com/cancer 4 Kraemer Cancer Center Cancer Annual Report – 2015 data 2015 Cancer Committee Cancer Committee members meet regularly to review and evaluate the quality and direction of the cancer program and make recommendations for improvement. Physician Members Colin Mooney, MD Chair, Cancer Committee; Medical Director, Hematology and Oncology, Kraemer Cancer Center Roxanna Aldstadt, MD Obstetrics and Gynecology Mark Bosbous, MD Plastic and Reconstructive Surgery William Bradley, MD Gynecologic Oncology John Burfeind, MD Cancer Liaison Physician, Hematology and Oncology Patrick Gardner, MD Pathology William Hall, MD Radiation Oncology Candice Johnstone, MD, MPH Medical Director, Froedtert & the Medical College of Wisconsin Cancer Network; Medical Director, Radiation Oncology, Kraemer Cancer Center; Radiation Oncology David Johnstone, MD Thoracic Surgery John Lacey, MD Urology Peter Langenstroer, MD, MS Urologic Oncology Kirk Ludwig, MD, FACS, FACRS Colorectal Surgery Kaizad Machhi, MD General Surgery Jared Robbins, MD Radiation Oncology April Shera, MD Otolaryngology Jeffery Smale, MD Pulmonology Eric Soneson, MD Surgery John Tomashek, MD Diagnostic Radiology Brian Wolter, MD Family Medicine 414-805-0505 • 866-680-0505 • froedtert.com/cancer 5 Kraemer Cancer Center Cancer Annual Report – 2015 data 2015 Cancer Committee Kraemer Cancer Center and Hospital Operations Sandra Bach, APNP Supervisor, Women’s Services Carol Barczak, BSN, RN, OCN Manager, Hematology and Oncology Nurse Coordinator, Thoracic Cancer Program, Prostate Julie Bluma, BSN, RN and Urologic Cancer Program Lisa Bruesch, PTA, CMT Cancer Rehabilitation Kristi Caddock, ANP-BC, APNP Nurse Practitioner Karen Ferkans-Rupert, MS, RTT Manager, Radiation Oncology John Fuchs Chaplain Jackie Grams, LCSW, OSW-C Oncology-Certified Social Worker Nedra Johnson, BSN, RN, CCRP Nurse, Clinical Research John Koenig Executive Director, Community Division, Froedtert & MCW Cancer Network Sue Knuth PT Director, Community Physicians Rehabilitation Tracy Lilach, CCS-P, CCA Oncology Data Management Technician, Cancer Registry Luanne Murray Aesthetics Wellness Coordinator, Small Stones Wellness Center Leslie Loftis, CTR, RHIT Certified Tumor Registrar, Quality Coordinator, Cancer Registry Amy Maurer Program Specialist, Community Engagement Tracy Morales-Diaz, RN, BSN, OCN Nurse, Hematology and Oncology Debra Nevels Representative, American Cancer Society Debbie Przedpelski, MSW, APSW Palliative Care Representative, Social Work Nancy Roecker, BSN, RN, OCN Nurse, Radiation Oncology Karl Schultz Director of Operations, St. Joseph’s Hospital Heidi Stark, BSN, RN, OCN Nurse Coordinator, Prostate and Urologic Cancer Program Alexandra Verbeten, MSN, RN, ACNS-BC, AOCNS Clinical Nurse Specialist Wendy Weiss, RN, BSN Performance Improvement/Quality Management Gina Wilson, RN, BSN, CBCN Breast Care Navigator Heather Wittnebel, MS, RTT Radiation Therapist 414-805-0505 • 866-680-0505 • froedtert.com/cancer 6 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer Registry Report Hospital-based cancer registries serve as the nation’s primary source of oncology statistics. The Cancer Registry’s comprehensive collection of patient data facilitates comparisons between individual facilities and the state or the nation as a whole. As with all cancer registries, the role of the Cancer Registry at Froedtert & the Medical College of Wisconsin St. Joseph’s Hospital continues to grow and evolve. With advances in cancer-related research, technology and treatments, the Cancer Registry collects more detailed information than ever before. Information is collected and analyzed from many aspects, including from demographics, personal and family histories, risk factors, diagnostic procedures, cancer site and histology, tumor markers, prognostic indicators, staging, treatment, follow-up and survival data for each patient. The Cancer Registry is an integral part of our cancer program and functions in accordance with guidelines set by the American College of Surgeons Commission on Cancer and the Wisconsin Cancer Reporting System. The Cancer Registry has a beginning reference date of Jan. 1, 2008, and is under the management and direction of St. Joseph’s Hospital and its cancer committee. In 2015, the number of patient cases in our Cancer Registry database totaled 3,477. Of the 581 newly reported cases added in 2015, 422 were analytical patient cases. The Cancer Registry works with the Wisconsin Cancer Reporting System, submitting and updating data each month. Patient cases are submitted to the National Cancer Database in January each year. The Cancer Registry maintains the confidentiality of private health information and does not release personal patient information in any cancer data statistics. The Cancer Registry works with hospital physicians, administrators and health care planners to provide coordination and support for cancer program development. It also tracks quality of care and treatment by monitoring compliance with national, evidence-based guidelines. Data is also used by the hospital for cancer conference presentations and administrative reports, as well as to evaluate staffing and equipment needs and guide the development of educational and screening programs for patients and the community. Cancer Registry staff maintains and submits required documentation to ensure the cancer program complies with all standards established by the Commission on Cancer to maintain its accreditation as a Community Cancer Program and ensure compliance with Wisconsin reporting standards. Staffing The Cancer Registry serves as a valuable resource for cancer information with the ultimate goal of preventing and controlling cancer. Since 2012, we have partnered with nThrive (formerly Precyse) Oncology Data Management Division to manage and staff the Cancer Registry at St. Joseph’s Hospital. The Cancer Registry is staffed by two registrars (1.5 full-time equivalents) who maintain certified tumor registrar credentials. They are assisted by an oncology data management technician (.5 full-time equivalent). Cancer registrars are members of the National Cancer Registrars Association and participate in educational conferences provided by this organization, as well as by their state affiliate organizations. Oncology data management technicians participate in educational opportunities offered by nThrive and have the option of obtaining certified tumor registrar credentials. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 7 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer Registry Report (continued) Follow-up Follow-up helps promote optimum patient care and provides a valuable record of patient outcomes. The primary purposes of follow-up are to ensure continued medical surveillance, determine outcomes of treatment and to provide documentation of continued disease-free status, residual disease or its spread and recurrence. The Commission on Cancer standard requirement is 80 percent yearly follow-up on all patients diagnosed and/or treated at St. Joseph’s Hospital since the Cancer Registry reference date of Jan. 1, 2008. The Commission on Cancer standard also requires 90 percent follow-up for patients diagnosed in the last five years. The Cancer Registry maintains ongoing data collection and continued lifetime observation on 2,247 patients. The current follow-up rate is 98.3 percent for patients diagnosed since the Cancer Registry reference date and 98.9 percent for patients diagnosed in the last five years. Follow-up information is obtained by reviewing patient medical records and/or by gathering updated information from the managing physician. Data Requests The Cancer Registry fulfills requests for cancer data from staff physicians, allied health professionals, other hospitals or institutions and requests for treatment and follow-up information from other Wisconsin cancer registries. All data requests are handled with the utmost care for the patient’s confidentiality. Data can be used in the process of determining the incidence and etiology of malignant neoplasms and/or evaluating measures designed to eliminate, alleviate or reduce the impact of cancer. In 2015, the Cancer Registry received 41 data requests. For More Information Cancer Registry: 262-836-7218 Registry Staff Samantha Conrad, CTR, MBA Lead Certified Tumor Registrar, Quality Coordinator/Oncology Data Management Consultant Tracy Lilach, CCS-P, CCA Oncology Data Management Technician Leslie Loftis, RHIT, CTR Lead Certified Tumor Registrar, Quality Coordinator/Oncology Data Management Consultant (2015) Jill McAndrew, CTR Certified Tumor Registrar, Oncology Data Management Consultant 414-805-0505 • 866-680-0505 • froedtert.com/cancer 8 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer Conferences Cancer conferences are a key component to the multidisciplinary approach for an American College of Surgeons Commission on Cancer accredited program. The conferences allow the cancer team – including surgeons, medical oncologists, radiation oncologists, pathologists and diagnostic radiologists – to consult and discuss recently diagnosed patients, challenging cases and cases of interest. A synoptic report is presented to the team, and pathology slides and imaging studies are reviewed for each patient when applicable. Nurses, navigators, genetic counselors and clinical research nurses also attend. In this way, patients benefit from the collective expertise and experience of multiple physicians and health care specialists who discuss treatment options for their patients and share information on current developments and studies available in cancer diagnosis and treatment. Discussions include patient history, diagnostic testing, surgical procedures, stage of disease at diagnosis, treatment options including clinical trials, evidence-based guidelines and survival outcomes. Cancer conferences are also used to educate the medical staff in new techniques and technology in the field of cancer diagnosis and treatment. In 2011, a dedicated breast cancer conference was started at the Froedtert & the Medical College of Wisconsin St. Joseph’s Hospital. Holding frequent, regularly-scheduled meetings allows the opportunity for more cancer patient cases to be discussed in real-time to assist in the management of patients. In 2015, 224 patients were discussed at the general cancer conferences and 162 patients were discussed at breast cancer conferences. Breast cancer patients are usually discussed pre- and post-operatively. General cancer conferences are held on Friday mornings and breast cancer conferences are held on Monday mornings. Summary of Multidisciplinary Cancer Conferences Conference Sessions Case Discussions Breast Cancer General Total 35 42 77 162 224 386 2015 Cancer Conferences by Site Lymphoid, 6 Gynecologic, 7 Musculoskeletal/ Soft Tissue, 4 Thyroid, 3 Unknown, 1 Head and Neck, 12 Skin, 12 Hematopoietic, 26 Breast, 162 Thoracic, 44 Breast Digestive System Genitourinary Gynecologic Head and Neck Hematopoietic Lymphoid Musculoskeletal/Soft Tissue Skin Thoracic Thyroid Unknown Digestive System, 44 Genitourinary, 65 414-805-0505 • 866-680-0505 • froedtert.com/cancer 9 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer Care Team From diagnosis through treatment and recovery, our dedicated cancer specialists work together to deliver the most effective treatment for our patients and their individual needs. Anesthesiologist The physician who administers medicine to put patients to sleep or to numb the area on which patients will be operated. Breast Care Navigator Experienced oncology nurse with advanced training in cancer care who works closely with breast cancer patients and families to coordinate all aspects of care. Cancer Specialists Physicians who diagnose and treat specific cancers such as breast, colorectal, lung or prostate cancers. Case Manager The social worker or nurse who discusses what to expect during a patient’s hospital stay and sets up support services for when patients return home. Clinical Pharmacist The pharmacist who works with the medical oncologist to plan chemotherapy and other infused therapy regimens for cancer patients. Dietitian A health care professional who assesses individual dietary and nutritional needs to keep cancer patients healthier during and after treatment and reduce the overall risk of cancer. Genetic Counselor A certified genetic counselor provides personalized consultations regarding a person’s risk for genetically-linked disease, how genes are linked to disease, how disease is inherited, guidance for genetic testing and options for early disease detection and prevention. Infusion Nurse A registered nurse who is an experienced and skilled professional with extensive training in infusion therapy and administering chemotherapy. Medical Oncologist The physician who plans chemotherapy and other infused treatments, directs care and monitors each patient’s ongoing status. Oncology Nurse Practitioner A registered nurse who has completed advanced training that allows him or her to provide direct patient care, including physical exams and ordering medications, lab tests and X-rays. Pathologist The physician who examines tissue removed during a colonoscopy or a procedure to evaluate malignancies and assists in making the diagnosis. Radiation Oncologist The physician who plans and oversees radiation therapy treatment, directs care and monitors each patient’s ongoing status. Radiation Therapist An experienced, skilled professional who has extensive training in administering prescribed doses of radiation to specific areas of the body. Surgeon The physician who performs surgical procedures and helps coordinate care. For breast cancer patients, board-certified plastic and reconstructive surgeons are available to perform breast reconstruction if needed. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 10 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer-Related Services Our cancer program has been recognized by the American College of Surgeons Commission on Cancer as offering the highest-quality cancer care. Since 2003, we have been proud to bring comprehensive, multidisciplinary cancer care close to home. Diagnostic Radiology Board-certified, specialty-trained radiologists use state-of-the-art advanced imaging technologies, which result in more accurate and comprehensive diagnoses. These medical imaging technologies include: • Advanced digital technology for screening and diagnostic mammograms, including 3D mammography (Tomosynthesis) • Dual-source, multidetector computed tomography (CT) • Nuclear medicine, including positron emission tomography/computerized tomography (PET CT) fusion imaging • Magnetic resonance imaging (MRI), including breast MRI and biopsy • Advanced ultrasound technologies • Interventional radiology, including image-guided biopsy and treatment • Fluoroscopy and conventional X-ray services Surgery Board-certified surgeons have the clinical expertise to deliver cancer-related specialty care in multiple areas. Additional surgical specialties are available through the Froedtert & the Medical College of Wisconsin Cancer Network at Froedtert Hospital campus. • Breast surgery • Colorectal surgery • Ear, nose and throat surgery • Thoracic surgery • Vascular surgery • Laparoscopic surgery, including gynecologic • Urologic surgery • Plastic and reconstructive surgery Hematology and Oncology Board-certified medical oncologists plan treatment and direct care for hematologic malignancies and benign blood disorders using expertise in multiple areas in collaboration with physicians, pharmacists, social workers, genetic counselors, oncology nurses and other members of the patient’s care team. • Biological response modifiers • Chemotherapy • Hormonal therapy • Clinical trials 414-805-0505 • 866-680-0505 • froedtert.com/cancer 11 Kraemer Cancer Center Cancer Annual Report – 2015 data Cancer-Related Services (continued) Radiation Oncology Board-certified radiation oncologists deliver therapy that uses high-energy X-rays to kill cancer cells. Radiation therapy technology at the Kraemer Cancer Center includes: • • • • • • • • • IMRT (Intensity-modulated radiation therapy) IGRT (Image-guided radiation therapy) 3D conformal radiation therapy Electron beam External beam radiation therapy Sterotactic body radiation therapy Systemic radioisotopes Clinical trials Additional radiation therapy technologies are offered at Froedtert & MCW Froedtert Hospital when needed, such as brachytherapy, Gamma Knife®, Radixact™ and Tomotherapy® Rehabilitation Services A wide range of rehabilitation therapies are available on an inpatient/outpatient basis for patients of all ages, including: • • • • • • Pain rehabilitation Lymphedema management Occupational therapy Physical therapy Speech therapy Stomal services/wound care Support Services A variety of resources is available to help patients cope with the stressors of cancer and the treatment process. • • • • • • • • Breast cancer navigator Clinical therapist Financial counselors Genetic counselors Home health agency Hospice Social workers (oncology-certified) Small Stones Wellness Center • • • • • • • Palliative care Nutrition services Nursing Psycho-oncology Spiritual services Support groups Survivorship education Community Education Programs Patients and others can learn about topics such as: cancer risk factors, signs and symptoms, screening guidelines, prevention and control strategies, new treatments and living with cancer. Examples include: • • • • • Breast health Cancer nutrition Prostate cancer screening Skin cancer prevention and screening Smoking cessation 414-805-0505 • 866-680-0505 • froedtert.com/cancer 12 Kraemer Cancer Center Cancer Annual Report – 2015 data Primary Sites STATISTICAL SUMMARY In 2015, 581 new cancer patient cases were added to the Cancer Registry database for the Froedtert & the Medical College of Wisconsin Kraemer Cancer Center at St. Joseph’s Hospital campus. Of these, 422 (73 percent) were classified as analytical. Analytical refers to patients who have had their diagnosis made and/or have received all or part of their first course of treatment at St. Joseph’s Hospital. It could also mean patients who are diagnosed elsewhere but choose to have all or part of their treatment at St. Joseph’s Hospital. The top 10 sites of analytical cases in order of decreasing frequency were: breast (103), lung/bronchus-non-small cell (52), prostate (27), non-Hodgkin lymphoma (24), leukemia (22), bladder (22), colon (19), pancreas (15), kidney/renal pelvis (12) and rectum/rectosigmoid (10). Of all analytical cancer patients diagnosed and/or treated at St. Joseph’s Hospital, 43.6 percent were male and 56.4 percent were female. In 2015, patients seen at St. Joseph’s Hospital for diagnosis and/or treatment of cancer ranged in age from younger than 20 (.5 percent) to 90 and older (2.6 percent). The majority of patients were older than 50. Most of our patients were clustered around the age range of 60-69 (32 percent), followed by patients in the 70-79 age range (24.4 percent). Patients younger than age 50 constituted 11.2 percent of all patients. Review of analytical patient cases by race showed that 421 of our patients were Caucasian (99.8 percent). One patient was African-American (.2 percent). The American Joint Commission on Cancer (AJCC) staging system is a classification system describing the extent of disease progression in cancer patients. It uses the TNM scoring system: Tumor size, Lymph Nodes affected, Metastases. The distribution by the AJCC stage at diagnosis chart demonstrates that for analytical cases, more than half of patients had stage 0, I or II cancers (51.9 percent). Patients with stage III disease represented 13.7 percent of the analytic cases, and 17.3 percent had stage IV cancers. AJCC staging was not applicable for 10.7 percent of analytical cases, and 6.4 percent of patients had an unknown stage of cancer. 414-805-0505 • 866-680-0505 • froedtert.com/cancer GENDER (Analytical Patient Cases) Number Percent Male 184 43.6 Female 238 56.4 TOTAL 422 100 AGE AT DIAGNOSIS (Analytical Patient Cases) Number Percent Under 20 years 2 0.5 20-29 years 3 0.7 30-39 years 15 3.6 40-49 years 27 6.4 50-59 years 71 16.8 60-69 years 135 32.0 70-79 years 103 24.4 80-89 years 55 13.0 90-99 years 11 2.6 TOTAL 422 100 RACE (Analytical Patient Cases) Caucasian African-American TOTAL Number Percent 421 99.8 1 0.2 422 100 AJCC STAGE AT DIAGNOSIS (Analytical Patient Cases) Number Percent Stage 0 44 10.4 Stage I 103 24.4 Stage II 72 17.1 Stage III 58 13.7 Stage IV 73 17.3 Not Applicable 45 10.7 Unknown 27 6.4 TOTAL 422 100 13 Kraemer Cancer Center Cancer Annual Report – 2015 data Primary Sites Top 10 Analytical Sites Rectum and Rectosigmoid, 3% Kidney and Renal Pelvis, 4% Pancreas, 5% Colon, 6% Bladder Breast Colon Kidney and Renal Pelvis Leukemia Lung/Bronchus-Non-Small Cell Non-Hodgkin Lymphoma Pancreas Prostate Rectum and Rectosigmoid Breast, 34% Bladder, 7% Leukemia, 7% Non-Hodgkin Lymphoma, 8% Lung/BronchusNon-Small Cell, 17% Prostate, 9% Top 10 Cancer Sites by Gender Rectum and Rectosigmoid 8 2 Kidney and Renal Pelvis 11 1 Pancreas 6 9 8 Colon Bladder Male Female 11 17 5 Leukemia 9 13 12 12 Non-Hodgkin Lymphoma 27 Prostate 21 Lung/Bronchus - Non Small Cell 31 2 Breast 0 101 10 20 30 414-805-0505 • 866-680-0505 • froedtert.com/cancer 40 50 60 70 80 90 100 Numbers per Gender 14 Kraemer Cancer Center Cancer Annual Report – 2015 data Site Group Total Cases Class Gender Primary Cancer Sites Using AJCC Staging Analytic Non-Analytic M F Stage Other Stage 0 Stage I Stage II Stage III Stage IV Unknown N/A HEAD AND NECK LIP 1 1 0 0 1 0 1 0 0 0 0 0 0 TONGUE 5 4 1 4 1 0 0 0 0 1 3 0 0 SALIVARY GLANDS, MAJOR 1 1 0 1 0 0 0 0 0 0 1 0 0 GUM 2 1 1 1 1 0 0 0 0 0 1 0 0 FLOOR OF MOUTH 2 1 1 1 1 0 0 1 0 0 0 0 0 TONSIL 1 1 0 1 0 0 0 0 0 0 1 0 0 OROPHARYNX 1 1 0 1 0 0 0 0 0 0 1 0 0 HYPOPHARYNX 1 1 0 1 0 0 0 0 0 0 1 0 0 DIGESTIVE SYSTEM ESOPHAGUS 12 8 4 9 3 0 0 0 1 2 3 2 0 STOMACH 6 5 1 4 2 0 0 0 0 1 3 1 0 SMALL INTESTINE 2 2 0 2 0 0 1 0 0 1 0 0 0 COLON 22 19 3 10 12 0 4 5 1 2 3 4 0 RECTUM & RECTOSIGMOID 13 10 3 8 5 0 1 3 0 4 0 2 0 ANUS, ANAL CANAL, ANORECTUM 1 1 0 0 1 0 0 0 0 1 0 0 0 LIVER 5 4 1 4 1 0 0 0 1 1 1 0 1 GALLBLADDER 2 2 0 1 1 0 0 0 1 0 1 0 0 BILE DUCTS 2 1 1 2 0 0 0 0 0 0 0 0 1 PANCREAS 23 15 8 14 9 0 0 2 4 2 7 0 0 RESPIRATORY SYSTEM AND THORAX NASAL CAVITY, SINUS, EAR 2 2 0 1 1 0 0 0 2 0 0 0 0 LARYNX 1 1 0 1 0 0 0 1 0 0 0 0 0 LUNG/BRONCHUS-SMALL CELL 13 10 3 5 8 0 0 1 0 3 6 0 0 LUNG/BRONCHUS-NON SMALL CELL 66 52 14 28 38 0 1 14 5 8 21 3 0 19 HEMATOPOIETIC LEUKEMIA 24 22 2 14 9 1 0 0 0 1 1 1 MYELOMA 8 6 2 5 3 0 0 0 0 0 0 0 6 OTHER HEMATOPOIETIC 10 7 3 4 6 0 0 0 0 0 0 0 7 4 2 2 2 2 0 0 1 0 0 0 1 0 16 10 6 13 3 0 0 6 2 2 0 0 0 120 103 17 2 118 0 22 37 27 12 5 0 0 BONE AND SOFT TISSUE SOFT TISSUE SKIN MELANOMA OF SKIN BREAST BREAST GYNECOLOGIC SITES CERVIX UTERI 1 1 0 0 1 0 0 0 1 0 0 0 0 CORPUS UTERI 14 8 6 0 14 0 0 4 0 1 2 1 0 OVARY 10 8 2 0 10 0 0 1 2 2 2 1 0 VAGINA 1 1 0 0 1 0 0 0 0 0 1 0 0 VULVA 2 1 1 0 2 0 0 1 0 0 0 0 0 PROSTATE 74 27 47 74 0 0 0 5 13 2 3 4 0 TESTIS 3 1 2 3 0 0 0 0 0 0 0 1 0 GENITOURINARY SITES BLADDER 30 22 8 24 6 0 14 4 2 0 0 2 0 KIDNEY AND RENAL PELVIS 18 12 6 15 3 0 0 6 2 2 2 0 0 URETER 2 1 1 1 1 0 0 1 0 0 0 0 0 BRAIN AND CENTRAL NERVOUS SYSTEM BRAIN 10 5 5 5 5 0 0 0 0 0 0 0 5 OTHER NERVOUS SYSTEM 3 2 1 1 2 0 0 0 0 0 0 0 2 THYROID 11 10 1 0 11 0 0 2 3 2 0 3 0 OTHER ENDOCRINE 1 1 0 0 1 0 0 0 0 0 0 0 1 THYROID AND OTHER ENDOCRINE GLANDS LYMPHOID NEOPLAMS HODGKIN DISEASE 2 2 0 2 0 0 0 0 2 0 0 0 0 NON-HODGKIN LYMPHOMA 27 24 3 14 13 0 0 8 3 8 4 1 0 UNKNOWN OR ILL-DEFINED UNKNOWN OR ILL-DEFINED TOTAL 6 3 3 4 2 0 0 0 0 0 0 0 3 581 422 159 282 298 1 44 103 72 58 73 27 45 M = male; F = female; N/A=not applicable, UNK = unknown. PLEASE NOTE: Tabulations for stage distribution include analytical cases only. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 15 Kraemer Cancer Center Cancer Annual Report – 2015 data Glossary Analytical Cancer patients diagnosed and/or receiving all or part of the first course of treatment at Froedtert & MCW St. Joseph’s Hospital. Non-Analytical Cancer patients at St. Joseph’s Hospital who receive care for recurrent or persistent disease, those who seek second opinions or patients who receive care for other reasons (who cannot be classified as analytical). Stage of Disease Determination of the extent of disease at time of patient’s diagnosis. TNM stage: American Joint Commission on Cancer Staging System, Seventh Edition. • T = Size and extent of tumor • N = Involvement of regional lymph nodes • M = Distant metastasis Please note: Tabulations for stage distribution include analytical cases only. First Course of Treatment The initial plan for tumor-directed treatment or series of treatments, usually initiated within four months after diagnosis. In situ Confined to site of origin. Abbreviations A = analytical N/A = non-analytical (includes patients seen for second opinion consultations) M = male F = female N/A, Non-Appl/Unk = not applicable or unknown NOS = not otherwise specified 414-805-0505 • 866-680-0505 • froedtert.com/cancer 16 Kraemer Cancer Center Cancer Annual Report – 2015 data A Report on Skin Cancer Screening: St. Joseph’s Hospital More than two million cases of skin cancer will be diagnosed in the United States this year. While melanoma is the rarest form of skin cancer, it is also the deadliest, causing more than 75 percent of skin cancer deaths. The American Cancer Society (2015) estimated almost 74,000 new melanoma patients would be diagnosed and about 10,000 would die from melanoma in the U.S. Melanoma rates have increased during the last 30 years. The disease is 20 times more common in Caucasians than in African-Americans, and the risk increases with age — the average age of onset is 62. Melanoma incidence in Wisconsin has also increased in the past 20 years. The Wisconsin Interactive Statistics on Health organization states, that of all the major cancers, melanoma rates increased most dramatically from 1995 to 2012: •. The age-adjusted melanoma incidence rate for females more than doubled from 8.5 to 20.4 per 100,000. •. Males had higher incidence rates of melanoma, but less of an increase, from 14.7 to 25.9 per 100,000. Skin cancer screening recommendations vary from organization to organization: • The American Cancer Society recommends skin checks every three years between ages 20 and 40 and yearly after age 40. • The American Medical Association recommends that patients talk with their physicians about the frequency of skin screening and do skin self-exams monthly. • The U.S. Preventive Services Task Force recommends that doctors: o B e aware that fair-skinned individuals ages 65 and older and people with atypical moles or more than 50 moles are at greater risk for melanoma. o L ook for skin abnormalities when performing physical exams. A concern with the U.S. Preventive Services Task Force guidelines is that it is based on studies done from 1999 to 2005 — when cancer rates were lower. More recent studies show the benefits of physician-directed total body skin exams and skin self-exams. The American Cancer Society recommends regular skin checks because with these exams, most skin cancers can be found early. Early detection makes skin cancer easier to treat. Regular exams are most important for people at high risk of skin cancer such as those with: • Reduced immunity • A personal history of skin cancer • A family history of skin cancer Early detection is especially important for melanoma patients because when caught early, it has a very high survival rate. When discovered late, survival can be low as 15 percent. Survival is directly related to the depth of the cancer at diagnosis, so the earlier it is found, the better. Skin cancers present on the skin and are often visible to patients and providers. Based on this data, Froedtert & the Medical College of Wisconsin St. Joseph’s Hospital offered a skin cancer screening to the community. The two-hour screening was held in May 2016 at the Froedtert & MCW Kraemer Cancer Center at St. Joseph’s Hospital campus. Free screenings were provided for individuals who did not have a prior history of skin cancer and were not under the care of a physician or a dermatologist at the time of screening. Dermatologists staffed the event and examined skin lesions such as moles, birth marks or scaly patches for signs of cancer or pre-cancerous conditions. Based on findings, patients were referred for additional care or biopsy. Of the 88 participants screened, 28 were referred for follow-up and seven were referred for biopsy. The majority of participants were ages 55 and older and Caucasian. Additional demographic data and evaluation of the event are included in tables 1-6. 414-805-0505 • 866-680-0505 • froedtert.com/cancer 17 Kraemer Cancer Center Cancer Annual Report – 2015 data This skin cancer screening drew a large number of patients. Patients who did not have current dermatologic care and individuals who would otherwise not have been seen were able to receive the screening. The Froedtert & MCW health network will continue to offer skin screening and other opportunities to improve the community’s awareness about skin cancer and other cancers. Patients identified for further screenings have shared their appreciation for community events like skin cancer screenings. The free screenings have been described as “lifesavers” by several patients who needed subsequent treatment. While education surrounding the dangers of sun exposure is valuable, early detection is key and has the added benefits of minimizing morbidity from surgery and decreasing health care costs. Cancer screening events in local communities make it possible for more people to participate in lifesaving, early detection initiatives. Table 1: AGE Percent 25-34 years 3 35-44 years 6 45-54 years 22 55-64 years 35 65 years + 34 Total 100 Table 2: RACE OR ETHNICITY Table 4: SOURCE OF EVENT INFORMATION Percent Newspaper 41 Website: froedtert.com 16 Flyer 12 Other 26 No data 5 Total 100 Table 5: HOUSEHOLD INCOME Percent Percent African-American 97 Less than $25,000 4 Caucasian 1 $25-50,000 29 Hispanic-American 1 $50-75,000 20 No data 1 $75-100,000 25 $100,000+ 13 No data 9 Total 100 Table 3: EDUCATION LEVEL Total 100 Percent 8th grade or less 1 High school or GED 28 Some college 36 Four-year college 22 More than four-year college 11 No data 2 Total Table 6: SCREENING MET EXPECTATIONS Percent Yes 13 No 0 No data 87 Total 100 100 Froedtert Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Attention: If you speak another language, assistance services, free of charge, are available to you. Call: 414-805-3000 (TTY: 1-800-947-3529) Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al: 414-805-3000 (TTY: 1-800-947-3529) Hmoob (Hmong): LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau: 414-805-3000 (TTY: 1-800-947-3529) 414-805-0505 • 866-680-0505 • froedtert.com/cancer 18