Download Cancer Registry Annual Report

2016
ANNUAL
REPORT
CAR L E C A N C E R R E G I ST R Y
Chairman’s Message
Welcome to the Carle Cancer Center’s 2016 report.
We have a lot of technology, an 80 year plus track record and a continued focus on patient care.
Our multidisciplinary efforts are exemplified by prospective tumor boards in head and neck, urology, breast, GI
(gastrointestinal), GYN (gynecological), thoracic and pulmonary cases, and general cancer and non-cancer cases. These meet
regularly with specialty surgery, medical oncology, radiation oncology, diagnostic imaging, pathology, as well as nursing,
genetics, nutrition, research staff, house staff, cancer registry staff, medical and nursing students and University of Illinois
graduate students.
Participation in national clinical trial continues with Alliance, SWOG (Southwest Oncology Group), and NRG (National
Oncology Group). University of Illinois trials are often unique to Carle. Our physicians publish in major journals. We have
NCORP (NCI Community Oncology Research Program) status with affiliates in Aurora, Illinois and Evansville, Indiana. QOPI
(Quality Oncology Practice Initiative) Breast Imaging and Radiation Oncology certified functions ASCO (American Society of
Clinical Oncology) show consistent achievement to the national standards.
The Cancer Registry (with Institutional Review Board approval) provides data for prospective research as well as data for
prospective Quality Assurance. Any staff physician may request this or sponsor University of Illinois faculty projects using
registry data.
The American College of Surgeons standards are regularly reviewed and discussed. Data entity to the Registry will eventually
need to go “real time” and will have to be more easily accessible.
Future goals include greater participation with the new Carle University of Illinois College of Medicine.
First class in Fall of 2018, this replaced the University of Illinois at Chicago Urbana Branch present since 1974.
Included in our report are studies for 2015 and new identification services such as high dose radiation.
Each year the Cancer Center hosts a symposium for medical personnel and facilitates education programs for the public.
Some are in cooperation with the American Cancer Society. National Cancer Survivors Day had its nineteenth event at Carle
in 2016.
Our patients have access to support groups at Carle as well as local community hospitals for those living at a distance.
We are always planning for a better future. I hope you find this report helpful as well as hopeful.
Sincerely,
James R. Egner, MD
CHAIRMAN, CARLE CANCER COMMITTEE
CANCER CENTER
(217) 383-3010 t
(217) 383-7080 f
[email protected] e
carle.org/cancer
CANCER REGISTRY
(217) 383-7170 t
(217) 383-7180 f
[email protected] e
For additional information for
State of Illinois cancer statistics:
www.idph.state.il.us/about/epi
2016 Cancer Committee Members and Alternates
PHYSICIAN MEMBERS
NON-PHYSICIAN MEMBERS
Anna Arthur, PhD
Betsy Barnick, BS, CCRP
Leia Flure, Dietitian UP-Chemo
Joshua Ward, BS, CRP
Frank J. Bellafiore, MD
Renee Daniels, MHA, PTA
Ike Uzoaru, MD
Elizabeth Camp, PT-MHS, CWS, CLT.
LANA-RR
DIETITIAN NUTRITIONIST
ALTERNATE
PATHOLOGY
ALTERNATE
Robert Dodson, MD
COLON/RECTAL SURGERY
Michelle Olson, MD
ALTERNATE
James Egner, MD
CANCER COMMITTEE CHAIRMAN, ONCOLOGY
Maria Grosse-Perdekamp, MD
ALTERNATE
Martin Kuntz, MD
RADIOLOGY
Juan Jimenez, MD
ALTERNATE
Kalika Sarma, MD
RADIATION ONCOLOGY
Sinisa Stanic, MD
ALTERNATE
Magesh Sundaram, MD
SURGICAL ONCOLOGY
Partha Ray, MD
ALTERNATE
Anna Higham, MD
LIAISON PHYSICIAN/BREAST SURGEON
Vamsi Krishna Vasireddy, DO
ALTERNATE
Marta Spain, MD
WOMEN'S HEALTH SPECIALIST
Michael Aref, MD
PALLIATIVE CARE SERVICES
April Yasunaga, MD
ALTERNATE
RESEARCH/CLINICAL TRIALS
ALTERNATE
HOSPITAL REHAB. REPRESENTATIVE
ALTERNATE
Sarah Glenn, MSN, RN, OCN
QUALITY COORDINATOR, CANCER REGISTRY
Sherry Rose, BSN, RN
ALTERNATE
Sharon Jacobson, CTR
CANCER REGISTRY
Angela Phillips, CTR
ALTERNATE
Jacquelyn Johnson, MD
GENETICS COUNSELOR
Shannon Sattler, MD, LCGC
ALTERNATE
Lynn Kolisetty, MSW/LCSW
SOCIAL WORKER
Kelly Harris, LCSW
ALTERNATE
Jeff McPike, M.Div., BCC
PASTORAL CARE REPRESENTATIVE
Caleb Miller, VP
SURGICAL SERVICES, ADM.
Pamela Bigler, RN, Chief Nursing Officer
ALTERNATE
Melissa Phillips, RN, MSN, MHA, OCN
ONCOLOGY
Christine Plotner, BSN, RN
ALTERNATE
Mary VanCleave, RN, BSN, OCN
NURSE NAVIGATOR
Timmie Gass, RN
ALTERNATE
Todd Thompson, R.Ph.
PHARMACY
Lauren Trisler, PharmD, BCOP
ALTERNATE
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AMERICAN CANCER SOCIETY REPRESENTATIVE
Linda Schulz, M.S. /Health Systems Manager,
Hospitals Lakeshore Division/American Cancer
Society, Inc.
Carle Cancer Center is approved by the American College of Surgeons/Commission on Cancer as an Academic
Comprehensive Cancer Program. Carle Cancer Center and Mills Breast Cancer Institute were surveyed in July 2014. Both
programs did very well. Carle Cancer Center was awarded a three–year Accreditation with Contingency. The program received
five of the seven commendations. Mills Breast Cancer Institute achieved a three-year Full Accreditation by the National
Accreditation Program for Breast Centers (NAPBC). This accreditation shows that Carle provides the highest quality of care
and management to our patients with cancer and their families. Our next surveys will be in June 2017.
The Cancer Committee selected the following members to represent each of the following cancer committee specialties:
CANCER COMMITTEE CHAIR/MEDICAL ONCOLOGIST
– James Egner, MD
CANCER LIAISON PHYSICIAN/CANCER CONFERENCE COORDINATOR
DIAGNOSTIC RADIOLOGIST
PATHOLOGIST
– Anna Higham, MD
– Martin Kuntz, MD, PhD
– Frank Bellafiore, MD
RADIATION ONCOLOGIST
– Kalika Sarma, MD
SURGEON, WOMEN'S HEALTH SPECIALIST IN CANCER CARE
– Marta Spain, MD
CANCER REGISTRY QUALITY COORDINATOR/ CERTIFIED TUMOR REGISTRAR
CANCER PROGRAM ADMINISTRATOR
– Caleb Miller, VP Surgical Services, Administration
CLINICAL RESEARCH REPRESENTATIVE OR COORDINATOR
COMMUNITY OUTREACH COORDINATOR
GENETICS PROFESSIONAL/COUNSELOR
ONCOLOGY NURSE
– Sharon Jacobson, CTR
– Betsy Barnick, BS, CCRP
– Mary VanCleave, RN, BSN, OCN
– Jacquelyn Johnson, MS
– Melissa Phillips, RN, MSN, MHA, OCN
PALLIATIVE CARE TEAM MEMBER, WHEN THESE SERVICES ARE PROVIDED ON SITE
PERFORMANCE IMPROVEMENT OR QUALITY MANAGEMENT COORDINATOR
PSYCHOSOCIAL SERVICES COORDINATOR/SOCIAL WORKER
– April Yasunaga, MD
– Sarah Glenn, MSN, RN, OCN
– Lynn Kolisetty, MSW/LCSW-SW/Kimberly Harden, MSW, LCSW-SW
REHABILITATION REPRESENTATIVE
– Renee Daniels, MHA, PTA
PASTORAL CARE REPRESENTATIVE
– Jeffrey McPike, M. Div, BCC
Carle’s cancer committee has four required quarterly business meetings for Cancer Registry discussing the Commission on
Cancer (CoC) eligibility requirements, program standards, registry activities and new business. The administrative cancer
committee determines the goals, studies, improvements, community outreach activities and screening and prevention
programs that will benefit our patients and the community.
This meeting is held on the 3rd floor in the Bio Med Conference Room of Mills Breast Cancer Institute. The 2016 meeting
dates were February 8, May 9, August 8 and November 7.
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2016
QUALITY STUDIES (CoC Standard 4.7):
1. TSH performed prior to and with each treatment cycle of a PD 1 antibody immunotherapy.
2. Hemoglobin levels obtained within one month of the radiation simulation for curative patients.
QUALITY IMPROVEMENTS (CoC Standard 4.8):
1. Assessment and documentation of patients reporting a pain score of 4 or greater.
2. Documentation of discussion with age appropriate patients regarding the possibility of infertility with treatment.
3. Patients with a change in their bio-impedance scores greater than 10 referred to lymphedema clinic.
CANCER PROGRAM GOALS (COC STANDARD 1.5):
Clinical Goals:
1. GI Cancer Clinic
Programmatic Goals:
1. Biopsychosocial screening
2. Palliative care clinic
CLINICAL EDUCATIONAL ACTIVITIES:
The 2016 Central Illinois Cancer Symposium was held on September 30, 2016, from 8 a.m. to 5 p.m. in The Forum at Carle.
This was a multidisciplinary event for all physicians and healthcare staff. Presented was the latest update in cancer
screening, diagnosis and treatment. Prevention, screening and survivorship were discussed. The topics were colon cancer
screenings, the genomics of colon cancer, GI cancer immunology, life after cancer, new anticoagulation in cancer patients,
cancer research and pre-hab and rehabilitation.
OBJECTIVES:
•
Identify key components of the transition of cancer treatment between primary care and specialty care.
•
Discuss considerations for aftercare from a primary care perspective.
•
Describe new research studies, findings, and implications for primary care providers.
OUTCOME STATEMENT:
This conference will allow the learner to better understand the process of cancer screening to a cancer patient survivorship
in select patient populations. This conference will also allow the learner to discuss the role primary care providers, specialty
providers and support staff play in operating an inter-professional team focused on improving patient outcomes and
experience.
AUDIENCE:
All health care professionals – including physicians, residents, advanced practice providers, registered nurses, radiologic
technologists, social workers, physical therapists, cancer registry staff, and health professional students are invited to attend.
Carle Foundation Hospital is accredited by the Illinois State Medical Society to provide medical education to physicians and staff.
169 health care physicians and staff attended this event.
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PROFESSION
APP (FNP, CRNA, NP)
Nurses (RN, LPN)
MD, DO, DC
Social Workers
Physical Therapists (PT/PTA)
Occupational Therapists
Radiology Technologists
Pharmacists
Other disciplines and students
CARLE/HAMP ATTENDEES
6
35
18
5
1
1
5
2
21
OUTSIDE ATTENDEES
0
4
30
0
3
0
0
0
4
AGENDA:
7 a.m.
Registration with Continental Breakfast
8 a.m.
Opening Remarks
Sinisa Stanic, MD
8:15 a.m.
Cancer Screenings: Low Dose Computed Tomography for Lung Cancer
Juan Jimenez, MD
Colon Cancer
Linda Schulz, MS and Noura Sharabash, MD
9:15 a.m.
The Genomics of Colon Cancer
Patrick M. Lynch, MD
10:15 a.m.
Break
10:30 a.m.
1 New Surgical Approaches to Colon Cancer
Robert Dodson, MD
11 a.m.
5 GI Survivorship Clinic
Lyn Tangen, MD and Melissa Phillips, MSN, MHA, NP-BC
12 p.m.
Lunch
1 p.m.
New Anticoagulants/Anticoagulation in Cancer Patients
Elaine Majerus, MD, PhD
2 p.m.
Current Concepts in Cancer Research
Circulating MircorRNA as Early Biomarkers of Colon Cancer
Risk to Facilitate Physicians During Patient Care and Diagnosis
Hong Chen, MD
3 p.m.
Break
3:15 p.m.
Sexual Health Survivorship Conditions: Fertility Options for Cancer Survivors
Nancy Fay, MD
Erectile Dysfunction
Ronald Konchanin, MD
4:15 p.m.
OSTRICH Rectal Cancer Center of Excellence Program
Michelle Olson, MD
4:50 p.m.
Closing Remarks
Sinisa Stanic, MD
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Each year, the cancer committee provides at least one cancer prevention program that is targeted to meet the needs of the
community and should be designed to reduce the incidence of a specific cancer. Carle's 2016 prevention programs are:
1. Cancer prevention to the underserved population at the University of Illinois at Urbana-Champaign and surrounding
areas.
2. Skin cancer prevention - the Penfield I & I Antique Tractor and Gas Engine Club Historic Farm Days.
Each year, the cancer committee provides at least one cancer screening program that is targeted to decreasing the number
of patients with late-stage disease. The screening program is based on community needs and is consistent with evidence
based National Treatment Guidelines and evidence based interventions. This process is developed to follow up on positive
findings such as the Skin Cancer Prevention and Screening event at the Penfield I & I Antique Tractor and Gas Engine Club
Historic Farm Days focusing on providing information to individuals in Vermilion County and the surrounding areas.
COMMUNITY OUTREACH PROJECTS IN 2016
1. July 8, 2016 – Antique Farm Days, Outreach Event in Penfield, Illinois. This Skin Cancer Awareness event featured
education and prevention hosted by Sarah Glenn, MSN, RN, OCN, and Mary VanCleave, BSN, RN, OCN, as well as a
screening component hosted by Dr. William Holmes, MD, FAAD. The education and prevention portion of the event
featured educating participants on how to spot skin cancer by using the ABCD method of identification. This Venue
was chosen for the increased incidence of Skin Cancer in Vermilion County per the Community Needs Assessment.
Information on how to choose a sunblock lotion was also given.
Participants were educated on the importance of eye protection and given complementary sunglasses.
attendance during this daylong event.
There were 27 participants from east central Illinois:
Vermilion County: 10
Iroquois County: 5
Livingston County: 1
Ford County: 1
Kankakee County: 1
Cook County: 1
Champaign County: 6
Will County: 1
Milwaukee, Wisconsin: 1
The screening portion of the event featured Dr. William Holmes, MD, FAAD. He screened participant’s skin and assessed any concerning lesions. These were documented and sent to both Carle and the American Academy of Dermatology.
No follow up post assessment were needed. There were three participants – one from Champaign County and two from
Vermilion County.
2. September 23, 2016 – Progressive AG Safety Day – St. Joseph School: Taught 200 students about sun safety.
3. October 11, 2016 – Volley for the Cure – Fisher School: Prevention information given, 46 participants from McLean,
Ford and rural Champaign Counties.
4. October 14, 2016 – Fight Like a Blue Devil – Villa Grove High School in Douglas County: 300 participants, followed
by a front page write up in the local paper, distributed in Douglas, Coles, Edgar and Moultrie Counties
5. October 18, 2016 – It’s A Wrap: Event hosted by the Centre for Philanthropy. Community event featuring the services
of Mills Breast Cancer Institute, Carle Cancer Center and Biomedical Research Center, 90 participants.
6. October 30, 2016 – Health Fair at St. Patrick’s Church: Eight risk appraisals done and one physicians consultation done.
All participants were from Champaign County.
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Carle Cancer Conferences
RESEARCH CONFERENCES
Research Conferences take place every Friday before the General and Gastrointestinal (GI) Cancer Conferences in the
Houseworth Conference Room. Dr. Kendrith Rowland is the chairman of research.
University of Illinois teaching researchers and Carle clinical researchers inform the physicians and staff of the different
protocols and clinical trials.
In the research conferences, the researchers and physicians present and discuss new clinical trials coming for the future and the
clinical trials that have opened and closed. On occasion, outside speakers present studies and interesting research topics.
GI AND GENERAL CANCER CONFERENCES
General and Gastrointestinal (GI) Cancer Conference meets weekly on Friday afternoons from 12:30 to 1:30 p.m. in the
Houseworth Conference Room which is located on the second floor of Mills Breast Cancer Institute. The Houseworth Conference
Room is designed with high tech equipment and capabilities of teleconferencing to outside facilities. Dr. James Egner is the
chairman of the General Tumor Board and GI Cancer Conference. Every week Crawford Memorial Hospital in Robinson, Illinois,
and the Carle satellite in Danville are invited to join the conferences by teleconferencing to Carle. The outside physicians can
participate, observe, and present cases in which Carle physicians provide their opinions on the cancer patients.
BREAST CANCER CONFERENCE
The Breast Cancer Conference meets every Wednesday from 12 to 1 p.m. in the Houseworth Conference Room. Dr. Maria GrossePerdekamp is the chairwoman of this conference. Breast cases are presented for review by pathologists, radiologists, specialty
radiologists, oncologists, radiation oncologists and surgeons giving their expert opinions on treatments, outcomes and survival.
HEAD AND NECK CANCER CONFERENCE
The Head and Neck Cancer Conferences are held the first and third Monday from 12 to 1 p.m. in the Houseworth Conference
Room, Dr. Kelly Cunningham is the chairwoman of this conference. The Head and Neck Cancer Conference reviews patients
with head and neck diagnosis. The physicians determine the most effective treatments with best survival outcomes.
Specialized physicians from oral surgery, pathology, oncology, radiation oncology and radiology attend this conference.
GYNECOLOGY (GYN) & GENITOURINARY (GU) CANCER CONFERENCE
The GU Cancer Conference and the GYN is a PILOT Cancer Conference held on the second and fourth Tuesdays of the month
from 12 to 1 p.m. in the Houseworth Conference Room. Dr. Ronald Kimball is the chairman of the GYN Conference and Dr.
Glen Yang is the chairman of the GU Conference. They present cases with GYN and GU cancers.
THORACIC SURGERY – PULMONARY CASE CONFERENCE
Every second and fourth Thursday of the month, the Thoracic Surgery – Pulmonary Case Conference meets in the Bio Med
Conference Room on the third floor of Mills Breast Cancer Institute from 12 to 1 p.m. In this conference the physicians
discuss thoracic and pulmonary cases, some of which might not be cancer related. They also discuss care plans, concerns and
literature review as well as future initiatives.
All conferences serve as a multidisplinary consulting board for presenting cancer cases and making recommendations for
the patient’s course of diagnosis, treatment and serve to educate the physicians that attend. The conferences are attended
by physicians, staff members, interns, medical students, residents, nurses, social services, genetic counselors, researchers,
cancer registry staff and approved guests. All of these conferences are held with the utmost of confidentiality and the
underlying goal is to ensure that high quality and seamless care is provided to all the cancer patients.
Carle Foundation Hospital is accredited by the Illinois State Medical Society to provide continuing medical education for
physicians. The Carle Foundation designates each educational activity for a maximum of 1 AMA PRA Category 1 Credit.
201 6 A n n ua l Rep o r t | 6
Cancer Registry
Cancer Registry abstracts, collects and maintains all cancer patient information at Carle. The Cancer Registry staff follows
the cancer patient for their life-time if they were diagnosed and/or treated at Carle. The abstracted information provides
the registry with measurement of outcomes and cancer patient survivals. An 80 percent follow-up rate is required by the
American College of Surgeons/Commission on Cancer for all living patients in our database since our reference date of
January 1, 2000. And a 90 percent follow-up rate is required within the last five years.
2016 CANCER REGISTRY STAFF
Sharon Jacobson, CTR
CANCER PROGRAM COORDINATOR
Angela Phillips, CTR
CANCER PROGRAM COORDINATOR
Sarah Glenn, MSN, RN, OCN
QUALITY MANAGEMENT COORDINATOR
Dawn Grabowski, CTR
SUPERVISOR WITH CHAMPS
Heather Benson, CTR
ABSTRACTOR WITH CHAMPS
Brandy Lewis, CTR
ABSTRACTOR WITH CHAMPS
Plus six interns from University of Illinois at Urbana-Champaign assisted with conferences and follow-up.
CANCER REGISTRY’S ACCOMPLISHMENTS FOR 2016
•
120 data requests from physicians, researchers and other staff
•
1,263 new cancer cases abstracted for 2015
•
Cancer Registry submitted all eligible and validated cases to the Illinois State Central Registry
•
NCDB Call for Data was submitted before the deadline to the Commission on Cancer free of errors
•
Over 10 percent of the annual cases were quality reviewed by Carle physicians for 2015
•
•
•
Cancer Registry achieved a successful Cancer Program Survey and National Accreditation Program for
Breast Centers Survey
Rapid Quality Reporting System (RQRS) participation Reporting cases on a monthly basis Additional data provided to the Carle Research Department to support grant applications for prospective clinical trial
studies
All of this would not have been possible without the help of our dedicated and devoted Cancer Registry team.
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TOP 5 FEMALE SITES IN 2015
225
Breast
80
Lung/Bronchus
64
Corpus & Uterus
46
Colon
27
Melanoma
TOP 5 MALE SITES IN 2015
101
Prostate
62
Lung/Bronchus
45
Melanoma
37
Bladder
35
Colon
ILLINOIS COUNTIES AT DIAGNOSIS
Counties with New Cases Treated and/or Diagnosed at Carle Facilities for 2014
540 Champaign
241 Vermilion
65 Douglas
64 Coles
56 Piatt
37 Iroquois
36 Edgar
25 Effingham
23 Ford
22 Crawford
19 McLean
Carle satellites are located in all of the counties.
Source: Metriq (Elekta) through Carle Foundation Hospital.
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Colon Cancer Report 2016
Colorectal cancer is the second leading cancer killer in the United States for cancers affecting both men and women.
According to the National Cancer Institute (NCI), there were approximately 134,490 new colorectal cancers in 2016. This
number represents 8% of all new cancer cases. 49,190 deaths due to colorectal cancers occurred in 2016, representing 8.3%
of all cancer deaths.
Colorectal cancer is most common among men in decreasing order; black, white, Hispanic, Asian/Pacific Islander and
American Indian/Alaskan Native. Women follow behind men, with highest rates seen in black women, then white women,
Hispanic, American Indian/Alaskan Native and finally Asian/Pacific Islander.
In the United States, Illinois has one of the highest incidence rates of colorectal cancer compared to other states. To better
address the needs of our colorectal cancer patients, Carle began planning a GI Cancer Multidisciplinary Clinic (GI-MDC)
in 2015. Our goal for this GI-MDC was to foster collaboration between GI and cancer care specialists to ensure timely and
optimal treatment.
Review of NCDB Benchmark reports for Carle Foundation Hospital Cancer Center was performed for the years 2003-2013.
The Carle Foundation Hospital Cancer Center data was compared to data from Comprehensive Community Cancer Program
Hospitals (in all states), as well as to all NCDB Reporting Hospitals over the same time period.
At Carle, 750 patients were treated for colon cancer over the 10 years spanning 2003-2013. Cancer staging is summarized in
the following graph:
Number of Cases
200
177
150
163
157
122
100
95
50
2
0
0
I
II
III
IV
Stage
Stage 0: 16.27%
Stage I: 21.73%
Unknown: 4.53%
201 6 A n n ua l Rep o r t | 9
Stage II: 23.6%
Stage III: 20.93%
Stage IV: 12.67%
NA: .27%
NA
34
UNK
First course treatment is summarized below. About 65% of colon cancer patients are treated with surgery alone. This is
consistent with 62% of patients having stage 0, I, or II disease. Only 6% of Carle patient have no treatment – and this is
consistent with national trends.
FIRST COURSE OF TREATMENT
70%
Carle Patients
Comprehensiv e Commu nity Cancer Center
All Hospit als
60%
50%
40%
30%
20%
10%
0%
Surgery
only
Surgery &
Chemo
Chemo
only
Radiation &
Chemo
Surgery,
Radiation &
Chemo
Chemo &
BRM
No 1st
course
treatment
Other
specified
therapy
Chemo &
Hormone
Therapy
Of patients who undergo surgery as their primary treatment, the vast majority (73%) of patients undergo partial or subtotal colectomy.
This is consistent with the rest of the nation where 79% of patients are treated in this manner. The database does not specific minimally
invasive approaches versus open approaches to surgery, but at Carle, the majority of Colon surgery is performed using MIS techniques.
FIRST COURSE SURGERY
CARLE PATIENTS
(N)
CARLE PATIENTS
(%)
COMPREHENSIVE
COMMUNITY
CANCER CENTER
(%)
Total proctocolectomy withresection of contiguous organ
4
0.53
0.32
0.39
Total Colectomy
31
4.13
1.96
2.12
0.27
0.37
0.43
Colectomy/Coloproctectomy with resection of contiguous organ 2
ALL HOSPITALS
(%)
Subtotal Colectomy/Hemicolectomy
423
56.4
50.2
50.48
Partial colectomy, segmental resection
126
16.8
28.92
27.51
Colectomy, NOS
1
0.13
0.62
0.66
Local tumor excision, NOS
55
7.33
3.26
3.3
None (no surgery at primary site)
71
9.47
10.24
11
Unknown if surgery performed
36
4.8
3.48
3.67
Introduction of the GI Cancer Multidisciplinary Clinic will continue to allow the cancer team to provide high quality care to our patients.
Dr. Michelle Olson
COLON/ RECTAL DEPT.
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ADDITION COMMENT
Those receiving no treatment most frequently declined due to significant co-morbidities. The “Stage Unknown” designation most
frequently involved a diagnosis made without clinical staging or treatment done elsewhere. We appear to be better with time at
doing clinical as well as pathological TNM staging.
1.The “First Course of Surgery” approaches have had not statistical change over the ten years.
2.The nonsurgical approaches have been stable as well.
Molecular markers such as microsatellite instability, NRAS, KRAS and even subsets within these are now recorded. We have identified
items for the GI Multidisciplinary Clinic to consider:
1.Definitions of rectal cancer verses low rectal colon cancer. This is likely to include distance from anal verge, sex and size of patient.
This raises the question:
a. Are statements about the peritoneal reflection still needed?
2.Timing of the cancer diagnosis until surgery (if definitive).
3.Adopting algorhythms for resection of liver metastasis? Identifying stage IV patients to be treated with curative intent.
Dr. James Egner
CANCER COMMITTEE CHAIRMAN
ONCOLOGY
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