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Based on 2015 Data 2016 Annual Oncology Report Cancer Center at Table of Contents Welcome Pg.3 Mission Statement Pg.4 DCH Pride Pg.4 Cancer Center Care Team Pg.5 Cancer Services Pg.7 Quality/Outcomes Pg.9 Focus on Prostate Cancer Pg.19 Professional Education/Community Pg.20 Welcome Cancer has no boundaries, it can and does affect anyone. At the Douglas County Hospital Cancer Center, our team focuses on providing a full spectrum of care with the highest standard available. The Cancer Treatment Team takes pride in serving the needs of the community and surrounding areas by addressing each patient’s needs individually. With our commitment to provide high quality patient care, and dedicated team of caregivers, Douglas County Hospital’s Oncology Center stands as a model of excellence in cancer care within our community. The focus of this year’s annual report is the care and treatment provided for patients with prostate cancer. Prostate cancer is the second most common cancer among men (after skin cancer). The American Cancer Society estimates about 180,890 new cases of prostate cancer and about 26,120 deaths from prostate cancer in 2016. About 1 in 7 men will be diagnosed with prostate cancer during their lifetime. Prostate cancer develops mainly in older men. Prostate cancer is rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50. About 6 in 10 cases are diagnosed in men aged 65 or older with the average age at the time of diagnosis being 66. Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 in 39 men will die of prostate cancer. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it; in fact, more than 2.9 million men in the US who have been diagnosed with prostate cancer are still alive today. On behalf of the DCH Cancer Committee, we encourage you to review our annual report which displays our dedication to the patients and the community we serve as well as provides meaningful and helpful information. Thank you The Douglas County Hospital Cancer Committee Mission Statement DCH Mission Statement: Our mission is to improve the health and wellbeing of the people we serve by providing innovative, cost-effective, and high-quality care – and to be regionally recognized as Central MN’s preeminent health system. Cancer Center Mission: The DCH Cancer Center strives to provide personal care and treatment that includes both the physical and emotional needs of the patient and their family. A wide range of patient-centered cancer care may include: medical oncology (chemotherapy), radiation oncology, diagnostic and interventional radiology, surgery, consultation, navigating the cancer experience, survivorship care planning and supportive services. Commission on Cancer (CoC): The CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive quality care. Established by the American College of Surgeons in 1922, the multidisciplinary CoC establishes standards to ensure quality, multidisciplinary and comprehensive cancer care delivery in health care settings. DCH achieved its first accreditation with the CoC in 2011, receiving an Outstanding Achievement Award (OAA). In July 2014 DCH underwent the re-accreditation process and again achieved full CoC accreditation for three years. Accreditation by the CoC demonstrates our cancer program’s commitment to providing high-quality, multidisciplinary, patient-centered cancer care. Other Accreditation: DCH is a community-based hospital located in West Central Minnesota, accredited by the Healthcare Facilities Accreditation Program (HFAP). HFAP was founded by the American Osteopathic Association (AOA) and is nationally recognized by the federal government, state governments, insurance carriers and managed care organizations. Cancer Center Care Team Meet Our Oncologists Oncologist and Hematologist Marion B. Raflores, M.D. – Sanford Health Broadway Clinic Marion B. Raflores, MD received her bachelor and medical degree from the University of the Philippines. She completed her Internal Medicine and Hematology Oncology fellowship at the Western Pennsylvania Hospital/Allegheny General Hospital in Pittsburgh, PA. She is board certified in Internal Medicine, Medical Oncology and Hematology. She treats adults with cancer, bleeding, clotting disorders, and other hematological problems. She is married with two children and enjoys traveling, snorkeling, and swimming. Internal Medicine Wade Swenson, MD Hematology and Medical Oncology Originally from Moorhead, Dr. Swenson received his BA in Chemistry at Minnesota State University in Moorhead. He received his Doctor of Medicine from the University of North Dakota in Grand Forks. Dr. Swenson completed his internship and residency in Internal Medicine at the University of Iowa in Iowa City. He completed his fellowship in Hematology and Medical Oncology at the University of Iowa, where he also received a Master’s Degree in Public Health specializing in Epidemiology. Certified by the American Board of Internal Medicine, Dr. Swenson is a member of the American Society of Clinical Oncology and the American Society of Hematology. Dr. Swenson and his wife, Lisa, have two children. Cancer Center Care Team Douglas County Hospital Cancer Committee Douglas County Hospital provides the highest quality of cancer care as evidenced through our ongoing accreditation of our cancer program by the American College of Surgeons (ACoS) , Commission on Cancer (CoC). The goal of the Cancer Committee at DCH is to continually strive for clinical excellence and to improve the care and services provided to our cancer patients and families. Each year the Cancer Committee, in conjunction with a sub-committee, reviews the quality and quantity of services provided. This review helps to identify gaps, sets goals to fill these gaps, and oversees the conduct of care improvement activities. These actions ensure we are always exceeding expectations and providing the highest level of patient-centered care. DCH 2016 Cancer Committee Coordinators Marion Raflores, M.D. Medical Oncologist, Cancer Liaison Physician, Cancer Committee Chairperson Jana Wegener, RN Cancer Program Administrator Jacqueline Nicolay, CTR Cancer Conference Coordinator, Cancer Registrar Mandy Larum, RHIT, CTR Cancer Registry Quality Coordinator Bonnie Freudenberg, RN, CPHQ Quality Improvement Coordinator Kelly Helmbrecht, LSW Psychosocial Services Coordinator Brittany Meissner, RN Clinical Research Coordinator Members Jonathan deHart, M.D. Pathology Mats Liden, M.D. Radiology Gina Brown, M.D. General Surgery Kathy Fredin, RN, OCN Oncology Clinical Nurse Manager Jason Peterson, RTT Radiation Oncology Manager David Gray, RPh Director of Pharmacy Margaret Kalina, RN, PhD Chief Nursing Officer Carl Vaagenes, CEO Douglas County Hospital Administrator Roberta Strom, RD, LD Dietician Sue Quist, RN Hospice and Palliative Care of Douglas County Pamela Mason American Cancer Society Representative Cancer Services Medical Oncology The medical oncology unit features: + Eleven semi-private, comfortable, individual treatment areas + Oncology-Certified Nursing Staff + Nutritional Counseling + Rehabilitation Services + Navigation and Survivorship Services + Individual patient and family education + Onsite Laboratory Services + Psychosocial Support and Services + Access to Research Programs + Referrals for Clinical Trials + Referrals for Other Services Radiation Oncology CentraCare Radiation Oncology at Douglas County Hospital is a collaborative relationship between CentraCare Health System-Melrose and Douglas County Hospital. Our professionals are committed to providing patients with personal care and treatment. CentraCare Radiation Oncology uses leading edge cancer treatment planning and technology: + Varian iX Linear Accelerator – Delivers dual energy photon and electron therapy. The accelerator has the capability to preform 3-D conformal imaging, Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT). + Philips Brilliance Computed Tomography (CT) Simulator – Delivers multi-slice imaging that enables retrospective respiratory gating with added treatment planning accuracy and capability. + Philips Pinnacle Treatment Planning System. + MIM Maestro Planning Software. Cancer Services CDI Imaging Services A variety of diagnostic and interventional radiology studies are available at the Alexandria Center for Diagnostic Imaging (ACDI) which is located at the Douglas County Hospital. The following advanced imaging services are available: + High Field 1.5T MRI wide bore (Magnetic Resonance Imaging) – ACR Accredited Services include Neuro, Spine, Orthopedic, Body, Breast, and Prostate Scans + 64 slice CT (Computed Tomography) – ACR Accredited. Some CT services offered include Neuro, Spine, Body, Cardiac, Orthopedic and Biopsy procedures + Nuclear Medicine – ACR Accredited. Including Cardiac, Bone, Lymphangiography and Thyroid + PET/CT (Positron Emission Tomography/Computed Tomography) – ACR Accredited PET/CT can be used to assist your physician with initial staging and restaging of certain types of cancer + Ultrasound – ACR Accredited. Some ultrasound services include Body, Breast, Vascular, Biopsy procedures, Paracentesis and Thoracentesis + Digital Mammography – ACR Accredited + Stereotactic Breast Biopsy + Diagnostic and Therapeutic Injections for pain + X-Ray. Pathology The pathologist assists the cancer team by diagnosing the presence of neoplasm and classifying tumor type. Important characteristics such as tumor grade, relative quantity as well as the location and degree of tumor extension are described. The adequacy of the surgical resection from the relevant tissue margins is also assessed. Occasionally, in follow-up specimens, the response to previous therapy is also assessed. Quality/Outcomes Hospice Because each patient’s needs are unique, the hospice team works with patients and their caregivers to develop a personalized plan for their care. To support patients and their families, Hospice of Douglas County provides: + Compassionate care by hospice team members. + Registered Nurse on call twenty-four hours a day to answer questions and provide support. + Coordination of care to maintain dignity and independence. + Medications and treatments to manage pain and other symptoms. + Necessary equipment, such as a hospital bed, oxygen, and supplies related to the illness. + Teaching and expertise to enable families or other caregivers to provide the needed care. + Grief support and bereavement services. Palliative Care Palliative Care, unlike hospice can be offered simultaneously with life prolonging curative therapy for patients living with serious illness. Patients and families facing a serious illness can get assistance to be able to carry on with everyday life by getting relief from symptoms, and improve ability to tolerate medical treatments. Consider palliative care if you or loved one: + Suffers from pain or other symptoms due to any serious illness. + Experiences physical or emotional pain that is NOT under control. + Needs help understanding your situation and coordinating your care. Quality/Outcomes Social Services Recognizing that Cancer affects the whole person, supportive services for patients and their families are provided on-site, or coordinated with local agencies. Licensed Social Workers/Discharge Planners are part of the Multidisciplinary Cancer Center Care Team. They assess the patient’s coping skills, support systems and family dynamics. They assist & arrange for appropriate discharges, whether to home with services, hospice, or to another facility along with educating patients and their families on community resources available to them. By connecting with Licensed Social Workers, patients can better understand their own needs and the resources available to support quality of life. Community resources that may be available include, but are not limited to: + Home Health Services + Financial Resources + Meals on Wheels + Durable Medical Equipment + Transportation Needs + Health Care Directives + Psychosocial Needs + Nursing Home Placement + Hospice and Palliative Care Services Rehabilitation Services Rehabilitation services (occupational, physical, and speech therapy) are available at Douglas County Hospital, the Alexandria Clinic and the YMCA. Physical, occupational, and speech therapists are adept at treating a variety of functional impairments related to issues with cancer and the treatment of cancer. Therapists are trained to evaluate these issues throughout the cancer experience and provide effective treatment strategies to return a person to their optimal level of physical function. Services are tailored to each individual’s needs, with the goal of maximizing function, reducing pain, and assisting the individual in returning to activities they love. Quality/Outcomes Below are examples of physical impairments addressed by Rehabilitation Services: Rehabilitation Services + Balance impairments + Movement impairments + Bowel/bladder dysfunction + Muscular pain/weakness + Chemotherapy-induced peripheral neuropathy + Osteopenia/osteoporosis + Cognitive impairment + Pain (back, neck, joint, muscular) + Compression neuropathy + Radiculopathy + Dystonia + Range of motion limitations + Gait dysfunction + Scar adhesions + Headaches + Sensory deficits + Hemiplegia + Speech impairment + History of Falls + Swallowing impairment + Lymphedema + Visual &/or proprioception dysfunction American Cancer Society Services Hotel Partners Program The Hotel Partners program is a cooperative effort with the American Cancer Society and local hotels that provide free overnight accommodations to cancer patients who must travel for outpatient treatment and need a place to stay. With at least 5 days advance notice, patients may receive this service provided they meet eligibility requirements. Lodging is also subject to availability and to restrictions imposed by the participating hotels. This service is available as a referral. Quality/Outcomes Relay For Life Relay For Life’s purpose is to celebrate survivors, remember those lost and continue to fight back against cancer. In 2016, a total of 42 teams and more than 550 participants walked in the Relay For Life of Douglas County and raised awareness of the event in the community. Local businesses, corporations and individuals donated to raise more than $186,000. This puts Douglas County in the top five Relays of the Midwest Division. The Douglas County Hospital/Alexandria Clinic/Heartland Orthopedic Specialist Relay For Life Team had 78 team members and raised $20,067.17. The team was blessed to welcome and honor the Survivors as they arrived the evening of the Relay for Life Event. This was a very emotional and rewarding experience for the team. Throughout the evening, the team also shared stories of loved ones lost and the hope of those fighting. The DCH Relay for Life Team enjoyed bonding together and becoming a Relay Family. Some of the team members had fun selling our Cancer T-Shirts and Sweatshirts and giving away Frisbees. The chair massages were also a huge hit!!! Thank you to everyone who supported the team! The DCH Relay for Life Team is looking forward to another successful year in 2017. The donations will go to cancer research and local groups that offer support and day to day help such as finding transportation, lodging, and helping answer financial and insurance questions. These local groups include Road to Recovery, Look Good Feel Good, the Hope Lodge and 24/7 hotline. If you are interested in joining the Douglas County Hospital Relay for Life Team, please contact our Team Captain, Jennifer Wegner at [email protected] or 320-762-6019. http://www.relayforlife.org Quality/Outcomes Cancer Registry Established in 1998, the Cancer Registry at Douglas County Hospital is an essential component of the Cancer Program. The Cancer Registry provides support for cancer program development, works to ensure compliance with regulatory reporting requirements/standards and serves as a resource for statistical cancer information. The Registry also coordinates the Commission on Cancer (CoC) accreditation process and ensures that Douglas County Hospital meets or exceeds all CoC Program Standards. In addition to the primary functions of collecting relevant data on each cancer patient Quality/Outcomes and conducting lifetime follow up, the Cancer Registry is involved in managing and analyzing cancer data. This clinical information is collected and analyzed for the purpose of education, research, quality of care and outcomes measurement. Cancer data is submitted to the Minnesota Cancer Surveillance System (MCSS) and the American College of Surgeons (ACoS) Commission on Cancer’s (CoC) National Cancer Data Base so it can be used as a clinical surveillance mechanism to review patterns of care, outcomes and survival, with the ultimate goals of preventing and treating cancer effectively. 2015 Cancer Data Summary During 2015, a total of 302 analytic cases were accessioned into the registry database. Analytic cases are patients whose cancers have been diagnosed and/or received first-course treatment at DCH. 2015 Summary of Cancer Cases by Primary Site PRIMARY SITE MALE FEMALE TOTAL ORAL CAVITY 3 0 3 LIP 0 0 0 TONGUE 2 0 2 OROPHARYNX 0 0 0 HYPOPHARYNX 0 0 0 OTHER 1 0 1 DIGESTIVE SYSTEM 3 0 3 ESOPHAGUS 1 0 1 STOMACH 5 1 6 COLON 13 8 21 RECTUM 10 5 15 ANUS/ANAL CANAL 0 0 1 LIVER 1 1 2 PANCREAS 1 1 2 OTHER 3 0 3 Quality/Outcomes 19 18 37 NASAL/SINUS 0 0 0 LARYNX 2 1 3 16 17 33 OTHER 1 0 1 BLOOD & BONE MARROW 1 0 1 LEUKEMIA 9 1 10 MULTIPLE MYELOMA 2 1 3 OTHER 1 1 2 BONE 0 0 0 CONNECT/SOFT TISSUE 0 0 0 SKIN 8 6 14 MELANOMA 8 5 13 PANCREAS 1 1 2 OTHER 3 0 3 BREAST 1 69 70 FEMALE GENITAL 0 22 22 CERVIX UTERI 0 1 1 CORPUS UTERI 0 13 13 OVARY 0 4 4 VULVA 0 2 2 OTHER 9 1 10 MALE GENITAL 45 0 45 PROSTATE 42 0 42 TESTIS 2 0 2 OTHER 1 0 1 14 9 23 BLADDER 8 3 11 KIDNEY/RENAL 5 5 10 OTHER 1 0 1 RESPIRATORY SYSTEM LUNG/BRONCHUS URINARY SYSTEM Quality/Outcomes BRAIN (BENIGN) 1 0 1 0 2 0 BRAIN (MALIGNANT) 1 0 1 OTHER 0 0 0 LYMPHATIC SYSTEM HODGKIN'S DISEASE 9 1 6 0 15 1 NON-HODGKIN'S 8 6 14 UNKNOWN PRIMARY 0 1 1 OTHER/ILL-DEFINED 0 1 1 BRAIN & CNS Top Cancer Sites in 2015 At Douglas County Hospital the top cancer sites in 2015 were: Breast, Prostate, Colorectal, Lung and Skin. Compared with state and national data, our incidences of breast and colorectal cancers at DCH are much higher than state and national averages. Lung, prostate and skin cancer incidence is comparable to state and national averages. SITE BREAST (FEMALE) DCH 23% Minnesota* Nationwide* 13% 14% PROSTATE 14% 13% 13% COLORECTAL 12% 7% 8% LUNG 11% 11% 13% SKIN 5% 4% 5% * MN & National statistics from ACS Facts & Figures (estimated new cases for 2014) Quality Improvement: In the spring of 2016, Douglas County Hospital implemented a new prior authorization automated process for IV medications given to medical oncology patients covered by variety of health insurances. This process will ensure that prior authorizations are completed prior to starting or scheduling IV therapy. Due to the success of this prior authorization process, Alex Clinic will begin to use the same automated process beginning Fall/Winter 2016. The hospital and clinic will continue to monitor and improve this process to ensure quality patient care and satisfaction. Quality/Outcomes Patient Navigation Based on the 2015 Douglas County Hospital Cancer Center Community Needs Assessment, the Cancer Committee implemented a Patient Navigation Program utilizing a dedicated Nurse Navigator focusing on newly diagnosed Lung Cancer Patients. Patient Navigation is a collaboration between patients, providers, nursing, social services, and the business office to provide a more patient centered approach to care. The Oncology Nurse Navigator will continue to focus on newly diagnosed lung cancer patients as the process is refined. Newly diagnosed Lung Cancer Patients will work with the Nurse Navigator as a common entry point. By utilizing the Nurse Navigator, the goal is to enhance the patient’s experience, and promote optimal outcomes for each patient. The goal is to ultimately reduce or eliminate disparities, and improve patient outcomes. The program plans to expand this service to help additional patients in future years. Some of the things the Navigator does are: + Providing evidence based patient specific education + Help connect to internal and community resources + Facilitate communication and works closely with your care team + Assist with appointment scheduling + Follow up – patient distress/barriers screening + Advanced care planning coordination – The Written Gift Survivorship: In 2016 the Cancer Committee implemented a process to provide Survivorship Care Plans to all Stage I-III Breast, Colorectal, and Lung Cancer Patients upon completion of active treatment. These Care Plans summarize the diagnosis, treatment, and future follow-up each survivor can use to continue to guide them on their journey of survivorship. Focus on Prostate Cancer Each year DCH makes an effort to raise awareness about one of the top five sites of cancer seen in our Cancer Center. In 2016, based upon DCH cancer registry data, DCH chose to highlight Prostate Cancer. Prostate Cancer The American Cancer Society (ACS) recommends that men make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the potential risks and benefits of prostate cancer screening. Discussions about screening should take place at: + Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. + Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). + Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). Professional Education/Community Community Outreach Community Outreach (education, prevention, and screening) is an essential component in the commitment to provide ongoing quality cancer care to the patients we serve and the surrounding area. The Cancer Committee continually assesses and organizes educational events that address the community’s needs. To promote prostate cancer awareness in the community and prevent late-stage diagnosis, DCH Cancer Program representatives attended various area activities in and around the community in 2016. The focus at these events included providing educational materials, encouraging screenings and promotion of discussions with primary care providers regarding the appropriateness of PSA testing. DCH was present at the following community events promoting the Cancer Center and Prostate Cancer Education: + KXRA Spring & Garden Show + Life’s Option Expo + Senior Expo + Relay For Life Event + Douglas County Fair + Alex High School Staff Wellness Expo + Women’s Show Case + Wellness Fair at Alexandria Technical & Community College + Great American Smokeout Event at DCH Professional Education/Community Prostate Cancer Screening Screening refers to testing to find cancer in people before symptoms occur. For some types of cancer, screening can help find cancers at an early stage when the cancer is likely to be easier to treat. Prostate cancer can often be detected early by testing for prostate-specific antigen (PSA) levels in a man’s blood. Douglas County Hospital offered the Prostate Cancer Screening Tool which was developed internally based on NCCN guidelines prostate cancer screening. This screening tool was offered during the Douglas County Relay for Life Event July 10, 2015 and again during the Douglas County Fair in August. During these events, staff offered a screening tool to determine if patients were candidates for direct access PSA testing for prostate cancer. The materials and screening tool promoted a discussion within the community on the incidence of prostate cancer and available screening options. The Cancer Committee views this education as important in the community due to Prostate cancer being a top 5 site. Lung Cancer Prevention RADON: Lung cancer can affect anyone, regardless of gender, ethnicity, or smoking history. Lung Cancer remains one of the top 5 cancer sites in the community served at the Douglas County Hospital Cancer Center. It is the most commonly diagnosed cancer worldwide, with over 1.8 million new cases diagnosed each year. Radon is the second leading cause of lung cancer, and the risk of lung cancer from radon is even higher among smokers. Radon is a radioactive gas that you cannot see, smell, or taste. It forms naturally in soil and rocks. Since radon is produced from soil, it is present nearly everywhere. Soil is porous, which allows radon gas to move up through the dirt and rocks and into the air that is breathed. If it accumulates, the radon gas becomes a health concern. High radon levels exist in every state in the US. In Minnesota, two in five homes have radon levels that pose a significant health risk. Professional Education/Community Because there is no way to know for sure without testing whether radon is in a building, the US Environmental Protection Agency (EPA) recommends that people test their homes for radon levels. If a high risk level is found, there are ways to lower it to make a home safer. In 2016, Douglas County Hospital partnered with the MN department of health to offer free Radon Test Kits to their employees. The Douglas County Hospital - Employee Health Department handed out almost 300 kits to their employees. In 2016 because of the successful response with the hospital staff, Douglas County Hospital Cancer Center wanted to offer the screening to the community. Radon test kits, educational materials, and information on prevention of lung cancer were offered during the Douglas County Fair. At the event 60 test kits were distributed to the community. In October 2016 a survey was sent out to employees who utilized the radon test kit. Of the 300 kits distributed: 35 30 Number of employees who completed the survey 25 Number of employees who said they had Radon have not uesed the kit 20 Number of employees who said they will use the kit in the future 15 Number of employees who said they had Radon levels that require mitigation 10 Number of employees who said they had completed recommended mitigation 5 Number of DCH Radon Tests completed that had Radon levels >4.0pCi/L 0 Est 280 Radon Test Kits Distributed to Employees in 2016 Professional Education/Community For information and resources on how to protect yourself from exposure to radon, visit the radon section of the EPA's website or contact your local Department of Health. Professional Education Professional Training is an essential component in DCH’s commitment to providing ongoing quality cancer care to individuals in the surrounding area reliant upon the Cancer Center for the best care. The DCH Cancer Program organizes annual professional educational events, based upon identified needs, targeting diagnoses, current treatment modalities and best practice guidelines. The 2016 professional education event related to Prostate Cancer was held November 8, 2016 at Douglas County Hospital. The event was titled: Prostate Cancer Education. The event educated staff and providers on the causes, symptoms and contributing risk factors of prostate cancer as well as the staging and prognosis of prostate cancer.