Download 2015 Cancer Program Annual Report

2015 Cancer Program
Annual Report
Table of Contents
Chairman’s Message.............................................................................................................. 1
Continuum of Care Role Statement..................................................................................2
The Cancer Committee.........................................................................................................3
Cancer Conferences (Tumor Boards).............................................................................. 4
Cancer Registry Report........................................................................................................ 4
2014 Cancer Registry Data Statistics............................................................................... 4
2014 Analytical Cancer Cases by County (Figure A)........................................5
Patient Age at Diagnosis by Gender (Figure B)..................................................5
PSJMC Top 10 Cancer Sites (Figure C)...................................................................5
Clinical Research.................................................................................................................... 6
Quality Improvement
Improvement starts with “I”.................................................................................... 8
Get Up and Go............................................................................................................. 10
2015 Community Outreach Report.................................................................................12
Patient/Family Resources and Support.........................................................................14
Cancer Screening Program — CT Lung Scan................................................................15
Glossary of Terms................................................................................................................. 22
References.............................................................................................................................. 23
1
Chairman’s Message
Dear Colleagues,
For your review, the Cancer Committee of Presence Saint Joseph Medical
Center respectfully submits our Cancer Program Annual Report for 2015.
The Presence St. Joseph Medical Center Cancer Program focuses on
improving the quality of care that we provide to our patients and on
enhancing the support services for their caregivers and families.
Our Cancer Program is accredited by the American College of Surgeons
Commission on Cancer. As a result of our last survey, we received a full
three-year Accreditation with five commendations. The Accreditation
acknowledges cancer programs that achieve excellence in providing
quality care to cancer patients.
In addition to this Accreditation, we also continued the fight against
cancer in many ways. We introduced many more clinical trials and other
procedures including chemoembolization. We participated in our first
breast program survey from the National Accreditation Program for
Breast Centers and received a full three-year approval. Presence Saint
Joseph Medical Center is proud to be the first Accredited Breast Center in
Will, Grundy and Kankakee County.
Jason Suh, MD
2015 Cancer Committee Chair
I am pleased to share these highlights from our 2015 cancer program
with you:
+Offering clinical trials of promising new treatments
+Using high-dose radiation therapy to attack tumors more
aggressively with pinpoint precision
+Providing free lung screenings to the community to detect lung
cancer in its earliest stage
It is my hope that you find the data in this report to be useful and insightful
as we come together to battle this disease each and every day.
Thank you for your interest.
Respectfully,
SM
Jason Suh, MD
2015 Cancer Committee Chair
2
Care Continuum Role
Statement
The Presence Saint Joseph
Medical Center Cancer
Program consists of a team
of health care professionals
who provide individualized,
compassionate, quality
cancer care and related
services close to home.
We dedicate ourselves to
the treatment of people
with cancer and other
chronic diseases, relief
of their symptoms, and
promotion of comfort. We
constantly strive to meet
the physical, emotional,
and spiritual needs of our
patients and their families.
Accreditation
Commission on Cancer
The cancer program at Presence Saint Joseph Medical
Center is accredited by the American College of Surgeons
Commission on Cancer (CoC). CoC accreditation is a
voluntary commitment by a cancer program that ensures
its patients will have access to the full scope of services
required to diagnose, treat, rehabilitate, and support patients
with cancer and their families. A cancer program is able
to continually evaluate performance and take proactive,
corrective actions when necessary. This continuous
evaluation reaffirms our commitment to provide highquality cancer care. Our most current Commission on
Cancer program survey was held on September 24, 2014
after which our program was awarded a three-year with
commendation accreditation.
National Accreditation Program
for Breast Centers
Accreditation by the National
Accreditation Program for
Breast Centers (NAPBC) is
granted only to those centers
that are voluntarily committed
to providing the best possible care to patients with diseases
of the breast. Each breast center must undergo a rigorous
evaluation and review of its performance and compliance
with NAPBC standards. To maintain accreditation, centers
must monitor compliance to ensure quality care and
undergo an on-site review every three years. Presence
Saint Joseph Medical Center participated in its first NAPBC
review on February 11, 2015 and was awarded a three-year
full accreditation. PSJMC is the first and currently the only
NAPBC-accredited breast cancer program in Will, Grundy,
and Kankakee Counties.
3
Cancer Committee
Five elements are vital to the success of an accredited
cancer program:
+ Clinical services to provide state-of-the-art pretreatment
evaluation, staging, treatment, and clinical follow-up for
cancer patients
+ Cancer Committee to lead the cancer program
+ Cancer Conferences to provide a forum for patient
consultation and contribute to physician/allied staff
education
+ Quality Improvement program to evaluate and improve
patient outcomes
+ Cancer Registry and database to monitor the quality of
care
The success of the cancer program depends on the Cancer
Committee to lead the program through setting goals,
monitoring program activity, evaluating patient outcomes,
and improving patient care. The committee membership
includes multidisciplinary physician members from the
diagnostic and therapeutic specialties, as well as allied
health professionals involved in the care of cancer patients.
2015 Cancer/Transfusion
Committee Membership
Quorum Members
Jason Suh, MD, Hematology/Oncology, Chair
James Urban, MD, Pathology; Cancer Conference Coordinator
Brian Blonigen, MD, Radiation Oncology
Diane Drugas, MD, General Surgery
Ellen Gustafson, MD, Hematology/Oncology, Cancer Program
Liaison Physician
Lynn McDonald, MD, Palliative Medicine
Bhavin Shah, MD, Surgical Oncology
Joshua Tepper, MD, Radiology
Non-Quorum Members
Janice Nemri, Chief Administrative Officer
Linda Castello, Director Imaging, Cardiac Cath Lab,
Cardiopulmonary Services
Deborah Condon, Senior Physical Therapist
Shirley Koren, Director Alverno Presence Lab
Susan Krueger, Director Clinical Diagnostic Services
Carrie Kruse, Director Care Management
Susan Kuhel, Oncology Nurse Navigator PCC/JOHA
Diane Labriola, License Cosmetologist, Reflections
Pete LaMotte, Regional Director Palliative Care
Loretta Mangers, Mammo QA Tech/Breast Navigator
Laura McHugh, Quality Improvement Analyst
Kim Midlock, Clinical Nurse Manager PCC/JOHA
Kathie Morris, RN, Palliative Care Nurse Navigator
Therese Murphy, Patient Care Manager 5 West
Diana Page, Clinical Pharmacist
Beth Rader, CTR, Lead Cancer Registrar
Karen Schlueter, CTR, Cancer Registrar
Elizabeth Schwenke, Community Outreach Manager
Michelle Shaban, GI Oncology Nurse Navigator
Eva Stobbe, Clinical Dietitian
Pam Tabler, CNP, Palliative Medicine
June Vargocko, General Manager Alverno Presence Lab
Danielle Villari-Swets, ACS Account Rep, Hospital Systems
Brittney Wirth, Social Worker
Jennifer Waters, Clinical Nutrition Manager
Jennifer Yanak, Oncology/Nurse Navigator PCC/JOHA
4
Cancer Conferences (Tumor Boards)
Cancer conferences improve the care of patients with
cancer by providing multidisciplinary treatment planning
and contributing to physician and allied medical staff
education. PSJMC Cancer and breast conferences are
held on the second and fourth Wednesday at 12:00 p.m.
One conference per month is held jointly with the staff
at Presence Mercy Medical Center in Aurora. The team
reviews each patient’s history and physical examination,
diagnostic procedures performed, radiology images,
pathology slides, and treatment given. Physicians from
Pathology, Radiology, Medical Oncology, Radiation
Oncology and Surgery attend as well as other physician
and allied health specialties. All physicians attending
cancer conferences at PSJMC receive one hour of
Category I Continuing Medical Education (CME) credit for
each hour of tumor board/specialty cancer conference
that they attend. Information about upcoming Cancer
Conferences is posted in the Medical Staff lounge and the
CME bulletin board.
In July 2014, we instituted Breast Cancer Conferences
twice a month as a supplement to our bi-monthly Tumor
Boards. In August 2015, we added a monthly GI Specialty
Conference. For 2015, we held 27 Tumor Boards, 24 Breast
Cancer Conferences and four GI Specialty Conferences and
presented a grand total of 176 cases.
Cancer Registry Report
The Cancer Registry monitors all types of reportable
neoplasms diagnosed and/or treated at Presence Saint
Joseph Medical Center (PSJMC). This is a critical element
in the evaluation of oncology care. Registry data collected
include patient demographics, diagnosis, staging,
treatment, and disease outcome. Data management
contributes to each patient’s treatment planning, staging,
and continuity of care. Complete and accurate cancer
registry data enables the facility cancer program and
administration to plan and allocate hospital resources and
is a valuable resource for research activities. The Cancer
Registry reports to the Director of Clinical Diagnostic
Services.
2014 Cancer Registry Data Statistics
For accession year 2014, the cancer registry abstracted
and reported 898 reportable oncology cases - 773 analytic
cases and 125 non-analytic cases. The following data for
2014 includes only analytic cases. Analytic cases are cases
that are accessioned because the patient was diagnosed
at PSJMC and/or the patient received all or part of the
first course of treatment at PSJMC. Since 1/1/2001, the
cancer registry has abstracted 9681 analytic cases into
our database (class of case 10-14, 20-22). Of those, we are
currently following 4864 cases. Our current follow-up rate
since our cancer registry reference date is 94.35%; our
follow-up rate for analytic patients diagnosed within the
last five years is 95.38%.
Approximately 80% of our patients live in Will County (see
Figure A). The 2014 analytic cases consist of 344 males
and 429 females. Seventy-two percent of male and 66% of
female patients were diagnosed between the ages of 50
and 79 (see Figure B).
Breast, bronchus/lung and colon/rectum were the most
common sites of cancer for all patients combined (Figure
C). Bronchus/lung, colon/rectum, and prostate were the
most frequent cancer sites for men, accounting for 42%
of the total number of male cases. For females, breast,
bronchus/lung, and colon/ rectum were the most frequent
cancer sites, accounting for 59% of the total number of
female cases.
5
Figure A: County Distribution
Figure B: Age at Diagnosis by Gender
Figure C: PSJMC Top 10 Cancer Sites
6
Clinical Research
The oncology program has been in effect since 1992. The program is affiliated with the Eastern Cooperative
Oncology Group (ECOG) as an affiliate of Northwestern
University of Chicago. Through our ECOG affiliation we can
also offer our patients additional clinical trials sponsored
by the National Cancer Institute’s Cancer Trial Support
Unit. In 2004 we expanded our program to include
Pharmaceutical Trials. The research team enrolls an
average of 100 patients annually to treatment, prevention
and observational clinical trials. Recently the team led by
Dr. Kulumani Sivarajan is the first medical center in the
world to begin a study with a new chemotherapy drug for
a type of non-Hodgkin’s lymphoma. The study is a Phase I
trial which is truly experimental and the first time patients’
have ever received the drug. Other centers within the
United States and Europe eventually will be participating in
the trial, as well.
PSJMC Research Activities: Summary of cases accrued to cancer-related clinical trials
CoC Standard 1.9: As appropriate to the cancer program
category, the required percentage of patients is accrued
to cancer-related clinical trials each year. The clinical
trial coordinator or representative reports clinical trial
participation to the cancer committee each year.
Patients eligible to meet this standard are those:
+ Seen at PSJMC for diagnosis and/or treatment and
placed on a trial through PSJMC
+ Seen at PSJMC for diagnosis and/or treatment and
placed on a trial through office of staff physician
Type of Trial
+ Seen at PSJMC for diagnosis and/or treatment and
placed on a trial through another facility
+ Seen at PSJMC for any reason and placed on a
prevention or cancer control trial
At the community hospital comprehensive cancer program
(COMP) category, the minimum required percentage
accrual to clinical trials is four percent of the number of
annual analytic cases. For commendation, the percentage
accrual to clinical trials is six percent of the number of
annual analytic cases.
2014 Breast
2014 All Sites
Prevention and control research studies
0
0
Quality of life and economics of care studies
0
0
Bio-repository/ bio-bank studies
0
0
Patient registry studies
0
0
Treatment Trials
14
52
Total
14
52
153
773
9.2%
6.7%
Other — please specify
Annual Analytic Caseload
Percent Accrued
7
8
Quality Improvement
Improvement starts with “I”: 5 West nurses collect trended data
to support increase in staffing
Source of Evidence
EP10: Provide two examples with supporting evidence
from different practice settings where trended data was
used during the budget process, with clinical nurse input,
to assess actual-to-budget performance to redistribute
existing nursing resources or to acquire additional nursing
resources. Trended data must be presented.
Objectives
Trended data is used during the budget process to
acquire additional nursing resources: Patient acuity and
chemotherapy administration data was used to advocate
for the approval of additional nursing resources.
Clinical nurses have input in the budget process:
Clinical nurses collaborated with nursing leaders and
interprofessional partners to develop a staffing proposal,
which was presented to the CNO and approved.
Purpose and Background
PSJMC’s 5 West Unit cares for patients with oncology or
hematology disorders and also serves general medical and
cardiac patients. In October 2014, the 5 West Unit Based
Leadership Council (UBLC) voiced concerns to the unit
manager regarding the nurse to patient ratio. The nurses
felt that the current staffing acuity tool did not accurately
reflect the actual acuity and demands of the unit.
5 West analyzed contributing factors that drive higher
acuity such as the administration and monitoring of
chemotherapy and frequent administration of blood
products. The unit administers the most blood products
in the Medical Center, outside of the operating room and
the intensive care units. In addition, patients often require
repeated pain medication interventions and emotional
support during their transition to hospice care. The 5 West
UBLC believed that the unit’s current nurse to patient ratio
was inadequate when compared to national and local
competitors.
Methods and Approach
In November 2014, UBLC members Ally Broderick and Kira
Smoots consulted with physicians from Joliet OncologyHematology Associates (JOHA) for input into their
staffing proposal. Suggestions included gathering data
and focusing on the financial impact. With the physicians’
feedback, the UBLC developed a data collection tool to
quantify the unit’s patient acuity to support their request
for additional nursing resources. The charge nurse
collected data during every shift in January and February
2015 and compiled the data for analysis.
Pharmacy Director Kim Janicek assisted the 5 West
UBLC with gathering data related to the number
of chemotherapy treatments and blood products
administered by the 5 West nurses:
+ The nurses administered nearly as many units of
chemotherapy in the first 4 months of 2015 as in the last
8 months of 2014 combined:
– 56 units of chemotherapy administered May-Aug 2014
– 78 units of chemotherapy administered Sept-Dec 2014
– 120 units of chemotherapy administered Jan-April
2015
+ A total of 1000 units of blood products were
administered in 2014, more than the 2 West Telemetry
Unit and 4 East Progressive Care Unit combined.
In collaboration with Director of Nursing Annmarie
McDonough, Director of Nursing Karen Gallagher,
and Patient Care Manager Therese Murphy, the UBLC
developed a staffing proposal that included a literature
review, the analysis of acuity data, nurse to patient ratios
of competing hospitals, and forecasted chemotherapy
administration rates. On July 9, 2015, clinical nurses Ally
Broderick, Kim Perona, Lisa Bailey, Kira Schmitt, Teresa
Orszulak and Matt Sanders met with Chief Nursing Officer
Jackie Medland to present their proposal.
9
Outcomes and Impact
From the data presented by the 5 West UBLC, Medland
agreed that staffing resources should be modified to be
better aligned with patient care needs. Medland gave
administrative approval for the staffing proposal, which
then was reviewed at the August 27, 2015, meeting of
the Staffing Acuity Committee. While the proposal went
through the full approval process, Medland approved an
increase in nursing resources by increasing the Hours Per
Patient Day from 9.2 to 9.82. Medland also committed to a
further evaluation of the unit’s resource needs for the 2016
budget year.
The 5 West staffing proposal was entirely nurse-driven,
embodying the Every Nurse a Leader philosophy. Clinical
nurses collaborated with interprofessional partners and
nursing leaders to advocate for increased resources to
meet patient care needs.
Participants
+ Clinical Nurses
– Lisa Bailey, RN, CCRT
– Ally Broderick, RN, BSN, 5 West
– Teresa Orszulak, RN, 5 West
– Kim Perona, RN, BSN, 5 West
– Matt Sanders, RN, BSN, 5 West
– Kira Schmitt, RN, BSN, 5 West
+
JOHA Physicians
– Nafisa Burhani, MD
– Ellen Gustafson, MD
– Sanjiv Modi, MD
– Sarode Pundaleeka, MD
– Kulumani Sivarajan, MD
– Jason Suh, MD
+ Karen Gallagher, RN, MSN, Director of Nursing
+ Kim Janicek, Regional Director, Pharmacy
+ Annmarie McDonagh, FNP, MBA, Director of Nursing
+ Jackie Medland, RN, PhD, Chief Nursing Officer
+ Therese Murphy, RN, BSN, FGNLA, Patient Care Manager,
5 West Medical/Oncology/Telemetry
10
Get Up and Go: Nurses implemented best practices
to prevent delirium and get patients moving
Source of Evidence
EP7EO: Provide one example, with supporting evidence, of
an improvement resulting from a change in clinical practice
due to the application of a professional organization’s
standards of nursing practice. The example provided may
be at the unit, division, or organizational level. Supporting
evidence must be submitted in the form of a graph with a
data table that clearly displays the data.
Objective
An improvement resulting in a change in clinical practice: The
implementation of delirium monitoring and early mobility
interventions on 3 West MISICU resulted in a decrease in the
rate of possible ventilator-associated pneumonia.
Application of a professional organization’s standards of
nursing practice: Interventions were implemented based
on standards set by the American Association of CriticalCare Nurses.
Purpose and Background
In 2008, PSJMC implemented the American Association of
Critical-Care Nurses (AACN)’s ABC protocol (Awakening and
Breathing Trial Coordination) – also known as the “Wake Up
and Breathe” protocol – for the care of patients requiring
acute or short-term mechanical ventilation. The goal of
the protocol is to evaluate patients for early removal from
ventilation. Prolonged use and the associated immobility
can result in possible ventilator-associated pneumonia
(PVAP) and delirium.
In November 2011, AACN issued a practice alert regarding
its ABCDE protocol, recommending that hospitals
implement Delirium monitoring and management and
Early mobility for acute ventilator patients. Early mobility
helps combat the loss of functional mobility, which can also
delay ventilator weaning.
The Presence Health System Critical Care Council began
discussions to implement the AACN’s ABCDE core bundle
into practice. Progress had stalled at the system level
and PSJMC’s 3 West Medical/Surgical Intensive Care Unit
(MISICU) Unit-Based Leadership Council (UBLC), embodying
the Every Nurse a Leader professional practice model,
stepped forward to implement the AACN standard at PSJMC.
Goal Statement
To reduce ventilator associated complications by
implementing AACN’s standards of nursing practice for
delirium monitoring and early ambulation as measured
by the decrease in rate or absence of possible ventilatorassociated pneumonia (PVAP). Exemplary Professional
Practice EP7EO.
Methods and Approach
3 West MISICU nurses, respiratory therapists and physical
therapists collaborated to decrease incidence of PVAPs
through implementation of professional nursing practice
standards as outlined by the AACN. The ABC portion of
the Wake Up and Breath protocol reduces patient sedation
to “wake” patients up and assess readiness to wean from
ventilator use. Early Mobility interventions were added
to the ABC protocol to improve outcomes for acutely
ventilated patients.
Early Mobility
If the patient is not ready to be weaned from the ventilator,
incorporating early mobility into their plan of care may
help the patient regain the functional ability to breathe
independently. When a patient fails the breathing trial, a
prompt is automatically sent to physical therapy to perform
an Early Mobility Safety Screen. The physical therapist
coordinates with the charge nurse to obtain a physician
order for early mobility if the patient does not meet any of
the exclusion criteria in the safety screening. The physical
therapist then works with the patient to perform active
range of motion activities – progressing to sitting, standing
and optimally walking.
Pilot Implementation
Critical Care Training and Development Specialist Christina
Martin and Respiratory Education Coordinator Wayne
Meirhofer helped implement the two new interventions
into the Meditech system. With assistance from the 3 West
UBLC, Martin and Meirhofer educated the MISICU nurses
to perform the assessments and implement appropriate
interventions. The pilot project was implemented on
September 16, 2014.
11
Outcomes and Impact
In Q3 2014, prior to the implementation of Early Mobility
interventions, the rate for possible ventilator-associated
pneumonias (PVAP) on 3 West was 2.79 per 1000
ventilator days. After the pilot implementation, the PVAP
rate decreased to zero for the following three quarters.
In addition, caregivers have succeeded in assisting five
acutely ventilated patients to walk. PSJMC plans to expand
the use of the Delirium and Early Mobility interventions to
the 4 West Cardiovascular ICU and 6 West Neuro ICU.
In October 2014, Meirhofer presented the results of PSJMC’s
early mobility program to the Presence Health System
Critical Care Council. It is the team’s hope that this best
practice will be implemented system-wide to help improve
quality of life for acutely ventilated patients and reduce the
side effects associated with acute mechanical ventilation.
Exemplary Professional Practice EP7EO
Participants
+ Jennifer Fewell, BSN, RN, Training and Development
Specialist, Former 3 West UBLC Chair
+ Jayne Haake, MP (ASCP), CIC, Manager, Infection Control
+ Christina Martin, MS, APN, RN ACCNS-AG, CCRN-CSC,
Former Training and Development Specialist
+ Julie Mills, BSN, RN, CCRN, Patient Care Manager,
3 West Medical/Surgical ICU
+
Physical Therapy
– Janet Clark, PT, Manager, Physical Therapy
– Paul Lagomarcino, PT, MBA, Director, Therapy Services
– Emily Mackanin, DPT, Physical Therapist
+ Respiratory Therapy
– Wayne Meirhofer, RRT, ACCS, NPS,
Respiratory Education Coordinator
– Kevin Schaumberg, RRT, NPS,
Manager Respiratory Care Services
12
2015 Community Outreach Report
January 20
Dr. Ayub – 15 attendees
February 13
Will Grundy Free Clinic Health Fair – 200 attendees
March 7
TEAM Asset Fair – 100 attendees
March 7
Shorewood Glen Health Fair – 300 attendees
March 14
New Lenox Chamber Expo – 200 attendees
March 12
Homer Glen Family Health Fair – 125 attendees
March
Plainfield Chamber Expo – 300 attendees
March 25
Lewis University Student Health Fair – 150 attendees
March 26
New Lenox Triad Health Fair – 50 attendees
April 15
City of Shorewood Employee Health Fair – 75 attendees
April 21
New Lenox Health & Safety Fair – 175 attendees
April 25
Joliet West High School Support Day – 130 attendees
May 1
May 11
New Lenox VFW Senior Meeting – Dr. Ansari – 25 attendees
May 15
Joliet Hospice Employee Health Fair – 50 attendees
May 16
Brown Church Health Fair – 120 attendees
May 26
Plainfield Cruise Night – 100 attendees
May 27
Timbers of Shorewood Expo – 250 attendees
May 30
Blue Stem Earth Festival – 200 attendees
June 3
Carillon Health Fair – 300 attendees
June 11
Chasing the Sun – 500 attendees
June 17
Teacher Expo – 300 attendees
June 20
July 18
August 1
August 28
Carillon Lakes Health Expo – 200 attendees
Chicagoland Speedway Expo – 1200 attendees
Plainfield Fest – 500 attendees
New Lenox Fire Department Family Health Fair – 75 attendees
Ladies Night Out at the Commons – 350 attendees
September 11
Carillon Health Fair – 300 attendees
September 14
Lisle High School – Jennifer Yanak
September 23
Guy Sell Older Adult Health Fair – 25 attendees
October 2
Emily McAsey Health Fair – 300 attendees
October 2
Breast Screening Fair – Presence Cancer Center – 12 attendees
October 6
Bosom Buddies Support Group, Deb Condon – 12 attendees
October 10
New Lenox Fire Department Health & Safety Fair – 100 attendees
October 10
Shorewood Glen Health Expo – 250 attendees
October 16
Friends Over 50 Radio Show – Dr. Drugas
October 21
New Strides in Mammography, Dr. Jester – 15 attendees
October 22
Prostate Cancer Screening – Presence Cancer Care
October 24
Mt. Zion Church Prostate Screenings – 35 attendees
November 14
New Lenox Fire Department Senior Pancake Breakfast
– 45 attendees
November 20
Latest Advances in Medical Oncology, Dr. Gustafson – 6 attendees
13
Lung Cancer Screenings
As much as 80% of lung cancer could be cured if detected
at an early stage. With the help of computerized
tomography (CT) scans, the Presence Lung Scan can do
just that. This simple test is a non-invasive, low radiation
procedure that dramatically improves the detection of
tumors, and takes approximately 15 minutes. To register,
call (877) 737-INFO. This test is FREE.
Colorectal Cancer Screening
Findings: PSJMC provides free colorectal cancer screening
annually. Kits have been distributed at many Health
Fairs and through the mail. Results are mailed to each
patient by the Laboratory Department. Those patients
with positive hemoccult blood tests are encouraged to
seek follow-up with a physician. A process is in place to
determine if patients with positive test results actually do
receive recommended follow-up. The majority of patients
with positive test results should undergo a complete
diagnostic evaluation. According to the American
Cancer Society, among the tests performed as part of a
complete diagnostic workup is a colonoscopy or a flexible
sigmoidoscopy together with a barium enema x-ray. The
test is especially recommended for men and women age
50 and older as well as individuals with a family history of
colorectal cancer. Call the INFO Line at Presence Health
at 877-737-INFO (4636) to request a colorectal cancer
screening kit. (Free)
Weight loss / physical activity
participation at PSJMC:
In 2015, PSJMC offered offering several exercise programs.
All classes are held in Suite 275 at the Presence Healing
Arts Pavilion, 410 East Lincoln Highway in New Lenox.
+ T’ai Chi Fundamentals is an introductory Yang
style class that combines relaxed, fluid non-impact
movements with a calm mind. Designed to improve
posture awareness, balance, strength and energy while
reducing stress. Cost: $30.00 for 5-week session.
+ Hatha Yoga focuses on breathing, poses and gentle
stretches. Positions will feel natural and comfortable
with fluid movement into another relaxed pose. The
practice begins with deep breathing through the nose,
followed by a series of stretches and positions, ending
with guided meditation. Taught by a certified personal
trainer and yoga instructor. Cost: $43 for 4-week session
or $15 per class drop-in.
+ PiYo is a music-driven, athletic workout that is inspired
by a combination of Pilates and yoga. It includes
flexibility and strength training, conditioning and
dynamic movement. Cost: $43 for 4-week session or $15
per class drop-in.
+ Candlelight Yoga: Hatha yoga practice that begins with
deep breathing through the nose, followed by a series
of stretches and poses, ending with guided meditation
performed in a serene and peaceful candlelight glow.
Cost: $43 for 4-week session or $15 per class dropin
+ Yoga Aroma strives to support the well-being of
body, mind and spirit. Aromatherapy achieves its
effects through the application and diffusion of pure
plant essential oils that influence physical wellness, a
positive emotional state and mental clarity. Combining
aromatherapy with yoga can powerfully enhance the
yoga journey. Cost: $48 for 4-week session or $15 per
class drop-in.
These classes run continuously throughout the year with
approximately 8-12 participants in each session. Classes
are open to all ages but attendees are mostly women ages
40–60.
PSJMC provides the Shape Shop exercise room and
equipment for all employees, physicians, volunteers and
their spouses. Retired employees may continue to use the
Shape Shop if they volunteer. The Shape Shop opened in
1995 and is open 24 hours a day, seven days a week.
PSJMC Clinical Nutrition staff members see patients in the
inpatient setting based on physician consults, information
from nursing admission assessment, their own screening
parameters tool or for follow-up. They also have an
outpatient nutrition and diabetes clinical at the PSJMC
campus and now also at the Healing Grounds in New
Lenox. Patients are generated from physician referrals.
14
They are seen for many different reasons, including weight
loss/management. PSJMC also has a bariatric program in
which the dietitians are involved in counseling.
The American Cancer Society provides free informational
materials on obesity/overweight, nutrition, and
physical activity at http://www.cancer.org/ or by calling
1-800-227-2345.
Summary
PSJMC physicians and employees participated in over
284 community outreach events in 2014 which included
health fairs, radio spots, and talks to outside groups and at
several adult living facilities and skilled nursing facilities,
including the Timbers, Shorewood Glen, Carillon, Carillon
Lakes, Guy Sell Senior Housing, Grand Haven, New Lenox
VFW, and Inwood Athletic Club.
Employees & physicians participated in the 9th Annual
Shorewood Scoot to benefit the Make Your Mark Pediatric
Cancer Foundation.
Roughly 1,450 monthly mammogram trigger reminders
are sent out each month to women who have not had their
annual mammogram.
Patient/Family Resources and Support
American Cancer Society
The American Cancer Society
provides educational information
and resources in PSJMC’s Patient
Resource Center located in the
West Tower. The Resource Center
also provides computers for patient, families, and visitors
to access the intranet in order to research their health
care questions. In addition, the American Cancer Society
actively works with the Cancer Care staff to provide
information and resources for patients undergoing
treatments.
Patient Resource Center
To enhance patient access to ACS services and information,
the Medical Center worked with the ACS to provide an ACS
Patient Resource Center within our facility. The ACS Patient
Resource Center opened at PSJMC on January 8, 2007,
and is now part of the Resource Center located in PSJMC
West Tower.
PSJMC Website
The PSJMC website at PresenceHealth.org/stjoseph-joliet
provides information about the Sister Theresa Cancer Care
Center and radiation oncology services; infusional therapy;
inpatient oncology unit; clinical trials; support services and
counseling; rehabilitation services; surgical services; support
groups; facility accreditations and affiliations; and specific
information about breast, prostate, and colorectal cancers.
Positive People
For cancer patients and their families. Contact the Sister
Theresa Cancer Care Center at (815) 741-7560.Meets the
first and third Wednesday of each month, 3:30 – 5 p.m.
Bosom Buddies
Bosom Buddies support group for breast cancer meets
the 1st and 3rd Tuesday of each month at Presence Cancer
Care/JOHA, 2614 West Jefferson Street, Joliet.
“Look Good Feel Better”
The American Cancer Society “Look Good Feel Better” is
offered six times per year at Presence Cancer Care/JOHA at
2614 West Jefferson Street, Joliet.
15
Cancer Screening Programs
Lung Cancer Screening 2015 – CT Lung Scan
CoC Standard 4.2: 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 guidelines and evidence-based
interventions. A process is developed to follow up on all positive findings.
Purpose:
To decrease the numbers of patients with late-stage lung cancers.
National Guideline: Clinicians with access to high-volume, high quality lung cancer screening and treatment centers should
initiate a discussion about lung cancer screening with apparently healthy patients ages 55-74 who
have at least a 30 pack-year smoking history, and who currently smoke or have quit within the past
15 years. A process of informed and shared decision making with a clinician related to the potential
benefits, limitations, and harms associated with screening for lung cancer with LDCT should occur
before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a
high priority for clinical attention in discussions with current smokers, who should be informed of their
continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.
(American Cancer Society Cancer Facts and Figures 2015)
Identified Need: Approximately 221,200 new cancers of the bronchus and lung are expected in the U.S. in 2015,
accounting for approximately 13% of new cancer cases. Lung cancer will account for 27% of all cancer
deaths for both sexes combined. Cigarette smoking is by far the most important risk factor for lung
cancer; risk increases with both quantity and duration of smoking. (American Cancer Society Cancer
Facts and Figures 2015)
The American Cancer Society issued guidelines for
lung cancer screening in January 2013. The Soci­ety
recommends that clinicians with access to high-volume,
high-quality lung cancer screening and treatment
programs should discuss lung cancer screening with
patients 55 to 74 years of age who have at least a 30
pack-year smoking history, who currently smoke or have
quit within the past 15 years, and who are in good health.
Informed shared decision making with a clinician related
to the potential benefits, limitations, and harms associated
with screening for lung cancer with low dose CT (LDCT)
should occur before any decision is made to initiate lung
cancer screening. Smoking cessation counseling should
be a high priority in discussions with current smokers,
who should be informed of their continuing risk of lung
cancer. Screening should not be viewed as an alter­native to
smoking cessation.
Risks associated with LDCT screening include cumulative
radiation exposure from multiple CT scans and unnec­
essary biopsy and/or surgery in patients who do not
have lung cancer (false positives). Some smokers might
use LDCT screening as an excuse to continue smoking
although some studies show higher rates of smoking
cessation among those choosing to be screened than
are seen at the community level in unscreened groups.
Therefore, smoking cessation efforts must accompany CT
screening for current smokers. (American Cancer Society
Cancer Prevention & Early Detection Facts and Figures
2015-2016)
16
Will County Community Health Needs Assessment Report
August 2013
The Community Health Status Assessment (CHSA) is one
of four assessments performed as part of the Mobilizing
for Action through Planning and Partnerships (MAPP)
strategic framework. During the assessment, information
about health status, quality of life, behavioral risk factors
and risk factors in the community is gathered and
analyzed. Data is collected from a variety of resources and
analyzed comparing local, state and national benchmarks
when available. This assessment is performed to meet the
hospital partners’ IRS requirement every three years and
the Will County Health Department’s Illinois Department of
Public Health IPLAN (Illinois Plan for Local Assessment of
Needs) requirement every five years.
organizations; Will County Health Department;
www.chna.org website; Behavioral Risk Factor Surveillance
System (BRFSS); and Illinois County Behavioral Risk Factor
Surveys (ICBRFS). The most recent county-level data
available is for the 2007 – 2009 round of the survey. Some
data sources may not be as current or complete as others.
Benchmarks were included wherever possible and came
from either Healthy People 2020 (HP2020) or County
Health Rankings (CHR) National benchmark. HP2020 goals
are set every ten years by the US Department of Health
and Human Services. The CHR standards are set at 90% of
current data. The goal is for all counties to be as healthy as
the top 10% of counties are now.
The CHSA provides a picture of our community by
answering three questions:
Behavioral risk factors: Risk factors in this category include
behaviors that are believed to cause, or are contributing
factors to injuries, disease and death during youth and
adolescence as well as significant morbidity and mortality
later in life.
1. Who are we and what do we bring to the table?
2. What are the strengths and risks in our community
that contribute to health?
3. What is our health status?
MAPP identifies health indicators in the following
categories for conducting the CHSA:
1. Demographics
2. Socioeconomics
3. Health resource availability
4. Quality of life
5. Behavioral risk factors
6. Environmental health
Key findings
Adults
+ While only 29% of adults have been diagnosed with high
blood pressure, 29% of those with high blood pressure
are not taking their required medicine.
+ 30.3% of adults are considered obese and 38.3% are
considered overweight.
+ The number of current smokers in Will County has
decreased but is still higher than the HP2020 target.
7. Social and mental health
Youth
8. Maternal and child health
+ Alcohol is the primary substance used among students
in all grades (6th – 12th grade).
9. Death, illness and injury
10. Communicable diseases
11. Sentinel events
Data was gathered from several sources including: US
Census and American Community Survey; Illinois state
agencies including IDPH IQUERY and IPLAN data sets;
US Department of Health and Human Services; community
+ The use of cigarettes and marijuana increased as the
grades increased, while the use of inhalants decreased.
+ The intake of fruits and vegetables slightly decreased as
the grades increased.
+ The prevalence of obesity remained the same across
all grades.
17
In 2007-2009, 17.6% of Will County adults were current smokers. The number of adult smokers in Will County improved
between 2001 and 2009, but continues to be worse than the HP2020 target, indicating an area of opportunity.
HP2020 Target: 12% of adults aged 18 years and older are current cigarette smokers.
In 2010, there were 3,761 deaths in Will County.
2010 leading causes of death in Will County
Number of deaths
Percent of Deaths
Cancer
973
25.8%
Heart disease
923
24.5%
Chronic lower respiratory diseases
183
4.8%
Accidents
175
4.6%
Cerebrovascular disease
173
4.5%
Nephritis and nephrosis
104
2.7%
Alzheimer’s disease
100
2.6%
Diabetes
86
2.2%
Pneumonia
69
1.7%
Septicemia
55
1.4%
All causes
3761
100%
Source: IDPH, Health Statistics
18
For the past three years, cancer has been the leading cause
of death in Will County. There were no notable findings
with cancer deaths by race. In 2009, the Will County cancer
mortality rate was 146.5 deaths per 100,000 population — below the HP2020 target (160.6 deaths per 100,000
population). In 2009, there were 1004 deaths in Will County
due to cancer; 54% of those were due to the following:
Lung cancer............................................................................. 272 deaths
Colorectal cancer.................................................................... 84 deaths
Breast cancer.............................................................................73 deaths
Prostate cancer........................................................................ 54 deaths
Leukemia..................................................................................... 43 deaths
Review of the Will County Health Status Assessment Report
clearly demonstrates a continued need for smoking cessation
programs and CT lung cancer screenings in our community.
19
PSJMC Cancer Registry Statistics:
At PSJMC in 2011-2014, cancers of the bronchus/lung were the most common site among men and second most common
site in women.
Incidence of lung cancer at PSJMC by gender (based on date of first contact):
Accession year
Male
Female
Total
Annual analytic caseload
Percentage of annual caseload
2011
87
61
148
869
17%
2012
74
80
154
819
19%
2013
87
60
147
784
19%
2014
69
60
129
773
17
Although the analytic caseload dropped slightly from 2011 to 2014, the percentage of lung cancer cases has remained
relatively constant.
Stage of disease at diagnosis at PSJMC (% of lung cancer cases by accession year):
AJCC Stage
2011
2012
2013
2014
Stage IA
20%
15%
16%
9%
Stage IB
3%
6%
6%
11%
Stage IIA
6%
4%
3%
2%
Stage IIB
3%
4%
7%
6%
Stage III
1%
n/a
1%
2%
Stage IIIA
16%
12%
12%
10%
Stage IIIB
4%
7%
4%
6%
Stage IV
47%
52%
50%
54%
Unknown stage
0%
n/a
1%
n/a
The percentage of cases diagnosed at Stage IA has dropped significantly from 2010 to 2014. Approximately 50% of our lung
cancer patients have Stage IV disease at diagnosis. There has been no improvement.
Tobacco History for patients accessioned at PSJMC in 2014:
Tobacco History
Number of cases
Percentage of cases
2012
2014
2012
2014
Never smoked (00)
11
21
7%
16%
Current smoker
68
46
44%
36%
Previous hx of smoking
75
61
49%
47%
Unknown smoking hx
0
1
0%
1%
In 2014, 83% of PSJMC lung cancer patients were smokers or had a history of smoking; 36% of those patients were active
smokers at the time of diagnosis of lung cancer. Tobacco use remains a significant health threat to our patient population
but there has been improvement since 2012.
20
Barriers to care:
+ Public not aware service offered at PSJMC
+ Current smoker resistant to smoking cessation
counseling
+ Most participants are self-referred; patients are more
apt to participate if physician provides counseling and
recommendation for screening
+ Self-pay service not covered by Medicare/insurance;
individual unable to pay
NOTE: Beginning in April 2015, PSJMC offers the low dose
CT lung screening exam at no charge; patients no longer
pay $99.
21
National Guideline — American Cancer Society Screening Guidelines for the
Early Detection of Cancer in Average-risk Asymptomatic People 2014
Cancer Site:
Lung
Population:
Current or former smokers ages 55-74 in good health with at least a 30 pack-year history
Test or procedure: Low dose helical CT (LDCT)
Frequency:
Clinicians with access to high-volume, high quality lung cancer screening and treatment centers should
initiate a discussion about lung cancer screening with apparently healthy patients ages 55-74 who have
at least a 30 pack-year smoking history, and who currently smoke or have quit within the past 15 years.
A process of informed and shared decision making with a clinician related to the potential benefits,
limitations, and harms associated with screening for lung cancer with LDCT should occur before any
decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority
for clinical attention in discussions with current smokers, who should be informed of their continuing risk
of lung cancer. Screening should not be viewed as an alternative to smoking cessation.
Findings:
PSJMC offers lung cancer screening with the Presence Lung Scan. Beginning in April 2015, there is no
cost for the exam. Patients can call the central INFO line at 877-737-INFO (4636) to schedule a screening.
Each patient participating in this screening receives a
Lung Scan Screening Health Guide and Report along with
the actual CT report stored in Meditech. In addition, each
patient receives a flyer of the various pulmonologists
available. Those patients who are currently still smoking
also receive a copy of the PSJMC “No Smoking” brochure.
John Walsh, MD, Pulmonology oversees all of these lung
cancer screening scans and a copy is sent to both him and
to the patient’s own PCP. Dr. Walsh sends a certified letter
to patients who require some form of follow up. He will also
at that time contact the PCP directly. Margaret Downey
also contacts each patient by telephone. Patient identifiers,
CT findings, referrals and contact attempts are documented
and this form is forwarded to Health Information Services
to be maintained as part of the patient’s permanent medical
record. Margaret Downey tracks pertinent data items for
each screening on a spreadsheet.
PSJMC began offering lung cancer screening in 2011.
Number of screenings performed by year:
2011.....................................................................................................................26
2012....................................................................................................................77
2013....................................................................................................................24
2014.....................................................................................................................19
2015.................................................................................... 172 (as of 11/4/15)
Results of CT lung cancer screenings as of 11/12/15:
Results
2011
2012
2013
2014
2015
TOTAL
Number of screenings performed
26
77
24
19
172
319
Number with lung abnormalities
17
47
15
12
121
212
Number with abnormalities other than lung
7
18
6
6
104
141
Number with normal results
2
12
3
3
21
42
Number with biopsies as result of screening
0
2
1
0
2
5
n/a
2/2+
1/1+
n/a
1/2+
4/5+
Biopsy results
Stage of disease
2012:
2013:
2015:
T3 N2 M0 Stage IIIA
T2a N2 M0 Stage IB
T3 N0 M0 Stage IIB
T2a N0 M0 Stage IB
Improvement:
As of April 2015, PSJMC is offering LDCT lung screening for free to eligible patients.
22
Glossary of Terms
Abstract: A summary of pertinent information about the patient, cancer, treatment, and outcome.
Components include patient identification, cancer identification, stage of disease at initial diagnosis,
first course of treatment, recurrence, treatment for recurrence or progression, and follow-up.
AJCC: American Joint Committee on Cancer (TNM staging).
Analytic case: Any patient diagnosed and/or receiving all or part of the first course of cancer
treatment at Presence Saint Joseph Medical Center.
Non-analytic case: Any patient diagnosed elsewhere and received their entire first course of cancer
treatment at another facility, or a patient diagnosed at autopsy.
Class of case: Determination of patient’s diagnosis and/or treatment status at first admission or
encounter for cancer at our facility.
First course of therapy: Cancer-directed treatment or series
of treatments, which is planned and usually initiated within four months of diagnosis.
TNM staging: Classification given to the extent of disease by the American Joint Committee on
Cancer. The TNM letters correspond to the extent of disease for the tumor, nodal involvement,
and distant metastases.
23
References
AJCC Cancer Staging Manual Seventh Edition
American Cancer Society Cancer Facts and Figures 2015
American Cancer Society Cancer Prevention
& Early Detection Facts & Figures 2015–2016
American College of Surgeons Commission on Cancer
National Cancer Data Base Benchmark Reports
Commission on Cancer Facility Oncology Registry Data
Standards (FORDS)
Commission on Cancer, Cancer Program Standards 2012
Elekta IMPAC Information Services
National Comprehensive Cancer Network web site
NCCN Clinical Practice Guidelines in Oncology
Presence Saint Joseph Medical Center web site
“Will County Community Health Status Assessment Report
August 2013