Download Cancer Program Annual Report 2016

CANCER PROGRAM
Cancer Program Annual Report 2016
Applying 2015 Cancer Registry Statistical Data
®
Message from
Cancer Services Manager
As you will see in the following pages of our annual report, this
past year at the Cancer Center has brought many changes; the
biggest one being the retirement of Nancy Klatt, RN as the
manager. She spearheaded many projects over the years and has
made an impact in the region on cancer care.
I took over for Nancy officially in November. Previously, I worked as
a chemotherapy treatment nurse. I am excited for the challenge of
continuing the high standard of care that we have provided here at
the Cancer Center. We have also added 2 navigators, Doreen
Langlois, RN and Robbie Narlock, RN to assist patients and
families in coordinating care.
We had our survey by the American College of Surgeons,
Commission on Cancer and we continue to be a fully accredited
cancer program with many areas of commendation.
Our goal is to always provide high quality services to our patients
and their families. We want patients and families to feel at home
and that we are treating them as part of our own family.
Beth Nelson, RN, OCN
Manager, Altru Cancer Center
Altru Health System is accredited as a Community Hospital Comprehension Cancer
Program and maintains accreditation with the American College of Surgeons
Commission on Cancer.
Table of Contents
Message from the Cancer Services Manager .......................................inside cover
Cancer Committee Membership 2016....................................................................1
Cancer Program Accomplishments, Goals,
Quality and Enhancements.....................................................................................2
Introduction of new Cancer Physician Liaison ......................................................3
Colon Cancer Study at Altru ...................................................................................4
Genetic Testing at Altru .....................................................................................5-6
Cancer Registry Information & Cancer by Site................................................7-11
Mission
Improving Health, Enriching Life
Vision
Deliver world-class health care to the residents of our region.
Values
Our Patients
Meeting the needs and expectations of our patients is our highest priority.
Our Care
We provide quality care that is demonstrated to achieve the best results for patients.
Our Team
We work as a team and treat each other with honesty, loyalty and respect.
Our Communities
We are committed to improving the health of our communities.
Cancer Committee
Coordinators for 2016
Kevin Panico, MD
Cancer Conference Coordinator
Beth Nelson, RN, OCN
The Cancer Committee is composed of
representatives of primary and specialty care
physicians, as well as team members involved in
the care of our cancer patients. The
Quality Improvement Coordinator
multidisciplinary Committee meets at least
quarterly to review and evaluate the quality and
direction of the overall cancer program, and makes
LeAnne Kilzer, RN, OCN
recommendations for improvement.
Cancer Registry Quality Control Coordinator
Shelly Evenson, RN
Education/Community Outreach Coordinator
Wanda DeKrey, RN, OCN
Research Coordinator
Vickie Misialek, LSW
Psychosocial Services Coordinator
Cancer Liaison
Physician for 2016
Stefan Johnson, MD
General Surgery
Daniel Walsh, MD, Chairman, Medical Oncology
Stefan Johnson, MD, General Surgery
Grant Seeger, MD, Radiation Oncology
Kevin Panico, MD, Medical Oncology
Marshall Winchester, MD, Radiation Oncology
Muhammad Siddique, MD, Medical Oncology
Mina Hanna, MD, Medical Oncology
Tim Weiland, MD, Pathology
David Chou, MD, Radiology
Laura Lizakowski, MD, Internal Medicine, Palliative Care
Todor Dentchev, MD, Medical Oncology
Tana Setness Hoefs, MD, Obstetrics & Gynecology
Henry Caoili, MD, Physiatrist
Jill Wilson, Administrative Director
Medical Specialty Care Division
Beth Nelson, RN,OCN, Cancer Services Manager
LeAnne Kilzer, RN, OCN, Oncology Resource Nurse
Jodi Savat, RN, OCN, Inpatient Medical Oncology
Shelly Evenson, RN, Quality/Utilization Review
Rachel Salberg, NP, Palliative Care
Denise Becker, RN, Medical Oncology
Wanda DeKrey, RN, OCN, Oncology Research
Aaron Kempenich, MS, Physicist
Vickie Misialek, LSW, Oncology Social Services/Case Manager
Anne Nygaard, NP, AOCNP, Medical Oncology
Amanda Dudgeon, NP, Medical Oncology
Emily Schmiedeberg, RN, Patient Referral Coordinator
Annie Berginski, RN, Outpatient Medical Oncology
Cassidy Rhondeau, RN, Outpatient Medical Oncology
Julie Sundby, RN, Hospice Case Manager
Danielle Conrad, LISCW, Grief Center
Kim Sheldon, CTR, Cancer Registry
Pam Vigen, CHUC, CTR, Cancer Registry
Lindsay Carpenter, Cancer Registry
Sara McGavaran, American Cancer Society
Peni Rosten, Recorder
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2016 Cancer Program Annual Report | Altru Health System
Accomplishments:
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Continued full accreditation status from the American
College of Surgeons, Commission on Cancer, with the
most recent survey visit in October 2015.
Conducted a study of quality on treatment
measurements for lung cancer, resulting in better
practices for pathology on lung resections and lymph
node removal. A study was also conducted looking at
the incidence of testing MSI for Lynch Syndrome in
colorectal cancer. Study findings are further detailed
in Dr. Hanna’s report on page 4. Another study was
conducted on referral patterns of our oncology
patients to hospice. Referrals have increased in 2015
due to steps to educate staff on the referral process
and promote more awareness.
Participation in Patient Center Outcome Research
Institute (PCORI) Special College of Surgeons Study
for breast, colorectal and lung cancers.
Continued participation with the Alliance Group,
offering patients access to clinical trials and
continued achievement of required number of
treatment accruals as per Commission on Cancer
standards.
Participated in and sponsored the successful 2016
American Cancer Society’s Relay for Life in Grand
Forks on June 18, 2016.
Continued success of the ‘Filling the Gap’ program
with events held throughout the year. This program
was developed to lessen the financial burden for our
patients by assisting with costs for nutritional support,
lodging and transportation. In 2015, over $105,000
was given to qualifying patients through this program.
2015-2016
Cancer Program
Accomplishments,
Goals, Quality and
Enhancements
Goals:
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Continued participation in community outreach events
such as Relay for Life and other educational programs.
Continued successful cancer prevention and screening
programs.
Continued coordination of Cancer Program team to
maintain full accreditation status from the American
College of Surgeons, Commission on Cancer.
Continued development and enhancements of the
Survivorship Care Plans.
Enhancements:
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Development and implementation of oral
chemotherapy guidelines following ONC/American
Society of Clinical Oncology.
Altru Health System received a grant through Million
Hearts to train staff for tobacco cessation for our
patients. Consultation and follow-up visits are now
provided by our nurse practitioner.
2016 Cancer Program Annual Report | Altru Health System
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Introducing our new Cancer Liaison Physician
As of March 2016, Altru Cancer Program is happy to announce the appointment of Stefan Johnson, MD,
Department of Surgery as our new Cancer Liaison Physician (CLP).
As the CLP, Dr. Johnson’s responsibilities are to serve in a leadership role within our cancer program and
to be responsible for evaluating, interpreting, and reporting our cancer program’s performance using data
from the National Cancer Data Base (NCDB). Dr. Johnson reports the results of this analysis to the
cancer committee at each quarterly cancer committee meeting.
The Cancer Liaison and the cancer committee membership monitors our cancer program’s expected
estimated performance rates for all accountability measures using the Cancer Program Practice Profile
Reports (CP3R). They have implemented an action plan to review and address any accountability
measure rate that falls below the expected performance rate.
The CP3R reports provide comparative information to assess compliance with
standard of care. Utilizing the CP3R reports, as a cancer program, we are able to
compare our care to that of other providers allowing us to identify any problems
in practice and to implement changes and enhancements for improvement.
Below are examples of two CP3R measurements for colon and rectal cancer. In
some cases, the total number cancer cases is so low that this will affect the
percentages. For example, in 2011 there was only 1 non-concordant colorectal
case, but the total number of cases was so low that the measure appeared only
80% concordant. This was reviewed and continues to be monitored as with all
cases in the CP3R.
Adjuvant chemotherapy is recommended or administered within
4 months (120 days) of diagnosis for patients under the age of
80 with AJCC stage III (lymph node positive) colon cancer
(Accountability)
Measure
Co Std/%
ACT
Not
Applicable
2010
2011
2012
2013
100.00 100.00 100.00 100.00
Preoperative chemo and radiation are administered for clinical
AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and
radiation are administered within 180 days of diagnosis for
clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or
Stage III; or treatment is recommended; for patients under the
age of 80 receiving resection for rectal cancer (Quality
Improvement)
Measure
Co Std/%
2010
2011
RECRTCT
4.5 85%
100.00
80.00
2012
2013
100.00 100.00
Stefan Johnson, MD
Altru Health System 2016 Cancer Liaison Physician
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2016 Cancer Program Annual Report | Altru Health System
Colorectal Cancer Study
At Altru Health System we currently see an estimated 80 to 90 newly diagnosed colorectal cancers each
year. In early 2016 we conducted a Quality Improvement study investigating our colorectal cancer cases.
We were interested in studying compliance with national treatment guidelines governing testing for Lynch
Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC).
Lynch Syndrome is an autosomal dominant genetic condition that has a high risk of colon cancer as well
as other cancers including endometrial, ovarian, stomach, small intestine, hepatobiliary tract, upper
urinary tract, brain, and skin cancers. Per the Mayo Clinic, it is estimated that about 3 out of every 100
colon cancers are caused by Lynch Syndrome.
Families of patients with Lynch syndrome usually have more cases of colon cancer than would generally
be expected. Lynch Syndrome may also cause colon cancer to occur at an earlier age than is usually seen
in the general population.
Testing for Lynch Syndrome consists of microsatellite instability
(MSI) and/or immunohistochemistry (IHC) testing. These tests
are performed to analyze colon and other tumor tissue samples
for features suggestive of Lynch Syndrome.
Study criteria referenced the 2015 national guidelines
(Bethesda Guidelines for HNPCC), with investigators looking
closely at colorectal cancer patients younger than age 50 years;
patients with additional cancers; and patients with family history
of Lynch Syndrome associated cancers.
In this study, a total of 68 cases were reviewed. Findings
suggest that increased MSI testing should be offered. We
identified 15 patients who were eligible for MSI testing and did
not receive it. However, ten of those patients met eligibility
requirements based on family history alone. It is possible that
documentation of family history may not have been reported
until after the testing window.
The 2016 national guidelines were revised to assure testing of a
broader patient population, including all colorectal patients
under age 70 regardless of family history. Following the
reporting of our findings for this study, there are plans to
conduct another Quality Improvement study in 2017 to review
further compliance with the new guidelines following awareness
and educational efforts.
Mina Hanna, MD
Medical Oncology
2016 Cancer Program Annual Report | Altru Health System
4
Understanding Cancer Genetic
Risk Assessments
It seems nowadays that everyone knows someone with cancer. Whether it
is a friend, family member, loved one, or acquaintance, it affects us in
some way. Cancer will affect approximately 1.6 million Americans in
2015. Cancer is the second leading cause of death in the US,
accounting for nearly 1 of every 4 deaths. In 2015 it is estimated that
3,800 individuals in ND will be diagnosed with cancer.
ANNE NYGAARD, FNP, AOCNP
Cancer can be caused by many factors. Some include: genetic,
environmental, medical, and lifestyle factors. One area that we can make
a difference in survival rates is cancer genetics. Many of you have
probably heard about genetic testing and want to know more. In this
article, I will share how genetic testing works, and how it can help in
detection and potential prevention of cancer caused by genetic mutation.
Cancer genetic testing for breast cancer genes, more commonly known as
BRCA, was first introduced in 1996. Genetic testing since that time is
constantly evolving with the addition of more cancer genetic syndromes.
The latest development is cancer gene panels. This is a next generation
sequencing technology that assesses inherited mutations in multiple
genes simultaneously. Current cancer gene panels vary in size from just
two genes (i.e., BRCA1 and BRCA2) to larger panels that include more
than 50 genes.
Many people have multiple cancers in their family and wonder if genetic
testing is right for them. Factors to consider are the types of cancers and
age of diagnosis in your family history. We call these red flags. Below are
some of the red flags that warrant risk assessment for a breast or colon
cancer genetic syndrome.
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Breast cancer before age 50
Ovarian cancer at any age
Male breast cancer at any age
Breast and ovarian cancer in the same person
Bilateral breast cancer (cancer in both breasts)
Eastern Ashkenazi Jewish ancestry
Relatives of BRCA mutation carrier
Colon or endometrial cancer diagnosed before age 50
Adenomatous polyps prior to age 40
A large number of polyps (> 10) occurring at any age or over a
lifetime
Multiple primary colorectal cancers or other hereditary syndromeassociated cancers
2016 Cancer Program Annual Report | Altru Health System
Currently, genetic risk assessments are performed at the Sanny & Jerry
Ryan Center for Genetics and Prevention at Altru Health System in Grand
Forks, ND. These assessments look at your family and personal history
and other factors to help you decide if and what genetic testing is right
for you. Jackie Roberts, FNP, AOCNOP and I, Anne Nygaard, FNP,
AOCNP are qualified professionals that assist with this genetic risk
assessment and testing.
Genetic risk assessment and informed consent prior to testing is
important. It helps determine if testing is appropriate for you and your
family, and what kind of testing you should undergo. Since genetic
factors result in about 5-10 % of cancer cases, it is important to test
those who are high risk. Genetic risk assessment and informed consent
help you to understand the implications of testing, such as the impact on
your health decisions and possible insurance changes. We want patients
and their families to understand the impact that genetics can have on
their health and the health of their family members.
For more information on genetic risk assessment and testing, please call
the Sanny & Jerry Ryan Center for Genetics and Prevention at
701.732.7620.
2016 Cancer Program Annual Report | Altru Health System
6
Cancer Registry
Summary
KIM SHELDON, CTR, PAM VIGEN, CHUC, CTR,
AND LINDSAY CARPENTER
The Cancer Registry is part of the cancer program and
is located within the Altru Cancer Center. The purpose
of the cancer registry is to maintain timely, accurate
and complete data on all types of cancer diagnosed
and/or treated at Altru Health System. Our reference
date is January 1, 2006. We currently have 8,318
cases in the database.
In 2015, 846 new cases were added to the cancer
registry database. The following pages show the site
distribution for these patients and also their
demographic information.
Altru Health System’s cancer data is part of national
statistics for incidence reporting and research. Our data
is submitted to the National Cancer Data Base (NCDB),
the Minnesota Cancer Surveillance System (MCSS) and
the North Dakota Central Registry Data Base (NDCR).
Guidelines are in place so that submission of data to
the aforementioned entities complies with HIPAA. The
most current NCDB Call for Data was completed in
January 2016. We submit data to the NCDB as part of
the Rapid Quality Reporting System (RQRS). In 2015
we also participated in the Patient Center Outcome
Research Institute (PCORI) Special College of Surgeons
Study for breast, colorectal and lung cancers.
If you have any questions or would like to request
data from the cancer registry,
please contact registry staff at 701.780.5395,
701.780.5396 or 701.780.5417.
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2016 Cancer Program Annual Report | Altru Health System
Primary Site
Oral Cavity
Digestive System
Esophagus
Stomach
Small Intestine
Colon
Rectum
Anus, Anal Canal
Liver/Bile Ducts
Pancreas
Respiratory System
Larynx
Pleura
Lung/Bronchus
Bone, Soft Tissue
Peritoneums, Connectives
Blood & Bone Marrow
Leukemia
Multiple Myeloma
Other
Skin
Melanoma
Other
Breast
Female Genital
Cervix Uteri
Corpus Uteri
Ovary
Vulva
Male Genital
Prostate
Testis
Urinary System
Bladder
Kidney/Renal Pelvis
Brain & CNS
Brain (Malignant)
Other
Endocrine
Thyroid
Other Endocrine
Lymphatic System
Hodgkin Disease
Non-Hodgkin
Unknown Primary
Cases
846
21
156
11
11
5
72
17
399
11
78
9
7
2
37
7
Female
447
10
78
2
4
3
35
10
5
0
5
15
20
134
3
1
130
2
9
50
21
14
15
26
25
1
162
35
6
18
10
1
89
84
5
67
38
29
20
7
13
17
14
3
46
5
41
12
8
8
72
3
0
69
1
4
27
11
9
8
16
15
1
4
0
0
0
0
0
89
84
5
51
31
20
7
4
3
4
2
2
23
3
20
9
7
12
61
0
1
61
1
5
23
10
5
7
10
10
0
158
35
6
18
10
1
0
0
0
16
7
9
13
3
10
13
12
1
23
2
21
3
2016 Cancer Program Annual Report | Altru Health System
Male
2015 Site
Distribution by
Gender
In 2015 we saw a total of
846 new cancer patients at
Altru Health System. The top
five most common sites
were: breast, lung, prostate,
colorectal and lymphoma.
8
2015
Estimated
New Cancers
Ten Leading sites by Sex,
United States (estimated
2015 cases by The American
Cancer Society) Versus 2015
data from Altru Health
System.
Altru numbers are similar to
national estimates. This year,
our statistics show a higher
number of lung and
colorectal cancers in both
men and women and a
higher number of renal
cancers in men.
Estimated New Cancers and
Distribution by Stage
MEN (%)
Site
Prostate
Lung and Bronchus
Colon and Rectum
Urinary Bladder
Non-Hodgkin Lymphoma
Melanoma of Skin
Oral Cavity and Pharynx
Kidney and Renal Pelvis
Leukemia
Liver and Biles Ducts
All other Sites
United States
27%
14%
8%
7%
4%
5%
4%
5%
4%
3%
19%
Altru Health System
17%
15%
12%
9%
3%
6%
4%
9%
4%
2%
19%
WOMEN (%)
Site
Breast
Lung and Bronchus
Colon and Rectum
Endometrium
Leukemia
Non-Hodgkin Lymphoma
Melanoma of Skin
Kidney and Renal Pelvis
Pancreas
Thyroid
All other Sites
9
United States
29%
13%
8%
6%
3%
4%
4%
3%
3%
6%
Altru Health System
30%
15%
9%
5%
3%
4%
4%
1%
3%
1%
21%
25%
2016 Cancer Program Annual Report | Altru Health System
2015 Cases per Stage and Age
2015
Distribution by
AJCC Stage
30%
25%
Statistics show that 846
cases in 2015 were staged.
Of these, 441 cases or 52%
were localized (early) stages.
This is important as many
cancers can be cured,
especially if found early and
catching cancer in its early
stage is our goal.
20%
15%
10%
5%
0%
141
74
8.75%
Stage 0
226
26.71%
Stage I
16.67%
107
12.65%
12.56%
Stage III
Stage II
154
18.20%
Stage IV
54
6.38%
Unknown
Cancer Stage
90
10.64%
Not
Applicable
2015 Cases
per Age
300
Statistics show most of our
patients are between the
ages of 60 and 80; however,
we have seen an increase in
younger patients over the
past several years.
250
200
150
100
50
2
0
10-19
12
20-29
31
30-39
48
40-49
164
50-59
239
60-69
230
70-79
108
80-89
13
90-99
Age at Diagnosis
2016 Cancer Program Annual Report | Altru Health System
10
2015 Cases per Demographics
DIVIDE
RENVILLE
BURKE
WILLIAMS
BOTTNEAU
MOUNTRAIL
WARD
1
MCKENZIE
MCLEAN
DUNN
BILLINGS
GOLDEN
VALLEY
SLOPE
MERCER
OLIVER
DIVIDE
MORTON
ROLETTE
CAVALIER PEMBINA KITTSON
ROSEAU
16 TOWN
LAKE OF
20
ER
43
12
67
THE WOODS
11
PIERCE
WALSH
7
MARSHALL
MCHENRY 2
KOOCHICHING
RAMSEY
45
29
BENSON
BELT
1
RAMI
62
14
GRAND FORKS
PENNINGTON - 35
3
NELSON
283
RED LAKE - 15
EDDY
18
POLK
WELLS
CLEARWATER
4
ITASCA
TRAILL 131
SHERIDAN
2
GRIGGS STEELE
FOSTER
3
MAHN
OMEN
1
NORMAN
3
HUBBARD CASS
BURLEIGH
STUTSMAN
KIDDER
1
BECK
ER
CASS
BARNES
CLAY
1
HETTINGER
LOGAN
GRANT
BOWMAN
ADAMS
SIOUX
EMMONDS
MCINTOSH
LAMOURE
RANSOM
DICKEY
SARGENT
OTTER TAIL
RICHLAND
1
TODD
GRANT
MORRISON
DOUGLAS
TRAVERSE
STEVENS
BIG STONE
The demographics
shown on map reflect
that 62% of our cancer
patients in 2015 are
North Dakota residents.
37% were from
Minnesota and <1%
were from out of state.
LAC QUI
PARLE
KANDIYOHI
MEEKER
CHIPPEWA
YELLOW MEDICINE
LYON
RENVILLE
ROCK
BENTON
CARLTON
PINE
ISANTI
SIBLEY
REDWOOD
BROWN
SCOTT DAKOTA
LA
GOODHUE
NICOLLETE SUEUR RICE
WABASHA
COTTON- WATONWAN
WOOD
NOBLES JACKSON
CHISAGO
ANOKA
WASHWRIGHT
INGTON
HENNEPIN
RAMSEY
MCLEOD CARVER
1
1
LINCOLN
PIPESTONE
MURRAY
MILLE
LACS
KANNABEC
LAKE
SHERBURNE
SWIFT
Many of our patients
travel a great distance
to receive care at Altru
Cancer Center. Our goal
through Patient
Navigation and various
programs is to ease the
burden of that distance
and to provide
excellent quality of
care for our patients
and their families.
11
STEARNS
POPE
AITKIN
CROW
WING
1
WADENA
WILKIN
COOKE
SAINT LOUIS
STEELE
BLUE
DODGEOLMSTED WINONA
EARTH WASEC
A
MOWER
MARTIN FAIRBAULT FREEBORN
FILLMORE HOUSTON
North Dakota
(524 Cases - 62%)
Minnesota
(310 cases – 37%)
283 - Grand Forks
62 - Ramsey
45 - Walsh
43 - Pembina
20 - Cavalier
18 - Nelson
16 - Rolette
14 - Benson
11 - Towner
4 - Eddy
3 - Traill
2 - Pierce
1 - Richland
1 - Ward
1 - Steele
131 - Polk
67 - Roseau
29 - Marshall
35 - Pennington
12 - Kittson
15 - Red Lake
7 - Lake of the Woods
3 - Beltrami
3 - Mahnomen
2 - Clearwater
1 - Koochiching
1 - Crow Wing
1 - Becker
1 - Carver
1 - Mcleod
1 - Cass
Out of State
(12 cases – 1%)
2016 Cancer Program Annual Report | Altru Health System
Altru’s Promise
Every moment of every day, we
promise to provide an excellent health
care experience. We will be respectful,
compassionate and thorough. We know
your family and friends are an important
part of your care; we will involve them
as you wish and extend the same
promise of excellence to them.
Every day, our patients take time to
celebrate in big and small ways.
On one recent occasion, our
patient, Marlin Jacobson,
celebrated with our staff the last
day of his treatments which just
happened to fall on his 53rd
wedding anniversary. Here he
celebrates with Kristine Krom,
RTT, Radiation Oncology.
2016 Cancer Program Annual Report | Altru Health System
12
Altru
®
CANCER CENTER
Improving Health, Enriching Life
960 South Columbia Road | Grand Forks, ND 58201 | altru.org