Download 2011 Annual Oncology Report

Cancer Center
At
Douglas County Hospital
2011 Annual
Oncology Report
Based on 2010 Data
Contents
The Past, Present, and Future of Cancer Services at Douglas County Hospital ........................................... 3
Cancer Services............................................................................................................................................. 4
Medical Oncology ..................................................................................................................................... 4
Imaging Services....................................................................................................................................... 5
Radiation Oncology .................................................................................................................................. 6
Surgical and Consulting Services ............................................................................................................. 7
Supportive Services ...................................................................................................................................... 8
Palliative Care ........................................................................................................................................... 8
Hospice ..................................................................................................................................................... 8
Rehabilitation Services ............................................................................................................................. 8
Reach to Recovery .................................................................................................................................... 9
Look Good Feel Better.............................................................................................................................. 9
Relay For Life ........................................................................................................................................... 9
2010 Activity Report................................................................................................................................... 10
AJCC Stage: 2010 Analytic Cases Abstracted........................................................................................... 10
2010 Site Incidence of Top Four Cancers ................................................................................................... 11
2010 Site Incidence Data – DCH ................................................................................................................ 12
Patient Interview ......................................................................................................................................... 13
Lung Cancer Outcomes Analysis................................................................................................................ 14
Professional Education and Community Outreach ..................................................................................... 15
Douglas County Hospital Cancer Committee ............................................................................................. 15
Page 2 of 15
The Past, Present, and Future of Cancer Services at
Douglas County Hospital
During recent years, residents of Douglas County and surrounding communities have had the
opportunity to obtain various diagnostic and treatment modalities for cancer care at Douglas
County Hospital. In 2007, Douglas County Hospital opened an eight bed outpatient medical
oncology unit which was an initial step to a larger vision in creating a comprehensive cancer
center at Douglas County Hospital.
In 2009, the Douglas County Hospital administration along with the Douglas County Hospital
Cancer Committee committed to making the vision of a cancer center a reality by beginning the
process of becoming accredited by the Commission on Cancer.
The Commission on Cancer (CoC) was established by the American College of Surgeons in
1922. The mission of the CoC is to improve survival and quality of life for cancer patients and
their families through standard setting, prevention, research, education and monitoring quality
care. The CoC accreditation ensures patients will have access to the full scope of services
required to diagnose, treat, rehabilitate, and support patients and the families of patients with
cancer.
2011 has been a fruitful year for the Cancer Center in Douglas County. Along with the Medical
Oncology program at Douglas County Hospital receiving a 3-year accreditation with all possible
commendations awarded by the CoC, the CentraCare Radiation Oncology department also
received a 3-year accreditation by the American College of Radiology on November 11, 2011.
These accomplishments show we provide quality cancer care based upon national standards here
in Alexandria and the surrounding area.
Cancer Services
Douglas County Hospital has the following services available to diagnose, treat and support
patients and their families during their cancer journey.
Medical Oncology
The medical oncology unit features:

Eight private, comfortable, individual treatment areas

Oncology-certified nursing staff

Individual patient and family education

Nutritional counseling

Rehabilitation services

Navigation of services

Psychosocial support

Access to research programs

Referrals for other services
2010 Statistics:
Oncology patients ..................................................................2, 589
Chemotherapy infusions administered ...................................2,953
Meet Our Oncologist
Marion B. Raflores, MD
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.
Page 4 of 15
Imaging Services
A variety of diagnostic and interventional radiology studies are available at the Alexandria
Center for Diagnostic Imaging which is located at the Douglas County Hospital. The following
services are available:
Advanced Imaging Services Include:








High-field 1.5T MRI (Magnetic Resonance Imaging)- ACR Accredited
64-Slice CT (Computerized Tomography) - ACR Accredited
Nuclear Medicine - ACR Accredited
Ultrasound - ACR Accredited
Digital Mammography - ACR Accredited
Stereotactic Breast Biopsy
X-ray
PET/CT (Positron Emission Tomography/CT)
Page 5 of 15
Radiation Oncology
CentraCare Radiation Oncology at Douglas
County Hospital opened in October, 1998. This is
a collaborative relationship between CentraCare
Health System-Melrose and the Douglas County
Hospital.
Radiation Oncologist
Eitan Medini, MD, is a Radiation Oncologist at
CentraCare Radiation Oncology unit located at
Douglas County Hospital.
CentraCare Radiation Oncology 2011 Cancer Report
2010 Statistics:
New Patients ..........................................................................179
Radiation Treatments Delivered ............................................4,603
We are pleased to announce the CentraCare Radiation Oncology program has
received full accreditation by the American College of Radiology/American Society
for Radiation Oncology. This is a three year accreditation from
November 11, 2011, through November 30, 2014. CentraCare is
one of only three radiation oncology programs in the state of
Minnesota to achieve this recognition.
www.acr.org
Radiation Oncologist
Dr. Medini, MD, a radiation oncologist is specially trained in utilizing
radiation therapy to treat a variety of cancers. The radiation oncologist
plans and prescribes the type and amount of radiation for cancer
treatments. Radiation therapy may also be prescribed to treat symptoms
which may be caused by growing tumors or cancers.
Page 6 of 15
Surgical and Consulting Services
There are approximately 5,000 surgeries performed at Douglas County Hospital annually.
Cancer surgeries may involve, but are not limited to, breast, colon, lung, prostate, kidney,
bladder and other gynecological conditions. The following surgical specialties are available at
Douglas County Hospital:

General

Orthopedic

Ophthalmology

Urology

Gynecology

Spine
Other physician disciplines and specialties are available on a consulting basis through Douglas
County Hospital. These include:

Cardiology

Anesthesiology

Nephrology

Neuro-Oncology

Neurology

Pain Specialist

ENT
Page 7 of 15
Supportive Services
Supportive Services are an integral part of the healing, recovery, and comfort for both the patient
and their families. Supportive services are available on site or as a referral basis.
Palliative Care
Palliative care can be initiated at the beginning of a diagnosis or at any stage during the illness
continuum. Palliative is beneficial for individuals and their families to address pain and
symptom management of cancer care and other chronic diseases. Palliative care consults are
available at Douglas County Hospital.
Hospice
Hospice care is focused on providing quality
care for individuals and families in the last
stages of life who have made a decision to
discontinue curative treatments. Individuals
requesting hospice are referred to Hospice of
Douglas County or a hospice agency in their
community.
Rehabilitation Services
There are a variety of rehabilitation services available onsite. These services are directed to
maintaining function and mobility, reducing pain, and assisting the individual to return to
previous level of functioning and independence. The following rehabilitation services are
available:

Physical Therapy

Occupational Therapy

Speech Therapy

Lymphedema Program
Page 8 of 15
Reach to Recovery
Reach to Recovery volunteers are specially trained individuals who are available to provide
support and education from breast cancer diagnosis throughout the continuum of care for breast
cancer. A Reach to Recovery visit can be scheduled upon a request for a visit or by referral.
http://www.cancer.org/Treatment/SupportProgramsServices/reach-to-recovery
Look Good Feel Better
Look Good Feel Better is a service program which is designed to teach beauty techniques to
women with cancer to manage appearance related side effects from cancer treatments such as
chemotherapy, radiation or other forms of treatment. This service is available as a referral.
http://www.lookgoodfeelbetter.org/
Relay For Life
Relay For Life is not a race – it is a celebration and awareness raising event for cancer survivors.
It is a wonderful source of inspiration for thousands of people year after year. Resourced by
volunteers and supported by many community-minded
businesses, Relay For Life unites the community in the fight
against cancer.
http://www.relayforlife.org
Page 9 of 15
2010 Activity Report
Table 1
Newly diagnosed cancer (excluding localized skin cancers)
2008
286
2009
243
2010
231
Analytic cancer cases 1
286
243
231
Cases in the cancer registry
3176
3055
1559
Cases in follow-up
1307
1456
1026
Hospital discharges (excluding newborns)
4615
4387
4083
Inpatient cancer discharges
179
168
138
Total cancer patient days
919
851
690
Average length of stay (excluding nursery)
3.6
3.6
3.6
Average length of stay (cancer patients)
5.1
5.2
5
Radiation therapy patients treated (Melrose Hospital owned)
233
235
193
Hospice patients (cancer)
68
74
89
Reach to Recovery patients
20
23
18
Cases presented at the Cancer Conference
Average number physicians attending monthly Cancer
Conference
37
33
37
6
6
6
1People
who were diagnosed and/or received their first course of therapy at Douglas County Hospital
AJCC Stage: 2010 Analytic Cases Abstracted
Table 2- (Four most frequent sites by stage at diagnosis)
Primary
In Situ
I
II
III
IV
Unstaged*
Total
All Cases
28
54
46
28
39
36
231
Breast
12
22
16
2
3
1
56
Lung
0
2
0
4
14
1
21
Bladder
14
4
3
1
1
1
24
Colon/Rectum
0
8
3
9
9
0
30
*This includes cancers that do not have AJCC staging classification
(AJCC = American Joint Commission on Cancer
Page 10 of 15
2010 Site Incidence of Top Four Cancers
Table 3 – (Compared to total number of cases diagnosed)
Site
DCH
Minnesota**
Nationwide**
Breast (female)
24%
13%
14%
Lung
9%
13%
15%
Bladder
10%
5%
5%
Colon/Rectum
13%
10
10%
** MN & National statistics from ACS Facts & Figures (estimated new cases for 2009)
Our Cancer Program continues to grow. Each year, we are providing service to more patients.
In 2010, there was about a ten percent increase in the chemotherapy/infusion services we have
provided.
Outpatient Chemotherapy Encounters
Total number of patients seen for administration of chemotherapy.
2008
2009
2010
2121
2699
2953
Chemotherapy Infusion Area
Page 11 of 15
2010 Site Incidence Data – DCH
People diagnosed and/or receiving the 1st course of therapy at Douglas County Hospital
Table 4
2009
2010
Ears, Nose & Throat
4
2
Digestive
49
47








3
3
0
28
9
2
1
3
4
3
0
23
7
6
1
3
Respiratory
24
21

24
21
Bone, Connective Tissue, Skin
11
2



1
0
10
0
1
1
10
13
6
0
3
1
5
0
4
4
Breast
46
56





27
24
2
0
1
18
16
2
0
0
Urinary
28
34



17
9
2
24
10
0
Nervous System
6
5


Brain
Meninges, other nervous system
5
1
4
1
Hematopoietic/Reticuloendothelial
34
27




14
9
3
8
13
6
3
5
Other
5
6



0
0
5
1
0
5
243
231
Esophagus
Gastric
Small Intestine
Colon
Rectum/Anus
Pancreas
Liver
Other
Pleura, Bronchus, Lung
Connective, subcutaneous and other
Bone
Skin (excluding basal and squamous)
Female Genital




Uterus
Cervix
Ovary
Other female genital
Male Genital
Prostate
Testis
Penis
Other male genital
Bladder
Kidney
Ureter
Hodgkin’s and Non-Hodgkin’s Lymphoma
Leukemia
Multiple Myeloma
Other
Thyroid, other endocrine glands
Eye
Unknown/ill-defined sites
Total
Page 12 of 15
Local Man’s Dream Comes True
Thanks to the Dream Foundation….
The first and largest national wish-granting organization for adults, Dream Foundation has been touching lives,
meeting needs, reuniting families, and providing peace, closure and joy at the end of life’s journey. Together
with hundreds of volunteers and more than 600 hospice and healthcare organizations nationwide, they fulfill
thousands of dreams across the country each year.
For a local Alexandria man, his dream recently came true. Allen Knollenberg has battled three different types
of cancer since being diagnosed in August of 2004. He is currently receiving treatment in our medical oncology
unit. Allen has always wanted to work on a “dude” ranch. He even bought himself a cowboy hat and boots.
One day he wore his hat and boots for his medical appointment with Dr. Raflores and the nurses complimented
him on his attire. His comment was, “Well, this is probably as close to working on a “dude” ranch as I will
get.” The nurses had received information on the dream foundation and asked Allen if he would write a dream
letter to the foundation and he agreed. They submitted his letter and he WON!
To celebrate his dream come true, a surprise party was held in the oncology unit at DCH. Allen was unaware
this was going to happen. His wife told him he needed to see the doctor before they left on their dream
vacation. So all his friends, the dream foundation team, and the team of doctors and nurses that care for Allen,
were all present, and they certainly surprised him with all kinds of goodies to take on his trip.
Allen and Audrey flew out to White Fish
Montana on October 23, 2011 for a 5 night
stay. When they arrived at the airport, there
stood a wrangler with a big sign that said
“Bar-W-Ranch.” Of course the
Knollenberg’s were easy to pick out of a
crowd because they had their University of
Minnesota sweatshirts on. They were
driven to the ranch and got settled into their
room. They said the hospitality was
unbelievable and they got a tour of the
ranch and facilities. Their room was lovely
and overlooked the mountains.
They rode horse every day with a trail
guide. The wranglers helped to assist them
on and off the horses. Allen’s first horse was named “Smokey” and he said the book that inspired him when he
was young was named “Smokey.” They also got to feed and help groom the horses. They were taught how to
rope cattle, inside an arena. They also enjoyed riding through the trails on a horse-pulled wagon.
The Knollenberg’s talked about the wonderful food they were served. Allen and Audrey said they got 3 hot
meals a day. The ranch rang a loud bell 5 minutes before the meal was served, and all the wranglers and
support staff ate together. One night, because it was the chef’s night off, they drove them into White Fish; and
they had a lovely dinner in the quaint little town of White Fish.
The medical oncology staff was so excited for the Knollenberg’s and they were so happy Allen was healthy to
fulfill his dream. They said they had a fabulous time. We wish them well as their journey continues.
Page 13 of 15
FOCUS ON LUNG CANCER
Lung Cancer is the second leading cause of cancer in both men and women in the United States.
Unfortunately, it is the leading cause of cancer death.1 In 2011, it is projected that lung cancer will claim the
lives of 156,940 Americans. There are two main types of lung cancer: small cell lung cancer (SCLCA) and nonsmall cell lung cancer (NSCLCA). In 2011, we analyzed the incidence, stage distribution and survival of
patients diagnosed with NSCLCA in Douglas County Hospital.
More than half of all patients with lung cancer are males. At
least a third of lung cancer patients are diagnosed in their late
70s.
Smoking is the leading cause of lung cancer. About 8 out of 10
people with lung cancer are current or former smokers. Because
of this, we provided educational programs on lung cancer, with
particular
emphasis on
smoking
cessation.
Early lung cancer usually has no symptoms and is diagnosed
incidentally during x-rays of the chest or CAT-scan done for
other reasons. Once symptoms of lung cancer appear, it
unfortunately portends a more advanced stage. In Douglas
County, consistent with the pattern we see nationwide, more
than half of all those diagnosed with NSCLCA have the cancer
spread to
regional lymph
nodes or to distant sites (Stage III or IV). In 2010, more than
60% of NSCLCA diagnosed in Douglas County Hospital was
Stage IV or terminal lung cancer.
In Douglas County Hospital, we strive to provide
individualized care to our lung cancer patients. Histology, or
the type of lung cancer cells, is important in determining the
type of treatment. Recent advancements in lung cancer therapy
also have made determining certain genetic alterations in the
tumor important.
A unique service available to lung cancer patients in Douglas County is palliative care provided by the Hospice
of Douglas County. This is a free service, funded by the Longfellow Foundation.
Page 14 of 15
Professional Education and Community Outreach
Professional education along with community outreach and education are essential components in the
commitment to provide ongoing quality cancer care to individuals in Douglas County and surrounding
communities. In 2011, the professional and community educational events were targeted to address diagnosis
and current treatment modalities related to lung cancer. These educational events were organized by the subcommittee with direction from the Cancer Committee. The educational efforts for 2012 will be directed
towards prostate cancer prevention, diagnosis and treatment.
Douglas County Hospital Cancer Committee
The Douglas County Hospital Cancer Committee is a multidisciplinary committee which provides leadership to
maintain quality cancer care to patients and their families. The Cancer Committee works in conjunction with a
sub-committee to establish and implement annual goals and ensure compliance with CoC accreditation
standards and evidence based practice.
2011 Cancer Committee
Coordinators
Marion Raflores MD ..................................................Medical Oncology, Chairperson/Cancer Conference Coord.
Barbara Friederichs RN .............................................Program Administrator, Quality Improvement Coordinator
Wendy Gunderson BSN .............................................Quality Improvement, Community Outreach Coordinator
Tisha Luoma Woodke RHIA .....................................HIM Director, Quality of Registry Data Coordinator
Other Members
Heidi Leach RHIT/CTR .............................................Cancer Registry
Kathy Colgrove RHIT................................................Cancer Registry
Steven Ferguson MD .................................................Family Practice/Liaison
William Flaig CEO/Carl Vaagenes CEO ...................Douglas County Hospital Administrator
Kathy Fredin RN ........................................................Oncology Clinic Manager
David Gray .................................................................Director of Pharmacy
Margaret Kalina .........................................................Chief Nursing Officer
Merry Luchau.............................................................Social Services
Eitan Medini MD .......................................................Radiation Oncology
Gary Paulson MD ......................................................General Surgery
Jason Peterson RTT ...................................................Radiation Oncology
Sue Quist RN .............................................................Douglas County Palliative Care & Hospice
Barbara Schneider RN ...............................................Surgical Services
Mark Spanbauer MD..................................................Pathology
Roberta Strom RD......................................................Dietician
Scott Sundby MD .......................................................Family Practice/Liaison
Scott Swenson MD ....................................................Imaging Services
Dean Trinh MD ..........................................................Pathology
Kevin Weedman RN ..................................................Medical Oncology Clinical Director
Page 15 of 15