Cancer Program Annual Report - St. Clair Hospital

2011
Cancer Program Annual Report
December 30, 2011
With Cancer Registry Data from 2010
12/1/2011

Cancer Committee Report for 2011
During 2011, The St. Clair Hospital Cancer Care Program has maintained the high standards of
the American College of Surgeons’ Commission on Cancer. Our program provides all patients
with a full range of diagnostic, treatment, and supportive services through the continuum of
cancer care. Accomplishments in Cancer Care for 2011:
The Cancer Program is approved as a Comprehensive Community Cancer Center by the
American College of Surgeons Commission on Cancer.
Richard Maley, Jr., M.D. continues to serve as our Cancer Liaison Physician and keeps the
Cancer Committee informed through quarterly presentations of National Cancer Data Base
information of St. Clair patients.
State of the art radiation techniques are available to our patients on-site through a
collaborative partnership with UPMC Cancer Centers. Treatments available are: 3-D conformal
External Beam Radiation; Intensity Modulated Radiation Therapy (IMRT) for the treatment of
breast, prostate, lung, and head & neck cancers; prostate seed program; and superficial electron
treatments for skin lesions or to give boost treatments to surgical margins.
The Cancer Care Committee continues to have weekly Cancer Care Conferences with
either a prospective, retrospective, or didactic presentation. The Cancer Care Conference is
attended by physicians from a variety of medical specialties, as well as nursing staff and other
disciplines. Major cancer sites such as prostate, breast, colon, lung, and bladder, as well as other,
less common primary site, have been topics of discussion and case presentation. Greater than
90 cases have been presented.
A monthly Breast Conference has been added to discuss cases with multidisciplinary
team input. In addition a weekly radiation oncology roundtable occurs to discuss current cases.
Internal auditing demonstrates that the tumor registry data is timely and compliant.
The Cancer Care Conference has been approved for Continuing Education Credits for
nurses.
A focus on survivorship is evidence through our supportive services. In 2011 over 1,000
oncology patients received rehabilitative services in the form of ostomy care, Physical Therapy,
Occupational Therapy, and Speech Therapy. The Cancer Program provided South Hills
Community residents with free cancer screenings and community programming. A new Head
and Neck Cancer Support Group has been added to the repertoire of established support groups.
Navigational services are now offered to newly diagnosed patients on the inpatient
oncology unit. Designated nurses ensure that patients have all appointments scheduled and all
necessary information to continue their care once they are discharged.
The Sipe Infusion Center was opened in July 2011. The new center is 3 times larger than
the former infusion center and provides an updated and comfortable space for oncology
outpatients at St. Clair hospital.
In the year 2011, we continued to work towards our primary goals of prevention, early
diagnosis, optimal treatment, rehabilitation, psychosocial support, and quality end of life care, to
decrease mortality and morbidity of cancer in the United States.
Anthony R. Haradin, M.D.
Medical Director, Cancer Center at St. Clair Hospital

2011 CANCER CARE COMMITTEE ROSTER
NAME TITLE DEPARTMENT/SECTION
REQIURED PHYSICIAN MEMBERS
Anthony R. Haradin, M.D. Medical Director, Hematology/Oncology
Cancer Center
Co-Chairman
Robert Werner, M.D. Active Physician Radiation Oncology
Co-Chairman
Richard Maley, Jr., M.D. Active Physician Thoracic Surgery
Cancer Liaison Physician
Ronald Fierro, M.D. Active Physician Hematology/Oncology
Leigh Nadler, M.D. Active Physician Colorectal Surgery
Susanna B. Levitt, M.D. Active Physician Pathology
Kris Ellis, M.D. Active Physician Radiology
AD HOC PHYSICIAN MEMBERS
Kevin Bordeau, M.D. Active Physician Urology
Robert W. Bragdon, M.D. Active Physician Plastic Surgery
David V. Glorioso, M.D. Active Physician Gastroenterology
Sandra Jones-Gordon, M.D. Active Physician Internal Medicine
Keith Lagnese, M.D. Active Physician Internal Medicine
Evan Restelli, M.D. Active Physician Pulmonary
Kenneth von der Porten, M.D. Active Physician Psychiatry
Stephen F. Wawrose, M.D. Active Physician Otolaryngology
Jason Whalen, M.D. Active Physician Dermatology
G. Alan Yeasted, M.D. Vice President Medical Affairs
Myles Zuckerman, M.D. Active Physician Family Practice
REQUIRED NON-PHYSICIAN MEMBERS
Barb Girod, BSN, MBA, RN Director Cancer Program Administrator
Sarah Darby, RHIA, CTR Oncology Registry Sup. Cancer Program
Rosemary Miller, BSN, MSN, RN Oncology Nurse Cancer Program
Karen Gasper, BSN, RN OCN CHPN Palliative Care Cancer Program
Cindy Loughman, BSN, MA, RN Quality Analyst Office of Healthcare QI
Karen Zientarski, BSN, RN Case Management Case Management Services
Kristen Willoughby, RHIA Oncology Registrar Cancer Program
ADDITIONAL/AD HOC MEMBERS
Nora Helfrich
Community Member
Diane White Representative American Cancer Society
Marjorie Mills, LCP Spiritual Counselor Pastoral Care
Kyra Williams Physical Therapist Physical Therapy
Joan Massella, MEd, RN, MBA Administrative Vice Nursing
Barry Vance, Pharm.D. Pharmacist Pharmacy
Jan Hilterman, RN OCN IV Nurse Infusion Center
Jean Lewis, MS RD Dietitian Nutritional Services
Eve-Ellen Mandler Director Medical Records
Rachel Mayo Representative American Cancer Society
Sherry Rowsick, MSW/LSW Social Worker Social Services
1

Hormone Therapy Compliance Study
Fall 2011
Kevin P. Bordeau, MD, FACS
Introduction
Prostate Cancer remains the second most common form of cancer in men
worldwide, with approximately 2.6 million men being diagnosed since 1995, and nearly
375,000 have lost their lives to the disease from 1995 to 2007. Although prostate cancer is
often thought of as a slow growing disease, it still has some fairly aggressive variants which
can cause not only death, but significant morbidity. The recent controversy over PSA
screening does not highlight this fact and therefore it is the opinion of the urologic
community that PSA testing can be a valuable tool in diagnosing and treating men with
prostate cancer.
Once a diagnosis of prostate cancer has been determined, disease factors such as
the pre-treatment PSA, Gleason score and digital rectal exam can be combined with patient factors such as age,
body habitus and co-morbidities to determine an appropriate treatment plan. The disease factors are used to
stratify patients as low, intermediate or high risk according to the following parameters:
Low Risk: PSA< 10 ng/mL and a Gleason score of 6 or less
Intermediate Risk: PSA >10 to 20 ng/mL or a Gleason score of 7 or
palpable disease on DRE
High Risk: PSA> 20 ng/mL or a Gleason score of 8 to 10
The treatment of the disease will vary according to the risk stratification. Options range from active
surveillance (i.e. monitoring the PSA without any form of active treatment), LHRH agonist therapy only, which
reduces the PSA and shrinks the cancer but does not definitively cure the cancer, radiation options including
brachytherapy and intensity modulated radiation therapy, and surgical removal. Randomized controlled studies
have shown that the combination of radiation therapy and LHRH agonist therapy is superior to radiation alone for
intermediate and high risk patients. It is, therefore, standard practice to give LHRH agonist therapy prior, during
and after radiation for these patients.
In an effort to strive to achieve excellent outcomes in our prostate cancer patients, we have undertaken this
study to look at our compliance with accepted treatment guidelines.
Methods
A retrospective chart review was performed by the staff from our office and the cancer registry, looking at
charts from 2009 and 2010, with an initial diagnosis of prostate cancer. These patients were then stratified based
on the above risk levels, and it was determined whether the patients that received radiation therapy did in fact
receive LHRH agonist therapy in accordance with accepted guidelines.
2

Results
In 2009 thorough 2010, 99 patients were diagnosed with prostate
cancer at St. Clair Hospital. Of these patients, a total of 61 received LHRH
agonist therapy. When we looked more specifically at those patients that
received radiation therapy, 41 patients with intermediate or high risk
prostate cancer received radiation therapy, either brachytherapy or
combined brachytherapy and IMRT, and 36 of those received LHRH
agonist therapy. This is a compliance rate of 87.8%.
Discussion
The purpose of our study was to take an objective look at our
compliance with standard cancer treatment guidelines, specifically those
for intermediate and high risk prostate cancer. In doing so, we hope to
highlight the appropriate treatment protocols and police our compliance
with them in an effort to maximize the care of our cancer patients and our
outcomes.
There are several limitations to this study starting with its
retrospective nature and the fact that it does not include patients that may
have either left our practice to have their care elsewhere or those that we
saw as second opinions after the diagnosis had already been made. In
general, the compliance rate of 87.8% also does not consider those
patients that may technically meet the criteria for intermediate risk
disease, but may have small volume disease and do not want to be
subjected to the side effects of LHRH agonist therapy which include hot
flashes, weight gain, and osteoporosis. There is also some increasing
evidence that diabetes and cardiovascular disease has been linked to long
term LHRH agonist treatment. The study also does not allow us to look at
the duration of LHRH therapy which is even more dictated by how well
patients are tolerating therapy. Although two and a half years of therapy
is indicated for high risk disease, some patients do not comply with this
based on their side effects, where as others may have no side effects at all.
At this time, the 5 year relative survival rate for prostate cancer at
St Clair is 97.3%, as compared to 99.6% nationwide. Although we are
close, we hope that optimizing compliance with stated guidelines can
improve our survival rate and equal if not surpass the national numbers.
3

Services
Rehab Services Evaluation
Occupational Therapy: Occupational Therapy (OT) was consulted in 410 cancer patients in 2010. Risk assessment
screening is completed by nursing staff on admission. A physician referral is required to order an OT evaluation.
OT evaluates patient’s ability to perform activities of daily living and assess patients’ ability to return to previous
level of functioning. OT is available to address pts with Lymphedema as well. OT services are available 7 days per
week.
Physical Therapy: Physical Therapy (PT) was consulted in 702 cancer patients in 2010. Risk assessment screening
is completed by nursing staff on admission. A physician referral is required to order a PT evaluation. PT works
with patients on functional mobility, strength and discharge recommendations based on the goals of the patient.
PT services are available 7 days per week.
Speech Therapy: Speech Therapy (ST) was consulted on 87 patients with cancer diagnosis in 2010. Nursing staff
provide swallow risk assessment screening on admission. A physician referral is required for ST Consult. ST
works with patients on swallowing, communication, cognitive issues, and provides diet recommendations for pts
with swallowing issues. ST is also an integral component of the Modified Barium Swallow test. ST services are
available 6 days per week.
All rehab services provide documentation in the patients chart regarding goals, progress, discharge plan
recommendations as well as education. 41 cancer patient charts were reviewed for rehab services notes. 100%
compliance was noted in all instances except for 3 charts which did not have goals however these patients were
independent and did not require skilled therapy services and were discharged from service after evaluation. Goals
were not applicable in these 3 cases.
Report on iLogic Inreach ® navigational technique and outcomes
iLogic Inreach navigational system is used to aid in the retrieval of viable specimens during
difficult bronchoscopy cases. Richard Maley Jr., MD has been using the iLogic® system at St.
Clair Hospital since June of 2010. A retrospective quality study was performed. Twenty-three
bronchoscopies were performed utilizing navigation technique from June 2010 to May 2011.
The study reveals that 83% yielded adequate specimen for diagnosis and treatment decisions.
Patient Care
Comprehensive oncology care is provided for patients at St. Clair Hospital. Inpatient and outpatient facilities are
supported by a full complement of interdisciplinary professionals. Oncology/hematology, surgery, radiation
oncology, nursing, nutrition, rehabilitation, case management, social services, clinical pharmacology, spiritual
counsel, palliative care and hospice work together to provide care throughout the continuum of a cancer diagnosis.
State of the art radiation therapies are provided by an on-site partnership with UPMC Cancer Centers. Outside
services such as the American Cancer Society and community representatives are consulted to assist in the
evaluation and support of patient care.
Support Programs
Supportive and educational programs for staff, patients, and the community round out the St. Clair comprehensive
cancer program. Staff receives oncology specific education and chemotherapy administration training to validate
and ensure competency. Fifteen outreach programs, including cancer screenings, educational seminars, spiritual
and counseling support services, and involvement in community events, were held in 2011. Cancer support groups
are offered on a regular basis to enhance survivorship quality of life. Navigation through the complex system of
oncology care is provided to all newly diagnosed cancer patients and a robust library provides educational
materials for patients and staff.
4

Grand Opening:
Sipe Infusion Center
July 2011
July marked the opening of the Sipe Infusion Center. This capital improvement was made possible through a
generous donation of a St. Clair patient. Denny Sipe was a frequent visitor to St. Clair’s Infusion Center. As part of
his legacy he wanted to leave behind a comfortable place for all cancer patients to be treated. Design of the center
included input from patients and staff as well as incorporating research on the design of infusion centers.
The bright space includes many amenities for patient comfort, privacy, and safety. Eleven treatment chairs are
arranged in pods of one or two chairs with sliding glass windows separating the pods. The design allows patients
to choose private space or the ability to converse with fellow patients. Reclining treatment chairs are equipped
with heat and massage and a
pivoting table for meal trays and
refreshments. Four private
bedrooms are available for those
patients requiring day-long
treatments or protective isolation.
The nurses’ work stations are only
steps away from the treatment
chairs, keeping patients in a clear
line of sight even when nurses are
documenting care in the electronic
record. The close proximity of
care givers to patients provides a
sense of security to patients
receiving complex therapies. The
nursing staff is trained in
chemotherapy administration and
treatment of side effects.
The Sipe Infusion Center provides convenience with hours of operation 7 days a week. This schedule allows
patients the flexibility to continue their current lifestyle with family and work.
Staff of the Sipe Infusion Center provides services for inpatients and outpatients. This includes chemotherapy
administrations, blood transfusions, PICC insertions, and therapeutic phlebotomies. Other services available
include care, repair and declotting of central lines, IV fluid and medication administration, injections and some
diagnostic procedures.
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Percentage of New Cases of Cancer
Oncology Registry Report
St. Clair Hospital’s Oncology Registry is staffed by one full-time Registry Supervisor and a full-time registrar
both of whom are Certified Tumor Registrars (CTR). A Registered Nurse works in the Registry 3 days a week
coordinating Cancer Care Conferences and facilitating education credits for the nursing staff. The Registry
supervisor and registrar perform all functions of the registry which includes case finding, abstracting, follow-up
and reporting to the State Department of Health and National Cancer Data Base (NCDB). The Registry utilizes
the Metriq Cancer Registry software package, which enables the Registry to maintain accurate data collection,
prepare multiple reports, and respond to various requests for data and Oncology Registry information. The
Oncology Registry staff abstract data according to the 2010 FORDS (Facility Oncology Registry Data
Standards) Manual.
The Seventh Edition of the AJCC (American Joint Committee on Cancer) provides staging guidelines for
physicians and the Oncology Registrars. As members of the Cancer Care Committee, the Oncology Registry
staff assists in the preparation for and attends quarterly Cancer Care Committee meetings and collaborated with
other members to conduct Quality Improvement and Patient Care Evaluation Studies.
All Registry staff attends the weekly Cancer Care Conferences. In 2010, the Oncology Registry staff regularly
attended continuing education sessions provided by such organizations as the Pennsylvania Association of
Cancer Registrars, Pennsylvania Department of Health and the National Cancer Registrars Association.
2010 Incidence of Cancer
St. Clair vs. PA and U.S. Estimates
Based on ACS Cancer Facts & Figures-2010
25.0
20.0
15.0
10.0
5.0
0.0
St. Clair
PA
U.S.
Top Five Sites
Figure 1 see incidence.xls
Figure 1 illustrates the leading sites of cancer incidence for St. Clair Hospital, Pennsylvania, and the United
States. The most frequently occurring sites are prostate, lung, colorectal, breast, and bladder. This data also
includes female only breast cancer cases. The state and national data is taken from the American Cancer
Society’s 2010 edition of Cancer Facts and Figures and includes estimated figures. With the reference date
being 1993, the Oncology Registry database consists of over 12,060 analytic cases.
6

1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Number of Cases
1100
1000
900
800
700
600
500
1993-2010 Trend Analysis St. Clair Hospital Cancer Cases
# Analytic Cases Ascession Year # Accessioned Cases
Figure 2 see trend analyis.xls
Figure 2 shows the number of analytic cases versus the number of cases accessioned. The number of both
accessioned and analytic cases has greatly increased this year. This is felt to be due to surgical additions to the
St Clair staff increasing the number of cancer directed surgeries performed at St Clair Hospital in 2010.
No data submission was requested by the NCDB in 2010 in anticipation of the planned 2011 submission
schedule increasing the frequency of reporting to every two months and providing more timely data analysis as
a result. St. Clair Hospital will meet reporting guidelines in 2011 as required by the American College of
Surgeons Commission on Cancer. This evaluation will enable the hospital to analyze those patients diagnosed
through 2010 at St. Clair Hospital and compare with those diagnosed at other facilities accredited by the
American College of Surgeons. The purpose of this study is to analyze the stage of disease at diagnosis and
treatment modality chosen with the NCBD composite data.
7

PRIMARY SITE
2010 Frequency Report/Analytic Cases
Total #
Cases
% of Total
Cases Sex AJCC Stage
M F 00 01 02 03 04' N/A Unk
Tongue 8 0.9% 7 1 0 4 0 1 2 0 1
Salivary Gland 1 0.1% 0 1 0 0 1 0 0 0 0
Floor of the Mouth 1 0.1% 1 0 0 0 1 0 0 0 0
Gum & Other Mouth 2 0.2% 1 1 0 1 0 0 1 0 0
Nasopharynx 1 0.1% 0 1 0 0 0 1 0 0 0
Oropharynx 1 0.1% 1 0 0 0 0 0 1 0 0
Hypopahrynx 1 0.1% 1 0 0 0 0 0 1 0 0
Esophagus 8 0.9% 5 3 0 2 0 1 1 0 4
Stomach 18 2.1% 11 7 0 5 1 4 2 0 6
Small Intestine 4 0.5% 0 4 0 0 0 1 2 1 0
Colon 87 10.1% 47 40 8 19 24 16 17 0 3
Rectosigmoid Junction 8 0.9% 6 2 0 3 1 1 3 0 0
Rectum 30 3.5% 15 15 2 15 3 5 3 0 2
Anus, Anal Canal 2 0.2% 0 2 0 0 0 1 0 0 1
Liver-Intrahep Bile Ducts 4 0.5% 4 0 0 1 1 0 2 0 0
Other Billiary 3 0.3% 2 1 0 0 1 0 1 1 0
Pancreas 11 1.3% 9 2 0 1 1 0 8 0 1
Perit, Omen & Mesen 2 0.2% 0 2 0 0 0 2 0 0 0
Other Digestive Organs 1 0.1% 0 1 0 0 0 0 0 1 0
Larynx 5 0.6% 5 0 0 2 0 2 1 0 0
Bronchus and Lung 121 14.1% 58 63 0 19 16 36 43 0 7
Soft Tiss Inc Heart 4 0.5% 3 1 0 3 0 1 0 0 0
Skin/Melanoma 9 1.0% 6 3 0 4 1 0 1 0 3
Non-Epithelial Skin 3 0.3% 2 1 0 1 1 0 0 0 1
Basal & Squamous Skin 1 0.1% 0 1 1 0 0 0 0 0 0
Breast 185 21.5% 3 182 49 50 33 17 10 0 26
Cervix Uteri 7 0.8% 0 7 1 5 0 1 0 0 0
Corpus Uteri 34 4.0% 0 34 0 24 2 2 3 0 3
Ovary 21 2.4% 0 21 0 5 0 8 8 0 0
Vagina 1 0.1% 0 1 0 1 0 0 0 0 0
Vulva 6 0.7% 0 6 2 2 0 1 0 0 1
Prostate Gland 60 7.0% 60 0 0 10 25 4 8 0 13
Testis 2 0.2% 2 0 0 2 0 0 0 0 0
Penis 1 0.1% 1 0 1 0 0 0 0 0 0
Spermatic Cord 2 0.2% 2 0 0 0 0 0 0 2 0
Bladder 59 6.9% 42 17 31 17 6 1 1 0 3
Kidney & Renal Pel 25 2.9% 17 8 1 13 0 9 2 0 0
Ureter 3 0.3% 1 2 2 0 1 0 0 0 0
Other Urinary Organs 2 0.2% 2 0 2 0 0 0 0 0 0
Brain 2 0.2% 2 0 0 0 0 0 0 2 0
Cranial Nerves/Oth Nerv
Sys 8 0.9% 3 5 0 0 0 0 0 8 0
Thyroid Gland 29 3.4% 9 20 0 18 2 2 0 0 7
Oth Endocrine/Thym 1 0.1% 1 0 0 0 0 0 0 1 0
Hodgkins Lymphoma 9 1.0% 5 4 0 4 4 0 1 0 0
Non-Hodgkin Lymph 32 3.7% 11 21 0 8 7 6 9 0 2
Multiple Myeloma 11 1.3% 3 8 0 0 0 0 0 11 0
Leukemias 3 0.3% 3 0 0 0 0 0 0 3 0
Mesothelioma 2 0.2% 1 1 0 1 0 1 0 0 0
Misc Sites 19 2.2% 11 8 0 0 0 0 0 19 0
TOTAL 860 99.4% 363 497 100 240 132 124 131 49 84
FIGURE 4
8