2004 HRMC Cancer Report - Health First · Surgeon and ACoS CoC Physician Liaison Bev Toppa, RN Director, Radiation Oncology ... of care criteria for localized prostate cancer for

Together, we’re better. www.health-first.org

Cancer Program2004 Annual Report

Holmes Regional Medical Center& Palm Bay Community HospitalPublished December 2005

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Holmes Regional Medical Center/ Palm Bay Community Hospital Cancer Committee Members in 2004

Kathy Bauman, BACancer Program Coordinator

Karen Beckman, PTA Rehabilitative Services

David Breault, RN, BSNDirector, 3 North, 6 West, 8 West, SICU

Rev. Robert M. Bruckart, PhD, LMHCDirector, Pastoral Care

John Caso, MSWCancer Program Social Worker

Ariana Cericola, RN, OCNOncology Nurse Manager, 6 East

Charles Chodorow, DOPathologist

Craig Deligdish, MDMedical Oncologist and Cancer Program Chairman

Patti Donahue, RN, MSNDirector, Cancer Services

Mike Edwards, RPh Pharmacist, HRMC

Nanialei Golden, MDRadiation Oncologist

Debbie HeltonDirector, Marketing and Public Relations

Roberta Humphreys, RN, BSN,MS, CPHQDirector, Quality & Outcomes

Darlene KerbyAmerican Cancer Society Representative

Stuart Liberman, MDUrological Surgeon

Novlett McKenzie, MSW, LCSWCancer Program Social Worker

Jessica Miller, RD, LDClinical Dietitian

Mark Miller, MDRadiologist

Diana Monda, BSCancer Program Social Worker

Natalie Norwood, PharmDPharmacist, Holmes Regional Medical Center

Susan Ohlin, CTRCertified Tumor Registrar

Kimberly Powell Cancer Registry Data Assistant

Ursula Rigsby, RN, BSN, OCNOutpatient Chemotherapy

Gina Schwader, RNQuality & Outcomes

Nancy Smith Oncology Abstractor

Alice Spinelli, ARNP, CNSOncology Clinical Nurse Specialist

James St. George, MDRadiologist

Ronald Stern, MDAnesthesiologist, Pain Control Physician

Agnes Straker, RN Case Management

Ida Stumpf-Osmun, RN, OCNOncology Clinical Research Associate

Albert Titus, MD, FACSSurgeon and ACoS CoC Physician Liaison

Bev Toppa, RNDirector, Radiation Oncology

Rev. Lynn Turner, DVM Oncology Chaplain, Pastoral Care

Roberta VanDusen, LCSWExecutive Director, Hospice of Health First

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The Cancer Registry at Holmes Regional Medical Center has been in existence since January 1985. When Palm Bay Community Hospital was designated as its own reporting entity, Holmes Regional Cancer Registry also assumed the role of reporting the cancers for Palm Bay Community Hospital.

Holmes Regional Medical Center’s Cancer Registry utilizes a data system designated for collection, management, analysis, and reporting of information of all cancer patients analytic cases (which includes all patients who have been diagnosed with and/or treated for cancer at Holmes Regional Medical Center or Palm Bay Community Hospital). Non-analytic cases (patients who were diagnosed with cancer more than 120 days from admission and still have cancer) are also reported. The data maintained within the Holmes Regional Medical Center Cancer Registry is available to and used by the medical staff, administration, and other healthcare professionals for special studies, reports, and research purposes. We also send information to the National Cancer Data Base (NCDB) annually for consolidated reports involving state and national comparison information.

The American College of Surgeons (ACoS) Commission on Cancer (CoC) requested two special studies of us this year. One of them was for assessments and comparison of quality of care criteria for localized prostate cancer for both black and white men. The other study involved local excision for rectal cancer. Participation in such efforts assists the national task of assuring quality care and evaluation of differences in outcomes associated with different kinds of procedures. Our Cancer Registrars are proud to support such efforts.

Capturing cancer-related treatment information about our patients remains a challenge as practice groups and insurance providers have changed the face of patient care, and ultimately, cancer care as a whole. Data once available

within the organization’s facilities is now delineated to outside healthcare providers. Pathology labs, radiation therapy centers, radiology facilities, etc., have increased data collection responsibilities over the past few years. We see this trend as becoming the norm and have made adjustments in our practices to accommodate these practices. Our cancer follow-up remains within the requirements of the ACoS CoC, and efforts are continuously in the works to access and acquire valid follow-up information for our Cancer Registry.

New legislation passed by both the U.S. House of Representatives and the Senate, which was signed into law by President Bush in October 2002, enacted the Benign Brain Tumor Cancer Registries Act (Public Law 107-260). This act requires the abstracting and reporting of non-malignant primary intracranial and central nervous system tumors. Any such tumors diagnosed on or after January 1, 2004, are now reported to the State of Florida.

In conjunction with North American Association of Central Cancer Registries (NAACCR) to reduce discrepancies between three major staging systems used in the United States (SEER, TNM, and EOD), 15 additional collaborative staging schema were added to each patient’s abstract. These additions allow even more accurate and complete data collection with regard to co-morbid conditions of patients and pre-existing conditions that may affect survival outcomes.

The Cancer Registry maintains its role in contributing to patient treatment planning, staging, and continuity of care through its review of cases at weekly Tumor Board meetings. The Registry also maintains an accurate and current database. With the new uploading of information to the Florida Cancer Data System (FCDS) at the University of Miami Medical Center, all information transmitted is in as accurate and appropriate format as possible. The FCDS accepts only cases that meet

Cancer Registry

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2004 Oncology Conferences

*Presenter is a member of the medical staff at Holmes Regional Medical Center and/or Palm Bay Community Hospital.

MEETING PRESENTATIONS/TUMOR BOARD DATES MEETINGS AND PRESENTERS

1/15 Breast Reconstruction Following Breast Cancer DiagnosisMauricio J. Castellon, MD*Plastic & Reconstructive Surgery

1/22 Prostate Cancer: Frontiers in Radiation OncologyTodd Scarbrough, MD*Radiation Oncology

1/29 CRYOcare: “Stop Cancer Cold”Steven J. Hulecki, MDTreasure Coast Urology, Vero Beach, Florida

2/05 Adenoid Cystic CarcinomaTimothy O’Hare, MD*Otolaryngology

the criteria set forth in its Data Acquisition Manual.

Quality review of cancer cases was supported through the Certified Tumor Registrar’s reports. These reports strengthen the Neoplastic Disease Committee’s monitoring of compliance throughout the year. In her role with the Continuing Medical Education Committee, the Certified Tumor Registrar provided access for all physicians to attend the following Oncology Conferences and Tumor Boards:

2/12 Partial Breast Irradiation for Early Stage Breast CancerClifford Gelman, MD*General Surgery

2/19 Lung CancerDavid Grisell, DO*Radiation Oncology

2/26 New Advances in the Treatment of Multiple MyelomaJames R. Berenson, MDProfessor of MedicineUCLA School of MedicineLos Angeles, California

3/04 Sentinel Lymph Node Mapping in Colon CancerAlbert Titus, MD*General Surgery

3/11 Multiple MyelomaStephen Yandel, DO*Medical Oncology & Hematology

3/25 Breast Cancer: New Cytotoxic Agents for Advanced Breast CancerHarold J. Burstein, M.D.Professor of MedicineDana Farber Cancer InstituteHarvard Medical School, Boston, Massachusetts

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4/08 Clinical Applications of Aromatase Inhibitor Therapy for Hormone Receptor-Positive Breast Cancer: A Case Study ApproachKathryn Tzaczuk, Associate Professor of Medicine & Oncology, University of MarylandDirector, Breast Evaluation & Treatment ProgramBaltimore, Maryland

4/15 ASH Update On Non-Hodgkin’s LymphomaJohn D. Hainesworth, MDProfessor of MedicalThe Sarah Cannon Cancer InstituteNashville, Tennessee

4/22 A Colorectal Cancer UpdateRobert B. Diasio, MD*Associate Professor Of MedicineUniversity of Alabama, Birmingham, Alabama

4/29 Consensus Development in the Treatment of Non-Small Cell Lung CarcinomaJoseph Mcclure, MD*Medical Oncology/HematologyTodd Scarbrough, MDRadiation Oncology

5/20 Combined Modality Therapy in the Management of Advanced Lung CancerWilliam Blackstock, MD, Associate ProfessorWake Forest UniversityWinston-Salem, North Carolina

5/27 New Advances in the Treatment of Lymphocytic LeukemiaFrancis J. Giles, MD, Professor of MedicineUniversity of TexasMD Anderson Cancer CenterHouston, Texas

6/3 Lung CancerZaki Elmaghraby, MD*Pulmonary Medicine

6/24 Pancreatic Islet Cell Tumors and Islet Cell TumorsJoseph McClure, MD*Medical Oncology/Hematology

7/08 The (Unanswerable?) Internal Mammary Nodal Irradiation QuestionTodd Scarbrough, MD*Radiation Oncology

7/15 RF-Ablation TreatmentJeffrey Shay, MD*Radiology

8/5 New Innovations in the Management of Colon CancerCaio Max S. Rocha Lima, MD,Associate Professor of MedicineGI/Thoracic Programs Sylvester Cancer CenterUniversity of Miami, Miami, Florida

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8/19 Cytoprotection for Upper Aerodigestive Tract Cancers: Update 2004Charles R. Thomas, MDRadiation OncologyAdjunct Associate Professor University of Texas Health Science CenterSan Antonio, Texas

8/26 EsthesioneuroblastomaTimothy O’Hare, MD*Otolaryngology

9/16 Care of the Critically Ill Cancer PatientJames Shaffer, MD*Pulmonary Medicine

9/23 Head & Neck Consensus GuidelinesTodd Scarbrough, MD*Radiation Oncology

10/21 New Advances in the Treatment of LeukemiaMichael J. Keating, MDProfessor of MedicineDepartment of LeukemiaMD Anderson Cancer CenterHouston, Texas

10/30 Multiple Myeloma Related FracturesDevin Datta, MD*Orthopaedic Surgery

11/11 Malignant Gliomas—Innovative Management StrategiesNanialei Golden, MD*Radiation Oncology

Tumor Boards are held weekly in the Oncology Service Line Conference Room at Holmes Regional Medical Center.

12/09 Recent Advances with Her1/EGFR-Targeting Therapies for Non-Small Cell Lung CancerRoman Perez-Soler, MDChairman, Department of OncologyAssociate ProfessorAlbert Einstein College of MedicineAlbert Einstein Cancer CenterBronx, New York

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Clinical Research AssociateActivities and accomplishments

• The closure of the Radiation Oncology Unit at Holmes Regional Medical Center in 2004 brought significant changes to the Oncology Clinical Research section of the Cancer Program Office. Appropriate follow-up continued for all patients on the Radiation Therapy Oncology Group (RTOG) trials through the Clinical Research Nurse. The Clinical Research Nurse communicated with numerous primary care physicians as to the required criteria and yearly testing for each patient in the RTOG trial. Once a patient signs up for a clinical trial we are required to follow the patient and report to the RTOG throughout the span of the patient’s life. Referrals to outside radiation oncologists are made according to protocol and the Clinical Research Nurse remains in contact accordingly.

• The Lymphedema Knowledge Study continues with good patient accrual numbers. Flyers have been placed in various physician offices and nursing staff continues their assistance in help with referrals.

• In an attempt to increase our clinical trial accrual numbers a search was run through the Internet for a Quality of Life Study in which a patient could be enrolled. With those search results we initiated accrual for the NCI/Inflexxion, Inc. Cancer Treatment Improvement Study. Correspondence with Inflexxion, Inc., indicates that our department’s referrals comprise the largest percentage of referred patients enrolled from the state of Florida. Each patient is paid $80 for enrolling in this study.

• The Oncology Clinical Trial Nurse was appointed this year as a reviewer for the Clinical Journal of Oncology Nursing (CJON). In this role she will review/edit oncology papers/articles submitted for publication.

Community Cancer ProgramsActivities and accomplishments

• Promoted and supported community education for cancer prevention and screening activities for prostate, breast, skin, lung, and colon cancer through our role and participation in the following community activities:• The “African-American Men’s Health Summit,” which

was the NAACP-sponsored, multiple hospital-supported venture for prostate screening and awareness

• Education of community groups with the Triple Touch II breast cancer education module

• Providing information on skin cancer prevention and sunscreen packets at the “Practice Safe Sun” informational kiosk during local events

• Active staff participation in the SWAT (Students Working Against Tobacco) initiative at Melbourne High School (including field trips/Great American Smoke Out/Street-Marketing campaigns)

• Co-sponsorship of the American Cancer Society’s (ACS) colon cancer awareness program to area community centers.

• Assisted with staffing and coordinaton of our volunteer-driven Oncology Resource Center, a one-stop community-based resource for cancer information. Volunteers from the Holmes Regional Medical Center Auxiliary staff this center on weekdays. Our Oncology Resource Center volunteers provided almost 1,750 hours of service this past year.

• Staff member continued service with the local youth-empowered tobacco prevention control program, “Students Working Against Tobacco” (SWAT), and as facilitator for the ACS’s “Look Good…Feel Better” signature program for women undergoing cancer treatment.

• Staff member participated as a trainer for the Brevard Public Schools Wellness Conference at Satellite High School.

Cancer ProgramOffice

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Cancer Program Office (Continued)

• Staff member participated in the Pain Management Conference as part of the ACS’s goal to incorporate this educational component into training of ACS Signature Program educators.

• In recognition of National Cancer Registrar’s Week, displayed an information board in the Holmes cafeteria for the month of April, highlighting the components of the Cancer Program Office and staff. This provided the opportunity to distribute sunscreen packets and information as well as colon, prostate, breast, and lung cancer information.

• With assistance from the Marketing & Public Relations staff, evaluated and addressed renovation of the Cancer Program website on our Cancer Program’s website pages.

• Increased efforts for communication with local physician offices to inform them of our Cancer Program services through creation and distribution of flyers.

• Staff members supported ACS’s Making Strides Against Breast Cancer events as well as Relay For Life fund-raisers.

• Staff member received recognition for her organization-wide pin design for Nursing.

• Staff members held an educational session with hospital coders to reconcile issues with histories of cancer, Polycythemia Vera, and liquid tumor coding on medical records. This supported case-finding efforts in the department.

Oncology Social WorkActivities and accomplishments

• Provided clinical social work services to patients, families, and significant others.

• Demonstrated clinical knowledge about the psychosocial impact of disease on individuals and families as it relates to their age and stage of development.

• Assessed, implemented, and evaluated clinical interventions to assist patients and families through their disease process.

• Provided psychosocial research, education, group facilitation and peer support programs. Two social workers from the department presented a program at the Gynecological Nursing Oncology Conference called “Group Treatment and Introducing New Groups.” One of their other topics presented and the main focus of the talk was called “New Normal — Looking at the Psychosocial Path of Cancer Patient Reforming and the Lessons Learned through Adversities.”

• Demonstrated an ongoing leadership role within the hospital, community and professional organization.

• Coordinated ongoing organized patient family programs and other sanctioned interventions.

• Assisted with coordination of post-acute care services. Participated in interdisciplinary rounds, Neoplastic Conferences, Tumor Board and required intra hospital quality review programs.

• Support Groups facilitated by John Caso, MSW: Friend to Friend and (co-facilitated) Leukemia and Lymphoma Support Group.

• Support Groups facilitated by Novlett McKenzie, LCSW: Woman to Woman and (co-facilitated) Leukemia and Lymphoma Support Group.

• Hosted “Putting the Pieces Together Workshop” for Children that have a loved one diagnosed with cancer, held twice annually on Saturdays. Facilitated by Oncology Social Work staff.

• Part-time social worker was added to the department to facilitate re-focusing on the Oncology Social Work programs.

• Assisted University of Central Florida interns in achieving their internships.

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Cancer ProgramOffice(Continued)

Bios of Oncology Social Workers in our Cancer Program:

Novlett McKenzie, MSW, LCSW, received her Bachelor of Arts degree in Psychology from Albany State University and Masters of Social Work from the University of Central Florida. She has been employed with Health First for the past 13 years, specializing in group therapy and community education. Additionally, she has made numerous presentations at local, state, and national symposiums. A member of the American Cancer Society (ACS) Board of Directors, she also serves as co-chair of the ACS Cancer Control Program.

John Caso, MSW, received both his Bachelor’s and Master’s of Social Work degrees from the University of Central Florida. Employed with Health First for the past five years, he specializes in community education and support group therapy. He’s frequently requested to make presentations at local, state, and national Oncology conferences. He completed his undergraduate internship with Hospice of Health First and his graduate internship with the Alzheimer’s Association of Brevard, after which he secured five years of gerontology-specific social work practice.

Diana Monda, BS, received her undergraduate degree from Western Kentucky University and is scheduled to complete her Master’s of Social Work degree at University of Central Florida in spring 2006. She joined our Cancer Program after four years at Hospice of Health First, where she continues to serve as a volunteer. She’s interested in cancer research and her past experience includes work in children’s services, adult psychiatric hospital services, and a nursing facility for disabled individuals.

Novlett McKenzie, MSW, LCSW

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Activities and accomplishments• Continued meeting the nursing care, spiritual, and psycho-

social needs of Oncology Unit patients.• Improved scheduling for outpatient services as part of

quality improvement initiative.• Continued participation in various hospital committees to

improve patient care services.• Improved neutropenic education for patients and families

to enhance continuity of care after discharge.• Advocated for optimal pain relief for cancer patients.• Improved interdisciplinary collaboration among Nursing,

Clinical Nurse Specialists, Nutritional Services, Hospice Workers, Case Management/Social Workers and Physical Therapy. This team approach facilitates optimal care.

• Oncology nurses served as preceptors for nursing students, preparing them for their nursing careers.

• Oncology nurses continued providing education to patients and their families about cancer research and clinical trial opportunities.

• Improved Patient Safety for Oncology patients through participation in nationwide and systemwide Patient Safety Campaign initiatives as well as unit-specific initiatives.

• Reviewed and updated Oncology policies to maintain the highest standard of care.

• Educated patients on the importance of maintaining optimal nutrition.

Oncology Nursing EducationActivities and accomplishments• Continued annual chemotherapy certification and re-

certification classes to ensure Oncology nurses’ skills are meeting evidence-based medicine and Oncology Nursing Society’s standards of quality.

• New graduate Oncology nurses were certified to provide chemotherapy within 18 months.

• Continued active involvement in the Oncology Nursing Society’s Space Coast Chapter and participation in their national annual conference.

• Oncology nurses continued to provide educational presentations to their peers and other departments.

• Oncology-focused continuing educating presentations were offered throughout the Health First healthcare system.

• Ursula Rigsby, RN, BSN, OCN, authored a chapter in a book published this year entitled, Continuing the Legacy: More Voices of Oncology Nurses.

• Professional development funds were available for Oncology Nurse Certification (OCN) credentialing.

Community activities• Participated in “The Sister Run”, a fund-raiser for the Ovarian

Cancer National Alliance.• Participated in “Putting the Pieces Together”, a one-day

program for children who have a loved one with cancer.• Celebrated Gynecologic Cancer Awareness Month in

September and Breast Cancer Awareness Month in October, with several activities within our hospitals and throughout the community. These included poster displays and educational brochures that were distributed in our hospitals and throughout the community.

• Provided presentations to community groups on cancer prevention and early detection.

2005 Goals• Strengthen collaborative efforts with community partners to

enhance patient care, for example, by increasing our referrals to the American Cancer Society.

• Develop Partnership Councils to address internal concerns and explore ideas to provide optimal care.

• Develop a Cancer Genetic Risk Assessment Program to counsel those who may have, or be at risk for, an inherited cancer.

• Develop a Gynecologic-specific Oncology Program.• Maintain smoking cessation education to all smokers prior to

discharge.

Oncology Unit

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Medical/Surgical Nursing Units

Activities and accomplishments

• Continued promotion of specific certifications for Trauma and Medical/Surgical (Med/Surg) Nursing.

• Continued appropriate educational rotation of nurses to the Surgical Intensive Care Unit (SICU) for two weeks of specialized training. The entire nursing staff has completed this training and the rotational training is now included with the orientation for all new Nursing associates.

• Improved the interdisciplinary process.• Offered in-service training on the unit, including classes

for Ventilator Management, Genitourinary Trauma, and Acute Alcohol Syndrome.

• Attended and presented educational opportunities included programs on Spinal Cord Injuries, Trauma Tracks, and Pain Resources.

• Continued using the new staff lounge to incorporate a continuum of communication for all shifts. The small staff library includes copies of all performance improvement measures, and communication regarding current scoring on these measures to assist all Nursing associates. Additionally, educational offerings, staff meeting minutes, and a host of other resources for communication improvement are available to all members of the unit.

• Enacted the Employee of the Month and Secret Pals programs for associate interaction and team building.

• Decreased pressure ulcer prevalence, including facility-acquired pressure ulcer prevalence, to well below the national average.

• Received national recognition for our Pressure Ulcer Prevention Program, and continue the process of writing articles and developing a poster for display at national conferences.

• Purchased sports beds for Medical and Surgical ICUs, resulting in dramatic decrease in pressure ulcers on those units. Also purchasing these beds for our other intensive care units.

• Developed Wound Management Protocols for Wound-Ostomy Care Nurses. These protocols were approved by the Medical Executive Committee and resulted in faster access to care for patients.

• Piloted an Incontinence Management Program, a program that will eventually roll out to all nursing units.

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The Rehabilitative Services Department continued to support the Oncology team consistently for the past year. On referral from a physician, occupational therapists, physical therapists and speech-language pathologists evaluated and treated patients with a primary diagnosis of cancer.

Rehabilitative staff services were required when a cancer patient had swallowing difficulties, communication problems, cognitive issues, or a functional decline requiring rehabilitative therapy.

Speech-language pathologists:• Helped cancer patients regain communication skills

following laryngectomies.• Determined aspiration risk through bedside swallow tests

and modified barium swallow tests.• Evaluated and treated cancer patients with expressive,

receptive, and global aphasia.• Identified and treated cancer patients with cognitive

problems. • Cancer patients were able to communicate more

effectively, decrease risk of aspiration, and increase their ability to problem solve as a result of speech therapy.

Occupational therapists:• Taught energy conservation, work simplification, and

activities of daily living in providing treatments for cancer patients.

• Provided education and practice in the use of adaptive equipment to increase independence.

• Performed exercises to improve upper-extremity strength and coordination and mental exercises to increase cognition.

Physical therapists: • Consulted when mobility was a problem for a cancer patient. • Worked with cancer patients and families to achieve safer

and/or more independent bed mobility, transfers, and gait.• Provided and assisted with strengthening exercises.• Instructed family members how to prevent injury and safely

help frail patients.

All our Rehabilitative Services therapists stressed education of cancer patients and their caregivers to assure carryover of therapy techniques. All therapists worked collaboratively with the entire healthcare team to increase the quality of life for cancer patients.

Rehabilitative Services

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• Continued providing medical nutrition therapy to cancer patients by assisting patients in managing the nutrition-related side effects and complications of cancer and its therapy to promote optimal outcomes of treatment.

• Provided tube-feeding recommendations and outpatient consultation for patients.

• Provided nutrition education for Hospice of Health First patients and staff.

• Provided assistance with food supplements for patients who were unable to pay.

• Participated in floor rounds with other interdisciplinary team members.

• Participated in Tumor Board meetings.• Provided nutrition information to staff members.• During and after community nutrition classes, discussed

cancer prevention diet and provided ACS handouts for those interested.

• Participated as guest speaker at Health First-sponsored Cancer Program’s support groups.

• Provided current and visually improved post-cancer treatment handouts to patients.

Proposed 2005 Goals

Improve patient satisfaction by assisting in development of new patient tray system for Holmes Regional Medical Center and Palm Bay Community Hospital, including simplification of the menu selection system:

• Present “Eating for the Health of It” at the Friend-to-Friend, Woman-to-Woman, and Leukemia/Lymphoma Society support groups.

Nutritional Services

• Present “Eating Well for Life” at the Ovarian Cancer Alliance of Florida Support Group.

• Participate in fundraising for Making Strides Against Breast Cancer in Melbourne.

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• A total of 899 patients were admitted to Hospice of Health First in Fiscal Year 2004 with an average length of stay of 68 days. Hospice care included a total of 59,677 days of routine home care and 710 inpatient days. Our specially trained volunteers, who have a vital and unique role in hospice care, contributed 19,046 hours of service valued at nearly $326,000. Visits by other members of the Hospice interdisciplinary team included: 16,156 visits by RN Case Managers, 13,383 visits by Home Health Aides, and 6,049 visits by Hospice Social Workers.

• The Bright Star Center for Grieving Children & Families celebrated its fourth anniversary on September 16, 2004. A total of 72 referrals were made to Bright Star; yearlong attendance was 570. Denise Stone, MA, RN, the first Program Administrator of Bright Star, retired this year. Camp Bright Star, our one-day grief camp for children who have lost loved ones, was once again offered twice in 2004 (October and May). This community service broadens both the scope of bereavement support services provided and opportunities to volunteer at Hospice of Health First.

• Hospice of Health First Bereavement Support Staff made 1,538 visits which were complemented by an additional 247 contacts made by trained Keep in Touch Volunteers.

• On August 20, 2004, Hospice of Health First hosted a weekend of Open House activities at the William Childs Hospice House, the first freestanding inpatient Hospice facility in Brevard County. Actual admissions of patients were delayed due to the three hurricanes that hit this area: Charlie, Frances, and Jeanne. The Hospice House served as a respite shelter for Hospice patients, a deployment base for Police and Fire Rescue personnel, and a temporary home for displaced Health First associates.

Hospice ofHealth First

• Hospice of Health First maintained expansion of its “Inpatient Palliative Care” program across the Health First system. In Fiscal Year 2004, we had 234 admissions. The opening of the William Childs Hospice House should show its impact through a decrease in these numbers as inpatient care is accessed and utilized at the House.

• Pain management is fundamental to quality Hospice care and is therefore a significant outcome measure. The organizational goal was to comply at a 95% rate for documentation of pain at time of admission, including an interdisciplinary assessment of pain. If documentation was missing, a telephone call was initiated to the patient and/or family to rate their satisfaction with pain management. The goal for Fiscal Year 2004 was 95%; at year-end Hospice exceeded the benchmark at 98%.

• “Home Safety” continued as a quality measure based upon the Joint Commission for Accreditation of Health Care Organizations (JCAHO) National Patient Safety Goals. Hospice of Health First focused on patient identifiers and avoidance of using “Prohibited Abbreviations” determined by the Health First systemwide Patient Safety Committee. Focused studies were done on Lifeline units, oxygen units, and Home Health Aide Care Plans. An RN Field Supervisor was hired with one goal being more effective oversight of Care Plan communication between RNs and HHAs. The overall goal was 95% compliance, and Hospice reached 95.5% compliance. These studies were conducted in preparation for the triennial JCAHO survey in Fiscal Year 2005.

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• The Chaplaincy team participated in regular rounds with all disciplines involved on the Oncology Unit, receiving valuable information in preparation for personal visits with patients and their families.

• The Chaplaincy team prioritized visiting patients who were imminently terminal, then those with new or chronic cancer diagnoses, extending spiritual and emotional support to the patients and their immediate circle of support.

• At patients’ request, the Chaplaincy team contacted patients’ local communities of faith for further spiritual support.

• The Chaplaincy team provided emotional and spiritual support, counseling, and prayers for all professional medical staff on the floor as needed or requested by individual healthcare personnel, including physicians, nurses, clinical nurse specialists, dedicated oncology social workers, health unit coordinators, and respiratory team staff members.

• The Chaplaincy team offered an inservice program on ‘Spirituality and the Patient’ for the Oncology Service Line.

• In collaboration with the Chaplaincy team, the Oncology Unit established a ‘Pastoral Care Requested Visitation’ list for the Chaplaincy to access at the unit desk, identifying patients in need of emergent pastoral care visitation.

• The Chaplaincy team instituted a spiritual assessment process in the electronic chart to enhance both the healthcare teams’ discernment of spiritual issues and an accompanying plan of action response.

• The Chaplaincy team encouraged systemwide awareness of oncology issues, in particular the annual “Relay For Life” events.

• Chaplaincy team worked with the Ethics Committee to

Pastoral Care

evaluate and revise the Ethics brochure disseminated throughout Health First organizations. Portions of the brochure are now available in both English and Spanish. This will support the rapidly changing culture of our community and understanding of these important subjects.

• The Chaplaincy Team welcomed Dr. Lynn Turner, DVM, as pastoral care support designee for the 6 East Oncology nursing unit.

• Our Chaplaincy Team worked with the Ethics Committee to evaluate and revise several ethics brochures disseminated throughout the Health First organization. Newly issued brochures included a tri-fold with information on how to request an ethics consult (“Ethics Consults”) and the more specific responsibilities of those assuming the role of a healthcare surrogate or healthcare proxy for a loved one (“The Rights and Responsibilities of a Health Care Surrogate”). These brochures will support understanding of these very important subjects in the rapidly changing culture of our community.

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The Department of Pathology is an active and vital participant of the Comprehensive Community Cancer Program at Holmes Regional Medical Center and Palm Bay Community Hospital. Once our pathologists make a tissue diagnosis of cancer, the patient can then begin to access all the services offered by our Cancer Program. As a result, the timing of our reports is both critical and sensitive. We proudly complete 94% of our cases within two days (48 hours).

Advances in imaging techniques have allowed clinicians to identify small lesions and detect cancer at an early stage. Our pathologists routinely analyze smaller biopsy specimens of these lesions, including thin-needle core tissue biopsies and fine-needle aspiration biopsies. Interpretation of these small biopsies allows for less-invasive diagnostic procedures that often occur in outpatient settings and require little or no anesthesia, thus reducing patient morbidity and expense.

Immunohistochemical stains for confirmation of malignant cell-line origin and for determining prognostic factors have been performed in our laboratory for many years. During the past year we began to use newly available immunohistochemical stains, including Cyclin D1, which is reactive in a subtype of non-Hodgkin’s lymphoma called mantle cell lymphoma; and a combination of keratin 7 and keratin 20, which helps to determine the primary site of origin in the diagnosis of metastatic adenocarcinoma of unknown origin.

Our pathologists participate on the Oncology Quality Review Committee, the Neoplastic Disease Committee, the weekly Tumor Board, and the Health First Institutional Review Board, which acts to review and monitor a variety of research protocols, many of which relate to new cancer therapies. Utilizing digital technology to project photomicrographs, we

Department of Pathology

discuss the pathologic aspects being presented at the weekly Oncology Conferences. The Department of Pathology continues to implement innovations as technology becomes available. Our laboratory remains accredited by the College of American Pathologists and the American Association of Blood Banks.

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Dedicated services of the Pharmacy Department included:• 24-hour pharmacist availability for medication information• 24-hour-a-day discharge prescription services for indigent

cancer patients• Direct pharmacist involvement with our Hospice Program• Direct pharmacist participation during interdisciplinary

rounds• Continuous monitoring of epoetin alfa and filgrastim

utilization in the oncology population • Maintenance of the chemotherapy prescribing

process. The “Adult Chemotherapy Order Form” and “Chemotherapy Pre-Medication Orders” are currently under revision for streamlining purposes, inclusion of new drugs, and enhanced data collection for drug dosing. The Antiemetic Protocol is also under revision for the inclusion of new drugs and streamlining of the treatment of delayed nausea and vomiting. Suggestions and changes will be presented to the Neoplastic Disease and Pharmacy & Therapeutics Committee.

• Ongoing efforts to continuously evaluate and improve central pharmacy distributive functions and outpatient chemotherapy scheduling and medication administration. Such activities have provided better coordination of Nursing, Pharmacy, and patient needs to produce improved satisfaction with the program.

• Coordination of procedures necessary to acquire and provide investigational chemotherapeutic agents consistent with protocols initiated at other cancer treatment centers (i.e., Moffitt and Shands in Florida). Thereby, we are not interrupting our patients’ existing regimens because of access to therapy.

• Other services included preparation and dispensing of chemotherapeutic agents, built-in double-checks, and

Pharmacy

assistance with drug education material for patients, families, and hospital staff members. Priming of IV administration tubing is now performed in the Pharmacy during the chemotherapy preparation process. This enabled the removal of the IV medication hood from the Oncology Unit, an important patient and medication safety initiative.

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Quality Outcomes Management

Activities and achievements

• Follow-up was coordinated and reported for the Ovarian Cancer Quality Study. Its purpose was to determine the level of care at Holmes Regional Medical Center and Palm Bay Community Hospital as compared with national data and standards. In all, 785 women with newly diagnosed ovarian cancer were included in follow-up review. Conclusions were twofold: 1) that the care provided to the women in our study was found to be less than optimal, yet consistent with national data; and, 2) women suspicious for ovarian cancer (based on National Institutes of Health, The American College of Obstetrics & Gynecology, and The Society for Gynecologic Oncologists guidelines) should be offered a referral to a Gynecologic Oncologist.

• Established need for and acquired Endorectal Ultrasound Equipment used to alter staging and treatment for early stage colon cancer.

• In partnership with ACS and another hospital system in our county, Wuesthoff Health System, our department developed a strategic plan to increase public awareness about colorectal cancer screening in the community.

• Developed and piloted new form used to assist in determining appropriate utilization of blood products. This was coordinated with the setting of a future goal of sending blood products to patient care areas via the pneumatic tube system. The idea originated at the request of Nursing in an attempt to prevent nursing staff from needing to leave the floor to pick up blood products from the Blood Bank. We ultimately found that the auditing component for appropriate blood utilization was too labor-intensive to roll out the same process to other patient care areas.

• Continued with ongoing mortality case review. No oncology patient deaths were found to be preventable.

• A series of educational conferences to further instruct staff members on coding to improve appropriateness of billing.

• As part of Health First’s participation in the blood distribution program, a new policy was implemented regarding detection of bacterial contamination in platelets. Following policy implementation, no units received from our supplier (Florida’s Blood Center) were found to have a positive culture.

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1919

American Cancer Society

Activities and achievements

• The American Cancer Society (ACS) provided volunteer support at the hospital to educate patients and families on their programs and services, which included “Look Good…Feel Better,” “Man to Man,” “Road to Recovery,” “Reach to Recovery,” and “Resources, Information, and Guidance (RIG).” Volunteers were supported by social workers in their efforts to increase patients’ quality of life.

• Hospital staff member conducted Continuing Education Unit opportunities for nursing staff in December 2004, emphasizing early detection and prevention of colon and breast cancer. The course also included information on supporting ACS programs and assisting in the effort to increase patient registration.

• Cancer Program and Oncology staff members are installed as members of ACS’s Unit Operating Board.

• A Nursing staff member and Social Worker continue service for the ACS’s Cancer Control Committee as Chairperson and Co-chairperson, respectively.

• Hospital staff members continually support the initiative to register patients with ACS.

• Hospital staff member continues service as an ACS Colorectal Ambassador, providing community-based education on colorectal cancer prevention and early detection, as well as outlining ACS screening guidelines.

• Hospital CEO collaborated with ACS on Colon Cancer Campaign for March 2004. The CEO participated in creating the awareness by revealing his personal experience with a colonoscopy to the media.

• The ACS continually supplies educational literature and brochures for the Cancer Library at Holmes Regional Medical Center.

• The Pro-Health & Fitness Center serves as host home for our monthly “Look Good…Feel Better” program that assists

women coping with appearance-related side effects of cancer treatment. A Cancer Program Office staff member continues facilitating the program.

• Continued support for the ACS’s signature fundraising event, Relay For Life.

• Participated in the yearly ACS western gala “The Cattle Baron’s Ball.” This event assists in supporting the ACS mission as well as sending children with cancer to ACS camps.

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Cancer RegistryData

A graphic presentation of our data for 2004 appears in the charts that follow on pages 21 and 22. The data is based on all cases for the year appearing in Holmes Regional Medical Center and/or Palm Bay Community Hospital. Charts 2 through 4 on page 22 reflect data by gender, males and females, respectively.

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CHART 1—2004 FREQUENCY OF CANCER BY SITE, GENDER, AND CLASSIFICATION

Primary Site Total Male Female Analytic Non-analytic

Base of tongue 5 4 1 5 0Other parts of tongue 4 2 2 3 1Floor of mouth 2 1 1 1 1Parotid gland 7 3 4 4 3Other major salivary glands 4 4 0 4 0Tonsil 8 5 3 8 0Oropharynx 2 2 0 2 0Nasopharynx 2 2 0 2 0Pyriform sinus 3 3 0 3 0Hypopharynx 2 2 0 1 1Other oral cavity 1 1 0 1 0Esophagus 11 5 6 8 3Stomach 26 13 13 24 2Small intestine 4 2 2 4 0Colon 115 56 59 104 11Rectosigmoid junction 12 6 6 11 1Rectum 35 21 14 31 4Anus and anal canal 7 3 4 7 0Liver/intrahepatic bile ducts 18 12 6 14 4Gallbladder 4 2 2 3 1Other parts of biliary tract 7 3 4 5 2Pancreas 27 11 16 21 6Nasal cavity 1 0 1 0 1Accessory sinuses 3 1 2 3 0Larynx 14 12 2 11 3Lung and bronchus 308 167 141 280 28Mediastinum and pleura 3 1 2 2 1Bones 2 2 0 1 1Hematopoietic and lymph nodes 100 54 46 74 26Skin 60 37 23 52 8Peritoneum 4 2 2 3 1Connective and other soft tissue 13 4 9 11 2Breast 280 2 278 261 19Vulva 2 0 2 2 0Cervix uteri 5 0 5 5 0Corpus uteri 22 0 22 22 0Uterus NOS 4 0 4 4 0Ovary 13 0 13 7 6Penis 2 2 0 2 0Prostate gland 246 246 0 227 19Testis 6 6 0 6 0Kidney 45 25 20 41 4Renal pelvis 2 2 0 2 0Ureter 2 1 1 2 0Bladder 134 100 34 123 11Other urinary organs 3 2 1 2 1Eye and adnexa 1 0 1 0 1Meninges 8 3 5 8 0Brain 41 23 18 38 3CNS Spinal cord 1 1 0 1 0Thyroid gland 9 2 7 9 0Pituitary gland 7 3 4 6 1Unknown primary 38 20 18 35 3Total 1685 881 804 1506 179

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Lung

Breast

Prostate

Bladder

Colon

Lymphatic andhematopoietic

All others

18%

17%

15%8%

10%

6%

27%Male and female cancer sitesOur top five sites are Lung, Breast, Prostate, Colorectal, and Bladder. Of the cases presenting at our facilities, 52.3 percent were men and 47.7 percent were women. This runs consistent with our facility mix and approximates the national mix of 51.1 percent men and 48.9 percent women.

CHART 2 — ALL CANCER SITES — MALE AND FEMALE

28%

19%

11%

10%

6%

4%

22%

Prostate

Lung

Bladder

Colorectal


Melanoma

All others

Male cancer sites Our prostate cancer incidence was 27.9 percent of all male cancer sites at our facilities. Nationally, prostate cancer runs at 33 percent of all new cases for men. This is a decline for our facilities from past years, which may represent the change in diagnostic testing taking place at Urologists’ offices rather than in our facility surgery centers. Lung and bladder cancers are elevated for this reporting year with 19 percent and 11 percent of all male cancer sites, respectively. All in all, our experience with the five major sites for men is similar to occurrence in the nation.

CHART 3 — ALL CANCER SITES — MEN

35%

17%10%

6%

4%

3%

25%Breast

Lung

Colorectal


Bladder

Corpus Uteri

All others

Female cancer sitesBreast cancer remains our leading cancer diagnosed in women, slightly higher than the national estimates (34.6 percent vs. 32 percent) for this site. This remains similar to our last year’s data. Lung cancer diagnoses slightly increased from last year and colorectal and bladder diagnoses remained consistent with last year. These differences are negligible.

CHART 4 — ALL CANCER SITES — WOMEN

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According to the ACoS Commission on Cancer’s Standard 2.11, the Cancer Committee analyzes patient outcomes and disseminates the results of the analysis each year. A survival analysis of one site is the preferred method, and our Cancer Committee chose to review survival for the top three sites of cancer presenting in our facilities.

As recommended, these survival studies included our comparison to the National Cancer Base Database reports for both Florida and the nation. In addition to comparing with both the State and the nation, our Cancer Committee compared with other facilities designated as Comprehensive Community Hospital Cancer Centers.

The information retrieved and compared for three of our top five sites was chosen to present in this report. These top three sites (Lung, Breast, and Prostate) comprise almost half of all cases abstracted in 2004 at Holmes Regional

Medical Center/Palm Bay Community Hospital. All of these sites were discussed and results disseminated to our hospitals’ Administration and Cancer Committee.

Treatment modalities are monitored by our Quality & Outcomes Department and are in line with the state and nation.

Lung cancerOur facilities compare favorably with both Florida and the nation for this site and cell type. Surgery was ultimately the treatment of choice for most of the localized cancers. As lung cancer has usually spread by the time of discovery, radiation therapy and chemotherapy were also used for some patients. Survival for Stage 4 cancer patients at our hospitals was slightly lower when compared with survival rates in our state, but it was determined that the number of patients in this category of comparison was negligible and that this was of no statistical significance.

2004 Survival Study:Top Three Cancer Sites at Holmes Regional Medical Center/ Palm Bay Community Hospital

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By Susan Ohlin, CTR, and Kathy Bauman, BA, Cancer Program Coordinator

STAGE 1 STAGE 2 STAGE 3 STAGE 4 COMBINED STAGE

38.02% 21.95% 6.99% 1.63% 14.43%

39.50% 23.80% 10.90% 1.40% 16.70%

38.37%NATION

FLORIDA

HRMC*

21.94% 7.37% 1.26% 14.08%

0%

10%

5%

15%

20%

25%

30%

40%

35%

GRAPH 1—LUNG—NON-SMALL CELL CARCINOMA 1995-1996 FIVE-YEAR OBSERVED SURVIVAL BY STAGE

HOLMES REGIONAL MEDICAL CENTER/PALM BAY COMMUNITY HOSPITAL COMPARED TO NATION AND FLORIDA**

*HRMC = Holmes Regional Medical Center, including Palm Bay Community Hospital.**Data from the National Cancer Data Base, NCDB Benchmark Reports, online at http://web.facs.org/ncdbr/surv.cfm.

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2004 Survival StudyTop Three Cancer Sites(Continued)

We continue our approach for lung cancer prevention through our efforts to keep youth from smoking through our support of the Students Working Against Tobacco (S.W.A.T.) initiative in Brevard County. A new smoking cessation push was activated this year to assist patients and family members in quitting the habit of smoking.

Breast cancerAgain, we compare favorably with both Florida and the nation for breast cancer survival. Numerous studies have shown that early detection saves lives and increases cancer options. This is true with our incidence of breast cancer and survival as well. There is a mild decrease in survival when compared to

STAGE 0 STAGE 1 STAGE 2 STAGE 3 STAGE 4

91.10% 85.70% 73.50% 45.80% 12.80%

97.20% 89.40% 76.60% 42.10% 13.00%

91.20%NATION

FLORIDA

HRMC*

86.30% 74.40% 49.10% 14.30%

COMBINED STAGE

76.80%

82.70%

77.30%

0%

20%

10%

30%

40%

50%

60%

80%

70%

100%

90%

GRAPH 2—BREAST CANCER1994-1995 FIVE-YEAR OBSERVED SURVIVAL RATES


Florida and the nation with regard to Stage 3 breast cancers, but this was determined as statistically insignificant due to the low numbers of this stage of disease in the study. With all stages of breast cancer combined, our facilities are somewhat above Florida and the nation. The same caveat applies, though, as the numbers presented in the study are small compared to the whole.

Our Cancer Program supports the American Cancer Society’s (ACS’s) initiatives with the Triple Touch II educational forum and promotes ACS guidelines for early detection.


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Respectfully submitted by:

Susan Ohlin, CTR, andKathy Bauman, BA

STAGE 1 STAGE 2 STAGE 3 STAGE 4 COMBINED STAGE

78.40% 81.90% 83.32% 39.23% 76.87%

80.00% 79.70% 84.00% 27.30% 77.90%

76.70%NATION

FLORIDA

HRMC*

84.06% 84.41% 38.17% 77.15%

0%

20%

10%

30%

40%

50%

60%

80%

70%

90%

GRAPH 3—PROSTATE CANCER1995-1996 FIVE-YEAR OBSERVED SURVIVAL BY STAGE


Prostate cancerOur facilities compare favorably with the nation in all stages except for Stage 2 and Stage 4 prostate cancer, and this difference is determined as insignificant due to the numbers involved. Nonetheless, overall combined stages show us right on target for survival for this disease.

We continue promoting prostate cancer education and screening and maintain partnership with the local chapter of the NAACP in highlighting awareness among African-Americans in our community.


References: American Cancer Society. Cancer Facts and Figures—2004. Atlanta, Georgia: American Cancer Society, 2004

National Cancer Data Base, NCDB Benchmark Reports, online at http://web.facs.org/ncdbr/surv.cfm, 2005.

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Cancer Program Office1350 South Hickory StreetMelbourne, Florida 32901(321) 434-7227

www.health-first.org

Holmes Regional Medical Center& Palm Bay Community Hospital

Documents

2004 HRMC Cancer Report - Health First · Surgeon and ACoS CoC Physician Liaison Bev Toppa, RN Director, Radiation Oncology ... of care criteria for localized prostate cancer for