2012-13 Cancer Services Annual Report

Taking Cancer Care to Heart2012 - 2013 ANNUAL REPORT

The First Western North Carolina Hospital to Win the Outstanding Achievement Award from the Commission on Cancer

B R E A S T C E N T E R

Park Ridge Health’s oncology program has been

recognized by the American College of Surgeons’

Commission on Cancer as offering the very best in

cancer care. Our oncology program was also awarded

the Outstanding Achievement Award, becoming the first

hospital in Western North Carolina to receive this honor.

Providing the best in cancer care in an atmosphere of Christian

compassion and healing

Table of Contents

1


Park Ridge Health Cancer Services

2 Introduction

Cancer Liaison Physician

9 Analysis: Breast Cancer

16 Specialty Services

16 Park Ridge Oncology

17 Oncology Pharmacy

17 Otolaryngology (Ear, Nose, Throat)

17 General Surgery/Reconstructive Surgery

18 Urology

18 Women’s Health

18 Dermatology

19 State-of-the-Art Diagnostic Radiology

20 Quality Improvement Summary 2013

21 Park Ridge Health Breast Center

22 Cancer Registry

26 Supportive Services

28 Kenmure Fights Cancer

28 Park Ridge Team Relay for Life

28 Park Ridge Health Contacts

29 Park Ridge Health Cancer Program Leadership

30 References

30 Acknowledgements

In November 2012, Park Ridge Health, Asheville Hematology & Oncology and 21st Century Oncology joined forces to create something unique in cancer care. In teaming together, we are able to offer the latest technologies and the highest quality physician care in medical oncology, radiation oncology and hospital-based care in Western North Carolina.

This new venture allows us to operate high-quality infusion centers with compassionate care in the communities where our patients live. This is important to us because we understand that is hard to travel when you do not feel well. We are now in three Western North Carolina locations: Park Ridge Infusion Center in Hendersonville, Asheville Infusion Center in Asheville and Haywood Infusion Center in Clyde. In November 2014, a fourth location will be added in Weaverville.

For more than twenty years, Asheville Hematology & Oncology has offered cancer care to patients in Western North Carolina. These physicians see patients with oncology and hematology needs. Oncology is the branch of medicine that deals with cancer and cancer treatments. Hematology is the branch of medicine that studies blood and blood diseases, such as anemia and blood clotting disorders.

21st Century Oncology is the largest global, physician-led provider of Integrated Cancer Care Services. The company offers a comprehensive range of cancer treatment services, focused on delivering academic-quality, cost-effective patient care in personal and convenient settings.

2 32012-2013 Annual Report Park Ridge Health Cancer Services

Introduction


Click here to view a beautiful and inspiring video testimonial featuring Park Ridge Health Cancer Services patient, Barbara Norris, and her physician, Dr. Vinogradov: https://www.youtube.com/watch?v=npB8qx-8MeI

At Park Ridge Health we work hard to ensure our patients receive the absolute best in health care. Accredited by the Commission on Cancer as a Community Cancer Program and the National Accreditation Program of Breast Centers, we seek to meet and exceed the current standards of cancer care, and during 2013 we implemented several quality improvements to further that goal.

To better serve the community, we expanded our outpatient oncology services with the addition of two outpatient infusion centers and several new staff members. Among these are seven board-certified Medical Oncology and Hematology physicians, an Oncology Social Worker, an Oncology Research Nurse, a full-time Breast Navigator, and an Administrative Director for the Park Ridge Health Cancer Services team. In addition, data are analyzed regularly through the Cancer Committee at Park Ridge Health. Resulting from that committee, and shared in this report, is a quality study highlighting our performance in comparison to national and state benchmarks regarding breast cancer.

Our vision is to deliver oncology health care that meets the needs of our community as part of Christ’s healing ministry and to incorporate Christian values at every level. We are committed to providing and improving upon screening and wellness programs to promote early detection. We continue to offer our patients high quality treatment and care in the comfort of their hometown and family support.

Testimonial

54 Park Ridge Health Cancer Services2012-2013 Annual Report

Mikhail Vinogradov, M.D., was born in Latvia and has lived throughout Russia. He is board-certified in Internal Medicine and Medical Oncology and Hematology. He received his Doctorate of Medicine from Samara Medical School in 1986 and obtained his Fellowship in Hematology and Oncology from East Carolina University, Brody School of Medicine.

Dr. Vinogradov has been with Park Ridge Health since 2008 and has served as the Medical Director and Cancer Committee Chairman. He is a member of the American

Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH) and the American College of Physicians (ACP). He has researched Melanoma, Renal and Colon Cancers. He lives in Mills River with his wife and has two daughters and a son. When not at work, Dr. Vinogradov enjoys traveling, gardening and playing chess. He speaks English, Russian and Ukrainian.

Dr. Vinogradov is joined by the physicians from Asheville Hematology & Oncology:

Mikhail Vinogradov, M.D.Park Ridge Health

Shonda M. Asaad, M.D., was born in Virginia and grew up in West Virginia. She received a Bachelor of Science degree from Bridgewater College in Virginia where she graduated Cum Laude. She received her Doctorate of Medicine from West Virginia School of Medicine and obtained her Fellowship in Hematology and Oncology from Penn State, Milton S. Hershey Medical School. She has lived in the Asheville area since 2010 with her husband and two sons.

Dr. Asaad is board-certified in Internal Medicine and Hospice and Palliative Care. She is board-eligible in both Hematology and Oncology. In 2006, she received the Wellspring Physician of the Year Award for South Carolina. She is a member of the American

Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), the Southern Medical Association (SMA), and the American College of Physicians (ACP). She has published articles on Colon Cancer and Hemophilia.

She enjoys many hobbies including needlework, snow skiing, SCUBA, horseback riding, fly fishing, and traveling with her family. In her spare time, she volunteers with Four Seasons Hospice where she and her dog enjoy pet therapy visits with patients. She also works with Casting for Recovery to give breast cancer survivors a chance to learn fly fishing. Dr. Asaad’s goal is to bring more palliative care to the beginning of treatment instead of just at the end.

Shonda M. Asaad, M.D.Asheville Hematology & Oncology

Anita Deshpande, M.D., joined Asheville Hematology and Oncology in 2009. Dr. Deshpande completed a fellowship at the University of Nebraska Medical Center, Omaha and residency in Internal Medicine the Creighton University Medical Center, Nebraska. She graduated medical school with the best medical student award from Karnataka Medical College Hubi, India. She is board-certified in Medical Oncology with special interests in lung and breast cancer.

Prior to her arrival, Dr. Deshpande was in private practice at Rocky Mountain Cancer

Centers in Pueblo, CO and Saint Francis Medical Center in Grand Island, NE. She is a member of the American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH) and the American College of Physicians (ACP). She has presented at national meetings and participating in clinical trials has been an integral part of her practice.

She lives in the Asheville area with her husband and two sons. When not at work, she enjoys hiking, cooking and traveling with her family. She believes in providing the very best integrated medical care.

Anita Deshpande, M.D.Asheville Hematology & Oncology

Don V. Jackson, Jr., M.D., earned his doctorate from the University of Virginia in Charlottesville. He completed his internship at Roanoke Memorial Hospital and his residency in medicine at the North Carolina Baptist Hospital where he was chief resident. His fellowship in hematology and oncology was at the Bowman Gray School of Medicine at Wake Forest University in Winston-Salem, and he is board-certified in Internal Medicine, Medical Oncology and Hematology.

Dr. Jackson served as an associate professor of medicine at Bowman Gray until 1989, when he went into private practice in Asheville. He has chaired several local hospital committees including the Transfusion and Procedure

Committee, the Cancer Committee and Bioethics Committee. He has also chaired numerous steering committees for clinical cancer symposia. An active volunteer in his community, Dr. Jackson enjoys preceptoring students from Mars Hill College, University of North Carolina at Asheville, area high schools, and medical residents from the Mountain Area Health Education program.

In Dr. Jackson’s spare time, he enjoys his family of four children and seven grandchildren. He and his wife of more than 45 years enjoy being with their family, doing construction projects together and traveling to and from the mountains and the coast of North Carolina.

Don V. Jackson, Jr., M.D.Asheville Hematology & Oncology

6 7Park Ridge Health Cancer Services2012-2013 Annual Report

Barton Paschal, M.D., earned his medical degree from Emory University School of Medicine in Atlanta, GA. Dr. Paschal completed a residency in internal medicine at Louisiana State University Medical Center in Shreveport, LA and a fellowship in medical oncology at Bowman Gray School of Medicine, Winston-Salem, NC. He is board-certified in Internal Medicine and Medical Oncology by the American Board of Internal Medicine.

Dr. Paschal was employed as a medical oncologist with Asheville Hematology & Oncology Associates before joining 21st Century Oncology in 2009. He is a member of the staff of Radiation Therapy Associates of Western North Carolina, PA, a 21st Century Oncology affiliate. Dr. Paschal sees patients at Haywood Cancer Center in Clyde, NC, Macon Cancer Center in Franklin, NC and Cherokee Indian Hospital in Cherokee, NC.

Dr. Paschal has served on several area hospital cancer committees and as a chairman of a Department of Internal Medicine. Over the years he has volunteered his services to local, regional and national community health organizations including the following: Medical Advisory Committee of the American Red Cross, Board of Directors for Mountain Area Hospice, Board of Directors of NC Division of the American Cancer Society, and Medical Director of Hospice of Henderson County. He has received many honors and awards including being named Fellow of the American College of Physicians. He holds memberships in a variety of national and local professional societies including Haywood County Medical Society and American Society of Clinical Oncology.

Dr. Paschal has written and coauthored articles, abstracts and letters to the editor in various medical publications including Journal of Clinical Oncology, Cancer, Human Pathology, New England Journal of Medicine, North Carolina Medical Journal, and Leukemia & Lymphoma.

Barton Paschal, M.D.Asheville Hematology & Oncology

Raymond Thertulien, M.D., Ph.D., was born and raised in Haiti where he received an excellent secondary education culminating in the completion of Baccalaureate 1 and 2. He subsequently received his Bachelor’s degree in science from Brooklyn College graduating magna cum laude. He received his medical degree and his doctorate of philosophy from the University of Rochester School of Medicine and Dentistry, Rochester, NY.

Dr. Thertulien completed his internship and residency in Internal Medicine at the New York Presbyterian Hospital, Cornell Medical Center and his fellowship in Hematology and Medical Oncology at the Memorial Sloan-Kettering Cancer Center. He also completed a research fellowship in the Department of Human Genetics at the Sloan-Kettering Institute, MSKCC. Dr. Thertulien has received many honors, awards and scholarships.

Dr. Thertulien has a strong basic and clinical research background and has published extensively in various leading scientific journals in clinical areas including multiple myeloma, lymphoma, secondary malignancies, treatment-related MDS, and leukemias. His current research interests are in developmental therapeutics.

Dr. Thertulien is board-certified in Internal Medicine, Hematology, and Medical Oncology. He is a member of the American Society of Hematology (ASH), the American Society of Clinical Oncology (ASCO), the American Association for Cancer Research (AACR), and the Western Carolina Medical Society.

In his spare time, Dr. Thertulien enjoys playing and watching soccer, listening to music, reading and traveling.

Raymond Thertulien, M.D., Ph.D.Asheville Hematology & Oncology


Praveen Vashist, M.D., was born and raised in India where he attended medical school at the Bangalore Medical College and Research Institute. He moved to the United States in 2003 to pursue advanced medical training. He completed his internship and residency in Internal Medicine and later, fellowship training in Hematology and Medical Oncology at the Oakland University William Beaumont Hospital in Royal Oak, Michigan. He was on faculty as a teaching attending physician at the hospital for two years. He joined Asheville Hematology and Oncology in August 2012.

Dr. Vashist is a member of the American Cancer Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), and the Western Carolina Medical Society (WCMS). He is board-certified in Medical Oncology, Hematology, and Internal Medicine. He has presented his research in breast and lung cancers at various state and national meetings. He is dedicated to his patients’ care, and believes that it is a privilege to be entrusted with that care – a privilege that he honors with dedication, compassion, and diligence. It is this belief that guides him every single day in his professional life.

He lives in Asheville with his wife and son. In his free time, he enjoys spending time with his family and traveling. He also enjoys biking, playing ping pong, tennis, and after a long break, hopes to resume horseback riding in the near future.

Praveen Vashist, M.D.Asheville Hematology & Oncology

Paul Schaefer, M.D. (board-certified Internal Medicine and Medical Oncology), and William M. Butler, M.D., F.A.C.P. (board-certified Internal Medicine and Medical Oncology, Hematology), also provide services to our patients when our physicians are out of the office.

The Cancer Liaison Physician program was established by the Commission on Cancer to allow physicians to manage clinically related cancer activities in their hospitals and communities. In this role the Cancer Liaison Physician (CLP) is a liaison between the cancer program, the Commission on Cancer and the American Cancer Society. The Cancer Liaison Physician is responsible for reporting on the program’s performance using the National Cancer Data Base (NCDB) data 4 times per year. The NCDB data includes the Cancer Program Practice Profile Reports (CP3R), Hospital Comparison

Benchmark reports and Survival reports. This data is used to evaluate and improve the quality of care at our institution. Dr. Michelle LeBlanc has been serving as the Cancer Liaison Physician for the cancer program at Park Ridge Health since 2011.

Cancer Liaison Physician

Analysis: Breast CancerIncidenceBreast cancer is the most common cancer in females, accounting for 29% of newly diagnosed cancers. One in eight women in the United States has a lifetime risk of developing breast cancer. In 2013, an estimated 232,340 new cases of invasive breast cancer and 64,640 additional new cases of in situ breast cancer were expected. In addition, about 2,240 men will be diagnosed with invasive breast cancer in 2013.

At Park Ridge Health there were 593 new cases of breast cancer identified from 2005 to 2012 by our Cancer Registry. This report will analyze Park Ridge Health’s breast cancer experience compared to national and state figures and as documented by the Commission on Cancer’s CP3R Quality Measures.


Age at DiagnosisBreast cancer incidence generally increases with age. 79% of cases are diagnosed in individuals 50 years of age and older. 1 Of the 593 cases diagnosed at Park Ridge between the years 2005 and 2012, the age at diagnosis ranged from 25 to 96 years of age with the most common incidence between 60 to 69 years of age. Table 2 displays age at diagnosis at our facility compared to data from North Carolina and NCDB results.2

1 http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042725.pdf

2 ©2014 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / June 30, 2014

20-39 40-49 50-59 60-69 70-79 90+80-89

BREAST CANCER AGE AT DIAGNOSIS

PRH

NC

0

5

10

15

20

25

30

35

NCDB

Breast Cancer Age At Diagnosis

DiagnosisThe diagnosis of breast cancer is made after an abnormality is noted on a physical exam or screening mammogram. Ideally, the diagnosis of breast cancer is then made with a needle biopsy prior to surgical intervention. Mammogram-guided stereotactic biopsies and ultrasound-guided core biopsies are the most frequent methods used to obtain the pathologic diagnosis which then determines the next step in treatment. The rate of needle biopsies prior to surgery is one of the quality measures tracked in the CP3R. At PRH, the overall rate of needle biopsy prior to surgery between 2010 and 2012 was 95%.

Stage at DiagnosisThe stage at diagnosis refers to the extent of cancer in the body and determines treatment options. Stage at diagnosis is correlated with survival. The majority of patients diagnosed from 2005 to 2012 at Park Ridge Health presented with Stage 0, 1, and 2 breast cancers.

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4

PRHNC

NCDB

0

5

10

15

20

25

30

35

40

AJCC STAGE OF BREAST CANCER COMPARISON RATESPRH-NC-NCDB

22.9%19.8%20.9%

37.3%38.8%38.5%

24.9%27.6%25.2%

9.5%8.3%7.8%

5.0%3.6%3.7%

AJCC Stage of Breast Cancer Comparison RatesPRH-NC-NCDB

©2014 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / June 30, 2014


Treatment by StageThe CP3R data monitors several treatment-related measures as listed in the following table.

Treatment for breast cancer requires a multidisciplinary approach requiring accredited individuals in the fields of surgery, medical oncology and radiation oncology. Also integral to this process are nurse navigators, cancer registrars, clinical social workers, hospice professionals, pharmacy, nursing, clinical research, and nutritional services. At Park Ridge treatment decisions are supported by the multidisciplinary cancer conference using NCCN guidelines.

Surgery is the most common first-line treatment for breast cancer. At Park Ridge Health, a significant number of the patients diagnosed from 2005-2011 presented with early stage disease. Therefore the most common treatment for breast cancer was surgery followed by radiation therapy and/or hormonal blockade. The most common treatment for locally advanced breast cancer was combination chemotherapy and radiation therapy followed by surgery.

CP3R Measures(2011) Most Current Data Available

PRH NCCENSUSREGION

ACSDIVISION

CommunityCancer

Programs

ALL CoC Approved Programs

Radiation therapy is administered within 1 year of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer.

Combination chemotherapy isconsidered or administered within 4 months of diagnosis for women under 70 with AJCC T1cN0,or stage IB-III hormone receptor negative breast cancer.

Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer.

92.3%

100%

93.3%

95.3%

95.1%

95.7%

91.7%

91.9%

90.0%

93.1%

92.9%

92.0%

91.1%

93.5%

91.2%

92.3%

92.7%

91.0%

©2014 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / June 30, 2014

During 2013, two breast cancer quality studies were performed. The first study was a comparative review of lumpectomy versus mastectomy rates in patients presenting with stage 0, 1, or 2 based on 2010 data.

See table below.

Lumpectomy orExcisional Biopsy

Total (Simple)Mastectomy

2010 LUMPECTOMY VSMASTECTOMY COMPARISON

0

10

20

30

40

50

60

70

80

PRH

NCDB

65.4%69.2%

34.6%30.8%

2010 Lumpectomy vs. Mastectomy Comparison Rates

The lumpectomy rate at PRH is 65.4% while the NCDB rate is 69.2%. The mastectomy rate at PRH is 34.6% while the NCDB rate is 30.8%. The mastectomy rate at PRH is slightly higher than the National average for this reference year. The decision for which type of surgery a patient will have involves a thorough discussion of the options and pros and cons of each surgery between the patient and her surgeon. Ultimately, each woman makes her decision based on her own values.

The second breast quality study involved a review of the re-excision rate after lumpectomy. This refers to the need for patients to have a second lumpectomy after their primary lumpectomy. We included patients presenting in early stage during the year 2012. Of the total number of breast cancer patients, 82% underwent lumpectomy. In this group, 23 % had positive margins or close margins <2mm. 14% underwent re-excision lumpectomy site and 9% underwent mastectomy. There is not a national guideline for the expected re-excision rate. The reported range of re-excision ranges from 0 to 70%. A rate of 0 may mean that surgeons are removing too much tissue therefore decreasing the cosmetic benefit of a lumpectomy whereas too high a rate is also a concern. Knowing the re-excision rate is helpful for counseling patients and is useful for monitoring quality.

SummaryMultiple factors affect breast cancer risk including gender, age, family history, diet, life expectancy, reproductive factors, and obesity. Beginning at age 40, the American Cancer Society recommends that women receive an annual mammogram. Early detection of breast cancer leads to a greater range of treatment options and improved survival. For detailed information on breast cancer screening options, see the American Cancer Society’s screening guidelines for breast cancer.

In conclusion, breast cancer remains a common cancer diagnosed at Park Ridge Health. The majority of patients presented between the ages of 60 and 69 years old and with early stage breast cancer. Patients are treated according to national guidelines with a multidisciplinary approach using surgery, radiation, hormonal blockade, and chemotherapy where appropriate.

As a Community Cancer Program, Park Ridge Health performs well in all breast cancer measures in comparison to other community cancer programs as well as state, regional, and national cancer programs.

Michelle LeBlanc, M.D.Cancer Liaison PhysicianPRH Cancer CommitteePRH Cancer Registry


*American Cancer Society Facts & Figures 2013

SurvivalAs mentioned above, survival from breast cancer is directly correlated with stage. Women who present with localized breast cancer have a 98.5% rate of survival. Women who present with regional breast cancer involving local lymph nodes and breast, have an expected survival of 84.6%. Women who present with distant disease have a 25% chance of survival.

The number of deaths from breast cancer is estimated at 22.6 per 100,000 women. In North Carolina, an estimated 1,260 deaths were expected during 2013.*


Park Ridge Health Specialty ServicesPark Ridge Oncology Highly trained, experienced, and compassionate nurses with advanced certification in oncology nursing offer care in a comfortable relaxed setting with all the amenities of home. We have snacks, plush recliners, television, movies, Get Well Network, ample reading materials, and a gorgeous view of the mountain scenery.

We have streamlined and expedited professional service maintaining close communication with primary physicians throughout the prescribed course of treatment. Our on-site infusion center pharmacy staff is extensively trained.

We operate as a cost-effective, outpatient service with coverage by Medicare and other insurances benefiting the patient. We are hospital-based and owned, providing patients the peace of mind that we maintain strict standards under the hospital’s quality program.

Park Ridge Health and Upstate Carolina Community Clinical Oncology Program Research AffiliationIn May of 2012, Park Ridge Health entered into an agreement with Upstate Carolina Community Clinical Oncology Program, an affiliate of Spartanburg Regional Health Services District, Inc. This agreement establishes a collaborative relationship whereby PRH can participate in high quality and high priority therapeutic and cancer control research protocols, data management, and analysis on data submitted by PRH.

Under the agreement, Upstate Carolina CCOP will make available proposed protocols and studies. They will also provide education and training for Park Ridge Health personnel and to organize and conduct an annual meeting for education and scientific exchange for our physicians. Although research participation is a requirement of the Commission on Cancer Accreditation, our physicians believe that scientific clinical research is vital in finding a cure for cancer.

Oncology Pharmacy Pharmaceutical care is an important part of Park Ridge Health Cancer Services. Our staff includes Doctors of Pharmacy and Certified Pharmacy Technicians who are solely dedicated to providing chemotherapy and other intravenous medications to our patients. All medications are mixed in an on-site biologic safety cabinet (vertical flow hood) to maintain sterility, prevent contamination, and protect staff during the process of compounding medications for intravenous administration. The pharmacy staff, nurses, and physicians work as a team to ensure that each patient is receiving the most appropriate and effective medication regimen for their particular cancer. Before beginning therapy, a nurse and pharmacist meet with each patient to provide education on the medications that are prescribed in their treatment. This allows the patient to ask questions about their regimen and is another example of the personal care provided at Park Ridge Health Cancer Services.

Otolaryngology (Ear, Nose, Throat)Also referred to as ear, nose, and throat doctors, our ENTs are physicians who specialize in head and neck disorders. The services our ENT physicians provide are very important in early detection of cancers arising in the head and neck.

General Surgery/ Reconstructive SurgeryWe are pleased to provide exceptional care to our patients. And, our services do not require a physician referral. Surgeons at Park Ridge Health are fully trained in the latest minimally invasive surgical procedures.

Services Include:• Inpatient and outpatient surgeries• General Surgery• GPS navigational surgical technology using lasers to pinpoint locations for surgical treatment• Orthopedic and spine surgeries

Some Specialty Areas Are:• Treatment of breast disease• Minimally invasive breast disease• Stereotactic- and ultrasound-guided breast biopsies• Sentinel lymph node biopsies• Lung cancer surgery• Endoscopy• Laparoscopic surgery for GERD (acid reflux)• Colonoscopy including colon cancer screening• Sigmoidoscopy• Surgery, including laparoscopic surgery for colon cancer• Skin cancer• Thyroid and parathyroid surgery


Reconstructive SurgeryPark Ridge Health offers plastic surgery services for the body and skin.• Breast enhancement (augmentation), reduction, lift, or reconstruction.• Liposuction• Male Breast Reduction• Skin Cancer• Wound care• Scar Revision

UrologyAt Park Ridge Health, our urologists offer professional care for men and women experiencing urinary tract issues, or men experiencing disorders of the reproductive system. Urologic cancers develop in any organ of the urinary system.

Women’s HealthPark Ridge Health offers complete women’s health services for women of all ages. Routine gynecological care includes yearly exams with PAP smears and diagnosis and treatment of gynecological problems.

DermatologyPark Ridge Dermatology provides expertise in the care of skin, hair, and nails, including skin cancer prevention and detection.

The earlier a cancer is detected, the greater chance of successful treatment and removal or treatment of premalignant abnormalities before it can become aggressive and spread. Not all lesions are cancerous; a biopsy of the tissue can identify the difference.

Screening tests can also improve survival and decrease mortality by detecting cancer at an early stage when treatment is more effective.

Source: American Cancer Society, Cancer Prevention & Early Detection Facts & Figures

State-of-the-Art Diagnostic RadiologyPark Ridge Health continues to provide state-of-the art, full-service diagnostic radiology services.

High quality equipment includes:• 64 detector CT scanner capable of coronary artery CT angiography and virtual colonoscopy.• MRI including dedicated breast MRI• Nuclear medicine including bone scans, thyroid imaging, cardiac imaging, and other studies.• High resolution ultrasound• DEXA bone density• Digital, filmless department with digital storage and display of images• The radiology department also provides PET/CT scanning for optimal staging and re-staging of cancers.

Women’s imaging includes digital mammography with computer-aided detection, breast ultrasound, and ultrasound-guided and stereotactic-guided breast biopsies.

Women have their own private dressing area and waiting area for mammography and ultrasound. The breast health nurse navigator calls each patient with mammography results within 24 hours and assists patients with scheduling and procedures.

Hendersonville Radiological Consultants interpret the exams and perform interventional procedures including PICC line placement, biopsies, percutaneous drainage, and vertebroplasty procedures.


The Oncology Quality Improvement team, a subcommittee of the PRH Cancer Committee, meets on a quarterly basis to review cancer-related studies and quality measures, to identify or develop improvements as a result of studies and/or opportunities within the institution, and report the results of the activities to the PRH Cancer Committee. The following is a summary of cancer-related quality improvements during 2013:

• As a result of the psychosocial distress screening study, hired an PT Oncology Social Worker • Hired a FT Patient Navigator• As a result of expansion of clinical research opportunities, additional physicians participated in clinical trials and hired a FT Clinical Research Nurse• As a result of expansion of services within the outpatient infusion setting, hired an Administrative Director of Cancer Services• Monitor the Commission on Cancer, CP3R quality measures regarding breast and colorectal.• Monitor a site-specific study: Breast Cancer (see study at beginning of this report) • Monitor the Cancer Registry Quality Activities• Implemented and distributed weight information alert flyers to infusion centers.

Quality Improvement Summary 2013

The Park Ridge Health Breast Center is designed with women’s breast health in mind. It is a member of the National Consortium of Breast Centers, recognized as a Certified Participant in the NQMBC program through the NCBC and designated as a Breast Center of Excellence through the American College of Radiology (ACR).

The Breast Center is a multidisciplinary “clinic without walls” and offers breast surgery, medical oncology, radiation oncology, plastic surgery, an interdisciplinary breast cancer conference, genetic counseling, pathology, psychological counseling through a licensed oncology social worker, a certified lymphedema therapist, patient navigator, clinical trial nurse, and many other services either directly or by referral. Patients are seen not only for malignant disease, but also for a variety of breast concerns.

The Center also offers in-office diagnostic ultrasound as well as ultrasound-guided procedures, such as vacuum-assisted core-needle biopsy and stereotactic breast biopsy. Other services include mammography and breast MRI (accredited through the American College of Radiology (ACR). Surgical procedures are all performed on the Park Ridge Health campus.

The center is staffed with Oncology Certified Nurses and Navigators who coordinate individualized care for each of our patients at the clinic, as well as preoperative and postoperative education to all patients undergoing breast surgery. Our specialized team contacts all mammography patients and facilitates the Breast Cancer Survivor and Friends support group, referrals and follow-up visits. Our Navigators also coordinate the American Cancer Society WNC Patient Resource Center, which is located at the Breast Center, as well as the Look Good Feel Better classes and Reach for Recovery referrals. Additionally, our care team also consists of an ONS Certified Breast Care Nurse and Breast Self-Examination Instructor through the NCBC.

Our Medical Director, Mikhail Vinogradov, M.D., is board-certified in Oncology, and a member of the National Consortium of Breast Centers. Our surgeon, Michelle LeBlanc, M.D., is board-certified in Obstetrics and Gynecology, and is an Associate of the American Society of Breast Surgeons and the Mastery of Breast Surgery Certification Program.



During 2012, there were 702 new cancer cases accessioned into PRH’s Cancer Registry. Of these, 51% were analytic cases (initially diagnosed and/or treated at this facility). The remaining 49% were non-analytic cases (diagnosed and/or treated elsewhere receiving subsequent treatment at this facility).

Summary of Cancer Registry Data for 2012:

Distribution Of Cancer By Site: 2012 Cases

All Sites Total Cases Analytic Non-Analytic Male Female 702 355 353 279 423

Oral Cavity 16 13 3 11 5Digestive System 82 37 45 48 34 Esophagus 5 1 4 4 1 Stomach 6 5 1 5 1 Colon 28 13 15 17 11 Rectum 13 8 5 5 8 Liver 11 3 8 7 4 Pancreas 8 2 6 4 4 Other 11 5 6 6 5Respiratory System 66 36 30 32 34 Larynx 6 3 3 3 3 Lung/Bronchus 60 33 27 29 31Blood & Bone Marrow 85 21 64 50 35 Leukemia 28 11 17 20 8 Multiple Myeloma 39 6 33 24 15 Other 18 4 14 6 12Bone 2 0 2 1 1Soft Tissue 3 1 2 3 0Skin 34 23 11 17 17 Melanoma 31 22 9 14 17 Other 3 1 2 3 0Breast 203 118 85 1 202Female Genital System 35 17 18 0 35 Cervix Uteri 2 1 1 0 2 Corpus Uteri 12 8 4 0 12 Ovary 10 3 7 0 10 Other 11 5 6 0 11Male Genital System 64 25 39 64 0 Prostate 62 24 38 62 0 Other 2 1 1 2 0Urinary System 28 17 11 22 6 Bladder 16 12 4 12 4 Kidney/Renal 10 3 7 8 2 Other 2 2 0 2 0Brain & Cns 21 14 3 2 7Endocrine 16 10 7 8 13 Thyroid 16 10 6 5 11Lymphatic System 34 16 18 10 24 Hodgkin’s Disease 1 1 0 0 1 Non-Hodgkin’s 33 15 18 10 23Unknown Primary 10 6 4 6 4Other/Ill-Defined 3 2 1 1 2

The Cancer Registry uses a data system designed for the collection, management, analysis, and reporting of information on patients with cancer who have been diagnosed and/or treated through Park Ridge Health. As required by law, each diagnosis of cancer or benign brain or central nervous system tumors in any person who is screened, diagnosed, or treated by the facility is reported to the North Carolina Central Cancer Registry, a unit of the North Carolina State Center of Health Statistics within the Division of Public Health, Department of Health & Human Services.

The Cancer Program at Park Ridge Health is accredited by the American College of Surgeons, Commission on Cancer as a Community Hospital Cancer Program. Since 2005, the Cancer Registry at Park Ridge Health has accessioned nearly 3000 cases into its database. Annually, Cancer Registry data is reported to the Commission on Cancer, National Cancer Data Base for use in national comparative studies; part of a nationwide effort to compile data on the diagnosis and treatment of all types of cancer.

The Cancer Registry coordinates the monthly multidisciplinary Cancer Conferences. These conferences provide consultative services for patients and focus on pre-treatment evaluation, staging, treatment strategy and rehabilitation. The conferences offer education to physicians and allied health professionals in attendance. There were 100 cases presented during 2012 involving various primary sites of cancer.

The Cancer Registry conducts annual follow-up on all patients treated for cancer at Park Ridge Health. Follow-up serves as a reminder to both physician and patient to schedule regular physical examinations. The Cancer Registry at PRH maintains a successful follow-up rate of 95% of these cases.

Cancer Registry


Pitt

Wake

Hyde

BladenPender

Bertie

Duplin

Onslow

Beaufort

Nash

Craven

Sampson

Halifax

Columbus

Johnston

Jones

Carteret

Brunswick

Burke2.3%

Wayne

DareMartin Tyrrell

Buncombe24.2%

Gates

Lenoir

Warren

Franklin

Wilson

Pamlico

McDowell2.0%

Edgecombe

Hertford

Greene

Graham.6%

GranvilleVance

Northampton

Washington

CamdenCurrituck

ChowanPerquimans

Pasquotank

New Hanover

TENNESSEE

VIRGINIASOUTH CAROLINA

Haywood9.6%

Madison2.3%

Transylvania2.3%

Jackson.6%

Henderson44.2%

Polk5.4%

Rutherford1.1%

Yancey1.7%

Mitchell.6%

Overall Total 100%

Nbr/Percentage

Caldwell.3%

Cherokee.8%

Iredell.3%

Macon.8%

Mecklenburg.3%

Swain.8%

A large majority of the patients diagnosed and/or treated during 2012 were residents of Henderson County.

Age At Diagnosis Distribution The gender distribution of all cancer patients at PRH was 36% male and 64% female. The largest age distribution of patients was between the ages of 60 and 69 years (32%), followed by the 70 to 79 age group (22%).

0

10

20

30

40

50

60

70

80

10-19 20-29 30-39 40-49 50-59 70-7960-69 80-89

AGE BY GENDER 2012

Male

Female

Age By Gender 2012

Ten Most Prevalent Cancer Sites 2012TEN MOST PREVALENT CANCER SITES 2012

CORPUS UTERI

NH LYMPHOMA

BLADDER

COLORECTAL

PROSTATE

LUNG

BREAST

PARK RIDGE HEALTH 2012

ACS PROJECTED FIGURES NORTH CAROLINA 2012

ACS PROJECTED FIGURES NATIONAL 2012

CERVIX

LEUKEMIA

MELANOMA

0% 5% 10% 15% 20% 25% 30%

Top 10 Cancer Sites at PRH Compared ACS NC/National

As shown to the left, cancer prevalence represents the most common cancers diagnosed and/or treated at PRH in 2012 compared to those estimated across North Carolina and the United States according to the American Cancer Society, Cancer Facts & Figures 2012. Incidence rates of breast cancer and melanoma were slightly higher than national and state figures. Incident rates for lung, prostate and colorectal cancer were slightly lower than state and national figures.

These estimated numbers of new cases as published from The American Cancer Society Cancer Facts & Figures 2012. PRH figures were obtained from the total number of analytic cases accessioned during 2012.

Respectfully Submitted, Park Ridge Health Cancer Registry

Geographic Distribution: 2012 Analytic Cases


Nutritional ServicesNutritional Services is very closely linked across the continuum of the diagnosis of cancer. Patients, families, and health care providers look to the expertise of the nutrition professional to aide in their search for answers to the puzzles that a diagnosis can bring. Prevention is another area where a registered dietitian is one of the key players. They provide education and support for the many questions that arise when the word “cancer” enters a person’s life.

At Park Ridge Health, a registered dietitian is at the direct disposal of anyone seeking answers before, during, and after a cancer diagnosis. A trained nutrition professional is involved in the Cancer Committee, providing expertise and services to the committee as needed. A “Breast Cancer Survivor & Friends” meeting is facilitated by the dietitian every year to directly answer questions patients and families might have. Clinical services are also provided in the inpatient setting for patients and families under the stress and strain of a cancer diagnosis.

Pastoral CareAt Park Ridge Health, we believe that true health comes from caring for the whole person: mind, body, and spirit. As the only faith-based hospital in Western North Carolina, we provide those guests who wish to do so with the opportunity to grow in their spiritual health. Our Pastoral Care team is comprised of compassionate individuals who are devoted to providing non-denominational support to our guests, visitors, and Park Ridge Health family. They are also available to assist with contacting your personal place of worship if you wish to visit with your personal religious counselor. To help ease the transition for those admitted to our facility, all new guests of Park Ridge Health are visited by one of our Pastoral Care team members within 24 hours of admission.

Case Management And Discharge PlanningCase Management and Discharge Planning services are available to all oncology patients and their families. Park Ridge Health Case Managers are licensed, trained professionals who are experienced when it comes to assessing patient and family needs. Case Managers meet with patients and /or their family members privately to discuss needs and to provide information regarding community resources, financial counseling and educational materials. They act as patient advocates by working closely with all members of the Healthcare Team to facilitate optimal outcomes. Their goal is to address and resolve patients’ concerns to their satisfaction. All information shared with the Case Manager is confidential.

Supportive Services Hospice and Palliative CareWorking in cooperation with Park Ridge Health, Four Seasons Hospice and Palliative Care is a non-profit organization deeply committed to serving the community through fulfilling its mission of affirming life and providing holistic care in harmony with the goals of individuals with serious life-limiting conditions, while offering support to their families and loved ones.

Nursing Staff Park Ridge Health is committed to caring compassionately for oncology patients. Our Oncology staff includes registered nurses who have demonstrated a desire to go beyond traditional nursing by completing special training for administering chemotherapy and caring for oncology patients. In addition, several of these nurses have completed additional training/certification and have received the designation of Oncology Certified Nurse (OCN) and Certified Breast Care Nurse (CBCN), certifications that require candidates to demonstrate knowledge in cancer nursing through experience and testing. Our nurses demonstrate a desire to treat the entire patient emotionally, spiritually, and physically throughout their stay. At Park Ridge Health, we aspire to give each patient a positive experience with the knowledge that those in charge of their care take an interest in them personally.

Laboratory/PathologyPark Ridge Health Laboratory offers comprehensive servicesto support the needs of the cancer program. STAT clinical laboratory testing is available to patients awaiting chemotherapy treatment. Anatomic Pathology services to include Histology and Cytology are performed on-site to minimize turnaround time of final pathology reports. Pathology Services and Medical Directorship are provided through a contractual relationship with Mountain Area Pathology, a local entity that offers consistent coverage for pathology. Representatives from the Laboratory and the Medical Director are regular participants in the monthly cancer conference, an interdisciplinary committee that focuses on best practice for cancer care.

Additional Park Ridge Health Support Services • Breast Cancer Survivors and Friends Support Group• Cancer Support Group• Consultation• Education• Genetics• Home Health Care• Infusion Therapy• Look Good, Feel Better®

• Mental Health Care• Pain Management• Smoking Cessation Services• Social Service Support

Park Ridge Health Rehabilitation Services • Lymphedema Management• Music Therapy • Occupational Therapy• Physical Therapy• Speech Therapy• Stomal Therapy• Wound Care


Kenmure Fights CancerCharitable giving touches the lives and hearts of countless people who battle cancer at Park Ridge Health. Since 2008, the residents of Kenmure in nearby Flat Rock have dedicated their annual fundraising efforts toward fighting cancer in our community. Park Ridge Health is deeply grateful to be a beneficiary of Kenmure Fights Cancer and for its gifts totaling $78,783. Thanks to this caring community, Park Ridge Health continues to purchase much-needed equipment used in our patients’ cancer treatment.

Park Ridge TeamRelay for LifeOn, August 15, 2013, dozens of Park Ridge team members came out to the annual Fletcher Relay for Life to volunteer, cheer, and show their support for cancer survivors and hope for a cure.

Since 2011, we have raised more than $20,000 for the Henderson County American Cancer Society’s Relay for Life.

Park Ridge Health ContactsYou can access the Park Ridge Health Cancer Program by letting your physician know you want to be treated at Park Ridge Health. To schedule, call the following access points:

Radiology - Ask your physician to schedule through Park Ridge

Stereotactic Breast Biopsy - Ask your physician to schedule through Park Ridge

Physician Offices:ENT (Ear, Nose, Throat) – 828.650.2748Surgery – 828.654.0073 Dermatology - 828.654.6045Plastic/Recon. Surgery – 828.654.5005Endoscopy/Colonoscopy - 828.654.0073Urology – 828.654.6015

Women’s HealthPark Ridge OB/GYN - 828.650.8077Hendersonville OB/GYN - 828.687.3800Park Ridge Women’s Services - 828.698.9934

Cancer Services Offices:Breath Health Center – 828.650.2790Park Ridge Health Hematology and Oncology – 828.681.2917Asheville Hematology & Oncology – 828.254.8232Haywood Infusion Center – 828.456.5214

If you would like more information about any of our Park Ridge Health physicians, or to make an appointment, call 855.PRH.LIFE (855.744.5433). Find us online at parkridgeheatlh.org/cancer-services.

2013 Cancer Committee Members

Physician MembersMikhail Vinogradov, MD, Medical Oncology/Hematology, ChairDaniel Baseman, MD, Radiation OncologyQuinten Black, MD, Radiation OncologyRory Dalton, MD, PathologyThomas Eisenhauer, MD, General SurgeryMichelle LeBlanc, MD, OB/GYN, Breast Surgeon, Cancer Liaison PhysicianW. Mark McCollough, MD, Radiation OncologyRalph Ricco, MD, Diagnostic RadiologistPaul Schaefer, MD, Medical Oncology/Hematology

Additional MembersLeigh Angel, RN, Director Medical SurgerySherri Beane, RN, BSN, Clinical Nurse ManagerSarah Gayle, MPH, American Cancer SocietyDebbie Gentry, MSN, OCN, CBCN Infusion Services & Breast Health ManagerDonna Hewitt, RN, BSN, OCN Patient NavigatorLindsay Hyder, RN, Clinical Research NurseRenae Johnson, RN, Director Quality Improvement Sharon Labbate, CTR, Cancer Registry CoordinatorCraig Lindsey, RN, VP, CNO Clinical ServicesMichael Lombardo, Chaplain, Director Pastoral CareBarbara McFarland, MBA, Operations Asheville Infusion CenterHarvey Nix, PA, Hospice and Palliative CarePatricia Scholtz, RD, Nutritional ServicesDiane Sedgwick, RN, BSPA, MHSA, Cancer Program Administrator, Community Outreach CoordinatorPaula Stegall, PharmD, Oncology PharmacistSuzanne Watkins, RN, OCN, Patient NavigatorLauren Woodard, MSW, LCSW, OSW-C, Psychosocial Services CoordinatorDeborah Wooten, RN, Case Management

Park Ridge Health Cancer Program Leadership

30 2012-2013 Annual Report

ReferencesCancer Facts & Figures, American Cancer Society

National Cancer Data Base, Hospital Comparison Benchmark Reports & Survival Reports

Park Ridge Health Cancer Registry

AcknowledgmentsThis has been an outstanding year for our cancer program and would not be possible without the great team of dedicated professionals working together to meet this goal.

This report can also be accessed via the Park Ridge Health website: parkridgehealth.org/cancer-services

Park Ridge Health Cancer Program

Documents

2012-13 Cancer Services Annual Report