2014 KCH Cancer Report | 2013 Data

Center for Cancer Care

1330 Coshocton RoadMount Vernon Ohio 43050

www.KnoxCommHosp.org740.393.5551

2014Annual Cancer Report2013 Data Collection

Husain Rasheed, MD Cancer Committee Chairman

Amy Murnen, MD Cancer Liaison Physician

Diana Endsley, RN, OCN Director, The Center for Cancer Care

Sandy Petros, BS, MT (ASCP), CTR Oncology Data Specialist

Mandy Holt, RN, OCN Patient Navigator

Becky Dangelo, MSN, RN, CNOR, BHN Breast Health Navigator

Ann Styer, MSM, RT (CT)(M)(A.R.R.T.) Director, Diagnostic Imaging

Center for Cancer Care

1330 Coshocton RoadMount Vernon Ohio 43050

www.KnoxCommHosp.org740.393.5551

2014Annual Cancer Report2013 Data Collection

table of contents

Section 1 - 1.1 A Word from Bruce D. White, CEO

1.2 A Word From... Husain Rasheed, MD, Cancer Committee Chairman

1.3 A Patient’s Journey Husain Rasheed, MD, Cancer Committee Chairman

1.6 Cancer Liaison Physician Overview Report Amy Murnen, MD, FACS, Cancer Liaison Physician

Section 2 2.1 Center for Cancer Care Service Report Diana Endsley, RN, OCN, Director of Center for Cancer Care

Section 3 - 3.1 Center for Cancer Care Registry Report Sandy Petros, BS, MT (ASCP), CTR, Oncology Data Specialist

Section 4 - 4.1 Cancer Conference Coordinator Report 4.2 Breast Health Navigator Report Becky Dangelo, MSN, RN, CNOR, BHN, Breast Health Navigator

Section 5 - 5.1 Community Outreach Program Report Mandy Holt, RN, OCN, Patient Navigator

Section 6 - 6.1 Diagnostic Imaging Report Ann Wilson, Director of Diagnostic Imaging

Our Cancer Committee Team

(Not Pictured)

Dietary: DiNa HeralD, rD,lD

Pharmacy: SeaN Cull, rPh

rehab & Wellness: Deb liNk, PT

radiation Therapy: barb STilTNer, rTT

Diagnostic imaging: aNN STyer, MSM-MCa, rT(CT), (M)

american Cancer Society representative: lyNN ayerS, Mba

knox County Health Department representative: Mike WHiTaker

HuSaiN raSHeeD, MD Cancer Committee Chair

THoMaS PeDriCk, MD radiation oncologist

aMy MurNeN, MD Cancer liaison Physician

kiNgSley orraCa-TeTTeH, MD Diagnostic radiologist

TiSHa Farrell, Do Pathologist

RequiReD PhysiCian MeMbeRs RequiReD non-PhysiCian MeMbeRs

ReCoMMenDeD MeMbeRs

DiaNa eNDSley, rN,oCNCancer Program administrator &

Clinical research Coordinator

SaNDy kollar, MSM-HCa, rN Vice President Quality

Quality improvement Coordinator

aDoNyaH WHiPPle, bSN,rN, CHPN Palliative Care representative

SaNDy PeTroS, bS,MT,(aSCP), CTr CTr & Cancer registry Quality

Control Coordinator

laureN MCDoWell-JaCobS, MD general Surgeon

liNDSay karaS, lSW,MSWSocial Services/Case Manager

beCky DaNgelo, MSN,rN, CNor, bHNbreast Health Navigator and

Cancer Conference Coordinator

MaNDy HolT, rN, oCN Navigator & Community

outreach Coordinator

aMy SHoeWalTer, bSN,rN,oCN Nursing

JeFFrey NorTHuP, Do

Chief Medical officer

JiM MiDDleToN, Mba,MSN, rN

Chief Nursing officer

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A word from... bruce D. White Chief executive officer

I am very pleased to provide the 2014 Cancer Report from The Center for Cancer Care at Knox Community Hospital. As you review this report you will find statistical and narrative accounts of all cancer cases diagnosed and/or treated at our Center in 2013. The Center for Cancer Care holds accreditation from The Commission on Cancer (CoC). This accreditation is granted only to facilities that have voluntarily committed to providing the very best in cancer diagnosis and treatment according to CoC standards.

The consistent care provided for patients in our community at the Center for Cancer Care requires the commitment of many people with a wide variety of professional and clinical skill sets. I am extremely proud of the care provided by our team of oncologists, surgeons, physicians, dieticians, pathologists, pharmacists, phlebotomists, radiologists, nurses, therapists, and all other support personnel. The Commission on Cancer has recognized this team for working so successfully and effectively to combine varying skills and experiences together, focusing on the most important thing of all — the patient. Most importantly, this team demonstrates that, while they are caring for a patient, they also care about them. It is this dedication to quality clinical care with a very real personal touch that makes this team at Knox Community Hospital so very special. And that is unquestionably the way it should, and will, be for the patients of the Center for Cancer Care at Knox Community Hospital.


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Dear friends,

Another year has passed. Here we are writing another annual report, this time for 2014. The data presented in this report is from 2013.

In addition to continuing our work of providing quality care for our patients, we remain engaged in educating the community about cancer prevention and the merits of screening and early diagnosis. In a rapidly changing field, we are diligently working to remain abreast with the new technologies and processes that are improving cancer care. In this regard, we are looking to incorporate 3-D mammography or digital breast tomosynthesis at KCH, which is a new and a more accurate and effective method to detect breast cancer as compared to the commonly used 2-D mammography. Recently, the Center for Medicare & Medicaid Services (CMS) has conditionally approved low dose CT scans to screen for lung cancer in heavy smokers. Consequently, we are working to implement a lung cancer screening protocol with low dose CT scans at KCH. Another big area of work for the coming year is going to be the implementation of the survivorship care plan. This is a new requirement by the Commission on Cancer (CoC) requiring all cancer institutions accredited by the CoC to implement a process to disseminate a comprehensive care summary and follow-up plan to cancer patients who are completing their cancer treatment. Additionally, we remain committed to providing clinical trials to cancer patients at KCH through the National Cancer Institute’s Community Oncology Research Program (NCORP, formerly CCOP) which allows KCH patients to have access to the same clinical trials that Columbus patients have at most Columbus hospitals.

We want to extend our gratitude to the KCH board and Foundation, and the KCH administrative team. Their vision and leadership has allowed us to provide high quality cancer care to the Knox and surrounding counties. We are also grateful to all the physicians, nurse practitioners, nurses and all other affiliated providers for helping us care for the cancer patients in many different ways. Most of all, our thanks go out to our patients and their families for entrusting us with their care.

husain Rasheed, MD Cancer Committee Chair The CenTer for CanCer Care

Medical oncology

A Word From...


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husain Rasheed, MD Cancer Committee Chair The CenTer for CanCer Care

A Patient’s Journey

Tom Lockard retired from Kenyon College in 2007 to take care of his wife after she was diagnosed with terminal breast cancer. She passed away in 2010. During this time, Tom himself was diagnosed with early stage prostate cancer. Tom consulted Dr. Thomas Pedrick, a radiation oncologist at Knox Community Hospital (KCH) and Riverside Methodist Hospital. He was treated with radiation therapy. His PSA normalized and he was cancer free.

About two years later, while taking a shower, Tom noticed lumps in his right armpit. He did not believe that this could be a cancer, stating “I have had my cancer and am done.” However, he was concerned. He immediately called his family physician, Dr. Elder, in Fredericktown. Dr. Elder asked Tom to come to his office that same day. Tom got dressed and drove to Dr. Elder’s office. After examining him, Dr. Elder recommended that Tom see a cancer specialist at KCH, Dr. Husain Rasheed. After examining Tom, Dr. Rasheed recommended a biopsy of his lymph glands.

Tom’s biopsy showed that he now had a different type of cancer called Hodgkin Lymphoma, a cancer that mainly involves lymph glands. After his diagnosis was confirmed with a biopsy, the next step was to figure out how far the cancer had spread. This is called staging of the cancer. Staging is important to determine the appropriate treatment. Tom underwent a specialized test at KCH called a PET CT scan. This test utilizes a radio tracer to “light up” the areas of cancer involvement in the body. Tom’s PET scan showed that he had cancer above and below his diaphragm. He had advanced stage Hodgkin Lymphoma.

Tom was advised to begin treatment with a chemotherapy regimen called ABVD. This chemotherapy regimen consists of four different medicines given intravenously to attack the cancer cells. The ABVD regimen was originally started in the late 1970s and has remained to this day the most effective and well tolerated treatment for most patients with Hodgkin Lymphoma. Other than feeling tired, Tom did remarkably well during his 24 weeks of treatment. After completion of his treatment, another PET CT scan was performed to evaluate his response to the treatment. His

continued on next page...

Tom Lockard with Husain Rasheed, MD


Sec 1 | 4Medical oncology report continued... Husain rasheed, MD

scan now showed that he was cancer free. Tom was relieved. He was quickly back to his normal routine. He went to Washington, D.C. for the annual pen show which he has been attending for many years. Tom loves to collect fountain pens. He has about 150 vintage and modern pens and writes with all of them.

About six months later, Tom started feeling tired. His blood tests during routine follow-up at the Center for Cancer Care showed that he had become anemic. CT scans were ordered by his oncologist. Unfortunately the CT scans showed new enlarged lymph glands and an enlarged spleen. Tom underwent another biopsy which confirmed recurrence of his Hodgkin lymphoma. Tom was disappointed but took the news in stride. He was ready to put up another fight.

Dr. Rasheed recommended salvage chemotherapy followed by autologous stem cell transplantation. Salvage chemotherapy is given to cure recurrent cancer. Tom started outpatient salvage chemotherapy at KCH. His lymphoma showed shrinkage with the salvage chemotherapy which is generally a good sign of success with the subsequent stem cell transplant. After completing the salvage chemotherapy, Tom was referred by Dr. Rasheed to see Dr. Sam Penza at OSU for the autologous stem cell transplant. In this procedure Tom’s stem cells were collected from his blood. Stem cells are parent or progenitor cells that have the capability of giving birth to other blood cells. After collection of his stem cells Tom underwent high dose chemotherapy which is intended to eliminate any remaining lymphoma cancer cells. However, in the process normal blood cells are also destroyed. The previously collected stem cells were now infused back into Tom’s body so that they could generate new blood cells and restore his normal blood. “I felt wiped out,” Tom said. Tom was kept in the hospital at OSU for about a month to monitor and treat for any infections. He received blood transfusions until his own body could make new blood from the recently infused stem cells. After lying in bed for 3 to 4 weeks at OSU he was finally discharged to a nursing home for physical therapy. He came back to Mount Vernon to Country Club Retirement Center. After four weeks of intense physical therapy he was finally happy to be back in the comfort of his own home. After he had recovered from the transplant Dr. Rasheed ordered another PET CT scan which showed that Tom was cancer free. “In light of my previous recurrence I always have lingering doubts that it is going to come back. I hope that it has worked.”

Amy Shoewalter, BSN, RN, OCN, Peg Horn, Tom Lockard, Husain Rasheed, MD and Diana Endsley, RN, OCN


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Hodgkin lymphoma is a relatively uncommon cancer. Approximately 9,000 new cases and about 1,200 deaths occur annually in the U.S. due to this cancer. It is more common in young adults but also shows a second peak in older age. Most patients present with painless, enlarged lymph glands. Some patients may also present with an enlarged spleen, fever, weight loss, drenching night sweats and generalized itching. Hodgkin lymphoma generally has a favorable prognosis with cure rates of approximately 75%. Relapse rates are 10 to 20% in early stage and 30 to 40% in more advanced stage disease. For relapsed patients, salvage chemotherapy with autologous stem cell transplant results in 5 year estimated overall survival of approximately 70%. Relapse after autologous stem cell transplant can be treated with emergent novel therapies including new antibodies and drugs that trigger the immune system to attack the cancer cells.

Tom is gradually recovering from the weakness associated with the stem cell transplant. He has been advised to continue follow-ups with Dr. Rasheed every three months. He is almost back to his normal routine. He goes out for coffee every morning in Gambier, and meets four or five friends to try to solve the world’s problems. Tom is planning to go to visit his grandchildren in Iowa. In October 2015, he is planning to go on a cruise to the Greek Islands through a Kenyon College sponsored program. The James Cancer Center had the technical wherewithal for him to undergo his stem cell transplant for which Tom is grateful. “However, I felt I always got as much care or even better care here at the Center for Cancer Care at KCH. This is an incredible resource for this community. The care here was very personal and very professional.”


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The Commission on Cancer (CoC), established in 1922, is a group of organizations that is dedicated to ensure that patients, who receive care in an accredited facility, receive comprehensive and quality cancer care. The CoC monitors treatment patterns and outcomes of the patients who receive care at centers who choose to participate and be accredited by this organization. Knox Community Hospital does participate and our Center for Cancer Care has been accredited with the CoC since 2010. Accreditation is not an easy feat and requires Knox Community Hospital meet many standards set by the CoC. As the Cancer Liaison Physician for Knox Community Hospital, I work as an intermediary between the CoC and our Center for Cancer Care.

I began as Knox Community Hospital’s Cancer Liaison Physician (CLP), a volunteer position, in 2012. As the CLP, I sit on our Cancer Committee and am responsible for evaluating, interpreting and reporting our Cancer Center’s performance using the National Cancer Data Base (NCDB) data. I report our outcomes to the Cancer Committee on a quarterly basis. The Cancer Committee is made up of our Chair of the Committee, Dr. Husain Rasheed, MD as well as our radiation oncologist, radiologist, pathologist, surgeons, primary care physicians, patient navigators, nutritionists and many others involved in the cancer patients’ care. We meet quarterly to ensure that our Center for Cancer Care is meeting all of the expectations set by the CoC and that our patients receive quality cancer care.

This past year has been an exciting year working as the Cancer Liaison Physician at Knox Community Hospital because our Center for Cancer Care started to participate in the National Cancer Data Base’ Rapid Quality Reporting System (RQRS). In the past I was only able to review past data from patients who received care at our Center one to two years prior. The RQRS collects “real time” clinical data about our patients who are currently receiving care at our Center. I am now able to review the data, sent to me on a monthly basis, to ensure that each patient is receiving the appropriate, current recommended cancer care.

As the CLP for Knox Community Hospital’s Center for Cancer Care, I can assure our community that we continue to give our patients quality cancer care that meets and often exceeds National Standards set by the Commission on Cancer. Our Center for Cancer Care provides high quality care for our community close to home.

amy Murnen, MD The CenTer for CanCer Care

Cancer Liaison Physician Repor t


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Diana endsley, Rn, oCn, Director

The CenTer for CanCer Care service Report

Our Center & StaffKnox Community Hospital’s Center for Cancer care is located in the Knox Medical Pavilion. We provide medical oncology, hematology and radiation therapy services to assist patients and their loved ones from the time of diagnosis to survival and end of life.

Medical Oncology/Hematology is provided by Dr. Husain Rasheed, who is board-certified in Medical Oncology and Internal Medicine. Radiation Oncology services are provided by board-certified physicians from Riverside Radiation Oncology group, Drs. Mark Crnkovich, Megan DeHaan, Praveen Dubey and Thomas Pedrick.

Ten registered nurses (nine oncology/chemotherapy certified), three registered radiation therapists, radiation oncology registered nurse, registered nurse Breast Health Navigator, registered nurse Patient Navigator, an Oncology Data Specialist and two secretarial support staff provide patient care.

Mark Crnkovich, MD(radiation oncology)

Tom Pedrick, MD(radiation oncology)

Praveen Dubey, MD(radiation oncology)

Megan Dehaan, MD(radiation oncology)

Radiation oncology

husain rasheed, MDboard-Certified in Medical

oncology and internal Medicine

Medical oncology

• laboratory Services• Diagnostic imaging• breast Health Navigator• Patient Navigator• rehabilitation & Wellness

• Lymphedema Therapy• occupational Therapy• Physical Therapy• speech Therapy• Massage Therapy

• Dietitian Services• Pain Management• Palliative Care• Pharmacists• Social Services• Wound/ostomy Services• american Cancer Society• Cancer Support group• breast Cancer Support

group• Men’s Cancer Support

group• young Women’s breast

Cancer Support group• Community Health resource

Center• education• Financial Counseling• Pre-certification Services

We offer an array of resources to our patients which include:

Department of specialty Care, General surgery

hydi Laidlaw-Smith, Doboard-Certified general Surgery

Lauren McDowell-Jacobs, MDboard-Certified general Surgery

Paul Taiganides, MDboard-Certified general Surgery

Michael heuman, MDboard-Certified general Surgery


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Since 2010 The Center for Cancer Care continues to be accredited by the Commission on Cancer (CoC). Established in 1922 by the American College of Surgeons the CoC sets standards to ensure organizations are dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care. Patients who obtain care at a COC accredited cancer program receive the following benefits:

• Quality care close to home

• Comprehensive care offering a range of state-of-the-art services and equipment

• A multi-disciplinary, team approach to coordinate the best cancer treatment options available

• Access to cancer-related information and education

• Access to patient-centered services such as navigation

• Options for genetic assessment, counseling and palliative care services

• Ongoing monitoring and improvement of care

• Assessment of treatment planning centered on evidence-based national treatment guidelines

• Information about clinical trials and new treatment options

• A cancer registry that collects data on cancer type, stage, treatments results and offers lifelong follow-up

Knox Community Hospital continues to be a member of the National Cancer Institute, Community Outreach Oncology Research Program (NCORP, formerly CCOP) . Originated in 1983 CCOP is dedicated to provide state of the art cancer care and prevention to physicians and the communities that they serve. CCOP now covers 35 counties in parts of 4 states. Clinical trials investigate new ways to treat diseases like cancer. Newly developed medications, combinations of existing and new medications or different ways of giving existing medication are some of the ways clinical trials help to improve the prevention, detection and treatment of cancer. Types of clinical trials include:

• TREATMENT TRIALS test new treatments (like a new cancer drug, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy or immunotherapy).

• PREVENTION TRIALS test new approaches such as medicines, vitamins, minerals, or other supplements that doctors believe may lower the risk of a certain type of cancer. These trials look for the best way to prevent cancer in people who have never had cancer or to prevent cancer from coming back or a new cancer occurring in people who have already had cancer.

• SCREENING TRIALS test the best way to find cancer, especially in its early stages.

• QUALITy OF LIFE TRIALS (also called Supportive Care Trials) explore ways to improve comfort and quality of life for cancer patients.

Service Report continued... Diana endsley, rn, oCn


Sec 2 | 3Service Report continued... Diana endsley, rn, oCn

Radiation oncology

Medical oncology

The Center for Cancer Care is dedicated to providing excellent service and compassion to our patients and their loved ones from our highly skilled team that focus on evidence based care.

Total Treatments

2006 1,082

Total Patients

2007 2,524

2008 2,957 2009

2,472

2010 3,077

20113,292

2012 3,083

2013 3,323

0

500

1000

1500

2000

2500

3000

3500

472006

1112007

1242008 106

2009

1252010

1322011 129

2012

1142013

0

1000

2000

3000

4000

5000

6000

Clinic Treatments - All

New Patients

Clinic Visits

2008 2009 2010 2011 2012 2013


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sandy Petros, bs, MT(asCP), CTR The CenTer for CanCer Care

Registry Report

Each year about 1.7 million people are diagnosed with cancer in the United States (ACS 2013) and must decide on a course of care. Many times patients go to multiple facilities to receive the care they need and sometimes the treatments can last for months. To facilitate Quality of Cancer Care, Rapid Quality Reporting System (RQRS) was implemented at Knox Community Hospital in 2014. RQRS promotes evidence-based cancer care at the local level through real clinical time compliance monitoring and assessment of four National Quality Forum endorsed measures and two surveillance measures for cancer care for breast and colorectal cancer patients. This offers a systematic data collection and reporting system for promoting evidence-based treatments. RQRS alerts the medical oncologist, clinical liaison physician (CLP), director, and oncology data specialist when it is coming close in time for the next treatment methodology. In the past, the reports were only done on analyses of retrospective data so this is a clear advantage as it will help improve patient outcomes by reducing delays for both referrals and treatment. More cancer sites are expected to be added to RQRS in the future for a potential of 25 quality measures.

The Commission on Cancer (CoC), a program of the American College of Surgeons (ACoS), recognizes cancer care programs for their commitment to providing comprehensive, high-quality, and multidisciplinary patient centered care. In July 2013 Knox Community Hospital was surveyed by the CoC. Hamesh Naik, MD spent his day with members of the Cancer Committee reviewing pathology reports, cancer program goals, the cancer registry quality control plan, clinical trial accruals, clinical educational activity, cancer registrar education, public reporting of outcomes, oncology nursing care, risk assessment and genetic counseling, palliative care services, patient navigation process, psychosocial distress screening, the survivorship care plan, prevention programs, screening programs, accountability measures, quality improvement measures, monitoring compliance with evidence-based guidelines, cancer liaison physician responsibilities, studies on quality improvements, and data quality.

Dr. Naik concluded his survey with the following remarks:

“The program is very well organized with dedicated providers and registry staff. Program members deeply care about their community and have grass roots activities designed to improve health of their community. They show tremendous dedication and insight into the needs of this community including needs of special populations. This program excels in providing high quality care by implementing standards as defined by the CoC and beyond.”


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KCH was awarded a “3 year Accreditation” with 7 standards rated with commendation. The Center for Cancer Care at Knox Community Hospital has been accredited by the CoC since 2010. The next survey will be in 2016.

In 2013, KCH had a total of 254 newly diagnosed cancer cases. Table 1 provides, in detail, the various sites of cancer, stage of cancer at diagnosis, and gender. The major sites overall were breast, lung, prostate, bladder, and colon. These cases were discussed at regularly scheduled multi-disciplinary tumor board meetings where facts about the patient and cancer were presented; followed by presentations by members of the diagnostic radiology, pathology, surgery, radiation oncology, and medical oncology teams. The multi-disciplinary team focused on the patient’s treatment options utilizing the National Comprehensive Cancer Network (NCCN) guidelines.

Registry Report continued... Sandy Petros, BS, MT(aSCP), CTr

Total Sex AJCC Stage GroupMale Female 0 I II III IV Unknown N/R*

Total 254 120 134 23 67 43 33 38 17 33Oral Cavity 7 4 3 0 0 1 2 2 2 0

Tongue 2 1 1 0 0 0 0 1 1 0Oropharynx 1 1 0 0 0 0 0 1 0 0Other 4 2 2 0 0 1 2 0 1 0

Digestive System 29 10 19 1 10 5 2 10 1 0Esophagus 4 3 1 0 2 0 0 1 1 0Colon 15 2 13 0 5 2 2 6 0 0Rectum 6 4 2 1 2 2 0 1 0 0Pancreas 2 1 1 0 0 0 0 2 0 0Other 2 0 2 0 1 1 0 0 0 0

Respiratory System 44 24 20 0 8 7 11 16 2 0Larynx 1 0 1 0 0 0 0 1 0 0Lung/Bronchus 43 24 19 0 8 7 11 15 2 0

Blood & Bone Marrow 20 9 11 0 0 0 0 0 0 20Leukemia 11 6 5 0 0 0 0 0 0 11Multiple Myeloma 5 3 2 0 0 0 0 0 0 5Other 4 0 4 0 0 0 0 0 0 4

Connect/Soft Tissue 2 2 0 0 0 0 1 0 1 0Skin 5 4 1 0 3 0 0 1 1 0

Melanoma 4 3 1 0 3 0 0 0 1 0Other 1 1 0 0 0 0 0 1 0 0

Primary Site of Cancers at KCH in 2013 by Stage Table 1

N/R*=not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown.

(continued next page)


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Total Sex AJCC Stage GroupMale Female 0 I II III IV Unknown N/R*

Total 254 120 134 23 67 43 33 38 17 33Breast 47 0 47 5 15 12 12 2 1 0Female Genital 12 0 12 0 2 1 0 0 9 0

Cervix Uteri 1 0 1 0 0 0 0 0 1 0Corpus Uteri 10 0 10 0 2 0 0 0 8 0Ovary 1 0 1 0 0 1 0 0 0 0

Male Genital 39 39 0 0 21 16 0 2 0 0Prostate 37 37 0 0 19 16 0 2 0 0Testis 1 1 0 0 1 0 0 0 0 0Other 1 1 0 0 1 0 0 0 0 0

Urinary System 22 15 7 17 4 0 1 0 0 0Bladder 20 14 6 17 3 0 0 0 0 0Kidney/Renal 2 1 1 0 1 0 1 0 0 0

Brain & CNS 7 1 6 0 0 0 0 0 0 7Brain (Benign) 2 0 2 0 0 0 0 0 0 2Brain (Malignant) 3 1 2 0 0 0 0 0 0 3Other 2 0 2 0 0 0 0 0 0 2

Endocrine 4 2 2 0 3 0 0 1 0 0Thyroid 4 2 2 0 3 0 0 1 0 0

Lymphatic System 9 6 3 0 1 1 4 3 0 0Non-Hodgkin 9 6 3 0 1 1 4 3 0 0

Unknown Primary 5 2 3 0 0 0 0 0 0 5Other/Ill-Defined 2 2 0 0 0 0 0 1 0 1

Primary Site of Cancers at KCH in 2013 by Stage Table 1 continued...

N/R*= not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown.



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The KCH Top Five Cancer Sites overall were compared to the American Cancer Society (ACS) Top Five Sites overall in Charts 1 and 1 a.

KCH Top Five ACS Top FiveBreast-18.5% Breast 14.1%Lung-16.9% Lung 13.7%Prostate-14.6% Prostate 14.4%Urinary Bladder-7.9% Colon 6.2%Colon-5.9% Melanoma 4.6%

Breast

Lung

Prostate

Urinary Bladder

Colon18.5%

16.9%

14.6%

7.9%

5.9%

KCh Top five Sites overall *Chart 1

american Cancer Society Top five Sites overall Chart 1a


Breast

Lung

Prostate

Colon

Melanoma14.1%

13.7%

14.4%

6.2%

4.6%

*The top five sites overall comprised 63.8% of the total cases seen at KCh.

*The top five sites overall comprised 53% of the total cases at the american Cancer society.


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2013 Analytic KCH Cases

FEMALE & MALE

Urinary Bladder

Corpus Uteri

Colon

Lung

Breast

Leukemia

Non-Hodgkin Lymphoma

Urinary Bladder

Lung

Prostate

4.5%7.5%

9.7%

14.2%

35.1%

5.0%5.0%

11.7%

20.0%

30.8%

2013 ACS Facts & Figures

FEMALE & MALE

Thyroid

Corpus Uteri

Colon

Lung

Breast

Melanoma

Colon

Urinary Bladder

Lung

Prostate

5.6%

6.2%

6.5%

13.7%

28.8%

5.3%

5.9%

6.4%

13.8%

27.9%

The KCH Top Male and Top Female Cancer Sites were compared to the ACS Top Sites by gender in Charts 2 and 2a.

Chart 2a

Chart 2



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Chart 3 illustrates that the majority of oncology patients presenting to KCH at the time of diagnosis reside in Mount Vernon.

The primary purposes of follow-up surveillance of oncology patients are to ensure continued medical care and to monitor the health status of these patients. Surveillance provides the documentation of residual disease or its spread, recurrence, or additional malignancies and vital status. Additional treatments may be added in the database. Long-term follow up (2006 to present) of all analytic oncology patients at KCH is 92.4%.

Chart 3Patient residence at Time of Diagnosis


KNOX COUNTY

All Others(Outside of Knox County)

Gambier

Centerburg

Danville

Fredericktown

Howard

Mount Vernon

254TOTAL CASES

44.1%

13.0%

13.4%

5.9%

3.1%

3.1%

17.4%


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becky Dangelo, Msn, Rn, CnoR, bhn The CenTer for CanCer Care

Cancer Conference Coordinator Report

Our Cancer Conferences (Tumor Board) are an integral component of our multidisciplinary approach to patient care, management and outcomes. Medical and radiation oncologists, surgeons, pathologists, and a radiologist discuss both prospective and retrospective cases as well as difficult cases and cases of interest. The conferences provide valuable consultation, collaboration and education.

Other key team members include physicians, advanced practice nurses (APN), breast health navigator, cancer navigator, oncology data specialist, clinical trial nurse, medical and radiation oncology nurses, pain and palliative care nurses, radiation therapists, social workers, occupational and physical therapists, lymphedema therapist, speech therapist, pharmacists, dietitian and members of the executive team.

The conference provides an opportunity to review the medical history, various diagnostic tests (x-rays, CT and PET Scans, endoscopic pictures, and digital camera pathology slides), surgical interventions, pathology reports, and the diagnosis. Collaboratively, recommendations and treatment options/planning for individuals are decided to provide optimal patient care utilizing NCCN staging and national treatment guidelines. Attendees receive continuing medical education credit.

Tumor Board meets Tuesday at noon in the third floor meeting room. All physicians, APNs, nurses, ancillary health care providers and students are welcome to attend the cancer conferences. Healthcare providers are encouraged to present cases at Tumor Board and may call 740.393.5579 to request a case presentation.

The Tumor Board Coordinator reports quarterly to the Cancer Committee. The report includes the number of tumor cases presented, the tumor sites, and attendance rates of the required multidisciplinary members.

Top Five 2013 KCH Cancer Sites Presented to the Tumor Board

128Cancer sites were presented to the

Tumor Board in 2013.

41Breast

13Colon 9

Lymphoma 4Esophageal

0

10

20

30

40

50

23Lung


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becky Dangelo, Msn, Rn, CnoR, bhn The CenTer for CanCer Care

breast health navigator Report

When a woman is informed of an abnormal mammogram and the need for further evaluation her anxiety level immediately increases. Regardless of whether the initial meeting with the woman is at the time that this occurs, or at the time of a surgical consult, it is important to be an advocate for concerns, to provide emotional support and education.

As with most cancer centers, breast cancer remains the number one cancer diagnosis at Knox Community Hospital. Breast cancer is the second leading cause of cancer death in women with lung cancer being number one.

It remains imperative that women are proactive for their health and wellness by following preventative care measures and health screenings. This includes having yearly mammograms and performing monthly breast self-awareness exams. Woman should have an annual clinical breast exam and pelvic exam by a healthcare provider (physician or nurse practitioner).

According to the American Cancer Society smoking may increase the risk of breast cancer. BREASTCANCER.ORG reports that smoking is linked to a higher risk of breast cancer in younger, premenopausal women. Research also has demonstrated that in postmenopausal women there may be a link between second-hand smoke exposure and a risk of breast cancer.

Women are provided information regarding smoking cessation and access to a Smoking Cessation Program available at the Knox County Health Department.

It is well known that “the best protection is early detection” which is imperative to fighting breast cancer, the most common cancer diagnosed in women. Although rare, breast cancer can also be diagnosed in men.

As the breast health navigator (BHN) my consistent goals include decreasing the time from identification of an abnormal mammogram to diagnostic examinations and surgical consult. Coordination of services to expedite care is provided for seamless, quality, competent and optimal patient care, satisfaction of both the patient and family, and outcome.

As the BHN I am dedicated to providing education related to prevention, screenings and navigation throughout the process, from early detection of an abnormal mammogram or self-found lump/mass, to diagnosis and/or the breast cancer journey, and survivorship.


Sec 5 | 3Breast Health Navigator Report continued... Becky Dangelo, MSn, rn, Cnor, Bhn

KCH provides services to women referred by the BCCP Project.

BREAST CANCER SUPPORT GROUP

The goal is to empower, enable, and to educate as well as to promote physical,

emotional and spiritual health and healing to breast cancer survivors. Patients share

their journey and experiences which promotes both individual and group

growth. This group meets monthly in the Knox Medical Pavilion.

YOUNG SURVIVORS BREAST CANCER SUPPORT GROUP

This group is for women in the age group of 20’s to 45. The goals are the same as with the other group however, younger women may be confronted with different issues than older aged women. This group has the opportunity to share and ask questions of concern and interest that may impact them at their age.

ONGOING FROM 2013

REACH TO RECOVERY

This program is provided by the American Cancer Society and provides one-on-one

support to a person with breast cancer. The support is provided by a trained

volunteer who has been through the journey of breast cancer. Referrals to

Reach to Recovery are ongoing.

LOOK GOOD…FEEL BETTER PROGRAM

Because how a woman looks can affect how she feels, this program helps improve a woman’s self-image as she undergoes treatment. This American Cancer Society program provides free classes each month in the Knox Medical Pavilion for all women receiving cancer treatment. A make-up kit valued at $300.00 is given to each participant. The program is facilitated by a licensed cosmetologist and a trained facilitator by the American Cancer Society. Women are instructed how to apply makeup, to wear hats and scarves, and to help them look good and feel better about themselves. This program is a collaborative effort by the American Cancer Society, the National Cosmetology Association, and the Cosmetic and Toiletry and Fragrance Association. The Look Good… Feel Better Program is held monthly at the Knox Medical Pavilion.

REGION 5 BREAST & CERVICAL HEALTH SCREENING PROJECT (BCCP)

Region 5 Breast & Cervical Health Screening Project (BCCP): The CDC initiated a federal grant to the Ohio Department of Health in 1994. Knox County is among the counties served by Region5 with services available including pap and pelvic exams, clinical breast exams, mammograms (screening & diagnostic) ultrasound, surgical consult, breast biopsy (on a limited basis) fine needle aspiration, colposcopy and endocervical curettage.

Knox Community Hospital provides services to women referred by the BCCP Project.

THE MOMENT YOU

RECEIVE YOUR

DIAGNOSIS YOU

BECOME A SURVIVOR.

THE MOMENT YOUR

CANCER HAS BEEN

DETECTED YOUR

SUCCESS STORY BEGINS.

2013 ACCoMplIsHMenTsGrant funding was obtained via allocation of the american Cancer society’s besT Program. Funding for that program was provided by the susan G. Komen for the Cure, Columbus affiliate.

This program provided assistance for those 40/older who were uninsured or under insured; 40/under at risk who were uninsured or under insured; and those 40/under with an area of concern or suspicious breast mass.

screening mammograms were provided to 120 women and 68 diagnostic mammograms were performed. There were 38 breast ultra sounds performed via the besT Program.


Sec 6 | 1

Mandy holt Rn, oCn, Patient navigator

The CenTer for CanCer Care

Community outreach Program Report

SUPPorT SerVICeS DATE HELD average monthly attendance outcomes CC REVIEW

American Cancer Society(ACS) Sponsored Programs Look Good feel BetterI Can Copereach to recovery

monthly3 - 4 times annually

by referral

1 8

1-4 participants

13-Dec-1313-Dec-1313-Dec-13

Breast Cancer Support Group 1st Tuesday each month 26 13-Dec-13

Young Women’s Support Group 1st Monday each month 9 13-Dec-13

PreVenTIon anD earLY DeTeCTIon ProGraMS DATE PRESENTED OUTCOMES CC REVIEW

CoLoreCTaL CanCer SCreenInG | Participants received letter with results, aCS screening guidelines and resource contact at KCh. follow up telephone calls made to participants with positive results

Offered 4-March - 5-April , 2013

Kits distributed 226Tested Positive 50 16-May-13

Mammograms 2013Screening 3,457Diagnostic 733BCCP 21

13-Dec-13

Colonoscopies 2013 Screening 658Diagnostic 318 13-Dec-13

oral, head and neck Cancer Screening in conjunction with the oral, head and neck Cancer alliance. Screening exams given by Dr. Christopher hetrick and Dr. Suzanne helming

3-Apr-13

Screened 35

Abnormal 5

Participants following w/ PCP 3

Participant biopsy 1 by Dr. Helming. Negative for cancer.

Follow-up with endocrinologist 1

16-May-13

Breast health education- Literature on breast health provided at the Kenyon athletic Center Feb-13 13-Dec-13

hispanic outreach Program. focus on prevention of breast and colorectal cancer Mar-13 18 Attended 13-Dec-13

CC Review = Cancer Committee Review


Sec 6 | 2

faCILITY BaSeD eDUCaTIon DATE PRESENTED OUTCOMES CC REVIEW

Webinar on Lung Cancer Screening by oMen at KCh 19-Feb-2013 Attendance: 14 CPL present 13-Dec-13

Sean Cull attended oSU hematology/oncology Series, "Phase I research". 25-Feb-13 13-Dec-13

Cancer Committee scheduled speaker heather hampel, MS, CGC, from the James Cancer hospital and Solove research Institute, who presented “Cancer Genetics".

7-Mar-13 24 Attended 13-Dec-13

Sandy Kollar, Becky Dangelo, Diana endsley and Julie Miller (Knox County Health Commissioner ) attended Roads Maps to Health Forum, "Ideas and Resources for Low-Cost Strategies to Promote Active Living and Healthy Eating" in new Philadelphia, oh; sponsored by the healthy Policy Institute of oh.

4-Apr-13 13-Dec-13

esophageal Cancer Webcast held in the 3rd floor Meeting room, presented by The ohio State University. 30-Apr-13 19 Attended 16-May-13

Dr. amy Murnen, CLP attended the american College of Surgeons meeting “nCDB 2010 analysis”. 3-May-13 16-May-13

PUBLIC eDUCaTIon DATE PRESENTED OUTCOMES CC REVIEW

“Cervical Cancer and hPV” presentation by rebecca Stilson, MD at KCh’s Urgent Care Meeting room. Jan. 29, 2013 8 Attended 13-Dec-13

articles focusing on prevention of cancer with nutrition and exercise for the Mount Vernon news, Dialogue and KCh facebook by Dina herald rD, LD, and Jason Mentzer, exercise Physiologist. an article by Diana endsley, rn, oCn for the Mount Vernon news, Dialogue , facebook

Feb-13 13-Dec-13

Becky Dangelo spoke at MVnU Social Work class. Topic: Support Groups 26-Feb-13 18 Attended 13-Dec-13

WMVo radio Show with anita Schuller, rn and Diana endsley, rn promoting colorectal cancer awareness. 7-Mar-13 13-Dec-13

Dr. hydi Laidlaw-Smith presentation to the Kiwanis on Colorectal Cancer (CrC) 11-Mar-13 35 Attended 13-Dec-13

Mount Vernon news article by Dr. hydi Laidlaw-Smith on CrC awareness. 12-Mar-13 13-Dec-13

educational handouts on head and neck cancer, smoking cessation and hPV provided to participants at oral, head and neck Screening in conjunction with the head and neck alliance.

3-Apr-13 35 Attended 16-May-13

MV news article: Cancer Screening & early Detection/Cervical Cancer by rebecca Stilson, MD Feb-13 13-Dec-13

Presentation on oral, head and neck Cancer awareness (ohnCa) given to the health Technologies and Sports Medicine Classes at the Knox County Career Center.

12-Apr-13 39 Attended 16-May-13

earth Day at Kenyon College: information provided on cancer screening and prevention. 21-Apr-13 13-Dec-13


Sec 6 | 3


ohnCa presentation given at Danville and east Knox Schools focusing on risk factors/prevention of oral, head and neck cancers.

24, 25-April-13 Attendance: 55 and 48 respectively. 16-May-13

Presentation by Dr. Suzanne helming on head &neck Cancer awareness and by Diana endsley on Colon Cancer awareness to the Mount Vernon rotary Club at the alcove restaurant.

9-Apr-13 56 Attended 13-Dec-13

Breast health program presented by Becky Dangelo at the Burrows Corporation. 25-April-2013 30 Attended 13-Dec-13

ohnCa presentation given to Centerburg School. 2-May-13 87 Attended May 16, 2013

"healthy happy hour" hosted by Knox County health Department (KChD) was held at alison's finer Diner in recognition of national Women's health Week. Dr. Deborah Cowden (KChD) addressed bone health.

14-May-13 13-Dec-13

article in the Mount Vernon news promoting Melanoma Skin Cancer awareness by Diana endsley rn, oCn. 28-May-13 13-Dec-13

annual Cancer Survivor event at the Gallagher Centre in Mount Vernon featured speaker Comedian and Cancer Survivor. Scott Burton’s talk was "Looking for Laughter in all the Wrong Places". Local Survivor Irene rivera spoke about her journey.

20-June-13 178 Attended 13-Dec-13

Sandy Petros educated participants of the Susan G. Komen rally for the Cure ways the Komen foundation has assisted our community. The event was held at the Mount Vernon County Club.

29-June-13 110 Attended 13-Dec-13

employees from the Cancer Center staffed the KCh booth at the Knox County fair providing cancer screening guidelines, blood pressures checks and skin cancer awareness information.

25-July-13 13-Dec-13

"Melanoma & non-melanoma Skin Cancers" presented by ramona Sarsama nixon, Do to nurses, Cosmetologists & estheticians at the Urgent Care Center Meeting room. elaine flowers, BSn, rn Infection Preventionist from KCh presented Safety and Infection Control.

20-July-13 24 Attended 13-Dec-13

Becky Dangelo provided breast health information at the Danville amish Safety Day. 9-Aug-13 29 Attended 13-Dec-13

Sandy Kollar spoke at "newton's annual Car Show" about services and resources available at the Center for Cancer Care.

2-Sept-13 Over 100 Attended 13-Dec-13

Sandy Kollar and amy Shoewalter provided information about resources for cancer patients and performed blood pressure checks at the fredericktown Tomato Show.

4-Sept-13 13-Dec-13

article in MV news on Prostate Cancer awareness & current screening guidelines by Dr. Praveen Dubey. Sept-13 13-Dec-13

Becky Dangelo & Diana endsley provided information on cancer screening guidelines and performed blood pressure checks at the first friday event in conjunction with a health fair organized by the KChD.

4-Oct-13 13-Dec-13


Sec 6 | 4


Becky Dangelo presented aBCs of Breast health to the Kiwanis. 7-Oct-13 56 Attended 13-Dec-13

annual Breast health awareness event Kalvari Kershner, local survivor, shared her journey through breast cancer. Linda Parks, breast cancer survivor, member of Susan G. Komen’s advisory Council & Speakers Bureau was the guest speaker. Topic: "and Yet We rise."

10-Oct-13 144 Attended 13-Dec-13

Dr. henry Brown presented a talk on men's urinary health. 24-Oct-13 13-Dec-13

Christy eagle and Diana endsley talked at Mount Vernon Middle School about radiation oncology. Nov-13 62 Attended 13-Dec-13

Diana endsley met with richard hoppe to plan a Men's Cancer Support Group. (Monthly support group meeting for men genitourinary cancers)

Nov-13 Began Jan-2013 13-Dec-13

2013 Cancer survivor awareness event 2013 Breast Cancer awareness event


Sec 7 | 1

The Diagnostic Imaging Department at Knox Community Hospital, under the medical direction of Kingsley Orraca-Tetteh, M.D., developed a long term relationship with Riverside Radiologists and Interventional Associates (R.R.I.A.) in April of 2013. R.R.I.A. and Dr. Orraca-Tetteh are now able to provide around the clock dependability and reliability in all general and subspecialty areas of radiology.

Diagnostic Imaging Service Divisions for R.R.I.A. include:

• Body Imaging

• Breast Imaging

• Cardiac Imaging

• General Imaging

• Musculoskeletal Imaging

• Interventional & Vascular Imaging

• Neuroradiology Imaging

• Nuclear Medicine

• Vascular/Stroke Neurology

• Vascular Medicine

• Women’s Imaging

In addition to having experts interpret your studies, our department has reduced our average turn-around-time (the time it takes from completion of an exam to the time a report is available for the referring physician) from an average of 12 hours in 2012 to an average of less than two hours. The average turn-around-time for a critical result dropped to just 20 minutes. Our department goal is to continue to improve in all that we do.

ann styer, MsM, RT (CT) (M)(a.R.R.T.) Director, Diagnostic imaging The CenTer for CanCer Care

Diagnostic imaging Report

knox Community Hospital has been accredited by the Commission on Cancer since 2010.

knox Community Hospital proudly partners with the american Cancer Society to provide

a full range of cancer care services.

you can contact the american Cancer Society by going to: www.cancer.org or by calling 1.800.ACS.2345.

get more information about knox Community Hospital by visiting:

www.knoxCommHosp.org

Medical Oncology 740.393.5551

Radiation Oncology740.393.5513

The Center for Cancer Care

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Documents

2014 KCH Cancer Report | 2013 Data