MidMichigan Health

Annual Cancer Report

Our Year in Review

2019 Edition

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Chairman’s Message

Our cancer committee is an integrated multidisciplinary team comprising of medical staff, nursing, clinical staff and

administration who serve in various capacities in the care of cancer patients. This committee meets quarterly to discuss

the progress of the program, review policies and assign goals for the following year. Over the last few years our

presence in mid and northern Michigan has grown and MidMichigan Health now covers 23 counties and over 950,000

accountable lives. Our tumor registry and registrars have worked diligently to bring all of our affiliates together and

within this short span we are now an Integrated Cancer Network and applying for Accreditation with the American

College of Surgeons. We are dedicated to providing mid-Michigan and neighboring regions with quality, comprehensive

cancer care through all phases of prevention, detection, management, rehabilitation and survivorship. Our goal is to

provide this care close to home and for options not available at a MidMichigan location our partnership with the

University of Michigan (Michigan Medicine) provides easy access to services available in Ann Arbor.

Early Detection is Key

Cancers treated at an early stage have better outcomes than those presenting with advanced disease. We continue to

offer screening for breast, colon and prostate cancer, continuously updating the protocols to meet new accepted

national guidelines. We have a robust lung cancer screening and tobacco cessation program available across the

system. We have expanded free mammograms access throughout the year and run a high risk breast cancer clinic in

Midland and Gratiot. Our genetic counseling program at MidMichigan Health assists patients and their family members

in assessing their risk and determining if testing is warranted and then how to respond to the test results. After a

temporary absence we are now excited to have two genetic counselors join our team, summer 2019.

Dedicated Medical Professionals

The strength of our program lies in our personnel. Our team continues to give unselfishly of their time and

talent. Each physician, physician assistant, nurse practitioner, nurse, therapist, pharmacist and other members of our

cancer team provide compassionate care, with genuine respect and concern for the individual patient. This has made

our Cancer Center the preferred provider for oncology care in our primary service areas. MidMichigan employees and

physicians have given personal time to participate in committees and the General, Thoracic, Colorectal and Breast

Cancer Conferences. Cases are discussed at these conferences with experts from across the network participating along

with our colleagues at Michigan Medicine, in reviewing all aspects of the diagnosis and collaboratively discussing

treatment options.

Strong Community Support

Our cancer program is fortunate to have strong community support. Volunteers at MidMichigan Health are generous

with their time in our inpatient and outpatient treatment areas. The Elsa U. Pardee Foundation for many years has been

generous in their support of our Tumor Registry and the annual Elsa U. Pardee Lecture. Many past patients and family

members continue to provide financial support with donations to our MidMichigan Home Care and Hospice

programs. We continue to collaborate with area schools and numerous other local organizations to help spread

awareness of cancer, educate on prevention and detection, and obtain support for our patients.

Awards and Accomplishments

We have accomplished a lot and are proud of all who have gone on to win awards both locally and nationally working for

our cancer team. Our breast program in Midland continues to do well and is one of the few NAPBC accredited centers in

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the state. We offer 3D mammography and high risk breast cancer clinics in Midland and Gratiot. We have plastic surgery

reconstruction options in Midland. Our lung cancer and thoracic program in Midland has burgeoned with the addition

of a thoracic surgeon, and offers minimally invasive options including esophageal surgery in Midland. We routinely use

bronchoscopic navigation for diagnosis of lung cancer, a new technology to reach lesions and nodes further into the

bronchial tree non-invasively. We continue to offer minimally invasive, including robotic surgery, for colorectal, uterine,

and prostate cancers. We have installed state of the art Linear Accelerators across the system in Midland, Alpena and

Gratiot. Starting in Midland and spreading to our affiliates we have reduced infusion wait times utilizing a Tracking

Board that was built into Epic by our team of IT specialists.

A Look Ahead to 2019

As always our aim is to expand the coverage and scope of our practice, but our focus over the next few years would be

on improving quality to exceed all national benchmarks in different aspects of cancer care and treatment in the areas

that we currently service. The single biggest achievement we hope to get is accreditation with the American College of

Surgeons as an Integrated Cancer Network. We have applied for ASTRO- APEX accreditation for our radiation oncology

programs and have on site surveys scheduled. We are collecting data for submission to the American College of

Surgeons next year when we will be applying for a rectal cancer center of excellence designation. Our goal is to provide

patients with excellent multidisciplinary team-based care and a comprehensive cancer program, served seamlessly and

close to home, with little or no disruption to their time or commitments and with outcomes that match or exceed

national benchmarks. This report provides a snapshot of our activities and goals and hopes to increase awareness of the

broad range of oncology services available through MidMichigan Health.

Director’s Report

In 2018 there were 1822 cancer cases diagnosed and treated at MidMichigan Health.

Midland: 1080

Gratiot & Mount Pleasant: 267

Alpena: 350

Clare: 54

Gladwin: 33

West Branch: 38

The strategic plan that focuses on four major cancer sites: Breast, Thoracic, Colorectal and GU/GYN remains the focus

of new initiatives—to highlight a few:

Breast Cancer:

• Received approval to expand the Breast Health program in Alpena adding a breast health nurse

navigator

• Began providing breast reconstruction in Midland with Drs. Cederna and Momoh from Michigan

Medicine and Dr. Yonick, plastic surgeons

Colorectal Cancer:

• Formed Rectal Cancer Center of Excellence Leadership team to address all standards for center of

excellence status with the American College of Surgeons; Dr. Busch is our physician leader for this

initiative.

Thoracic Cancer:

• Recruited a thoracic surgeon, Dr. Alvelo-Rivera

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• Developed smoking cessation pathway in Epic

• Added the ability to provide diagnostic manometry for esophageal patients

• Dr. Alvelo-Rivera began post-op telemedicine visits with patients that live in the Alpena area

Urological Cancers:

• Dr. Miraka joined our Urology team in Midland and began providing robotic assisted prostatectomies

and nephrectomies.

Cancer Registry & Cancer Conferences

Timely and accurate case finding is done to report and collect cancer cases including malignant tumors, benign

brain and central nervous system tumors that are diagnosed and/or received for first course treatment at

MidMichigan Health.

Our cancer data is collected gets reported to the State of Michigan and the National Cancer Database. Registry

data contributes to treatment planning, staging and continuity of care for patients, evaluating outcomes,

comparative analysis with other hospitals and ultimately for research in the fight against cancer. Annual follow

up is performed on all cancer cases.

Our weekly Network Cancer Conferences are attended regularly by the following specialty groups: Medical

Oncology, Radiation Oncology, Surgery, Radiology and Pathology. Cancer cases are discussed at these

conferences with experts from our program and Michigan Medicine reviewing all aspects of the diagnosis and

collaboratively discussing treatment options. In 2018 there were 982 cases presented at cancer conferences.

Our top 5 sites of cancer are: Breast, Lung, Colorectal, Bladder and Prostate across our health system.

Here are the total for some of our primary sites for all facilities for 2018 for our annual analytical cases in our

network:

• Bladder: 98

• Brain/CNS: 40

• Breast: 320

• Colon: 106

• Esophagus: 23

• Kidney & Renal Pelvis: 34

• Oral Cavity & Pharynx: 32

• Leukemia: 20

• Lung & Bronchus: 308

• Lymphoma: 76

• Myeloma: 14

• Melanoma: 41

• Pancreas: 42

• Prostate: 155

• Rectum: 56

• Thyroid: 45

• Corpus & Uterus: 41

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Cancer Liaison Report

Each year our cancer program follows quality improvement and accountability measures. Our Cancer Liaison

Physician (CLP) is a leader on our cancer committee who evaluates and reports our cancer program’s data from

the National Cancer Database. Our CLP and alternate are Dr. Regenbogen and Dr. Hitzelberger. Data submitted

to the National Cancer database annually with the Call for Data comes from the Tumor Registry. Our Certified

Tumor Registrars collect data on each cancer site and this data can be used in many ways to review the quality

of our cancer program.

The following reports are made available to our cancer committee for review:

o RQRS-Rapid Quality Reporting System (for breast and colon cases)

o CQIP-Cancer Quality Improvement Program

o CP3R-Cancer Program Practice Files

o National Benchmarking reporting

o Survival Data reporting

As part of the CP3R data reporting there are many measures that the CLP along with the Cancer Committee

review on a quarterly basis. Here a few of those measures:

Breast: Tamoxifen or a third generation aromatase inhibitor is considered or administered within 1 year of a

diagnosis of breast cancer for Stages 1b-3 with hormone receptors positive breast cancer:

o Required percentage: 90%

o Midland: 100%

o Gratiot & Mount Pleasant: 100%

o Alpena: 100%

Lung: Surgery is not the first course of treatment for cN2, M0 lung cancer: o Required percentage: 85% o Midland: 100% o Gratiot & Mount Pleasant: 100% o Alpena: 100%

Infusion Center

Monthly there were 4618 infusions provided for our health system for 2018.

Midland has 16 chairs & 3 private rooms and our average per month is 1422 patients.

Gratiot has 10 chairs & 2 private rooms and our average per month is 684 patients.

Mount Pleasant has 8 chairs & 2 private rooms and our average per month is 631 patients.

Alpena has 11 chairs & 5 private rooms and our average per month is 1881 patients.

Breast Cancer Navigators

Midland Center for Women's Health performed 12,324 mammograms in 2018

Gratiot performed 6,673 mammograms for 2018.

Mount Pleasant performed 2,277 mammograms for 2018

Alpena performed 5,677 mammograms for 2018.

A High Risk Breast Assessment is being done at the time of mammogram.

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We now offer Free Mammogram Screening all year for our health system.

Alpena is budgeted for the High Risk assessment for the next fiscal year.

Gratiot has also passed their Radiology Ultrasound and MRI ACR Accreditation.

Midland now has a high risk breast clinic with Alison Funka, A.G.N.P.C and holds a specialty plastic surgery clinic

once a month with Michigan Medicine. She holds clinics in Midland and Gratiot.

Quality Improvement

In Midland the Center for Women's Health achieved recognition as Certified Breast Center for Excellence.

Gratiot and Mount Pleasant began video conferencing their cancer conferences with physicians and staff

attending every other week and also in 2018 we updated our video conferencing equipment.

Alpena relocated bone marrow biopsies to the OR suite to allow patients the options for conscious sedation

during the procedure.

Radiation Oncology

MidMichigan Health has three Radiation Oncology Centers located in Midland, Gratiot and Alpena. The Alpena

location is a joint agreement with Michigan Medicine.

Midland provided 8054 total treatments in 2018

Gratiot provided 3058 total treatments in 2018

Alpena provided 5269 total treatments in 2018

Diagnostic Imaging & Lung Cancer Navigator

In 2018 there were 784 Low Dose Lung CT Scans performed at Midland, Gratiot and Alpena.

Our Lung Cancer Navigator works to reduce or eliminate barriers to care and pave the way for early and timely

screening. Our Lung Cancer Screening process helps to identify high risk patients, diagnosis and recommend

treatment for lung cancer. This screening allows tumors to be detected at earlier stages allowing more timely

treatment.

Pathology

• Our Pathology departments at Midland, Gratiot and Alpena are certified through the College of American

Pathologists. Our laboratory service department is dedicated to provide quality service in clinical pathology,

anatomical pathology and cytopathology testing.

Genetic Counseling

We now have 2 Genetic Counselors on staff Brittany Allen and Rebecca MacFalda. They will be starting summer

2019. Clinics will be held in Midland and Gratiot with a goal to provide this service to Alpena via telemedicine by

2020.

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Pharmacy

• The oncology pharmacists, as a part of the multidisciplinary team, continue to review chemotherapy protocols to ensure that patients receive the most up-to-date treatment according to the National Comprehensive Cancer Network guidelines.

• Quality Improvement: The Infusion Centers/Cancer Centers piloted an EPIC track board to better communicate patient flow throughout the building(s) and decrease patient wait time. The pharmacists have begun utilizing this track board to communicate to the Infusion Center nurses when the patient’s medication is ready. Having this tracking mechanism in place has reduced patient wait times and improved productivity.

• Quality Improvement: Pharmacy has lead improvement efforts to ensure compliance with new guidelines surrounding hazardous medication handling. Following these new guidelines ensures the safety of employees, patients, and visitors in hazardous medication handling areas. Although the changes do not need to be implemented before December of 2019, the pharmacy team has been working to lay the groundwork for these changes in 2018.

Social Work

• Oncology social workers are master level clinicians (MSW) trained in prevention, education, advocacy, research

and counseling who provide multilevel assessment and intervention for patients (and families) undergoing

cancer treatment.

• Social workers remove barriers to treatment by obtaining funding from foundations and drug manufacturers

when the patient’s insurance will not cover recommended treatment and maintain state licensing requirements

via continuing education.

• They also provide crisis intervention to patients and their support systems and work to educate patients on

advance medical directives and assist with completion of these documents. Lastly, Social workers connect

patients to home care services, hospice, and palliative care.

Nutritional Services

We offer nutritional assessments that an individualized care plan can be formulated integrating diagnosis, stage

of the disease and treatment into the overall plan. The practice of oncology nutrition covers research,

prevention, treatment, recovery and palliative care.

Palliative & Hospice Care

Living with cancer can cause patients great difficulty in all aspects of their lives – physical, emotional, spiritual

and social. Palliative care helps these patients manage the pain and other symptoms related to cancer, or other

chronic disease.

In 2018 a total of 308 patients received palliative care & 703 patients received hospice care. Bereavement

support is also provided for our patient’s family members.

Hospice is a program for terminally ill individuals and their families. It provides clinical management of

symptoms and pain, enabling patients to live as fully and comfortably as possible while remaining in the familiar

surroundings of home, or wherever the patient is most comfortable.

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Clinical Trials & Research

MidMichigan Health Clinical Trials program is an aligned affiliate with Michigan Medicine and the Southwest

Oncology Group (SWOG).

We have 10 Open Clinical Trials at MidMichigan Health

Overall accrual for enrollment for 2018: 863/1308=66%

o MidMichigan Health total enrolled: 13 o Referred to Michigan Medicine total enrolled: 10 o Registry Totals (Lung and Breast): 840 o Overall Cumulative total: 863 o Total analytical cases: 1308

Community Outreach, Screening and Prevention

Healthcare access-strategies include: Connecting people to services through Find a Doctor online, health

Navigators, distributing information on obtaining and paying for health care services at community event,

promoting and supporting public transportation efforts & providing transportation for people with cancer who

do not have a ride or are unable to drive themselves.

Oncology E-Newsletter Readership related to cancer prevention, colorectal cancer, lung cancer and HPV had

over 2,777 readers.

Tobacco Cessation: 53 individuals participated in cessation programs, over 9,940 tobacco cessation social media

readership, and 250 Michigan Quit Kits were distributed.

Cancer Support Services: Provided $81,000 to Friends Together to provide 7 support groups, Road to Recovery,

gas gift cards and lodging assistance for those seeking treatment for those in the Alpena Service Area.

There were 437 Colorectal Risk Assessments completed with 90 deemed high risk for which follow-ups were

completed.

There were 77 Lung Cancer Risk Assessments completed with 12 deemed high risk for which follow-ups and

LDCTs were recommended.

There were 150 Breast Cancer Risk Assessments completed with 14 deemed high risk for which follow-ups

were completed.

There were 55 Free Mammograms provided to uninsured women with 14 requiring an additional ultrasound.

Road to Recovery provided 137 rides to cancer patients at MidMichigan Medical Center - Gratiot and

MidMichigan Medical Center - Mt. Pleasant

The MidMichigan Access line had 9,925 calls in 2018 many of which were oncology related.

The Oncology Patient Van provided more than 1,040 trips or more than 67,500 miles to provide rides to

patients living outside of Midland County.

Cancer Services

Cancer Services has 6 support groups for cancer patients.

They have provided services to over 500 clients and over 1000 caregivers with an annual budget of $500,000.

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American Cancer Society

American Cancer Society provides support and services to cancer patients including: access to care through

transportation and lodging, support services such as wigs and the peer-to-peer program Reach to Recovery, as

well as, trusted information and support available 24/7 through 800-227-2345 and www.cancer.org.

The digital Personal Health Manager became available in December of 2018. This exciting new tool is

comprehensive and customizable for all patients and caregivers to help organize, inform, and support patients

along the cancer journey. www.cancer.org/phm

In total, the Society is currently funding 22 grants for more than $11.8 million in Michigan. Including $955,500

to the University of Michigan and $6,849,500 to the Regents of the University of Michigan.

Our 24/7 helpline handled more than 22,000 calls and live chats from Michigan residents seeking support,

information, and resources.

Our website, cancer.org, had more than 1.8 million visits from Michigan residents for the latest, most accurate

information on virtually all topics related to cancer.

MidMichigan Health Foundation

Many people joined together in 2018 to give of their time, talent and money to help those we care for deal with the challenges of this disease. These contributions came from memorials, grants, planned gifts, events and outright donations. Support for MidMichigan’s cancer program in 2018 totaled more than $300,000. The 5th Annual Lafarge Presque Isle Quarry Run raised $35,000 for the Cancer Center of MidMichigan Medical Center – Alpena. A total of $185,000 in contributions has been raised from this event over five years.

The Alpena High School Class of 1957 supported Alpena’s Cancer Center at their class reunion with a collection to honor and memorialize their classmates. The Scotty G. Fishing Tournament raised $4,600 for transportation assistance for Alpena Cancer Center patients. The Ossineke Auxiliary held community walks and collected $4,540 to assist with the cancer program in Alpena.

The Clare High School Girls Cross Country Team collected more than $1,000 from the sale of specially designed T-shirts and sweatshirts to help area residents needing breast health care & The Ithaca Yellowjacket Volleyball program donated $1,500 to support the Breast Health Fund for patients served at MidMichigan Medical Center – Gratiot. The Sanford Eagles #3677 and Bullock Creek High School’s “Creekers for a Cause” supported women in need to provide free mammograms at MidMichigan Medical Center – Midland thanks to their donations.

Cancer-related expenses for Midland County residents who qualify continue to be supported through the foresight, generosity and compassion from planned gifts left behind by Robert (Bob) and Veronica (Ronnie) Cermak.

Our cancer patients are touched deeply by the personal support they receive from numerous individuals and organizations who regularly donate their time and talent to make hats, slippers and blankets to help them stay warm as they receive their treatments. Volunteers from MidMichigan Medical Center – Gladwin and MidMichigan Medical Center – Midland provided funding for the distribution of special gift bags that offer support and encouragement to those undergoing chemotherapy treatments. Our volunteers also help dispense other nutritional items that are supported through gifts made to MidMichigan’s Cancer Fund. A Day of Cheer marks the community coming together in December at MidMichigan Medical Center – Alpena to support cancer patients both past and present.

Gratitude to the Elsa U. Pardee Foundation: We would like to add our voice to the many others in recognizing and acknowledging the Elsa U. Pardee Foundation. This Foundation continues to be instrumental in developing MidMichigan’s cancer program including its ongoing support of the annual Elsa U. Pardee Memorial Cancer Lecture and Tumor Registry. Our deepest appreciation is extended to the Elsa U. Pardee Foundation and to all who have chosen to help those who face the challenges of cancer through their gifts of generosity and hope.

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Pardee Cancer Treatment Fund

The Pardee Cancer Treatment Fund of Midland/Gladwin Counties and Williams Township administered approximately $400,000.00 in financial assistance for medical expenses for the treatment of cancer for the 2017-2018 fiscal year. The major source of funding comes from the Elsa U. Pardee Foundation and any memorials and donations that are received by Pardee goes back onto patient accounts for their medical expenses. The Pardee Cancer Treatment Funds are located in Midland, Bay City, Clare, Mt. Pleasant and Gratiot Counties. Patient assistance is determined by the patients’ county of residence and not by treatment facility location. Since the funds all have a limited annual budget, the Fund’s Committee works hard to constantly stretch the dollars so that more patients can be assisted annually.

The Midland office handles this process for the other four Pardee offices when they have a patient in need of drug assistance by utilizing drug company and copay assistance programs. For the fiscal year October 1, 2017-September 30, 2018, the Midland office was able to save all Pardee offices over $478,600.00 using Indigent Drug Programs and Co-Pay Assistance Programs. Around 100 patients enrolled in drug company and co-pay assistance programs with 83 different medications being covered.

Services provided: Referrals to the food pantry for Boost/Ensure products and food, Michigan Medicine referrals for M-support with 83% of patients receiving 55-100% assistance on their medical expenses incurred there, Referrals to the Care Giving Network for Thanksgiving and Adopt-a Family program for Christmas.

The Midland Pardee office assisted over 262 patients in 2017-2018 financially and we assisted over 1493 patients with non-financial means during that same time period.

Friends Together

Friends Together of Alpena is a non-profit organization whose sole purpose it to help people during and after their cancer experience.

Over 3500 contacts were made with clients in several programs of support in 2018-2019, including Alpena, Presque Isle, Oscoda, Iosco, and Montmorency Counties. Countless more took advantage of our ‘open door’ to receive support and navigation as they travel the cancer journey and attend Friends Together sponsored community educational forums. 16 Support Groups are offered annually.

Goals for 2019 will to be to provide the following: Maintain present services to current populations and reach out to include more people as resources allow. Friends Together will develop strong leadership at the Board level and plan effectively for the transition from our founding Director/President to the next generation of leadership.

Friends Together will have adequate human, physical and financial resources to be recognized as a sustainable service organization in our community.

Friends Together is actively engaged in community. Networking for the greater benefit of our clients. Friends Together Organizational Competencies:

• Provide a warm, confidential, safe environment. • Develop and implement support groups, materials and events supporting patients and families coping

with diagnosis, treatment and beyond. • Deliver safe, reliable, free transportation and services. • Focus our growth on service. • Build a community where no one faces cancer alone.

Friends for the Future. Make a gift that Lasts Forever. A new endowment fund for Friends Together was established in November, 2018.

Enhanced partnership with MidMichigan Health Services continues to be regarded as the single most important component of sustainability in the future.

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Midland Midland, Gratiot, Mount Pleasant & Alpena