BRONSON BATTLE CREEK CANCER CARE CENTER · 2018. 11. 27. · lung cancer than from colon and rectal, breast and prostate cancers combined . For the past 25 years, lung cancer has

Battle Creek

BRONSON BATTLE CREEKCANCER CARE CENTER

2018ANNUAL REPORT

with a special focus onLUNG CANCER

2018 ANNUAL REPORT

BRONSON BATTLE CREEKCANCER CARE CENTER

SPECIAL FOCUS ONLUNG CANCER

A Word from the COO

2

Lung Cancer Overview . . . . . . . . . . . . . . . . . . . . . 3

Types of Lung Cancer . . . . . . . . . . . . . . . . . . . . . 3

Causes of Lung Cancer . . . . . . . . . . . . . . . . . . . . 3

Signs and Symptoms of Lung Cancer . . . . . . . . . .4

Diagnosing Lung Cancer . . . . . . . . . . . . . . . . . . 4

Lung Cancer Staging and Typical Treatments . . . 4

Treating Lung Cancer with Chemotherapy . . . . . 4

Targeted Treatments . . . . . . . . . . . . . . . . . . . . . . 5

Cancer Research and Technology Update . . . . . 6

Advancing Research Through Leadership and

Collaboration . . . . . . . . . . . . . . . . . . . . . . . . 6

Treating Lung Cancer with Radiation Therapy . . 7

Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The Cancer Patient’s Survivorship Care Plan . . . 9

Lung Cancer Screening . . . . . . . . . . . . . . . . . . . . 10

Treating Lung Cancer with Surgery . . . . . . . . . 11

Monitoring Compliance and Continuous

Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Measuring and Improving Quality . . . . . . . . . . . 12

Clinical Research Trials Involving

Non-Oncologic Treatment . . . . . . . . . . . . . . 12

Prevention, Screening, and Community

Outreach Programs . . . . . . . . . . . . . . . . . . . 13

Comparison of Lung Cancer Statistics . . . . . . . 14

About the Cancer Care Center . . . . . . . . . . . . . 16

Dear Friends,

I am proud to introduce Bronson Battle Creek Cancer

Care Center’s Annual Cancer Report for 2018 . With a

special focus on lung cancer, this report highlights our

comprehensive approach to lung health . From testing and

diagnostics, to treatment and survivorship planning, our

exceptional team works closely together to provide our

patients and community with the highest level of care .

In this report, we’ve also included local and national

cancer data so you can see how well our performance

compares to others .

Since 1995, Bronson Battle Creek has been recognized by

the Commission on Cancer of the American College of

Surgeons . With an exemplary staff, leading technology and

robust research, we have the highest level of confidence

in the programs and clinical outcomes we deliver . Bronson

Battle Creek is also nationally recognized for patient safety

earning an ‘A’ Hospital Safety Grade from the Leapfrog

Group in Fall 2018 .

I hope you find our 2018 annual report informative . If you

have any questions about the Cancer Care Center and our

capabilities, please contact us at (269) 245-8056 (radiation

oncology) or (269) 245-8660 (medical oncology) .

Sincerely,

Jim McKernan

Chief Operating Officer

Bronson Battle Creek

Lung cancer occurs when normal cells within the lungs grow abnormally and multiply without control . For both men and women, it is the leading cause of cancer deaths in the United States and throughout the world . In the United States, more people die from lung cancer than from colon and rectal, breast and prostate cancers combined . For the past 25 years, lung cancer has even outpaced breast cancer as a cause of death for women .

Most lung cancers are malignant, which means they don’t just invade the lungs but actually damage healthy tissue . The rich blood vessels and lymphatic channels that make up the lung provide a network through which the cancerous cells travel, increasing the likelihood that the tumors may spread, or metastasize, to nearby lymph nodes, or even to other organs .

Early diagnosis is critical . At least half of all patients who receive an early diagnosis will be alive and free of cancer within five years . However, once lung cancer has metastasized, the five-year overall survival rate is less than 5 percent .

Types of Lung Cancer

Two main types of lung cancers account for about 95 percent of all lung cancers: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) . These are characterized by the cell size and type of tumor when viewed under the microscope .• NSCLC includes several subtypes of tumors: adenocarcinoma, squamous cell carcinoma

and large cell cancer .

- Adenocarcinoma accounts for 30 to 40 percent of all cases . It includes a subtype called bronchoalveolar cell carcinoma, which looks like pneumonia on chest X-rays .

- Squamous cell carcinoma accounts for about 30 percent of all cases, making it the second most common type of lung cancer .

- Large cell cancer makes up 10 percent of all cases .• Less common, SCLCs make up 20 percent of all cases . They grow more quickly and are

more likely to metastasize . Often, they have already spread when the cancer is diagnosed .• About 5 percent of lung cancers are of rare cell that includes carcinoid tumors,

lymphoma and others . Just 1 percent of all cases are carcinoid tumors .

Causes of Lung Cancer

Smoking is the number one cause of lung cancer, accounting for 90 percent of all cases . Smoking more than one pack of cigarettes per day increases a person’s lung cancer risk by 20 to 25 times when compared to someone who has never smoked . Cigar and pipe smoking also increase a person’s risk . However, that risk gradually decreases after quitting, and after 15 years of not smoking, the risk is comparable to someone who has never smoked .

Other causes include:• Secondhand smoke• Air pollution• Exposure to asbestos• The presence of other lung diseases, such as tuberculosis (TB) or chronic obstructive

pulmonary disease (COPD)• Exposure to radon • Exposure to arsenic, chromium, nickel, aromatic hydrocarbons, and ethers• A previous diagnosis of lung cancer

Lung Cancer OverviewBy Niyati Bhagwati, MD, FACP, Bronson Oncology & Hematology Specialists

3

BRONSON BATTLE CREEK CANCER CARE CENTER 2018 ANNUAL REPORT

At least half of all

patients who receive an

early diagnosis will be

alive and free of cancer

within five years.

4


Signs and Symptoms of Lung Cancer

A new and persistent cough could be a symptom of lung cancer, especially for smokers, former smokers and anyone at a higher risk . Coughing up blood is another warning sign, as is an aching, dull and persistent chest pain . Shortness of breath, wheezing or hoarseness could indicate a blockage of air flowing to the lungs, fluid collecting around the lungs, or the spread of a tumor throughout the lungs . Another potential sign is frequent or persistent respiratory infections .

Symptoms of metastatic cancer occur in 30 to 40 percent of patients living with lung cancer . Signs of metastatic lung cancer include loss of appetite, feeling full without reason or unexplained weight loss . Depending on where the cancer has spread, other signs may include vision problems, weakness on one side of the body or even seizures .

Diagnosing Lung Cancer

Assessing a patient for risk of lung cancer begins with a series of questions about symptoms, medical and surgical history, nicotine and tobacco use, work history, and other lifestyle factors such as overall health and medications . Tests may include a series of diagnostic procedures depending upon the symptoms exhibited . These may begin with an X-ray, CT or PET scan . A biopsy is subsequently performed either by bronchoscopy, needle biopsy, endoscopic ultrasound, thoracentesis, thoracotomy or mediastinoscopy .

Treating Lung Cancer with Chemotherapy

Chemotherapy uses anti-cancer drugs that are typically given as a combination of drugs delivered by mouth or intravenously as a series over a period of weeks or months . It may be prescribed alone or in combination with other therapies and procedures .

LUNG CANCER OVERVIEW(continued from page 3)

Once a cancer diagnosis has been established, staging determines the extent of the tumor’s growth and/or spread . The Cancer Care Center uses a team approach to determine the best treatment recommendations and works to coordinate care from diagnosis through recovery and follow-up . Advances in research and access to clinical studies both within the Bronson Healthcare System and nationally give patients a range of options and treatment plans based on their individual needs .

Lung Cancer Staging and Typical Treatments

The following are typical treatment guidelines from the American Cancer Society:• Small cell carcinoma is usually advanced at presentation and is more responsive to

chemotherapy . • Non-small cell carcinoma may be treated with a combination of therapies even if

they are at an advanced stage .

Typical non-small cell carcinoma treatments:

Stage 0: The tumor is limited to the lining of airways and is typically treated by surgery alone for patients who are appropriate candidates .

Stage I: A localized cancer typically treated by surgery alone .

Stage II: The cancer has spread to nearby lymph nodes . Usually treated by surgery plus chemotherapy .

Stage III: Known as localized advanced disease, the cancer is found in the lymph nodes in the center of the chest . Treatment usually includes chemotherapy plus radiotherapy .

Stage IV: The cancer has spread to other organs and is typically treated with chemotherapy alone .

5


Chemotherapy may be used before surgery to reduce the size of the tumor and make it easier to remove . It is often used after surgery to kill any remaining cancer cells . It may be prescribed alone or in combination with radiation therapy . Chemotherapy may also be used to relieve the pain and symptoms of advanced cancers .

For people with non-small cell lung tumors that can be surgically removed, evidence suggests that chemotherapy after surgery, known as adjuvant chemotherapy, may help prevent the cancer from returning . This is particularly true for patients with stage II and III . Questions remain about whether adjuvant chemotherapy applies to other patients and how much they benefit .

For people with stage III lung cancer that cannot be removed surgically, doctors typically recommend chemotherapy in combination with definitive (high-dose) radiation treatments . In stage IV lung cancer, chemotherapy is typically the main treatment . In stage IV patients, radiation is used only for palliation of symptoms .

The chemotherapy treatment plan for lung cancer often consists of a combination of drugs . Among the drugs most commonly used are cisplatin (Platinol) or carboplatin (Paraplatin), plus docetaxel (Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol), vinorelbine (Navelbine) or pemetrexed (Alimta) .

There are times when these treatments may not work . Or, after these drugs work for a while, the lung cancer may return . In such cases, doctors often prescribe a second course of drug treatment, referred to as second-line chemotherapy .

Recently, the concept of maintenance chemotherapy has been tested in clinical trials . This may include switching to another drug before the cancer progresses or continuing one of the drugs used initially for a longer period of time . Both of these strategies have shown advantages in selected patients .

Targeted Treatments

Unlike chemotherapy drugs, which cannot tell the difference between normal cells and cancer cells, targeted therapies, also known as precision medicines, are designed specifically to attack cancer cells by attaching to or blocking targets that appear on the surfaces of those cells . People who have advanced lung cancer with certain molecular biomarkers may be treated with a targeted drug alone or in combination with chemotherapy . These treatments include:

Erlotinib (Tarceva), Afatinib (Gilotrif), Gefitinib (Iressa) Shown to benefit some people with non-small cell lung cancer by blocking a specific kind of receptor on the cell surface—the epidermal growth factor receptor (EGFR) .

Bevacizumab (Avastin) Blocks vascular endothelial growth factor (VEGF) from stimulating the growth of new blood vessels in cancer cells . When combined with chemotherapy, it has been shown to improve survival rates for patients with certain types of non-small cell lung cancer such as adenocarcinoma and large cell carcinoma .

Crizotinib (Xalkori), Ceritinib (Zykadia) Has shown to benefit people with advanced non–small cell lung cancer who have the ALK gene mutation . l

Recently, the concept

of maintenance

chemotherapy has been

tested in clinical trials.

Recent trends in oncology research continue to progress at an unprecedented rate . In the last year alone, the U .S . Food and Drug Administration (FDA) approved 31 new therapies

for more than 16 types of cancer . Among the most exciting of these are advances in immunotherapy and precision medicines . These new treatments are occurring across all cancers, but include important applications in lung cancer treatment as well .

Immunotherapy uses a patient’s immune system to fight cancer . Often this means the use of drugs to boost the patient’s natural cancer-fighting abilities but may include non-drug solutions as well . In the past year, immunotherapy research has advanced on three fronts . New, novel drugs were approved . Additionally, indications for existing medications were expanded to include new tumor types . This essentially means applying therapies in new ways, with new combinations of treatments, or at varying stages of treatment . Finally, scientists are using new technology to modify a patient’s immune system genetically .

Genetic modification is an exciting new frontier for lung cancer research and immunotherapy . The first among these is called CAR T-Cell therapy . With this approach, doctors harvest a patient’s T cells—the white blood cells essential to immune function—and insert an artificial gene into the T cells to boost their capabilities to better fight cancer . The improved T cells are then multiplied in the lab and infused back into the patient . At present, this is used to fight leukemia and lymphomas, but other applications continue to be studied .

Cancer research is also making progress in precision medicine . This method uses individualized information about a patient’s genes, proteins and environment to treat his or her cancer .

Extending this concept further, last year we saw the first approval of a new drug based on the genetic makeup of cancer cells . This is vastly different from traditional approaches that treat cancer by its location within the body . To

understand how this differs, consider how antibiotics are used to treat infections . Whether an infection attacks the bladder, liver or throat, the particular strain of infection may be the same, such as streptococcal bacteria (the cause of strep throat) . Similarly, we are beginning to look at the genetic makeup of cancerous cells and how their mutations occur . This way, we can then address their mechanism for mutation, no matter where it occurs within the body .

The first FDA approved drug of this kind is called Pembrolizumab, (also known by its trade name Keytruda®) . It was approved for any tumor that has specific genetic changes known as mismatch repair (MMR) or high microsatellite instability (MSI-H) . Essentially, this has a predisposition to a particular mutation within the gene . While this mutation is not necessarily common, this approach marks a turning point in the medical treatment of cancer . As we better understand the DNA of both healthy and cancerous cells within the body, our ability to regulate their function more precisely will only increase, and this field of cancer treatment will continue to expand .

Research advances specific to lung cancer treatment include new protocols for combining immunotherapy with standard chemotherapy or radiation treatments . Immunotherapy has been widely used over the last few years as a second line treatment for lung cancer . In some cases, it has been used as a first line of treatment for metastatic cancer . Recently, however, for patients who are not candidates for surgery, an immunotherapy drug called Durvalumab (or trade name Imfinzi®) has been approved for use after chemotherapy and radiation with curative intent .

Durvalumab does not work for every patient . But for the minority of patients for whom it does work, it works incredibly well . It’s a game changer . Now, in addition to providing new hope for a small percentage of patients, research is exploring why and how it works . If we can understand the mechanism of the cancer genes and how Durvalumab counters its effects, we may discover new ways to treat other cancers and perhaps even prevent cancer from forming in the first place . l

Cancer Research and Technology UpdateBy Timothy Cox, MD, FACP, Managing Physician, Bronson Oncology & Hematology Specialists


6

The Cancer Care Center is part of the Research Consortium of West Michigan—a combined effort of healthcare organizations in Michigan providing patients with access to national clinical studies right here in Battle Creek . Funded by the National Cancer Institute, our membership in the consortium gives our patients access to well over 100 national clinical trials for a variety of cancers, patient support and cancer prevention . In addition to participation in national clinical trials, local trials are also available through our association with the Western Michigan University Homer Stryker M .D . School of Medicine (WMed) . And we are also active with the Michigan Oncology Quality Consortium (MOQC) . This is a group of more than 40 oncology practices throughout Michigan that collect and share data to drive quality and improve patient outcomes .

Advancing Research Through Leadership and Collaboration

In the treatment of lung cancer, radiation therapy has many uses, both curative and for symptom control, that can be tailored to the individual patient . It may be used alone or in combinations with other forms of treatment depending upon an individual’s specific diagnosis and medical needs .

At the Cancer Care Center, every lung cancer case is discussed at our regular tumor boards, which are attended by a multi-disciplinary team

of specialists . This approach ensures that each patient has a comprehensive and thorough assessment, and is provided with an optimal treatment recommendation .

For patients with early-stage lung cancer, a treatment called Stereotactic Body Radiation Therapy (SBRT) delivers a very high dose of radiation in a precise, targeted manner . This procedure is beneficial for patients who are not candidates for surgery . Patients with poor pulmonary function, for example, or those who have other medical conditions that make surgery dangerous, would be ideal candidates for SBRT . Appropriately selected patients treated with SBRT have cure rates that are equal to patients who have surgery .

Patients who have more advanced lung cancer can also be treated with conventional radiation, often with the addition of chemotherapy . This is typically a six-week course of radiation treatment .

Radiation may also be coupled with surgery . This is done for select patients when multiple lymph nodes are found or if the surgeon is not able to remove all cancer . In these instances, radiation can be used post-operatively to try and eradicate any residual cancer that’s left behind .

For patients with incurable lung cancer, radiation therapy is effective in improving quality of life through pain control and symptom relief . For example, a patient whose disease has spread to the brain may be experiencing seizures, slurred speech or weakness in a limb . These symptoms can be reduced and possibly eliminated with radiation .

At the Cancer Care Center, we have state of the art equipment so we can provide three-dimensional treatments and when indicated, Intensity Modulated Radiation Therapy (IMRT) . These use sophisticated computers to design and deliver the radiation . With these advances in computer-assisted medicine, we can provide a more powerful, accurate design and delivery of radiation . This means more precise targeting with minimal adverse effects to adjacent organs that don’t require treatment .

Treating Lung Cancer with Radiation TherapyBy Randy Mudge, MD, Bronson Oncology & Hematology Specialists,Medical Director of the Cancer Center and Director of Subspecialty Practices

7


(continued on page 8)

In the treatment of

lung cancer, radiation

therapy has many uses

both curative and for

symptom control that

can be tailored to the

individual patient.

At the Cancer Care Center, every lung cancer case is discussed at

our regular tumor boards, which are attended by a multi-disciplinary

team of specialists.

8


National organizations like

the Commission on Cancer

ensure that accredited

hospitals meet the highest

quality, safety and

care standards.

As a comprehensive cancer center, patients also have access to social workers, research studies, dietary and nutrition assistance, financial counseling, palliative care and survivorship support . We can offer patients not only the medical treatments but all of the support services they need throughout their treatment for cancer .

Accreditation

National organizations like the Commission on Cancer (CoC) ensure that accredited hospitals meet the highest quality, safety and care standards . Our participation in their programs is more than a stamp of approval—although our accreditation does signify that we’ve achieved a level of excellence that sets us apart from unaccredited centers . Accreditation encourages continuous improvement across a wide range of services, from research and technology advances to patient care, our building and facilities, and even how we communicate with one another and our patients . In short, the standards set by accrediting organizations help us provide cutting-edge care at every level of our institution .

The ASTRO APEx®

The Cancer Care Center has been nationally recognized for its radiation oncology services with a four-year Accreditation Program for Excellence (APEx®) from ASTRO, the largest radiation oncology society in the world . This endorsement focuses on five pillars of patient care: process of care, radiation oncology team, safety, quality management and patient-centered care . Bronson Battle Creek is one of just two APEx®-accredited cancer centers in the state of Michigan . And at the time of accreditation, it was one of only 24 such centers in the nation, including MD Anderson and Johns Hopkins .

CoC AccreditationThe Cancer Care Center has been once again granted a three-year accreditation by the Commission on Cancer . The Center received six out of six commendations from the CoC, the highest commendation achievable . The hospital has been accredited by the CoC since 1995 and has received several outstanding achievement awards .

NAPBC AccreditationFor the second term in a row, Bronson Battle Creek has been recognized for the high level of care it provides to breast cancer patients . The American College of Surgeons National Accreditation Program for Breast Centers (NAPBC) approved a three-year accreditation citing the hospital’s use of the latest technology and scientific evidence in treating patients . The College of Surgeons also recognized Bronson Battle Creek Cancer Care Center for its quality and patient outcomes . l

TREATING LUNG CANCER WITH RADIATION THERAPY(continued from page 7)

Cancer survivors will tell you that the journey from diagnosis through the completion of their active treatment is a whirlwind experience . It is emotionally charged, often confusing and always worrisome—if not downright frightening . It is filled with teams of medical professionals whose sole focus is caring for their health .

When treatment ends, the activity slows and the waiting begins . There are now more than 15 million cancer survivors in this country, and

many say this phase of cancer can be among the most difficult .

At the Cancer Care Center, we recognize the emotional toll of living with, through and beyond cancer—and we’re here to help . In addition to our assistance coordinating emotional, spiritual, medical and financial support services throughout treatment, we also work to help patients plan their “new normal” when treatment ends .

Among the most common questions we hear is, “Why must I wait so long after treatment for new diagnostic tests?” and, “When do I know if the cancer is gone?”

This period is torturous for patients, but it takes time for the body to heal from the procedures it’s undergone . Sometimes, it can take months for the inflammation to subside enough to ensure accuracy in testing . We work to help schedule those tests and coordinate that care .

One of the tools we use in our survivor support process is the Survivorship Care Plan . This comprehensive report contains two essential elements . The first is a treatment summary, which details every aspect of a patient’s cancer care, from the first diagnostic tests to the final treatment administered . It’s an important, concise report that helps patients return to their primary care doctor with a complete picture of their cancer experience .

For those who may not have a primary care doctor, we strive to refer them to a local provider who will meet their particular healthcare needs . We believe that it’s essential for patients to have a medical professional to monitor their health on an ongoing basis .

The second part of this plan is important, too . It addresses the future . It provides a follow-up plan and describes what surveillance will look like—what tests survivors will need and how often they’ll need to repeat them . Every patient is different with unique and individualized needs . This is another reason why having a primary care doctor is so important .

As a nationally accredited breast center, the Commission on Cancer requires providing a plan like this for at least half of our breast cancer patients . We’re proud to say that we develop a Survivorship Care Plan for every cancer patient that requests one . That means 100% of patients who choose to engage with our free survivorship program receive a report . But our support doesn’t end there . Our team remains available to each survivor whenever they have questions—no matter how long after treatment those questions arise . l

The Cancer Patient’sSurvivorship Care PlanBy Timothy Sparling, DNP, RN, AGPCNP-BC, ACHPN, Bronson Oncology & Hematology Specialists

9


For those who may

not have a primary

care doctor, we strive

to refer them to a

local provider who will

meet their particular

healthcare needs. We

believe that it’s essential

for patients to have a

medical professional to

monitor their health on

an ongoing basis.


10

The best way to combat

lung cancer is to eliminate

it through prevention.

However, when that’s not

possible, early diagnosis

gives patients their best

chance for a cure.

Advances in the treatment of lung cancer have increased life expectancies for survivors, but it remains a deadly disease . The best way to combat it is to eliminate it through prevention . However, when that’s not possible, early diagnosis gives patients their best chance for a cure . Screening is recommended for high-risk patients even before symptoms arise .

Lung cancer screening uses a special low-dose CT scan, which can be ordered by a primary care doctor . If there is a suspicion of lung cancer, the radiologist who performs the test will contact a pulmonologist or a thoracic surgeon to discuss treatment options or refer the patient to a specialized lung nodule clinic . They may recommend further testing .

For high-risk patients, screening at the Cancer Care Center is available and approved for coverage by Medicare and Medicaid Services (CMS) .

Patients are considered high-risk when they meet the following criteria:

• Age 55-77 years

• Asymptomatic (no signs and symptoms of lung cancer)

• Current smoker or one who has quit smoking within the last 15 years

• Tobacco smoking history of at least 30 pack years (number of cigarettes smoked per day multiplied by the number of years smoked)

Patients may also qualify for screening under this program if they are 50 years old with a greater than 20 pack per year history of smoking and a history of exposure to radon or asbestos or have a family history of lung cancer or COPD .

Depending upon the results of the screening, typical next steps may include:

• If lung nodules are found, patients are referred to the Bronson Lung Nodule Clinic, where expert pulmonologists are available to help diagnose, monitor and treat lung nodules .

• If no lung nodules are found, annual lung cancer screening is recommended .

• Discussion about cigarette smoking and smoking cessation options . l

Lung Cancer ScreeningBy Nadine Potempa, MD, Bronson Critical Care & Pulmonary Medicine Specialists

11


At Bronson, nearly

90 percent of our lung

resections are performed

with minimally invasive

surgical techniques.

When lung cancer is diagnosed early, surgical removal of the tumor provides excellent results . When the disease is caught while still contained within

the lungs—considered localized—the five-year survival rate is 50 to 90 percent, depending upon the stage .

It’s important to note that surgery may be one part of a comprehensive treatment plan, depending upon the stage of diagnosis, whether the cancer has spread to other organs and the overall health of the patient . It may be used in combination with other treatments such as radiation and/or chemotherapy . At the Bronson Battle Creek Cancer Care Center, every lung cancer case is discussed at our regular tumor boards, which are made up of a team of professionals from a wide range of specialties .

When surgery is recommended, one of three procedures is typically used to excise the tumor . The surgical standard of care is a lobectomy, which removes a functional unit of the lung . In some cases, it may be necessary to perform a sub-lobar resection, which removes a pie-shaped wedge containing the cancer and a healthy margin of tumor around, it but does not remove the entire lobe . Our cardiothoracic surgeons are also accomplished at performing complex procedures for large, central tumors, such as a pneumonectomy or sleeve lobectomy .

Whether the surgery is performed through an open approach or through minimally invasive video-assisted thoracoscopic surgery (VATS) is another critical factor . VATS may reduce the length of hospitalization required and can help patients return to normal activities sooner .

The National Society of Cardiovascular and Thoracic Surgeons has established a goal for 60 percent of all lung cancer operations to be performed minimally invasively as a way to drive improved outcomes . At Bronson, nearly 90 percent of our lung resections are done this way . This compares to a national average of approximately 30 percent .

It’s also important to note that lung cancer surgery is not limited to patients based on their age . Although that may be one consideration, an individual’s overall health is more relevant . In the U .S ., the median age of lung cancer diagnosis is 70, according to the American Cancer Society . At Bronson, we frequently perform surgery on highly-select lung cancer patients well into their 80s .

Nationally, Bronson is ranked in the 95th percentile of all institutions for the number of lung resections performed, and those volumes continue to increase every year . This is important as high surgical volumes correlate with better outcomes . There are several reasons why this number continues to rise for us . We’re performing more complex surgeries on more high-risk patients . At the same time, as a result of our lung screening program, we are diagnosing patients at an earlier stage .

These are some of the reasons why our lung surgery outcomes rank among the very top hospitals in the state according to data from The Michigan Society of Thoracic and Cardiovascular Surgeons and its MTSTCVS Quality Collaborative . l

Treating Lung Cancer with SurgeryBy Nathan Molberg, DO, Bronson Cardiothoracic Surgery Specialists


12

We’re constantly asking,

“What non-treatment-

specific interventions

can we provide to

improve outcomes?”

In 2018, our cancer committee, comprised of oncology and specialty care physicians, as well as hospital staff members involved in the care of cancer patients, conducted

two studies to determine if we are evaluating and treating our patients according to evidence-based national treatment guidelines . The Cancer Care Center uses the National Comprehensive Cancer Network (NCCN) guidelines . These standards help everyone involved in cancer care (physicians, nurses, pharmacists, insurance companies, patients and their families) make decisions to improve patient care and outcomes . Scientific in nature, these studies are evidence-based and follow strict protocols . The following are examples of this research and their results:

Study# 1:

Led by Nidhi R . Mishra, MD, Bronson Oncology & Hematology Specialists, we studied the records of cancer patients treated with rectal cancer stage III neoadjuvant (before surgery) and adjuvant (after surgery) radiation therapy at the Cancer Care Center from February 2016 through August 2017 . The results of this project showed that all patients received the appropriate treatment for their stage III rectal cancer according to NCCN guidelines, which means our patients received the best cancer care available .

Study #2:

This project studied treatment administered to Cancer Care Center endometrial cancer patients through a review of their records during the period of January 2016 through October 2017 . Led by Dr . Mudge, it showed that all patients received the appropriate treatment based on NCCN guidelines, again, demonstrating that our patients received the best cancer care available .

Measuring and Improving Quality

Each year, the Cancer Care Center is required to conduct studies that measure the quality of care we provide to our patients and implement improvements based on those findings .

During 2018, we considered the NCCN standard for palliative care and studied Cancer Care Center patients diagnosed with stage IV non-small cell lung cancer . We wanted to know if they were receiving a referral for a palliative care consultation within three months from the time of their diagnosis . We learned that we did not have an adequate process in place to make sure every patient was receiving this important contact . We have since put measures in place to correct this oversight . Now, a nurse reviews each new oncology consultation that occurs . Patients with this diagnosis are flagged for a palliative care referral . To make sure that happens, our scheduling staff makes the appointment . We believe this change will provide a better patient experience .

Clinical Research Trials Involving Non-Oncologic Treatment

In addition to our participation in clinical trials around treatments, procedures and other oncology interventions, the Cancer Care Center seeks to improve all aspects of every patient’s care through a holistic approach . We’re constantly asking, “What non-treatment-specific interventions can we provide to improve outcomes?”

We’re proud to now offer access to two such trials currently underway at the Cancer Care Center—an exceptional opportunity for an institution of our size . These are made possible through our relationship with the Western

Monitoring Compliance andContinuous ImprovementBy Heather West, MSN, RN, Bronson Battle Creek – Patient Safety & Quality Manager,Cancer Quality Improvement Coordinator

As a comprehensive community cancer program, the Cancer Care Center regularly provides evidenced-based prevention and screening programs to the public . These are a response to our community needs assessment . A highlight of events during 2018 include:

• Fecal immunochemical test (FIT) kits distributed for screening of colon cancer at the Calhoun County Fair & the “Get Your Colon Rollin’” race

• Prostate cancer screening at the Cancer Care Center

• Skin cancer prevention—sunscreen and educational literature distributed at the Calhoun County Fair

• Carol Selden, RD, and Bronson Battle Creek Food Services Chef presented on “Poor Nutrition and Relationship to Cancer Prevention”

Spring Fling

In addition to informational sessions, the Cancer Care Center hosted its 10th Annual Spring Fling this year along with our community partners, the Calhoun County Cancer Control Coalition and the American Cancer Society . Each year this event raises awareness and funding to support our shared efforts in the fight against cancer . l

Prevention, Screening and Community Outreach Programs

13


Michigan University Homer Stryker M .D . School of Medicine (WMed), which is monitoring patient protection and privacy throughout these trials . Both are currently open to select patients .

Trial #1:

A randomized trial to determine if earlier social work intervention, with a standardized approach, decreases a cancer patient’s anxiety and distress levels as measured by using the NCCN screening tool for measuring distress .

This trial is open to all newly diagnosed cancer patients receiving treatment at the Cancer Care Center . Each patient receives a resource booklet for use throughout the study . The trial was opened in September 2016, and we’ve enrolled 100 patients as of this publication .

Trial #2:

To determine if daily use with incentive spirometry during thoracic radiation treatment helps patients maintain a baseline lung function, and whether it affects lung function and also it the use of an incentive spirometry during radiation treatment may impact a patient’s quality of life .

This trial began in August 2017 and is open to all patients who have a cancer diagnosis requiring thoracic radiation treatment at the Cancer Care Center . We’ve enrolled 24 participants as of this publication .


14

The following graphs compare data from Bronson Battle Creek Cancer Care Center with data from the National Cancer Data Base (NCDB) . Given our sample size, our statistics compare favorably with what other cancer centers are reporting .

Comparison of Lung Cancer Statistics

Distance Traveled2015

70

60

50

40

30

20

10

0 <5 Miles 5-9 Miles 10-24 Miles 25-49 Miles 50-99 Miles >100 Miles Unknown

Perc

ent

of C

ases

Ethnicity of Non-Small Cell Lung Cancer Diagnosed2010–2014

100

90

80

70

60

50

40

30

20

10

0 White Black Hispanic Asian Other

Perc

ent

of C

ases

Age of Non-Small Cell Lung Cancer Diagnosed2011–2015

35

30

25

20

15

10

5

0 0-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

Perc

ent

of C

ases

Gender of Non-Small Cell Lung Cancer Diagnosed2011–2015

55

50

45

40

35

30

25

20

15

10

5

0 Male Female

Perc

ent

of C

ases

Bronson Battle Creek

National Average

15


Stage of Non-Small Cell Lung Cancer at Diagnosis2011–2015

45

40

35

30

25

20

15

10

5

0 0 I II III IV Unknown

Perc

ent

of C

ases

Age of Colon Cancer Diagnosed2010–2014

25

20

15

10

5

0 RC N S R C AS SRC O SC SR

Perc

ent

of C

ases

RC – Radiation & Chemotherapy

N – No 1st Course

S – Surgery

R – Radiation

C – Chemotherapy

AS – Active Surveillance

SRC – Surgery, Radiation & Chemotherapy

O – Other Specified Therapy

SC – Surgery & Chemotherapy

SR – Surgery & Radiation

Bronson Battle Creek, Battle Creek, MI: C3PR Lung

The estimated performance rates shown below provide your cancer program with an estimate of the proportion of patients concordant with measured criteria by diagnosis year . If appropriate, the CoC Standard and benchmark compliance rate is provided . This application provides cancer programs the opportunity to examine data to determine if performance rates are representative of the care provided at the institution and to review and modify case information using the review function for the measure of interest .

Select Measures Measure CoC Std / % 2012 2013 2014 2015

Systemic chemotherapy administeredwithin 4 months to date preoperatively or dateof surgery to 6 months postoperatively, or it is LCT 4 .5 / 85% 0 .00 100 .00 100 .00 100 .00recommended for surgically resected cases withpathologic lymph node-positive (pN1) and (pN2)NSCLC (Quality Improvement)

Surgery is not the first course of treatment forcN2, M0 lung cases (Quality Improvement)

LNoSurg 4 .5 / 85% 100 .00 85 .70 80 .00 100 .00

Battle Creekbronsonhealth.com/cancer

Bronson Battle Creek Cancer Care Center provides individualized patient treatment plans to support the body, mind and spirit of its patients . Conveniently located next to Bronson Battle Creek Hospital, the Center specializes in a broad range of cancer services . They include diagnostics, genetics assessment, hematology, medical oncology and chemotherapy, pathology, radiation oncology and technology, and surgical oncology . Conferences for breast, thoracic and all other tumor sites regularly bring expert physicians together to review and discuss treatment options for individual patients . The Center is a member of the Cancer Research Consortium of West Michigan—a combined effort of health care organizations in Michigan providing patients access to national clinical studies while remaining in their communities .

About the Cancer Care Center

Documents

BRONSON BATTLE CREEK CANCER CARE CENTER · 2018. 11. 27. · lung cancer than from colon and rectal, breast and prostate cancers combined . For the past 25 years, lung cancer has