Cancer Services Report 2010

2009-2010 Annual ReportThe First Western North Carolina Hospital to Win the Outstanding Achievement Award from the Commission on Cancer

Taking Cancer Care to Heart

Park Ridge Healths oncology program has been recognized by the American College of Surgeons Commission on Cancer as offering the very best in cancer care. Our oncology

program was also awarded the Outstanding Achievement Award, becoming the fi rst hospital in Western North Carolina to receive this honor.

Providing the best in cancer carein an atmosphere of Christian

compassion and healing

12009-2010 Annual Report

Park Ridge Cancer Committee Chairman

At Park Ridge Health, we have worked hard to ensure that we exceed our patients expectations to provide the very best health care. As part of the Commission on Cancers Accreditation Program, we follow all the current standards of cancer care.

Our goal and vision is to deliver oncology care to meet the needs of our community as part of Christs healing ministry and to incorporate Christian values at every level. In order to achieve this, we offer many screening and wellness programs to promote early detection. Our participation in national quality initiatives guarantees our patients are provided the same, proven treatment options offered throughout the country at major medical centers. Our patients receive high-quality treatment and care without leaving the comfort of their hometown and family support.

Mikhail Vinogradov, M.D., OncologistChairman, Park Ridge Health Cancer Committee

Park Ridge Health Cancer Services

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OncologyHighly-trained, experienced, compassionate nurses with advanced certifi cation in oncology nursing offer oncology care in a comfortable, relaxed setting with all the amenities of home. We have snacks, plush recliners, television, movies, ample reading materials and a gorgeous view of the mountain scenery.

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

We provide cost-effective, outpatient services that can be covered by Medicare and other insurances benefi ting the patient. We are hospital-based and operated, giving patients the peace of mind that we maintain strict standards under the hospitals quality program.

Oncology PharmacyPharmaceutical care is an important part of Park Ridge Cancer Services. Our staff includes a Pharm. D. (Doctor of Pharmacy) and CPhT (Certifi ed Pharmacy Technician), who are solely dedicated to providing chemotherapy and other intravenous medications to our patients. All medications are mixed in an on-site biologic safety cabinet (vertical fl ow hood) to maintain sterility, prevent contamination, and protect staff during the process of compounding medications for intravenous administration. The pharmacy staff, nurses, and physicians work as a team to ensure that each patient receives the most appropriate and effective medication regimen for their particular cancer. Before beginning therapy, a nurse and pharmacist meet with each patient to provide education on the medications that are prescribed in their treatment; since chemotherapy often comes with diffi cult side effects. This allows the patient to ask questions about their regimen and is just another example of the personal touch that we provide at Park Ridge Cancer and Infusion Center.


Breast Health CenterThe Park Ridge Breast Health Center is proud to report the following:This year has been an exciting one of change and service enhancements for the Breast Health Center. We are proud to maintain our compassionate, highly-trained staff, and multi-disciplinary team approach for cancer patients. The Breast Health Center was re-accredited by the American College of Surgeons in June 2010. The Breast Health Center then joined the Park Ridge Health Cancer and Infusion Center for the convenience of our patients.

In 2009, the Park Ridge Breast Health Center was the fi rst in Western North Carolina to attain accreditation by the National Accreditation for Breast Centers (NAPBC). The Breast Health Center is also a certifi ed participant in the National Quality Initiative through the National Consortium of Breast Centers. Park Ridge Breast Health Center Medical Director, Mikhail Vinogradov, M.D., helped us welcome Michelle LeBlanc, M.D., in July. Specializing in breast disorders and breast surgery, Dr. LeBlanc is a skilled and caring physician who is an avid advocate for womens health.

The Breast Health Center has three registered nurses who function as Breast Patient Navigators. The Navigators work closely with the Park Ridge Radiology Department and call women with their mammogram results within 24-hours of their screening. These nurses are Oncology Certifi ed. For any abnormal results, the Navigators help guide each woman through the process of obtaining additional testing, answer questions, and to help with comfort and assurance during what can be a diffi cult time.

The Breast Health Center also offers the following services: Treatment and diagnosis of breast disorders (lumps/masses) Cancer and benign breast processes Digital mammography Ultrasound Radiation treatment Clinical trials Chemotherapy Hormonal therapy

Cancer Support Services: American Cancer Society Patient Resource Room Free wigs, prostheses, scarves and hats for patients Reach to Recovery referrals Look Good, Feel Better classes Cancer Library Computer station for cancer website access for patients and their families Breast Cancer Survivors & Friends Support Group

24-Hour Mammogram Results: Every patient receiving screening mammography

at Park Ridge Health will receive a phone call about their test from a breast health nurse within 24-hours of the day of their visit.

NAP BCNATIONAL ACCREDITATION PROGRAM

FOR BREAST CENTERS 3

Quality Improvement Summary 2010Nursing staff continuously monitor pain assessment and interventions for inpatients on the Oncology Unit. For the year 2009, pain assessment compliance was recorded at 87 percent. Documentation of patient education and response to pain medication was recorded at 97 percent, which was noted to be signifi cantly improved from 2008 data. There was also improvement in implementing alternative pain relief interventions.

Using data from January through December 2009, a comprehensive review of charts showed the following results related to the patients implantable ports: a. 96 percent of the time the ports were assessed per policy. b. 91 percent had dressing changes performed per protocol.c. 93 percent had blood cultures drawn from ports when indicated.

The patient population for monitoring of these quality indicators has been expanded for 2010. The Oncology Supervisor has oriented two registered nurses to perform data retrieval, collection and analysis. The nurses will also continue to monitor pain assessment, implantable ports and to inform staff of outcomes at regularly-scheduled staff meetings.

Quality Outcome Study


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5Pastoral Care

We live in a time when health and happiness should go hand in hand. Never has it been more important to understand the physical and spiritual laws of health than today when stress, mental illness, heart disease, AIDS, and cancer are ravaging our society. The Pastoral Care Department seeks to fi nd ways to share in extending the healing ministry of God to our cancer patients during their greatest hours of need. For our cancer patients, a diagnosis might bring on a sense of hopelessness, anxiety and fear of the

unknown. Visitation, refl ective readings and soothing music are some of the tools available. The power dwelling in Gods Spirit has brought comfort and strength to many at Park Ridge Health. As chaplains, we have dedicated ourselves to share in the journey, no matter how long or how far it takes us.

Relay For Life TeamThis year Park Ridge participated in the Fletcher Relay for Life. The team had 16 members, eight of whom stayed the entire night. Our team was joined by many family members and friends who came out in support of the event.

A chair massage offered by Dave and Salina Freeman was a huge success as an on-site fundraiser. Debbie Gentry was named a Grand Club Member! She raised a total of $1,326 in memory of her brother Paul.

The team exceeded the goal of $5,000, raising a total of $6,195. The grand total raised for the Fletcher Relay for Life was $72, 249.

Chaplain Art Slagle, Pastoral Care



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Components and ActivitiesCase Management and Discharge PlanningCase management and discharge planning services are available to all oncology patients and their families. Park Ridge Health case managers are licensed, trained professionals with specialized training and experience assessing patient and family needs. Case managers meet with patients and/or their family members privately to discuss needs, and to provide information regarding community resources, fi nancial counseling and educational materials. They act as patient advocates by working closely with all members of the health care team to facilitate optimal outcomes. Their goal is to address and resolve each patients concerns. All information shared with the case manager is confi dential.

Hospice CareFour Seasons Hospice and Palliative Care is a non-profi t organization working in cooperation with Park Ridge Health. Four Seasons is deeply committed to serving the community through fulfi lling its mission of affi rming life and providing holistic care in harmony with the goals of individuals with serious life-limiting conditions; while offering support to their families and loved ones.

Laboratory/PathologyThe renovation and expansion of the Laboratory and Pathology departments was recently completed. The technology has been streamlined and updated to allow our physicians to receive results faster. This allows the physicians to communicate with their patients more quickly and effi ciently. The laboratory and pathology teams work diligently to make sure that accurate results are given as quickly as possible to the physicians.

Nursing StaffPark Ridge Health is committed to caring compassionately for oncology patients. Our oncology staff includes 11 registered nurses who have demonstrated a desire to go beyond traditional nursing, by completing specialized training to administer chemotherapy and care for oncology patients. Six of these nurses have completed additional training and certifi cation and have received the designation of Oncology Certifi ed Nurse (OCN). One of our nurses earned certifi cation as a Certifi ed Breast Care Nurse (CBCN), which requires candidates to demonstrate knowledge in cancer nursing through experience and testing. Our nursing staff demonstrates a desire to treat the entire patient emotionally, spiritually, as well as physically. At Park Ridge Health,

7we aspire to give each patient a positive experience with the knowledge that those in charge of their care take an interest in them personally.

Nutritional ServicesNutritional Services is very closely linked across the continuum of cancer prevention, treatment and care. Patients, families and health care providers look to the expertise of the nutrition professional to aid in their search for answers to the puzzles that a diagnosis can bring. Nutritionists provide education and support for the many questions that arise when cancer enters a persons life.

Park Ridge Health offers a registered dietitian to anyone seeking answers before, during and after a cancer diagnosis. A trained nutrition professional sits on the Cancer Committee and provides expertise and services the committee might need. Additionally, one Breast Cancer Survivor & Friends meeting is led by a dietitian each year to directly answer questions patients and families might have. Nutritional services are also provided in the inpatient setting for patients and families under stress and strain of a cancer diagnosis.


8Park Ridge Health Cancer Services

SPOTLIGHT: Head and Neck Cancer

Thirty-eight patients with carcinomas of the head and neck were diagnosed and/or treated at Park Ridge Health between 2005 and 2009. Patients with skin cancers were excluded. Given the limited follow-up interval, this analysis will focus on the patient demographics and treatments delivered. The patients ranged in age from 39 to 87 years, with the majority in their 50s and 60s. Seventy-four percent were men. Seventy-six percent gave a history of prior or current tobacco use, which is an established risk factor for most head and neck cancers.

The most common primary site was larynx with 15 patients, followed by oropharynx (tonsil, pharynx, base of tongue and soft palate), with 11 patients, and oral cavity (oral tongue and fl oor of mouth) with fi ve patients. Less common primary sites included the hypopharynx (piriform sinus) in three patients, nasopharynx in two patients, and parotid gland in two patients. The AJCC stages were as follows: Stage 0 - three patients, Stage I - eight patients, Stage II nine patients, Stage III six patients and Stage IV 12 patients.

The patients cases were often presented at a multidisciplinary tumor conference with a review of pathology and imaging studies to facilitate a treatment plan in accordance

with NCCN (National Comprehensive Cancer Network) guidelines. Thirty-four patients were approached with curative intent with treatments detailed by site and AJCC stage in the accompanying table. Overall, 11 patients underwent surgery alone, eight received radiation alone, 10 were treated with chemotherapy and radiation and fi ve were managed with a combination of surgery, radiation and chemotherapy. Four patients were not medical candidates for or refused curative therapy, and were managed palliatively. When utilized along with radiation, chemotherapy usually consisted of weekly cisplatin; multi-drug regimens used in a limited number of patients. Cetuximab was given in four patients. Three patients received (neoadjuvant) chemotherapy prior to chemo-radiation.

As this study demonstrates, patients with Early Stage (I-II) head and neck carcinoma are usually treated with either surgery alone or radiation alone in order to limit toxicity and preserve function, while still achieving a high cure rate. Chemotherapy and radiation play prominent roles in Stage III and IV head and neck cancer. In the past, radical surgery such as laryngectomy (removal of the voice box) was usually required in Advanced Stage larynx cancer. The emphasis now is to use

W. Mark McCollough, M.D., Radiation Oncologist


initial chemotherapy to select patients with a good response for larynx preservation with chemo-radiation, in an attempt to avoid laryngectomy. Surgery continues to play a pivotal role in advanced, disease management of the neck and for salvage.

Though the majority of the patients in this study had a history of tobacco use, there is an emerging slow epidemic of oral cancer in non-smoking patients related to a common infectious agent, the human papillomavirus (HPV). Fortunately, HPV-related oral cancer has a more favorable prognosis, relative to those associated with a history of tobacco or alcohol use.

Treatment Modality by Site and Stage34 Park Ridge patients treated with curative intent

Oral CavityOropharynx

Larynx

HypopharynxNasopharynxParotid Gland

AJCC Stage 0 I II III IV

S=3 patients

S=4 patients

S+R+C=1 patientR=1 patients

R=2 patients R+C=1 patientR=5 patients

S=2 patients

R+C=2patients

S+R=C=3 patientsR+C=3 patientsR+C=2 patients

R+C=1 patient S+R+C=1 patientR+C=1 patient

R=2 patients

S - Surgery R - Radiation C - Chemotherapy

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Diagnostic Radiology

Park Ridge Health continues to provide state-of-the art, full-service diagnostic radiology services.

High-quality equipment includes: 64-slice CT scanner capable of coronary

artery CT angiography and virtual colonoscopy

MRI, including dedicated breast MRI Nuclear medicine, including bone scans,

thyroid imaging, cardiac imaging and other studies

High resolution ultrasound DEXA bone density An all-digital, fi lmless department with

digital storage and display of images PET/CT scanning for optimal staging and

re-staging of cancers Womens imaging, including digital

mammography with computer aided detection, breast ultrasound, as well as ultrasound guided and stereotactic guided breast biopsies

Women have their own private dressing area and waiting area for mammography and ultrasound. There are three Breast Health Nurse Navigators who call each patient with mammography results within 24-hours and assist patients with scheduling and procedures.

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

Ralph N. Ricco, M.D., Diagnostic Radiologist


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Park Ridge Health Rehabilitation Services Cancer Center Library Breast Cancer Survivors & Friends Support Group Consultation Education Genetic Testing and Analysis Home Oxygen and Medical Devices Infusion Therapy Look Good, Feel Better Nutrition Support Pain Management Palliative Care and Hospice Free Valet Parking Smoking Cessation Services Social Service Support Wound Care Stromal Therapy Physical Therapy Occupational Therapy Activity Therapy Lymphadema Management Music Therapy Social Services to assist in fi nancial and social

transitions associated with a cancer diagnosis


The Park Ridge Health Cancer Registry is an information database system designed for the collection, management and analysis of cancer patient data. Our cancer registry participates with the North Carolina State Central Cancer Registry and also submits cases to the American College of Surgeons National Cancer Database. This is part of a nationwide effort to compile data on the diagnosis and treatment of all types of cancer.

Park Ridge Health Cancer Registry

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Primary Site TotalBreast 29%Lung 13%Colorectal 9%Prostate 9%Skin Melanoma 5%Total Percent Top Five 65%

Primary Site Total Male FemaleOral Cavity 8 2 6Digestive 31 13 18Respiratory 36 19 17Blood & Bone Marrow 8 4 4Connective Tissue 1 1 0Skin Melanoma 12 6 6Breast 64 1 63Female Specifi c 11 0 11Male Specifi c 21 21 0Urinary 12 6 6Brain (Includes Benign) 2 1 1Thyroid 4 1 3Lymphatic 9 7 2Unknown Primary Site 4 4 4 Total 2009 223 84 139

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29.0%

13.0%

9.0%

9.0%

5.0%

14.0%

15.0%

9.0%

14.0%

4.0%

14.0%

17.0%

9.0%

15.0%

5.0%

BREAST

LUNG

COLORECTAL

PROSTATE

MELANOMA

Source: American Cancer Society "Cancer Facts & Figures 2010

5 Most Prevalent Cancer SitesPark Ridge Health Comparison of Top 5 Sites with National and State Figures

PRH USA NC

Five Most Prevalent Cancer SitesPark Ridge Health Comparison of Top Five Sites with National and State Figures

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Park Ridge Specialty ServicesPark Ridge Health is pleased to offer a variety of board-certifi ed specialists in the fi elds of:

Dermatology Breast Surgery General Surgery Oncology and Hematology Otolaryngology (Ear, Nose and Throat) Plastic and Reconstructive Surgery Psychiatry Pulmonology Urology Womens Health Wound Therapy

Several of our primary care physician offi ces are accepting new patients. For a complete listing of all physicians and services offered, please visit us at parkridgehealth.org or call 828.684.8501.

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Cancer Committee MembersMikhail Vinogradov, M.D., Medical Oncologist, ChairmanMichelle LeBlanc, M.D., Breast Center, Cancer LiaisonR. Scott Roberts, M.D., Radiation OncologistRobert Dowdeswell, M.D., Pathologist, Quality of Registry DataRalph Ricco, M.D., Diagnostic RadiologistWilliam McCollough, M.D., Radiation Oncologist, Cancer Conference CoordinatorPhilip Lartey, M.D., PsychiatristCraig Lindsey, R.N., V.P. Clinical Services, Cancer Program Administrator & Community OutreachDiane Sedgwick, B.S.P.A., M.H.S.A., Administrative Director for Outpatient ServicesTiffany Burghart, R.N., O.C.N., Inpatient OncologyRenae Johnson, R.N., Quality CoordinatorChristi Gibbs, R.N., Case ManagementMelissa Chandler, C.T.R., Cancer RegistrarSarah Gayle, M.P.H., American Cancer SocietyKimberly Kite, O.C.N., C.M.S.R.N., Nursing DirectorDebbie Gentry, B.S.N., O.C.N., C.B.C.N., Oncology & Breast Health ManagerChaplain Art Slagle, Pastoral CareTricia Scholtz, DieticianPaula Stegall, Pharm. D.

Park Ridge Health CancerProgram Leadership

ReferencesNorth Carolina Facts & FiguresCancer Facts and Figures, American Cancer SocietyNational Cancer Data Base, Hospital Comparison Benchmark Reports & Survival ReportsPark Ridge Health Cancer Registry

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

The 2009-2010 Park Ridge Health Cancer Program Annual Report was prepared by Melissa Q. Chandler, C.T.R. Questions regarding this report or requests for additional information may be directed to Melissa at 828.650.2692. This report can also be accessed via the Park Ridge Health website: parkridgehealth.org.

Documents

Cancer Services Report 2010