Annual Report 2012CENTER FOR

CANCER & BLOOD DISORDERS

Our Mission is to continue the healing ministry of the Catholic Church in the Spirit of St. Marguerite d’Youville by providing preventive, curative, restorative, and supportive services with compassion and respect for everyone. We commit to these values as guides to our decisions and behavior: RESPECT, EXCELLENCE, COMPASSION AND STEWARDSHIP.

Our Mission

St. Mary’s Center for Cancer & Blood Disorders is led by specially trained oncologist/hematologist physicians and surgeons.

We offer:

INFUSION CENTER

CANCER RESEARCH AND CLINICAL TRIALS

PATIENT NAVIGATOR

BREAST HEALTH AND CHEST ONCOLOGY PROGRAMS

AMERICAN CANCER SOCIETY PATIENT RESOURCE CENTER AND LIBRARY

SUPPORTIVE SERVICES

KAREN CLARK, MSN, RN VP Physician Network/VP Patient Care Services

Administrative Representative

MAHESH PANDEY, MDMedical Director/Oncology - Committee Chair and Liaison

YELENA PATISORNIK, MDHematology/Oncology - Cancer Conference Quality Coordinator

GREGORY EMMONS, MDHematology/Oncology - Cancer Registry Quality Coordinator

EVELYN TAYLOR, BSN, RN, OCNOncology Program Manager - Quality Coordinator

MARSHA O’ROURKE, MDGeneral Surgeon - Medical Director Breast Health

JAMES PLACE, MDMedical Director/Radiology

OLA MELHUS, MDMedical Director/Pathology

LISA MORIN, BSSafety/Risk Management - Quality Management Professional

MAURA CLARK, LCSW-OSW-COncology Social Worker - Psychosocial Services Coordinator

JENNIFER HAZEN, BSN, RN, OCNHamotology/Oncology Nurse Navigator

LORI DYER, RN, OCNHematology/Oncology Clinical Trials Nurse

Clinical Research Coordinator

ELIZABETH KEENE, MA, FTVP Mission Integration - Palliative Care Team Representative

JEFFERY BROWN, MDInternal Medicine - Palliative Care Representative

CAROLYN BAUER, RPHPharmacy/Representative

JENNIFER RADELCommunity Relations Manager

Community Outreach Coordinator

DIANA CHAMPEON, RD, LDNutrition Services/Representative

REBECCA HARRINGTON, PTPhysical Therapy/Representative

VICKI OWENS, RN, CCMNursing Case Management/Representative

TERRY BAKERAmerican Cancer Society/Representative

LORI WILBUR-DUNHAM, CTRCancer Registrar

Cancer Committee Members

COMMITTEE GUESTSSusan Keiler, COO, SMRMC; Cindy Brousseau, Director of Diagnostic Services; Maryann Lecompte-Mason, Education Manager; Maria Ikossi, MD, Thoracic Surgeon; Roger Austin, MD, Hospice House Director; Karen Flynn, RN, AHHA; Sue Rodgrigue, NP, Psychiatry; Russ Donahue, Marketing Director; Umesh Sarma, MD, Radiology; Doreen Rancourt, Laboratory Manager; and Dorothy Guild, RN, OCN, Breast Health Clinical Coordinator/Navigator.

Chairman’s ReportIntroduction to St. Marys

St. Mary’s Regional Medical Center is a 233 bed acute care hospital that offers a full range of inpatient and outpatient services to the growing and changing needs of the Central Maine Community. St. Mary’s Center for Cancer and Blood Disorders provides comprehensive care to patients with can-cers and hematologic disorders.

In May, the Center was surveyed by the CoC and awarded a 3 year accreditation with commendation by The Commission on Cancer (CoC). The CoC is an organization that provides accreditation to hospitals and is dedicated to monitoring the quality of care provided by hospitals. This is done by estab-lishing standards for care, prevention, research, and educa-tion. St. Mary’s was honored to be recognized for its out-standing quality of care and patient centered focus.

In accordance with the CoC, new programs were put into place relating to psychosocial distress screening, navigation services, and development of survivorship care plans.

Navigation services proved very useful in coordinating care between different specialties and in strengthening the sup-port provided to the multidisciplinary plan of treatment for patients.

As we move forward to the year 2013, we are excited with the new standards and guidelines that are being established by the CoC, which will allow us to reflect on and enhance the quality of our cancer care and enhance the quality of life for our patients and our community.

Dr. Mahesh PandeyMedical DirectorCenter for Cancer and Blood Disorders

At the Center for Cancer and Blood Disorders, 8 out of 9 nurses continue to maintain their Oncology Certification. Only one newly hired nurse will need to take the exam in 2013. All of the nurses are chemo-therapy and biotherapy certified by the Oncology Nursing Society.

Oncology Nurse Certification

St. Mary’s Center for Cancer and Blood Disorders is committed to maintaining the best possible quality of life for patients and families. Palliative Care is an approach that honors the dignity of the person while maintaining quality of life in the midst of serious illness. In 2012, St. Mary’s offered community education about advance care planning and advance care directives to help ensure patients’ voices and choices are heard, even if they cannot speak for themselves. St. Mary’s also collaborated with local home health and hospice care agencies that offer palliative care programs to provide pain and symptom management expertise and emotional/spiritual support.

The team at St. Mary’s Center for Cancer and Blood Dis-orders want to make sure our patients have access to the newest and most innovative cancer treatment op-tions. To accomplish this, we participate in various can-cer research trials and studies. Our providers and clini-cians work together to find the best studies and trials for each patient to positively impact their treatment and long-term survivorship. In 2012, we came up with a three-pronged approach to clinical trials to best serve our patients. Part One: The clinical trials nurse brings information concerning specific trials to providers for group discus-sion. The group accesses trials to decide which would best suit each patient.Part Two: The clinical trials nurse researches the stage and diagnosis of new patients and presents the patient-specific trial options to the provider to go over with the patient during their initial visit.Part Three: The clinical trials nurse follows patients who are sent to another hospital for second opinion for ac-crual to clinical trials. In 2012, we had 14 patients who have been referred to another facility and started on a trial.

All staff in the Oncology and Breast Health departments participated in a one hour service excellence training to help improve the patient experience at St. Mary’s.

Service Excellence Training

ELIZABETH KEENE, VP MISSION INTEGRATION

RELIEF THROUGH PALLIATIVE CARELORI DYER, RN, OCN

CLINICAL TRIALS

Quality of Life &Newest Treatments

As medical oncologists, hematologists, nurses, and support staff, our goal is to provide optimal care to our patients in the most efficient and effective means available based on current literature and best practice guide-lines. As a result of our continued dedication to our patients and their families, a significant amount of time is invested in determining areas for improvement each year. By focusing on these areas, we enhance patient care, shorten infusion chair times and decrease side effects of treatments. 2012 saw many new and exciting changes and will set the standard for future care here at St. Mary’s Center for Cancer and Blood Disorders.

At St. Mary’s, we take great pride in knowing that our nurses have each achieved the highest level of training available to hematologic and oncologic nurses. Each nurse exceeds hospital and national requirements for continued education and maintains a nursing oncology certification. In 2012, we transi-tioned Jennifer Hazen, RN, into the role of oncology nurse navigator. Oncology navigators ensure that patients are aware of their diagnosis, treatment plans, imaging dates and sites, as well as other appointments. They also provide edu-cation to patients and family members, clarify questions that may arise, and provide support during times of need. Jen is excited for this opportunity and will also help determine our patient’s needs in the community setting and work on a survivorship plan for our patients. The survivorship plan outlines follow up visits and imaging and laboratory testing recommendations while providing opportunities for patients to reestablish themselves with their community.

In addition to the quality improvements provided by nursing navigation, St. Mary’s recently participated in a breast health survey by the National Accreditation Program for Breast Centers (NAPBC) and was granted full accredi-tation (see http://www.napbc-breast.org). NAPBC sets high standards to en-sure quality care is being provided to patients with breast cancer and is guided by the American College of Surgeons. We are proud to state that St. Mary’s has

become only the fourth cancer center with this accreditation in the state of Maine!

St. Mary’s also began the rigorous task of becoming Quality Oncology Practice Initiative (QOPI) certified (visit their website http://qopi.asco.org). Obtaining a QOPI certification suggests that a practice is current with standard practices, patient-centered, and strives for excellence in the treatment of patients. St. Mary’s set a goal of obtaining full certification within a year and will begin to participate in this ex- citing program in January 2013. Currently, only three other prac-tices are QOPI certified in the state of Maine. By participating in QOPI and maintaining a NAPBC accreditation, St. Mary’s Center

for Cancer and Blood Disorders will be one of only two hospitals or private practices in the state of Maine striving to reach such high markers

BREAST HEALTH NURSE CERTIFICATION

The Nurse Navigator for the Breast Health Program, Dorothy Guild, earned her Certified Breast Patient Navigator in Imaging and Cancer (CBPN-IC) credentials in 2012 from the National Consortium of Breast Centers (NCBC). This certification program validates Dorothy’s knowl-edge and skills in navigating a breast patient through their breast care/ cancer continuum of care. Through this process some fund-ing was given to the Radiology de-partment to obtain their American College of Radiology accreditation allowing for more stringent quality controls and a greater sense of pride for our Radiology team.

Reflections andFuture DirectionsGREGORY S. EMMONS, DOONCOLOGIST

Let’s face it; you’ve never heard a woman say she was excited to get her mammogram. Well, that may change with the introduction of Mammo Parties at St. Mary’s Regional Medical Center in 2012! A Mammo Party is a private event to lessen the anxiety about breast cancer screen-ings and have fun. Here’s how it works. The host is encouraged to invite 5-6 of her friends to the Women’s Imaging Center during “after hours.” There, they are treat-ed to hors d’oeuvres, drinks, breast health education, and a little pampering. The party is in a relaxed atmosphere that creates a more pleasant mammogram experience. Screening mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease. It can greatly reduce the number of deaths from breast cancer among women ages 40 to 70.

• During a presentation about skin cancer we offered a sun damage screening. We offered the same screening at about a half-dozen events in the community. This always

attracts a big crowd to our display booth providing the opportunity to disseminate educational materials, as well as promote our navigators, hematologists/oncologists, oncology social worker, and support services. • Maine Breast and Cervi-cal Health Program (MBCHP) paid for many women to have free mammograms and pap smears.• St. Mary’s Center for Family Urology offered pros-tate cancer screening during

an open house. Six screenings were performed. • St. Mary’s Center for Cancer and Blood Disorders sponsored three cancer prevention educational seminars for the community. The events attracted an average of 25 attendees. Topics included lung, prostate, and breast cancers, which are among the top 5 cancers in the state of Maine. • Members of our Breast Health Program and our Women’s Imaging Department provided education to staff at Bates College about the importance of monthly breast self-exams and Mammography.

Prevention & ScreeningsJENNIFER RADEL COMMUNITY RELATIONS MANAGER/COMMUNITY OUTREACH COORDINATOR

NEW IN 2012 -- MAMMO PARTIES! COMMUNITY OUTREACH

Navigating PatientsThrough the Health Care MazeJENNIFER HAZEN, BSN, RN, OCNPATIENT NAVIGATOR

A cancer diagnosis is often a frighten-ing and overwhelming experience. At St. Mary’s, a patient navigator will be there to offer support and guidance through this difficult time. St. Mary’s implemented its navigation program in March of 2012 with the addition of Patient Navigator, Jennifer Hazen. As a navigator, Jennifer is the single point of contact at the hospital who guides patients from diagnosis, through treatment and into survivorship. She collaborates with other providers and services to help patients navigate through the oftentimes complicated health care system.

In 2012, our navigation program focused largely on lung cancer patients. The Center for Cancer and Blood Disorders at St. Mary’s saw a 19% in-crease in the incidence of lung cancer from 2011 to 2012. We saw a 34% increase in lung cancer patients staying with St. Mary’s for at least their first treatment during this time period.

The role of a navigator includes: coordination of care/appointments and services such as setting up transportation and/or helping patients to find resources in the community; and often assist patients with insurance issues and filling out disability/FMLA paperwork. The navigator also pro-vides education for patients and their families. Most importantly, patients feel that they are only a phone call away from somebody that can offer them with support. We also set a goal to provide patients with treatment summaries and survivorship care plans. We implemented protocols so each lung cancer patients received these documents after the completion of their first line of treatment.

The Oncology Supervisor and the Breast Health Navigator went to the annual National Consortium of Breast Centers (NCBC) conference in March, 2012. A great amount of information was taken back to the oncology and breast health teams on standards of care for breast health patients.

Continuing Education

of quality oncology/hematology.

Final improvements that occurred in 2012 include: continued improve-ments to our treatment guidelines, development and distribution of treatment summaries, expanded multidisciplinary case conferences, relocating the Breast Health Pro-gram to the Center and the begin-nings of some cosmetic updates to the Center.

It is with great pride that I work at St. Mary’s Center for Cancer and Blood Disorders. I am impressed with our staff, our associations with neighboring facilities, and our commitment to quality care for our patients. St. Mary’s is on the move! With contin-ued reflections for improvement, adaptation to patient requests and needs, and attainment of high quality certifications as mentioned above, St. Mary’s Center for Cancer and Blood Disorders is well one its way to become a leading blood and cancer center in Maine. We welcome your consultations, second opinions and visits to our facilities. Come see what makes St. Mary’s unique!

In our ongoing effort to enhance the patient experience, multiple patient surveys were done at St. Mary’s Center for Cancer and Blood Disorders in 2012. These surveys identified patients’ greatest concerns which included fatigue, pain, chemotherapy side effects, and symptom management. We chose to address issues regarding fatigue and pain first. In doing so, it was revealed that nurses were not meeting patient expectations in ad-dressing these concerns and often needed more educa-tion. Therefore, new measures were implemented, which increased patient satisfaction and brought new patient education material to the center. These measures also changed the way nursing staff assessed pain and side effects experienced by patients when dealing with a cancer diagnosis.

To continue addressing patient satisfaction, we imple-mented a new patient satisfaction survey that began in October, 2012. NCR Picker, a company well known for its extensive research in patient experience, coordinates the survey. The survey results will help us identify areas where we are succeeding and where there is room for improvement.

Our community has a large Somali population, of which many members’ first language is not English. This poses issues when patients who face cultural and language barriers need to access the healthcare system. An infu-sion nurse at the center has been working on cultural competency to address these barriers. This is an ongoing project and has proven to be very beneficial.

The nurse collaborates with our interpreters and other healthcare organizations throughout the region to access patient education materials and teaching tools. We currently have a variety of education materials that come in several languages, including videos for patients to watch if they cannot read. The nurse will continue to engage in research and looks forward to doing some community outreach with local and regional healthcare facilities to address cultural concerns and seek out ways to break down barriers. This will better equip the staff at St. Mary’s Center for Cancer and Blood Disorders to overcome the challenges of treating patients who are from multicultural backgrounds and dealing with a cancer diagnosis.

Two Quality Initiatives Addressed in 2012EVELYN TAYLOR, BSN, RN, OCN

PATIENT SURVEYS BREAKING DOWN BARRIERS

*Class of Case 00 not included/required by CoC (n=179)

*Class of Case 00 not included/required by CoC (n=179)

*Class of Case 00 not included/required by CoC (n=179)

The Tumor Registry Department at St. Mary’s Regional Medical Center (SMRMC) collects information on patients who were diagnosed and/or received their first course of treatment at SMRMC. Since its start prior to 1978, the Tumor Registry has compiled information on over 10,000 cancer cases.

Cancer Registries play a vital role in improving the means of detection, prevention and treatment of cancer. Our primary role is the collection of data, both demogra-phic and clinical, beginning at diagnosis and continuing throughout the cancer patient’s lifetime. The collected data is an invaluable tool in the fight against cancer. Among its many uses are: ~ Treatment planning at cancer conferences ~ Evaluation of the effectiveness of current treatment modalities ~ Submission of data to state and national databases for comparison ~ Calculation and comparison of survival and quality of life ~ Development of staff, patient and public educational programs

The Cancer Program at St. Mary’s Regional Medical Center is approved by the American College of Surgeons. On our most recent survey, our cancer center received Accom-modation with 3 Year Commendation. The Registry staff is an integral part of the cancer program and consists of two staff members, one being the Cancer Registrar who is cer-tified by the National Cancer Registrar’s Association. The Registrar attends local, regional and national educational offerings to remain informed about the latest advances in cancer care and the requirements of the American Col-lege of Surgeons Commission on Cancer.

Participation and collaboration with the Maine Cancer Consortium, Maine Health Oncology Quality Commit-tee and the Maine Health Registry Network (2012) helps provide valuable quality initiatives, comparison data and community needs on both local and state levels. The Registry strives to provide the highest quality data-base. We endeavor to achieve this through uniformity of data collection, annual physician case reviews, software edit checks, and accurate and timely follow-up informa-tion on our patients. Our ultimate goal is to contribute to the prevention and cure of cancer.

The Tumor Registry at St. Mary’sLORI A. WILBUR-DUNHAM, CTR