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KAISER PERMANENTE

ANNUAL CANCER REPORT 2016

MEDICAL CENTER

THE PERMANENTE MEDICAL GROUP

COMMISSION ON CANCER COMMITTEE

DECEMBER 2016

SOUTH SAN FRANCISCO

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OUR MISSION IS SIMPLE: Support our specialists in providing the best in

personalized cancer care. Kaiser Permanente’s integrated health care system

brings together a team of specialized physicians and cutting-edge technology

to provide each patient with the best in personalized cancer care.

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OUR COMMITMENT to Patients

Cancer care touches our lives both professionally and personally. It is a top

priority at Kaiser Permanente. All of our physicians work on cancer in one way or

another—whether to prevent it, detect it early, treat it when we find it, care for the

survivors, or comfort those who may pass away as a result of the disease. We’ve

made huge strides and continue to challenge ourselves through our commitment

to every patient.

OUR WORLD-CLASS Cancer Care Team Includes:

• Experienced specialists who treat

high volumes of patients

• Support at every step of care: risk

reduction, screening, diagnosis,

treatment, and survivorship

• Seamless and timely care

coordination

• Cutting-edge technology

• Patient-centered care

Our specialists work collaboratively to ensure world-class cancer care treatment

and outcomes for every patient, by leveraging our expertise, investing in cutting-

edge technology, and pushing the boundaries of what’s possible.

Cancer Care Achievements

Integrated Approach to Cancer Care……..5

Commission on Cancer Accreditation …...7

Kaiser Permanente’s Cancer Research

Paves the Way for Improved Outcomes…..9

Trends in Cancer Diagnosis……………..10

Appendix…………………………………..12

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Cancer Care Achievements

Cancer care is complex. We simplify screening, diagnosing, and treating patients with cancer

through our integrated approach to care.

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INTEGRATED Approach to Cancer Care

As one of the largest integrated health care systems in the United States, we can quickly adapt to advances

in treatment. We bring those benefits to our patients every day to perform thousands of treatments each year. At the

same time, we create truly transformational innovations. Both rapidly adapting and developing new advancements

is only possible by leveraging our specialists’ knowledge from many disciplines and medical centers linked together

by our electronic health record system.

We continuously weave advancements in equipment

and techniques with each patient’s medical history,

preferences, and unique needs. This means we

can automatically review incidental findings, such

as a thoracic imaging study that can be reviewed

by various experts. This process facilitates rapid

and consistent follow-up on unexpected cancer

discoveries at imaging.

Our expert care team will work together to:

• Review newly flagged cases

• Meet with each patient to discuss next steps,

treatment options, and personalized care

recommendations

It is the same as getting a second, third, and fourth

opinion at the start of the process.

Our integrative approach to care also allows us to

apply the most effective screening protocols to save

more lives, such as using universal reflex genetic

testing for Lynch Syndrome of all newly diagnosed

colorectal cancer patients.

Our multispecialty physician team will:

• Recommend multiple ways to provide patient-

centered care

• Bring cutting-edge treatment to patients

This multidisciplinary approach is distinctive of our

medical group and doesn’t exist in the fragmented

fee-for-service health care sector. We’re able to

standardize the best possible care, giving our patients

their best chance to beat cancer.

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CANCER CARE represents a large portion of our work at Kaiser Permanente. Only heart

disease affects more people than cancer in the United States, and the number of cancer cases

is quickly growing to surpass heart disease soon. We have an opportunity that other health care

systems may not—to change that trajectory. The Commission on Cancer provides a foundation

to focus on key quality care standards and our cancer program can lead this change.

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COMMISSION on Cancer Accreditation

There are more than 1,500 Commission on Cancer (CoC) accredited cancer

programs in the United States, representing only 30 percent of all hospitals

and treating more than 70 percent of all cancer patients. All Kaiser Permanente

facilities are accredited or pursuing accreditation. To earn this prestigious

accreditation, a cancer program must meet or exceed 34 quality care standards,

be evaluated every 3 years, and maintain levels of excellence in the delivery of

comprehensive patient-centered care.

When cancer patients seek care at

a CoC-accredited cancer center,

they gain access to comprehensive,

state-of-the-art cancer care close

to home. Kaiser Permanente takes

this one step further. Our integrated

health care system allows for true

multidisciplinary, end-to-end care,

and treats cancer as a complex group

of diseases treated by a team of

specialists. Because of this approach,

patients have access to clinical trials,

new treatments, genetic counseling,

and patient-centered services,

including psychosocial support,

patient navigation, and a survivorship

care plan. We improve our patients’

quality of life—both before and after

cancer. These integrated partnerships

result in improved patient care.

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Clinical Trials Matter to Us

We’re proud to offer cancer patients access to cutting-edge treatment through

participation in clinical trials.

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Kaiser Permanente’s Cancer Research

Paves the Way for Improved Outcomes

We’re recognized for participating in numerous clinical trials with national and international research

organizations. All of our medical and radiation oncologists are investigators on our cancer research

team. There are more than 70 clinical trials available to patients at any given time. Because of this,

we offer patients access to cutting-edge treatment options and research in symptom management,

screening, and prevention.

In 2014, Kaiser Permanente was awarded

a 5-year grant of 10.4 million dollars from

the National Cancer Institute (NCI) to

conduct cancer clinical trials and cancer

care delivery research studies. We joined

4 other Kaiser Permanente Regions to

form an NCI Community Oncology

Research Program (NCORP). This new

program represents 1 of every 40 patients

in the United States and continues to bring

cutting-edge treatment options to our

patients while comparing existing cancer

treatments on a patient-by-patient basis.

The new funding will allow Kaiser Permanente

to expand its focus on research into care

delivery by:

• Evaluating alternative treatment delivery

systems

• Examining disease prevention

• Exploring pain and symptom management

• Investigating disparities in cancer outcomes

and how to eliminate them

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TRENDS in Cancer Diagnosis

The cancer registry is an essential component of the Commission on Cancer (CoC) accredited cancer

program and an invaluable tool in the fight against cancer. Like all CoC-accredited facilities, Kaiser

Permanente maintains a cancer registry and contributes data to the National Cancer Database (NCDB).

This nationwide oncology outcomes database is the largest clinical disease registry in the world. All

types of cancer are tracked and analyzed through the NCDB and used to explore trends in cancer

care. CoC-accredited cancer centers, in turn, have access to information derived from this type of data

analysis, which is used to create national, regional, and state benchmark reports.

Our cancer registry data aids in identifying trends, assists in program planning, and allows our

continuous evaluation of cancer care.

Specialists at this hospital interface with patients throughout our system. Our specialists’ experience

within the system is summarized in Table 1.

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Table 1. Kaiser Permanente, Northern California RegionAll Cancer Cases Diagnosed 2011–15: All Behaviors, All Stages

Leading Diagnoses by Year of Diagnosis (Ranked for 2015 Diagnoses)

SOURCE: Kaiser Permanente—Northern California Cancer Registry (08/22/2016)

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2016 Clinical Goal

Any clinical goal involves the diagnosis, treatment, services,

and care of our cancer patients.

For 2016, we focused on using a newly created staging tool in

our electronic medical record system. This tool allows for

accurate communication amongst the entire care team,

reporting the cancer stage for a given patient in a single

location. It also allows providers to stage a cancer based on

national guidelines (AJCC). The staging tool information can

then be brought into provider notes and treatment

summaries, thus improving care delivery, minimizing

information gaps, and fostering information and knowledge

exchange.

Cancer staging is the fundamental basis for all treatment

recommendations as well as providing overall prognosis for

cancer patients. As such, we identified it as a priority for

2016. Our goal is to increase utilization of the staging tool to

80% for new diagnoses of breast, colorectal, lung, and gastric

cancers in 2016.

2016 Programmatic Goal

Any programmatic goal is directed toward the scope,

coordination, practices and processes of cancer care.

Many of our patients have inquired about holistic options for

their cancer journey, including imagery and meditation. Based

on this feedback, we decided to create the Mind/Body Self

Care Skills Group to provide holistic and social support to

patients coping with cancer.

The group is made up of 8 weekly sessions. Topics covered

weekly include breathing techniques to manage stress,

movement exercises, and journaling.

The course is taught by Dr. Aruna Chinnakotla, MD, who is

board-certified in Integrative and Holistic Medicine. She is

also an Advanced Mind-Body Medicine Practioner.

The series was offered three times during 2016. Based on

overwhelmingly positive patient feedback, we plan to

continue offering the series once a quarter in 2017.

Program GOALS

Each calendar year, the local cancer committee establishes, implements, and monitors one clinical and one programmatic goal for work related to cancer care.

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When Patients ASK, We LISTEN

As part of the accreditation work, we conducted a community needs assessment to better understand our patients’ needs and challenges as they go through their cancer journey. We surveyed our cancer patients in spring 2016.

Many patients said assistance with making appointments and having a knowledgeable person to answer questions about their treatment plan would be an area of opportunity. In response, we brought an Oncology Nurse Navigator onboard. The Navigator will serve two primary functions: assist cancer patients with coordinating their appointments, and

be the point of contact for any questions about their treatment plan or symptom management.

Having resources on diet and nutrition, side effects of treatment, and alternative medicine were other ideas put forth by our patients. To address these needs, we created a comprehensive cancer resources guidebook that includes information on all departments, online resources, and educational activities related to cancer at our medical center. Our Mind/Body Self Care Skills Group is another resource developed to provide alternative medicine for our patients.

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In the COMMUNITYIn spring 2016, Kaiser Permanente South San Francisco Medical Center made a significant achievement in cancer care, becoming a designated center of excellence for gastric cancer, one of just two in Northern California.

The local cancer committee recognized the need of a specialized referral center for gastric cancer. This is possible at South San Francisco due in large part to the hard work and expertise of surgeons Dr. Robert Li, MD, and Dr. Swee Teh, MD, both of whom are leaders in the field of laparoscopic surgery for gastric cancer.

Gastric cancer is a relatively rare cancer; in Kaiser Permanente’s entire Northern California region last year there were roughly 60 cases. For this reason, many surgeons may see just one or two cases a year. Yet between them ,Dr. Li and Dr. Teh performed 22 gastric cancer surgeries between April and September 2016, the first six months of operating as a designated gastric cancer center.

The higher volume is beneficial to patients, who prefer when possible to choose a surgeon who has a great deal of experience with a particular procedure. We know from multiple studies that surgeons who perform a particular type of surgery more frequently and in higher volumes have better patient outcomes. This makes sense -- with repetition comes increased expertise, a higher comfort level, and a more practiced routine.

Gastric cancer is more common in Asian and Hispanic populations, which makes up a significant percentage of Kaiser Permanente’s diverse Bay Area patient

population. For this reason, we see more cases of gastric cancer than would betypical in other population groups.

Dr Li and Dr. Teh are both recognized as proponents of the latest minimally invasive laparoscopic surgical techniques, which result in smaller incisions and reduced hospital stays and recovery times. Patients can return to their normal routine activities much more quickly than after open large-incision surgery.

Kaiser Permanente’s integrated health care system enables our physicians to treat patients using a multidisciplinary approach that draws upon the expertise and collaboration of multiple specialists to coordinate and deliver comprehensive care. We coordinate regionally so that patients who come to South San Francisco for gastric surgery can receive other services, including pre- and post-op care and chemotherapy, if needed, closer to home.

Patients also benefit from the use of secure messaging, video visits, electronic health records, and the Kaiser Permanente app to make their care as comprehensive and convenient as possible.

Creating such a designated center of gastric cancer expertise fits within Kaiser Permanente’s overall mission to provide our members with the latest advances in cancer diagnosis and treatment in the context of a patient-centered care experience.

ABOVE and BEYOND: ROBERT LI, MD & SWEE TEH, MD

Kaiser Permanente’s South San Francisco Medical Center is lucky to have two of the finest gastric cancer surgeons in the Bay Area.

Together they spearheaded Kaiser Permanente South San Francisco Medical Center’s designation as the Kaiser Permanente Northern California regional referral center for gastric surgeries.

ABOVE and BEYOND: ROBERT LI, MDGastric Cancer and Bariatric Surgeon

Dr. Robert Li, MD, developed an interest in the newly emerging field of laparoscopic surgery while completing his residency in general surgery at Stanford University Medical Center. Excited by the possibilities of these advanced surgical techniques, he decided to further his training with an additional year of postgraduate training as a Fellow in laparoscopic surgery at the University of California at San Francisco.

Since joining Kaiser Permanente as a general and advanced laparoscopic/bariatric surgeon in 2004, Dr. Li has been instrumental in leading Kaiser Permanente South San Francisco Medical Center to the forefront of gastric cancer surgery. “I chose my career path because I enjoy helping people in a very direct way. The immediacy of surgical intervention can save someone’s life, whether the procedure is a simple appendectomy, a complex gastric bypass for obesity, or a life-altering cancer surgery,” says Dr. Li. “I have a particular interest in gastric cancer and specialize in the laparoscopic techniques for surgery for gastric cancer.”

Dr. Li continues to pursue his interest in the field, always staying on top of the latest developments and technologies and bringing that expertise to his patients. Dr. Li is also chief of the bariatric surgery department, which has been certified as a Bariatric Surgery Center of Excellence by the American Society of Metabolic and Bariatric Surgery and the American College of Surgery since 2012.

“To me, surgery is a very tangible field, both in its practice and in its results. I find it extremely challenging both intellectually and physically, and I never feel as if I am not making a difference when I come to work. I am very thankful for the opportunity to treat patients in such a rewarding and satisfying field of medicine.”

Outside the operating room, Dr. Li is active in research, serving as the local research chair for Kaiser Permanente South San Francisco and reviewing research grant proposals as a member of the Central Research Committee at the Kaiser Permanente Northern California Division of Research.

ABOVE and BEYOND: SWEE TEH, MDGeneral and Oncology Surgeon

Dr. Swee Teh, MD, is a leading proponent of the techniques and benefits of minimally invasive surgery for gastric cancer and other cancers of the digestive tract. He first became interested in surgical oncology while completing his general surgery residency at the Mayo Clinic in Rochester, Minnesota. “While there, I trained under many great mentors, sparking my interest in cancer surgery,” says Dr. Teh. “In addition, I spent two additional years in tumor angiogenesis research.”

“Traditionally, most cancer surgeries have been performed through a large open incision,” says Dr. Teh. “It’s only recently that the technique of minimally invasive or smaller incision surgery with the assistance of cameras and instruments has been used in large organ chest and abdominal procedures.”

Prior to that, Dr. Teh, who is originally from Malaysia, had spent three years training at hospitals in Dublin, Ireland, after completing his medical degree there. He followed that with a two-year fellowship in advanced laparoscopic gastrointestinal and hepatobilliarysurgery at the Oregon Health Sciences University in Portland.

Dr. Teh then spent four years developing a gastrointestinal oncology program in private practice in Oregon before joining Kaiser Permanente in July 2011. He specializes in many types of gastrointestinal cancer, including esophagus, stomach, liver, bile duct-gallbladder, and pancreas. ”Many of the procedures I offer are unique in this field –specifically laparoscopic pancreatic resection, esophagectomy, gastrectomy and radiofrequency liver ablation,” says Dr. Teh.

Dr. Teh believes that smaller incision surgery has numerous benefits for the patient, including shorter hospital stays and recovery times and the ability to more quickly return to routine activities. “Although not all cancer procedures can be accomplished through small incisions, I strongly believe each patient should be assessed for this potential approach.”

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COMMISSION on Cancer Committee Members

The membership of our local cancer committee is multidisciplinary, representing physicians from diagnostic and treatment specialties and non-physicians from administrative and supportive services.

Our many thanks to these committee members for their leadership and support. Many other physicians and administrative leaders have contributed as well, and we appreciate their time and energy.

Cancer Committee ChairAmy Gillis, MD

Cancer Liaison PhysicianEdmond Schmulbach, MD

Cancer Program Administrator Rose Carino, RN

Diagnostic RadiologistVishal Sidhar, MD

PathologistSarah Cherney, MD

Medical Oncologist William Huang, MD

Radiation OncologistsDas Mohan, MDMilan Patel, MD

SurgeonsFawzi Khayat, MDRobert Li, MDSwee Teh, MD

Palliative CareAruna Chinnakotla, MD

Oncology NursesRose Marie Borja, RN, BSN,OCNHelen Archer-Duste, RN, MS

Psychosocial Services CoordinatorWendy Martino, RN, BSN, MS

Quality ManagementDorothy Totah, RN, BSN, MPA, CPHRM, CPPS

Certified Tumor RegistrarMichael Oehrli, MPA, CTR

Physical TherapistPatty Casey, PT

Social WorkerNancy Lee-Enriquez, RN, BSN

Project ManagerJacqueline Jaszka, MBA

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Some photos may include models and not actual patients.© 2016, TPMG, Inc. All rights reserved. Regional Health Education. 05736 (Revised 9/16)