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KAISER PERMANENTE

ANNUAL CANCER REPORT 2018

CENTRAL VALLEYMEDICAL CENTER

THE PERMANENTE MEDICAL GROUP

CANCER COMMITTEEDECEMBER 2018

MODESTO, STOCKTON & MANTECA

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OUR MISSION IS SIMPLE: Support our specialists in providing the best inpersonalized cancer care. Kaiser Permanente’s integrated health care systembrings together a team of specialized physicians and cutting-edge technologyto provide each patient with the best in personalized cancer care.

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OUR COMMITMENT to PatientsCancer care touches our lives both professionally and personally. It is a toppriority 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 thesurvivors, or comfort those who may pass away as a result of the disease. We’vemade 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: riskreduction, screening, diagnosis, treatment, and survivorship

• Seamless and timely carecoordination

Cutting-edge technology

Patient-centered care

•

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Our specialists work collaboratively to ensure world-class cancer care treatmentand 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 AchievementsCancer care is complex. We simplify screening, diagnosing, and treating patients with cancerthrough our integrated approach to care.

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INTEGRATED Approach to Cancer CareAs one of the largest integrated health care systems in the United States, we can quickly adapt to advancesin treatment. We bring those benefits to our patients every day to perform thousands of treatments each year. At thesame time, we create truly transformational innovations. Both rapidly adapting and developing new advancementsis 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 wecan automatically review incidental findings, suchas a thoracic imaging study that can be reviewedby various experts. This process facilitates rapidand 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 carerecommendations

It is the same as getting a second, third, and fourthopinion at the start of the process.

Our integrative approach to care also allows us toapply the most effective screening protocols to savemore lives, such as using universal reflex genetictesting for Lynch Syndrome of all newly diagnosedcolorectal 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 ourmedical group and doesn’t exist in the fragmentedfee-for-service health care sector. We’re able tostandardize the best possible care, giving our patientstheir 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 AccreditationThere are more than 1,500 Commission on Cancer (CoC) accredited cancer programs in the United States, representing only 30 percent of all hospitalsand treating more than 70 percent of all cancer patients. All Kaiser PermanenteNorthern California facilities are accredited. To earn this prestigiousaccreditation, a cancer program must meet or exceed 34 quality carestandards, be evaluated every 3 years, and maintain levels of excellence in thedelivery 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 closeto home. Kaiser Permanente takesthis one step further. Our integratedhealth care system allows for truemultidisciplinary, end-to-end care,and treats cancer as a complex groupof 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 survivorshipcare plan. We improve our patients’ quality of life—both before and after cancer. These integrated partnershipsresult in improved patient care.

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Clinical Trials Matter to UsWe’re proud to offer cancer patients access to cutting-edge treatment throughparticipation in clinical trials.

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Kaiser Permanente’s Cancer ResearchPaves the Way for Improved OutcomesWe’re recognized for participating in numerous clinical trials with national and international researchorganizations. All of our medical and radiation oncologists are investigators on our cancer researchteam. 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 awardeda 5-year grant of 10.4 million dollars fromthe National Cancer Institute (NCI) toconduct cancer clinical trials and cancercare delivery research studies. We joined4 other Kaiser Permanente Regions toform an NCI Community OncologyResearch Program (NCORP). This newprogram represents 1 of every 40 patientsin the United States and continues to bringcutting-edge treatment options to ourpatients while comparing existing cancertreatments on a patient-by-patient basis.

The new funding will allow Kaiser Permanenteto expand its focus on research into caredelivery by:

• Evaluating alternative treatment deliverysystems

• Examining disease prevention

• Exploring pain and symptom management

• Investigating disparities in cancer outcomesand how to eliminate them

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TRENDS in Cancer DiagnosisThe 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 cancercare. CoC-accredited cancer centers, in turn, have access to information derived from this type of dataanalysis, 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’ experiencewithin the system is summarized in Table 1.

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Table 1. Kaiser Permanente, Northern California RegionAll Cancer* Cases Diagnosed 2013-2017: All Behaviors, All StagesLeading Diagnoses by Year of Diagnosis (Ranked for 2017 Diagnoses)*NOTE: Brain/Other Nervous Category includes Benign/Borderline tumors

SOURCE: Kaiser Permanente—Northern California Regional Cancer Registry (10/04/2018)

PRIMARY SITE OR TYPE 2013 2014 2015 2016 2017 TotalBREAST 3,885 3,746 3,937 3,873 3,926 19,367

MELANOMA 2,026 2,273 2,503 2,607 2,620 12,029PROSTATE 2,449 1,443 1,729 1,788 2,052 9,451

COLORECTAL 1,559 1,685 1,652 1,687 1,648 8,231LUNG/BRONCHUS 1,753 1,778 1,807 1,752 1,627 8,717

URINARY BLADDER 840 864 901 920 850 4,375CORPUS UTERI 650 759 742 823 816 3,790

NON-HOD. LYMPHOMA 730 862 841 889 814 4,136KIDNEY/RENAL PELVIS 606 585 716 748 732 3,387

BRAIN/OTHER NERVOUS 721 793 724 673 564 3,475ORAL CAVITY/PHARYNX 466 508 525 521 529 2,549

PANCREAS 476 505 532 529 482 2,524THYROID 396 411 479 448 455 2,189

ALL LEUKEMIA 534 535 497 545 366 2,477LIVER/INT. BILE DUCTS 368 452 436 401 336 1,993

STOMACH 247 299 294 328 299 1,467OVARY 247 303 285 263 232 1,330

MYELOMA 248 267 280 267 224 1,286ESOPHAGUS 150 164 184 168 179 845

SOFT TISSUE/HEART 161 149 150 170 169 799ANUS/ANAL CANAL 165 180 187 188 165 885

VULVA 162 169 154 161 154 800TESTIS 108 121 131 122 124 606

HODGKIN LYMPHOMA 83 116 88 115 108 510OTHER ENDOCRINE 187 169 170 157 96 779

SMALL INTESTINE 78 85 89 99 95 446CERVIX UTERI 87 93 90 107 86 463

LARYNX 81 70 93 80 84 409OTHER SKIN 83 97 118 104 83 485

OTHER BILIARY 67 73 59 79 67 345ILL-DEFINED 661 607 574 540 355 2,737ALL OTHERS 397 421 447 467 460 2,192

TOTAL 20,671 20,573 21,414 21,619 20,797 105,074

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Program GOALS

According to the American Cancer Society, the use

of tobacco is the single largest contributor to the risk

for head and neck cancer. Tobacco use includes:

chewing tobacco, cigarettes, pipes, snuff and

vaping. Secondhand smoke also increases an

individual’s risk of developing head and neck cancer.

The National Comprehensive Cancer Network®

guidelines for head and neck cancer patients

recommends that current smokers be counseled to

quit smoking, and former smokers be advised to

continue to refrain from smoking. Head and neck

cancer patients who are using tobacco products are

now being referred to our Kaiser Permanente

smoking cessation program to support them in

making this change.

“Quitting is a process — it doesn’t happen

overnight. But with the right support, patients

can make a lasting change. And as soon as they

begin to quit, the body can start getting healthier.

In fact, within 24 hours, patient’s heart rate and

blood pressure go down,” says Dr. Elizabeth Lai,

Head & Neck Surgeon at our Modesto Medical

offices. “Over time, patients may even notice

other improvements, such as better breathing,

vision, smell, and taste.” Find more information

on quitting techniques, motivation, and more in

our quit smoking center.

Elizabeth Lai, MDHead and Neck Surgery

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In the COMMUNITYOur 2016 Community Needs Assessment identified obesity as a problem in our community. The National Cancer Institute states “there is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers.” This year our cancer prevention program targeted reducing the

incidence of cancer in our communities by promoting two of our classes, Healthy Weight and Whole Food, Plant Based Eating, and evaluated changes in lifestyle practices, health beliefs and weight that resulted from completing the class(es). Participants completing the Healthy Weight I 6-week session class demonstrated the following changes:

• 53% of respondents increased their physical activity by at least 30 minutes per week and 33% increased their fruit/vegetable servings by 2 or more per day;• 67% noted they were confident in preparing healthy meals and snacks and 93% understood the link between weight and cancer risk;• the average weight loss was 4.9 pounds.

Individuals completing the hour and a half Whole Foods, Plant Based Eating class shared that, after attending the class, they were more confident in their ability to prepare healthy snacks and meals and understood the link between weight and cancer risk. Find more information on these two classes by visiting kp.org/centralvalley and contacting our Health Education Department.

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When Patients ASK, We LISTENKP Central Valley recently established a new class, “Recovery from Breast Cancer Surgery,” that supports national guidelines recommending patient support to mitigate the side-effects of breast surgery. The class, taught by our Certified Lymphedema Therapists, provides instruction on post-operativeactivities, addresses cancer-related fatigue

concerns and reviews ways patients can reduce their risk for lymphedema. To confirm that our workflows supported patients not only being referred for this class but also that they attended, our Commission on Cancer Committee sponsored a study.This study evaluated the number of patients referred to the class compared to thenumber of patients who

underwent breast cancer surgery and if those registered attended the class within 3 weeks of their surgery date. The study evaluated all breast surgery cases in the 2nd quarter of 2018. Our target was to have 80% of patients referred and 50% completing the one-and-a-half-hour class.The results of our study demonstrated that we exceeded our targets. “For the

three-month period of the audit, 71 of our patients had breast cancer surgery. Eighty-nine percent of those patients were referred to the class, and more than eighty-one percent of our patients completed the class,” shared Cathy Osnaya, RN, Breast Nurse Navigator. “These numbers demonstrate the strength of the integrated care we provide to our breast cancer patients.”

ABOVE and BEYOND:Nearly 70 years ago, Kaiser Permanente founders Henry J. Kaiser and Sidney Garfield first articulated their pledge for total health and their vision for high quality, affordable health care. In pursuit of excellence, we, the physicians and employees of Kaiser Permanente, strive to deliver that vision every day.

No one is ever prepared for their image of health & happiness to be interrupted by cancer: suddenly

thrust into a whirlwind of appointments, treatments & emotions.We are committed to offering high-quality care and hope for our patients. Our integrated model of care is represented by a team of dedicated physicians & staff from various specialties, collaborating closely to ensure streamlined & personalized support from the time of diagnosis to life after treatment.

We take great pride in our successful and well received multidisciplinary treatment teams available to meet the care needs of our members and reduce the “sleepless nights” when faced with a diagnosis of cancer.

Our accomplishments are built from the firm commitment & relentless work towards enhancing the care and services we provide to our cancer patients. We thank you for your trust & your partnership in your journey to getting well.

Megumi Tomita, MDOncologist

Assistant Physician in ChiefChair of the Cancer Committee

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Cancer CommitteeMembership

Oncology• Megumi Tomita, MD• Cynthia Lan, MD• Jasmine Ingraham, RN• April Spiller, LCSW, OSW-C.Cancer Care Services• Sharon Likely, RN, OCN• Deshawn Jackson, RHIT• Anne Hansen, RN, OCN

Adult & Family Medicine• Janet Thaung, MD• Sukhjit Samra, MD

Cancer Registry• Michael Oehrli, CTR• Iram Rana, CTR

Clinical Trials• Vanessa Sheldon, RN, OCN

Surgery• Saif Ghole, MD • Tony Chang, MD• Brenna Cole, RN

Pathology• Caishu Deng, MD• Jun Liu, MD

Palliative Care• Paul Luong, MD• Garfield Pickell, MD

Pulmonology• Theodore Fong, MD

Cancer Screening• Ester Baldwin, LCSW, PhD• Ola Olusola, RN

Radiology• Charlyne Wu, MD• Bradley Carlton

Gastroenterology• Merle Sogge, MD

Head & Neck Surgery• Elizabeth Lai, MD

Health Education & Nutrition Services• Raquel Moreno, RD

Psychiatry• Allison Faris, PsyD• Ashley Hill, PsyD

Patient Representative• Colleen Preston

Genetics• Megahn Hanely, LGC• Karin Wagner, LGC

Urology• John Weedin, MD

Rehabilitation• Beatina Agagon, PT, CLT

Pharmacy• Lindsey Bui, PharmD

Administration• Doreen Roberts, RN• Leigh Anna Rubio• Domenique Narimanfar• Melinda Hamon

American Cancer Society• Samantha Ruegsegger

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Some photos may include models and not actual patients.© 2016, TPMG, Inc. All rights reserved. Regional Health Education. 06832 (Revised 10/18)