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KAISER PERMANENTE

ANNUAL CANCER REPORT 2018

MEDICAL CENTER

THE PERMANENTE MEDICAL GROUP

CANCER COMMITTEEDECEMBER 2018

SANTA ROSA

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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

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)

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

*NOTE: Brain/Other Nervous Category includes Benign/Borderline tumors

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Program GOALSIn 2018, our Cancer Committee established two program goals for improving patient care.

Results from the most recent Community Needs Assessment revealed that tobacco use and lung cancer continue to be prevalent in our community. We have focused this year on educational efforts on lung cancerscreening programs to allow earlier treatment and reduced mortality. In partnership with the Regional Lung Cancer Screening program, we looked to increase our patient participation.

Clinical Goal: Increase the number of patients completing the Lung Cancer Screening class in the eligible patient population by 20% from 26 patients in the baseline period (Sep 2017 – Feb 2018) to the next six month period (Mar 2018 – Aug 2018).

End of Year ResultsFrom Mar 1 – Aug 31, a total of 37 patients completed the Lung Cancer Screening class in the eligible patient population. This represents a 42% increase in patients completing the class from the baseline period (Sep 2017 –Feb 2018).

At the request of our Cancer Patient Advisory Council, we expanded our survivorship classes to include classes targeted to the survivorship population.

Programmatic Goal: Implement a minimum of two new Survivorship classes targeted to our cancer patient survivorship population.

End of Year Results

The first Surviving Cancer: Life After Treatment class was held on Sept 19. Due to the success of the first class, a second class was held on December 5. The first Integrative Medicine class will be held in Q1 2019.

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In the COMMUNITY.This year, in addition to our regular cancer prevention program, Kaiser Permanente Santa Rosa sought to address the

prevalence of lung cancer in our service area membership, and Sonoma County as a whole.

Lung Cancer prevention was the primary focus of our outreach efforts. We created an interactive and hands on tobacco

use prevention kit and display that highlighted the dangerous ingredients in cigarettes, including e-cigarettes. We also

taught community members about the financial costs of regular tobacco use by having them guess the amount of dollars

in a jar that represented the annual costs of smoking one pack of cigarettes per year.

Throughout the year, our Santa Rosa Medical Center clinicians and staff provided tobacco use prevention education at

diverse community events to 1,216 adults and children, including the Human Race, Graton Casino Employee Health Fair,

Summer Health Career Institute for High School Students, and the North Bay Discovery Day. In addition, the Health

Education Department provided tobacco cessation classes to 43 participants and individual appointments to 345

members in 2018. As a medical center, we documented 1,134 quits YTD through September 2018.

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When Patients ASK, We LISTEN

Our Cancer Patient Advisory Council (CPAC), formed in early 2017, continues to capture the voice of the patient.

The CPAC was formed in conjunction with our clinical team. Its mission is to provide excellent care that combines

evidence-based medicine with the art of healing, to serve patients with utmost commitment, respect, and

compassion, and nurture their hope, trust, and dignity.

The council, which meets on campus once a month, is comprised of a diverse group of Kaiser Permanente cancer

patients who are either undergoing or have completed treatment. In 2018, the CPAC continued to focus on

survivorship programs and patient access to post-treatment resources. This included implementation of two new

Survivorship classes: 1. Life After Treatment and 2. Integrative Medicine.

At the advice of the Council, additional work is currently under way to improve the patient care experience in the

waiting rooms, exam rooms, and other areas of the Oncology Suite. Specifically, the spaces will be reorganized,

patient care materials will be standardized in the exam rooms, and artwork will be installed in late 2018/early 2019.

ABOVE and BEYOND: Irwin Lee, MDDr. Irwin Lee had just taken his written boards and was talking to his then 5-year-old

daughter about his day. “How was the test?” she asked. “I think I probably passed,” he

said. Her reply? “Probably everyone thinks they passed.” It was and is still one of his

proudest moments as a parent, knowing she had already learned the value of healthy

skepticism. As a member of the Cancer Care Team at Kaiser Santa Rosa, his goal is to

help patients achieve the best outcomes possible.

Throughout his training at Harvard, both as an undergraduate in Chemistry and Physics

and while completing an MD/PhD in biophysics, he honed his ability to think critically

about both scientific and clinical studies. In his last year of medical school, he chose to

become a radiation oncologist, in part because of exciting technical advances in the field

but mainly as a result of observing multidisciplinary tumor boards during his clinical

rotations. He enjoyed seeing how a team of specialists could work together to determine

the most appropriate plan for a given patient and was impressed that the field of radiation

oncology is a rigorous, data-driven specialty.

For the past 3 years, he has served as both the Cancer Liaison Physician and the Quality

Improvement Coordinator for the Cancer Committee. Now that Kaiser Permanente Santa

Rosa has successfully achieved Cancer Center Accreditation from the Commission on

Cancer, he looks forward to having more robust data on outcomes in Santa Rosa to guide

our never-ending effort to provide outstanding care for our patients.

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CANCER Committee MembersSanta Rosa Medical Center’s Cancer Committee is chaired by Patricia May, MD, with Radiation Oncologist Irwin Lee, MD, serving as Cancer Liaison Physician, and Assistant Medical Group Administrator Courtney Galbraith as Program Administrator.

Northern California Cancer Registry Quality Coordinator Michael Oehrli, a certified tumor registrar, provides ongoing consultation.

Teresa Miller serves as the Project Manager and Performance Improvement Consultant.

Our multidisciplinary Cancer Committee meets regularly throughout the year. Represented departments include: Surgery, Oncology, Radiology, Pathology, Palliative Care, Psychosocial Services, Clinical Research, Community Outreach & Health Promotion, Program Administration, and Performance Improvement.

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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)