LCC Cancer Report 2016 - Lutheran Hospital · 2016-12-21 · commendation status as a Community Hospital Comprehensive Cancer Program. Lutheran Cancer Program received its 4th consecutive

ACCREDITED PROGRAM

LUTHERAN CANCER CENTER2016 REPORT | 2015 DATA

Joint Commission accreditation and certifi cation

is recognized nationwide as a symbol of quality

that refl ects an organizations commitment to

meeting certain performance standards.

Lutheran Hospital has received

the CoC accreditation with the

outstanding achievement award

since 2007.

ACCREDITATIONS

Brian BauerCEO, Lutheran Hospital

A MESSAGE FROM THE CEO

A cancer diagnosis can change lives. That’s why the physicians and staff of the

Lutheran Cancer Center make every effort to not only physically treat the disease,

but to also nurture patients and their families emotionally and spiritually. Most of

all, they offer hope.

Hope gives patients a reason to fight, it creates optimism and courage. At the

Lutheran Cancer Center, patients can rest assured knowing they are receiving

technologically advanced treatments from some of the region’s most experienced

and knowledgeable specialists.

The 2016 Lutheran Cancer Center’s annual report provides an overview of services,

cancer registry data and physician-led programs offered at the center. The report

reflects the commitment of physicians and staff to care for and guide patients on

each step of their journey, through one of life’s most challenging ordeals.

Hope is happening here.

ACCREDITED PROGRAM

LUTHERAN CANCER CENTER2016 REPORT | 2015 DATA

Joint Commission accreditation and certifi cation

is recognized nationwide as a symbol of quality

that refl ects an organizations commitment to

meeting certain performance standards.

Lutheran Hospital has received

the CoC accreditation with the

outstanding achievement award

since 2007.

ACCREDITATIONS

Brian BauerCEO, Lutheran Hospital

A MESSAGE FROM THE CEO

A cancer diagnosis can change lives. That’s why the physicians and staff of the

Lutheran Cancer Center make every effort to not only physically treat the disease,

but to also nurture patients and their families emotionally and spiritually. Most of

all, they offer hope.

Hope gives patients a reason to fight, it creates optimism and courage. At the

Lutheran Cancer Center, patients can rest assured knowing they are receiving

technologically advanced treatments from some of the region’s most experienced

and knowledgeable specialists.

The 2016 Lutheran Cancer Center’s annual report provides an overview of services,

cancer registry data and physician-led programs offered at the center. The report

reflects the commitment of physicians and staff to care for and guide patients on

each step of their journey, through one of life’s most challenging ordeals.

Hope is happening here.

3

A WORD FROM THE CANCER COMMITTEE CO-CHAIRMEN

The Lutheran cancer program is recognized as

a regional leader for its innovative and effective

cancer care. Since first surveyed by the American

College of Surgeons Commission on Cancer in

May 2007, the program has continued to hold

commendation status as a Community Hospital Comprehensive Cancer Program. Lutheran

Cancer Program received its 4th consecutive Outstanding Achievement Award for the May

2016 CoC survey, signifying twelve consecutive years of the highest rating possible from

the American College of Surgeons. The program continues to grow, building on established

strengths while continually enhancing and adding diagnostic and treatment options,

programs and services.

Radiation Oncology Associates completed the installation of a TrueBeam linear accelerator in

2016. Designed to treat moving targets with advanced speed and accuracy, the TrueBeam is a

fully integrated image-guided radiotherapy system. This new technology features an optimal

surface mapping system, volumetric modulated arc therapy and subtotal body radiotherapy

capabilities. Another new technology is the Xoft intraoperative system which delivers highly

selective radiation therapy to early-stage breast cancer patients. Thus far, 22 patients have

been successfully treated with this technology.

Because the cancer team is committed to top-quality patient care that results in positive

patient outcomes, the center continues to participate in clinical research, one of the hallmarks

of state-of-the-art cancer care. Fort Wayne Medical Oncology and Hematology and Radiation

Oncology Associates are actively enrolling patients in six national cooperative group trials as

well as eighteen pharmaceutical company sponsored trials.

It is our pleasure to continue to co-chair the Lutheran Cancer Committee. The cancer team

will continue striving to enhance the quality and accessibility of comprehensive care for

cancer patients in our community and throughout the region.

Steven Rhinehart, MD*

Fort Wayne Medical Oncology and Hematology

R. Prasad Mantravadi, MD*

Radiation Oncology Associates

4

CHARTING THE COURSE TO RECOVERY — NURSE NAVIGATORSFor more than a decade, Lutheran’s cancer navigators have helped thousands face the confusing and anxious days that follow

a cancer diagnosis. Navigators empower patients and their families with the knowledge they need to make the choices that

are right for them. The center’s nurse navigators include a certified breast care nurse and a lung cancer screening navigator.

Navigator services include:

FREE RESOURCE

Lutheran Cancer Resource Center: (260) 435-7959 Lung Cancer Screening Hotline: (260) 435-7522

LUTHERAN CANCER CENTERThe Lutheran Cancer Center, which is part of Lutheran Hospital and the Lutheran Health Network, is a 48,000 square-foot

comprehensive cancer treatment facility located on the Lutheran Hospital campus. Medical and radiation oncologists,

surgeons and the entire cancer care team work together to deliver innovative and high-tech cancer treatments while

also caring for patients’ minds, bodies and spirits. This integrated approach not only gives patients fast access to top-

notch cancer care, it also lets them know the team is with them, helping them overcome obstacles and fear with physical,

educational and emotional support.

} Explaining treatment options

} Helping patients and their families understand

the cancer diagnosis

} Providing emotional support

} Helping patients schedule and navigate

through physician appointments

} Addressing psychosocial needs by connecting patients

with needed services such as financial assistance,

home health, nutrition counseling, physical therapy

and support groups

} Providing ongoing support after treatment

Inside the Lutheran Cancer Center

} Breast Surgical Oncology

} Clinical Dietitian

} Fort Wayne Medical Oncology and Hematology*

} Genetic Counseling*

(collaboration with the Northeast Indiana Genetic Counseling Center)

} Gynecological Oncology of Northeast Indiana*

} Lutheran Adult Outpatient Clinic

} Lutheran Cancer Registry

} Lutheran Cancer Resource Center

(a free service provided by Lutheran Hospital)

} Lutheran Children’s Hospital Outpatient Pediatric

Hematology/Oncology Clinic

(affiliated with Riley Hospital for Children, Indianapolis)

} Palliative Care Clinic* (affiliated with Visiting Nurse)

} Radiation Oncology Associates*

} Surgical Oncology

Services Accessible through the Lutheran Cancer Resource Center

} Case management/social services

} Dietary

} Home health and hospice

} Pastoral care

} Support groups/survivorship

Services Available by Referral

} American Cancer Society

} Cancer rehabilitation

} Cancer Services of Northeast Indiana

} Clinical trials

} Diagnostic (imaging and laboratory)

} Lymphedema management

0

400

800

1200

1600

2000

2400

2800

3200

2011 2012 2013 2014 2015

510

2502

3054

2707

3247

5

Hollie Painter, RN, CN-BNBreast Navigator

Cancer Navigators:

Barbara Gard, RN, MSN, CNS, OCN, CBCNOncology Clinical Nurse Specialist

Susan Berghoff, RN, CHPN, OCNOncology-Certified Nurse

Wendy Rowland, RN, BSN, OCN Oncology-Certified Nurse

Executive Director of Oncology:

Linda Jordan, RN, BSN, MBA, OCNOncology-Certified Nurse

PALLIATIVE CAREPalliative care is specialized medical care for people with serious, life-limiting illnesses. The primary goal of palliative care

is to improve quality of life for both patients and families by relieving symptoms associated with the illness or treatment,

such as anxiety, constipation, dyspnea, fatigue, insomnia, loss of appetite, nausea and pain, as well as symptoms caused

by various medications. Palliative care can be provided with curative or life-prolonging treatment and can be initiated at

any time during an illness. Unlike hospice care, palliative care services are not dependent on a prognosis.

Palliative services are provided in both the inpatient and outpatient setting by a care team that includes a palliative care

physician, certified palliative care nurses, nurse practitioners, social workers, case managers and chaplains. In addition to

symptom management, the team helps patients and families better understand the illness and its future challenges, helps

establish a current and long-term plan of care based on patient goals and ensures appropriate resources are available

when needed.

PALLIATIVE CARE: INPATIENT VOLUMES

THE RESOURCE CENTER STAFF(LEFT TO RIGHT)

6

PHYSICIAN-LED PROGRAMS

Clinical Trials

Patients receiving treatment at the Lutheran Cancer Center have access to clinical

trials through collaboration with Fort Wayne Medical Oncology and Hematology

and Radiation Oncology Associates. Affiliated with Cancer and Leukemia Group B,

Southwest Oncology Group, Hoosier Oncology Group, Radiation Therapy Oncology

Group, UCLA and other national and regional clinical research groups, these trials

allow qualified patients to receive innovative treatments without leaving the Fort

Wayne area. Many of these trials are landmark studies that have changed practice

standards and oncology guidelines.

Oncologists who practice at the Lutheran Cancer Center are some of the most

active specialists in the country for clinical trial enrollment. FWMOH has been

recognized by the American Society of Clinical Oncology as one of the top 10

community practices for clinical cancer trial enrollment in the United States.

Weekly Cancer Conference

A group of multispecialty physicians and clinical staff meet each Friday to review

the most challenging cancer cases. Patient histories, diagnostic and pathological

data, National Comprehensive Cancer Network guidelines pertaining to each case

and up-to-date results from scientific studies are examined. These conferences

provide an opportunity for physicians to discuss treatment options and garner

feedback from their colleagues and provide patients the opportunity to have

a team of physicians discuss their cases and reach a consensus for the best

treatment protocol. Recommendations are then communicated to the treating

physicians. Physicians interested in presenting a case should contact the tumor

registrar at (260) 435-7939.

Lutheran Cancer Committee

The Lutheran Cancer Committee meets quarterly to evaluate, plan, initiate and

implement cancer-related activities that enhance services and programs. The

committee sets ambitious goals that keep the entire program on the leading edge

of cancer care. The cancer committee consists of physicians from various specialties

and representatives from administration, cancer registry, case management,

education, hospice, marketing, nutrition services, oncology nursing, pastoral care,

pathology, pediatric oncology, pharmacy, quality, radiology rehabilitation, research

and social services as well as representatives from the oncology community.

} Breast ...........................................80

} Colorectal ...................................33

} Pancreas .....................................30

} Gastrointestinal ....................... 16

} Skin ................................................ 15

} Lung ............................................... 13

} Lymphoma ................................. 12

} Genitourinary ............................ 11

} Head and Neck ......................... 11

} Sarcoma.........................................9

} Unknown ....................................... 7

} Didactic Lectures ..................... 3

} Gynecologic ................................ 3

} Leukemia ...................................... 2

} CNS ................................................... 1

2015 CANCER CONFERENCES

SITE TOTAL CASES PRESENTED

Age

0–9

Age

10–1

9

Age

20–2

9

Age

30–3

9

Age

40–49

Age

50–59

Age

60–69

Age

70–7

9

Age

80–89

Age

90–99

0

Nu

mb

er

of

Pa

tie

nts

100

200

300

400

500

2011

2012

2013

2014

2015

7

(LEFT TO RIGHT)

Kimberly Cardin, RN, RHITTumor Registrar

Peggy Downs, CTRCancer Registry Supervisor, Certified Tumor Registrar

Nicki LuginbillClerk

Colleen Condron, RHIT, CTRCertified Tumor Registrar

Constance Barker, CTRCertified Tumor Registrar

CANCER REGISTRARS

CANCER REGISTRYThe Lutheran Cancer Registry collects and reports data about cancer and tumor disease to the Indiana State

Department of Health and the National Cancer Data Base. Data is collected by certified cancer registrars. Registrars

capture a complete summary of patient history, diagnosis, treatment and status for every cancer patient diagnosed

or treated at the Lutheran Cancer Center.

The registry staff also coordinates the weekly cancer conference and is responsible for helping to maintain the

certification of a Community Hospital Comprehensive Cancer Program with the American College of Surgeons

Commission on Cancer.

Since 2004, the year the hospital began submitting data to the National Cancer Data Base, the Lutheran Cancer

Registry team has abstracted a total of 19,134 diagnoses of cancer. Since the registry’s inception in the late 1980s,

the registry team has reported 34,917 incidents of cancer. The registry team is also charged with following patients

for their lifetime and reporting any incidents of recurrence. The registry currently exceeds the mandated 90 percent

lifetime follow-up rate.

AGE AT DIAGNOSIS, 2011 – 2015

8

PRIMARY SITE TABLE — 2015 DATA

* Excluding basal and squamous cell carcinoma

Buccal cavity and pharynx 3.4% 1 17 27 5 1 47 2 2 41 10

Lip 0.4% 1 5 0 0 0 5 0 1 5 1

Tongue 1.1% 0 5 11 1 0 16 1 0 13 4

Major salivary gland 0.4% 0 1 2 2 1 5 0 1 4 2

Floor of mouth 0.1% 0 1 0 1 0 2 0 0 1 1

Gum and other mouth 0.3% 0 3 0 1 0 4 0 0 3 1

Nasopharynx 0.1% 0 0 1 0 0 1 0 0 1 0

Tonsil 0.9% 0 0 13 0 0 12 1 0 12 1

Oropharynx 0.1% 0 1 0 0 0 1 0 0 1 0

Hypopharynx 0.1% 0 1 0 0 0 1 0 0 1 0

Other buccal cavity 0.0% 0 0 0 0 0 0 0 0 0 0

Digestive system 20.7% 4 85 107 95 16 285 19 3 169 138

Esophagus 1.7% 0 3 9 13 0 24 1 0 21 4

Stomach 1.4% 0 10 4 7 0 19 2 0 9 12

Small intestine 0.9% 0 8 4 2 0 14 0 0 10 4

Colon, excluding rectum 6.3% 1 33 33 17 10 89 5 0 48 46

Rectum and rectosigmoid 3.4% 0 14 25 10 2 45 4 2 27 24

Anus anal canal anorectal 0.5% 2 4 2 0 0 8 0 0 3 5

Liver 0.7% 0 5 1 5 0 9 1 1 9 2

Gallbladder 0.4% 0 0 2 4 0 6 0 0 1 5

Other biliary 0.2% 0 1 2 0 0 3 0 0 3 0

Pancreas 4.9% 1 6 25 36 4 66 6 0 38 34

Retroperitoneum 0.1% 0 1 0 0 0 1 0 0 0 1

Peritoneum 0.1% 0 0 0 1 0 1 0 0 0 1

Other digestive organs 0.0% 0 0 0 0 0 0 0 0 0 0

Respiratory system 22.7% 0 87 72 172 6 316 16 5 181 156

Nasal cavity sinuses 0.3% 0 2 1 1 0 4 0 0 2 2

Larynx 1.5% 0 10 6 5 1 20 1 1 15 7

Lung and bronchus 20.9% 0 74 65 166 5 291 15 4 163 147

Trachea, pleura and other 0.1% 0 1 0 0 0 1 0 0 1 0

Bones and joints 0.3% 0 1 2 1 1 4 1 0 3 2

Soft tissue (including heart) 0.4% 0 5 1 0 0 6 0 0 3 3

Skin* 5.9% 10 25 5 8 39 80 1 6 45 42

Melanomas of the skin 5.2% 10 18 4 7 38 72 0 5 39 38

Other skin cancers 0.7% 0 7 1 1 1 8 1 1 6 4

Breast 10.9% 10 77 45 16 13 140 17 4 1 160

Female genital system 5.0% 4 30 18 17 5 64 9 1 0 74

Cervix uteri 0.7% 0 1 5 2 2 9 1 0 0 10

Corpus uteri 2.4% 0 23 7 4 1 28 6 1 0 35

Uterus NOS 0.1% 0 0 0 0 1 1 0 0 0 1

Ovary 1.2% 0 3 3 11 1 17 1 0 0 18

Vagina 0.1% 0 1 1 0 0 2 0 0 0 2

Vulva 0.5% 4 2 2 0 0 7 1 0 0 8

Other female genital organs 0.0% 0 0 0 0 0 0 0 0 0 0

SITE % of TOTAL CASES STAGE RACE SEX

I L R D U W B OTHER M F

9

Note: sites listed in orange are Lutheran's top five sites.

TOP CANCER SITES: MALE

} Lung and bronchus ................................ 163 (21.7%)

} Prostate gland ............................................ 78 (10.4%)

} Urinary bladder ..........................................49 (6.5%)

} Colon (excluding rectum) ....................48 (6.4%)

} Non-Hodgkin’s lymphoma ...................43 (5.9%)

} Breast .............................................................160 (21.9%)

} Lung and bronchus ................................ 147 (20.1%)

} Colon (excluding rectum) ....................46 (6.3%)

} Non-Hodgkin’s lymphoma .................. 40 (5.5%)

} Melanoma of skin ......................................38 (5.2%)

SITE SITETOTAL CASES PRESENTED TOTAL CASES PRESENTED

Source: 2015 Lutheran Hospital Cancer Registry

TOP CANCER SITES: FEMALE

SITE % of TOTAL CASES STAGE RACE SEX

I L R D U W B OTHER M F

Male genital system 5.9% 0 44 22 12 10 83 5 0 88 0

Prostate gland 5.3% 0 39 20 10 9 73 5 0 78 0

Testis 0.6% 0 5 2 2 0 9 0 0 9 0

Penis 0.1% 0 0 0 0 1 1 0 0 1 0

Other male genital organs 0.0% 0 0 0 0 0 0 0 0 0 0

Urinary system 8.4% 37 55 18 9 5 118 6 0 96 28

Urinary bladder 4.0% 34 15 7 1 3 59 1 0 49 11

Kidney and renal pelvis 4.0% 1 39 10 8 1 54 5 0 44 15

Ureter 0.3% 2 1 1 0 1 5 0 0 3 2

Other urinary organs 0.0% 0 0 0 0 0 0 0 0 0 0

Eye 0.1% 0 0 0 1 0 0 0 1 1 0

Brain and other nervous system 1.0% 0 9 6 0 0 14 1 0 8 7

Brain 0.9% 0 9 5 0 0 13 1 0 8 6

Other nervous system 0.1% 0 0 1 0 0 1 0 0 0 1

Endocrine system 2.7% 0 28 7 3 2 35 2 3 12 28

Thyroid gland 2.5% 0 25 7 3 2 32 2 3 12 25

Other endocrine 0.2% 0 3 0 0 0 3 0 0 0 3

Lymphomas 6.1% 0 18 26 35 11 82 4 4 47 43

Hodgkin’s disease 0.5% 0 1 5 1 0 6 0 1 4 3

Non-Hodgkin’s lymphomas 5.6% 0 17 21 34 11 76 4 3 43 40

Multiple myeloma 1.5% 0 0 0 22 0 22 0 0 16 6

Leukemias 2.3% 0 0 0 34 0 30 3 1 21 13

Acute lymphocytic 0.7% 0 0 0 11 0 10 1 0 8 3

Chronic lymphocytic 0.2% 0 0 0 3 0 2 1 0 1 2

Acute myeloid 0.7% 0 0 0 10 0 10 0 0 5 5

Chronic myeloid 0.5% 0 0 0 7 0 6 1 0 6 1

Other leukemias 0.2% 0 0 0 3 0 2 0 1 1 2

Other ill-defined & unknown 2.6% 0 0 1 9 29 38 1 0 19 20

Cervix insitu 0.1% 2 0 0 0 0 2 0 0 0 2

I = Insitu D = Distant W = White M = Male

L = Local U = Unknown B = Black F = Female

R = RegionalKEY

21 63 4 5

108 9 11 12 13

15 16 17 18

27

29

26

30 31 32 33

22 23 24 25

19 20

10

THE PEOPLE MAKE THE DIFFERENCEMeet a few of the specialists, who along with hundreds of other physicians, nurses and staff members,

devote themselves to treating patients at the Lutheran Cancer Center.

7

14

28

21

11

± 1 Neal Agee, MDLutheran Medical Group

± 2 Lubna Ahmed, MDLutheran Children’s Hospital, Lutheran Medical Group

3 Charles Aust, MD*

PathGroup

4 Sunil Babu, MD*


± 5 Patricia Bader, MD*

Northeast Indiana Genetic Counseling

6 Matthew L. Carr, MD*


7 Nathan Comsia, MD*


8 Christopher Dempsher, MD*

PathGroup

± 9 Nadine Floyd, MD*

Center for Colon & Rectal Care

10 Ryan Gonzales, MD*


± 11 Rachael Hayes, MDLutheran Medical Group

12 Eric V. Heatwole, MD*

Summit Radiology

13 Steven M. Jones, MD*

PathGroup

± 14 Praveen Kollipara, MD*


15 Xiao Lin, MD*


16 David Lippie, MDLutheran Medical Group

± 17 R. Prasad Mantravadi, MD, FACR, FACRO*


± 18 Ann M. Moore, DO, FACCOI, CMD*

Visiting Nurse

19 Scott Myers, MDLutheran Children’s Hospital, Lutheran Medical Group

20 Yasolatha Nalamolu, MD*


21 Sreenivasa R. Nattam, MD*


± 22 Dennis O’Brien Jr., MDLutheran Children’s Hospital, Lutheran Medical Group

23 Iwona Podzielinski, MD*

Gynecologic Oncology of Northeast Indiana

24 Dolly R. Quispe, MD*


25 Mark C. Ranck, MD*


26 Donald N. Reed Jr., MD, FACSLutheran Medical Group

± 27 Steven N. Rhinehart, MD*


± 28 Rich Sibley, MD*

Summit Radiology

29 Bryon Stephens, MDLutheran Medical Group

30 Mary Wilger, DO*

Visiting Nurse

±31 Peter Wu, MD*

PathGroup

32 Gerald Yancey, MD*

PathGroup

33 David Zimmerman, MD*


± Denotes Lutheran Cancer Committee member

12

Study Topic: To evaluate the prescribed antiemetic regimen for patients receiving chemotherapy agents classified

as high emetic risk.

National Guideline: NCCN Clinical Practice Guidelines in Oncology for Antiemesis outline treatment using the

following four categories:

} High emetic risk: 90% or more of patients experience acute emesis

} Moderate emetic risk: 30% to 90% of patients experience acute emesis

} Low emetic risk: 10% to 30% of patients experience acute emesis

} Minimal emetic risk: fewer than 10% of patients experience acute emesis

The incidence and severity of nausea and/or vomiting in patients receiving chemotherapy, radiation therapy or

chemoradiation are affected by numerous factors, including:

} Specific therapeutic agents used

} Dosage of the agents

} Schedule and route of administration of the agents

} Target of the radiation therapy: whole body, upper abdomen

} Individual patient variability: age, sex, prior chemotherapy, history of alcohol use

More than 90 percent of patients receiving highly emetogenic chemotherapy will have episodes of vomiting.

However, if they receive preventive antiemetic regimens before treatment only about 30 percent will have an

episode of vomiting. The NCCN Guidelines define antiemetic regimens for particular chemotherapy drugs that

cover the entire duration of time a patient is at risk for nausea and/or vomiting.

Results: Retrospective chart audit of 21 patients over a three month period demonstrated the following results:

} 9/21 or 43% were receiving high emetogenic chemotherapy regimens and were prescribed

the recommended antiemetic medications

} 11/21 or 52% were receiving moderate emetogenic chemotherapy regimens and were

prescribed the recommended antiemetic medications

} 1/21 or 5% received a low emetogenic chemotherapy regimen and received the

recommended antiemetic medication

Action Plan: This study demonstrated that our cancer patients are receiving the recommended antiemetic

regimens. Results reported to cancer committee.

2015 QUALITY STUDY #1

References:

2016 Antiemesis Clinical Practice Guideline: www.nccn.org

2016 Antiemetic Guideline: www.mascc.org

13

2015 QUALITY STUDY #2

Study Topic: To track the timeframe of prescribed intervention for oral mucositis/stomatitis in patients receiving

chemotherapy agents known to cause this side effect.

Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology Guideline

(MASCC/ISOO)/Oncology Nursing Society:

Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment

dosage, altered nutrition, dehydration, infection, pain, higher health costs due to symptom management and an

increase in the hospital length of stay for some patients. Treatment of chemotherapy-induced oral mucositis begins

with patient education, oral assessments, prompt interventions and reinforcing the importance of good oral care

throughout cancer treatment.

Results: Retrospective chart audit over a 3-month period of patients receiving chemotherapy resulted in the

following:

} 25 chemotherapy agents were delivered either in a combination regimen or as a single agent

over the 3-month period with the potential for causing some form of severity of mucositis

} 16/25 or 64% of the agents administered were known to cause mucositis

} 9/25 or 36% of the agents administered could cause mucositis

} All patients received a medical intervention at first sign of discomfort or within a timeframe

of three to seven days from administration of the chemotherapy agent

Action: This study demonstrated that our cancer patients were prescribed medical interventions at time of discovery

and throughout resolution. Results and future action plan presented to the cancer committee.

References:

Brennan, M.T., Spijkervet, F.K. & Elting, L.S. (2010) Systemic reviews and guidelines for oral complications of cancer therapies: current challenges and

future opportunities, Support Care Cancer 18:977-978.

NCCN Task Force Report: Prevention and Management of Mucositis in Cancer Care: www.nccn.org

Lalla, R.V. et.al. (2014) MASCC/ISOO Clinical Practice Guideline for the Management of Mucositis Secondary to Cancer Therapy, Cancer, May 15, 2014:

www.ons.org

14

QUALITY IMPROVEMENT TOPIC 1

Review documentation of oral assessments in the electronic medical record of patients receiving chemotherapy

agents that can cause oral side effects. The oral assessment is generalized for all patients and not specific for our

cancer patients receiving chemotherapy that are known to cause some degree of oral side effects during their

treatment.

Goal of the Quality Improvement

Implement a best practice tool for oral assessments that is intuitive and easy to use. Frequent oral assessments are

important in the setting of chemotherapy to detect and monitor oral mucositis/stomatitis progression. This concept

being similar to taking routine vital signs.

Process Change

Education of oncology nurses on the importance of oral assessments and patient education for patients that are

receiving chemotherapy agents that are known to cause mucositis/stomatitis. The education packet development

and distribution process will be discussed in our Service Excellence Committee.

Quantifiable Improvements

The electronic medical record review of oral assessment documentation demonstrated a 100 percent completion rate

upon patient admission and daily per shift. The present oral assessment field in the electronic medical record does

not list specific interventions for our oncology patients identified at a high risk for developing mucositis/stomatitis

from their prescribed cancer treatment. This demonstrates the need to implement a best practice assessment tool

to help assure that oral assessments can be consistently applied as part of routine patient care.

Follow-up Steps to Monitor Implemented Education

Education plan roll out is a three step process with evaluating and implementing an oral assessment tool, monitoring

nursing documentation and implementation of patient education. The oncology unit manager will implement any

process change needed to provide quality care for our cancer patients. Report process and updates to cancer

committee.

QUALITY IMPROVEMENTS

The Lutheran Hospital Cancer Committee reviewed, discussed and implemented two quality improvement initiatives

to enhance patient care.

15

QUALITY IMPROVEMENT TOPIC 2

To evaluate the timeframe from admission to the oncology unit to the administration of the patient’s chemotherapy/

biotherapy agents utilizing the Chemotherapy Dose Edge computer program. The Chemotherapy Dose Edge

computer program allows the nurse to track where the antineoplastic agent is in the preparation process of

completion but is dependent on when the order gets entered into the computer program.

Goal of the Quality Improvement

There are no benchmarks identified for timeliness of chemotherapy administration. Literature reviews revealed

timeliness is determined by each institution based on their census and staff expectations. A timeframe of 120 minutes

was established from meetings with pharmacy and nursing for actual completion of chemotherapy preparation and

delivery to the oncology unit.

Process Change

The satellite pharmacy prepares inpatient and outpatient chemotherapy/biotherapy agents. The pharmacist

contacts the nurse who will be administering the chemotherapy agent to discuss her expectation of starting the

administration. The set timeframe of 120 minutes did not allow for any prior procedures the patient might need prior

to administration of their chemotherapy.

Quantifiable Improvements

Review of inpatient chemotherapy admissions to the inpatient oncology unit to the actual administration of the

chemotherapy ranges from 270 minutes to 360 minutes. This takes into account the patient admission process,

intravenous access, radiology and/or laboratory testing needed and the double check process between the oncology

nursing staff prior to administration. To date, the communication between pharmacy and nursing is more efficient

than just tracking the process in the Chemotherapy Dose Edge computer program. We are presently looking at how

to streamline the admission process on the oncology unit to decrease the time from admission to administration.

Brain

Leukemia

Endocrine

Genital, Female

Skin

Head and Neck

Lymphoma

Genital, Male

Urinary

Breast

Respiratory

Digestive

0 50 100 150 200 250 300 350

2011

2012

2013

2014

2015

16

CANCERS TREATED, 2011 – 2015

2011 2012 2013 2014 2015

Brain 38 33 23 35 15

Leukemia 31 43 35 32 34

Endocrine 54 68 59 60 40

Genital, Female 52 68 82 63 74

Skin 73 70 73 76 87

Head and Neck 119 110 68 49 71

Lymphoma 76 101 80 85 90

Genital, Male 123 124 93 77 88

Urinary 164 143 133 130 124

Breast 227 193 156 155 161

Respiratory 289 271 276 257 311

Digestive 347 333 337 316 305

White African American Other

1600

1400

1200

1000

800

600

400

200

02015

1366

8730

2011

1590

61 22

2012

1555

59 21

2013

1391

68 37

2014

1295

66 31

Male Female

800

700

600

500

400

300

200

100

0

751 732

2015

841 832

2011

835800

2012

777719

2013

726666

2014

17

GENDER DISTRIBUTION, 2011 – 2015

RACE AND ETHNICITY, 2011 – 2015

Stage 0

Stage I

Stage II

Stage III

Stage IV

Unknown12.37 %14.43 %

34.02 % 37.11 %

2.06 % 0.24 %1.58 %

43.30 %

19.10 %

21.65 %

14.25 %

11.34 %

24.86 %

7.22 %

19.29 %

6.19 %

5.71 %

4.12 %

8.78 %

3.09 %

0.96 %

2.06 %

2.69 %

1.03 %

2.83 %

0 %

1.54 %

Lutheran Hospital

State of Indiana

29.13 %

11.13 %

18.38 %

39.54 %

18

STAGE AT DIAGNOSIS

FIRST COURSE TREATMENTNon-Small Cell Carcinoma Diagnosed in 2014

Non-Small Cell Carcinoma Diagnosed in 2014

Source: 2016 National Cancer Data Base (Commission on Cancer). Accessed Nov. 10, 2016.

NCDB COMPARISON CHARTSThe following charts compare non-small cell carcinoma cancer stage at diagnosis and first course of treatment at

Lutheran Hospital with 20 other comprehensive community cancer programs in the state of Indiana (data from

20 hospitals).

LUTHERAN HOSPITAL STATE OF INDIANA

Surgery Only

No First Course Rx

Radiation & Chemo

Radiation Only

Surgery & Chemo

Chemo Only

Chemo & BRM

Surgery, Radiation & Chemo

Other Specified Therapy

All Other Treatments

0

0

0

0

0

0

100

100

100

100

100

100

92.6 %n = 54

83.4 %n = 6

94.8 %n = 57

86.7 %n = 15

94.4 %n = 71

100 %n = 1

19Source: 2016 National Cancer Data Base. Accessed Nov. 8, 2016.

RAPID QUALITY REPORTING SYSTEM

Breast Conserving SurgeryRadiation therapy is administered within one year

(365 days) of diagnosis for women under age 70

receiving breast conserving surgery for breast cancer.

Hormone TherapyTamoxifen or third generation aromatase inhibitor is

considered or administered within one year (365 days)

of diagnosis for women with AJCC T1 cN0M0, or stage

IB–III hormone receptor positive breast cancer.

Combination ChemotherapyCombination chemotherapy is considered or

administered within 4 months (120 days) of diagnosis

for women under 70 with AJCC T1cN0M0, or stage

IB–III hormone receptor negative breast cancer.

Radiation TherapyRadiation therapy is recommended or administered

following any mastectomy within one year (365 days)

of diagnosis of breast cancer for women with ≥4

positive regional lymph nodes.

Regional Lymph NodesAt least 12 regional lymph nodes are removed and

pathologically examined for resected colon cancer.

Adjuvant ChemotherapyAdjuvant chemotherapy is considered or administered

within four months (120 days) of diagnosis for

patients under the age of 80 with AJCC Stage III

(lymph node positive) colon cancer.

BC

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MA

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7910 W. Jefferson Blvd.

Fort Wayne, IN 46804

LutheranHealth.net/cancer

LUTHERAN CANCER CENTER

Lutheran Hospital is owned in part by physicians.

*�Independent members of the medical sta� of Lutheran Hospital.

For more information or to refer a patient, call:

(260) 435-7959

RINGING THE BELL OF HOPE

Patients ring the Bell of Hope, which

is located in the Cancer Resource

Center’s garden, after completing a

course of treatment, such as radiation

therapy and/or chemotherapy. Ringing

the bell symbolizes hope for the future

for patients as cancer treatments end

and the next phase of life begins.

20

The Lutheran Cancer Committee monitors practices to ensure patients at Lutheran Hospital receive care according to

nationally accepted measures. The Commission on Cancer measures compliance with current CoC quality reporting

tools, including the Cancer Program Practice Profile Reports. Below is the CP3R performance report for 2014, the most

current year for which data is available. Lutheran Hospital meets or exceeds all current standards.

CANCER PROGRAM PRACTICE PROFILE REPORTS (CP3R)

Quality Measure Required Performance Rate

Lutheran Hospital

Image or palpation-guided needle biopsy (core or FNA)

of the primary site is performed to establish diagnosis of

breast cancer.

80% 88.9%

Tamoxifen or third generation aromatase inhibitor is

considered or administered within one year (365 days)

of diagnosis for women with AJCC T1c or stage IB-III

hormone receptor positive breast cancer.

90% 100%

Radiation therapy is administered within one year (365

days) of diagnosis for women under age 70 receiving

breast conserving surgery for breast cancer.

90% 100%

Combination chemotherapy is considered or

administered within four months (120 days) of diagnosis

for women under 70 with AJCC T1cN0 or stage IB-III

hormone receptor negative breast cancer.

90% 100%

Adjuvant chemotherapy is considered or administered

within four months (120 days) of diagnosis for patients

under the age of 80 with AJCC stage III (lymph node

positive) colon cancer.

90% 100%

At least 12 regional lymph nodes are removed and

pathologically examined for resected colon cancer.

85% 96.2%








(260) 435-7959

















(260) 435-7959










Documents

LCC Cancer Report 2016 - Lutheran Hospital · 2016-12-21 · commendation status as a Community Hospital Comprehensive Cancer Program. Lutheran Cancer Program received its 4th consecutive