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*
Fort Wayne Medical Oncology and Hematology
± 5 Patricia Bader, MD*
Northeast Indiana Genetic Counseling
6 Matthew L. Carr, MD*
Fort Wayne Medical Oncology and Hematology
7 Nathan Comsia, MD*
Radiation Oncology Associates
8 Christopher Dempsher, MD*
PathGroup
± 9 Nadine Floyd, MD*
Center for Colon & Rectal Care
10 Ryan Gonzales, MD*
Fort Wayne Medical Oncology and Hematology
± 11 Rachael Hayes, MDLutheran Medical Group
12 Eric V. Heatwole, MD*
Summit Radiology
13 Steven M. Jones, MD*
PathGroup
± 14 Praveen Kollipara, MD*
Fort Wayne Medical Oncology and Hematology
15 Xiao Lin, MD*
Radiation Oncology Associates
16 David Lippie, MDLutheran Medical Group
± 17 R. Prasad Mantravadi, MD, FACR, FACRO*
Radiation Oncology Associates
± 18 Ann M. Moore, DO, FACCOI, CMD*
Visiting Nurse
19 Scott Myers, MDLutheran Children’s Hospital, Lutheran Medical Group
20 Yasolatha Nalamolu, MD*
Fort Wayne Medical Oncology and Hematology
21 Sreenivasa R. Nattam, MD*
Fort Wayne Medical Oncology and Hematology
± 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*
Fort Wayne Medical Oncology and Hematology
25 Mark C. Ranck, MD*
Radiation Oncology Associates
26 Donald N. Reed Jr., MD, FACSLutheran Medical Group
± 27 Steven N. Rhinehart, MD*
Fort Wayne Medical Oncology and Hematology
± 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*
Fort Wayne Medical Oncology and Hematology
± 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.
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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%
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.
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.