2013 KCH Annual Cancer Report | 2012 data

The Center for Cancer Care

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2013annual cancer report

2012 data collection


Medical Oncology 740.393.5551

Radiation Oncology740.393.5513


Husain Rasheed, MD, Cancer Committee Chairman

Amy Murnen, MD, Cancer Liaison Physician

Sandy Kollar, MSM-HCA, RN, Director, The Center for Cancer Care

Sandy Petros, BS, MT (ASCP), CTR, Oncology Data Specialist

Amy Shoewalter, BSN, RN, OCN, Quality Improvement Coordinator

Diana Endsley, RN, OCN, Patient Navigator

Becky Dangelo, MSN, RN, CNOR, BHN, Breast Health Navigator

2013annual cancer report

2012 data collectionThe Center for Cancer Care


table of contents

Section 1 - Center for Cancer Care Service Report 1.1 A word from Bruce D. White, CEO 1.2 A word from Husain Rasheed, MD, Cancer Committee Chairman 1.3 Amy Murnen, MD, FACS, Cancer Liaison Physician Cancer Liaison Physician Overview Report

Section 2 2.1 Meet Pat & Elmer Newton 2.2 Sandy Kollar, MSM-HCA, RN, Director of Center for Cancer Care Center for Cancer Care Service Report

Section 3 - Sandy Petros, BS, MT (ASCP), CTR, Oncology Data Specialist 3.1 Center for Cancer Care Registry Report

Section 4 - Amy Shoewalter, BSN, RN, OCN 4.1 Patient Care Improvement Report

Section 5 - Becky Dangelo, MSN, RN, CNOR, BHN, Breast Health Navigator 5.1 Cancer Conference Coordinator Report 5.2 Tumor Board Report 5.3 Breast Health Navigator Report

Section 6 - Diana Endsley, RN, OCN, Patient Navigator 6.1 Community Outreach Program Report

Section 7 - Kwi Holland, Vice President of Information Systems 7.1 Information Technology Report

Section 7 - Ann Wilson, Director of Diagnostic Imaging 8.1 Diagnostic Imaging Report

Section 9 - Adonyah Whipple, BSN, RN, CHRN 9.1 Palliative Care Report

Section 10 - Debbie Link, Director, Center for Rehabilitation & Wellness 10.1 Rehabilitation Report


Our Cancer Committee TeamHusain Rasheed, MD Cancer Committee Chair

Mark Crnkovich, MD Radiation Oncologist

Amy Murnen, MD Cancer Liaison Physician

Lauren McDowell-Jacobs, MD General Surgeon

Kingsley Orraca-Tetteh, MD Diagnostic Radiologist

Tisha Farrell, DO Pathologist

Bruce Behner Chief Operating Officer

Joan Sevy Majers, MS, RN Interim Chief Nursing Officer

Sandy Kollar, MSM-HCA, RN Director , Center for Cancer Care

Amy Shoewalter, BSN, RN, OCN Quality Improvement Coordinator

Adonyah Whipple, BSN, RN, CHPN Palliative Care Representative

Becky Dangelo, MSN, RN, CNOR, BHN, Breast Health Navigator

Diana Endsley, RN, OCN Patient Navigator

Bethany Lee, BSN, RN, OCN Clinical Trials Coordinator

Sandy Petros, BS, MT(ASCP), CTR Oncology Data Specialist

Lauren Whitehead, RT (R) (T) Radiation Therapy

Sean Cull, R Ph Pharmacist

Kathy Swihart, JD Quality and Compliance

Ann Wilson, RT (CT, M) Director, Diagnostic Imaging

Deb Link, MS, PT Director, Rehabilitation & Wellness

Dina Herald, RD, LD Dietitian

Lynn Ayers American Cancer Society Representative

Like what you see? | Send this report to a friend.Section 1 | 1

A word from... Bruce D. White, Chief Executive Officer

I am so pleased to introduce the 2013 Cancer Report from Knox Community Hospital (KCH). As you review this report you will find statistical and narrative accounts of all cancer cases diagnosed and/or treated at our Center for Cancer Care in 2012. In recognition of the consistent quality of care received by cancer patients at KCH, the Center for Cancer Care holds accreditation from The Commission on Cancer (CoC). This accreditation is granted to facilities that have voluntarily committed to providing the very best in cancer diagnosis and treatment according to CoC standards.

The exemplary care provided for patients at the Center for Cancer Care requires the dedication of many people with a wide variety of professional skill sets. I am so proud of the care provided by our team of oncologists, surgeons, physicians, dieticians, pathologists, pharmacists, phlebotomists, radiologists, nurses, therapists, and all other support personnel. This team works successfully and effectively to combine their wide array of skills and experiences together, focusing on the most important thing of all — the patient. Most importantly, this team always demonstrates that, while they are caring for a patient, they also care about them. This personal support and true caring is what makes this team at Knox Community Hospital so very special. And that’s absolutely the way it should be — our patients deserve no less.


Husain Rasheed, MD Cancer Committee Chair THE CENTER FOR CANCER CARE

Medical Oncology Report

Dear friends,

We are happy to present the KCH annual cancer report for 2013. The data submitted in this report is from 2012.

As an accredited institution by the Commission on Cancer (CoC), we are always striving to deliver cancer care at KCH which meets the comprehensive standards of quality mandated by the CoC. The cancer committee at KCH, which is comprised of a multidisciplinary team, meets quarterly to review and assess our goals and programs to ensure that we are maintaining the required standards of care. We were surveyed and evaluated this year in July by the CoC and, based on our performance, we have been reaccredited for the next three years. Congratulations to all who have worked diligently to keep us on track!

One of the standards of the CoC for cancer care is community outreach and a portion of our report this year focuses on our community outreach programs. As you go through the report, you will recognize and appreciate some of the community initiatives that have been offered in the past years. These programs allow us to disseminate very useful cancer related education and conduct cancer preventive programs for the community at large. Additionally, support group services are made available for cancer survivors. We have also made efforts to reach out to minority and under served groups to provide education and cancer screening services to them. We hope to continue these community initiatives as part of a comprehensive cancer care strategy in our community.

In 2012 we joined the Columbus CCOP, which is a nonprofit cooperative group for conducting clinical trials in cancer patients. Due to this affiliation, cancer patients at KCH have access to the same clinical trials as patients at most other hospitals in Columbus. Participation in clinical trials, while currently encouraged, will be a mandatory standard for CoC-accredited institutions in the next two to three years. Consequently, we are happy to be ahead in this area and should have a well-structured clinical trials process in place by the time it becomes a mandatory requirement.

“In 2012, we joined the Columbus CCOP which is a non-profit cooperative group for conducting clinical trials in cancer patients.

Due to this affiliation, cancer patients at KCH have access to the same clinical trials as patients at most other hospitals in Columbus. ”

A word from...


Another area we are looking to get ahead in is the reporting of our cancer registry data to the National Cancer Data Base (NCDB). The vast majority of hospitals currently report their cancer data to NCDB with a lag time. Likewise, we have been reporting our data with a lag time of about six months. There is, however, a newer reporting process, the Rapid Quality Reporting System (RQRS). The reporting in the RQRS takes place in real time while the patient is actively going through their cancer treatment. A big advantage of participating in the RQRS is that the system is designed to provide timely feedback to the institution regarding a patient if, for some reason, the patient’s treatment is falling short of a quality standard. This will allow for timely rectification. While participating in the RQRS is more labor intensive, we are committed to moving forward with the RQRS to additionally ensure that the cancer care at KCH is timely and appropriate.

I would like to thank the KCH administrative team for providing the necessary support and resources for the care of cancer patients in this community. As you read this report, you will quickly recognize that good cancer care requires input from people within many different disciplines. Thanks to all of them for their continued invaluable contributions.

Most of all, I am grateful to the community for placing their trust in us as we continue our work to provide high quality cancer care.

Medical Oncology Report continued... Husain Rasheed, MD

Source: http://www.facs.org/cancer/ncdb/rqrsflyer.pdf

What Is RQRS?

The Rapid Quality Reporting System (RQRS) promotes and facilitates evidence-based care for patients at Commission on Cancer-accredited programs by actively monitoring and assessing compliance with four National Quality Forum-endorsed measures and two surveillance measures of cancer care for breast and colorectal cancer patients in real clinical time.

2013 Cancer Event, held annually for survivors in our community.

L-R Bruce Behner, COO, Husain Rasheed, MD and Bruce White, CEO


The Commission on Cancer (CoC) was established in 1922 by the American College of Surgeons in order to assure that cancer patients were receiving consistent and quality care for their cancer treatment. Since that time, the CoC has evolved, and is currently a consortium of organizations dedicated to improve the quality of cancer care provided in the United States as well as to improve the lives of cancer patients. They do this, in part, by setting standards which cancer programs accredited by the CoC must meet. Each accredited program must submit data about their patients and the treatments provided to those patients to be reviewed and compared against national data using the National Cancer Data Base (NCDB). The CoC provides trained physicians to perform a survey of each cancer program every 3 years in order to assure standards are being met. The Center for Cancer Care at Knox Community Hospital has been accredited since 2010 and just completed our survey in July 2013.

One standard set forth by the CoC is that each cancer program have a Cancer Liaison Physician (CLP) who reviews that cancer center’s data and presents it to the Cancer Committee at least four times a year. This is a volunteer position that I assumed in the summer of 2012. Dr. Lauren McDowell-Jacobs served in this position for four years prior, and was instrumental in our Center for Cancer Care receiving its initial accreditation. It is now my job to evaluate and interpret our program’s performance and present it to our Cancer Committee. This committee is made up of our Chair, Dr. Hussain Rasheed MD, our Oncologist, as well as specialists from Surgery, Radiation Oncology, Radiology, Pathology, Physical, Occupational and Speech Therapy, Dietitian Services, Pain Management and Palliative Care as well as our Breast Health Navigator, Patient Navigator and many other health care providers — all involved with ensuring that cancer

patients receive exceptional care. I feel fortunate to participate on such an important committee to assure our cancer patients receive quality, compassionate care close to home.

As the Cancer Liaison Physician I have several other responsibilities. It is my role to serve as a liaison between the CoC as well as the American Cancer Society. In May I attended the American College of Surgeons conference for Cancer Liaison Physicians (CLP) in Columbus. At that conference, the role of the new CoC standards were discussed by Ohio’s Co-Chairs of CLP, V. Moysaenko, MD, FACS and Patrick Ross Jr., MD, FACS. I also heard Robert Indian, Planning Administrator at the Ohio Department of Health, give his plans to eradicate cancer in Ohio. In June I attended another conference, along with several other committee members, to help our Center for Cancer Care prepare to meet the new standards set forth by the CoC. This was my year to learn my new role and become inspired!

The most recent data available to review from the National Cancer Data Base are from 2010. Based on review of those data, I am confident that our patients at The Center for Cancer Care receive quality & comprehensive cancer care. More exciting is that our Cancer Committee has just approved recommendations to move forward and begin participating with the Rapid Quality Reporting System (RQRS). This is a system that reviews current patient care and will alert us if standards are not being met. This will require more intensive work from our Cancer Data Specialist, but it will provide us with current data rather than data about patients from two years back. This will allow us to make sure every patient is receiving the current quality care at the time of need.

As a family physician referring my patients, as well as a Cancer Survivor who receives my own care at Knox Community Hospital’s Center for Cancer Care, I feel very fortunate to have such an outstanding Center for Cancer Care here in our community. I am very enthusiastic about my role as Cancer Liaison Physician at Knox Community Hospital and hope I can continue to assist in assuring quality cancer care close to home.

Amy Murnen, MD THE CENTER FOR CANCER CARE

Cancer Liaison Physician Repor t


Meet Pat & Elmer Newton

Elmer and Pat Newton feel very strongly about their local Center for Cancer Center at Knox Community Hospital. Those strong feelings, their desire to make a difference, and their love for old cars merged into the Newton Car Show held annually on Labor Day. Since 2006 the proceeds from the annual show have been generously donated to the Center for Cancer Care and as of 2012 totaled $14,400. The donations have been utilized to assist in purchasing numerous patient care items including a chemotherapy chair, shoulder retractor, digital camera, wheelchair, fluid warmer, an ice machine, two temporal thermometer scanners, tumor registry software and a motorized stretcher.

Elmer and Pat, along with their family and friends have worked tirelessly to plan and host this annual event. The Center for Cancer Care would like to thank the Newtons, their family and friends, sponsors, car show workers, and the car owners for their dedication and generosity.

For more information about the next annual Newton Car Show contact Elmer or Pat at 740.392.9921.

For more information on how you can donate, call The Foundation for Knox Community Hospital at 740.393.9602 or visit www.KnoxCommHosp.org.


Sandy Kollar, MSM-HCA, RN

THE CENTER FOR CANCER CARE Service Report

Our Center & StaffThe Center for Cancer Care at Knox Community Hospital is located in the Knox Medical Pavilion and provides radiation therapy and medical oncology/hematology as well as a multitude of ancillary support services/resources for cancer patients and their families. Medical oncology/hematology is provided by Dr. Husain Rasheed, board-certified in Medical Oncology and Internal Medicine. Radiation oncology services are provided by board-certified physicians Drs. Mark Crnkovich, Megan DeHaan, Praveen Dubey, Thomas Pedrick, and Jason Seavolt of Riverside Radiation Oncology group.

Patient care is provided by ten registered nurses (seven of which are oncology certified), three registered radiation therapists, a physicist, dosimetrist, registered nurse breast health navigator, registered nurse patient navigator, clinical trials registered nurse, an oncology data specialist and two secretarial support staff. In addition to medical and radiation oncology, laboratory and diagnostic imaging services are also available adjacent to the Center for Cancer Care.

Mark Crnkovich, MD(Radiation Oncology)

Tom Pedrick, MD(Radiation Oncology)

Praveen Dubey, MD(Radiation Oncology)

Megan DeHaan, MD(Radiation Oncology)

Radiation Oncology

Husain Rasheed, MDBoard-Certified in Medical

Oncology and Internal Medicine

Medical Oncology

• Breast Health Navigator• Patient Navigator • Rehabilitation & Wellness

services including lymphedema therapy, occupational therapy, physical therapy, and speech therapy

• Dietician services• Clinical trials• Pain Management• Palliative Care • Hospice referral• Pharmacist(s)

• Licensed Social Workers • Wound/Ostomy services• American Cancer Society • Cancer Support group • Breast Cancer Support group• Community Health Resource

Center • Education• Massage Therapy• Financial Counseling• Pre-certification services

We offer a multitude of resources to our patients which include:

Hydi Laidlaw-Smith, DOBoard-Certified General Surgery

Lauren McDowell-Jacobs, MDBoard-Certified General Surgery

Paul Taiganides, MDBoard-Certified General Surgery

Department of Specialty Care, General Surgery


The Center for Cancer Care is proud to be accredited (with Commendation) by the Commission on Cancer (CoC). CoC accreditation is granted to facilities that have voluntarily committed to provide the best in cancer diagnosis and treatment and are able to comply with the established CoC standards.

Patients who obtain care at a CoC-accredited cancer program receive the following benefits: • Quality care close to home• Comprehensive care offering a range of state-of-the-art services and equipment• A multidisciplinary team approach to coordinate the best cancer treatment options available• Access to cancer-related information and education • Access to patient-centered services such as navigation• Options for genetic assessment and counseling, and palliative care services• Ongoing monitoring and improvement of care• Assessment of treatment planning based on evidence-based national treatment guidelines• Information about clinical trials and new treatment options

• A cancer registry that collects data on cancer type, stage, and treatment results, and offers lifelong patient follow-up

Knox Community Hospital (KCH) continues to be a member of the Columbus Community Clinical Oncology Program (CCOP). CCOP is an Ohio nonprofit corporation whose mission is to deliver state-of-the-art cancer care to patients in their communities through clinical trials. The National Cancer Institute (NCI) defines clinical trials as research studies in which people help doctors find ways to improve health and cancer care. Each study tries to answer scientific questions and to find better ways to prevent, diagnose, or treat cancer.

There are different types of clinical trials including: • Treatment Trials test new treatments (like new cancer drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods

such as gene therapy).• Prevention Trials test new approaches, such as medicines, vitamins, minerals, or other supplements that doctors believe may lower the risk of a certain type

of cancer. These trials look for the best way to prevent cancer in people who have never had cancer or to prevent cancer from coming back or a new cancer occurring in people who have already had cancer.

• Screening Trials test the best way to find cancer, especially in its early stages.• Quality of Life Trials (also called Supportive Care Trials) explore ways to improve comfort and quality of life for cancer patients.

Service Report continued... Sandy Kollar, MSM-HCA, RN


The Center for Cancer Care continually strives to serve the needs of our community by providing excellent service, evidence-based care and the best outcomes for our patients.

Radiation Oncology

2012 2011 2010 2009 2008

Total Treatments 3,083 3,292 3,077 2,472 2,957

2012 2011 2010 2009 2008

Total Patients 129 132 125 106 124

Medical Oncology

2012 2011 2010 2009 2008

Clinic Visits 3,036 2,875 2,992 2,864 2,650New Patients (IP/OP) 362 346 354 228 258Clinic Treatments - all 5,449 4,985 4,515 4,650 4,686

Service Report continued... Sandy Kollar, MSM-HCA, RN


Sandy Petros, BS, MT(ASCP), CTR THE CENTER FOR CANCER CARE

Registry Report

The Cancer Registry at Knox Community Hospital (KCH) continues to be an integral part of the Center for Cancer Care. The registry reports cancer cases to both the National Cancer Data Base (NCDB) and to the Ohio Cancer Incidence Surveillance System (OCISS) and follows many detailed instructions for coding patient diagnoses, treatment, and outcomes. Registry data is maintained with standardized quality control mechanisms supporting meaningful evaluation and analysis.

The registry also participates in monitoring compliance with the Commission on Cancer (CoC) reporting tools such as the Cancer Program Practice Profile Reports (CP3R). For 2012, Knox Community Hospital is in 100% compliance with these measures.

KCH accessioned 240 patients with a new diagnosis of cancer in 2012. Table 1 (next page) provides, in detail, the various sites of cancer, stage of cancer at diagnosis, and gender. The major sites overall were breast, prostate, lung, colon, and corpus uteri. These cases were discussed at regularly scheduled multidisciplinary tumor board meetings where facts about the patient and his or her cancer were presented; followed by presentations by members of the diagnostic radiology, pathology, surgery, radiation oncology, and medical oncology teams. The tumor board focused on the patients’ treatment options and all treatments followed the National Comprehensive Cancer Network (NCCN) guidelines.

“A cancer registry is a data system designed for the collection, management and analysis of data on persons with the diagnosis of a malignant or neoplastic disease (cancer). The basic source document is the patient’s health record, from which pertinent information is abstracted for use in the registry.”

(National Cancer Registrars Association, 1998)


Total Sex AJCC Stage GroupMale Female 0 I II III IV Unknown N/R*

Total 240 110 130 19 51 57 22 50 27 14Oral Cavity 11 9 2 1 1 0 1 7 1 0

Lip 2 2 0 1 0 0 0 0 1 0Tongue 3 3 0 0 0 0 0 3 0 0Other 6 4 2 0 1 0 1 4 0 0

Digestive System 42 18 24 1 8 13 4 12 4 0Esophagus 3 3 0 0 1 0 1 1 0 0Stomach 1 0 1 0 1 0 0 0 0 0Colon 18 8 10 1 1 8 3 3 2 0Rectum 5 0 5 0 2 2 0 1 0 0Anus/Anal Canal 2 2 0 0 1 1 0 0 0 0Liver 1 1 0 0 0 0 0 0 1 0Pancreas 7 2 5 0 0 2 0 4 1 0Other 5 2 3 0 2 0 0 3 0 0

Respiratory System 26 15 11 0 1 3 8 14 0 0Larynx 2 1 1 0 0 1 1 0 0 0Lung/Bronchus 23 14 9 0 1 1 7 14 0 0Other 1 0 1 0 0 1 0 0 0 0

Blood & Bone Marrow 13 7 6 0 0 1 0 0 0 12Leukemia 6 2 4 0 0 0 0 0 0 6Multiple Myeloma 5 3 2 0 0 0 0 0 0 5Other 1 1 0 0 0 0 0 0 0 1

Bone 1 1 0 0 0 1 0 0 0 0Skin 8 3 5 3 2 0 0 1 2 0

Melanoma 8 3 5 3 2 0 0 1 2 0

Primary Site of Cancers at KCH in 2012 by Stage Table 1

N/R*=not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown.


Total Sex AJCC Stage GroupMale Female 0 I II III IV Unknown N/R*

Total 240 110 130 19 51 57 22 50 27 14Breast 52 0 52 5 18 16 8 2 3 0Female Genital 17 0 17 0 1 0 0 3 13 0

Cervix Uteri 1 0 1 0 0 0 0 0 1 0Corpus Uteri 13 0 13 0 1 0 0 2 10 0Ovary 2 0 2 0 0 0 0 1 1 0Vulva 1 0 1 0 0 0 0 0 1 0

Male Genital 34 34 0 0 13 21 0 0 0 0Prostate 33 33 0 0 13 20 0 0 0 0Testis 1 1 0 0 0 1 0 0 0 0

Urinary System 19 12 7 9 2 1 0 5 2 0Bladder 10 8 2 8 1 0 0 1 0 0Kidney/Renal 7 3 4 0 1 0 0 4 2 0Other 2 1 1 1 0 1 0 0 0 0

Brain & CNS 1 1 0 0 0 0 0 0 0 1Brain (Malignant) 1 1 0 0 0 0 0 0 0 1

Endocrine 3 0 3 0 3 0 0 0 0 0Thyroid 3 0 3 0 3 0 0 0 0 0

Lymphatic System 13 10 3 0 2 2 1 6 2 0Hodgkin’s Disease 1 1 0 0 0 0 0 0 0 0Non-Hodgkin’s Disease 12 9 3 0 2 2 0 6 2 0

Other/Ill-Defined 1 1 0 0 0 0 0 0 0 1

Primary Site of Cancers at KCH in 2012 by Stage Table 1 continued...

N/R*= not recorded includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-defined or unknown.


The KCH Top Five Cancer Sites overall were compared to the American Cancer Society (ACS) Top Five Sites overall in Charts 1 and 1 a. 21.6%

Corpus Uteri

Colon

Lung

Breast

Prostate

5.4%

7.5%

9.5%

13.7%

KCH Top Five Sites OverallChart 1

Melanoma

Colon

Lung

Breast

Prostate

14.4%4.6%6.2%

13.7% 14.1%

American Cancer Society Top Five Sites Overall Chart 1a

American Cancer Society, Facts and Figures, 2012

Registry Report continued... Sandy Petros, BS, MT(ASCP), CTR


2012 Analytic KCH Cases

FEMALE & MALE

Pancreas

Corpus Uteri

Colon

Lung

Rectum

Breast

Bladder

Prostate

NHL

Lung

Colon

47.3%

3.6%

8.2%

7.7%

11.8%

3.6%

8.1%

29.7%

12.6%

7.2%

7.2%

2013 ACS Facts & Figures

FEMALE & MALE

MelanomaThyroid

Bladder

Corpus Uteri

Colon Lung Prostate

Breast

Colon

Lung

28.8%

13.7%

6.5%

6.2%

5.6%

13.8%

5.9%

6.4%

5.3%

27.9%

The KCH Top Male and Top Female Cancer Sites were compared to the ACS Top Sites by gender in Charts 2 and 2a.

Chart 2aChart 2



Chart 3 illustrates that the majority of oncology patients presenting to KCH at the time of diagnosis reside in Mount Vernon.

The primary purposes of follow-up surveillance of oncology patients are to ensure continued medical care and to monitor the health status of these patients. Surveillance provides the documentation of residual disease or its spread, recurrence, or additional malignancies, and vital status. Additional treatments may be added in the database. Long-term follow-up (2006 to present) of all analytic oncology patients at KCH is 93.5%

Chart 3Patient Residence at Time of Diagnosis

KNOX COUNTYAll Others(Outside of Knox County)Gambier

Centerburg

Utica

Danville

Fredericktown

Howard

Mount Vernon 240 TOTAL CASES

47.7%

12.3%

11.2%

3.7%

3.7%

3.3%

3%15.1%



Amy Shoewalter, BSN, RN, OCN THE CENTER FOR CANCER CARE

Patient Care Improvement Report

The mission of The Center for Cancer Care is “to provide compassionate healthcare service that exceeds the expectations of our community.” Due in part to input for improvements from our center’s staff and members of the Cancer Committee and the continued support from our hospital administration, 2012 was again a year of growth for The Center for Cancer Care.

• Implementation of facility-wide Computerized Documentation System (CDS)

• CEA study conducted in 2011 to identify if patients undergoing colon resection had a pre-op CEA level drawn

Evaluation of 2012 data identified an 18% improvement from 2011 in collection of pre-operative CEAs

• Completion of ONS Course - Safe Handling for Hazardous Drugs for RNs in The Center for Cancer Care

Review of current ONS Standards with implementation of updated policy and improvements in personal protective equipment (PPE) for chemotherapy administration

• Additional Radiation Therapist on staff

• Completion of Palliative Care Quality Study

Development of Physician order set for Symptom Management

Mark Crnkovich, MD(Radiation Oncology)

Tom Pedrick, MD(Radiation Oncology)

Praveen Dubey, MD(Radiation Oncology)

Megan DeHaan, MD(Radiation Oncology)

Radiation Oncology


Becky Dangelo, MSN, RN, CNOR, BHN THE CENTER FOR CANCER CARE

Cancer Conference Coordinator Report

Our weekly Tumor Board, also known as Cancer Conference, is a multidisciplinary forum comprised of medical and radiation oncologists, surgeons, pathologists, and a radiologist. The other

team members are physicians, a breast health navigator, cancer navigator, oncology data specialist, clinical trial nurse, medical and radiation oncology nurses, pain and palliative care nurses, radiation therapists, social workers, occupational and physical therapists, a lymphedema therapist, speech therapist, pharmacists, a dietitian, and members of the executive team.

The conference provides an opportunity to discuss cancer cases, reviewing medical history, x-rays and various scans, surgical interventions, pathology reports, and the diagnosis. Collaborative recommendations and treatment options/planning for individuals are decided to provide optimal patient care utilizing NCCN staging and national treatment guidelines. The conferences, which are a vital part of the patient care process, provide exceptional education and sharing of knowledge among the healthcare team members. Attendees receive continuing medical education credit.

The majority of presented cases are prospective, however, retrospective cases are also discussed. Both unusual tumors and main tumor sites are presented at the conferences. Endoscopic Pictures, PACS radiology, and digital camera pathology slides are viewed during the Tumor Board case presentations.

Tumor Board meets each Thursday at noon in the third floor meeting room. All physicians, advanced practice nurses, general nursing staff, ancillary health care providers and students are welcome to attend the cancer conferences. Healthcare providers are encouraged to present cases at Tumor Board and may contact 740.393.5579 to request a case presentation.

The Tumor Board Coordinator reports quarterly to the Cancer Committee. The report includes the number of tumor cases presented, the tumor sites, and attendance rates of the required multidisciplinary members.

Head & Neck Cases6Lymphoma Cases8

Lung Cases11

Colon Cases12

Breast Cases29

Top Five 2012 KCH Sites Presented to the Tumor Board

0

20

40

60

80

100

TONSILLARTESTICULARSPINDLE CELLSTOMACHSMALL BOWELRENAL

RECTUM

PROSTATE

PANCREASOVARIAN

LYMPHOMA

LUNG

HEAD & NECK

GISTEWING SARCOMAESOPHAGEAL

COLON

CERVICAL

BREAST

BLOOD ANDBONE MARROWBLADDERAPPENDIXANAL

CORPUS UTERI

96 KCH Sites Presented to the Tumor Board in 2012


Becky Dangelo, MSN, RN, CNOR, BHN

THE CENTER FOR CANCER CARE

Breast Health Navigator Report

Breast cancer remains the number one cancer diagnosis at Knox Community Hospital, as it is in the majority of cancer centers. Breast cancer is the second leading cause of cancer death in women with lung cancer being number one.

A drastic reduction of approximately 7% in the incidence of breast cancer was noticed between 2002 and 2003 following results of a study publicized by the Women’s Health Initiative (WHI). The results were attributed

to the decreased use of hormonal replacement therapy (HRT) following menopause. The WHI identified the use of combined estrogen plus progestin HRT being associated with not only an increased risk of coronary heart disease but also breast cancer.

According to the American Cancer Society Facts & Figures (2012) an estimated 229,000 people would be diagnosed with breast cancer in the United States (227,000 women and 2,000 men). According to the CDC (2010) the estimated death rate in Ohio, due to breast cancer, is between 23.4% -30.4%.

In August 2012 I attended a conference in Columbus sponsored by Susan G. Komen and Key Bank. A statement was made that “although Ohio is not the state with the highest number of breast cancer cases Ohio is 4th in the nation in breast cancer mortality.”

The purpose of the conference was to form a group of healthcare advisors to provide and promote education to people in Ohio to decrease the number of breast cancer cases and, more specifically, mortality in our state.

The best protection is early detection, which is imperative to fighting breast cancer, the most common cancer diagnosed in women. Breast cancer develops in breast tissue, usually in the milk ducts (tubes that carry milk to the nipple), or in the lobules (glands that make milk). Inflammatory breast cancer is an aggressive type of breast cancer with the cancer cells blocking the lymph vessels in the skin of the breast. Due to the breast appearing red or inflamed and swollen it is referred to as inflammatory breast cancer. Although rare, breast cancer can also be diagnosed in men.

Education about performing the ABCs (annual mammogram, breast self-awareness exam, and clinical exam) is imperative for breast health and early detection of any skin changes or lumps. Mammography can identify a breast cancer at an early stage when treatment is more effective and a cure is most likely. While mammography is not perfect, it is an accurate screening method. The recommendation is for women to begin having an annual mammogram at age 40.

The earliest indication of a breast cancer is most frequently detected via mammogram prior to being palpated by a woman or her healthcare provider. During a self-exam a woman should look for any skin changes such as puckering, dimpling, indentation, thickening, redness, swelling, nipple inversion, bloody nipple discharge, and/or peau de orange (orange peel appearance of the skin), or breast tenderness. Breast pain is not an early breast cancer symptom. A clinical exam, performed by a healthcare provider, is a physical examination of the breast to observe for any changes in breast size, skin changes, or to feel any lumps and should be performed annually.

Continued on next page...


Important risk factors include being a woman and age. A family history, especially a first degree relative (mother, daughter, or sister) or a personal history of breast cancer is another risk factor, as is gene mutations of BRCA1 or BRCA2. Genetic testing and counseling should be offered to women with a strong family history of breast and/or ovarian cancer.

Digital mammography, breast ultrasound, minimally invasive biopsy procedures, and bone sensitometry are available at Knox Community Hospital as screening and diagnostic services.

The work-up and diagnosing are similar for men and women. Outcomes and treatment options are influenced by the following factors:

• Type of cancer (identified by the pathologist from biopsied tissue)

• Receptor status: estrogen receptor (ER) and progesterone receptor (PR)

• Herceptin receptor (Her 2 Nu)

• Stage which is determined after surgery, various scans and other testing

• General health status, any co-morbidities, and age at time of diagnosis

There is a period of increased anxiety for women, and men, who are informed of the need for further evaluation due to an abnormal mammogram. Goals, as the breast health navigator (BHN), are to decrease a patient and loved one’s fear/anxiety and to shorten the time from identification of an abnormal mammogram to diagnostic examinations and surgical consult. Coordination of services to expedite care is performed to provide seamless, quality, competent and optimal patient care, satisfaction, and outcome. This BHN is dedicated to providing education concerning prevention, screenings, and navigation throughout the process, from early detection of an abnormal mammogram or self-found lump/mass, to diagnosis and/or the breast cancer journey, and survivorship.

Breast Health Report continued... Becky Dangelo, MSN, RN, CNOR, BHN

Affected father Unaffected mother

Affected

Unaffected

heterozygous homozygousrecessive

Affectedson

Affecteddaughter

Unaffectedson

Unaffecteddaughter

Source: http://upload.wikimedia.org/wikipedia/commons/2/2f/Autodominant_en.svg

Key BRCA Points• A woman’s risk of developing breast and/

or ovarian cancer is greatly increased if she inherits a deleterious (harmful) mutation in the BRCA1 gene or the BRCA2 gene.

• Men with these mutations also have an increased risk of breast cancer, and both men and women who have harmful BRCA1 or BRCA2 mutations may be at increased risk of additional types of cancer.

• Genetic tests can check for BRCA1 and BRCA2 mutations in people with a family history of cancer that suggests the possible presence of a harmful mutation in one of these genes.

• If a harmful BRCA1 or BRCA2 mutation is found, several options are available to help a person manage their cancer risk.



2012 Accomplishments:

The Mother, Daughter, Sister and Friends Project (MDSF Project) grant proposal was submitted to the Susan G. Komen for the Cure Columbus Affiliate and accepted for 2012-2013. The MDSF Project provided coverage for those 40/older who were uninsured or underinsured, ineligible for Breast and Cervical Health Screening Project assistance; 40/under at risk who were uninsured or underinsured; and those 40/under with an area of concern or suspicious breast mass. Treatment needs, survivorship issues, and support was provided.

Mother, Daughter, Sister and Friends Project

0 30 60 90 120 150

Tai ChiNutritional Counseling

Surgical BrasLymphedema Evaluation & Sleeve

Bone DensityMRI

Surgical ConsultFine Needle Aspiration

BiopsiesDiagnostic Mammogramsand/or Ultrasounds

Screening Mammograms

Survivorship assistance massage therapy, medication assistance and transportation were also provided.

Services Provided

An Amish Preventative Care Clinic was initiated in August 2012 which evolved after a community outreach program was provided to a group of Amish women in 2011. During the educational program about breast health an inquiry was made by the women of the availability of a clinic. After numerous planning sessions the clinic was initiated with a total of 29 women participating in the clinics with various services (mammograms, annual exams, pap tests, and lab work) available to them. An educational program was provided during the clinic with provision of information about various types of cancer and preventative screenings, heart health, diabetes, exercise and nutrition.

The women reported being very pleased that the clinic had been initiated. The majority had never had a mamogram and reported it was not what they envisioned it to be like. They also related that they would have mammograms in the future. The women were very appreciative of the services and various aspects of health education presented.

Amish Preventative Care Clinic

A Young Survivors Breast Cancer Support Group was initiated in March 2012. This group continues to meet monthly. The Young Survivor Coalition continues to provide information and kits for these young women.

Young Survivors Breast Cancer Support Group

The moment you survive your diagnosis you become a survivor.

The moment your cancer has been detected your success story begins.


The goal is to empower, to enable, and to educate as well as to promote physical, emotional, and spiritual health and healing to breast cancer survivors. Patients share their journey and experiences which promotes both individual and group growth. This group meets monthly in the Knox Medical Pavilion.

Breast Cancer Support GroupBecause how a woman looks can affect how she feels, this program helps improve a woman’s self-image as she undergoes treatment. This American Cancer Society program provides free classes each month in the Knox Medical Pavilion for all women receiving cancer treatment. A make-up kit valued at $300.00 is given to each participant. The program is facilitated by a licensed cosmetologist and a facilitator trained by the American Cancer Society. Women are instructed how to apply makeup, to wear hats and scarves, and to help them look good and feel better about themselves. This program is a collaborative effort by the American Cancer Society, the National Cosmetology Association, and the Cosmetic and Toiletry and Fragrance Association. The Look Good…Feel Better Program is held monthly at the Knox Medical Pavilion.

Look Good… Feel Better Program

This program is provided by the American Cancer Society and provides one-on-one support to a person with breast cancer. The support is provided by a trained volunteer who has been through the journey of breast cancer. Referrals to Reach to Recovery are ongoing.

Reach to Recovery


Ongoing in 2012:

This group is for women in the age group of 20s to 45. The goals are the same as with the other group however, younger women may be confronted with different issues than older aged women. This group has the opportunity to share and ask questions of concern and interest that may impact them at their age.

Young Survivors Breast Cancer Support Group

The CDC initiated a federal grant to the Ohio Department of Health in 1994. Knox County is among the counties served by Region5 with services available including pap and pelvic exams, clinical breast exams, mammograms (screening & diagnostic), ultrasound, surgical consult, breast biopsy (on a limited basis), fine needle aspiration, colposcopy and endocervical currettage.

Knox Community Hospital provides services to women referred by the BCCP Project.

Region 5 Breast & Cervical Health Screening Project (BCCP)

The moment you survive your diagnosis you become a survivor. The moment your cancer has been detected your success story begins.


Providing our community with education on cancer prevention, detection and screening guidelines/opportunities is an integral part of our services from the Center for Cancer Care at Knox Community Hospital.

Our Annual Survivor Event was held on June 21 at Kenyon College. Over 80 attendees enjoyed talks from local survivors Jan Legg and John Shaw. Nationally known comedian Mack Dryden , also a cancer survivor, kept the evening light with humor.

The Center for Cancer Care continues to partner with the American Cancer Society (ACS). Promotion and coordination as well as meeting rooms are provided for ACS programs such as I Can Cope and Look Good Feel Better. ACS programs were promoted to our cancer support groups, on WMVO radio and to local groups.

In 2012 the Center for Cancer Care provided wigs to individuals with hair loss from cancer treatment. The “Wig Bank,” a program from the ACS, provided the wigs at no cost to the community.

In 2012 our county was honored to be selected as a site to host enrollment for the Cancer Prevention Study 3 (CPS 3). CPS 3 is a national study funded by the ACS and designed to better understand the impact of lifestyle, environment and genetic factors on an individual’s risk to develop cancer. This is the third such study from the ACS. The first study conducted in the 1950s linked cigarette smoking to cancer. CPS II, conducted from 1982 to 2006, focused on similar aspects to CPS 3. Enrollment held at the Knox County Relay for Life on June 15 consisted of registration, abdominal circumference, a laboratory panel and a short survey. Staff from the CCC volunteered, serving as chair and various other duties during enrollment. Community interest was generated by presentations to local groups and businesses. The number of persons enrolled at our site was 125. National enrollment opportunities for CPS 3 will conclude in December 2013.

Staff volunteered at the Knox County Fair on July 25 to hand out information on Melanoma and Screening Guidelines from the American Cancer Society. We also provided beaded bracelets that change color with sun exposure as a reminder of sun safety.

Plans for community education and services in 2013 include: hosting a head and neck cancer screening night, provide an educational offering to review recognition of possible skin cancer lesions to area cosmetologists, and continuing to raise awareness of colorectal cancer by offering free screening kits during the month of March.

Diana Endsley RN, OCN, Patient Navigator

THE CENTER FOR CANCER CARE

Community Outreach Program Report


Community Outreach Program Report continued... Diana Endsley RN, OCN, Patient Navigator

Supportive Services Date Presented Outcomes/Findings Cancer Committee Review Date

Look Good Feel Better - A partnership with the American Cancer Society

Held the 3rd odd Mon. & 3rd even Wed. of the month

Average monthly attendance: 1-2 12/13/2012

Breast Cancer Support Group Held the 1st Friday of the month Average monthly attendance: 19 12/13/2012

Cancer Support GroupHeld the 2nd Thursday of the month (excluding July & August)

Average monthly attendance: 2 12/13/2012

Young Women’s Cancer Support Group (New group initiated in March 2012)

Held the 3rd Monday of the month Average monthly attendance: 10 12/13/2012

I Can CopeOffered monthly/ held 3 months in 2012

Average monthly attendance: 10-11 12/13/2012

Prevention & Early Detection Programs Date Presented Outcomes/Findings Cancer Committee

Review Date*Colorectal Cancer Screening FIT Kits offered to the community

During the month of March614 kits distributed/165 specimens returned/15 specimens positive for blood

12/13/2012

*Mammograms 2012Screening 3,488 Diagnostic 793/BCCP 18

12/13/2012

*Colonoscopies 2012 962 colonoscopies 12/13/2012

*Prostate Screening offered by Dr. Scott Barkin. Digital Rectal Exam (DRE) and PSA included.

Offered 1 day in September and in October 2012

68 men screened/8 abnormal DRE/3 elevated PSA’s/5 with BPH/1 diagnosed with cancer

12/13/2012

Amish Preventive Care Clinic: Ongoing from December 2011. Committee met weekly to plan, implement and evaluate clinics. Meetings with the Amish community held to determine interest and need. Screening mammograms, laboratory panel, pap/pelvic exams and breast health information offered.

Clinics held:8/24, 9/21, 10/19, 11/19, and 12/14/2012

A total of 29 women seen in the clinic. 22 mammograms with 2 abnormal resulting in US with benign finding. 6 routine pap/pelvic exams and 1 pelvic exam; all negative for lesions or malignancy. 13 laboratory panels, 6 elevated cholesterol results; f/u by PCP.

12/13/2012




Prevention & Early Detection Programs Date Presented Outcomes/Findings Cancer Committee

Review Date

Breast Health Education

2/92012

5/11/2012

5/14/2012

9/25/2012

10/4/2012

10/5/2012

10/24/2012

Display and literature presented at Kenyon Athletic Center.

ACS programs available for breast cancer patients, presented on WMVO radio talk show.

Breast cancer survivor shared the benefit of mammograms. Education on breast health presented to Curves; 52 attended.

Breast health education presented at Annual Amish Safety Day; attendance 150.

Education provided at Wal-Mart.

Education to Junior and Senior Health Technologies Class at the Knox County Career Center; attendance 30.

Annual Breast Health Awareness Event Community cancer survivors speakers were Joan Kidwell and Britney Misencik. Ron Coleman, a breast cancer survivor, was the main speaker. Dakota Smith spoke in support of breast cancer awareness; attendance 119.

Colorectal Cancer Education 2012 Hispanic Community Education/Attendance: 10

Facility Based Education Date Presented Outcomes/Findings Cancer Committee Review Date

CoC Seminar: Ensuring the delivery of Patient Center Cancer Care

1/24/2012 12/13/2012

Webinar Presentations offered to KCH staff in the 3rd Floor Meeting Room at KCH

9/9/2012

10/23/2012

New Developments in Prostate CancerAttendance: 9

Colon Cancer Screening/ Attendance: 8

Journal Club for OncologyMet once a month during the months of February, March & April

12/13/2013

Paragon computer system and meaningful use throughout the hospital

April 2012 Education on new EMR for staff 12/13/2013



Facility Based Education (continued) Date Presented Outcomes/Findings Cancer Committee

Review DateIndividual Staff Education 2/24/2012

5/16/2012

6/16/2012

8/2/2012

8/9 & 10/2012

8/14/2012

8/25/2012

11/28/2012

Diana Endsley attended/ ASH review

Vicky Lacksonen attended/ Venous Disease, Lymphedema and Compression

Peg Horn & Dr. Rasheed attended the ASCO Review

Becky Dangelo completed Susan G. Komen Community Health Advisor Training Program

Vicky Lacksonen attended Wound Management Strategies for Patients with Lymphedema

Vicky Lacksonen and Becky Dangelo attended the Lymphedema Summit

Sandy Kollar and Becky Dangelo attended Quality Measure: From Development to Practice

Amy Shoewalter and Karen Cherup provided “Train the Trainer”, reviewing the policy and competency for implanted port access/care with 17 KCH Unit Coordinators

12/13/2013

Public Education Date Presented Outcomes/Findings Cancer Committee Review Date

Education Posters: One poster displayed monthly in the lobby on the ground floor of the Knox Medical Pavilion.

2012

Posters on Cervical Cancer; Non-Small Cell Lung Cancer; Colon Cancer; Cancer Awareness; Ovarian Cancer; Melanoma; Pancreatic Cancer; Prostate Cancer; Breast Cancer; Lung Cancer; and Esophageal Cancer.

12/13/2013

Grants Date Presented Outcomes/Findings Cancer Committee Review Date

Susan G. Komen Grant; Mother, Daughter, Sister, and Friends Project.

February 2012

4/1/2012

December 2012

February notice from Komen that the grant submitted in December 2011 was approved. Funding for 2012 was $83,937.

April 1 the grant became effective.

December grant proposal for 2013-2014 submitted.

12/13/2013

* Commission on Cancer Standard 4.2



Kwi Holland, Vice President of Information Systems THE CENTER FOR CANCER CARE

Information Technology Report

We have implemented a new Electronic Health/Medical Records system environment that consists of a McKesson Paragon suite of applications, and a Forms on Demand system that delivers benefits to our patients by providing enhanced features to already existing key functions as well as new features that enable better patient care.

The new system environment provides timely delivery of information for the medical staff and other care givers. Calling up a patient’s past medical history and current medication information, looking up test results, running queries to search for adverse drug reactions, and reviewing the multidisciplinary care documentation to support medical decision making are all part of new functionalities of our new EHR/EMR.

We are improving patient safety through the use of a Medication Administration System that automatically documents the administration process that results in complete clinical documentation for every patient. The positive ID verification and bar coding system double checks medication and other vital supplies. Integrated interface systems working together to collect and evaluate patient vitals, standardized Clinical Assessment and care plan throughout the facility and the adoption of standardized order sets are all coming together to deliver better patient care services at Knox Community Hospital.


Ann Wilson, Director, Diagnostic Imaging THE CENTER FOR CANCER CARE

Diagnostic Imaging Report

The Diagnostic Imaging Department was able to complete work on several long-term initiatives in 2012. First, a new PACS (computerized image review and storage system) was implemented in March so that it would be ready to interact with the new hospital computerized system which was implemented in June. Also in June, a Voice Recognition System was implemented to perform physician transcription in order to decrease the time that it takes to send a dictated report to a waiting physician. The Report Turn-Around-Time (TAT) was decreased drastically as users became more accustomed to the use of the voice recognition product. Report TAT is measured from the time an exam is completed to the time a typed report is available for an ordering physician to view. TAT in Diagnostic Imaging decreased from 24 hours on average before the use of voice recognition to an average of 12 hours or less before the end of the year.

A new CT unit was installed in June of 2012. The new unit is capable of performing advanced 3D imaging with the use of 64 slice CT technology.

Under the direction of the department’s Medical Director, Kingsley Orraca-Tetteh, MD, the hospital began a search for an organization to partner with Dr. Orraca-Tetteh to interpret all exams on a 24/7 basis. An interdisciplinary team was established in December to investigate all possibilities.


Adonyah Whipple, BSN, RN, CHPN THE CENTER FOR CANCER CARE

Palliative Care Report

Palliative Care is patient and family centered care focusing on quality of life by preparing for, preventing and treating suffering. Beginning at the time of a cancer diagnosis, The Palliative Care Team has the goal of supporting an individual and their loved ones through the hardships of achieving cancer survivorship. This model of care is designed to work hand in hand with curative and life-prolonging treatments with intense focus on symptom management. The Palliative Care Team works to prevent and manage any physical, emotional, social or spiritual burdens an individual may be experiencing. Patients and loved ones served by the Center for Cancer Care at Knox Community Hospital are supported before, during and after the curative plan of care with the purpose of maintaining strength, comfort and independence.

In 2012, the Center for Cancer Care and the Palliative Care Team came together to embark on a new and exciting journey. With the active integration of Palliative Care Services within the Center, 39 patients were provided with a new model of collaborative cancer care. Of these 39 patients, there were 27 symptom management visits and 14 visits for end-of-life care needs. Fifteen loved ones who experienced loss to the battle with cancer are being served by the Bereavement Program sponsored by the Palliative Care Team. This program helps to guide individuals through the grief process for 13 months or longer after the death of the individual who lost their battle with cancer.

An article published by the New England Journal of Medicine in the August 9, 2010, edition, written by Dr. Jennifer Temel, MD and colleagues, reported how early introduction of Palliative Care helped patients with metastatic lung cancer to be less depressed, have a better quality of life and longer life expectancy. These are some of the most important benefits to having a Palliative Care Program. Patients have access to resources such as physicians, nurses, dietitians, social workers, clergy, physical and occupational therapists, massage therapists, pharmacists and more. This allows the patients an opportunity to make informed healthcare decisions that are best suited for them as individuals.

It is the intention of the Palliative Care Team at Knox Community Hospital to support the Cancer Survivor and their loved ones in mind, body and spirit throughout the entire disease process. With competent interdisciplinary care and support, a person can maintain a sense of self and quality of life when it feels as

if life is being stripped away. The Center for Cancer Care and The Palliative Care Team at Knox Community Hospital wish to help individuals find a smile where sometimes only tears and anger can be found.

To get through the hardest journey, we need take only one step at a time; but we

must keep on stepping.

~ Chinese Proverb


Debbie Link, Director, Center for Rehabilitation & Wellness THE CENTER FOR CANCER CARE

Rehabilitation Report

Occupational and Physical Therapy and Speech Therapy are vital to the treatment of individuals who are under going and recovering from various cancer treatments. Custom treatment programs are developed for each person and targeted toward increasing joint range of motion, strength and flexibility while decreasing pain, improving gait and balance, and helping with speech and cognitive skills.

Lymphedema management at Knox Community Hospital is proactive and often provides pre-surgical education for clients that are anticipated to have lymph nodes removed. This includes taking circumferential measurements that can be used for comparison should lymphedema symptoms develop over time. Lymphedema develops gradually as the lymphatic system becomes overwhelmed and unable to handle the lymphatic fluid levels. Lymphedema is a progressive disorder and can lead to skin integrity changes, pain, and self – concept problems. Strategies are taught by a Certified Lymphedema Therapist for long term management of symptoms and compression garment options are discussed. Common areas treated are the breast and thorax, lower extremities, and head and neck.

The Center for Rehabilitation and Wellness is located at 1375 Yauger Road, Mount Vernon, Ohio 43050. Our hours for therapy are Monday and Wednesday 7 am – 7 pm, Tuesday 8 am – 5 pm, Thursday 8 am – 6 pm, and Friday 7 am – 6 pm, with variation occurring on an as needed basis.


Knox Community Hospital has been accredited by the Commission on Cancer since 2010.

Knox Community Hospital proudly partners with the American Cancer Society to provide

a full range of cancer care services.

You can contact the American Cancer Society by going to: www.cancer.org or by calling 1.800.ACS.2345.

Get more information about Knox Community Hospital by visiting:

www.KnoxCommHosp.org


Medical Oncology 740.393.5551

Radiation Oncology740.393.5513


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2013 KCH Annual Cancer Report | 2012 data

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