2015 - Blessing Health System · 2018-07-04 · 4 CANCER COMMITTEE CHAIRMAN REPORT CHRISTIAN R....

2015 annual report

Accredited Comprehensive Community Cancer Program

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COMMITTEE MEMBERS / PROGRAM COMMITTEE REPORTS 2015Blessing Hospital Cancer Committee Members....................................................3Cancer Committee Chairman Report..................................................................4-5Cancer Committee Liaison Physician Report........................................................6Cancer Center Director Report/Team Picture.......................................................7-8Radiation Oncology Report................................................................................9Radiation Therapy Team Picture.........................................................................10Monitoring Compliance with Evidence-Based Guidelines......................................11Medical Oncology Report/Team Picture..............................................................12-13Cancer Registry Report.....................................................................................14American Cancer Society Representative Report.................................................15

SUMMARY OF CANCER REGISTRY STATISTICSRegistry Incidence by Site & Sex Compared to American Cancer Society...............162014 Estimated Facts and Figures and Summary Report......................................17 Counties Served by Blessing Cancer Center 2014................................................18Cancer Projections in Illinois 2015......................................................................19 Class of Case Report & Age at Diagnosis by Sex Report.......................................20Primary Site Five-Year Trend..............................................................................21-22Summary by Body System & Gender Report.......................................................23Screening Program Report 2015........................................................................24-25Breast Cancer Report........................................................................................26 Lung Cancer Report..........................................................................................27Studies of Quality..............................................................................................28-31Clinical Trial Accrual Report................................................................................32

FEATURED SITE - MELANOMA OF THE SKIN STUDYOverview Report by Dr. Christian Zwick, D.O., General Surgeon............................33-35Staging of Melanoma.........................................................................................36-37Risk, Type, Protection, Symptoms.......................................................................38-39Incidence & Mortality Trends & Projections..........................................................40-47Cost to Treat.....................................................................................................48Key Points.........................................................................................................49References........................................................................................................50Five-Year Rate Change Incidence & Mortality........................................................51-52Age by Gender & Stage......................................................................................53-54Treatment & Histology........................................................................................55Blessing Hospital Cancer Registry Reports............................................................56-58Illinois Incidence................................................................................................59

REFERENCES...................................................................................................60

CANCER CENTER SERVICES............................................................................61-62

TABLE OF CONTENTS

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BLESSING HOSPITAL COMPREHENSIVE CANCER PROGRAM 2015 CANCER COMMITTEE MEMBERS

Cancer CommitteeChairmanCancer Liaison Physician/SurgeonDiagnostic RadiologistPathologistMedical OncologistMedical OncologistRadiation OncologistCancer Program AdministratorPalliative Care Team MemberSocial Worker / Psychosocial Services CoordinatorCancer Conference CoordinatorCancer Registry Quality Coordinator / CTRCommunity Outreach CoordinatorClinical Research CoordinatorOncology NurseQuality Improvement Coordinator

Christian Zwick, DO

Harsha Polavarapu, MD

John Schlepphorst, MD

Robert Gutekunst, MDRaymond Smith, MDM. Amjad Ali, MDMark Khil, MD

Lori Wilkey, MBA, RTRM

David Lockhart, MD

Claudia Lasys, MSW, LCSW, OSW-C

Cathy Brogdon, AAS, CTR

Vera Bickhaus, CTR

Stephanie Willey, RN, BSN

Kelly Sorrill, CCRP

Carla Smith, RN, MSN, AOCNSHeather Girouard, Performance Excellence Coordinator

Karthik Koduru, MD

Christian Zwick, DO

Josh Reike, MD

Rex Schulz, MDKathryn Arrambide, MDChristian El-Khoury, MDYoung Yu, MD

David Loyd, RN, MBA

Jeri Conboy, PhD

2015 Cancer Committee Members 2015 Designated Alternates

John Arnold, MD Richard O’Halloran, MDSarah Pruett, RN, BSN, OCN, Cancer Center Nurse Navigator

Donna McCain, MS, RNEmily McCaughey, RD, LDNJo Fuller, Administrative Secretary Rosie Baskett, Cancer Center Financial Counselor

Brenda Blickhan, RN, OCNAshley Janssen, RN, BSN, OCN

Jennifer Micho, Cancer Registry Coordinator

Courtney Heiser, American Cancer Society

Kristen Cook, BSN, RN-BC, Nurse Manager, Oncology

Sheila Hermesmeyer, RN, OCN, Breast Center Nurse Navigator

Karen Dames, RN, BSN, Admin. Coordinator Regulatory Compliance

Karen Kerns, MS, CCC-SLP, MBASara Heinecke, RN, ROCN, Radiation Therapy Supervisor

Regenia Stull, RN, MSN, Associate CNO, Acute Care SVS

2015 Active Participants

Standard 1.3: Cancer Committee 2015 Attendance: Each required member or the designated alternate attends at least 75% of the cancer committee meetings held during any given year and this was achieved in 2015.

Resigned Members/Participants 2014: Marsha White, RN

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CANCER COMMITTEE CHAIRMAN REPORT CHRISTIAN R. ZWICK, D.O.

The dedicated personnel that work at our Cancer Center here at Blessing Hospital can be proud of their many accomplishments for 2015. As I look back and review this information, the efforts of the nurses, providers, and staff caring for the people in our community become apparent. Allow me to highlight some of our accomplishments.

MEDICAL ONCOLOGY:• Met and exceeded goal to increase nutritional assessment in patients with gastrointestinal and

lung cancers.• Opened Blessing Hospital Infusion Center.• Increased number of patient nurse navigators to two, driven by community needs.• Increased number of oncology nurse practitioners to expand access.

RADIATION ONCOLOGY:• Addition of new TrueBeam Linear Accelerator used for Stereotactic Radiation Therapy and special

procedures like Stereotactic Radiation Surgery.

RADIOLOGY:• 3D Mammography available at both Blessing Hospital and Quincy Medical Group.

SURGERY:• Recruitment of Cardiothoracic Surgeon.• Investigate use of radioactive seeds in tumor localization for breast cancer treatment.

PALLIATIVE CARE:• Extended palliative care consultative services to three long-term care facilities.

CLINICAL TRIALS:• Plans to advance number of clinical trials from prior year with goal for commendation level.

PREVENTION: • Genetic Counseling available through Siteman Cancer Center• Multiple screening and prevention programs – testicular, skin, breast, colorectal, and oral.• Flyer created for primary care providers and patients regarding colorectal screening education.• Provide “No Tobacco” education to grade school students.

STUDIES:• Asked to participate in Commission on Cancer (CoC) studies and investigate follow-up and

recurrence after cancer treatment in hopes of tailoring follow-up based on individual risks.• Monitor compliance with evidence-based treatments.• Check stage and geographic locations for melanoma – help target screening and prevention

opportunities to outlying areas.• Study shows returns to surgery for patients treated with lumpectomy for breast cancer less

frequent with the use of intraoperative ultrasound, margin map and real time mammographic check at time of surgery.

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CANCER COMMITTEE CHAIRMAN REPORT (CONTINUED)CHRISTIAN R. ZWICK, D.O.

QUALITY:• Accredited by Commission on Cancer (CoC) until 2017.• Decreased specimen turnover time in pathology with the appropriate non-use of

Immunohistochemistry (IHC) testing on selected sentinel lymph nodes.• Set up guidelines and recommendations regarding melanoma patients to assist providers –

Adopt CoC guidelines.

ACCOUNTABILITY:• CP3R quality measures show we exceed necessary percentages in all five areas.• CP3R report shows excellent treatment compliance rates for most cancers.• All breast cancer and colorectal patients discussed at multi-team meeting twice monthly.

GENERAL:• New Cancer Liaison Physician named.• New dedicated Administrative Director for Cancer Center.• Two Certified Tumor Registrars (CTRs) and new dedicated Cancer Registry Coordinator.• Addition of resident Liaison.• Needs assessment formed to address healthcare disparities and break down barriers to access

for non-insured and under-insured patient population.• 35 chemotherapy trained nurses and 20 oncology certified or advanced oncology certified nurses.

SURVIVORSHIP:• Expand use of distress tool to Radiation Oncology as well as Medical Oncology.• Dispense survivorship care plans for some prostate and breast cancer patients, with intent to

grow the program in 2016.• Addition of Oncology Nurse Practitioner to assist in extending survivorship care.

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CANCER COMMITTEE LIAISON PHYSICIAN REPORTHARSHA POLAVARAPU, M.D., FACSCOLORECTAL SURGEONThe Cancer Liaison Program was established in 1963 as a component of the Commission on Cancer (CoC) to ensure adequate monitoring of cancer-related activities in their local institutions and surrounding communities. The standards set forth by the CoC ensure that supportive services, prevention, and early detection opportunities are provided to cancer patients and their families.

I am honored to serve in this role since January 2015. I have been collaborating with American Cancer Society (ACS), to ensure appropriate and adequate support services are available to patients and their families. More specifically, we collaborated with the ACS in “80% by 2018” initiative to raise awareness for colorectal cancer screening. We are proud to have all the healthcare providers and leaders in the community involved in this ongoing effort to increase colorectal cancer screening. We also stepped up the awareness and screening programs for Melanoma with the support of Cancer Committee members and the community outreach staff.

As we journey forward into 2016, we do so with a strong pillar of support from our Cancer Committee members, community physicians, patient caregivers, community partners, and Blessing administration and support services. It’s with this circle of strength and dedication that we are able to provide quality cancer treatment to the patients and families of the tri-states area.

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BLESSING CANCER CENTER ADMINISTRATIVE DIRECTORLORI WILKEY, MBA, RTRMThe Blessing Cancer Center is dedicated to the mission of improving the health of our community. We implement best practices in patient care, acquire state-of-the art technology, and focus on prevention, education, and research. As you will see in the following report, the physicians working in our cancer program are the cornerstone of these efforts. Their leadership and the dedication of our team of caregivers and staff is paramount to our success, but they cannot do

it alone. The support of our community make these goals and our mission attainable. Each year our neighbors and friends in this region and beyond show their support for our patients through financial, in-kind and moral support. This support is the foundation of the high-quality and holistic care we are able to bring to region.

Through the financial support of the donors to the Blessing Foundation Cancer Fund, we ensure the patient care plan extends beyond medical necessity. The fund ensures that if a patient is suffering financially, we can offer gas cards to get them to appointments, house payments to lessen their stress, nutritional supplements that they once might have skipped. Our financial specialist and care providers can ask, “What else do you need?” and make sure no financial burden is hindering a patient’s ability to get better.

The support of our community also allows us to improve our technology and environment of care. In 2015, we installed a TruBeam STx System. This advanced technology allows the radiation therapy team to deliver treatment with greater precision and speed. Also new in 2015, the Foundation provided funds to the medical oncology area for individual televisions so patients can control their entertainment during treatment, and the Infusion Center received an exercise bike to help patients pass the time.

In June of 2015, Blessing Hospital’s Moorman Pavilion patient care addition was also completed with unprecedented financial support from the community. The addition provides 52 new single-bed rooms and allows 52 existing patient rooms to become single-bed rooms. It includes the new Blessing Infusion Center. The Infusion Center serves outpatient needs for chemotherapy, blood transfusions, IV antibiotics and fluids, injections, and other treatments. These services were formerly provided on the Medical/Oncology unit.

You will also read in the report about educational and screening efforts. The Cancer Center was able to provide FOBT kits to help screen and raise awareness around colon cancer. These kits are valued at $50 and with the support of the cancer fund, we can provide them to the public for $5. Dr. Quintero, Dermatologist at Blessing Physician Services, also volunteered his time to conduct two free skin cancer screenings. Dentists Dr. Lacey Hauk and Dr. Dennis Wagner similarly stepped up to screen individuals for oral cancer free of charge.

These efforts and more are detailed in the following pages of this report. The Blessing Cancer Center team is committed to providing high-quality cancer care close to home and helping individuals in our community reduce their risk of developing cancer, and when prevention is not possible, giving them the knowledge to take action for early diagnosis. We couldn’t do any of this without your generous support. Thank you for helping us improve the health of our amazing community!

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BLESSING CANCER CENTERADMINISTRATIVE TEAM

BACK ROW, LEFT TO RIGHT: Carla Smith, Stephanie Willey, Ashley Janssen, Emily McCaughey, Rosie Scott, Sarah Pruett

FRONT ROW, LEFT TO RIGHT: Vera Bickhaus, Cathy Brogdon, Jennifer Micho, Claudia Lasys

NOT PICTURED: Lori Wilkey

In 2015, we welcomed Ashley Janssen, RN, BSN, MSN, into the role of Blessing Cancer Center Nurse Manager. Ashley is responsible for the operations of the Blessing Infusion Center and leads the Cancer Center Administrative Team.

Ashley received her Bachelor of Science degree in Nursing at Blessing-Rieman College of Nursing in 2010. Ashley has been an employee of Blessing Hospital for the past nine years working in various roles on the oncology unit. She is an Oncology Certified Nurse and member of the Tri-State Oncology Nurses Association as well as the Oncology Nursing Society.

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BLESSING CANCER CENTER RADIATION ONCOLOGY OVERVIEWYOUNG YU, M.D., RADIATION ONCOLOGISTBoard Certification: American Board of Radiology: Therapeutic RadiologyMedical Education: Yonsei University School of Medicine Seoul, KoreaInternship: St. Clare’s Hospital & Health Center, New York, NYResidency: State University of New York, SUNY Upstate Medical Center

Radiation Therapy is one of three major modalities in the treatment of cancer, with surgery and chemotherapy.

Blessing Hospital’s Radiation Oncology Department has been accredited by the American College of Radiation Oncology (ACRO) since 2001. The ACRO accreditation process ensures that Radiation Oncology facilities, staff and treatment program are in accordance with modern accepted standards for Radiation Therapy delivered in the United States.

Blessing’s Radiation Oncology Department is led by two board certified Radiation Oncologists, Young W. Yu, M.D. and Mark S. Khil, M.D. These experienced physicians work full-time at Blessing Hospital and are on-site daily to oversee the radiation treatment of each patient. The Radiation Oncology Team also consists of a board certified Ph.D. Physicist, a certified Dosimetrist, certified Radiation Therapists (5), nursing staff (3) and a simulation technologist. The radiation Oncology Department treats an average of 350 new patients a year, delivering an average of 8000 radiation therapy treatments annually.

Currently, the department houses two linear accelerators, the Varian Trilogy and the Varian TruBeam. Blessing Hospital’s Radiation Oncology Department installed the Varian TrueBeam STX system and has been treating patients with this State-of-the-Art linear accelerator since October 2015. The new TrueBeam STX system also has built-in cone beam CT functions. The robotic treatment couch can further increase the accuracy of the treatment significantly. The TrueBeam STX is significantly faster and precise. In Radiation Oncology practice, stereotactic radiosurgery and stereotactic body radiation therapy are increasingly important. Our new Varian TrueBeam STX system offers a major advantage in delivering stereotactic radiation therapy with precision and speed.

The Blessing Radiation Oncology Team continues to offer brachytherapy including radioactive Iodine-125 seeds implants and administration of radioactive Radium to treat painful bony metastases.

Along with the excellent service provided by the Radiation Oncology Department, complementary services are offered in the form of financial counseling, nutritional counseling, and psychosocial counseling to assist the patient as needed throughout their treatment journey.

Mark S. Khil, M.D., Radiation OncologistBoard Certification: American Board of Radiology - Radiation OncologyMedical Education:College of Medicine Seoul National UniversityInternship:State University of New York - Downstate Medical CenterState University of New York Health Science CenterResidency:State University of New York - Downstate Medical CenterState University of New York Health Science CenterFellowship:State University of New York - Downstate Medical CenterState University of New York Health Science Center

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Sara Heinecke, RN, is the Supervisor of the Radiation Therapy Department. She has been with the organization since 2007 and received a Radiation Therapy Certificate in 2013. She is a graduate of the John Wood Community College LPN Program and received her Associate Degree in Nursing from Southeastern Community College. Prior to joining Blessing Hospital, she was clinic nurse and then Director of Nursing at skilled nursing facilities.

BLESSING CANCER CENTERRADIATION THERAPY TEAM

BACK ROW, LEFT TO RIGHT: Carla Smith, Stephanie Willey, Ashley Janssen, Emily McCaughey, Rosie Scott, Sarah Pruett

FRONT ROW, LEFT TO RIGHT: Carol Akers, Deanna Marcionetti, Wendy Hamilton, Tu Haifeng, Katie Karhliker, Gina Eickelschulte, Valerie Satterhwaite

SECOND ROW, LEFT TO RIGHT: Michelle Schafer, Sara Heinecke, Kathy Rossmiller, Stacy Brod, Megan Hale, Shelley Echternkamp, Pamlah Teel, Chad Powell

NOT PICTURED: Lori Flesner

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STANDARD 4.6: MONITORING COMPLIANCE WITH EVIDENCE-BASED GUIDELINES

HARSHA POLAVARAPU, M.D., COLORECTAL SURGERY SPECIALIST

Each year, a physician member of the cancer committee performs a study to assess whether patients within the program are evaluated and treated according to evidence-based national treatment guidelines* (NCCN). Study results are presented to the cancer committee and documented in cancer committee minutes.

STUDY NAME: Lung Non-small Cell Carcinoma (Stage IIIA – IIIB). Surgery is not the first course of treatment for cN2, M0 cases REASON FOR STUDY: Study was completed to be proactive with being compliant with **CP3R measure for the year of 2013 and 2014 using cancer registry data. STUDY OUTCOME: 2013: Total of 10 patients compliant. One patient refused treatment, admitted to hospice.2014: Total of 5 patients compliant. One patient refused treatment, expired.

STUDY CONCLUSION: 100% of patients met this measure when compared to NCCN guidelines and CP3R measures.

Harsha Polavarapu, MD

*National Evidence-Based Guidelines (NCCN): On January 31, 1995, a press conference was held to announce the creation of a national alliance to develop and institute standards of care for the treatment of cancer and perform outcomes research – and so the NCCN was born. With 13 original NCCN Member Institutions, the goal was to ensure delivery of high-quality, cost-effective services to people with cancer across the country. NCCN became a developer and promoter of national programs to facilitate the fulfill-ment of NCCN Member Institution missions in education, research, and patient care. Now an alliance of 26 of the world’s leading cancer centers, NCCN develops and communicates scientific, evaluative information to better inform the decision-making process between patients and physicians, ultimately improving patient outcomes.

**CP3R Measures: The CP3R provides feedback to Commission on Cancer (CoC), accredited cancer programs to:• Improve the quality of data across several disease sites• Foster preemptive awareness of the importance of charting and coding accuracy• Improve clinical management and coordination of patient care in the multidisciplinary setting• CP3R currently includes 19 measures covering 8 primary sites.

References: cp3rnavigation. Pdfhttp—www.nccn.org

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BLESSING CANCER CENTER MEDICAL ONCOLOGY OVERVIEW

Quincy Medical Group’s Medical Hematology/Oncology team is dedicated to the care of patients with cancer and blood disorders. Our highly specialized care takes a multidisciplinary approach and focuses on quality of life for those we serve.

The medical oncology team consists of 5 board certified hematologist/oncologist and 2 certified nurse practitioners. Our team consists of approximately 40 other health care specialists including oncology certified registered nurses, licensed practical nurses, certified medical assistants, financial specialists, pharmacists, pharmacy technicians, patient excellence representatives, medical laboratory technicians, just to name a few. We have a full-time oral oncolytic nurse who specializes in assisting the providers with patients receiving oral drug therapy ensuring compliance with oral therapy is achieved.

Medical Oncology has an 18-chair infusion suite providing chemotherapy, biotherapy, immunotherapy, hormonal therapy, targeted therapy and a variety of infusion services. Medical Oncology also offers participation in clinical trials through Alliance for Clinical Trials in Oncology, sponsored by Washington University School of Medicine. This affiliation provides access to a full menu of new trials and opportuni-ties for our patients. We believe in engaging patients with a survivorship program aimed at transitioning a cancer survivor from active treatment to long term survivor.

Quincy Medical Group Medical Oncology has been recognized by the Quality Oncology Practice Initiative (QOPI) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI Certification Program provides a three-year certification for outpatient hematology-oncology practices that meet the highest standards for quality cancer care. QOPI is a voluntary, self-assessment and improvement program launched by ASCO in 2006 to help hematology oncology and medical oncology practices assess the quality of the care they provide to patients. This certification for outpatient oncology practices is the first program of its kind for oncology in the United States. Oncologists can achieve certification by meeting the highest standards of care. The QOPI seal designates those practices that not only scored high on the key QOPI quality measures, but meet rig-orous chemotherapy safety standards established by ASCO and the Oncology Nursing Society (ONC). The QOPI Certification Program is a project of ASCO’s Institute for Quality, an ASCO affiliate dedicated to innovative quality improvement programs. For more information, please visit: Http://qopi.asco.org/certification.html

Medical Oncology is committed to providing the best care for every patient every time. We provide personalized, compassionate care right here in Quincy at the Blessing Cancer Center and throughout the tri-state area at six different outreach sites. Our outreach sites in Keokuk, IA; Hannibal, MO; Memphis, MO, Pinkneyville, IL; Pittsfield, IL; and Rushville. IL. Additionally, medical oncology has a relationship with Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine in St. Louis, MO. This direct relationship allows for ease in referrals for services not offered here such as genetic counseling and bone marrow transplant services.

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BLESSING CANCER CENTERQUINCY MEDICAL GROUP- MEDICAL ONCOLOGY TEAM

Raymond Smith, MD Kathryn Arrambide, MD M. Amjad Ali, MD Christian El Khoury, MD Karthik Koduru, MD

Karen Weems, CNP Lisa Knuffman, AOCNP

Quincy Medical Group Medical Oncology Team

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BLESSING HOSPITAL 2015 CANCER REGISTRY REPORT

Jennifer Micho Vera Bickhaus Cathy Brogdon

The Blessing Hospital Cancer Registry has been in existence since 1965 and the Cancer Program at Blessing Hospital first received its accreditation April 1, 1966, through the American College of Surgeons ACoS) Commission on Cancer (CoC). Blessing Hospital Cancer Program renewed its accreditation in January of 2015. The Multidisciplinary CoC was established by the American College of Surgeons (ACoS) in 1922. The CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care.

Blessing Hospital Cancer Registry is currently employed by three full-time cancer registrars. Registrars are data management experts who maintain statistics on patients diagnosed and/or treated with cancer and certain blood disorders at Blessing Hospital. The registry also is required to report benign brain tumors. Registrars analyze statistics and perform studies requested by physicians, administrators, and health care planners to provide support for cancer program development. Blessing’s cancer registrars are members of the National Cancer Registrars Association and Cancer Registrars of Illinois and are required by the CoC to be a Certified Tumor Registrar (CTR) or become a CTR three years after the date of hire. In order to maintain CTR status, registrars comply by meeting CoC standards for continuing education.

Approved by CoC, the reportable date for data collection is January 1, 1995. This ensures better accuracy for reporting statistical data. It is mandatory by law to report cancer data to the Illinois State Cancer Registry and other entities that extract statistical information for public reporting which include, but are not limited to National Cancer Data Base (NCDB), American Cancer Society (ACS), National Cancer Institute (NCI,) SEER Program (Surveillance, Epidemiology, and End Results), and Cancer of Disease Control (CDC). The registry maintains confidential data on patient identification, cancer identification, stage of disease at initial diagnosis, first course of treatment, first recurrence, subsequent treatment for recurrence or progression and yearly follow-up of our patients. The registry successfully maintains a follow-up rate of over 95%. Submitting accurate follow-up information is crucial in order to provide accurate statistics for survival rates. Documenting accurate information on first recurrence after initial treatment is a way of tracking standard treatment modalities.

The registry is comprised of 12,572 analytic/non-analytic cases from 1995-2014. Of this number, 4,426 patients are currently followed on an annual basis. In 2014 there were 585 cases in total added to the Cancer Registry Database System, 563 analytic and 22 non-analytic cases. This report serves as our 2015 Annual Report based on 2014 data.

The Cancer Registry would like to express our sincere appreciation to the Cancer Committee for their leadership and support to the Cancer Registry. As Cancer Registrars, we are proud to be a part of the team made up of physicians, nurses, administration, community outreach and all staff of the Cancer Program who contribute to the diagnosis, treatment and care of our patients.

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American Cancer Society – Lakeshore DivisionCoutney Heiser, BS, Health Systems Manager, Hospitals

Your local American Cancer Society office is a source for most relevant information to help guide you. Appointments are needed for all services to ensure we have the right people available to meet your needs. Hours and services vary by location. You can always call our Cancer Information Specialists at 1-800-227-2345, 24/7 to connect with our valuable services and resources.

TOTAL NO. OF CONSTIENTS SERVED FROM 1/1/15 – 12/31/15

No. of constituents served: 300

No. of newly diagnosed: 274

No. of uninsured and/or on Medicaid: 31

RACE

African American: 9

Caucasian: 181

Declined: 1

Unknown: 109

TOP CANCER SITES

Breast: 102

Lung: 48

Colon/Rectal: 38

Prostate: 12

Bladder: 8

SERVICE TYPE

Personal Health Managers: 247

General Information: 157

Transportation: 88

Hotel/Hospitality: 84

Look Good...Feel Better: 42

Support Groups: 40

Wigs: 32

Reach to Recovery: 20

In 2015, Blessing Hospital, Quincy Medical Group, SIU Family Practice have signed the 80% by 2018 nationwide colorectal cancer screening pledge.

80% by 2018 is a movement in which dozens of organizations have committed to eliminating colorectal cancer as a major public health problem and are working toward the shared goal of reaching 80% screened for colorectal cancer by 2018.

For more information http://nccrt.org/

Courtney is an active participant on the Cancer Committee and is our region’s representative from the American Cancer Society. Courtney serves as ACS staff support for Commission on Cancer (CoC) Programs and has been very helpful in bringing forth resources in the form of e-mail attachments and webinars to share among committee members and health care professionals. Courtney also shares information to help with the new 2015 CoC Standards; Standard 3.1 - Patient Navigation Process, Standard 3.2 - Psychosocial Distress Screening, and Standard 3.3 - Survivorship Care plan. Some of these resources include: “Implementing Survivor Care Plans CoC-accredited Cancer Programs” – Webinar; Colorectal Cancer Survivorship guidelines; Cancer Survivorship E-Learning Series for Primary Care Providers; Collaborative Action Plan Guide 2012: Ensuring Patient –Centered Care; ACS Partnership Report, Support of CoC Standards and Eligibility Requirements.

Courtney is committed in the fight against colorectal cancer, having Blessing Hospital, Quincy Medical Group, and SIU Family Practice sign the 80% X 18 colorectal cancer nationwide screening initiative. She works closely with the community outreach coordinator, Stephanie Willey, and implementing the Freshstart program on campus and has a strong working relationship with current Cancer Liaison Physician (CLP), Dr. Harsha Polavarapu, whom is instrumental in the 80% X 18 colorectal screening initiatives. Courtney is dedicated in providing and ensuring quality services provided by ACS to our patients and staff and has proven in her efforts and commitment to be a valuable Cancer Committee team member.

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REGISTRY INCIDENCE MALE AND FEMALE BLESSING HOSPITAL PRIMARY SITE VS AMERICAN CANCER

SOCIETY FACTS AND FIGURES (ALL SITES) 2014

SITE MALE FEMALE TOTALBH % OF

TOTAL CASES*NTNL # / % OF

TOTAL EST. CASES**LUNG 69 51 120 21.0% 224,210/14.0%BREAST 4 114 118 20.0% 235,030/14.0%PROSTATE 52 0 52 9.0% 223,000/14.0%COLON 18 26 44 8.0% 96,830/6.0%MELANOMA 23 15 38 6.4% 76,100/5.0%BLADDER 32 6 38 6.4% 74,690/5.0%LYMPHOMA 13 9 22 4.0% 79,990/4.0%KIDNEY/RENAL PELVIS 11 4 15 2.5% 63,920/4.0%BRAIN/OTHER CNS 5 10 15 2.5% 23,380/1.0%UNK PRIMARY/MISC 5 10 15 2.5% 31,430/2.0%RECTUM 8 5 13 2.0% 40,000/2.0%PANCREAS 6 5 11 2.0% 46,420/3.0%LIVER & INTRAHEPATIC BILE DUCT & OTHER BILIARY

6 5 11 2.0% 43,840/3.0%

ORAL CAVITY & PHARYNX 7 4 11 2.0% 42,440/3.0%UTERINE CORPUS 0 10 10 1.7% 52,630/3.0%ESOPHAGUS 7 0 7 1.0% 18,170/1.0%LARYNX 5 1 6 1.0% 12,630/0.7%ANUS, ANAL CANAL & ANORECTAL 1 5 6 1.0% 7,210/0.4%TESTIS 4 0 4 0.6% 8,820/1.0%OVARY 0 4 4 0.6% 21,980/1.0%STOMACH 1 2 3 0.5% 22,220/1.0%SMALL INTESTINE 1 2 3 0.5% 9,160/1.0%THYROID 2 1 3 0.5% 62,980/4.0%MYELOMA 1 2 3 0.5% 24,050/1.0%NOSE, NASAL CAVITY & MIDDLE EAR

2 0 2 0.3% 5,710/0.4%

SOFT TISSUE (INCLUDING HEART) 2 0 2 0.3% 12,020/0.7%VAGINA 0 2 2 0.3% 3,170/0.1%VULVA 0 2 2 0.3% 4,850/0.2%URETER 0 2 2 0.3% 3,000/0.1%OTHER DIGESTIVE ORGANS 0 1 1 0.1% 5,760/0.4%CERVIX UTERI 0 1 1 0.1% 12,360/1.0%LEUKEMIA 0 1 1 0.1% 52,380/3.0%

TOTAL 285 300 585 585/100% 1,640,380/100%*Percentage of Total Cases Entered Into Blessing Hospital Cancer Registry, 2014. **Percentage of Estimated New Cancer Cases Nationwide According to American Cancer Society Facts & Figures, 2014. (Comparisons of ACS Estimated Facts & Figures has been approved by the Cancer Committee).

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BLESSING HOSPITAL SUMMARY OF REGISTRY STATISTICS 2014

(ALL SITES)

Analytic - Patients Diagnosed and/or treated at Blessing HospitalNon-Analytic - Patients Diagnosed and Treated Elsewhere During First Course of Treatment and Presented to Blessing For Subsequent treatment.

Analytic Cases 563 White 576Non-Analytic Cases 22 Black 7

Asian Indian or Pakistani

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Total Cases 585 Total Patients 585

American Joint Commission on Cancer for Tumor, Nodes and Metastasis (AJCC/TNM)And Collaborative Staging were utilized in abstracting all eligible 2014 cases.

• The top five sites diagnosed and/or treated at Blessing Hospital in 2014 are lung, breast, prostate, colon and melanoma/bladder totaling 410 (70.0%) out of 585 cases.

• Lung was the most prevalent cancer diagnosed in 2014 at 120 cases. Out of 120 / 20.5% Lung cancer cases, 69 are male and 51 are female.

• Breast cancer closely followed at 118 cases. For breast cancer, 114 or 19.4% are female and 4 (0.6%) are male.

• When compared to National for both lung and breast cancers, Blessing is at 21.0% and 20.0%, respectively, which is 7.0% and 6.0% higher than National, respectively.

• Third and fourth top sites are prostate and colon, 52 and 44, respectively. Prostate cancer at 9.0% is 5.0% lower than National at 14.0% and for colon cancer, Blessing is 2.0% higher at 8.0% with National at 6.0%.

• Fifth top sites include both melanoma and bladder at 38 cases each or at 6.4%, respectively, 1.4% higher than National at 5.0%, respectively.

• For hematopoietic diseases (lymphoma and leukemia), at Blessing there were 23 cases or 3.9% vs National at 5.0% and kidney/renal pelvis closely compared at 2.5% vs 4.0%, respectively.

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COUNTIES SERVEDBLESSING HOSPITAL CANCER REGISTRY

2014 AND 2013 COMPARISONS (RED)

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CANCER PROJECTIONS IN ILLINOIS 2015

This map shows the number of cancer cases projected for each county for 2015. In 2015, Illinois expects a total of 69,470 cancer cases.

Cancer data in Illinois is collected in a standard format so it can be compiled with other state registries to form a national database of cancer data.

Each year Illinois cancer registry staff process about 92,000 cancer reports for about 65,000 cancer patients.

Source: Incidence projections was derived from cancer incidence data from the Illinois Department of Public Health Illinois State Cancer Registry as of November 2013

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Class 00 = Initial diagnosis at the reporting facility AND all treatment or a decision not to treat was done elsewhere. (17.26%/101)

Class 10 = Initial diagnosis at the reporting facility or in a staff physician’s office AND part or all of first course treatment or a decision not to treat was at the reporting facility, NOS. (29.06%/170)

Class 13 = Initial diagnosis at the reporting facility AND part of first course treatment was done at the reporting facility; part of first course treatment was done elsewhere. (27.18%/159)

Class 20 = Initial diagnosis elsewhere AND all or part of first course treatment was done at the reporting facility, NOS. (10.6%/62)

Class 21 = Initial diagnosis elsewhere AND part of first course treatment was done at the reporting facility; part of first course treatment was done elsewhere. (9.23%/54)

Class 32 = Initial diagnosis and treatment was done at facility and presented to reporting facility for subsequent treatment or (38) diagnosed by autopsy. (6.67%/39)

CLASS OF CASE REPORT DIAGNOSED AND/OR TREATED AT BLESSING HOSPITAL

ALL SITES - 2014

Cases not included above are cases not eligible for AJCC staging (No. = 40) and stage group unknown (No. = 10)

AGE AND STAGE AT DIAGNOSIS 2014 (No.=517)

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PRIMARY SITE 2010 2011 2012 2013 2014 TOTAL %

Oral Cavity & Pharynx 22 17 8 15 11 73/2.5%

Esophagus 11 3 10 12 7 43/1.5%

Stomach 3 6 8 2 3 22/0.8%

Small Intestine 3 6 4 3 3 19/0.7%

Colon 50 42 38 46 44 220/7.5%

Rectum 15 17 13 23 13 81/2.8%

Anus, Anal Canal & Anorectum 2 3 3 3 6 17/0.6%

Liver & Intrahepatic Bile Duct 3 2 3 4 7 19/0.7%

Gallbladder 1 1 1 1 0 4/0.1%

Other Biliary 1 1 2 3 4 11/0.4%

Pancreas 9 12 7 10 11 49/1.7%

Peritoneum, Omentum & Mesentery 1 0 0 2 0 3/0.1%

Other Digestive Organs 1 0 0 0 1 2/0.1%

Nose, Nasal cavity & Middle Ear 0 0 0 0 2 2/0.1%

Larynx 5 6 10 6 6 33/1.1%

Lung & Bronchus 94 112 102 111 120 539/18.5%

Trachea, Mediastinum & Other Respiratory 1 1 0 0 0 2/0.1%

Bones & Joints 0 0 1 1 0 2/0.1%

Soft Tissue (Including Heart) 5 4 4 3 2 18/0.6%

Melanoma – Skin 25 28 37 27 38 155/5.3%

Other Non-Epithelial Skin 1 3 1 4 0 9/0.3%

Breast 109 88 104 106 118 525/18.0%

Cervix Uteri 1 1 1 3 1 7/0.2%

Corpus & Uterus, NOS 11 16 10 9 10 56/2.0%

Ovary 1 8 8 2 4 23/0.8%

Vagina 0 0 0 0 2 2/0.1%

Vulva 2 4 1 3 2 12/0.4%

Other Female Genital Organs 1 0 0 1 0 2/0.1%

Prostate 63 74 47 51 52 287/9.8%

Testis 3 3 3 5 4 18/0.6%

Penis 0 0 2 0 0 2/0.1%

Urinary Bladder 36 35 40 32 38 181/6.2%

Kidney & Renal Pelvis 19 15 19 21 15 89/3.1%

Ureter 0 0 4 4 2 10/0.3%

Eye and Orbit 1 0 1 0 0 2/0.1%

Brain 11 10 11 5 6 43/1.5%

Cranial Nerves Other Nervous Sys 8 12 10 15 9 54/2.0%

Thyroid 3 5 8 6 3 25/1.0%

Other Endocrine Including Thymus 3 6 3 3 0 15/0.5%

Hodgkin Lymphoma 4 3 4 2 2 15/0.5%

Non-Hodgkin Lymphoma 19 24 14 19 20 96/3.3%

Myeloma 8 4 5 7 3 27/1.0%

Leukemia 10 13 10 3 1 37/0.6%

Mesothelioma 1 1 1 1 0 4/0.1%

Unknown Primary / Miscellaneous 9 19 13 5 15 61/2.1%

TOTALS 576 605 571 579 585 2,916/100%

PRIMARY SITE - FIVE-YEAR TREND (2010-2014)

Registry numbers may not reflect past annual report totals due to additional cases potentially added to database.

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PRIMARY SITE - FIVE-YEAR TREND (2010-2014)

26%

5%7%

Registry numbers may not reflect past annual report totals due to additional cases potentially added to database.

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SUMMARY BY BODY SYSTEM AND GENDER REPORTBLESSING HOSPITAL & STATE OF ILLINOIS 2014

Thyroid 1 (0.0%)Lung & Bronchus 51 (17.0%Breast 114 (38.0%)Kidney & Renal Pelvis 4 (1.0%)Ovary 4 (1.0%)Uterine Corpus 10 (3.0%)Colon & Rectum 31 (10.0%)Non-Hodgkin Lymphoma 7 (2.0%)Melanoma of the Skin 15 (5.0%)Leukemia 1 (0.0%)

Oral Cavity & Pharynx 7 (2.0%)Lung & Bronchus 69 (24.0%) Pancreas 6 (2.0%) Kidney & Renal Pelvils 11 (4.0%) Urinary Bladder 32 (11.0%) Colon & Rectum 26 (9.0%)Prostate 52 (18.0%)Non-Hodkin Lymphoma 13 (5.0%)Melanoma of the Skin 23 (8.0%)Leukemia 0 (0.0%)

AGE AT DIAGNOSIS - MALE VS FEMALEBLESSING HOSPITAL 2014 - ALL CANCER SITES (NO.585)

Every day in Illinois: 176 people are diagnosed with cancer. 26 women are diagnosed with breast cancer. 21 men are diagnosed with prostate cancer. 17 people are diagnosed with colorectal cancer. 25 people are diagnosed with lung cancer. 67 people die from cancer.*

*Illinois Department of Public Health, Illinois State Cancer Registry, public data file, data as of November 2014

Type of Cancer Men Women

Prostate 23.6% ---

Breast --- 29.9%Lung Bronchus 14.8% 13.6%Colon and Rectum 10.0% 8.9%Urinary Bladder 6.6% ---Kidney & Renal Pelvis 4.7% 2.9%Melanoma of Skin 4.5% 3.4%Non-Hodgkin Lymphoma 4.3% 3.7%Oral Cavity & Pharynx 3.7% ---Leukemia 3.3% ---Pancreas 2.8% 2.8%Corpus & Uterus --- 6.9%Ovary --- 2.6%Thyroid --- 4.7%

TOP 10 CANCER CASES IN ILLINOIS*

SUMMARY BY BODY SYSTEM AND GENDER REPORTBLESSING HOSPITAL 2014 - TOP 10 SITESWOMEN MEN

All other sites62

(21.0%)46

(16.0%)

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STANDARD 1.8 SCREENING PROGRAMSCOMMUNITY OUTREACH EDUCATOR REPORTSTEPHANIE WILLEY, RN, BSNThe community outreach coordinator monitors the effectiveness of community outreach activities on an annual basis. The activities and findings are documented in a community outreach activity summary that is presented to the cancer committee annually.

Quality Improvements, Standard 4.8 - Annually, the quality improvement coordinator, under the direction of the cancer committee, implements two patient care improvements. One improvement is based on the results of a completed study that measures patient quality of care and outcomes. One improvement can be identified from another source or from a completed study. Improvements are documented in the cancer committee minutes and shared with medical staff administration.

MELANOMA SKIN CANCER SCREENINGAll participants with suspicious results received a certified letter in follow-up to the screening.No melanoma was diagnosed.

During 2015 the Blessing Cancer Center sponsored 2 free community skin cancer screenings and a total of 131 participants were screened, compared to 134 participants in 2014.

February 12, 2015 84 Screening Participants 12 Cancellations/No Shows

• 46 (55%) Suspicious• 38 (45%) Negative

June 26, 2015 47 Screening Participants 6 Cancellations/No Shows

• 22 (47%) Suspicious• 25 (53%) Negative

Quality Improvement: Increase the percent of FOBT actually turned back in by the consumer. Based on the 2014 Colon and Rectum study showing the need for increased screenings to diagnose colon and rectal cancer. Process: Charge a nominal fee to get consumer “buy in” to encourage the consumer to follow through with the screening program. Result: Increased the FOBT rate of return from 39% to 62%.

All participants who had specimens reporting blood in the stool received a certified letter and three phone calls in follow up to the FOBT screening.

2015 Colorectal Cancer Screenings (FOBT)

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STANDARD 1.8 SCREENING PROGRAMSCOMMUNITY OUTREACH EDUCATOR REPORT

STEPHANIE WILLEY, RN, BSN

In an effort to provide healthy environments for its patients, visitors, physicians and employees, all Blessing Corporate Services health care entities are smoke-free effective November 16, 2006. For more information regarding smoking cessation, visit www.blessinghospital.org - patient services and view Smoke-Free Campus.

In November of 2015, the Blessing Cancer Center sponsored an Oral Cancer Screening Program, and Stephanie Willey, RN, Outreach Nurse Educator, went out in the community to educate adults regarding the availability of smoking cessation counseling. It was another successful year in educating fourth graders in Adams County against the harm of cigarette smoking and asking them to sign the No Tobacco Pledge.

Community needs assessment shows a high rate of smokers in Adams County.What are we doing to help prevent smoking in our community?

BLESSING CANCER CENTER ORAL CANCER SCREENINGNovember 19, 2015- The Great American Smoke Out11:30 AM to 1:00 PM and 4:30 PM to 6:00 PM

PARTICIPANTS: 25 (All with negative results) 10 Patients had history of tobacco use. 21 of 25 received pulmonary function testing. 4 of 10 received tobacco cessation counseling. 1 participant cancelled 1 no show; 1 walk-in

We had 25 participants in 2015 compared to 20 in 2014

2015 No Tobacco Education Adams County

801 fourth grade students signed the “No Tobacco Pledge” in November 2015 at 11 schools in our community.

Smoking Cessation Counseling

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BREAST CANCER REPORT BREAST ONCOLOGY NAVIGATORSHEILA HERMESMEYER, RN, BSN, OCNA cancer diagnosis is overwhelming to say the least. Doctors and nurses want to ensure every patient has all of the information and knows every treatment option. However, the onslaught of unfamiliar medical terms and seemingly endless decisions to make can cause more anxiety than calm.

This is where Sheila Hermesmeyer, the Blessing Breast Center Navigator, enters the picture. An oncology certified registered nurse with 35 years of nursing

experience, she is well prepared for this important role. Her role as Navigator is to guide patients through the healthcare system and serve as an advocate and be a consistent contact person for the patient and family.

“I am not here to make decisions for the patient, I am here for support and to make sure they understand every opportunity and option available to them.”

This is her role throughout the patients’ journey. She accompanies them from surgery to medical oncology, chemotherapy or hormone therapy, radiation therapy and beyond. “I provide individualized support to our patients,” says Hermesmeyer. “I am their communicator back to their nurses and doctors at every point in their treatment all the way through to survivorship.”

New in 2015

3D Mammography Clinically proven, superior mammography. Detects 41% more invasive breast cancers.

Introducing a new dimension of care

Schedule your appointment! 217-223-8400, ext. 4300

927 Broadway, Suite 320, Quincy blessing3d.org

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LUNG CANCER REPORTCANCER CENTER NAVIGATORSARAH PRUETT, RN, BSN, OCNLung cancer is one of the most prevalent cancers diagnosed and or treated yearly at Blessing Hospital, either top site or second to breast cancer. Top graph: According to the 5-year trend at Blessing Hospital 2010 to 2014, the number of cancer patients are increasing. For this reason, Sarah Pruett accepted the position to navigate lung cancer patients through their treatment journey.

In 2015, two goals set by the Cancer Committee is to work on starting a new can-cer screening program and also to navigate lung cancer patients through the initial treatment course and survi-vorship process.

Bottom graphs: Compared to National Cancer Data Base (NCDB), Blessing Cancer Center is diagnosing patients at an earlier age and diagnosing more Stage III than average, but is lower in all other stages except for age group 50 where Blessing for Stage IV is 14.9% higher than National. Another future goal established by the Cancer Committee, along with breast and colorectal cancers, is to add a lung site specific multi-disciplinary team for lung cancer patients.

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STANDARD 4.7 STUDIES OF QUALITYCOORDINATOR REPORTHEATHER GIROUARD, PERFORMANCE EXCELLENCEEach year, based on category, the quality improvement coordinator, under the direction of the cancer committee, develops, analyzes, and documents the required studies that measure the quality of care and outcomes for patients with cancer.

BREAST CANCER INTRA-OPERATIVE ULSTRASOUND STUDY COMPARISON 2013 VS 2015 LUMPECTOMY AND QUADRANTECTOMY TREATMENT

CHRISTIAN ZWICK, D.O.

PURPOSE:The intent of the intra-operative ultrasound study is to encourage all surgeons to utilize this method. Compared were the effectiveness of using ultrasound during lumpectomy and quadrantectomy operations over the last 5 years to achieve clearer margins and reduce the number cases returned for re-excision or mastectomy.

CRITERIA:• Dr. Christian Zwick’s patients• Data from three physicians who do not use intra-operative ultrasound• All cancer related lumpectomy/quadrantectomy cases from July 2009-December 2014• Use of intra-operative ultrasound vs. not using intra-operative ultrasound• Clear margins with the use of intra-operative ultrasound vs. returning back to the OR for

subsequent resection of positive margins due to not obtaining intra-operative ultrasound during procedure

CONDUCTING THE STUDY:Total Dr. Zwick’s Cases Reviewed: 143

SUMMARY OF FINDINGS: OVERALL OUT OF 143 PATIENTS: • 11 / 7.7% patients with the use of Intra-operative US had to return back for re-resection or

mastectomy• 24 / 16.9% patients without the use of intra-operative US had to return back for re-resection

or mastectomy.• OVERALL OUT OF 97 OTHER PHYSICIAN PATIENTS:• 17 / 17.5% patients without the use of intra-operative US had to return back for re-resection

or mastectomy.

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STANDARD 4.7 STUDIES OF QUALITYCOORDINATOR REPORT

INTRA-OPERATIVE ULTRASOUND STUDY

From July 2009 through July 2012 in all Dr. Christian Zwick’s lumpectomies, 50 cases without the use of intra-operative ultrasound, 28.0% of cases returned for re-excision or mastectomy. Out of 31 cases that used intra-operative ultrasound, 22.6% of cases returned for re-excision or mastectomy. From January 2013 through December 2014, 34 cases without the use of intra-operative ultrasound, 26.0% of cases returned for re-excision or mastectomy. Out of 28 cases that used intra-operative ultrasound, 14.0% of cases returned for re-excision or mastectomy.

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INTRA-OPERATIVE ULTRASOUND STUDY

Total Other Physician Cases Reviewed: 97 without the use of Intra-Operative Ultrasound

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INTRA-OPERATIVE ULTRASOUND STUDYCONDUCTING THE STUDY:Total Dr. Zwick’s Cases Reviewed: 143

SUMMARY OF FINDINGS:OVERALL OUT OF 143 PATIENTS: • 11 / 7.7% patients with the use of Intra-operative US had to return back for re-resection or

mastectomy• 24 / 16.9% patients without the use of intra-operative US had to return back for re-resection

or mastectomy.OVERALL OUT OF 97 OTHER PHYSICIAN PATIENTS:• 17 / 17.5% patients without the use of intra-operative US had to return back for re-resection

COMPARISON:In comparison with other physicians, Dr. Zwick’s patients who had the use of Intra-operative Ultrasound had the lowest returns back for re-resection or mastectomy.

According to a study published in the Annals of Surgery, Volume 233, titled, “Intraoperative Ultrasound Is Associated with Clear Lumpectomy Margins for Palpable Infiltrating Ductal Breast Cancer”, the findings were similar to Blessing Cancer Center’s study. The conclusion of this study was the use of ultrasound-guided surgery, optimized the surgeon’s ability to obtain satisfactory margins for breast-conserving techniques in patients with breast cancer. Their results showed improved surgical accuracy and margin status. This study also looked at the cost related issues and found not only was cost not affected using the ultrasound study but a cost savings to the patient is realized.

ACTION PLAN:With the continual effectiveness of using ultrasound during lumpectomy and quadrantectomy operations, this is a skill set that should be utilized to further improve patient outcomes. Dr. Christian Zwick wants to encourage all surgeons to use this technique and will discuss these findings with other surgeons that perform breast cancer surgery at Blessing as well as present a CME for further education. This study as well as the referenced study from the Martha Jefferson Physician Hospital Organization will be made available to all surgeons.

REFERENCES:Marcia M. Moore, MD, Lawrence A. Whitney, BA, Lisa Cerilli, MD, John Z. Imbrie, PhD, Michael Bunch, MBA, Virginia B. Simpson, RN, and John B. Hanks, MD “Intraoperative Ultrasound Is Associated With Clear Lumpectomy Margins for Palpable Infiltrating Ductal Breast Cancer”Presented at the 112th Meeting of the Southern Surgical Association, 2000Published 2001 Annals of Surgery Vol. 233, No.6, 761-768

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STANDARD 1.9 CLINICAL TRIAL ACCRUAL:CLINICAL RESEARCH COORDINATOR REPORTKELLY SORRILL, CCRP

As appropriate to the cancer program category, the required percentage of patients is accrued to cancer-related clinical trials each year. The clinical trial coordinator or representative reports clinical trial participation to the cancer committee each year.

In 2014, Quincy Medical Group expanded Clinical Research services for cancer patients by joining the Alliance for Clinical Trials in Oncology through Washington School of Medicine. In addition to our current array of on-site trials, we now can

offer the option of a National Cancer Institute sponsored clinical trial. The patient can be treated on an Alliance study right here close to home. The collaboration goal is to develop and conduct clinical trials with promising new cancer therapies, and utilize the best science to improve treatment and prevention strategies for cancer, as well as research methods to alleviate side effects of cancer and cancer treatments.

Our trained and experienced Clinical Investigators and dedicated Certified Clinical Research Coordinators are devoted to managing clinical trial activity. A complete screening process is in place to identify patient eligibil-ity. Clinical trial resources are also available to patients at the Cancer Center. Good clinical and ethical research practices require that subjects are appropriately informed about the risks and benefits of participating in clinical research trials before they participate. An external, institutional review boad (IRB) is utilized to oversee the conduct of the trial.

Clinical Research was successful in achieving the Commendation Level in 2014 for our Comprehensive Community Cancer Program. 62 patients were enrolled at the site, which represents 10.5% of 590 analytic cases. We were also able to include 8 additional patients that were enrolled to studies at other sites, making a total of 70 patients enrolled or 11.8% of 590 analytic cases. Our goal for 2015, is to enroll the new percentage requirement of 4% for the minimum and 6% for commendation of analytic cases.

Active Studies:Protocol GO29537- Phase III, Open Label, Randomized Study to Investigate the Efficacy and Safety of Atezolizumab (ANTI−PD-L1 Antibody) in Combination with Carboplatin + Nab-Paclitaxel for Chemotherapy Naïve Patients with Stage IV Non Squamous Non-Small Cell Lung Cancer and Protocol GO29437 for Squamous CellProtocol GO29527 - Phase III, Open Label, Randomized Study to Investigate the Efficacy and Safety of Atezolizumab (Anti-PD-L1 Antibody) Compared with Best Supportive Care Following Adjuvant Cisplatin Based Chemotherapy in PD-L1 Selected Patients with Completely Resected Stage IB-IIIA Non-Small Cell Lung CancerProtocol Alliance A031201 - Phase III Trial of Enzalutamide vs Enzalutamid, Abairaerone and Prednisone for Castration Resistant Metastatic Prostate CancerProtocol Alliance CALGB/SWOG 80702 - Phase III Trial of 6 Versus 12 Treatments of Adjuvant FOLFOX Plus Celecoxib or Placebo for Patients with Resected Stage III Colon CancerProtocol I3Y-MC-JPBLb - Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study of Fulvestrant with or without Abemaciclib, a CDK4/6 Inhibitor, for Women with Hormone Receptor Positive, HER2 Negative Locally Advanced or Metastatic Breast CancerProtocol INCB 18424-268 - Randomized, Double-Blind, Phase 2 Study of Ruxolitinib or Placebo in Combina-tion With Capecitabine in Subjects With Advanced or Metastatic HER2-Negative Breast CancerProtocol CA209153 - Phase IIIb/IV Safety Trial of Nivolumab in Subjects with Advanced or Metastatic Non-Small Cell Lung Cancer Who Have Progressed During or After Receiving At Least One Prior Systemic Regimen Protocol GO28915 - Phase III, Randomized Study to Investigate the Efficacy and Safety of Atezolizumab (Anti –PD-L1 Antibody) Compared with Docetazel in Patients with Non-Small Cell Lung Cancer after Failure with Platinum Containing Chemotherapy (OAK)

Please Contact the Clinical Research Dept at 217-277-3500 Extension 7780 with any questions.Current Clinical Research information can be viewed at the following sites: www.quincymedgroup.com, National Institutes of Health www.clinicaltrials.gov, and www.blessinghealthsystem.org

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MELANOMA OF SKINSITE STUDY REPORT

MELANOMA OF THE SKIN OVERVIEWSkin cancer is the most common form of cancer in the United States, and melanoma is responsible for the most skin cancer deaths with over 9,000 each year. Total melanoma treatment costs are about $3.3 billion annually in the United States and is only expected to rise based on the observed and projected melanoma rise in incidence, particularly among white race, in the absence of new interventions. A comprehensive skin cancer prevention program is estimated to result in an average annual reduction in spending of $250 million on newly diagnosed melanoma cases, and a total of $2.7 billion during 2020–2030. (This is assumed that the observed reduction in melanoma incidence would be attributed to SunSmart, a multicomponent community-wide sun protection program in Australia, reproduced by a nationwide program in the United States.)

The data also reveals rising incidence of melanoma diagnosed and/or treated at Blessing Hospital as well as rising incidence on a National level. In 2011 at Blessing Hospital, melanoma was the sixth top cancer site for men and fourth for women. When compared to 2014, melanoma incidence increased in men from sixth top site to fourth with women remaining the same. Likewise, Illinois Department of Public Health Statistics for Adams County, white race, five-year trends, from 1993-1997 to 2008-2012 shows a 20.2% increase for men and 6.3% increase for women. Based on Surveillance, Epidemiol-ogy, and End Results (SEER) from 1992 to 2012, the number of new cases of melanoma was 21.6 per 100,000 men and women per year and estimated percentage of all new cancer cases for 2015 is 4.5%. The number of deaths was 2.7 per 100,000 men and women per year (rates are adjusted and based on 2008-2012 cases and deaths). At Blessing Hospital 2003 – 2014, total of 12.9% men and women expired from melanoma; men’s group percentage 16.2% vs. women 8.4%; men 7.8% higher than women. A total of 67.2% are alive without active disease, 16.2% expired from other cause, and 3.5% are alive with active disease.

Among persons aged 15-49 years, higher melanoma incidence rates were observed among women, whereas among those age >50 years, higher rates were observed among men. From 2009-2013, Blessing Hospital also shows higher incidence in women diagnosed ages 30-49 and higher incidence in men 50-89. Likewise, National Cancer Data Base (NCDB) reveals higher incidence in women ages < 20 and 30-49 and for men, higher incidence in age groups 50-90+. In Stage I, Blessing Hospital has higher percentages in age groups 60-89, but is 11.0% lower in age group 30-39 vs NCDB. Blessing is 23.0% higher than National in Stage II for age group 30-39 and in age group 90+, Blessing is 31.0% higher vs. National. In age group 40-49 for Stage IV, Blessing is 8% higher than National.

In 2014, 70.0% of patients were either diagnosed at Blessing or elsewhere, but all patients were treated at Blessing, 17.5% patients were diagnosed only and treated elsewhere, and 12.5% came to Blessing to receive treatment for recurrence or progression of disease. For melanoma recurrence 2003-2014, 7.1% patients died from melanoma, 0.3% died from other cause, 1.9% are alive without active disease, and 1.2% are alive with active disease. Despite increases in melanoma incidence, decreases in melanoma mortality among persons aged <65 years have been observed, likely reflects earlier detection and improved treatment. Meanwhile, increasing melanoma mortality rates among persons aged ≥65 years and increasing incidence for both

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thin and thick lesions, along with the substantial contribution of thin lesions at diagnosis to melanoma mortality (about 30%), suggest that cumulative overexposure to UV radiation plays a substantial role. More than 90% of melanoma cases in the United States are attributed to skin cell damage from ultraviolet (UV) radiation exposure. Sun-protective behaviors (e.g., using sunscreen, wearing sun-protective clothing, and seeking shade) can reduce harmful exposure to UV. Sunburns are a significant risk factor for melanoma. Nearly 40% of persons in the United States report sunburn each year, indicating that many are not adequately protecting their skin from damaging UV that can cause melanoma. Higher rates among young females compared with young males might be attributable, in part, to the widespread use of indoor tanning among females, which is associated with an increased risk for melanoma. Nearly one-third of non-Hispanic white women aged 16–25 years engage in indoor tanning each year. Meanwhile, higher melanoma rates among older non-Hispanic white men may be attributable, in part, to lower rates of sun protection and more time spent outdoors throughout life compared with women. Additionally, men are less likely to use sunscreen compared to women; thus, clothing and wide-brimmed hats might be particularly effective sun protection options for males, as well as increasing the use of sunscreen. Our community in the tri-state area, Illinois, Missouri and Iowa, is largely a farming community, but in Adams County alone the population is much higher due to the city of Quincy, Illinois, which has an estimated population of 40,000. Younger women having a higher incidence of melanoma could be related to indoor tanning and higher incidence in men 50+ could be due the large farming community. Most frequent primary site for women is skin of arm, back, shoulder, chest, cheek, lower leg, thigh, foot, and breast. Most frequent primary site for men is skin of arm, back, shoulder, ear, chest, neck, scalp, jaw, and temple. Blessing closely compares to National data when compared to first course of treatment, but it is noted that Blessing Hospital is 10.6% higher than National for histological type of nodular melanoma and 10.0% higher for superficial spreading melanoma.

At Blessing Hospital, surgeons and medical oncologists work closely together in following current National Comprehensive Cancer Network (NCCN) treatment guidelines and American Joint Commission on Cancer (AJCC) Tumor, Nodes and Metastasis (TN and M) clinical and pathological staging guidelines. These guidelines are followed to ensure each patient receives treatment tailored for their specific cancer diagnosis in order to achieve the best possible outcome.

According to the NCCN clinical practice guidelines for melanoma Stage IB (0.76-1.0 mm thick with ulceration or mitotic rate > 1 /mm2) or Stage IB or II (>1 mm thick, any feature, N0), sentinel lymph node biopsy is recommended. At Blessing Hospital if patient meets these guidelines, sentinel lymph node biopsy is discussed and offered to the patient. In 2013-2014 at Blessing Hospital, 94% or 16 patients received or were considered for sentinel lymph node biopsy and 5.8% or 1 patient did not receive sentinel lymph node biopsy. Sentinel lymph node biopsy is not recommended for primary mela-noma ¬< 0.75mm thick, unless there is significant uncertainty about the adequacy of micro-staging. In patients with thin melanomas (<1.0mm) apart from primary tumor thickness, there is a little consensus as to what should be considered “high risk” features for a positive SLN. Conventional risk factors for a positive SLN such as ulceration, high mitotic rate, and LVI are very uncommon in melanomas <0.75mm thick. When present, SLNB may be considered on an individual basis.


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It is recommended by the Cancer Committee that the primary clinician or referral surgeon have the original biopsy slides from the outside facility sent to the pathology department at Blessing Hospital for review, ideally before the definitive surgical procedure is performed. This would serve two purposes. First, it is a “second look” to insure that a major surgical, and potentially disfiguring, procedure is being done for a correct diagnosis. Secondly, it would allow the pathology department to assess all tissue resected and allow the compilation of the separate diagnoses to provide accurate pathological staging. In our community, Blessing Hospital’s Cancer Program community nurse educator continues to provide sun safety education with free sunscreen and chap sticks given to golf courses, pools, farm bureaus, and child care centers. Educational materials in looking for signs of melanoma such as asymmetry, border, color, diameter, and signs of evolving (ABDCE) are distributed as well. Because of the increasing incidence of melanoma diagnosed in our community, the ongoing goal of Blessing Hospital’s Cancer Program is to increase skin cancer awareness, skin screening programs, and continue to educate all ages regarding the harm of UV radiation exposure, indoor tanning, and lack of skin protection for all ages, especially in our farming community.

Thank you, Christian Zwick, D.O.

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STAGING OF MELANOMANew Melanoma Staging System – By means of an unprecedented cooperative effort among cancer centers around the world, the classification system recommended by the American Joint Commission on Cancer (AJCC) has been updated as of 2010. New findings about melanoma are incorporated to provide the most accurate diagnosis and prognosis (a forecast of how the disease is likely to progress).

Formerly, very thin tumors were classified according to Clark’s level of invasion, the number of layers of skin penetrated by the tumor. In the newest staging system, Clark’s level has far less importance.The most important factors in the new staging system are the thickness of the tumor, known as Breslow’s thickness (also called Breslow’s depth), the appearance of microscopic ulceration (meaning that the epidermis on top of a major portion of the melanoma is not intact), and mitotic rate, the speed of cell division (how fast-growing the cancer cells are). Clark’s level will enter into serious consideration only in the rare instances when mitotic rate cannot be determined.

The presence of microscopic ulceration upgrades a tumor’s seriousness and can move it into a later stage. Therefore, the physician may consider using a more aggressive treatment than would otherwise be selected. Mitotic rate has been introduced into the staging system based on recent evidence that it is also an independent factor predicting prognosis. The presence of at least one mitosis (cancer cell division) per millimeter squared (mm2) can upgrade a thin melanoma to a later stage at higher risk for metastasis.

To be exact, Breslow’s thickness measures in millimeters (1 mm equals 0.04 inch) the distance between the upper layer of the epidermis and the deepest point of tumor penetration. The thinner the melanoma, the better the chance of a cure. Therefore, Breslow’s thickness is considered one of the most significant factors in predicting the progression of the disease.

• In situ (non-invasive) melanoma remains confined to the epidermis.• Thin tumors are less than 1.0 millimeter (mm) in• Breslow’s depth.• Intermediate tumors are 1.0-4.0 mm.• Thick melanomas are greater than 4.0 mm.

T categories (for Tumor)• Stage Tis. The tumor is in situ and remains non-invasive in the epidermis.• Stage T1a. The tumor is invasive but less than or equal to 1.0 mm in Breslow’s thickness, without

ulceration and with a mitotic rate of less than 1/mm2.• Stage T1b. The tumor is less than or equal to 1 mm thick. It is ulcerated and/or the mitotic rate is

equal to or greater than 1/mm2.• Stage T2a. The tumor is 1.01-2.0 mm thick without ulceration.• Stage T2b. The tumor is 1.01-2.0 mm thick with ulceration.• Stage T3a. The melanoma is 2.01-4.0 mm thick without ulceration.• Stage T3b. The melanoma is 2.01-4.0 mm thick with ulceration.• Stage T4a. The tumor is thicker than than 4.0 mm without ulceration• Stage T4b. The tumor is thicker than 4.0 mm with ulceration.


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Stage III. By the time a melanoma advances to Stage III or beyond, an important change has occurred. The Breslow’s thickness is by then irrelevant and is no longer included in staging, but the presence of microscopic ulceration continues to be used, as it has an important effect on the progres-sion of the disease. At this point, the tumor has either spread to the lymph nodes or to the skin between the primary tumor and the nearby lymph nodes.

(All tissues are bathed in lymph — a colorless, watery fluid consisting mainly of white blood cells — which drains into lymphatic vessels and lymph nodes throughout the body, potentially carrying cancer cells to distant organs.)

A tumor is assigned to Stage III if it has metastasized or spread beyond the original tumor site. This can be determined by examining a biopsy of the node nearest the tumor, known as the sentinel node. Such a biopsy is now frequently done when a tumor is more than 1 mm in thickness, or when a thinner melanoma shows evidence of ulceration. As the sentinel node biopsy is not considered necessary in all cases, you may wish to discuss the matter with your physician.

In-transit or satellite metastases are also included in Stage III. In this case, the spread is to skin or underlying (subcutaneous) tissue for a distance of more than 2 centimeters (1 cm equals 0.4 inch) from the primary tumor, but not to the regional lymph nodes.

In addition, the new staging system includes metastases so tiny they can be seen only through the microscope (micrometastases). Just how advanced the tumor is into Stage III (the “N” category, for “nodes”) depends on factors such as whether the metastases are in-transit or have reached the nodes, the number of metastatic nodes, the number of cancer cells found in them, and whether or not they are micrometastases or can be seen with the naked eye.

Stage IV. The melanoma has metastasized to lymph nodes distant from the primary tumor or to internal organs, most often the lung, followed in descending order of frequency by the liver, brain, bone, and gastrointestinal tract. The two main factors in determining how advanced the melanoma is into Stage IV (the “M” category, for “metastases”) are the site of the distant metastases (nonvisceral, lung, or any other visceral metastatic sites) and elevated serum lactate dehydrogenase (LDH) level.

REFERENCE: http://www.skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma/guide-to-staging-melanoma


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People more at risk for skin cancer: (1)• Lighter skinned, have freckles, have blond, red, or light brown hair• Work outdoors or live in high altitudes• Who have received treatment with immune suppressing medicine• Have had excessive exposure to light from tanning lamps, booths or sunlight

Types of melanoma: (2)• Most common type of melanoma is cutaneous melanomas which develop on the skin, particularly

in areas exposed to the sun. In men, the most common site is the chest or back, while in women, the legs are affected most frequently. Melanomas are also commonly found on neck or face.

• Melanomas can occur on the palms of the hands, soles of the feet or under fingernails.• More rarely, melanomas can develop in the eyes - called ocular melanoma, or mouth or vagina.

Skin protection from the sun (Slip, Slop, Slap and Wrap): (3)• Apply sunscreen 30 minutes before exposure and every 2 hours or sooner if swimming.• Slip on a shirt.• Slap on a hat-2 to 3 inch brim.• Slop on sunscreen, sunscreen SPF 15 or higher.• Wrap-around sun glasses that block 99% of UVA & UVB radiation. Check the label.• Stay in the shade, particularly between 10 am and 4 pm.

Skin cancer symptoms may vary – and not all melanomas develop from moles – it is important to discuss any new or unusual skin growths with your doctor. Checking for melanoma: (3)• A for asymmetry – A mole that has an irregular shape, or two different looking halves• B for border – Irregular, blurred, rough or notched edges may be signs of melanoma• C for color – Most moles are an even color – brown, black, tan or even pink – but changes in

shade or distribution of color throughout the mole can signal melanoma.• D for diameter, larger than a pencil eraser or growing – Moles larger than ¼ inch (6mm, the size

of a pencil eraser) across may be suspect, although some melanoma cancers may be smaller• Sores that do not heal• Pigment, redness or swelling that spreads outside the border of a spot to the surrounding skin• Itchiness, tenderness or pain• Changes in texture of scales, oozing or bleeding from an existing mole• In addition to examining the legs, trunk, arms, face and neck, it is important to look at the areas

between the toes, underneath nails, palms of the hands and soles of the feet, genitals and even the eyes

REFERENCES:(1) http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-risk-factors(2) http://www.cancercenter.com/melanoma/types/(3) http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-prevention


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A - Asymmetry This benign mole is not asymmetrical. If you draw a line through the middle, the two sides will match, meaning it is symmetrical. If you draw a line through this mole, the two halves will not match, meaning it is asymmetrical, a warning sign for melanoma.

REFERENCE: http://www.skincancer.org/skin-cancer-information/melanoma?gclid=CNT_pInN2csCFQUFaQodmxgCEA#panel1-4


B - Border A benign mole has smooth, even borders, unlike melanomas. The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

C - Color Most benign moles are all one color — often a single shade of brown. Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue

D - Diameter Benign moles usually have a smaller diameter than malignant ones. Melanomas usually are larger in diameter than the eraser on your pencil tip (¼ inch or 6mm), but they may sometimes be smaller when first detected.

E - Evolving Common, benign moles look the same over time. Be on the alert when a mole starts to evolve or change in any way. When a mole is evolving, see a doctor. Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.

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Vital Signs: Melanoma Incidence and Mortality Trends and Projections – United States, 1982-2030 (Source: Centers for Disease Control and Prevention)

INTRODUCTION: Skin cancer is the most common form of cancer in the United States, and melanoma is responsible for the most skin cancer deaths with over 9,000 each year. An individual dying from melanoma loses an average of 20.4 years of potential life (1). Total melanoma treatment costs are about $3.3 billion annually in the United States (2). Melanoma is the fifth most common cancer for men, and is the seventh most common cancer for women. (Graphs Below) In 2011 at Blessing Hospital, melanoma for men was the sixth most common cancer and for women the fourth most common and when compared to 2014, melanoma is the fourth most common cancer for men and women, respectively.

Blessing Hospital Cancer Registry Data 2011 Vs 2014


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MELANOMA REPORTSITE STUDY REPORT

“Melanoma incidence rates have continued to increase in the United States, and risk behaviors remain high.”

(Above Graphs) Blessing Hospital’s Cancer Registry reveals an increase in melanoma incidence from 2003 - 2015. Likewise, National Cancer Data Base also reveals gradual rising incidence of melanoma from 2003-2013. Reference: ©2016 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Friday, January 29, 2016

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MELANOMA REPORT SITE STUDY REPORT

More than 90% of melanoma cases in the United States are attributed to skin cell damage from ultraviolet (UV) radiation exposure (3,4). Sun-protective behaviors (e.g., using sunscreen, wearing sun-protective clothing, and seeking shade) can reduce harmful exposure to UV. Sunburns are a significant risk factor for melanoma (5,6). Nearly 40% of persons in the United States report sunburn each year (7), indicating that many are not adequately protecting their skin from damaging UV that can cause melanoma.

The Guide to Community Preventive Services (Community Guide) (http://www.thecommunityguide.org/news/2014/skin-cancer.html) recommends multi-component community-wide programs and educational, environmental, and policy interventions based on evidence that they increase UV protective behaviors, decrease skin damage that can develop into melanoma, and reduce health care spending (8,9). Community-level interventions to reduce sun exposure include providing sunscreen and shade, increasing the availability of protective clothing and hats, and scheduling activities before or after midday hours. Prevention strategies include reducing UV exposure from sunbathing and indoor tanning, and increasing the use of sun protection (13). In our community, Blessing Hospital’s Cancer Program community outreach educator continues to provide sun safety education with free sunscreen distributed to golf courses, pools, farm bureaus, and child care centers.

This report presents current melanoma incidence and death rates for 2011, projections of melanoma incidence rates and cases, mortality rates, and treatment costs through 2030, and describes the potential impact of a comprehensive skin cancer prevention program in the United States. Melanoma incidence rates have continued to increase in the United States, and risk behaviors remain high. Previous research suggests that melanoma trends reflect increases in cumulative exposure to UV and increases in skin cancer awareness and early detection. Despite increases in melanoma incidence, decreases in melanoma mortality among persons aged <65 years have been observed, likely reflecting earlier detection and improved treatment. Meanwhile, increasing melanoma mortality rates among persons aged ≥65 years and increasing incidence for both thin and thick lesions, along with the substantial contribution of thin lesions at diagnosis to melanoma mortality (about 30%), suggest that cumulative overexposure to UV radiation plays a substantial role (10).

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In 2011, a total of 65,647 invasive melanomas of the skin were reported in the United States (Table 1). Below is a report that found among persons aged 15–49 years higher melanoma incidence rates were observed among women, whereas among those aged ≥50 years, higher rates were observed among men. Higher rates among young females compared with young males might be attributable, in part, to the widespread use of indoor tanning among females, which is associated with an increased risk for melanoma (20). Nearly one-third of non-Hispanic white women aged 16–25 years engage in indoor tanning each year (21). Meanwhile, higher melanoma rates among older non-Hispanic white men may be attribut-able, in part, to lower rates of sun protection and more time spent outdoors throughout life compared with women (15,22). Additionally, men are less likely to use sunscreen compared to women (15); thus, clothing and wide-brimmed hats might be particularly effective sun protection options for males, as well as increasing the use of sunscreen.


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(Table 2) In 2011, a total of 9,128 melanoma deaths occurred in the United States. The overall age-adjusted melanoma death rate was 2.7 per 100,000, with a higher death rate among non-Hispanic whites (3.4). Melanoma death rates increased with age and were higher among men (4.0) than among women (1.7).

Melanoma survival is poorest among black populations who develop it in non–sun-exposed skin, possibly because of later diagno-sis, lower perceived risk among patients and physicians, and a higher proportion of certain types of melanoma with poorer survival (16–18).Incidence count and rate projections for whites are based on SEER data from 1982 to 2011, representing approximately 10% of U.S. populations http://www.seer.cancer.gov. http://www.census.gov/population/projections/data/national/2012.html. Age-period- Death count and rate projections for blacks and whites are based on mortality data from1982 to 2011. Population projections were obtained from the U.S. Census Bureau cohort regression models were analyzed using statistical software, with assumptions that offset expo-nential increases or decreases in rates and that gradually reduced current trends over time (11). Projections were based on either long-term trend data or the most recent 10-year period data, depending on whether there was a statistically significant curvature in the trend over time. Predicted cancer incidence and death counts for the entire U.S. population were estimated by applying the age-specific rates to U.S. population projections.


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RESULTS: From 1982 to 2011, melanoma incidence rates increased while mortality rates remained constant (Figure 1). Melanoma incidence rates doubled from 1982 to 2011. In the absence of new interventions, 112,000 new melanoma cases are projected in 2030 (Figure 2). A comprehensive skin cancer prevention program is estimated to prevent 20% of melanoma cases from 2020 to 2030, corresponding to an average of 21,000 melanoma cases averted each year (a total of 230,000 cases from 2020 to 2030).

(FIGURE 1. Observed and projected age-adjusted melanoma incidence and mortality rates, By sex and race – United States, 1982-2030*)

FIGURE 2. Annual observed and projected number of new melanoma cases among whites — United States, 2011–2030


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In the absence of new interventions, the annual cost of treating newly diagnosed melanoma cases is estimated to increase by 252.4% from 2011 to 2030 (from $457 million to $1.6 billion) (Figure 3). A comprehensive skin cancer prevention program is estimated to result in an average annual reduction in spending of $250 million on newly diagnosed melanoma cases, and a total of $2.7 billion during 2020–2030. To estimate the cost of melanoma treatment in the initial year of diagnosis, age- and sex-specific treatment costs were used (12). Cost estimates were adjusted using the per capita projected increase in national health expenditures through 2023 ( http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html). The annual rate of growth from 2024 through 2030 was calculated using the average increase in the 3 preceding years. Adjusted per capita treatment costs were multiplied by the projected number of new melanoma cases each year through 2030.

FIGURE 3. Annual observed and projected cost of treating new melanoma cases among whites — United States, 2011–2030

To determine the effectiveness of a comprehensive skin cancer prevention program in the United States, it is assumed that the observed reduction in melanoma incidence attributed to SunSmart (8), a multicomponent community-wide sun protection program in Australia, can be reproduced by a nationwide program in the United States. Similar to previous studies (9), the lag period between program implementation and reduced melanoma incidence was set at 5 years.

The Affordable Care Act is reducing financial barriers to preventive services by requiring many plans to cover clinical preventive services rated A or B by the U.S. Preventive Services Task Force (USPSTF) without patient cost sharing. Behavioral counseling is now provided with no cost-sharing to counsel individuals aged 10–24 years with fair skin about minimizing their exposure to UV radiation to reduce risk for skin cancer (14). USPSTF has stated that current evidence is insuf-ficient to recommend skin cancer screening; an updated recommendation is in progress (http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/skin-cancer-screening?ds=1&s= ).


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Key Points• Melanoma incidence rates have doubled from 1982 to 2011.• In 2011, in the United States, there were 65,647 cases of melanoma and 9,128 deaths.• The annual cost of treating newly diagnosed melanomas is projected to triple by 2030.• Melanoma can be prevented by reducing ultraviolet radiation exposure from sunbathing and

indoor tanning and increasing the use of sun protection.• A comprehensive national skin cancer prevention program could avert 230,000 melanoma cases

and $2.7 billion in initial year treatment costs from 2020 to 2030.• Additional information available at http://www.cdc.gov/vitalsigns.

Methods: CDC analyzed current (2011) melanoma incidence and mortality data, and projected melanoma incidence, mortality, and the cost of treating newly diagnosed melanomas through 2030. Finally, CDC estimated the potential melanoma cases and costs averted through 2030 if a compre-hensive skin cancer prevention program was implemented in the United States.

Conclusions: If additional prevention efforts are not undertaken, the number of melanoma cases is projected to increase over the next 15 years, with accompanying increases in health care costs. Much of this morbidity, mortality, and health care cost can be prevented.

Implications for Public Health Practice: Substantial reductions in melanoma incidence, mortality, and cost can be achieved if evidence-based comprehensive interventions that reduce ultraviolet (UV) radiation exposure and increase sun protection are fully implemented and sustained.

The findings in this report are subject to at least six limitations. First, delays in melanoma reporting might result in an underestimate of cases; reporting delays are more common for cancers such as melanoma that are often diagnosed and treated in nonhospital settings such as physicians’ offices. Second, incidence projections are based on data that represent approximately 10% of the US population and have a lower percentage of whites. Third, accurate confidence intervals are not available for the incidence and death projections. Fourth, the impact of a skin cancer prevention program is based on the assumption that a reduction in incidence could be achieved in 5 years. Fifth, the impact of a prevention program is extrapolated from a state in Australia to all of the United States, which has a different underlying population and health care system. Finally, cost estimates only include health care costs incurred in the initial year after diagnosis. For more details of Methods, Conclusion and Comments, this report in its entirety can be viewed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6421a6.htm?s_cid=mm6421a6_w


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References1.Ekwueme DU, Guy GP, Li C, Rim SH, Parelkar P, Chen SC. The health burden and economic costs of cutane-ous melanoma mortality by race/ethnicity—United States, 2000 to 2006. J Am Acad Dermatol 2011;65:S133–S143.2. Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. Am J Prev Med 2015;48:183–7.3.Gilchrest BA, Eller MS, Geller AC, Yaar M. Mechanisms of disease: the pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med 1999;340:1341–8.4. Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? Melanoma Res 1993;3:395–401.5. CDC Preventing skin cancer: findings of the Task Force on Community Preventive Services on reducing expo-sure to ultraviolet light. MMWR Recomm Rep 2003;52(No. RR-15).6. Dennis LK, Vanbeek MJ, Beane Freeman LE, Smith BJ, Dawson DV, Coughlin JA. Sunburns and risk of cuta-neous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol 2008;18:614–27.7. Holman DM, Berkowitz Z, Guy GP, Jr., Hartman AM, Perna FM. The association between demographic and behavioral characteristics and sunburn among U.S. adults—National Health Interview Survey, 2010. Prev Med 2014;63:6–12.8. Shih ST, Carter R, Sinclair C, Mihalopoulos C, Vos T. Economic evaluation of skin cancer prevention in Austra-lia. Prev Med 2009;49:449–53.9. Carter R, Marks R, Hill D. Could a national skin cancer primary prevention campaign in Australia be worth-while?: an economic perspective. Health Promot Int 1999;14:73–82.10. Tiwari RC, Clegg LX, Zou Z. Efficient interval estimation for age-adjusted cancer rates. Stat Methods Med Res 2006;15:547–69.11. Moller B, Fekjaer H, Hakulinen T, et al. Prediction of cancer incidence in the Nordic countries: empirical comparison of different approaches. Stat Med 2003;22:2751–66.12. Mariotto AB, Robin Yabroff K, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103:117–28.13. US Department of Health and Human Services. The Surgeon General's call to action to prevent skin cancer. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2014. Available at http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer .14. Moyer VA. Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommenda-tion statement. Ann Intern Med 2012;157:1–8.15. CDC. Sunburn and sun protective behaviors among adults aged 18–29 years—United States, 2000–2010. MMWR Morb Mortal Wkly Rep 2012;61:317–22.16. Wu XC, Eide MJ, King J, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999–2006. J Am Acad Dermatol 2011;65:S26–S37.17. Battie C, Gohara M, Verschoore M, Roberts W. Skin cancer in skin of color: an update on current facts, trends, and misconceptions. J Drugs Dermatol 2013;12:194–8.18. Myles ZM, Buchanan N, King JB, et al. Anatomic distribution of malignant melanoma on the non-Hispanic black patient, 1998–2007. Arch Dermatol 2012;148:797–801.19. Jemal A, Saraiya M, Patel P, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992–2006. J Am Acad Dermatol 2011;65:S17.20. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: system-atic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57.21. Guy GP, Berkowitz Z, Watson M, Holman DM, Richardson LC. Indoor tanning among young non-Hispanic white females. JAMA Intern Med 2013;173:1920–2.22. Gandini S, Stanganelli I, Magi S, et al. Melanoma attributable to sunbed use and tan seeking behaviours: an Italian survey. Eur J Dermatol 2014;24:35–40.


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“Melanoma is responsible for the most skin cancer deaths, with about 9,000 persons dying from it each year.”

Melanoma in Illinois shows the five-year rate change rising 2008-2012 with an estimated 1.1% annual change compared to the United states with melanoma at 0.0%.


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For mortality five-year rate change, Illinois is higher than US at 0.5% vs. 0.2%. Reference: http://statecan-cerprofiles.cancer.gov/recenttrend/index.php?0&17&0&9599&001&999&01&0&0&0&2#results


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Blessing 2009-2013 shows higher incidence in women diagnosed ages 30-50 and NCDB ages under 20 and 30 – 49 higher incidence of men diagnosed from ages 50 -89. For women this might be contributed to indoor use of tanning and for men, lower rates of sun protection and more time spent outdoors throughout life compared with women (15,22). Additionally, men are less likely to use sunscreen compared to women.


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55Reference: 2016 National Cancer Data Base (NCDB – Commission on Cancer (CoC) – Benchmark


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REFERENCES

American College of Surgeons

Surveilance, Epidemiology, and

End Results

North American Association of Central

Cancer Registries

National Cancer Data Base

National Oncology Data Alliance

Illinois State Cancer Registry

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BLESSING CANCER CENTER SERVICES(217) 277-3500

BLESSING CANCER CENTER DIRECTOR: Lori Wilkey, MBA, RTRM, Ext 7716.

BLESSING CANCER CENTER AND INFUSION CENTER MANAGER: Ashley Janssen, RN, BSN, OCN, Ext 7704.

RADIATION ONCOLOGY DEPARTMENT: Ext 7800. RADIATION ONCOLOGISTS: Young Yu, MD and Mark Khil, MD, Ext 7800. RADIATION ONCOLOGY NURSE: Sara Heinecke, RN, OCN, Ext 7804

MEDICAL ONCOLOGY DEPARTMENT: Ext 7700. MEDICAL ONCOLOGISTS: Amjad M. Ali, MD, Kathryn Arrambide, MD, Christian El-Khoury, MD, Karthik Koduru, MD, and Raymond Smith, MD, Medi-cal Director. CERTIFIED NURSE PRACTITIONERS: Jennifer Knuffman, AOCNP; Karen Weems, CNP

ONCOLOGY CLINICAL NURSE SPECIALIST: Carla Smith, RN, MSN, AOCNS, Ext 7706.

ONCOLOGY NURSE NAVIGATOR: Sarah Pruett, RN, BSN, OCN, Ext 7711.

BREAST CANCER NAVIGATOR: Sheila Hermesmeyer, RN, OCN, Ext 4300.

COMMUNITY OUTREACH EDUCATOR: Stephanie Willey, RN, BSN, Ext 7718.

NUTRITION SERVICES: Emily McCaughey, RD, LDN, Ext 6431.

SOCIAL WORKER/CLINICAL THERAPIST: Claudia Lasys, MSW, LCSW, OSW-C, Ext 7717.

CLINICAL RESEARCH COORDINATOR: Kelly Sorrill, CCRP, Ext 7780.

FINANCIAL COUNSELOR: Rosie Scott, Ext 7709.

BLESSING HOSPICE: Ext 5521.

UNITY POINT HOSPICE: 217-277-4098

PALLIATIVE CARE CONSULTATION SERVICES: Jeri Conboy, PhD, Ext 4701.

REHABILITATION SERVICES: Karen Kerns, MS, CCC-SLP, MBA, Ext 8754.

APPEARANCE CENTER & “LOOK GOOD, FEEL BETTER” PROGRAM: Rosie Scott, Ext 7709 or Jo Fuller, Ext 7715.

COMPLEMENTARY SERVICES: Pet Therapy, contact Jo Fuller, Ext 7715.

PEER TO PEER PROGRAM: Former cancer patients volunteer to be a peer advocate who offer support and encouragement to current cancer patients. Call the Cancer Center, Ext 7715.

SUPPORT GROUPS: www.blessinghospital.org has a complete listing of support groups on its website under the patient and visitors tab.

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BLESSING CANCER CENTER SERVICES(217) 277-3500 (CONTINUED)

REACH FOR RECOVERY: This is a personalized service for breast cancer patients. Call Helen Zimmerman, Ext 6431 or call the Cancer Center, Ext 7715.

LOOK GOOD FEEL BETTER: Teaches beauty techniques to women in active cancer treatment. For reservations call Ext 7709.

HOSPITALITY HOUSE: Located at 1129 Oak Street, the Quincy Hospitality House offers short term, affordable housing for patients and/or family members needing a place to stay. For information call (217)228-3022 or (217)223-1200.

TRANSPORTATION: Patients are encouraged to contact the American Cancer Society (800)252-5302 or Rosie Scott (217)223-8400 Ext. 7709 for information about transportation services.

AMERICAN CANCER SOCIETY REPRESENTATIVE: Courtney Heiser, BS, Health Systems Manager. www.cancer.org or 1-800-227-2345.

CANCER CONFERENCE COORDINATOR: Cathy Brogdon, CTR, Cancer Registrar, Ext 7724.

CANCER REGISTRY QUALITY COORDINATOR: Vera Bickhaus, CTR, Cancer Registrar, Ext 7720, and Jennifer Micho, Cancer Registrar, Ext 7721.

QUALITY IMPROVEMENT COORDINATOR: Heather Girouard, Performance Excellence, Ext 6896.

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The Blessing Cancer Center provides a holistic cancer care program with the latest in treatment, diagnostic, educa-tional and support services. The compassion and expertise of our multidisciplinary team, combined with state-of-the art technology in a comfortable setting, provide patients with seamless care.

The Blessing Hospital board and staff are committed to providing nationally-accredited programs and services close to home. The Blessing Cancer Center is accredited by the American College of Surgeon’s Commission on Cancer. The Blessing radiation therapy team is led by board-certified physicians and accredited by the American College of Radiation Oncology. Our partner, Quincy Medical Group, is certified by The Quality Oncology Practice Initiative (QOPI) and provides medical oncology services by physicians board-certified in internal medicine, medical oncology, and hematology.

Broadway at 11th Street . Quincy, Illinois . (217) 223-1200

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