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2010 Reflecting 2009 Data Cancer Annual Report
2010 Reflecting 2009 Data
Cancer Annual Report
OAK HILL ANNUAL REPORT
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A Message from From Nursing
The nursing department at Oak Hill Hospital is committed to providing the highest level of care and compassion to our oncology patients.
In our dedicated oncology unit, nurses are equipped with the necessary skills to administer and monitor patients receiving chemotherapy and to provide the support necessary for the patient and family to navigate through diagnosis, treatment and ongoing care. We work collaboratively with all members of the health care team to support patients through this difficult time.
Mission Statement Page 2
Message From the CEO Page 3
Message From the Committee Chairman Page 4
Cancer Registry Report Page 5
Cancer Registry Report Page 6
Cancer Committee Members Page 7
Cancer Conference Report Page 8
Hospital Services/Education Page 9
Scope of the Problem Pages 10 - 13
Hospital Cancer Site Breakdown Page 14
Hospital Comparison to State and Nation Page 15
Contacts and Definitions Page 16
TABLE OF CONTENTS
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Our
Mission, Vision & ValuesOUR MISSION Provide Excellence in Healthcare and Patient Service.
OUR VISIONLeading the Community in Healthcare Excellence.
OUR VALUESCustomer / Always FirstActions / Speak Louder Than WordsRespect / The Golden RuleExcellence / Is Our Standard
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We are proud that the Cancer Institute at Oak Hill Hospital is now in its 17th year of service to the Hernando and Citrus Communities. We are particularly grateful that Dr. Sanjay Emandi continues to offer his leadership as chairman. Under his guidance we carry on to meet the needs of our community.
We are in our second year of a three year renewed accreditation cycle by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). Oak Hill Hospital’s cancer program has been continuously fully accredited since 1993. Hernando and Citrus Counties are evolving, and so does our commitment to support cancer care professionals in their commitment to provide the very latest in diagnostic and treatment equipment as well as the latest cancer clinical trials. We are committed to the concept that no one needs to travel out of the area to receive the latest cancer treatment options and the compassion that they deserve.
We maintain our longstanding affiliation with Shands Health Care and the Shands Cancer Center. This enables our community to receive cooperative diagnostic and treatment protocols and continuing medical education opportunities for our local physicians for specialized healthcare of very complex medical conditions.
Our community outreach is as strong as ever, through educational presentations, cooperative forums, and community screenings. We have increased our commitment as a community partner by not only being a major sponsor of Relay for Life and Making Strides Against Breast Cancer events in the three county area, but by also conducting our annual Celebration of Life where the countless survivors are recognized. The number of participants in our Celebration of Life grows every year.
Since our registry began in 1993, we have achieved a total of 15,328 cases in our registry. In 2009, 817 cases were recorded, of which 495 cases were analytic. The top five cancer sites are lung, breast, colon/rectum, prostate, and bladder in that order.
Once again we wish to remind everyone that the primary method of fighting cancer is through prevention. Oak Hill Hospital offers a variety of screening programs – many cost-free. We encourage you to take advantage of the programs we offer.
Again, on behalf of our physicians, associates, and volunteers, I wish to express our deepest gratitude to all involved in our program for their commitment, dedication, time, and energy in carrying out the cancer mission, especially during these times. As a collaborative team we will continue to make a difference. We are here for you with demonstrated quality care and compassion when it’s most needed.
A Message From Our
Chief Executive Officer
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In 2009 The Cancer Institute at Oak Hill Hospital continued to improve the lives of cancer patients and their families in the Brooksville area. In 2009 we decreased the turnaround time for women waiting to complete a surgical procedure after having positive radiological studies. We improved these by creating a new Women’s Center at Oak Hill Hospital and improving the timeliness of the patients receiving the results of their radiological studies. Oak Hill Hospital also had three screening events for the public and hospital staff in 2009. We had a prostate screening in September and at that time we also had colon cancer screening kits available. Oak Hill Hospital also had low cost mammography available to the public. In 2010 we furthered our improvements of the cancer program with more quality reviews of processes within the hospital, registry data and treatment patients received.
Our cancer program continues to be highly involved with The American Cancer Society. Oak Hill Hospital is a major sponsor of The Relay for Life and Making Strides Against Breast Cancer. In the future we will continue this partnership with the American Cancer Society and continue to support their great programs.
In 2009 we added 817 total new cases into the cancer registry and 495 of those cases were analytic. This brings the total number of cases in the cancer registry to 15,328. Our top five sites at Oak Hill Hospital continue to be lung with 123 cases, breast with 76 cases, colo-rectal with 54 cases, prostate with 23 cases, and bladder with 42 cases.
Our cancer program also has twice monthly cancer conference meetings. These meetings are multi-specialty and include the attendance of a surgeon, pathologist, radiologist, medical oncologist and radiation oncologist. These meetings provide a forum for physicians to bring interesting cases to a group of physicians that can review and discuss these cases for diagnosis, stage and treatment of cancer.
Our cancer program at Oak Hill Hospital continues to go above and beyond the minimum to make improvements. The program could not continue without the support of administration, physicians and ancillary staff. I would personally like to thank all those that have given their time and energy into our Cancer Institute at Oak Hill Hospital.
A Message From The
Committee Chairman
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Sanjay Emandi, M.D.Radiation Oncology, Committee Chairman
Sawsan Bishay, M.D.Radiation Oncology, Physician Liaison
Raju Rao, M.D.Medical Oncologist
Steven Visnaw, M.D.General Surgery
Krishnan Ganti, M.D.Otolaryngologist
Anil Bhatia, M.D.Internal Medicine
Kathleen Mobley, M.D. Pathology
Kathleen Harris, M.D.Radiology
Niloufer Kero, M.D.Gynecology
Mickey Smith, CEOAdministration
Walter Pannone, R.N., CNOAdministration/Nursing
Linda Harvey, R.N.Nursing
Barbara Adkins, R.N.Quality
Michael Jackson, PharmDPharmacy
Susan TrepenMedical Staff Office
Thomas Assante, RHITHealth Information Management
Richard LinkulMarketing
Sue RugeRadiology
Marisa JordanCase Management
Cindi CrisciAmerican Cancer Society
Kathy Thompson, R.N.Hospice
Paul ErnandesRehabilitation
Bubblela Simmons, RHIA, CTRDirector Cancer Registry
Stephanie Fox, CTRCancer Market Coordinator
Cancer Committee Members
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Cancer Registry ReportOak Hill Hospital has had an approved cancer program since 1993. The Commission on Cancer (CoC) approval shows the dedication that Oak Hill Hospital has on cancer care. To receive this approval by the CoC it takes a commitment of many different groups of physicians and ancillary staff members. This group contains the cancer registry, pharmacy, physicians, nursing, radiology quality assurance and administration.
The cancer registry is in charge of data collection for the hospital. This collection includes incidence data, site specific data, extent of disease at diagnosis, treatment, and survival/disease outcome for all analytic cases. These analytic cases are not only submitted yearly to NCDB. The data submitted to NCDB is used for treatment studies through the CoC and used for outcome analysis by the American Cancer Society. Non-analytic cases are also collected by the cancer registry and are submitted monthly to the state so that patients with a cancer diagnosis can be followed for treatment and survival.
To ensure the quality of the data collected by the cancer registry, physicians review 10% of the cases that are abstracted. Physicians are reviewing the case to ensure the quality of the histology, site of the cancer, stage of disease and treatment. The software used by the cancer registry also has edits built in to ensure that the data elements are compatible. The state collection agency also reviews every 25th case for potential errors, and if an error is found that case is sent back the abstractor for review and re-submission.
The cancer registry is required to keep lifetime follow-up on the analytic cases at the hospital. The Commission on Cancer has set a minimum requirement on the percentage of patients needed to be followed that were diagnosed within the past five years and all analytic cases within the registry. We must follow at least 80% of all analytic cases within the registry and at least 90% of analytic cases within the past five years.
The cancer market coordinator in the registry must maintain the CoC standards at the hospital by reviewing and submitting reports to the cancer committee quarterly. The market coordinator also organizes the cancer conference meetings by getting cases to be presented from physicians, collecting the pathology, collecting the radiology, and advertising the meetings to the physicians.
Figure 1:Data Requests Oak Hill Hospital in 2010:
6/10/10: Cases or 2009 for Quality Study on staging.
8/2/10: Site Distribution for Annual Report-Administration.
8/2/10: Prostate Cancer Numbers for the past five years for physician portion of the annual report.
9/16/10: Analytic case numbers for annual report-Marketing and physician request.
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The following chart and graph show the age and sex of the analytic cases at Oak Hill Hospital in 2009.
The next chart and graph show the age and sex of all cases at Oak Hill Hospital in 2009.
TOTALS 243 256
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Cancer Conference ReportOur bi-monthly cancer conference meetings at Oak Hill Hospital are when the physicians can bring cancer cases to the attention of other physicians to discuss treatment options. The cancer committee meetings are for the committee members to review the goals for the year, to make sure the standards required by the CoC are being met, and to bring up and review any quality issues that the physicians may see while treating patients.
Cancer conference meetings are held on the second and fourth Tuesdays at noon. These meetings are attended by a multidisciplinary group of physicians that includes medical oncology, radiation oncology, surgeons, pathologists, and radiologists. They discuss treatment options and compare these options to NCCN guidelines. Clinical and pathological staging are also discussed by using pathology and all imaging studies done whether in the hospital or as an outpatient.
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Services2009 Summary:
Total Number of Conferences: 21
Total Number of Cases Presented: 67
Prospective Cases Presented: 59
Retrospective Cases Presented: 8
Please contact the Tumor Registry at (727) 848-1733 ex. 2220 to schedule a case for presentation at Oak Hill Hospital.
• Digital Mammography at Women’s Imaging
• Minimally Invasive Ultrasound Guided Biopsy
• CT Scans
• MRI
• PET Scans
• Bone Density Screenings
• Physical Therapy
• Speech Therapy
• Occupational Therapy
• Endoscopy
• Endoscopic Ultrasound
• Laparoscopic Surgery
• Smoking Cessation
• Support Groups
• Prostate Screening Events
• Colon Cancer Screening Cards
• Breast Self-Exam Shower Cards
• Pain Management
• Hospice Care
• Nutritional Services
• Social Services
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Scope of the Problem
Scope of the problem:Approximately 192,280 patients were diagnosed with the disease in the U.S. in 2009. Prostate cancer is the most common form of cancer in men, next to skin cancer, effecting one in six American men. Unfortunately, there were 27,360 deaths in 2009 making prostate cancer the second leading cause of death next to lung cancer. The good news is that death rates are declining. The goals of prostate cancer detection are to identify patients at an earlier stage when cure rates are much higher. We can help accomplish this by undergoing an annual PSA test and digital rectal exam.
Prostate Anatomy: The prostate is not essential for life, but it is responsible for reproduction. The prostate is a walnut sized gland that sits under the bladder and in front of the rectum and surrounds the urethra. The seminal vesicles sit just above the prostate. The prostate gland is made of three lobes and is muscular tissue and glandular tissue1.
Risk Factors:• Age: The older you are the more likely you are to get diagnosed with prostate cancer. Only 1 in
10,000 men under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. Sixty-five percent of cases are diagnosed for males over the age of 65.
• Family history: Having a father or brother that has had prostate cancer doubles your risk for getting prostate cancer.
• Race: African American men have a higher chance of getting prostate cancer than Caucasian men. Japanese and African men living in their native countries have a low incidence of prostate cancer.
• Environmental: Smoking, high fat diets, lack of sun exposure, and exposure to heavy metals may increase the incidence of prostate cancer.
Symptoms: • Frequent need to urinate, especially at night• Difficulty starting or stopping urine stream• Weak or interrupted urinary stream• Painful or burning urination• Painful ejaculation• Blood in urine or semen
By Dr. Sanjay Emandi
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Screening:Screening should start at age 40 for those men with a higher risk of prostate cancer. For the general population, screenings for prostate cancer should start at age 50. The age to stop screening is a controversial issue. A new recommendation to stop screening at 75 was recently announced. Many believe this is a personal decision based on life expectancy and overall current health.
There are two commonly used tests for prostate cancer, PSA and DRE. The PSA, or prostate specific antigen test, is a blood test that tests for the increase of the antigen in the blood. DRE is a digital rectal exam that is used to see if there are any hard or lumpy areas in the prostate. Neither of these tests are perfect, but they are used together for patterns.
If these tests are abnormal, the patient would normally have a prostate biopsy. Transrectal biopsies are the most common type, and are completed by inserting a needle into the prostate through the rectum. These cells are then microscopically examined for cancer cells. These prostate biopsies are usually completed in the urologist’s office.
Treatment:If you are diagnosed with prostate cancer there are a few treatment options:
• Active Surveillance: Similar to “watchful waiting.” However, with Active Surveillance the patient undergoes a PSA and DRE every 3-6 months and agrees to undergo an annual prostate biopsy. If they have a significant progression of disease, they can always undergo treatment at a later time. The benefit of this treatment is to avoid treatment side effects and possible complications. The downside is the stress related to not treating the cancer and concerns about lower cure rates if the disease becomes more advanced. These patients typically have low-grade tumors, have a low PSA, and have a low volume of tumor. This is not actually a treatment but a close form of patient management.
• Radical versus Laparoscopic Prostatectomy: This procedure entails removal of the entire prostate. The most common is a radical retro-pubic prostatectomy in which an incision is made in the abdomen and the prostate is removed from behind the pubic bone. A radical perineal prostatectomy is sometimes done. This is when an incision is made in a space between the anus and the scrotum. Nerve-sparing surgeries are completed by cutting to the very edges of the prostate, taking care to spare the erectile nerves that run alongside the prostate. Laparoscopic surgeries are done through very small incisions in the abdomen. Instruments are inserted that have a camera attached; this allows the surgeon to visualize the internal structures. To this date the open and laparoscopic procedures have not been compared head-to-head for cancer control and side effects.
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• Radiation Therapy: Radiation therapy can be used in local or locally advanced prostate cancer. External beam therapy or IMRT (Intensity-Modulated Radiation Therapy) can modulate the dose or intensity of the radiation beam to better deliver the radiation therapy to the prostate. 3-D conformal radiotherapy is a computerized mapping program that finds the exact location of the prostate tumor so the highest dose of radiation can reach the cancer cells. External Radiation Therapy is combined with Image Guided Radiation Therapy (IGRT). With IGRT, the doctor places three gold fiducial markers into the prostate gland, which allows your doctor to track the prostate on a daily basis. IGRT improves the precision and accuracy of daily radiation treatments.
• Brachytherapy is also a radiation therapy treatment option. However, with this procedure radiation is delivered internally. There are two types, low dose permanent and high dose temporary brachytherapy. Both have radioactive seeds implanted into the prostate through ultrasound guidance. The low dose usually has 40 to 100 seeds implanted and these implants are never removed3. The high doses are inserted for 5-15 minutes and then are removed; this is repeated two to three times over the next several days.
• Hormone Therapy: Hormone therapy or androgen-deprivation therapy (ADT) is designed to stop the production of testosterone. This is an important treatment for “high risk” and advanced prostate cancer. Hormone therapies include orchiectomies (surgical removal of testes), LHRH agonists, which blocks the release of a hormone that produces testosterone, and LHRH antagonist, which blocks the hormone from stimulating the production of testosterone.
• Chemotherapy: Chemotherapy is used only in hormone refractory cancer when all other treatments have failed.
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Prostate Cancer at Oak Hill Hospital:
This is the total number of analytic prostate cancers at Oak Hill Hospital over the last five years.
91% of prostate cancer cases diagnosed at Oak Hill Hospital are over the age of 60. The national average is 65% of all cases are men over the age of 65. In 2009, the population in Hernando County over the age of 65 is 26.3%.
(quickfacts.census.gov).From 1999-2006 (SEER staging) 80% of prostate cancer cases were diagnosed at a localized stage. 76.5% of prostate cancer cases diagnosed at Oak Hill Hospital in 2009 were diagnosed at a local stage (when the 6 unknown stage cases removed from the demoninator).
1-Ohio State University Medical Center2-Prostate Cancer Foundation3- WebMD
Number of Cases Last 5 Years Oak Hill Hospital
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Site Breakdown
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Site Breakdown
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Oak Hill Compared to State and Nation
2009 Oak Hill Hospital Cancer Sites Compared to American Cancer Society
2009 Oak Hill Hospital Cancer Sites Compared to American Cancer Society
All Sites Lung
Lung
Colo-rectal
Colo-rectal
Breast
Breast
Bladder
Bladder
Prostate
Prostate Total
Nation
Florida
Oak Hill Hospital
Nation
Florida
Oak Hill Hospital
1,479,350
102,210
495
114.8%
17.4%
24.8%
219,440
17,790
123
9.9%
10.2%
10.9%
146,970
10,420
54
13.1%
12.4%
15.4%
194,280
12,650
76
4.8%
5.4%
8.5%
70,980
5,490
42
13.0%
12.1%
4.6%
192,280
12,380
23
55.7%
57.5%
64.2%
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Contacts and DefinitionsAnalytic cases: Cases that are diagnosed and/or treated at the reporting facility.
Non-analytic cases: Cases in which the patient had an active cancer of some type while admitted at the reporting facility.
NCDB: National Cancer Database, where analytic cases are submitted quarterly.
FCDS: Florida Cancer Data System, where all cases are submitted monthly.
CoC: Commission on Cancer, where standards for cancer programs are created and the governing body in charge of surveying and approving hospitals.
