Cancer Care ANNUAL REPORT 2012

A broad spectrum of quality care

ST. LUKE’S

Table of Contents

Kimberly Ivester

Director, St. Luke’s Cancer CareDr. Brimmer

General Surgeon,

PCI Surgical Specialists

Cancer Liaison Physician,

St. Luke’s Cancer Care

Message from Leadership

UnityPoint – St. Luke’s Cancer Care brings together a team of experts to fight cancer. Every patient

we treat is part of that team, giving them and those supporting them a central role in their cancer

care. Our providers, nurses, care coordinators, social workers, dietitians and numerous other support

staff work together with patients and their families to provide the best, most comprehensive care

possible. We do this because it is what’s best for our patients and their support team.

We’re proud to tell you about our successes in 2012. Our patient-centered care incorporates

state-of-the-art technology, such as intraoperative electron radiation therapy (IOERT), compre-

hensive evidence-based programs, diagnostic and treatment services and quality care to cancer

patients and their families through a multidisciplinary approach. Our commitment to educating

our community, providing programs that improve the patient’s quality of life and ensuring we put

the needs of our patients first is evident in the many programs and services that are highlighted in

this report.

We’re excited about our collaboration with the Helen G. Nassif Community Cancer Center of

Iowa, which involves more than 200 local doctors working together across disciplines. Together

we have developed one place where patients can receive consolidated outpatient services. Whether

patients begin their cancer journey through St. Luke’s or the Helen G. Nassif Community Cancer

Center, the clinical and supportive services detailed in this report are made available to them.

The partnerships we’ve developed through our collaborations with community providers and our

patients have helped us grow and become a leader in the community.

At St. Luke’s, we work closely with our physician leadership team to look for ways to expand

and improve upon the life-saving cancer care we’ve been providing to our community for more

than 129 years. We are extremely proud of our services for cancer patients and their families.

We look forward to continuing the fight against cancer with them.

Collaboration with Helen G. Nassif Community Cancer CenterIn 2011, a group of local cancer experts from multiple specialties formed the Helen G. Nassif Community Cancer Center. The collaboration brought together more than 200 doctors from Physicians’ Clinic of Iowa, P.C., independent providers and St. Luke’s to improve cancer care in our community by better coordinating resources and services that support cancer patients and their loved ones. As a result of this collaboration, providers have adopted evidence-based pathways to standardize cancer care, improved coordination between specialties and made providing supportive services to patients a priority.

The Helen G. Nassif Community Cancer Center has become the “hub” of supportive services for St. Luke’s, area providers and the community. It is a connecting link for coordination of care and is open to all providers in the community.

1 Advances in breast cancer

2-3 St. Luke’s Breast and Bone Health 4 Cancer Risk Assessment Services 5 Specialty Support Services 6 Caring for the community 7 St. Luke’s Cancer Committee 8-9 Data analysis of breast cancer

Dr. Warren

Medical Oncologist,

PCI Hematology and Oncology

Medical Director and

Cancer Committee Chair,

St. Luke’s Cancer Care

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tissue from unnecessary radiation. In one to two minutes, patients receive radiation equal to five to seven daily radiation treatments. After the surgery, patients require three weeks of follow-up daily radiation treatments rather than the usual six weeks.

“In one procedure, a woman can have a cancer operation, radiation to the tumor bed and maintain optimal appearance and symmetry with the other breast,” said Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon. “IOERT is a concise, con-venient and cost-effective treatment. This is true innovation.”

Connie Rabe is the first patient in Cedar Rapids to receive the newest technology available to breast cancer patients. Called intraoperative electron radiation therapy (IOERT), this treatment combines surgery with an initial dose of radiation precisely focused on the area where most breast cancers recur.

“I feel so fortunate it was available to me,” said Rabe. “When they say the word ‘cancer,’ you pretty much don’t remember anything else they say. I was glad Wendy Young,

“ In one procedure, a woman can have a cancer operation, radiation to the tumor bed and maintain optimal appearance and symmetry with the other breast. IOERT is a concise, convenient and cost-effective treatment. This is true innovation.”

Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon

Rabe’s lumpectomy was performed by Dr. Brimmer. The surgery and IOERT treatment were an outpatient procedure that took about two hours. Rabe was able to go home shortly afterward and was back to traveling and her usual activities after just three weeks of external beam radia-tion. “The shortened follow-up treatment allows women to get back to their daily commitments much sooner,” Dr. Brimmer explained.

“I think IOERT is a huge advancement in the treatment of breast cancer and we’re so fortu-nate it’s available in eastern Iowa,” Rabe said.

St. Luke’s began offering ioert in the fall of 2012

for early stage breast cancer patients through an international clinical trial.

Advances in breast cancer CLINICAL TRIALS

my care coordinator, helped me navigate the steps I needed to take. She explained I might be a candidate for IOERT. I hadn’t heard about this new technology, but she explained I would receive three weeks of radiation versus six weeks – because of that – she had my attention.”

IOERT is used during lumpectomy surgery. After the patient’s surgeon removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy

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Breast and Bone Health care coordinators Registered nurses with oncology experience coordinate care for every patient diagnosed with breast cancer. Called care coordina-tors, these specially trained nurses are also certified breast care nurses (CBCN) through the Oncology Nursing Society. Each care coordinator possesses the clinical expertise patients require, but also understands the cancer journey, enabling them to help patients through emotionally difficult experiences. They help connect patients and their families with resources available to them at St. Luke’s and in our community. This service is available at no cost to every-one in the community.

Patients who require additional follow-up after an abnormal screening also receive assistance from care coordinators who help

them navigate the many different disciplines to complete their work-up and care. In 2012, St. Luke’s care coordinators provided educa-tion and care for over 300 patients.

Patient satisfaction Patients’ rating of their experience with St. Luke’s Breast and Bone Health is at the forefront of the management team every day. We listen to our patients and use their feed-back to enhance our programs and improve the quality of care we provide.

2012 Press Ganey survey resultsSt. Luke’s Breast and Bone Health received an overall patient satisfaction survey score in the upper five percent of facilities reporting.

Press Ganey surveys patients about their healthcare experience for providers across the country.

Kristi Thomson, managerSt. Luke’s Breast and Bone Health

St. Luke’s Breast and Bone Health

St. Luke’s Breast and Bone Health takes pride in leading efforts in our community for early detection of breast cancer, diag-nostic services, individualized care and educating women about their health.

In 2012, an essential part of St. Luke’s Cancer Services growth came from implementing the latest technology and collaborating with the Helen G. Nassif Community Cancer Center to expand our care coordination program.

St. Luke’s care coordinators work with every patient diagnosed with cancer.

ST. LUKE’S Cancer care coordinators

Care coordination team pictured L to R standing: Mona Cook, Andrea Watson. Seated: Dawn DeMean, Wendy Young and Emi Chapman

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Expert staff – degrees and certificationsBreast and Bone Health is led by a radiologic technologist with primary certification in radiography and advanced-level certification in mammography, bone densitometry and quality management and a Bachelor of Science in Health Care Administration.

Technologists have advanced level certifications in the services they perform, for example, mammography and bone densitometry certifications through the American Registry of Radiologic Technologists (ARRT) or International Society of Clinical Densitometry (ISCD).

Nurses have their Bachelor of Science in Nursing (BSN), and three care coordinators are also Certified Breast Care Navigators (CBCN) through the Oncology Nursing Society.

Raising standards for patient careSt. Luke’s Breast and Bone Health is a Certified Quality Breast Center in the National Quality Measures for Breast Centers (NQMBC), which measures and compares facility performance between like facilities. St. Luke’s is striving to improve and exceed the bench-marked 75 percentile ranking. Our goal for 2013 is to be named a Certified Quality Breast Center of Excellence by the NQMBC.

“St. Luke’s Breast and Bone Health is an active participant in the quality assurance initia-tives set forth by the NQMBC. With national standards to compare our local results, we are implementing studies to show our current strengths in providing care to women with breast cancer and to determine the areas where we can improve, in both the deliv-ery and quality of care to our patients, throughout the spectrum of treatment, from the initial detection of breast cancer until treatment is complete. By comparing ourselves against national standards, we can affirm the great care patients receive in the fight against breast cancer. That care will continue to improve in the years to come.”

Stephen Burke, MD, Radiology Consultants of Iowa, PLC

Time elapsed between discovery of

an abnormality during a diagnostic mammogram to performing a needle or core biopsy to determine whether it is

cancerous or benign.

St. Luke’s2.66

days

Nationalaverage2.95 days

Breast cancer patients diagnosed at St. Luke’s receive the

appropriate chemotherapy 100 percent of the time.

St. Luke’s100% of patients

NationalCoC approvedprograms91.7% of patients

“Truly outstanding staff – their caring and personal demeanor made a very difficult situation easier to handle.”

St. Luke’s Breast and Bone Health patient

2010 – 2012 data provided by the National Quality Measures for Breast Centers (NQMBC)

The Commission on Cancer (CoC), a pro-gram of the American College of Surgeons,

is a consortium of professional organiza-tions dedicated to improving survival

rates and quality of life for cancer patients through standard-setting, prevention,

research, education and the monitoring of comprehensive, quality care.

The cancer program at St. Luke’s Hospital earned a three-year accreditation with commendation from

the CoC of the American College of Surgeons in 2010.

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Heredity can play an important role in the development of cancer. Medical research has in-creased our understanding of the link between genetics and cancer. With the discovery of the BRCA genes, we have been able to provide genetic testing for patients at an increased risk for breast and ovarian cancer. This genetic testing can be a powerful tool in cancer prevention and helps determine the most appropriate treatment for those diagnosed with breast cancer. Provid-ing patients with an individualized cancer risk assessment, including counseling, education, testing, referrals and ongoing support is an innovative way the Helen G. Nassif Community Cancer Center shows commitment to their patients. There is a cost for the blood test, which some insurance companies may cover. Genetic counseling services are free.

“Cancer and Genetic Risk Assessment Counseling provides patients and their families with the education they need to make informed decisions about their healthcare. Working closely with a patient’s healthcare provider, a prevention plan is tailored specifically to each individual based on their family’s cancer history. For those patients diagnosed with a genetic mutation, more extensive education is provided about options for prevention and surveillance.”

Julie Thompson, ARNP-BC, Cancer and Genetic Risk Assessment Helen G. Nassif Community Cancer Center of Iowa

“I tested positive for the BRCA1 genetic mutation,” said 27-year-old Amy White, who has had five members of her family on her dad’s side diagnosed with either breast or ovarian cancer. She decided to pursue genetic testing recently after she learned her 40-year-old cousin was diagnosed with breast cancer and tested positive for the BRCA1 gene mutation. “I wanted to be proactive so I would be able to take preventative steps to hopefully keep cancer at bay,” White explained.

The White family at their rural Independence home with the John Deere tractor they painted pink and white to raise awareness of breast cancer.

Genetic testing increases cancer knowledgeWomen who carry either the BRCA1 or BRCA2 gene mutation have an 85 percent lifetime risk of developing breast cancer and a 25 – 45 percent risk for ovarian cancer. Many individuals with the gene mutation choose to remove their breasts and ovaries before re-ceiving a cancer diagnosis to greatly reduce their risks. White, at 26, wasn’t ready for the cancer-sparing surgeries. However, she took immediate steps to develop a care plan with her doctor, Lisa Hess, MD, OB-GYN Associ-ates, which included annual mammograms and other

tests, such as an MRI and pelvic ultrasound to look for ovarian and breast cancer.

White and her husband, Andy, have two children, Kynzley, 3, and Kohen, 2. With her

positive test, White’s children have a 50/50 chance of also carrying the gene mutation. She said, “When

the time comes, I anticipate having both of our kids

go through genetic testing – when they

are older.”

Cancer Risk Assessment SERVICES

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To help patients and their families navigate the often difficult cancer journey, St. Luke’s collaborates with the Helen G. Nassif Community Cancer Center and other community organizations to provide support services to patients, caregivers and family members. Many of these cancer support groups and services are provided at no charge, some are provided for a small fee and others may be covered by insurance. These services consist of the Cook Cancer Wellness Program, support groups including a secure/private Face-book group for cancer survivors and a variety of educational workshops and programs.

• Mind-body skills group• Body image & sexuality group• Family and individual counseling• Sexuality and body image counseling• Caregiver resources• Lymphedema management• Massage therapy• Art therapy• Music therapy• Group exercise classes – Zumba,

Tai Chi, Pilates, Yoga

• Complementary therapies• Reiki• Cooking demonstrations• Cancer Connections newsletter• Patient and caregiver mentor program• LiveStrong Cancer Transitions workshop• Cancer Really Sucks

(in partnership with Gems of Hope)• What About Us? Children’s support group (in partnership with Gems of Hope)

With progress in diagnosing certain cancers at an earlier stage and improvements in treat-ment, the number of cancer survivors con-tinues to climb. These survivors are in need of additional services that help them tackle treatment-related side effects and adjust to a new personal health altered by a diagnosis of cancer. In response to these needs, St. Luke’s Hospital launched the Cook Cancer Wellness Program in 2009. It provides multiple services to cancer survivors and addresses quality-of-life issues in an individualized way.

Use of the St. Luke’s Cook Cancer Wellness Program is free to any cancer patient in the community and doesn’t end when the patient stops treatment. It’s intended to be available to individuals for as long as they need it – even if that means years after their last treatment.

In collaboration with the Helen G. Nassif Community Cancer Center, specialized staff are available to work with cancer survi-vors, including a program coordinator to

help survivors identify needs post cancer, a social worker, an exercise specialist who works with individuals to devise an exer-cise and wellness plan and a dietitian to assist patients and survivors with choosing healthy foods. Also cancer wellness massage is available to patients and survivors dealing with prolonged pain from treatment and a risk assessment advisor is available to work with individuals to determine additional cancer risks.

Wellness Program

Pictured clockwise L to R: Julie Thompson, Matt Schmitz, Beth Beckettand Nancy Hagensick.

SPECIALTYSupport Services

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Free Mammography Day St. Luke’s Breast and Bone Health provided no-cost mam-mography screening to 29 unin-sured or underinsured women over the age of 40 on March 19. Three of the women received ad-ditional imaging and follow-up.

“Pink in the Rink” St. Luke’s Breast and Bone Health and Cancer Care partnered with the Cedar Rapids Roughriders Hockey organization to promote breast cancer awareness on September 19. Over $2,300 was raised for the Spirit Fund through ticket sales – with the Rough Riders donating $2 of every ticket sold – and a silent auction.

Breast Health Summit For the first time in Cedar Rapids, last March over 100 women gathered to focus on education, risk prevention and detection of breast cancer in African American women. The conference was held at the African American Museum and was organized with assistance through the Iowa Cancer Con-sortium, Iowa Department of Public Health and many com-munity partners, including St. Luke’s Cancer Care and Breast and Bone Health.

Bras for the CauseCarousel Motors, a major contributor to the Bras for the Cause organization, chose St. Luke’s to receive $10,000 in Bras for the Cause donations. The money will be used primar-ily for screening mammography for the uninsured and underin-sured. St. Luke’s Breast and Bone Health, in collaboration with St. Luke’s Foundation, is plan-ning a screening event in June 2013 to provide approximately 57 screenings to women who otherwise would not receive recommended breast screenings.

Breast Cancer Awareness “Bat” Boat St. Luke’s Breast and Bone Health and Cancer Care once again sponsored the Breast Cancer Awareness “Bat” Boat, an offshore racing boat with a “batwing” design. The boat helps promote breast cancer awareness and education in the community when it appears at events such as the Uptown Marion Market and Cedar Rapids’ St. Patrick’s Day and Holiday DeLight parades.

St. Luke’s works to ensure there are programs in our community that provide services and promote health and healing in response to identified community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge, or relieve the burden on government or other community efforts.

St. Luke’s community support includes education, charity care, subsidized health services, community health improvement activities and more. Here’s a look at a few programs St. Luke’s Cancer Care makes available to Cedar Rapids and the surrounding community.

Bras for the Cause is a nonprofit organization that raises funds for mammograms and cervical screenings and promotes women’s health and wellness education.

CARING FOR THECommunity

Photojeania, Inc.

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Photos L to R: Breast Cancer Awareness “Bat” Boat; “Pink in the Rink”; Breast Health Summit

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Carmen Kinrade Director, St. Luke’s Nursing Services

Pat Thies St. Luke’s Pharmacy Director

Christy Thurman American Cancer Society

Michelle Niermann St. Luke’s Administration

Physician Members

Members

Rhonada Weber Certified Tumor Registrar,

Quality Control of Registry Data Coordinator

Sherrie Justice Performance Improvement

Professional, Quality Improvement Coordinator

Maureen McEvoy Palliative Care, Spiritual Care

Julie Thompson Cancer & Genetic Risk Assessment

Beth Beckett Nutrition/Dietary Specialist

Kimberly Ivester Cancer Program Administrator

Emi Chapman Cancer Care Coordinator

Community Outreach Coordinator

Mona Cook Oncology Nurse

Cancer Conference Coordinator

Denise Abel Oncology Nurse, Manager Inpatient

Oncology & Hospice Units

Nancy Hagensick Social Worker, Psychosocial

Services Coordinator

Ruth Macke, MD Pathologist, Cedar Valley Pathology

Jasmine Nabi, MD Medical Oncologist

Oncology Associates

J. David Cowden, MD Pulmonologist

Respiratory and Critical Care Asociates

Wook Lee, MD Radiation Oncologist

Radiation Oncology of Cedar Rapids

James Bell, MD St. Luke’s Palliative Care & Hospice

Stephen Burke, MD Radiologist, RCI

Robert Brimmer, MD Cancer Liaison Physician (CLP)

PCI General Surgery

Thomas Warren, MD Chair

PCI Medical Oncologist

ST. LUKE’S HOSPITALCancer Committee Program leadership

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Breast cancer is the most frequently diagnosed cancer in women, excluding skin cancer. The American Cancer Society estimated that 226,870 new cases of invasive breast cancer occurred in the United States in 2012 and 39,510 women died of the disease. Breast cancer ranks second as a cause of cancer death in women (after lung cancer). Breast cancer was the most frequently diagnosed cancer at St. Luke’s in 2012.

Although some breast cancers are extremely aggressive and spread quickly, most tend to grow slowly and are present for years before they can be felt. Therefore, it is important for women to follow recommended screening guidelines for detecting breast cancer at an early stage, before symptoms develop. Breast cancer typically produces no symptoms when the tumor is small and most treatable.

The optimal treatment for breast cancer depends on how advanced the tumor is at diagnosis. Staging of the cancer is the process used to determine how large the tumor is, whether lymph nodes are involved and if the tumor has spread to other organs. Generally, the smaller the stage, the better the prognosis of the cancer. In the 2010-2012 data included in this report, 407 breast cancer cases were treated and abstracted into the St. Luke’s Cancer Care registry. As shown, over 87 percent of breast cancer patients diagnosed at St. Luke’s are diagnosed in an early stage when treatment is optimal. In fact, more stage 0 and stage I diagnoses were identified at St. Luke’s than other compre-hensive hospitals in the ACS division of the Midwest.

To support early diagnosis in our community, St. Luke’s Breast and Bone Health proudly collaborates with the Care For Yourself program and Bras for the Cause to provide breast cancer screening to uninsured and underinsured women in Cedar Rapids and surround-ing communities. St. Luke’s also supports the community through education on the importance of breast cancer prevention and screening.

In 2012, St. Luke’s introduced several advances focusing on the diagnosis, treatment and care of breast cancer patients. Molecular breast imaging (MBI) was successfully introduced by nuclear medicine to help find small breast cancers in very dense breast tissue. St. Luke’s also formed a Breast Care Committee in 2012 to help sharpen the focus on breast cancer. Multiple highly specialized, experienced and dedicated physicians work in collaboration with the experts at St. Luke’s Breast and Bone Health to ensure optimal quality and preci-sion are practiced across the continuum of breast cancer care. This team also focuses on the clinical and psychosocial needs of the patient, her family and her caregivers.

St. Luke’s is the only hospital in Iowa and one of three in the Midwest to offer intraop-erative electron radiation therapy (IOERT) using a mobile electron generator. IOERT is available to treat early stage breast cancer patients, decreasing side effects and dramati-cally minimizing the duration of radiation therapy. The unique opportunity to complete both surgical care and the initial radiation therapy simultaneously promotes breast preservation and avoids unnecessary mastectomies.

We are supremely confident our efforts, in conjunction with highly dedicated personnel and unique equipment, such as IOERT, will improve the number of women diagnosed at an early stage and advance the innovative care provided to women looking for state-of-the-art breast cancer care.

Over 87% of breast cancer patients

diagnosed at St. Luke’s are diagnosed at an early stage.

From 2010-2012, 407

were treated and abstracted into the St. Luke’s Cancer Care registry.

breast cancer cases

In 2012, molecular breast imaging

(MBI) was successfully introduced

to help find small breast cancers in very dense breast tissue.

Data analysis OF BREAST CANCER

More St. Luke’s patients were diagnosed with breast

cancer at stage 0 and stage 1than those diagnosed at the other

similar-sized hospitals in the Midwest, from 2010-2012.

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Top cancer sites Seen at St. Luke’s – 2012

Primary Site Total Male Female Breast 113 0 113 Prostate 108 108 0 Lung/Bronchus 88 47 41 Female Genital 76 0 76 Melanoma 70 45 25 Blood & Bone Marrow 64 31 33 Colon 45 18 27 Bladder 47 31 16 Lymphoma 37 23 14 Kidney/Renal 30 20 10 Brain & CNS 25 3 22 Thyroid 24 8 16 Unknown Primary 17 8 9All other sites 126 81 45 All Sites 870 423 447

Breast cancer surgical treatment at St. Luke’s

2010 to 2012

Stage of breast cancer diagnosed 2010 to 2012

50%

40%

30%

20%

10%

Percentage of patients diagosed with breast cancer according to stage at diagnosis.

0 Stage I Stage II Stage III Stage IV Unkown

18%

42%

26%

8% 3%3%8%

21%

46%

21%

2%1%

St. Luke’s Like-sized hospitals in Midwest

The most recent publication of mastectomy rates from the Surveillance, Epidemiology and End Results (SEER) database shows a 38.4% national

mastectomy rate in 2008 for early stage breast cancer patients.

346 patients with Stage 0 – 111A breast cancer

Mastectomy

48% Lumpectomy

52%

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