Oncology FY 2014 REPORT
Our advanced technologies and treatment options, along with our multidisciplinary approach, have earned Carilion Clinic the reputation as our region’s leader in cancer care. We provide comprehensive services for diagnosis, treatment, rehabilitation and survivorship for adult and pediatric cancer patients in the Roanoke Valley, southwest Virginia, and beyond. From highly developed therapy options such as CyberKnife® stereotactic radiosurgery to the area’s only dedicated inpatient medical oncology unit, we are committed to providing the highest quality care for cancer patients and their families. In addition to our cancer center, we have a number of support facilities that include 22 private inpatient rooms located within Carilion Roanoke Memorial Hospital, an ambulatory infusion center at 1 Riverside, and the Carilion Breast Care Center, which continues to be a regional pillar for women’s health in the Roanoke Valley for all women. With our commitment to excellence in all areas of cancer care, as well as our strong partnership with the Virginia Tech Carilion School of Medicine and Research Institute, Carilion has earned the Commission on Cancer (CoC) accreditation by the American College of Surgeons as an Academic Comprehensive Cancer Center. The CoC accreditation recognizes cancer care programs for their commitment to providing comprehensive, high-quality, and multidisciplinary patient-centered care. We’re pleased to share information about our services and latest achievements here, and invite you to join us in commending the hard work of the many oncology professionals that it represents. We’re especially grateful to the physicians and staff of Blue Ridge Cancer Care and the American Cancer Society, whose partnership is essential in making this high level of care possible for patients in our region.
Steven Arner President, Carilion Medical Center
David Buck, M.D. Cancer Committee Chair
The cancer program at Carilion Clinic is directed by a multidisciplinary committee of physician and non-physician members who are dedicated to the quality care of cancer patients and their families. The American College of Surgeons Commission on Cancer (ACoSCoC) has set forth mandatory standards for the programs that bear the ACoSCoC accreditation. Our cancer committee follows the program standards set forth by the ACoS and the structure for the cancer program at Carilion Clinic. There are five key areas that define a quality cancer program according to ACoSCoC standards:
Clinical services that provide state-of-the-art pretreatment, staging, treatment, and follow-up care at the facility for primary and ongoing care or end-of-life care
A cancer committee that leads the program with goal setting and also maintains activity, monitors patient outcomes, and improves care
Cancer conferences, which used to be called Tumor Boards, that provide a platform for patient consultation and physician education
A quality improvement program that is in place to provide a mechanism for evaluating and improving patient outcomes
The cancer program maintains a hospital cancer registry and database to maintain quality of care
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Each area of the cancer program at Carilion Clinic has a significant role in the quality of care of our patients.
THE STRENGTH OF OUR CLINIC IS THAT
each part is a part of a whole.
OUR CANCER TREATMENT PROGRAMS at Carilion, in collaboration with the physicians of Blue Ridge Cancer Care, provide the full range of cancer treatments on both an inpatient and an outpatient basis. All types of adult and pediatric cancers are treated, and comprehensive cancer prevention and screening programs are available.
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EXPERTISE IN CHEMOTHERAPY ADMINISTRATION Our highly trained nursing staff in the medical/surgical oncology unit provides care to patients who have complex needs related to their diagnoses or side effects of treatment.
INPATIENT CLINICAL SERVICES INPATIENT ONCOLOGY The area’s only medical/surgical oncology unit that is exclusively dedicated to the treatment of adults is located in the south tower of Carilion Roanoke Memorial Hospital. With 22 private rooms and a highly trained nursing staff, with expertise in chemotherapy administration and knowledge of oncology patient needs, this unit provides care to patients who have complex needs related to their cancer diagnosis, including leukemias, or side effects of treatment such as neutropenic fever, anemia, wound care, and pain management. Ancillary support services include dietitians, dedicated therapists, social services, case management, pharmacy, and chaplain services. Padmaja Mallidi, M.D., serves the inpatient oncology unit as our medical director.
SURGICAL ONCOLOGY Because surgery is among the most effective treatments for many types of cancer, we offer our patients access to a team of highly skilled, specialized, and experienced surgeons who treat many forms of cancer, including gastrointestinal cancers, gynecologic cancers, thoracic cancers, head and neck cancers, and many others. One specialized tool that our surgeons have available is the da Vinci® Surgical System. As part of our mission to deliver the latest, most innovative, state-ofthe-art technology to our patients, the da Vinci® is often used to perform a variety of surgical procedures, both cancerous and noncancerous, including removal of gynecologic cancers and cancers around male reproductive organs such as prostate, bladder, and kidney cancers.
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INPATIENT CLINICAL
PALLIATIVE CARE Palliative care is specialized care of seriously ill patients with the goal of improving pain and symptom management while assisting the patient and family with establishing goals of care. The palliative care team consists of nurses, advanced practice nurses (CNS, NP), bereavement counselors, fellows, residents, and physicians. This team is augmented by chaplaincy, dietary, social work, case management, and pharmacy services. These disciplines participate in daily interdisciplinary unit rounds. Common diagnoses include advanced cancer, cardiac, pulmonary, renal, liver, and neurological conditions/diseases. The palliative care team provides comprehensive management of patients’ physical, psychological, social, and spiritual needs while supporting their families/caregivers. Additionally, bereavement services are provided to families for up to a year after the loss of their loved one.
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INPATIENT CLINICAL
PHARMACEUTICAL Our oncology pharmacists maintain a clinical practice by working with medical and nursing personnel to optimize the pharmacotherapeutic aspects of patient care. A residencytrained pharmacy oncology specialist was added to the staff in August 2014 to further advance our oncology practice. This includes optimal selection of pharmacologic agents to maximize therapeutic benefit and minimize toxicity along with ongoing daily follow-up on the clinical effects of the regimen, with adjustment as necessary to achieve desired outcomes. Pharmacokinetics dosing or monitoring occurs for all patients where therapeutic levels are reported. Drug and clinical information is provided to other health care professionals in response to specific questions regarding new or evolving issues related to the care of patients with cancer. The IV Admixture Center is staffed with highly trained pharmacists and pharmacy technicians who carefully and accurately make all IV chemotherapy preparations and other medications. Prepared inside a biological safety cabinet designed for chemotherapy, the sterile environment and techniques assure each dose is provided to ensure quality patient care.
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OUTPATIENT CLINICAL SERVICES MEDICAL ONCOLOGY Carilion offers a full range of medical oncology services in the inpatient and outpatient settings, partnering with the physicians of Blue Ridge Cancer Care to provide comprehensive cancer treatment to oncology patients in southwest Virginia. Patients are offered the latest in chemotherapy, biologic therapy, and clinical trial research.
RADIATION ONCOLOGY The state-of-the-art radiation oncology treatment opportunities offered at Carilion are unmatched anywhere in the region. The technology of the CyberKnife® and other, more traditional radiation therapies continue to offer patients more treatment options from a radiation oncology team that is highly trained and enthusiastic about the stellar patient care they provide. Some of the radiation therapy options include: »» Intensity modulated radiation therapy (IMRT) »» Image-guided radiation therapy (IGRT) »» High-dose rate brachytherapy (HDR) »» Prostate seed implant »» Selective internal radiation (SIR-Spheres) »» Stereotactic radiosurgery (CyberKnife®) The skilled and highly trained radiation team consists of radiation oncologists, physicists, nurses, and radiation technologists who offer personalized care to each and every patient. David Buck, M.D., serves as our medical director.
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“It is gratifying to help families find answers for their cancer histories and provide tailored surveillance plans through genetic risk assessments.” - Thuy Vu
GENETICS
GENETICS Cancer has a variety of causes, including genetic, and Carilion’s Cancer Genetics program is committed to assisting our patients and their family members to understand the risks of hereditary cancer and to develop a plan of action to reduce the risk or prevent cancer altogether. Patients are referred either by a physician or are self-referred and are able to speak to a trained genetics counselor in a private setting. We typically see patients who have: »» An unusual pattern of cancer in the family »» Onset of cancer at an unusually young age among family members »» Family members with the same kind or related types of cancer »» Family members with more than one kind of cancer »» Rare forms of cancer among family members Our services include: »» Education about cancer risks »» Guidelines for cancer screening and prevention »» Referrals to resources and support groups »» Coordination of genetic testing and related insurance issues »» Identification and enrollment of eligible patients in cancer research studies 13
OUTPATIENT CLINICAL
AMBULATORY INFUSION CENTER Our Infusion Center, located on the third floor of Riverside 1, provides intravenous chemotherapy, biotherapy, and subcutaneous injections for our patient population. The chemotherapy biotherapy course offered by the Oncology Nursing Society provides education and training for each Infusion Center nurse to provide safe, quality, and evidence-based patient care through the use of chemotherapy and biologic medications. The Infusion Center is equipped with 10 patient care chairs and staffed by five registered nurses. Our patient population includes gynecologic oncology, rheumatology, and gastroenterology patients. Our infusion nursing staff uses their specialized knowledge of medications to care for rheumatology patients with conditions such as rheumatoid arthritis, psoriatic arthropathy, ankylosing spondylitis, vasculitis, and lupus, as well as gastrointestinal conditions such as ulcerative colitis and Crohn’s disease. The nursing staff administers chemotherapy to the gynecologic oncology patients with GYN cancers such as endometrial, cervical, ovarian, or peritoneal cancers. Janet Osborne, M.D., serves as the medical director for the Infusion Center.
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HOSPICE Carilion Clinic Hospice is a unique provider in the continuum of care, providing end-of-life services and support to the patient and family, while maintaining dignity and comfort. Hospice care has been a service for over 40 years and is 100 percent covered by Medicare. Medicaid and most private insurances also provide these benefits to patients, with little to no co-pay. Our hospice staff consists of an interdisciplinary team that provides skilled nursing services, medical social workers, volunteers, chaplains, certified nursing assistants, massage therapists, music therapists, pet therapists and medical directorship. All of these staff members make visits to the patient’s home, nursing home, or hospital for care, a service that our team is honored to provide. Bereavement services are available for the family and caregivers free of charge and last for up to 13 months after the passing of a loved one. Carilion Clinic Hospice holds several grief support groups throughout the year for anyone that has experienced a loss. Camp Treehouse is held annually to provide an opportunity for children ages 6-17 a place to grieve, remember their loved one, and meet others who have also lost someone dear to them.
“We so appreciate the support, care and loving hands that attended to Milton during his final time with us. Thank you so much for the constant help you provided. Your diligent care eased our suffering and gave us the strength we needed during our loss. We are blessed to have had you in our lives. May you continue the caring and loving work that aides so many.� - Family of Milton
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INPATIENT AND OUTPATIENT CLINICAL SERVICES GYN ONCOLOGY Carilion provides comprehensive care for all patients with gynecologic malignancies. Through inpatient and outpatient care, we are committed to providing the highest quality of services using the latest treatment options and procedures, including the da Vinci® Surgical System. GYN oncology services include GYN surgery for malignant diseases, cancer screenings, genetic counseling, palliative care, GYN cancer support groups, and the opportunity for clinical trial participation through the national NRG research group.
BREAST PROGRAM Our Breast Care Center is a national leader in breast cancer screening, diagnosis, and treatment. We believe in an interdisciplinary approach to the treatment of breast cancer. Our skilled and compassionate integrated care team provides: »» Nurse navigation to provide individualized care, support, and education throughout the cancer treatment journey. »» Weekly cancer treatment planning conferences, so every woman receives the benefit of the combined expertise of a team of specialists. »» L arge-format pathology, a more accurate pathology approach that may lower the rate of breast cancer recurrence. »» Breast MRI, an advanced technology that allows for more precisely targeted treatment.
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COMPASSION Our skilled and kindhearted care team uses an interdisciplinary approach to the treatment of breast cancer.
INPATIENT AND OUTPATIENT
PEDIATRIC HEMATOLOGY/ONCOLOGY The Carilion Clinic Children’s Hospital (CCCH) offers family and patient-centered services for infants, children, adolescents, and young adults with cancer and blood disorders. The diagnosis and treatment of a childhood cancer or a blood disorder presents extraordinary psychological, emotional, and social challenges to the entire family. CCCH offers a variety of services to help families adapt to the treatment against these diseases, treating each young patient as a unique individual. An extended team of physicians, nurses, nurse practitioners, psychologists, child life specialists, dietitians, social workers, chaplains, pharmacists, case managers, and volunteers provided an integrated, multidisciplinary approach to children’s cancer treatment, with access to Carilion’s many subspecialty areas. CCCH is a proud member of the Children’s Oncology Group, which is instrumental in conducting the most current and dynamic research for children’s cancer treatments.
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PAIN MANAGEMENT Carilion’s pain management team of Rachel Huddleston, R.N.-B.C., B.S.N., M.S.N., and Lisa Simpson, R.N.-B.C., B.S.N., M.S.N., F.N.P.-C., evaluate patients in all areas of need, whether in the intensive care unit, the pediatric intensive care unit, or our medical/surgical units. Both practitioners are board certified in pain management, as well as trained in and embrace many modalities of pain management. When the situation is appropriate, they refer or suggest outpatient providers for massage, acupuncture, Reiki, water aerobics, and addiction. Lisa and Rachel provide education at meetings, helped organize the Pain Resource Nurse Program and the biannual Pain Conference at Carilion Clinic and provide expertise to several hospital committees.
PATHOLOGY Eleven board-certified pathologists provide diagnostic pathology services for our oncology patients. These services include intraoperative consultation; gross examination of patient specimens obtained at surgery; and microscopic examination of surgical specimens, biopsies, and cytologic specimens. All pathology reports are rendered using College of American Pathologists synoptic formats developed in cooperation with the oncology community. These formats ensure completeness of reporting and ease of access to information for patient management. Our pathologists are also often called upon to review cancer diagnoses from other institutions, and they also provide 22 hours each month to patient care conferences.
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SUPPORT SERVICES ONCOLOGY NUTRITION An oncology-certified registered dietitian/nutritionist provides nutrition services to our oncology inpatients and outpatients, as well as the inpatient Palliative Care Unit. The services include performing nutritional assessments, developing and implementing nutritional care plans, as well as providing nutritional counseling and diet education. Counseling covers modified diets, symptom and weight management, complementary nutritional therapies, and optimizing wellness for cancer survivorship. The registered dietitian also coordinates the cancer prevention program related to diet, lifestyle, and cancer risk reduction. Angela Charlton, our oncology registered dietitian, also maintains specialty certifications in oncology and nutrition support. All inpatients are evaluated and monitored for nutrition care and management per hospital policy. Inpatients are screened on admission by a nurse for nutrition risk and triggers such as unplanned weight loss, difficulty chewing or swallowing, admissions with parenteral nutrition, immune system compromise, or symptoms of dehydration. All outpatients are screened for nutritional risk by nursing using the patientgenerated subjective global assessment, a validated tool for oncology. Patients generating an increased risk score are referred to our registered dietitian for assessment. Additionally, all patients with feeding tubes, TPN, or those with head and neck, esophageal, or primary gastrointestinal tumors are also referred to the dietitian for evaluation. Staff members also refer any patient who is experiencing significant difficulties through the course of treatments.
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SUPPORT SERVICES
SOCIAL WORK AND CASE MANAGEMENT Oncology social workers and case managers provide specialized services to individuals undergoing cancer treatment and their family members. These services are available at Carilion Roanoke Memorial Hospital’s inpatient oncology and palliative care units as well as the Radiation Oncology Outpatient Clinic. Our oncology social workers meet with individuals and their family members to address practical problems such as transportation, financial concerns, or making treatment decisions. They are knowledgeable about local and national resources and can make appropriate referrals as needed, and provide short-term counseling, education, and problem-solving strategies to address quality-of-life issues such as adjusting to the cancer diagnosis/treatment, depression, and survivorship concerns. Our team of social workers also helps individuals prepare for important conversations with family members and cope with possible reactions. In addition, for inpatients, they can assist with transferring to either a skilled nursing or assisted living facility. Inpatient case managers work in collaboration with oncology social workers and are available at Carilion Roanoke Memorial Hospital. A case manager evaluates each individual after admission for specific discharge needs, such as referrals for home health/ hospice services, physical/occupational therapy, medical equipment, home oxygen, and medication assistance.
Healing Emotions Through Art Providing the very best patient care means treating more than just physical symptoms. We address the emotional needs of patients and families by integrating literary, performing, and visual art experiences into the healing process. The result is a more inspirational, supportive, and restorative environment for patients, visitors, and caregivers of Carilion Clinic. Some of the activities have included: »» Live music weekly in radiation oncology »» Bedside and public area activities by artists-in-residence, including painting, pottery and creative writing, as well as live cello and dance performances »» Inpatient and outpatient journaling »» V isual art exhibitions »» “ Poems in the Waiting Room,” a poetry brochure available for patients and visitors in waiting areas
SUPPORT SERVICES
PASTORAL CARE Carilion’s chaplains provide emotional and spiritual support for patients and families of all faiths as they deal with illness, suffering, and death. Services include pastoral counseling, reflective listening, prayer, and pastoral presence. Our chaplains offer support and therapeutic care in situations of crisis and grief, and help resolve conflicts and promote communication between patients, families, and staff concerning religious and cultural traditions that may affect health care decisions.
“As Director of Chaplaincy Services, I’m grateful that we can support and enhance the faith of our patients and their families during hospitalizations. The chaplain’s role in the healing process ensures that we are caring for the entire person in mind, body and spirit.” - Richard Brown 22
CLINICAL TRIALS AND RESEARCH By taking part in clinical trials and innovative cancer research, we are able to stay on the forefront of cancer treatment. Our patients can be assured that physicians who are involved in clinical trials are staying up to date on the latest treatment options and will provide the best possible care right here at home. Carilion Clinic’s gynecologic oncology program attracts significant funding each year for research which conducts progressive research trials through the NRG Oncology Group and the National Cancer Institute. Our program conducts 15 to 20 studies at any given time and continues to grow. Carilion Clinic Children’s Hospital’s childhood cancer program conducts clinical research trials through its association with the Children’s Oncology Group. We see approximately 15 to 20 new oncology patients per year. Having the only three board-certified pediatric hematologist/oncologists in southwestern Virginia and southeastern West Virginia allows us to offer cutting-edge cancer treatment to pediatric patients and their families. Carilion has partnered with Blue Ridge Cancer Care to offer patients access to cutting-edge medical and radiation oncology clinical trials. The radiation clinical trial program, which kicked off in September 2013, gives cancer patients a chance to participate in the development of future treatments while providing access to the very latest therapies that can potentially increase survival while improving quality of life. The trials are a collaborative effort among Blue Ridge Cancer Care, Carilion Clinic, US Oncology Research and NRG Oncology. In addition to the radiation clinical trials, the medical oncology clinical trials have also been an integral part of our efforts to provide cancer patients access to the latest therapies and treatment options for many years. Blue Ridge Cancer Care offers 25 to 30 medical oncology clinical trials at any given time, including breast cancer, lymphoma, lung cancer, gastrointestinal cancer, hematological malignancies, and much more. The trials are offered via a collaborative effort from US Oncology Research and/or pharmaceutical companies that sponsor the clinical trials.
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CARILION CANCER COMMITTEE The Carilion Cancer Committee is a multidisciplinary committee comprised of physician and non-physician members according to guidelines established by the American College of Surgeons Commission on Cancer. It is the responsibility of the committee to establish and evaluate annual goals related to cancer care for the program, to establish cancer conference frequency, maintain quality, and to provide for oncology education for medical and allied health professional staff at the facility. The American College of Surgeons (ACoS) has designated a position on the committee entitled the Cancer Liaison Physician (CLP) to act as a liaison between the committee and the ACoS. During 2014, the committee was chaired by David A. Buck, M.D., of radiation oncology. Dr. Buck also served as the CLP for the committee. The committee functions under the leadership of six coordinators. For 2013, these coordinators were: Catherine Hagan, M.S.N., C.B.N.®, outreach coordinator; Natasha Holt, C.C.R.P., clinical trials coordinator; Padmaja Malidi, M.D., cancer conference coordinator; Mary Ward, R.N., B.S., O.C.N.®, cancer registry quality coordinator; Jean Westervelt, L.S.W., psychosocial coordinator; and Lisa Mitchell, quality improvement coordinator.
CANCER CONFERENCES Multidisciplinary cancer conferences provide opportunities for physicians to present patient cases in a collaborative setting with physician specialists and other health care team members at Carilion Clinic in order to offer patients the most thorough and up-todate oncology treatment options. Conference attendees include medical oncologists, radiation oncologists, radiologists, pathologists, surgeons, and specialists in the conference discipline. Attendees also include nurses, mid-level providers, allied health professionals, medical students, and residents. Conferences offer patients the opportunity for multidisciplinary care and offer medical professionals ongoing education opportunities. Carilion is a regional leader in cancer conference offerings. Currently over 20 individual monthly conferences are held in the following specialty areas:
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»» Thoracic oncology
»» Breast pre-treatment planning
»» Pediatric oncology
»» General oncology
»» GYN oncology
»» Head and neck oncology
»» GI oncology
»» Neuro-oncology
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PAID
Roanoke, VA Permit No. 247
Non-Profit Org. U.S. Postage
On October 10, 2014, Carilion Clinic sponsored a Gastrointestinal Oncology Symposium for the purpose of presenting pertinent and up-to-date information about a variety of gastrointestinal (GI) cancers, treatment options, genetic testing, and survivorship care to primary care physicians and allied health professionals in the community. The conference was held at the Jefferson Center and was attended by over 100 health professionals from Roanoke and surrounding areas. Presenters included GI specialists, surgeons, radiologists, a pathologist, a radiation oncologist, medical oncologists, and a genetics counselor. The symposium, uniquely designed in a multidisciplinary case presentation format, offered medical professionals continuing medical hours of professional credit. Topics included: »» G enetics and pathology of colorectal cancer »» Surgical options for primary colorectal malignancy
annual
Oncology Symposium TransformaTive issues in GasTroinTesTinal CanCers
Friday, Oct. 10, 2014 The Jefferson Center Roanoke, Va.
Carilion Clinic P.O. Box 13727 Roanoke, VA 24036
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GASTROINTESTINAL ONCOLOGY SYMPOSIUM
»» Adjuvant and neoadjuvant therapy options »» Survivorship and supportive care issues
9/4/14 7:36 AM
»» Hepatocellular cancer »» Pancreatic adenocarcinoma
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PREVENTION PROGRAM Evaluation of the 2012 Roanoke Valley Health Needs Assessment indicated that there was a need for the establishment of a program focused on making healthy lifestyle choices as a way to prevent cancer. In response, Carilion created a cancer prevention program entitled Eat Right, Be Fit, Reduce Your Risk. Our oncology dietitian, Angela Charlton, R.D., developed a program, based on recommendations from the American Institute for Cancer Research and the American Cancer Society, that is aimed at reducing cancer in specific cancer-risk populations and teaches participants how to make healthy lifestyle choices. The program was used at several community events in the past year: »» Wake Up Wednesday A two-hour Carilion-sponsored event on Feb. 5, 2014 at Carilion Roanoke Memorial Hospital. Our oncology dietitian, a nutrition graduate, and our community health educators were on hand to answer questions about healthy lifestyle choices, and they also handed out educational materials to our employees and visitors that focused on reducing the risk of colon cancer. In addition, cancerfighting smoothie samples were offered, and participants were able to win prizes by answering questions related to healthy diet and lifestyle choices that would reduce their risk for cancer. Other materials distributed included our list of local healthy living/wellness resources, healthy recipes, and American Cancer Society booklets: Cooking Smart, Living Smart; and Eat Smart with Fruits and Vegetables. Fifty people attended.
»» A fternoon Healthbreak A two-hour Carilion-sponsored event on Feb. 20, 2014 at CASB. Hosted by Julie Blanchard, our community health educator, the event offered the same content as Wake Up Wednesday and targeted our employees. Attended by approximately 60 people.
»» C arilion Clinic Living TV Segment Filmed on March 26, 2014, the TV spot featured our oncology dietitian and focused on the diet recommendations for cancer risk reduction based on Eat Right, Be Fit, Reduce Your Risk program.
»» E at Right, Be Fit, Reduce Your Risk As part of a marketing partnership with the Roanoke Natural Foods Co-Op, our oncology dietitian and a nutrition graduate presented this one-hour program, handed out educational materials, and provided healthy smoothie samples on April 15 (attended by seven people). The same program was then presented to the radiation oncology staff on June 24 (attended by 16 people).
»» S ister’s Night Out Held on Sept. 25, 2014, this three-hour breast cancer event was aimed at educating underinsured African American women. Our oncology dietitian, an oncology nurse, and the manager of our tumor registry distributed educational materials and answered questions, as well as offered fresh fruit and muffin samples. Attended by 126 people.
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SCREENING PROGRAMS Our cancer program is committed to improving the lives of the people in the communities we serve. One way we strive to do this is by sponsoring screening programs. For 2014, the Cancer Committee sponsored two screening programs that were administered by the Every Woman’s Life program through the Carilion Breast Care Center.
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e re s c re e n e d . breast cancers were diagnosed
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We are pleased to partner with the Virginia Breast and Cervical Early Detection Screening program sponsored through Every Woman’s Life. During 2014, 722 women were screened for cervical and breast cancer and were provided mammograms and Pap smears, as well as follow-up care from our physicians. Through this program, 27 breast cancers and 11 cervical cancers were diagnosed.
cervical cancers were diagnosed
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QUALITY IMPROVEMENT Quality cancer care is our goal, and measuring quality patient outcomes has been a hallmark of the Carilion cancer program since its inception.
Methotrexate Administration in Interventional Radiology Quality Improvement Methotrexate, a chemotherapy drug, is a hazardous medication requiring special drug handling and administration. It is usually administered by chemotherapy-trained nurses on the oncology unit. A subset of patients receive this drug in the Interventional Radiology unit; thus, in 2013, a quality study was conducted to identify key areas of improvement in workflow, education for staff, and documentation. This initiated a performance/quality improvement project for 2014. The project components included: »» D evelopment of an improved workflow to incorporate the recommendations of the American Society of Clinical Oncology and Oncology Nursing Society’s (ASCO/ONS) guidelines for safe drug administration and documentation. »» D evelopment of a department policy and procedure for Methotrexate administration that included the ASCO/ONS’s guideline recommendations for safe administration of hazardous drugs. »» Education of all staff members on the drug, side effects, need for proper patient assessment and documentation, and requirement for proper documentation of the drug. This was administered by the oncology nurse educator. Criteria for evaluation of the project were completion of the policy and procedure, education of the staff, and chart review for measurement of vital signs and proper assessment of patients during treatment, patient education of side effects of treatment, and proper documentation of dual signature at administration of the drug per ASCO/ONS guidelines. In August 2014, the Interventional Radiology department developed a policy to include the workflow recommendations per ASCO/ONS guidelines and that 100 percent of staff had been educated on the drug, side effects, and workflow and department expectations. A June 2014 chart review revealed that 100 percent of charts of patients had a nursing assessment charted, and dual signature was noted on 100 percent of charts. Methotrexate administration in Interventional Radiology is a low-volume procedure, and the department managers recognize the necessity of ongoing education and further evaluation as the process continues to evolve. The department will continue to collaborate closely with the Oncology Department.
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QUALITY IMPROVEMENT
Increasing Screening Mammography Through Physician Practice Collaboration This quality improvement project was based on a 2013 study that identified the need to overcome barriers to mammography screening by creating access, educational and clinical resources for patients and physicians, and direct scheduling. In October 2013, the Carilion Clinic Breast Care Center approached the Carilion Clinic OB/GYN Highland primary care office regarding a quality project to increase mammography compliance. The four-month reporting period for 2014 demonstrated a 3.72 percent increase in mammography screenings. This is significant, in that mammography screening volume has been declining in other locations within Carilion.
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HOSPITAL CANCER REGISTRY The cancer registry at Carilion Roanoke Memorial Hospital has a reference date of January 1, 1985 and has over 60,000 patients listed. The five-year follow-up rate is 94 percent and the overall follow-up rate is 89 percent, which far exceeds the CoC standards. The registry employs a manager and five full-time, highly qualified and trained professionals who also provide support to physicians presenting at cancer conferences and to the Cancer Committee. The staff members abstract cases not only for Carilion Roanoke Memorial Hospital, but also for all of Carilion’s five additional hospitals and ambulatory physician practices. The registry ensures that the data of all the cancer cases diagnosed or treated at all Carilion facilities are maintained in a timely and accurate manner. The data is collected in a confidential manner and is used for measuring quality improvement, providing followup information, allocating resources, developing educational programs for health care providers, and reporting cancer incidence at the state and national levels.
CANCER PROGRAM PRACTICE PROFILE REPORTS Carilion’s cancer program is a voluntary participant in the Commission on Cancer’s Rapid Quality Reporting System (RQRS), which monitors the real-time reporting of breast and colorectal cancer cases at Carilion Roanoke Memorial Hospital. The purpose of RQRS is to improve patient outcomes of care by allowing better monitoring of patient treatment on a real-time basis. Reports are sent to the American College of Surgeons on a quarterly basis and monitored by the Cancer Committee for compliance with national treatment guidelines. Patients who are in need of timely treatment can be quickly evaluated and recommendations made to the managing physician. This allows for higher quality patient care.
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CANCER STATISTICS 2013 data from Carilion Facilities
Most Cancers Primary MOSTCommon COMMON CANCERS BY by PRIMARY SITE Site 450 400
427 377
Breast Lung & Bronchus
350
Colorectal
300
262
250
Prostate 212
Melanoma - Skin
202
Corpus & Uterus, NOS
200
Urinary Bladder
150
114
100
114
Non-Hodgkins Lymphoma
92 63
63
Pancreas Thyroid
50 0
CANCER NUMBERS BY RACE
White 88.66% | 2,322
Total: 2,619 American Indian .04% | 1
Black 8.90% | 233 Japanese .04% | 1
Hawaiian .04% | 1 Other 2.33% | 61
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CANCER NUMBERS BY GENDER
Total: 2,618
Females 53.51% | 1,401
Males 46.49% | 1,217
TOP FIVE CANCERS Top FiveFEMALE Female Cancers 450
422
400 350
Breast
300
Lung & Brochus
250 200
Colorectal
164 129
150
114
100
Corpus & Uterus, NOS 92
Melanoma - Skin
50 0
TOPFive FIVE MALE CANCERS Top Male Cancers 250 213
212
200 Lung & Bronchus 150
Prostate
133
Colorectal
110 100
78
Melanoma - Skin Urinary Bladder
50
0
CLASS OF CANCER CASE
Total: 2,618
Analytic/new dx 79.8%% | 2,089
Non-analytic/recurr 20.2% | 529
CANCER STAGE DISTRIBUTION (ANALYTIC CASES ONLY) 0
100
200
300
Total: 2,089 400
500
Stage 0 Stage I Stage II Stage III Stage IV 88 Unknown
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Summary by Body System, Sex, Class, and Best AJCC Stage Report 2013 Data
Summary by Body System, Sex, Class, and Best AJCC Stage Report
SEX Primary Site
Total No.
Male
Female
64
44
20
Tongue
28
18
10
Salivary Glands
1
0
1
Floor of Mouth
5
3
2
Gum & Other Mouth
6
5
1
Nasopharynx
2
2
0
Tonsil
15
9
6
Oropharynx
4
4
0
Hypopharynx
3
3
0
DIGESTIVE SYSTEM
479
265
214
Esophagus
27
23
4
Stomach
33
26
7
Small Intestine
20
11
9
Colon Excluding Rectum
181
87
94
Rectum & Rectosigmoid
81
46
35
Anus, Anal Canal & Anorectum
19
8
11
Liver & Intrahepatic Bile Duct
33
23
10
Gallbladder
5
2
3
Other Biliary
8
5
3
Pancreas
63
34
29
Retroperitoneum
1
0
1
Peritoneum, Omentum & Mesentery
6
0
6
Other Digestive Organs
2
0
2
419
246
173
Nose, Nasal Cavity & Middle Ear
4
1
3
Larynx
34
29
5
Lung & Bronchus
377
213
164
Pleura
1
0
1
Trachea, Mediastinum & Other Respiratory Organs
3
3
0
BONES & JOINTS
2
1
1
SOFT TISSUE
14
9
5
14
9
5
211
116
95
202
110
92
9
6
3
ORAL CAVITY & PHARYNX
RESPIRATORY SYSTEM
Soft Tissue (including Heart)
SKIN EXCLUDING BASAL & SQUAMOUS Melanoma -- Skin Other Non-Epithelial Skin
CLASS OF CASE
STAGE DISTRIBUTION - ANALYTIC CASES ONLY
Analy
NA
Stg 0
Stg I
Stg II
Stg III
Stg IV
53
11
1
10
8
9
25
24
4
1
6
3
4
10
1
0
0
1
0
0
0
5
0
0
2
1
0
2
3
3
0
0
1
1
1
2
0
0
0
0
0
2
12
3
0
0
1
4
7
3
1
0
0
1
0
2
3
0
0
1
1
0
1
417
62
7
74
107
101
71
23
4
0
7
7
2
5
33
0
1
4
3
5
8
20
0
0
4
4
3
2
153
28
4
28
50
43
15
75
6
1
14
15
27
9
13
6
0
1
5
4
1
28
5
0
7
6
6
4
5
0
1
1
0
1
1
8
0
0
1
1
1
2
51
12
0
7
16
5
22
1
0
0
0
0
0
0
6
0
0
0
0
3
2
1
1
0
0
0
1
0
366
53
5
81
36
70
158
4
0
1
0
0
1
0
29
5
0
14
5
3
7
329
48
4
67
31
66
151
1
0
0
0
0
0
0
3
0
0
0
0
0
0
2
0
0
1
0
0
1
12
2
0
1
0
4
4
12
2
0
1
0
4
4
42
169
4
12
6
4
4
35
167
4
11
5
3
4
7
2
0
1
1
1
0
35
Continued... 2013 Data
SEX
Summary by Body System, Sex, Class, and Best AJCC Stage Report
Primary Site
Total No.
Male
Female
BREAST
427
5
422
FEMALE GENITAL SYSTEM
198
0
198
Cervix Uteri
23
0
23
Corpus & Uterus, NOS
114
0
114
Ovary
40
0
40
Vagina
4
0
4
Vulva
16
0
16
Other Female Genital Organs
1
0
1
MALE GENITAL SYSTEM
221
221
0
Prostate
212
212
0
Testis
8
8
0
Penis
1
1
0
20
11
9
Urinary Bladder
173
114
59
Kidney & Renal Pelvis
114
78
36
Ureter
51
31
20
Other Urinary Organs
5
3
2
EYE & ORBIT
2
2
0
BRAIN & OTHER NERVOUS SYSTEM
78
38
40
Brain
42
23
19
Cranial Nerves Other Nervous System
36
15
21
80
24
56
Thyroid
63
15
48
Other Endocrine including Thymus
17
9
8
101
54
47
Hodgkin Lymphoma
9
6
3
Non-Hodgkin Lymphoma
92
48
44
MYELOMA
30
17
13
LEUKEMIA
49
26
23
Lymphocytic Leukemia
18
12
6
Myeloid & Monocytic Leukemia
28
12
16
Other Leukemia
3
2
1
MESOTHELIOMA
4
4
0
MISCELLANEOUS
71
37
34
2,623
1,223
1,400
URINARY SYSTEM
ENDOCRINE SYSTEM
LYMPHOMA
Total
CLASS OF CASE
STAGE DISTRIBUTION - ANALYTIC CASES ONLY
Analy
NA
Stg 0
Stg I
Stg II
Stg III
Stg IV
406
21
65
173
121
23
19
170
28
4
75
13
39
26
20
3
1
2
3
5
7
105
9
2
61
6
17
11
36
4
0
8
4
13
8
1
3
0
0
0
1
0
7
9
1
4
0
2
0
1
0
0
0
0
1
0
149
72
0
36
77
21
12
140
72
0
29
77
20
12
8
0
0
6
0
1
0
1
0
0
1
0
0
0
20
1
0
4
4
3
143
30
39
39
21
13
16
88
26
38
15
16
7
4
47
4
1
23
3
6
11
5
0
0
0
2
0
1
0
2
0
0
0
0
0
74
4
0
0
0
0
0
39
3
0
0
0
0
0
35
1
0
0
0
0
0
75
5
0
37
5
5
4
60
3
0
37
5
5
4
15
2
0
0
0
0
0
83
18
0
21
19
19
17
7
2
0
2
2
2
1
76
16
0
19
17
17
16
22
8
0
0
0
0
0
30
19
0
0
0
0
1
7
11
0
0
0
0
1
21
7
0
0
0
0
0
2
1
0
0
0
0
0
4
0
0
1
0
0
3
50
21
0
0
0
0
0
2,098
525
125
561
413
308
361
37
CARILION CANCER COMMITTEE 2014 Members PHYSICIAN MEMBERS David Buck, M.D., Radiation Oncology Sandy Fogel, M.D., General Surgery Evelyn Garcia, M.D., Radiology William Jefferson, M.D., Pathology Padmaja Malidi, M.D., Medical Oncology
NON-PHYSICIAN MEMBERS Verne Baker, senior vice president and administrator, Cancer Program Danielle Cummings, C.T.R. Catherine Hagan, M.S.N., C.B.N.速, outreach coordinator Natasha Holt, C.C.R.P., clinical research coordinator Deborah Joyce, B.S., R.T.T., manager, Rehabilitation Services Patricia Kingery, M.S.N., R.N., senior director, Oncology Services Lisa Mitchell, M.B.A., practice director, Radiology Services Cindy Smith, M.S.N., R.N., N.E.A.-B.C., C.P.H.Q., quality improvement representative Thuy Vu, M.S., C.G.C., Genetics Counseling Mary Ward, R.N., B.S., O.C.N.速, manager, Cancer Registry Jean Westervelt, L.C.S.W. Phyllis Whitehead, Ph.D., M.S.N., Ap.R.N., A.C.H.P.N., Palliative Care
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