2009 Mon tgom ery Gen er a l Hospita l C a nc e r C e n t e r | A n n ua l R e p or t
Better. Stronger. Close to you.
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C a n c e r C o mm i t t e e C h a i r ’ s R e p o r t
T
he Cancer Center at MGH continues to evolve in order to improve and expand treatment services for our patients. I am happy to report that construction of the new outpatient infusion center was completed in
October 2009. The new and improved outpatient infusion center is in full operation and it is conveniently located next to the Helen P. Denit Radiation Oncology Center. Having a separate entrance from the hospital, will further reduce a patient’s exposure to the risk for infections sometimes associated with acutely ill patients. The infusion center is beautifully decorated by paintings donated by Barbara Piegari and myself, as well as survivor quilts donated by 2009 Olney Relay for Life, Chick’s for Life Team. Thanks to the generous donation of both Mrs. Mary D. Howes, and Mrs. Joan Derrick the center is surrounded by two beautiful gardens. The gardens help to provide tranquility and serenity to our cancer patients. The area in the hospital that corresponded to the old infusion center will be utilized to build private rooms for our oncology patients. In addition, there are plans underway to bring an oncology multidisciplinary clinic in the summer of 2010. Our nursing staff is constantly working on improving quality of care from decreasing the time it takes to have the chemotherapy delivered to the
The new and improved outpatient
hypersensitivity standing orders that allow immediate response to patient’s allergic
infusion center is in full operation.
acquisition of a new CT camera that will more accurately stage cancer patients.
reactions. The nuclear medicine department will upgrade equipment with the
2 0 0 9 M o ntg o m e r y g e ne r al H ospital Can ce r ce n te r | coM mitte e Chair ’ s r e por t
Physician Communit y Liaison Report It’s an exciting year for the Montgomery General Oncology Program. As the Physician Liaison, I have been privileged to see our program expand our multidisciplinary role. This means that anyone diagnosed with cancer will soon be able to meet their entire team at one time extending from the surgical,
As Montgomery General Hospital (MGH) is now a proud member of MedStar Health
medical, radiation oncology roles. This will
we value the ease in collaborations with many of our sister hospitals. One such
allow the patient to meet their team early in
opportunity in 2009 was to create with Washington Hospital Center a combined
the treatment and to know that they have a
breast cancer tumor board. The breast tumor board is delivered through the use of
dedicated panel of physicians working with
teleconference technology. This allows for a broader discussion and the sharing of
them and enable them to make informed
available diagnostic and treatment information for the best care of breast cancer
decisions regarding their care. As always,
patients.
we are dedicated to improve the outcome by also addressing cosmetic, nutritional
MGH with our MedStar affiliation continues to work to provide excellent cancer care
and psychological concerns. The medical
to our patients. We’re expecting 2010 to be another year where we can continue
world has made rapid advancements in the
to enhance our services and provide the most comprehensive cancer care to our
treatment of cancer and our team is here to
community.
individually guide each patient. Shawn Tweedt, D.O.
Sincerely,
General Surgeon Physician Community Liaison
Isabella C. Martire, MD, Medical Oncologist Chairman, Cancer Committee
The Brains, Breast and Beauty program has continued efforts to outreach to minority women aged 18-40. This past April, we developed and implemented a breast health summit to reach our targeted population.
2 0 0 9 M o ntg o m e r y g e ne r al hospital Can ce r ce n te r | commu n ity ou tr e ach
Ma k i n g a d i f f e r e n c e i n t h e c o mm u n i t y
T
he Brains, Breast and Beauty program has continued efforts to outreach
group that holds informal sessions combining self esteem, beauty and other young
to minority women aged 18-40. This past April, we developed and
women’s issues. They are interested in incorporating sessions of our program into
implemented a breast health summit to reach our targeted population.
these events and we look forward to working with them. Brains, Breast and Beauty
The major focus was breast health and education. The greatest impact of this
will continue to provide practice techniques on breast models for simulating breast
summit was through the high quality speakers and diverse panel of experts which
examination at health fairs and other events throughout the county.
included two of our own doctors, Dr. Isabella Martire and Dr. Matrice Browne as well as Dr. Minetta Liu of the Lombardi Comprehensive Cancer Center at
Earlier this year, we ran a program geared toward
Georgetown University.
African American men and their families regarding prostate cancer. This program trained and utilized
To date, the Brains, Breast and Beauty program has trained 11 individuals
barbers in the community to educate their clients
designated as Health Ambassadors to assist with outreach to minority women.
on prostate cancer screenings and encouraged them
This is a culturally sensitive group and includes four bilingual people. The program
to speak with their doctor about getting screened.
has contracted with Dr. Margruetta B. Hall M. Sc., PhD, to serve as our Program
We referred them to low cost or free screenings
Evaluator. As a result of this ongoing evaluation, we have been able to, interpret
at the People’s Wellness Community Center and
and utilize the data collected from participants to enhance our program. We have
throughout the community.
also had an opportunity to collaborate with Montgomery College campuses to host educational sessions as a part of the Women’s Health Studies Program. In addition
During the health fair this year, Montgomery General was able to offer free skin
to this, the Brains, Breast and Beauty program is also in discussion with Southern
cancer screenings to the community. Our community outreach was also part of the
Management Corporation, which has 12
Olney Relay for Life held at the Sherwood High School outdoor track.
apartment complexes in Montgomery County. Plans are underway to conduct
We have also collaborated with MGH Foundation to put on a cancer exhibit at the
educational sessions at these venues or
MGH Women’s Board Annual Picnic and Bazaar as well as setting up an educational
to be a part of already existing programs.
breast cancer exhibit during the month of October for breast cancer awareness for
We have also met with other community
hospital employees.
groups to further our outreach. One group is Youth Connex, a young adult Christian
— Sharnika Merricks, B.A. Psychology, Community Outreach Specialist
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200 9 Montgomery gen era l h o s p ita l C a n c er c e nt e r | p r ostat e c anc e r
t h e s u rg i c a l t r e a t m e n t o f p ro s t a t e c a nc e r ationally, in 2008, prostate cancer remained the most commonly
For those men diagnosed at this
diagnosed malignancy in men, excluding skin cancer, with an estimated
institution, the overwhelming majority,
186,000 newly diagnosed cases. This represented roughly 25% of all new
81%, had Stage II disease. Only eight
cancer diagnoses in men. Prostate cancer accounted for 10% of the estimated
percent were diagnosed with Stage I
294,000 deaths attributed to cancer in 2008, making it the second leading cause
disease. The number for men diagnosed
of cancer death in men behind lung cancer.
with Stage I cancer (often those who were
(1)
noted to have an elevated PSA without While the root causes of prostate cancer are not fully understood, some
abnormal findings on digital rectal examination) is likely to be artificially low
associated risk factors, such as diets high in fat, might be reduced with lifestyle
in this database secondary to the propensity for these men to have biopsies at
changes. Others such as age, race and family history remain beyond anyone’s
outpatient facilities.
control. The American Cancer Society (ACS) recommends that men of higher risk for developing the disease, African Americans or those with first degree
When prostate cancer is diagnosed, particularly in its early stages, many options
relatives with prostate cancer, begin to have the conversation regarding prostate
for treatment are available. Some include surgery, various forms of radiation
cancer screening at age 45. For men of average risk, the ACS recommends that
therapy, cryosurgery, primary hormonal manipulation or expectant management.
conversation begin at the age of 50.
Treatment options are usually tailored for the individual patient and can be based on age, general health status and patient preference. For those who were
At Montgomery General Hospital (MGH), new diagnoses of prostate
diagnosed at MGH in 2008, 46% had surgery, 23% had some form of radiation,
cancer accounted for just under 10% of new cancer cases in 2008.
while others had cryosurgery.
In recent years, this figure has remained consistently lower than national averages as a result of many men in this area undergoing
In summary, prostate cancer diagnoses at MGH were
biopsies at outpatient centers. Nonetheless, the presenting
somewhat below national averages for the reasons stated
characteristics of those diagnosed at this institution remain
above. However, the stage distribution and treatment
largely compatible with national averages.
modalities chosen were consistent with regional and national benchmarks.
The average age of men diagnosed with prostate cancer in 2008 at MGH was 70 years. Most of these men were diagnosed in their seventh or eighth decade of
— Luther Ampey, MD, Radiation Oncologist
life. Nearly forty percent were diagnosed between the ages of 50-59 or 80-89. (1) ACS “Facts and Figures” 2008
First course treatment
NO TREATMENT 8%
DIAGNOSTIC 12%
SURGERY 45%
DIAGNOSTIC/SURGERY 12%
RADIATION 23%
When prostate cancer is diagnosed, particularly in its early stages, many options for treatment are available. Treatment options are usually tailored for the individual patient and can be based on age, general health status and patient preference.
M ONTGO M ERY GENERAL H OSPITAL P r o s t a t e C a n c e r 5 y e a r s u r v i va l r a t e b y s t a g e d i a g n o s e d 1 9 9 8 - 2 0 0 1 , O b s e r v e d u p t o 2 0 0 6 CO MPARED TO MARYLAND , SOU T H EA S T AN D NATIONAL | A JC C TN M E D 5 | S our c e : 2 0 0 9 N at i ona l Can ce r Database /Commission on Can ce r
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
MGH MARYLAND SOUTHEAST US NATIONAL
S TAG E 1
S TAG E 2 RATE
S TAG E 3
CASES
RATE
CASES
CASES
1
100.0%
85
85.0%
5
554
85.0%
11,276
91.0%
2,099
80.0%
80,870
13,519
80.0%
RATE
S TAG E 4
A L L S TAG E S
CASES
RATE
CASES
RATE
80.0%
10
10.0%
101
77.0%
1,791
93.0%
683
38.0%
14,304
88.8%
88.0%
8,999
89.0%
5,342
38.0%
97,310
85.5%
345,018 88.0%
40,738
89.0%
25,158
38.0%
424,433 85.5%
2 0 0 9 M o ntg o m e r y g e n e r al hospital Can ce r ce n te r | pr ostate can ce r
Montgomery Gener al Hospital Malignancies by Gender s umma r y by b ody sy ste m TYPE OF CANCER ORAL CAVITY & PHARYNX
Tongue Tonsil DIGESTIVE SYSTEM
Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Gallbladder Other Biliary Pancreas Other Digestive Organs RESPIRATORY SYSTEM
Larynx Lung & Bronchus BONES & JOINTS
Bones & Joints SOFT TISSUE
Soft Tissue (including Heart) SKIN EXCL BASAL & SQUAMOUS
Melanoma — Skin BREAST
Breast
MALE 5 2 3 24 3 3 2 10 4 0 0 0 2 0 13 1 12 1 1 1 1 2 2 0 0
FEMALE
TOTAL
1 1 0
6 3 3
FEMALE GENITAL SYSTEM
TYPE OF CANCER
19 0 2 0 12 1 1 1 1 0 1 13 0 13 0 0 1 1 1 1 45 45
43 3 5 2 22 5 1 1 1 2 1 26 1 25 1 1 2 2 3 3 45 45
MALE GENITAL SYSTEM
Corpus & Uterus, NOS Ovary Prostate Testis URINARY SYSTEM
Urinary Bladder Kidney & Renal Pelvis Other Urinary Organs BRAIN & OTHER NERVOUS SYSTEM
Other Nervous System ENDOCRINE SYSTEM
Thyroid LYMPHOMAS
Hodgkin Lymphoma Non-Hodgkin Lymphoma MULTIPLE MYELOMA
Multiple Myeloma LEUKEMIAS
Lymphocytic Leukemia Myeloid & Monocytic Leukemia MISCELLANEOUS
Miscellaneous Sites CUMULATIVE TOTAL
MALE 0 0 0 28 27 1 30 20 9 1 2 2 1 1 2 1 1 1 1 0 0 0 2 2
FEMALE 6 5 1 0 0 0 7 4 3 0 1 1 5 5 13 3 10 0 0 4 1 3 4 4
TOTAL 6 5 1 28 27 1 37 24 12 1 3 3 6 6 15 4 11 1 1 4 1 3 6 6
112
120
232
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c ancer registry report
T
he Cancer Registry reports cancer information to the Maryland Center Data System
quarterly, ACOS (American College of Surgeons) and National Cancer Database on an annual basis. Most importantly, this data is used to analyze current trends to improve patient care by comparing diagnostic studies, treatment, stage and survival data for national research. The Cancer Registry is also required to conduct a lifetime follow up of the patients. Current patient health status information is obtained monthly via letters to physicians, hospitals, and patients. The MGH cancer registry database consists of 4,019 patients since our reference date of 1998.
Most importantly, this data is used to analyze current trends to improve patient care by comparing diagnostic studies, treatment, stage and survival data for national research.
— Shirlana Gabriel, CTR Oncology Data Coordinator
2 0 0 8 Montgomery general hospital C ancer center | can ce r r e g istr y r e por t
top five sites male for 2008
top five sites female for 2008
The to p fi ve si te s f o r ma l e at M G H a r e p r ostat e , l u n g ,
Th e to p f i v e s i t es f o r Fe m ale at M GH are b rea st, lung, c olon,
b l a dd er, c o l o n a nd k i d ne y.
th yr oids an d lymphoma.
90 90
90
90
80 80
80
80
70 70
70
70
60 60
60
60
50 50
50
50
40 40
40
40
30 30
30
30
20 20
20
20
10 10
10
10
0 0
0
CANCER CANCER SITE SITE CANCER SITE MALEMALE MALE FEMALE FEMALE FEMALE
11
0 M A LM EALE MALE
COLONCOLON COLON 10 10 12 12
10 12
BRONCHUS BRONCHUS BRONCHUS & LUNG & LUNG & LUNG 12 12 12 12
12 12
F E MM FAEA LM EL EA L E FEMALE
PROSTATE PROSTATE BREAST BREAST CANCER BLADDER SITE BLADDER PROSTATE BLADDER GLAND GLAND BREAST GLAND 26 26 0 0
26 0
0 0 45 45
0 MALE 19 19 45 FEMALE0 0
19 0
KIDNEY COLON KIDNEY KIDNEY 10 7 7 12 0 0
7 0
THYROID BRONCHUS THYROID THYROID GLAND & LUNG GLAND GLAND 012 0 0 512 5 5
LYMPH PROSTATE LYMPH LYMPH NODES GLAND NODES NODES 0 260 0 13 013 13
TOTAL BREAST TOTAL TOTAL 74 074 74 85 4585 85
BLADDER
KIDNEY
19
7
0
0
12
200 9 Montgomery gen era l h o s p ita l C a n c er c e nt e r | c anc e r c onf e r e nc e s
c ancer Conferences
T
he cancer conference is an
2 0 0 9 C a n c e r c o mm i t t e e M e m b e r s PHYSICIANS
General Members Randy Bursaw Nuclear Medicine
weekly basis.
Luther L. Ampey, III, MD Radiation Oncology/ Medical Director, Denit Cancer Center
The conference offers a forum for
Paul Bannen, MD Medical Oncology
important component of the clinical management of cancer
patients at MGH. These are held on a
discussion of pertinent patient issues including pre-treatment strategy and rehabilitation. This is a multidisciplinary meeting of physicians and allied health professionals. Physicians are encouraged to present prospective and occasionally retrospective cancer cases. This provides an opportunity for presentation of case management issues at a time when management of the patient can be influenced by decision. To continue to increase the quality of our program we have joined with Washington Hospital Center in a monthly breast teleconference held on the first Wednesday of every month.
Joseph Kaplan, MD Medical Oncology Roger Leonard, MD Vice President, Medical Affairs Isabella Martire, MD Cancer Committee Chairman Medical Oncology Garrett J. Reilly, MD Oncology/Hematology Ajay s. Sufi, MD Radiology Curtis W. Ollayos, MD Pathology Chitra Rajagopal, MD Oncology/Hematology Shawn Tweedt, D.O. Surgery Arthur F., Woodward, Jr., MD Surgery
Tracy Douglas Wheeler Director, OP Services Sharon Ford, RN Community Health Shirlana Gabriel, CTR Oncology Data Coordinator Chris Grose, RN, OCN NPER/Oncology Brian Hunt Advanced Care, Pastoral Care Gary Magnus, RPH Pharmacy Mary Miller, RN Director of Nursing Leslie Ortiz, RCD Nutritional Services/Sodexo Debra Otani, RN, OCN Manager, Outpatient Oncology Services PI Coordinator Gail Patterson, RN, OCN Functional ONC Unit Manager
BA Secrist, VP Quality, Safety and Compliance Connie Stone, CNO, VP Patient Care Services Lynda Suh, RN PIRM Nikki Yeager Director, Marketing Sharnika Merricks Community Outreach Specialist Sheila Lampel, RN, BSN Cancer Care Navigator
The conference offers a forum for discussion of pertinent patient issues including pre-treatment strategy and rehabilitation.
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200 9 Montgomery gen era l h o s p ita l C a n c er c e nt e r | c al e ndar o f Ev e nts
2 0 0 9 c a l e n da r o f e v e n t s
The infusion center is surrounded by two beautiful gardens.
February
“Third Annual Art Show” Fundraising event with proceeds going to
MGH Comprehensive Cancer Center
March
“Daffodil Days” Fundraising event to benefit American Cancer
Society
“MGH Annual Health Expo” Dr. Abertoli and Dr. Sarah Mess
provided free skin cancer screenings and cancer education
April
Women’s Breast Health Summit, Expert Speaker, followed by a
Multidisciplinary Panel Discussion, Breast Health Education, Cancer
Support Services, Exhibits and spa-like activities for the community
May
Commission on Cancer Survey — Awarded continued Approval
with Commendations 2008-2011
June
“Relay For Life of Olney” MGH was corporate sponsor and provided
cancer information at this highly successful annual relay which
raised $247,000 for the American Cancer Society
“4th Annual Oncology Update” Topics included palliative
pain control and oncology clinical trials
July
“Women’s Board Annual Picnic and Bazaar” MGH Cancer Program
provided informational table
September “Blue Ribbon, Prostate Awareness Day” to educate the
community and hospital staff on prostate health information
October
“Breast Health Awareness Day” was an interactive educational
event on breast health for employee hospital visitors
Infusion Center Grand Opening Event
• “Reach To Recovery” Partnering with American Cancer Society to provide support and information for those with a diagnosis of breast cancer • “Nutrition Services” Registered clinical dieticians provide free counseling now expanded to outpatient oncology patients • “Grand Rounds” Hospital-wide educational seminars providing information on broad range of topics including cancer • “Cancer Conferences” Weekly multidisciplinary conferences where specific cases are presented and discussed to facilitate a team approach to treatment planning • “Breast Cancer Teleconference with Washington Hospital Center” Monthly multidisciplinary conference where specific breast cancer cases are presented and discussed to facilitate a team approach to treatment planning • “Brains, Breast and Beauty” Partnership with Susan G. Komen for the Cure
O ng o i ng p ro g r a m s • “Look Good Feel Better” Partnering with American Cancer Society to provide beauty & health tips for women undergoing the effects of chemo and radiation treatments • “I Can Cope” Partnering with American Cancer Society to provide support and information for people facing cancer
and community partners for breast health education, navigational outreach to women 18-40, minorities and the uninsured in Montgomery County. • “Have Faith in Your Health” Partnership with American Cancer Society for cancer prostate education and navigation, primarily targeting minorities and the uninsured in Montgomery County.
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200 9 Montgomery gen era l h o s p ita l C a n c er c e nt e r | c ontact i nf o r m at i on
Montgomery General Hospital 18101 Prince Philip Drive Olney, MD 20832 301-774-8693 (Cancer Center) For information about joining the staff of Montgomery General Hospital, visit www.MontgomeryGeneral.com
ON C OLOGY SERVI C ES Oncologic Surgery • General surgery, breast, gynecology, urology, otolaryngology, abdominal, thoracic, neurosurgery, orthopedic, plastic and reconstructive surgery, and dermatology • Outpatient Surgery Center Medical Oncology • Medical/Oncology Inpatient Unit • Outpatient chemotherapy/infusion therapy, blood and blood products transfusions, hydration Radiation Therapy • External beam radiation • 3-D treatment planning • CT stimulation • Prostate seed implant • IMRT • IGRT Nursing • Inpatient and outpatient units staffed by Oncology Nursing Society Certified Nurses • Enterostomal therapist • Wound, Ostomy Nurse Nurse Navigation • Oncology • Nurse Navigator
Laboratory Medicine • Clinical laboratory, cytology, and anatomic pathology services • Blood irradiation
Social Work • Discharge planning • Supportive counseling for needs of each patient and family
Medical Imaging • Fixed radiography • Digital interventional and cardiac catheterization • Intravascular ultrasound, diagnostic ultrasound • Spiral CT Scan • 65 Slice CT • MRI • Nuclear Med • PET Scan • Digital Mammography (CRA)
Pastoral Care • Spiritual support to patients and families • Ethical decision-making assistance
Rehabilitation Medicine • Inpatient and outpatient physical therapy, occupational therapy and speech pathology • Breast Cancer Lymphedema Management • Transitional Care Unit Supportive Services • Cancer Support Group Monthly • Look Good, Feel Better – Quarterly group skin care and makeup workshop Community Outreach • Education classes for community and faith based organizations • ACS Have Faith in you Health • Brains, Breast and Beauty
Nutrition Services • Nutritional assessment/screening • Enteral and parental nutritional therapies • Outpatient nutrition counseling Home Health/Personal Care • Nursing: Medical/Surgical, Mental Health • Infusion Therapy: Chemotherapy, TPN, PPN, Blood and blood products • Therapy: Physical Therapy, Occupational Therapy, Speech-Language Therapy • Home Care Aides • Social Work • Health Watch personal emergency response system • Palliative Care • Advanced Care Team • Symptom Management
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