2016 Oncology Annual Report

Leading Cancer care and research 2016 year in review

II

houston methodist sugar land Hospital

contents Oncology PROGRAM HIGHLIGHTS CANCER CONFERENCES AND CANCER REGISTRY STATISTICS

3

DIAGNOSTIC MODALITIES

6 10

BREAST CARE CENTER

12

INFUSION CENTER

14

RADIATION ONCOLOGY

16

MAIN PAVILION 4E ONCOLOGY UNIT

17

Community Outreach and Education

18

QUALITY IMPROVEMENTS AND OUTCOMES

20 22

SURVIVORSHIP

24

Our Campus

25

Compassion and Support

10

15 12

20

HOUSTON METHODIST SUGAR LAND HOSPITAL ONCOLOGY PROGRAM – WHERE THE SCIENCE OF TECHNOLOGY MEETS THE ART OF CARING.

A Message From our Cancer committee chair Oncology Program Highlights

2016 proved to be a year of “newness” for the Oncology Program here at Houston Methodist Sugar Land Hospital. Within this annual report, you will find how we have embraced our I CARE values (Integrity, Compassion, Accountability, Respect, and Excellence) to deliver the only cancer care in Fort Bend County accredited by the American College of Surgeons Commission on Cancer.

This year brought new people, new technology and a new interest in enhancing and expanding our cancer survivor support program.

In January, we kicked off our new monthly thoracic cancer conferences. The thoracic cancer conference provides a forum for a multidisciplinary team of physicians and other allied health professionals to jointly review and discuss cases of patients with lung cancer. The goal is to provide real-time consultative services for patients so an effective treatment plan may be developed based on best evidence.

In June, the new oncology service line director arrived followed by the new cancer program coordinator in August. Multiple supportive changes were implemented for our survivors including the implementation of volunteers and pet therapy through Faithful Paws in our Infusion Center. In keeping with our commitment to ensure our survivors are informed, we updated our cancer resource guide and established an advance directives algorithm so that survivors can have the opportunity to learn about these very important documents.

From a technology standpoint, Lymphoseek (Technetium Tc99m Tilmanocept) was implemented in the nuclear medicine department in August 2016. Tc99m is a radioactive diagnostic agent used for lymphatic mapping and for guiding sentinel lymph node biopsy (SLNB) for squamous cell carcinoma of the oral cavity, breast cancer or melanoma.

In the Breast Care Center, we added upright stereotactic breast biopsy with tomosynthesis capability.

Our preoperative testing area was expanded from six rooms to nine rooms; thereby enhancing the preoperative testing experience for our surgical oncology patients.

As this report will show, there is an incredible amount of teamwork that goes into the delivery of cancer care at Houston Methodist Sugar Land. We are committed to providing the best cancer care in Fort Bend County, and our mission continues — to provide for the comfort of our patients, while delivering the best value to the community in a spiritual environment of caring.

Charles Conlon, MD Cancer Committee Chair

04 houston methodist sugar land Hospital

Cancer Committee Physician Leadership

Charles Conlon, MD Hematology/Oncology Cancer Committee Chair

Swarna Balasubramaniam, MD Colorectal Surgery Cancer Liaison Physician

Jorge Darcourt, MD Hematology/Oncology Clinical Research Coordinator

Ali mahmood, MD Colorectal Surgery Quality Improvement Coordinator

"We are committed to providing the best cancer care in Fort Bend County."

CHARLES CONLON, MD Cancer Committee Chair

Seema Mullick, MD Pathology Cancer Registry Quality Coordinator

Timothy Oppermann, MD General Surgery Community Outreach Coordinator

STEPHEN PHILLIPS, MD Diagnostic Radiology Breast Imaging

Clive Shkedy, MD Radiation Oncology Cancer Conference Coordinator

SUPPORTING PHYSICIANS Ashok Balsaver, MD Pathology

Bisong Haupt, MD Pathology

PRIYA OOLUT, MD Pulmonology

NSIKAK UMOH, MD Colorectal Surgery

John Boon, MD Urology

Ognjen Kosarac, MD Pathology

Nadeem Qurashi, MD Hematology/Oncology

William Velasquez, MD Hematology/Oncology

Bushra Cheema, MD Hematology/Oncology

robert malone, md Radiology

Kathleen Shadle, MD Radiation Oncology

Alexander Wong, MD Hematology/Oncology

pierre chevray, md Breast Cancer Reconstructive Surgery

Sindhu Nair, MD Hematology/Oncology

Sandra Templeton, MD Breast Surgery

MICHAEL YAAKOVIAN, MD General Surgery

Kelly Dempsey, MD Breast Surgery

SUNEESH NAIR, MD Pulmonology

UTTAM TRIPATHY, MD Cardiothoracic Surgery

Tarrik Zaid, MD Gynecologic Oncology

ROSHANA HARRIS IHEKERE Director, Health Information Management

Ann Daniel, RN Radiation Oncology Nurse

CATHERINE LOGAN, LVN, CCRP Clinical Research Coordinator

Sally Shen, RN Associate Chief Nursing Officer

Scott Berdou, LMSW Psychosocial Services Coordinator

Kathleen Dunlap, CCS, CTR Cancer Registrar

Diane McGraw, RN Director, Quality Improvement

Maria Socci, RN Breast Care Navigator

Bill Bross, M.Div., BCC Director, Spiritual Care & Values Integration

Nichelle Everett, RPh Director, Pharmacy

JAMIE PRINSTER, RT (R)(M) BSRS Manager, Breast Care Center

Lowell Stanton, CFO Oncology Program Administrator

Joy Fey, RN, OCN Oncology Nurse

Sheena Robertson American Cancer Society Representative

Dane Thannou, PhD Medical Physicist

supporting staff

Craig Butler Chaplain JANELLE CHARLES Oncology Program Coordinator

Frances Goerlich, BSR (R)(T) Director, Cancer Center/General Cancer Navigator

DEBORAH COOPER CanCare Representative

TRACY GRIER, PTA Rehabilitation Services

Andrea Dalcour-Cotton, RN, OCN Oncology Nurse Manager

JANET LEATHERWOOD, CNO Oncology Program Administrator

Amy Saenz Physician Liaison AMY SEBASTIAN-DEUTSCH, DNP, APRN, CNS, AOCNS Director, Oncology Services

Kathleen thoede, MA, CCC-SLP Speech Language Pathologist (Rehabilitation) Aileen Velasquez, MS, RD, LD Nutrition Associate Manager

06 houston methodist sugar land Hospital

CONFERENCES AND PROGRAMS Cancer Conferences

ONCOLOGY PROGRAM/CANCER REGISTRY

The cancer conferences are treatment-planning conferences available to all physicians and staff. The general hematology conferences are held at least monthly, and the breast conferences are held at least twice monthly. In 2016, thoracic cancer conferences were added and are held at least once monthly. The conferences are coordinated by Janelle Charles, oncology program coordinator, and facilitated by Dr. Charles Conlon, hematologist/oncologist and cancer committee chair, and Dr. Clive Shkedy, radiation oncologist and medical director of the Houston Methodist Cancer Center at Sugar Land.

Houston Methodist Sugar Land Hospital is fully committed to providing excellent cancer care to Fort Bend and surrounding counties. In 2014, the hospital received a three-year accreditation with commendation from the American College of Surgeons Commission on Cancer (CoC) program. Houston Methodist Sugar Land is currently the only hospital in Fort Bend County with this accreditation and will be surveyed again in June 2017. CoC accreditation establishes standards to ensure high quality, multidisciplinary, comprehensive cancer care. By holding this accreditation, cancer programs are challenged to enhance and expand the care they provide by addressing patient-centered needs and measuring the quality of the care they deliver against national standards. The goal is to consistently achieve improvement in the quality of cancer care. The accreditation consists of meeting 36 standards focused on improving quality care through various cancer-related programs and activities that cross the cancer care continuum. The on-site survey by the American College of Surgeons CoC affords the surveyors an opportunity to assess program compliance with these standards, and true dedication to excellence in providing comprehensive patient-centered care.

All cancer conferences offer attending physicians Category 1 CME credits. The physicians that attend the conferences are specialists in pathology, radiology, medical oncology, radiation oncology and surgery.

Each year, the cancer committee offers at least one cancer-related educational activity, other than cancer conferences, to physicians, nurses and other allied health professionals. The activity is focused on the use of American Joint Committee on Cancer or other appropriate staging in clinical practice, the use of appropriate prognostic indicators and evidence-based national guidelines used in treatment.

This year, we focused on triple-negative breast cancer, and the educational event was conducted by Dr. Jorge Darcourt, hematologist/oncologist and clinical research coordinator for the cancer committee.

In 2016, 168 cancer cases were presented at the cancer conferences. The purpose of these conferences is to create a treatment plan for patients who have not started treatment, or for patients who have a new development in the course of the disease and a new treatment plan needs to be developed.

Receiving care at Houston Methodist Sugar Land gives patients access to: • resources to implement their care plan

• information on clinical trials and the treatments • genetic counseling • patient-centered services including psycho-social support and patient navigation.

168

cases presented throughout 2016

864

ANALYtIC CASES Of the 1,235 newly abstracted cases in 2016, 864 met the definition of an analytic case.* The top five analytic disease sites for 2016 were: 1. Breast 2. Bronchus & Lung 3. Colorectal 4. Prostate 5. Blood & Bone Marrow In fact, these top five disease sites equated to approximately half of our total case volume for both years. * An analytic case is defined by an initial diagnosis and/or first course of treatment at Houston Methodist Sugar Land Hospital.

08 houston methodist sugar land Hospital

Houston Methodist Sugar Land Hospital Total Volume Distribution for Top 5 Cancer Sites Years 2012 – 2016

Houston Methodist Sugar Land Hospital Analytic Cases — Distributed by Site

300

250

300 300 200

300

300

300 300

250250

250

250

250 250

200

200

200 200

150150

150

150

150 150

10050 100

100

100

100 100

50 50

50

50

5050

150 200200

100

0

2012 0

0

0

Breast

2013 0

2014

2015

2016

0 0

Bronchus & Lung

Prostate Gland

Colorectal

Kidney

Blood & Bone Marrow

8,710

Total number of patients in the Registry Jan. 2009 - Dec. 2016

Like all CoC-accredited facilities, the hospital maintains a cancer registry and contributes data to the National Cancer Database (NCDB), a joint program of the CoC and American Cancer Society (ACS). This nationwide oncology-outcomes database is the largest clinical disease registry in the world. De-identified data on all types of cancers are tracked and analyzed through the NCDB and used to explore trends in cancer care. The data is also used to measure cancer care quality and to monitor treatment patterns and outcomes. CoC-accredited cancer centers, in turn, have access to information derived from this type of data analysis, which is used to create state, regional and national benchmark reports. These reports help CoC facilities with their quality improvement efforts.

In addition to the CoC's accreditation registry reporting standards, the Texas Health and Safety Code also provides regulations for data submission. The cancer registrar reviews all required cases and abstracts information using a standard, prescribed format. This de-identified data is periodically submitted to the Texas Cancer Registry (TCR). The Texas Cancer Registry is one of the largest state cancer registries in the U.S., and currently meets the National Program of Cancer Registries (NPCR), Centers for Disease Control and Prevention high quality data standards and is Gold Certified by the North American Association of Central Cancer Registries. The ultimate goal and purpose of the TCR is to collect, maintain, and disseminate the highest quality cancer data that will contribute towards cancer prevention and control, improving diagnoses, treatment, survival, and quality of life for all cancer patients. By submitting data to registries such as TCR and NCDB, Houston Methodist Sugar Land participates and contributes to the fight against cancer.

10 houston methodist sugar land Hospital

Imaging & Diagnostic Services Imaging and diagnostic services at Houston Methodist Sugar Land Hospital include a complete spectrum of imaging services. See the full list below.

The range of patients served by the department and the variety of technologies it uses is reflected in the specialization of its technologists, nurses and radiologists.

As the Department of Imaging and Diagnostic Services has grown and added new technology, it has developed specialized teams dedicated to those capabilities, providing expert patient care.

Ongoing communication between the referring physician and the imaging team is a priority — keeping the patient’s needs at the top of the list.

Diagnostic Radiology Effective treatment of a condition begins with an accurate diagnosis. Houston Methodist Sugar Land’s state-of-the-art diagnostic radiology procedures include:

• Angiography

• Fluoroscopy

• Nuclear medicine

• CT scan

• MRI

• Ultrasound

• Echocardiogram

• Myelogram

• X-ray

Interventional Radiology Interventional radiology provides diagnosis and treatment using advanced, minimally invasive radiologic techniques. Examples of interventional procedures include, but are not limited to, MRI-guided biopsies, CT-guided biopsies, ultrasound-guided biopsies, and placement of implanted venous access devices.

Lymphoseek The nuclear medicine department adopted the use of lymphoseek (Technetium Tc99m Tilmanocept), a radioactive diagnostic agent that was specifically engineered to enhance lymphatic mapping and to guide sentinel lymph node biopsy (SLNB) for squamous cell carcinoma of the oral cavity, breast cancer or melanoma.

The material itself is less acidic and therefore minimizes pain experienced by patients.

Due to its rapid uptake and transport, high accumulation and sustained retention, fewer injections are used, which in turn means less pain for our patients. This has been a great patient satisfier.

Pathology and Genomic Medicine Houston Methodist Sugar Land offers a comprehensive spectrum of pathology services to our patients. With the full resources and technology of the Houston Methodist Hospital Department of Pathology and Genomic Medicine supporting our efforts, physicians are able to provide fast and accurate diagnoses and the best medical care available.

A dedicated professional, technical and administrative staff supports this vital service. The department faculty is comprised of accomplished pathologists, many of whom are leaders in their respective fields, with results from original research published in the most respected medical journals. Regular clinical pathology conferences are held to discuss challenging and interesting cases, further ensuring accurate and timely diagnoses. These conferences are especially important when diagnosing rare conditions or reviewing cases presented through the second opinion consultation service.

Our laboratories are registered with the Food and Drug Administration (FDA) and certified by the appropriate accrediting boards and certification programs as required by the Clinical Laboratories Improvement Amendments (CLIA) and the Centers for Medicare and Medicaid Services (CMS), including the College of American Pathologists (CAP), American Society for Histocompatibility and Immunogenetics (ASHI), and American Association of Blood Banks (AABB).

MOLECULAR DIAGNOsTICS Molecular Diagnostics utilizes advanced technology to diagnose and monitor disease, detect risk and assist with predicting a patient’s response to a new treatment. Borrowing from the disciplines of Genomics (the study of all genes in a cell or organism) and Proteomics (the study of all proteins), Molecular Diagnostics determines how genes and proteins interact in a cell — focusing on gene/protein activity or expression patterns — in cancerous or precancerous cells. The activity or expression patterns can assist with the design of new targeted therapies in addition to predicting a patient’s response to a new therapy.

12 houston methodist sugar land Hospital

the Breast Care Center The Houston Methodist Breast Care Center at Sugar Land provides full breast care services for their patients. Physicians and staff walk patients through the experience from the time they come in for a screening mammogram all the way through biopsy, surgery and, if necessary, navigation to oncology services.

Services include: • Bone density

• Patient clinical and oncology

• Breast MRI

• Diagnostic mammography (2-D and 3-D tomosynthesis)

• Breast needle localization

• Galactograms

• Prone stereotactic biopsy

• Breast ultrasound

• MBI

• Screening mammography (2-D and 3-D tomosynthesis)

• MRI breast biopsy In the past year, our Breast Care Center added two new Hologic Dimensions mammography units allowing for both 2-D and 3-D imaging. 3-D/tomosynthesis imaging provides more detailed imaging, especially for patients with known dense breast tissue. The difference in sliced imaging can increase the sensitivity allowing an increase in breast cancer detection rates and lower the callback for additional imaging rate. This new technology also allows us to perform upright stereotactic biopsy with tomographic imaging, which affords us the ability to biopsy smaller areas that are hard to see or would not have been detected by 2-D mammography.

Houston Methodist Sugar Land is also trialing two new technologies in place of needle localization. Savi Scout and MagSeed allow patients to have a sensor placed in the area needing to have surgical removal up to 30 days prior to

19,886

BREAST CARE CENTER PATIENTS SERVED THROUGHOUT 2016

nurse navigation

• Ultrasound breast biopsy • Ultrasound cyst aspiration • Upright stereotactic biopsy (with tomosynthesis capability)

surgery. This is more comfortable than having to come into the center early in the morning the day of surgery, have wires placed and then sit and anxiously wait for the assigned surgical time. By placing the sensor in advance using a small needle and sending the patient home with a Band-Aid covering the site, the patient can arrive directly to day surgery to check in with minimal stress.

We value the time of our patients and want to ensure they are comfortable when visiting our Breast Care Center. We offer a variety of warm beverages at the time of arrival and, by changing the work flow, have cut down on wait times from 25 minutes in 2015 to an average of 10 minutes in 2016. Patients can also expect to receive a more spa-like experience with the addition of warm robes and a designated private area to wait in until escorted for their exams.

Treatment MODALITIES Surgery In 2016, we saw a sizable expansion in the surgical setting based on an increasing volume of patient procedures and an expansion of services offered.

The Heart & Vascular Center operating rooms opened in February with the addition of four open operating rooms, two minor procedure rooms and two hybrid rooms, bringing the total operating suites to 27. Hybrid surgery involves the addition of advanced interventional techniques coupled with cardiovascular surgery. Hybrid rooms incorporate the best in intraoperative angiography and fluoroscopy as well as carefully designed operating tables allowing for the integration of interdisciplinary usage by surgeons, anesthesiologists and interventionalists.

Within the 27 operating rooms, physicians and patients have access to some of the most innovative technology and techniques in surgery today, such as:

• Active electrode monitoring (AEM) instrumentation, an advanced monitoring system that shields patients from electrosurgical burns. Houston Methodist Sugar Land set the standard by being the first to bring this technology to Fort Bend County.

• da Vinci® XI and SI Surgical Systems, robotic surgical tools that enable surgery with less pain and scarring, diminished blood loss, a shorter hospital stay and reduced recovery period for a quicker return to daily activities.

• Digital radiography, used to X-ray breast cancer patients in the operating

10 minutes

average wait time in 2016 Compared to 25 minutes in 2015

room to ensure cancerous lesions that cannot be felt are successfully removed. The X-ray is sent electronically to the breast radiologist for interpretation. It can also decrease both time under anesthesia and the potential for re-excision.

• StealthStation® neuronavigation, which allows surgeons to visualize the patient’s anatomy in 3-D before and during cranial surgery. It also allows surgeons to see the exact location of their surgical instrumentation.

14 houston methodist sugar land Hospital

THE INFUSION CENTER The Houston Methodist Infusion Center at Sugar Land offers patients infusion therapy treatment for a variety of medical concerns. We provide patients with comprehensive infusion services in a comfortable, private setting, delivered by well-trained and experienced staff.

Services

Our multidisciplinary team of hematologists/ oncologists, chemotherapy-credentialed nurses, pharmacists, dieticians and chaplains help coordinate care and treat our patients and their families with compassion and respect. Our nurses cultivate close relationships with those patients who come for daily, weekly or monthly treatments.

In 2016, we enhanced the patient experience by adding volunteers, pet therapy and an expanded menu selection.

Infusion services are provided by oncology nurses who are experts in the following:

• Ambulatory pump management

• Injectable anticoagulants

• Biotherapy

• Injectable hormonal therapy

• Blood product transfusions

• Iron infusions

• Chemotherapy

• Patient teaching and education

• Hematologic growth factors

• Routine care for venous access devices

• Immunotherapy

• Therapeutic phlebotomy

16 houston methodist sugar land Hospital

radiation oncology Located in the Houston Methodist Cancer Center at Sugar Land, the Radiation Oncology Department of Houston Methodist Sugar Land Hospital has been providing service to Fort Bend County since 2004.

It is our commitment to provide the best standard of care and treatment options to our patients close to home.

Our Varian treatment equipment enables us to deliver external beam therapy; intensity modulated radiation therapy (IMRT) as well as high dose rate (HDR) brachytherapy.

The cancer center staff includes a board-certified radiation oncologist, medical physicists, medical dosimetrist, physician assistant, radiation oncology nurse and registered radiation therapists as well as support staff. All staff are dedicated to helping the patient on their cancer journey.

HDR continues to be a focus for breast and gynecologic cancers using accelerated partial breast irradiation. IMRT has been enhanced by the use of the cone beam CT scanner on TrueBeam, which allows for the benefit of more accurate radiation delivery.

Enhancements to the radiation oncology patient experience include the addition of a beverage and nourishment center and seasonal decorations for more pleasant surroundings. Area women’s groups and churches have donated handmade items such as hats, scarves and pillows for patients.

Support for patients is provided by CanCare, the American Cancer Society and Faithful Paws.

Cancer Center equipment includes:

• Phillips Brillance CT 16 slice • Varian 21EX Linear Accelerator • Varian TrueBeam • Varian Varisource HDR

MAIN PAVILION 4 EAST ONCOLOGY UNIT Main Pavilion 4 East is the designated inpatient oncology and general surgery unit for Houston Methodist Sugar Land Hospital. The unit is comprised of 28 beds, and the nursing staff provides care to both adult and geriatric patients who require skilled oncology and postsurgical nursing care.

The goal of 4 East is to provide safe and effective patient care that is aligned with the hospital's mission while promoting patient satisfaction. Several registered nurses maintain certification in oncology nursing (OCN).

Medical Oncology care is provided to patients with a variety of diagnoses such as acute leukemia, lymphoma, breast cancer, prostate cancer and colorectal cancer (not all inclusive). The nursing staff is credentialed to administer chemotherapy and biotherapy treatments. Postsurgical care is provided to patients after mastectomy, prostatectomy and colon resections (not all inclusive).

• Case managers

In addition to nursing care, the interdisciplinary care team includes: • Chaplains • Dietitians • Oncology nurse navigators • Social workers

18 houston methodist sugar land Hospital

Community Outreach and Education

Baines Middle School visit

Houston Methodist Sugar Land Hospital used our top cancer sites to guide our outreach planning and utilized a community needs assessment to help guide our strategy for target audience selection.

In 2016, we focused on colorectal cancer prevention and lung cancer screening with continued awareness around breast cancer. Numerous ads and articles regarding cancer awareness and prevention were featured in local magazines, newspapers and on social media.

COLON & RECTAL Colorectal Cancer Prevention and Screening Seminar – March 2016 A colorectal surgeon and gastroenterologist discussed the importance of early detection, screening guidelines and what to do if cancer is diagnosed. All attendees were given an at-home E-Z Detect fecal occult blood test. Attendees were instructed to contact their physician if they had an abnormal result.

• 85 people attended and returned questionnaires commenting they would follow up with their physician after doing at-home screening. Some attendees scheduled appointments with the physician speakers

BREAST

LUNG CANCER

EMPLOYEE Breast Cancer & MAMMOGRAM SCHEDULING – October 2016

LUNG cancer SCREENING PROGRAM

Employees, including men, were encouraged to stop by the booth set up in the hospital atrium to learn more about breast cancer and schedule their yearly mammograms.

• 40 appointments scheduled, 19 appointments completed, and three additional diagnostics were required

Houston Methodist Sugar Land offers a lung cancer screening program to provide individuals who are at risk for developing lung cancer with an early stage diagnosis and evidence-based treatment plan.

This program includes annual low-dose CT scans, consultations with health care providers, access to tobacco cessation programs and referrals to physician specialists, if cancer is found.

BAINES MIDDLE SCHOOL VISIT – OCTOBER 2016

Lung Cancer Awareness and Screening Seminar – November 2016

Students from the Baines Middle School leadership class and volleyball team visited Houston Methodist Sugar Land to drop off gifts for breast cancer survivors.

A panel of pulmonary, medical oncology, thoracic surgery, radiation oncology and diagnostic radiology specialists discussed lung cancer diagnosis, screening and treatment. The focus was the importance of early diagnosis and treatment. The American Cancer Society was also available to meet with patients following the event to share more information on tobacco cessation.

Patients were given the opportunity to schedule a lung cancer screening with appropriate medical consultation.

While they were here, our Breast Care Navigator, Maria Socci, taught them the importance of early detection through screenings such as mammograms. Socci encouraged them to speak to their moms and other women in their lives about the importance of getting yearly mammograms.

Two breast cancer survivors also shared their stories with the students.

• 24 people attended; one screening was scheduled; many others were interested but did not meet screening criteria

OTHER CANCER SURVIVOR & COMMUNITY EVENTS BREAST CARE CENTER OPEN HOUSE – FEBRUARY 2016 The Houston Methodist Breast Care Center at Sugar Land showcased its latest state-of-the-art technology and provided tours and educational information to more than 800 attendees from the community.

RELAY FOR LIFE SPONSORSHIP – APRIL 2016 Held at Mercer Stadium, the Cancer Center team consisted of 10 members who included staff members and their families. Previous patients walked with staff in the initial caregiver lap at the beginning of the walk. A booth was set up to distribute information.

National Cancer Survivors Day Celebration – June 2016

Hospital lit up purple throughout April in honor of Testicular Cancer Awareness Month.

Every June, Houston Methodist Sugar Land Hospital celebrates National Cancer Survivors Day®, an annual, worldwide celebration of life that is held in hundreds of communities throughout the United States, Canada and other participating countries. Houston Methodist Sugar Land holds an annual luncheon for cancer survivors and a guest to join in a special celebration of life to honor those living with a history of cancer.

Throughout 2016, physicians and staff promoted cancer prevention and screening, early detection and general awareness through participation in the following speaking engagements hosted by Houston Methodist Sugar Land Hospital and other community organizations.

REAL MEN WEAR PINK – October 2016

YMCA Missouri City – January 2016

Houston Methodist Sugar Land was a proud sponsor of this program that raised funds to help the American Cancer Society fund innovative breast cancer research, provide free comprehensive information and support, and help people reduce their breast cancer risk. Spearheaded by our CEO and CFO, we raised the most funds in the Greater Houston area.

An oncologist presented to a group of seniors, 55 and older. Discussion included the importance of nutrition as it relates to cancer, eating healthy foods to help prevent cancer, recommended foods while receiving treatment, and the connection between obesity and cancer and the importance of having a healthy body mass index (BMI).

Community Educational Seminars

Houston Methodist Sugar Land Hospital – February 2016 Nutrition and weight management seminar for the Fort Bend community.

Attendees could schedule mammograms and received lung cancer screening information. No current smokers were interested in being screened, but pulmonologists shared tobacco cessation information, tips and lung cancer awareness information.

Brookdale Assisted Living – October 2016

Chris Siebenaler, CEO, and Lowell Stanton, CFO

A gynecologic oncologist discussed gyncologic cancers with 32 seniors. Discussion included risk factors, symptoms, treatments and recommended screenings.

20 houston methodist sugar land Hospital

COMPASSION and SUPPORT Understanding that cancer care extends beyond the patient’s physical needs, we offer a number of programs designed to support cancer patients, their families and caregivers.

Our support services and classes provide information and support for attendees. Support groups are open to individuals of all faiths and beliefs, and offer patients, family members and friends the opportunity to meet others, find support and share experiences.

Breast Cancer Support – Survivors Offering Support meets on the third Thursday of each month from 5:30 to 7:30 p.m. for anyone whose life has been touched by breast cancer.

Care Navigation – The mission of the patient navigator program is to enhance patient care by providing a seamless navigation process from diagnosis to survivorship. Patient navigators are available to answer general questions about treatment options, coordinate patient care with the health care team, direct patients to health care services for further diagnosis and treatment and direct patients to local resources and support when needed.

Financial Support – Recognizing the financial challenges of cancer treatment and the resulting distress it creates for cancer survivors, our financial navigation program helps patients apply for potential financial assistance. With the help of our financial navigator, 108 patients were approved for financial support in 2016.

Grief Support – Meets on the second Tuesday of each month from 5:30 to 7:30 p.m.

Counseling is also available.

Ostomy Support Group – New or existing ostomy patients and their caregivers can obtain information and education about ostomy maintenance and new products, seek guidance and support and have a safe place to share their own experiences and coping strategies. Meets quarterly for patients with urostomies, colostomies or ileostomies.

Powerful Tools for Caregivers – A six-week program offered in the spring and fall for anyone caring for older adults with a long-term health condition.

Spiritual Support – Our staff chaplains, volunteer lay ministers, holy communion ministers and CanCare volunteers offer 24-hour pastoral support as well as spiritual resources, including Bibles (in English, Spanish and six additional languages), scripture cards, prayer ministry, bereavement support and more.

COMMUNITY PARTNERS Houston Methodist Sugar Land Hospital is proud to partner with the American Cancer Socety, CanCare and Faithful Paws.

American Cancer Society As an American Cancer Society Resource Center, Houston Methodist Sugar Land facilitates dynamic education and support programs such as:

• Look Good Feel Better (Beauty techniques for women undergoing treatment) • Reach to Recovery (Breast cancer survivor volunteers) • Road to Recovery (Transportation program) CanCare Houston Methodist Cancer Center at Sugar Land is affiliated with CanCare, a volunteer outreach program. CanCare volunteers are cancer survivors who devote their time to offering cancer patients emotional support, understanding and insight.

FAITHFUL PAWS We recognize that providing a healing environment for our patients stretches beyond technology. That’s why we partner with Faithful Paws to provide an extra measure of love and support for our patients. Faithful Paws brings specially trained dogs to visit patients on a weekly basis. These dogs provide unconditional love and therapy to our patients and help make their treatments more enjoyable.

22 houston methodist sugar land Hospital

2016 Quality Improvement and Outcomes Cancer Research & Clinical Trials Houston Methodist is a leader in clinical research, overseeing more than 800 clinical protocols annually.

In 2016, The Houston Methodist Cancer Center offered nearly 100 clinical trial opportunities for patient participation, to further cancer research discovery. Six of those trials were investigator initiated studies, unique to Houston Methodist locations. These trials were clinical concepts developed by Houston Methodist physicians with a focus and emphasis on the cancer population’s uncharted territory. In addition, Houston Methodist Sugar Land Hospital successfully enrolled cancer patients in

therapeutic, prevention, diagnostic, screening and quality of life studies to explore ways to improve the quality of life and to prevent disease from returning for patients with cancer.

In 2016, more than 100 patients from Houston Methodist Sugar Land were screened for clinical trial participation. One of the most exciting clinical trial offerings in 2016 was the National Cancer Institute’s Molecular Analysis for Therapy Choice (MATCH) Study.

In the MATCH study, patients were reassigned to receive treatment based on the genetic changes found in their

tumors through genomic sequencing and other tests.

Study eligibility included patients with advanced solid tumors, lymphomas or myeloma that had progressed on standard treatment for their cancer, or if they had a rare cancer for which there is no standard treatment.

Houston Methodist Sugar Land successfully enrolled cancer patients in therapeutic, prevention, diagnostic, screening and quality of life studies to explore ways to improve quality of life, test new approaches to prevent disease and prevent diseases from returning for patients with cancer.

QUALITY IMPROVEMENT AND OUTCOMES Several quality initiatives were made to the cancer program and services in 2016, including the addition of 3-D Mammography Guided Biopsy Services. The 3-D Mammography Guided Biopsy Services began in July of 2016 and a total of 46 exams were performed in 2016.

The benefits of 3-D Mammography Guided Biopsies include the ability to more quickly and accurately locate possible cancers and expose patients to less radiation than older methods. 3-D mammography has allowed radiologists to find abnormalities in the breast that may not be seen using conventional mammography.

In keeping with a commitment to quality, members from the cancer committee conducted the following quality studies: Advance Directives in the Cancer Center,

Infusion Center Time Study and Skin Toxicity in Breast Cancer Patients: Conventional Radiation vs Hypo-Fractionated Radiation.

Advance Directives in the Cancer Center In 1990, Congress enacted the Patient Self Determination Act (PSDA), which was designed to acknowledge a patient’s right to either refuse or accept medical treatment, empower patients by safeguarding their autonomy and preserving self-determination, protect patients against maltreatment, and foster communication between patients and health care team members. Hospitals were tasked to ask patients if they had advance directives (Living Will, Medical Power of Attorney and Out of Hospital DNR) and to make

forms available to patients who did not have one. The literature indicates that only 18-30 percent of Americans have completed an advance directive (ADs) and that less African Americans and Hispanics have them than Caucasians. With this information in mind, two methods were utilized to assess the status of ADs within the cancer center (infusion therapy and radiation oncology).

First, 30 charts were randomly reviewed. It was noted that none had any advance directives (0 percent). The second method used involved a three-statement AD patient survey. The statements were: 1) I know what ADs are. 2) I have ADs. 3) I would like more information about ADs.

Thirty patients were surveyed and there were 29 evaluable responses. Eighty percent knew what ADs were, 40 percent had ADs and only 18 percent wanted additional information about ADs. Based on the outcomes, labeled AD holders were placed on the wall by where patients are weighed in both English and Spanish. Patients are asked on admission if they have ADs and if they do not have them, they are offered the opportunity to receive information during the weighin process. Additionally, if they want more in-depth information, the chaplains are contacted to come to the cancer center to answer questions and provide more information.

Also, staff received some training provided by the social worker on how to answer questions about ADs. After the interventions had been in place a month, 30 more charts were reviewed with an increase to 10 percent having ADs in place. Patients continue to respond that they do not want to discuss the topic but rather “think about it.�

Infusion Center Time Study A new director started in June 2016 and subjectively noted that there seemed to be diminished infusion chair utilization, chemo delays, patient delays and lab delays.

She also noticed that new Houston Methodist Sugar Land Hospital chemotherapy patients were started on treatment at the Houston Methodist West campus due to scheduling delays of up to three weeks.

A time study was conducted over one week in early September. Results were reviewed and analyzed by the infusion center director, the medical director, the director of pharmacy and the infusion center charge nurse.

Multiple delays were noted, including: late patient

arrival and three complex chemotherapy treatment patients scheduled to start treatment all at 8:30 a.m.

It was noted that it takes an average of 30 minutes to mix one (1) complex chemotherapy treatment. Additionally, there were lab delays caused by patients not having lab work performed prior to the day of treatment. There were also delays related to a lack of transportation and caregiver arrival to pick up patients. And finally, it was noted that 30 percent of our infusion chairs were being utilized by non-oncology patients (which when there were fewer oncology patients, was acceptable) but with oncology volume increasing, the loss of 30 percent of our treatment chairs to non-oncology patients resulted in new chemotherapy patient scheduling delays.

The following initial interventions were carried out. The scheduling of three complex chemotherapy patients at the same start time was stopped by implementing staggered start times of 8, 8:30 and 9 a.m. To do this, nursing schedules were changed to accommodate staggered scheduling of chemotherapy patients.

An infusion center new patient welcome letter was developed and included the importance of arriving on time (no later than 15 minutes). We also implemented automated appointment reminder phone calls. It was also decided to build a separate IV therapy department with seven more infusion chairs to accommodate the non-oncology patients as well as some oncology patients if deemed appropriate.

With the advent of staggered scheduling, some improvement in pharmacy delay was noted; however, shortly after the implementation of staggered scheduling of chemotherapy administration times, pharmacy

implemented a safety methodology called Dose Edge, which resulted in additional delays during the time staff were learning how to work with the new safety enhancement. This will warrant ongoing observation and analysis as time progresses.

Skin Toxicity in Breast Cancer Patients: Conventional Radiation Therapy (CRT) vs Hypo-Fractionated Radiation Therapy (HRT) A few recent studies have been conducted and published in the literature pertaining to the use of hypofractionated radiation therapy vs conventional therapy in early breast cancer. Study results confirm the feasibility and safety of hypo-fractionated radiation therapy in patients with early breast cancer; the efficacy and toxicity of HRT in locally advanced cancer is still being studied.

Seventeen patients were treated with either CRT or HRT and levels of skin toxicity were graded. Grading of toxicity for the CRT patients (stages 0-IIA) occurred at weekly visits (1-7), 2-3 weeks post treatment and at 3 months post treatment. HRT patients (stages 0-IA) were graded for skin toxicity at weeks 1-4, 2-3 weeks post treatment and at 3 months post treatment.

No difference in skin toxicity was noted between the CRT and HRT patients. It was noted that due to the decrease in required time to treat in the patients receiving HRT, it could be more convenient for patients perhaps resulting in better patient compliance.

24 houston methodist sugar land Hospital

SURVIVORSHIP It used to be thought that survivors were patients with a cancer diagnosis who were free of disease at five years or that you became a survivor after you completed treatment. But then in 1986, the National Coalition for Cancer Survivorship created a new definition “from the time of discovery and for the balance of life, an individual diagnosed with cancer is a survivor.” More recently, the National Comprehensive Cancer Network (NCCN) defined survivorship as “an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life.

Family members, friends, and caregivers are also survivors as they are also affected by cancer.” Houston Methodist Sugar Land Hospital defines survivorship as “from point of diagnosis through treatment and beyond and it includes both survivors and caregivers.”

The Foundation of our Survivorship program is based on the Quality of Life Model Applied to Cancer Survivors (Ferrell & Grant, City of Hope Beckman Research Institute, 2004) and is depicted below.

Our survivor and caregiver support program includes a breast cancer support group, ostomy support group, grief support group, an annual cancer survivor celebration as well as Powerful Tools for Caregiver classes. Other support services include CanCare volunteers who make regular visits, an oncology nurse navigator, dietitian, chaplain, social worker, and the pet therapy team. We also have a financial navigator who can assist with finding financial resources for our infusion therapy patients.

Additionally, we initiated completion of survivor care plans in order to provide a summary of treatment as well as follow-up care and surveillance recommendations after the survivor’s acute treatment phase is concluded. The development of survivor care plans is in keeping with the American College of Surgeons Commission on Cancer (ACOS CoC) accredited cancer program requirements and is being implemented through a gradual program rollout.

Quality of Life Model Applied to Cancer Survivors

Physical Well Being and Symptoms • Functional Activities • Strength/Fatigue

• Overall Physical Health

• Sleep and Rest

• Fertility • Pain

Social Well Being • Family Distress

• Appearance

• Roles and Relationships

• Enjoyment

• Affection /Sexual Function

• Finances

• Isolation • Work

Psychological Well Being

s

s

• Control

• Fear of Recurrence

• Anxiety

• Cognition/Attention

• Depression

• Distress of Diagnosis and Control of Treatment

• Enjoyment/Leisure

Cancer Survivorship

s

s

Spiritual Well Being • Meaning of Illness

• Hope

• Religiosity

• Uncertainty

• Transcendence

• Inner Strength

our campus Contact us for more information about oncology services offered at Houston Methodist Sugar Land Hospital: Hospital Main Number 281.274.7000

AMC THEATRE

T O W N C E N T E R B LV D . S O U T H

Breast Care Center 281.242.PINK (7465)

GIFT SHOP ENTRANCE

RESTROOM

IV IV Therapy Therapy

Breast Breast Care Care Center Center

SWEETWATER PAVILION

Main Main Imaging Imaging

Outpatient Outpatient Imaging Imaging

EMERGENCY ENTRANCE

MEDICAL OFFICE BUILDING 3

MAIN PAVILION Main Main Conference Conference Center Center

Lab Lab

BRAZOS PAVILION Brazos Brazos Conference Conference Center Center

MAIN ENTRANCE

Spiritual Care Department 281.274.7164

ORTHOPEDICS & SPORTS MEDICINE

ENTRANCE

Powerful Tools for Caregivers 281.274.7164 Radiation Therapy 281.242.CURE (2873)

PARKING GARAGE (under construction)

Childbirth Childbirth Center Center

MEDICAL OFFICE BUILDING 1

Neuroscience Neuroscience & & Spine Spine Center Center Wound Care Program

SWEETWATER BLVD.

PARKING GARAGE (FREE)

EMERGENCY ROOM LEVEL 2 SKYWALK

MEDICAL OFFICE BUILDING 2

Heart & Vascular Center

Lung Cancer Screening Program 281.274.0188

Outpatient Imaging Scheduling 281.274.7170

PARKING RESERVED PARKING

Infusion Infusion Center Center

Financial Navigator 281.276.8226

Ostomy Support Group 281.274.7689

INFORMATION

Cancer Cancer Center Center

Cancer Registry 281.274.8038

Infusion Center 281.276.8201

DINING ELEVATOR

Breast Care Navigator 281.276.8989

Grief Support Group 281.274.7164

CHAPEL

SOUTHWEST FWY. Connect with us:

facebook.com/methodistsugarland

houstonmethodist.org/sugarland

26

Houston Methodist Sugar Land Hospital 16655 Southwest Fwy. Sugar Land, TX 77479

houstonmethodist.org/sugarland

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW. At Houston Methodist, we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines. that same culture of excellence inspires us to be the pioneers of tomorrow.