Cancer Annual Report 2020
Maintaining accreditation status with these respected organizations is of the utmost importance to Pardee Cancer Center. These achievements demonstrate Pardee’s high standards for providing the best care possible to our cancer patients, in both a safe and ethical environment. Accreditation standards are very patient centered. They ensure that we, as health care professionals, continually set new goals for our cancer program, which ultimately benefit the people who matter most – our patients and their families.
YEAR IN REVIEW
2 Chairman’s Report
T H O M A S L . E I S E N H AU E R , M D , FA C S
3 A Year in Review BRIAN LEUTNER, MBA
BREAST CANCER SPECIAL UPDATE
5 Advanced Technology for a Better Breast Experience 7 Breast Program Update
J E N N I F E R Mc A L I S T E R , M D , FA C S
8 By the Numbers 9 Breast Cancer Navigation J O D I R E C TO R , R N , B S N
10 Highlights INNOVATIONS
11 Radiation Oncology Updates YASEEN ZIA, MD
12 Lung Cancer Advances
C AT H Y J E N K I N S , R N I I I , B S N , C C R P
Pharmacy Technology R O B Y N B RY S O N
SUPPORT
13 Survivorship Program
LEANN NOAKES, RN III, BSN, CCRP
14 Palliative Care Services CONNIE SEWELL, MD
15 Nutrition Services
K R I S T E N K OWA L C Z Y K , R D N , C S O
CANCER RESEARCH & DATA
15 Cancer Physician Liaison JOHN K. HILL, MD
16 Cancer Research Report LY N N H OW I E , M D
17 Cancer Incidences and Cases
YEAR IN REVIEW
Chairman s ’ REPORT T H O M A S L . E I S E N H AU E R , M D , FA C S Many of the people in Henderson County will remember 2020 for a multitude of reasons. Some individuals were diagnosed with cancer, some family members were found to have cancer, and some community members succumbed to the disease. Pardee Cancer Center continued to care for our oncology patients every day. Our providers prescribed and administered various forms of chemotherapy, radiated tissue to destroy the offending disease, and surgically removed malignant growths in an attempt to avoid spread to more distant sites. Other staff members offered their specific professional services during these various forms of therapy. Some provided guidance as patient’s progressed from one visit to another. Special financial counselors helped alleviate economic fears to our patients. And everyone at Pardee Cancer Center with an employee badge provided words of encouragement, ears to listen, tears, hugs, and comfort on a daily basis. By the way, 2020 also brought the COVID-19 pandemic to the United States and specifically to our area. Did you see the impact it had on the care of our oncology patients as noted in the paragraph above? Neither did I. While the pandemic had an overwhelming impact on health care and our community in general, it did not have the capability to stop our oncology team from providing the necessary services to our neighbors. Yes, we had to make some modifications to the way that certain services would be provided so that our immunocompromised patients would actually be and feel safe. Every day our team members were there providing their expertise for our oncology service line. While we did not replace worn out hip and knee joints or remove cataracts in our operating rooms for a period of time, we continued to excise cancerous growths each morning because our patients did not have the ability to defer treatment. Fewer numbers of patients were seen in our primary care providers’ offices for routine visits, but we infused chemotherapy drugs daily while wearing extra protective devices for the safety of our patients and team members.
When performed appropriately, cancer care is complex and requires numerous individuals with varied areas of expertise. Over the years, our multidisciplinary cancer conference has reviewed thousands of patients and helped to create an appropriate treatment plan. This historically has been in a larger, conference room to allow an effective group discussion. With the distancing plan in place, we have had to create an effective substitute for what we had done in the past. We now meet in a “virtual” room digitally to continue our multidisciplinary approach for cancer care. I initially was concerned about this as it does not afford the immediate visual feedback in a conversation with our colleagues. Actually, it has allowed us to be more effective in some of our discussions. It also has given other colleagues the opportunity to participate with the conference at a distance who previously could not participate in person. While I hope that we transition in the future to some version of our previous in-person meetings, I do think that it will be some hybrid version to continue to allow others to participate even if they cannot be physically present in the actual conference room. Pardee UNC Health Care’s oncology program continues to provide excellent cancer care. New techniques and treatments options are being utilized on a regular basis. Tracking patient outcomes with respect to their specific type and stage of cancer allows us to assess our ability to care for cancer patients. Our statistics show that we provide excellent oncologic care for the patients that we treat. We consider it an honor to provide this service to you. We want to share this privilege with you, our community, and trust you will allow us to continue to care for your cancer needs.
PARDEE CANCER ANNUAL REPORT 2020
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YEAR IN REVIEW
A Year in Review
B R I A N L E U T N E R , M B A , Administrative Director, Pardee Oncology Services
This year has been an interesting journey in cancer care due to the COVID-19 concerns across the country and our local region. The protocols for COVID-19 screening went into place early throughout Pardee and needed to be monitored on a more detailed level with our cancer patients. This pandemic also brought on virtual patient visits and virtual meetings between colleagues. The providers and staff had to learn new technologies and ways to communicate that still provided the highest quality of care, while keeping our patient satisfaction as a key priority. The oncology team stepped up to the challenge and remained open minded by creating new ways in approaching patient care to ensure that our patients, their families and co-workers remained safe while continuing to give the needed therapies and procedures to our patients. The Breast Center expanded its technologies to offer the community more access and increase our state of the art care for the region we serve. We added a second 3D mammography unit which allows more flexibility for patient scheduling due to the demand in our communities. The SmartCurve breast stabilization system was added to assist in decreasing the discomfort that our patients would often complain about when receiving their mammograms. Also, we are excited to now offer Automated Breast Ultrasound (ABUS) technology as a comfortable, non-ionizing alternative to other screening options for women with dense breasts. When used in addition to traditional mammography, the ABUS can improve breast cancer detection by 38 percent over mammography alone in those women with dense breast tissue. The medical oncology infusion volumes continued to increase with new immuno
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2
3-D MAMMOGRAPHY SUITES A second suite was added to the Breast Center in 2019 (see page 7).
INDIVIDUALS SCREENED for prostate and skin cancer through Pardee’s free community screenings.
108 VIRTUAL CONFERENCING OF CARE TEAM
Allows patient’s multi-disciplinary team to continuously synchronize active plans for care and treatment.
CLINICAL TRIALS PATIENTS
enrolled since program’s inception.
1000+ PARTNERED WITH NFL AND AMERICAN CANCER SOCIETY
to receive NFL Change Grant funds for lung cancer screenings (see page 12).
CANCER SURVIVORSHIP PROGRAMS Ten survivorship programs were offered in 2019 (see pages 9 and 13).
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COMMUNITY PARTNERSHIPS Four Seasons Palliative Care is an essential resource for patients in need of these services, by providing support, symptom management and increased quality of life (see page 14).
NEW RADIATION TECHNOLOGIES
SBRT delivers radiation in 5 or less treatments over 1-2 weeks. ABC protects vital organs during breast radiation therapy (see page 11).
2
NEW COMPOUNDING SOFTWARE BD IV Prep TM controls precise dosing of chemotherapy and immunotherapy drugs (see page 12).
PREVENTION OF MALNUTRITION
and chemotherapies, blood products and non-chemotherapy regimens offered to our patients. Radiation oncology kept their patients under treatment and new patient visit volumes up as well. This was all happening while our parameters around COVID-19 restrictions was steadily increasing. The providers and clinical teams throughout all of the oncology service line remained, and continue to remain, focused on high quality care to our patients and their family members. We still hosted free annual community screenings for prostate and skin cancer, with a special vigilance on keeping them safe during these trying times. We remained focused on our survivors with a virtual survivorship series for young women affected by Breast Cancer, Living Beyond Breast Cancer, done via a virtual platform. We are thrilled to have partnered with the American Cancer Society, Blue Ridge Health and Advent Health to offer a more robust and focused lung cancer screening program through an NFL Change grant. There also was a focus and awareness put on staff that work directly with cancer patients and deal with the hardships of grief. A program was created in partnership with Four Seasons Palliative Care to help team members deal with grief and loss that is experienced in our environment. Although this has been a year like no other, the entire Pardee oncology program continues to ensure that our community gets the care they need close to home, with the advanced technology they deserve. ď ľ
Regular interval screenings provided to assess risk and automatically refer patients to a dietitian (see page 15).
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BREAST CANCER SPECIAL UPDATE
Advanced Technology for a Better Breast Experience Improvements in Mammogram Technology Pardee uses 3D mammography, which is the only equipment that is FDA approved as superior to standard 2D mammography. Multiple clinical studies show 3D mammography is beneficial for all women, no matter your breast type or density. The 3D mammography detects 41 percent more invasive breast cancers and reduces false positives by up to 40 percent. For the patient, this means more accuracy and less anxiety. Pardee recently installed a second 3D mammogram screening room, providing the ability to see more patients with significantly less wait time for patients wanting to schedule an exam.
Going Beyond Traditional Biopsy Pardee is one of only two facilities in Western North Carolina to offer 3D-guided biopsy. This biopsy technique samples lesions which cannot be detected with the standard 2D digital mammography, and can only be identified with 3D mammography. The 3D-guided biopsy is the highest level technology available today for sampling lesions in the breast, which may be an indication of breast cancer. The suite of 3D services now available at Pardee allows for an easier, more streamlined procedure that takes less time and uses less radiation.
Comfort and Accuracy In addition to the 3D technology now firmly in place and upheld as the standard of care for breast health, Pardee recently added a few new improvements to its suite of diagnostic tools to make the exam more comfortable and accurate. In order to deliver a more comfortable mammogram experience, Pardee has now added the new SmartCurve System. The SmartCurve System provides curved paddles specifically designed for more comfortable compression during breast imaging. It is clinically proven to deliver a more comfortable mammogram without compromising image quality, workflow or dose. The technology has the potential to increase screening volume and compliance for the countless women who have reported avoiding mammograms due in large part to the fear of discomfort associated with breast compression.
Addressing Breast Density Dense breasts are one of the strongest common risk factors in developing breast cancer and approximately 40 percent of women have dense breasts. Women with dense breasts are four to six times more likely to develop breast cancer
and 71 percent of breast cancers are found in women with dense breasts. To respond to this need, Pardee is now offering a new, advanced technology for detecting breast cancer in women with dense breasts. The Invenia ABUS 2.0 is a new, advanced technology for detecting breast cancer in women with dense breast tissue. The Invenia ABUS 2.0 has been shown to improve detection in women with dense breasts by more than 37 percent when used in addition to mammography. Using 3D ultrasound technology, the Invenia ABUS 2.0 quickly and comfortably images dense breasts; an exam typically takes 15 minutes.
Guarding Against Radiation When radiation therapy is needed, the Active Breathing Control (ABC) device is utilized to help limit the amount of radiation that is exposed to the heart. This is a noninvasive technology that guides the patient through a series of breath holds while the radiation oncologist captures CT images of the tumor in order to prepare a custom treatment plan. Taking deep breaths increases the distance between the area receiving radiation and the heart. Increasing this distance decreases the risk for developing radiation-induced heart disease while also limiting the amount of radiation to surrounding healthy tissue.
Lymphedema Therapy The Lymphedema Clinic at Pardee Physical Therapy is focused on improving individualized health and wellness during cancer recovery. This specialty clinic is committed to providing a holistic approach to care for those affected by lymphedema by managing the condition using the Vodder Method of Completed Decongestive Therapy. In addition, our Post Mastectomy Program can aid in the overall recovery process and includes improving range of motion and strength post-surgery, lymphedema risk reduction, and education for infection prevention.
Treatment and Surgery Jennifer McAlister, MD, FACS, has over a decade of experience as a board-certified surgeon, specializing in breast surgery. As the only fellowship trained female breast surgeon in Western North Carolina, Dr. McAlister evaluates and manages patients with benign breast conditions (breast pain, lumps, and cysts), and those with breast cancer. Dr. McAlister recently adopted the innovative surgical technique of Breast Seed Localization, in place of using wires for localizing surgeries. Breast Seed Localization is a procedure where a tiny metal seed, about the size of a sesame seed, is placed into abnormal breast tissue to mark its location. During surgery, Dr. McAlister uses a special tool to find the breast seed and the surrounding abnormal tissue. This approach allows the surgeon more precise targeting of the area of breast involved and may allow for less breast tissue removal. ď ľ (at left) SmartCurve System curved paddles for mammograms; (this page) Invenia ABUS 2.0
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BREAST CANCER SPECIAL UPDATE
Breast Program Update J E N N I F E R Mc A L I S T E R , M D , FAC S
Pardee’s Breast Program has experienced significant growth this year. We have seen 209 new breast cancer patients in the last year. Our ability to provide comprehensive breast cancer care at Pardee is exceptional with breast surgery, medical oncology and radiation oncology services all under one roof at Pardee Cancer Center. Our patients continue to be navigated through their journey by our Breast Navigator, Jodi Rector. Jodi has continued to provide excellent patient care in her new role. We are able to provide individualized care for all breast cancer patients and are now seeing patients not only from Henderson County, but from surrounding counties as well. Our services and staff at the Breast Center have grown. We have now increased our capacity for mammograms with the addition of a second 3D mammography unit. This has also increased our capacity for biopsies. The Elizabeth Reilly Breast Center recently added ABUS (Automated Breast Ultrasound) as an additional imaging modality for patients with dense breast tissue. Additionally, we now have the capability to perform MRI guided breast biopsy. These additional modalities allow us to provide patients with all of their breast imaging needs where in the past, they had to go outside our system. At Pardee Breast Surgery, our staff has continued to grow as well to allow for excellent patient-centered care. As far as newer surgical techniques, were are no longer using wires for localizing surgeries but instead are using a seed that is placed prior to surgery. This allows for more precise targeting of the area. We have also decreased the number of injections that patients require prior to cancer surgery. Our anesthesia providers are also now using techniques to decrease postoperative pain in our breast cancer patients. Pardee’s services are expanding and we are excited to provide excellent, comprehensive breast cancer care to all patients in Western North Carolina.
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By the Numbers
209
BREAST CANCER PATIENTS
treated at Pardee Cancer Center within the last year (2019-2020)
31.5% 14% 5 32” Of total caseload of patients, this percentage had a diagnosis of
BREAST CANCER
The percentage of breast cancer patients who were treated at Pardee Cancer Center that are
The approximate size of the tiny metal seed placed into abnormal breast tissue to mark its location, a technique called
UNDER THE AGE OF 50
BREAST SEED LOCALIZATION
14,000
Over 14,000 patients received
SCREENING MAMMOGRAMS
4,400+ DIAGNOSTIC MAMMOGRAMS
performed at the Breast Center
13.8% 65.2% 13.2% 4.4% 3.4%
Stage 0 Stage I Stage II Stage III Stage IV
38% Pardee’s new technology,
AUTOMATED BREAST ULTRASOUND (ABUS) can improve
breast cancer detection by 38 percent over mammography alone in women with dense breast tissue.
PARDEE CANCER ANNUAL REPORT 2020
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BREAST CANCER SPECIAL UPDATE
Breast Cancer Navigation J O D I R E C T O R , R N , B S N , Breast Care Navigator
Navigation services for breast cancer patients are an integral part of the cancer care experience. These services are often structured in various ways to ensure the needs of the patient are met. At Pardee Cancer Center, we focus on offering individualized assistance to patients, families and caregivers to help overcome healthcare system barriers. We strive to individualize care based on a needs assessment, availability of family support and involvement, patient willingness to participate, patient acuity and a variety of other factors. We value our health care community partners and work closely with them to guarantee local resources are available to our patients. Specifically, as a Breast Care Navigator, my role is to connect with each newly diagnosed breast cancer patient and assist them with any needs they may have during their journey, from diagnosis through survivorship. In 2019, we treated 209 newly diagnosed patients with breast cancer, and of those, 14 percent were under the age of 50. Breast cancer cases accounted for 31.5 percent of our total analytical caseload in 2019. One of the community partners our breast navigation program works with is Living Beyond Breast Cancer (LBBC). LBBC is a national non-profit agency that works diligently to provide women with accurate and credible breast cancer information. They are based in Philadelphia, and offer a variety of resources, programs and trainings/seminars for patients, volunteers and medical professionals. Recently, they offered a survivorship training program that focused on the most common challenges young breast cancer survivors face. I was honored to be one of 12 breast care navigators in the southeastern part of the country selected to attend their three-day intensive workshop. We have just recently implemented our very own “Survivorship Series for Young Women” as part of LBBC’s Young Women’s Initiative. It is a four-part educational series for women diagnosed with breast cancer before the age of 45 and focuses on their unique challenges, such as early menopause, long term effects of cancer treatment, sex and intimacy as well as self-care after breast cancer. This series is currently being offered virtually, due to COVID-19, but we have found that the virtual setting has allowed increased participation among young survivors; surpassing our expectations. The target audience of this program is a very specific demographic but the positive response has shown us just how great the need is. It has also helped me, as the breast navigator, connect with younger patients who have typically been reluctant to attend the cancer center’s monthly breast cancer support group. This collaboration is just one example of how we at Pardee are continuing to strengthen and refine our navigation program. Partnerships such as these are essential in ensuring we offer our patients the highest quality, comprehensive care from diagnosis through survivorship. We look forward to working with LBBC on future initiatives such as focused support and education for patients with metastatic disease, triple-negative disease and caregiver trainings. Our goal is to be the link that connects patients to their care providers, actively involves them in their care and breaks down any barriers to care.
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Highlights
(clockwise) Pardee employees wear pink for World Mammography Day 2019; ‘Ribbon Gardens’ on campus in October 2019; Radiation Oncology nursing team; Survivor support group members painted pumpkins for Breast Cancer Awareness Month 2019; Cancer Research nursing team; Radiation Oncology staff wear pink masks, 2020
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INNOVATIONS
Radiation Oncology Updates YASEEN ZIA, MD
Radiation Oncology at Pardee Cancer Center continues to develop and implement new technologies and techniques to provide the most advanced oncological care to our patients and our community. This past year we are proud to have added Stereotactic Body Radiation Therapy (SBRT) and Active Breathing Coordinator (ABC) to our armamentarium. These additions allow us to offer therapeutic options that were previously unavailable to treat our patients while minimizing treatment toxicities. Stereotactic Body Radiation Therapy (SBRT) delivers very high doses of radiation in an extremely precise manner to the tumor. SBRT uses sophisticated image guidance to pinpoint the three-dimensional location of the tumor so that treatment be delivered to it while minimizing dose to the surrounding normal tissues and reducing treatment toxicity. SBRT, as compared to conventional radiation therapy, is administered in five treatments or less over the course of one to two weeks. We have implemented this modality in the treatment of our early stage lung cancer patients. These patients can be treated by surgical resection, but in some cases their medical co-morbidities preclude a surgical approach. SBRT has been documented to provide a viable alternative with excellent local control of disease and one that we are pleased to offer to patients now. This development has allowed us to more comprehensively treat lung cancer and to allow our patients to receive their care closer to home and their support system. Radiation therapy is an integral component in the treatment of breast cancer. The delivery of radiotherapy is often challenging due to the close proximity of the breast to critical normal organs, with the heart being one of the foremost. The implementation of Active Breathing Coordinator (ABC) allows us to better treat the breast while avoiding the heart and mitigating potential cardiac toxicity. The patient is instructed in Deep Inspiratory Breath Hold (DIBH) which serves to position the heart farther away from the treated breast. The ABC monitors the patient’s breathing cycle while treatment is delivered and ensures that radiation is administered when the heart is away from the radiation field. This results in a lower heart dose and resultant potential cardiac toxicity. Due to being able to minimize heart dosage better, patients who require it are able to be treated more comprehensively to lymph node regions that are in close proximity to the heart. I am pleased to share these advancements and look forward to advancing the fight against cancer in our community. ď ľ
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Lung Cancer Advances
C AT H Y J E N K I N S R N I I I , B S N , C C R P, Lung, Head & Neck Nurse Navigator Lung cancer is one of the leading causes of death among men and women in the United States. More people die annually of lung cancer than of colon, breast, and prostate cancers combined. The American Cancer Society estimates there will be about 228,820 new cases of lung cancer and 135,720 lung cancer deaths in the U.S. in 2020. Symptoms of lung cancer typically do not appear until the disease is already in an advanced stage. Early detection leads to better treatment results. People between the ages of 55 and 77 years old, who currently smoke, have smoked in the past 15 years, or smoked a pack of cigarettes for at least 30 years, should discuss a lung cancer screening with their doctor. The screening uses a low dose spiral CT scan to detect lung cancer at an early stage.
The NFL has provided funds for the American Cancer Society to increase lung cancer screening awareness and tobacco cessation activities. Pardee is one of two community health-screening partners for the American Cancer Society NFL Change Grant Lung Cancer Screening. In collaboration of with Blue Ridge Health Center, grant monies will provide lung cancer screening and smoking cessation resources for uninsured patients, who are at high risk for lung cancer. In addition to offering low dose lung cancer screenings, Pardee’s pulmonary nodule program reviews incidental pulmonary nodules identified on CT scans. Most pulmonary nodules are not cancerous but are the result of old infections, scar tissue, or other causes. Primary care physicians receive recommendations for pulmonary nodules requiring close monitoring. Radiologic surveillance can lead to early diagnosis of lung cancer. The complexities of the health care system can be overwhelming for the newly diagnosed lung cancer patient. As a nurse navigator, I provide education and resources to facilitate informed decision making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum. Serving as a point of contact for patients and their families, the nurse navigator provides patient centered care to ensure a sense of hope, healing and security.
Pharmacy Technology RO B Y N B RY S O N
The oncology infusion pharmacy at Pardee Cancer Center implemented a new computer software program, BD IV Prep™, in the fall of 2019 with the assistance of Kenmure Fights Cancer. This software allowed for the sterile compounding of the chemotherapy/immunotherapy medications to be done based on gravimetric weight (density) instead of based on syringe volume. Using gravimetric weight of the medication allows for precise doses being dispensed to the patient to lessen the potential for under- or overdosing. Another benefit with this software is the ability to identify the medications and solutions using bar code scanning. The software program moves the pharmacy technician through each step in compounding the medication using bar code scanning, weight, and pictures of the product. A patient-specific label is generated that allows the pharmacist to perform the final verification using the pictures obtained at each step of compounding.
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SUPPORT
Cancer Survivorship Program L E A N N N O A K E S , R N I I I , C C R P, Cancer Navigator
In January 2020, the Commission on Cancer (COC) released new accreditation standards. Standard 4.8 is ‘A Survivorship Program’, which is a phase in standard, meaning cancer centers have a one year period to get a Survivorship program up and running. The cancer committee at Pardee UNC Health Care appointed a Survivorship Program Coordinator in February 2020 and developed a Survivorship Team, which consists of a physician, nurse navigator and cancer registrar as well as representatives for rehabilitation and nutrition services and patient financial services. This team determines a list of services and programs which address the barriers and needs of our cancer survivors and reports the data to the cancer committee. The following survivorship program services are offered at Pardee: • Treatment summaries / Survivorship care plans • Screening programs for new cancers and recurrences • Rehabilitation services • Nutritional services • Psychological support and psychiatric services • Support groups and services • Seminars for survivors • Physical activity programs • Financial support services • Formalized referrals to experts in cardiology, pulmonary services, sexual dysfunction and fertility counseling The survivorship program team will be reporting out data to the cancer committee on our screening programs for new cancers and recurrences, as well as our referrals to rehabilitation and nutrition services. Although we are not collecting the data on survivorship care plans this year, the cancer navigators are continuing to develop the care plans and review them with each patient who has completed definitive treatment. The survivorship care plan contains information on the patient’s care team, diagnosis including stage, treatments received for this diagnosis, recommended follow up care and local or online resources. Pardee Cancer Center, in collaboration with Pardee @Work business and industry services, offers cancer screening to the community. We have offered free skin screenings, a prostate screening, and in the past, a head and neck screening. Our screening data will include our public screening as well as the number of patients who are sent for colonoscopies, mammograms, low dose lung CT and follow-up scans for patients with a cancer diagnosis, as well as patients who are being evaluated for a cancer reoccurrence. Patients with a cancer diagnosis who are in active treatment with chemotherapy, radiation therapy, or after a surgery are at higher risk of developing issues with weight loss, changes in appetite, loss of energy, and decrease in strength and muscle mass. These patients are screened often by physicians, navigators, nurses, or dietitian for the need for rehabilitation and nutrition services. Pardee has oncology-certified dietitians who are able to see our patients at the center while they are receiving their treatment. Pardee also has a wonderful rehabilitation program that can help our patients increase their quality of life. The Survivorship Program will continue to assess the needs of our patients at the cancer center as well as our community to enhance our current services and develop new services to better assist our patients during their cancer journey.
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Palliative Care Services CONNIE SEWELL, MD
Pardee Cancer Center is committed to offering full comprehensive care to their patients, and has partnered with Four Seasons Palliative Care since 2018 to provide palliative care services. Palliative Care is collaborative, patient-centered care, focusing on providing relief from symptoms and improving quality of life for people who are facing a serious illness. Palliative care clinicians can help manage symptoms (including psychological and emotional needs), help with communication about goals and treatment preferences, coordinate with other supportive services such as home care or home health, or help with planning for future medical care. Palliative care services are often combined with other types of treatment, adding an extra layer of support for people with serious illness and their families. Patients, families, or any member of the oncology team may request a consult with a palliative care clinician. The initial consultation is at Pardee Cancer Center, and then follow-up care may be scheduled. The community palliative care team consists of specialty-trained clinicians (MDs or nurse practitioners), a social worker, and telephonic support with registered nurses and administrative personnel. Pardee has a palliative care team for inpatient consultations, usually centered around goals of care discussions and complex medical decision making for acutely ill patients. In 2019, Four Seasons Palliative Care received 107 referrals from Pardee oncologists (compared to 58 referrals in 2018), and provided initial consultation and follow-up for 94 of these patients and their families. On average, there were 28 visits per month with the palliative care clinician, provided mostly at the cancer center, and occasionally at home or at a rehabilitation facility. In addition, the Palliative Care LCSW provided independent visits either via telephone or in person for ten of these patients. Patients may have only one visit, which is their initial consultation, or may be followed as often as once a month – visits are determined by patient’s goals and needs. Of those referrals requesting support in specific areas, approximately 80 percent requested collaboration with the oncology team to assist with symptom management, and 70 percent requested discussions exploring goals of care and complex decision making. These discussions may involve exploring transition to hospice services if a patient and family decide to shift focus from intensive medical therapies to symptom management and remaining at home for as long as possible. Although two-thirds of the referrals were for patients with stage IV or advanced cancer, the palliative care team is available to support any person struggling with cancer at any stage of their illness. ď ľ
Blue Ridge Community College (BRCC) students show their support for cancer survivors. BRCC also occupies a floor of the Henderson County Health Sciences Center, the same building in which Pardee Cancer Center is housed.
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CANCER RESEARCH & DATA
Nutrition Services K R I S T E N K O WA L C Z Y K , RDN, CSO
Kristen Kowalczyk, RDN, CSO, and Rebecca Howell, RDN, CSO, are registered dietitians who provide personalized nutrition counseling for patients at Pardee Cancer Center. Dietitians work with patients to tailor nutrition advice based on personal preferences and culture. Goals of nutrition counseling can be to minimize the impact of symptoms from cancer treatment or to assist patients with adopting a healthier diet and lifestyle. Patients can be referred by a physician or may self-refer for dietitian services. The dietitians have worked with the Epic (electronic medical records) team and nurse navigators to start screening patients at regular intervals using validated nutrition screening tools, including the PG-SGA (Patient Generated Subjective Global Assessment and NUTRISCORE. This helps to ensure that patients at risk of malnutrition during treatment are automatically referred to a dietitian.
Cancer Physician Liaison JOHN K. HILL, MD
The Cancer Liaison Physician (CLP) is responsible for reviewing Pardee’s RQRS and CP3R data on a regular basis and reporting the data to the cancer committee. The data is monitored and interpreted using the National Cancer Data Base reporting tools and there is also the capability to compare our hospital to state, national and cancer programs in the same accreditation category. Pardee UNC Health Care is in the Comprehensive Cancer Program category. Once the data is reviewed, we can review each case that does not meet the criteria. It can be updated if needed, or we can document why the criteria was not met. Each patient’s treatment plan is different and the treatment modalities are not always done in the same order for patients. This can sometimes make the measure read lower than it actually is. Once that patient’s abstract is updated with the complete treatment information, the case is resubmitted and our percentages will be updated as well. Taking care of cancer patients is ever changing, and data entered into the cancer registry is very fluid. This requires very close monitoring and frequent updating. No two patients are the same, and no two abstracts are the same. Patients may receive part of their treatment at Pardee Cancer Center and part at another facility, so we must work closely with the other facility to make sure we have all of the treatment information. As the CLP for Pardee, I communicate on a regular basis with our cancer registrar regarding our data submission frequency and completeness and regarding any measures that we do not meet. This is shared with our cancer committee on a quarterly basis and we discuss what measures, if any, need to be taken to improve our data.
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Clinical Research Report LY N N H O W I E , M D
Since the development of Pardee’s clinical research program, over 1,000 patients have been enrolled in studies evaluating new therapies. These trials help us to better understand how to help people live longer and better lives. Nationally, only about three to five percent of adults with cancer participate in clinical trials. In 2019, we enrolled 60 patients, which is nine percent of our population.
Pardee’s program is successful due to the efforts of its clinical research nursing staff, which includes Karen Morris, Kathy Cantrell, Jennifer Haynes, and Alina Thompson. We are supported by dedicated physician investigators and through the efforts of our local Institutional Review Board (IRB), which is led by Dr. John Kogoy and is comprised of Pardee Cancer Center staff and local Henderson County community members. We are proud of our ability to offer leading clinical trials to patients right here in Western North Carolina.
2019 CLINICAL TRIAL ACCRUALS
REGISTRY TREATMENT CANCER CONTROL BIOREPOSITORY PHARMACEUTICAL
CANCER CARE DELIVERY
PARDEE CANCER ANNUAL REPORT 2020
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CANCER DATA & RESEARCH
Cancer Incidence Bone
MALE
1
FEMALE TOTAL
0
4
7
Breast 1
208
209
MALE
FEMALE TOTAL
19
17
36
Penis
1
0
1
Prostate
61
0
61
Testis
2
0
2
0
3
3
1
0
1
Heart/Mediastinum/ Pleura
2
0
2
Male Genital
Meninges
Connective / Soft Tissue 1
Lymphoma
1
Brain & Central Nervous System 3
BY SITE 2019
1
2
Digestive System
Other / Ill-Defined
Anus/Anal Canal
0
3
3
Colon
12
21
33
Esophagus
3
5
8
Liver and Bile Ducts
2
1
3
Other Biliary Tract
1
0
1
Pancreas
17
12
29
Larynx
2
0
2
Rectum
11
5
16
Lung
35
37
72
Small Bowel
4
6
10
Stomach
6
8
14
13
4
17
1
4
5
Bladder
23
5
28
Kidney
8
2
10
Kidney/Renal Pelvis
2
1
3
Other
0
1
1
Ureter
1
0
1
8
6
14
270
392
662
Female Genital Cervix Uteri (invasive)
0
1
1
Corpus Uteri
0
8
8
Ovary
0
1
1
Vulva
0
1
1
Head & Neck Base of  Tongue
2
0
2
Nasal Cavity/Middle Ear
1
0
1
Nasopharynx
0
1
1
Oropharynx
1
0
1
Partoid Gland
1
0
1
Respiratory System
Skin Thyroid Urinary System
Unknown Primary Site
Hematopoietic
17
22
25
47
TOTALS
Cancer Cases 20-29
3 13
30-39
44
40-49
AGE
IN 2019
90
50-59
175
60-69
219
70-79
94
80-89
24
90+
40
80
120
160
200
RACE
0
WHITE
651
BLACK
9
OTHER
2
COUNTY
BUNCOMBE (67)
HENDERSON (480)
POLK (37) TRANSYLVANIA (27) RUTHERFORD (16) HAYWOOD (6) OTHER NC (11) OUT OF STATE (18)
PARDEE CANCER ANNUAL REPORT 2020
18
Cancer Services Pardee Cancer Center . . . . . . . . . . . . . . . . . . . . . . . . (828) 694-4300 Cancer Navigators Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7334 General Cancer . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7317  Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7364 Cancer Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . (828) 696-4716 Mammography Services . . . . . . . . . . . . . . . . . . . . . (828) 696-1305 Medical Oncology . . . . . . . . . . . . . . . . . . . . . . . . (828) 692-8045 Pardee Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . (828) 694-8438 Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . (828) 696-1330 Surgical Oncology . . . . . . . . . . . . . . . . . . . . . . . (828) 693-7230
Pardee UNC Health Care 800 North Justice Street Hendersonville, NC 28791
9020-275 (10/09/2020)
Pardee Cancer Center 805 6th Avenue West, Suite 100 Hendersonville, NC 28739
pardeehospital.org
