Based on data compiled in 2013
2014
CANCER ANNUAL R E P O R T
CHAIRMAN’S REPORT THOMAS L. EISENHAUER, M.D., FACS CANCER SERVICES UPDATE JAMES BLOODWORTH CANCER INCIDENCES & CASES CANCER RESEARCH REPORT JAMES RADFORD, M.D. ELIZABETH REILLY BREAST CENTER UPDATE CHARLES A. ALBERS, M.D. SITE SPECIFIC STUDY KRISTI OWENS, M.D. EDUCATION, PREVENTION, SCREENING & EARLY DETECTION CAROL BROWN, CTR, ABA STAR PROGRAM LORI HART, MSPT PATIENT NAVIGATION & SURVIVORSHIP KRISTY CAPPS, RN, CBPN-IC LEANN NOAKES, RN, CCRP
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3 4-5 6-7 8-9 10 11 12 13 14-15
The Comprehensive Cancer Center at Pardee Hospital had a great year in 2013. The program continues to grow in numbers of patients as well as the services that are offered to these patients. It is exciting to lead this oncology program through the various stages of growth that it has been experiencing. These are just a few of the many enhancements that are highlighted in this year’s Annual Report. The Elizabeth Reilly Breast Center continues to serve individuals with breast disease. Since its opening, the Breast Center has been assisting women with their breast care, and providing patient education for breast self-examination, cancer risk assessment and cancer treatment options. The Breast Care Navigator is available to help each patient schedule follow-up mammograms, arrange appointments with the appropriate physicians and prepare for surgical procedures. Women report an overwhelmingly positive response to the services provided for this specific cancer, and the number of support groups and meeting opportunities continues to grow. Our breast program continues to maintain its certification through the National Accreditation Program for Breast Centers. The weekly Cancer Conferences provide a forum where multiple physicians of various specialties meet to discuss unusual or difficult types of cancers. Attendance at these conferences continues to be very high and is one of the best of its kind in western North Carolina. This group allows us to anonymously review certain patients and gather a variety of ideas regarding patient care. These discussions benefit the patients because their care
is reviewed by as many as 35 members of the cancer team. This is a benefit for the medical staff as it is an ongoing educational process allowing specialists to provide input regarding his or her area of expertise, thereby educating the rest of the members. The new standards that were released from the Commission on Cancer in 2012 continue to be utilized by the cancer program. These are national guidelines that give cancer programs recommendations to follow so that patients across the United States have access to the same quality of care for their given disease. Special programs dealing with survivorship plans and genetic counseling are being created. Additional staff have been hired for the Navigational Program, an area designed to help patients overcome barriers or obstacles to their cancer treatment. Additionally, community evaluations are performed to identify specific areas of cancer care that need more community education and screening.
Thomas L. Eisenhauer, M.D., FACS
Pardee’s Comprehensive Cancer Program continues to provide excellent cancer care. New techniques and treatment options are utilized on a regular basis. Tracking patient outcomes with respect to their specific type 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. This ability is what the people in our area want and deserve in order to receive the care that is best for them, close to home.
CANCER ANNUAL REPORT
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CANCER SERVICES UPDATE James Bloodworth Service Line Development
The year 2014 was a pivotal time for the growth and development of Pardee Cancer Services. Building on the myriad of strengths which were recognized by the Commission on Cancer Award of Accreditation with Commendation in 2013, the Pardee Cancer Program made seminal progress enhancing coordination of existing clinical capabilities and tooling a more effective operational infrastructure.
Pardee Cancer Services also made noteworthy progress toward meeting key mandates from the Commission on Cancer related to patient navigation, survivorship planning and implementation of psychosocial distress screenings for patients. The program forged valuable working partnerships with Western North Carolina YMCA and UNC Lineberger Cancer Center.
KEY ACCOMPLISHMENTS INCLUDE: • With invaluable support from the Pardee Hospital Foundation, Pardee made cancer patient navigation available to all cancer patients. Leann Noakes, RN, with cancer nursing experience at both the Pardee Cancer Research Program and Hendersonville Hematology and Oncology at Pardee, was appointed Cancer Nurse Navigator for all non-breast cancer patients. • Pardee’s Cancer Patient Navigation Program joined the UNC Cancer Navigators Network. • Hilda Connor, Practice Director for Hendersonville Hematology and Oncology at Pardee, added operational responsibility for our Radiation Oncology program to her role. Hilda is now Operational Director for Pardee Cancer Practices. This is an important step in realizing best practice cancer center operations. • Partnered with UNC Lineberger Cancer Center to assess business office operations. This partnership will work towards finding best practice billing and financial operation for the cancer program at Pardee. Results of this collaboration should measurably enhance the financial performance of cancer services. • Launched the STAR (Survivorship Training and Rehab) Program, which is an indispensable component of a vigorous survivorship program that collaborates with Pardee Outpatient Rehabilitation Program. STAR is an important link in ensuring optimal patient clinical outcomes and coordination across the care continuum, and is vital to the future of our program in an accountable care environment. • Developed a navigated program for Low Dose CT Lung Cancer Screening patients. • Implemented navigation pathway for state mandated breast density screenings. • Expanded outreach in screening efforts with Pardee Signature Care Center and Pardee Outpatient Rehabilitation Center.
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• Designed and implemented Multidisciplinary Head and Neck Clinic. This was introduced through a multidisciplinary Continuing Medical Education program sponsored by Blue Ridge Community Health Services. • Launched free educational teleconferences for patients and professionals in coordination with UNC Lineberger Cancer Center. • In coordination with Pardee Pharmacy Department leadership, Hendersonville Hematology and Oncology at Pardee finalized plans to offer a dedicated oncology pharmacy. • July 2014, Pardee announced plans to open in the Summer of 2016, an approximately 20,000 square foot community cancer center on the first floor of a Henderson County owned building. The new facility will also include separate floors for health care education and training components of both Blue Ridge Community College and Wingate University. Pardee Surgical Associates will be located in a space contiguous to the new Pardee Cancer Center on the first floor.
This community cancer center is planned to house key Pardee cancer services, provide a state-of-the-art healing environment for cancer patients and their caregivers, and an optimal work environment for health care professionals and staff. All stakeholder constituencies related to the cancer center were involved in initial design. This stakeholder participation in design development included discussion groups for current and past patients, as well as caregivers. CANCER ANNUAL REPORT
5
Total
Male
Female
Total
Male
HEAD AND NECK
FEMALE GENITAL
Tongue 4 4 0 Hypopharynx 1 1 0 Other 8 6 2
Cervix Corpus Uteri Ovary Vulva Other
DIGESTIVE SYSTEM Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other
5 4 1 10 5 5 60 28 32 12 6 6 4 2 2 9 5 4 17 7 10 7 2 5
RESPIRATORY SYSTEM Larynx Lung
6 3 3 70 38 32
HEMAOPOIETIC Leukemia 19 10 9 Multiple Myeloma 11 7 4 Other 8 6 2
BONE
1 0 1
Female
1 0 1 13 0 13 6 0 6 4 0 4 3 0 3
MALE GENITAL Prostate Testis
45 45 0 2 2 0
URINARY SYSTEM Bladder Kidney Other
27 23 4 18 12 6 2 2 0
Nervous System Brain Other
4 1 3 4 1 3
LYMPHATIC SYSTEM Hodgkin’s Non-Hodgkin’s
1 0 1 10 7 3
UNKNOWN PRIMARY
16 11 5
TOTALS
540 253 287
CONNECTIVE TISSUE
1 0 1
SKIN Melanoma 15 14 1 Non-Melanoma 1 1 0
BREAST
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115 0 115
AGE
14 106 136
158
78 27 7 3
COUNTY
453 Transylvania
33 28 13 7 6
RACE PAYOR GENDER
521 19
CANCER CASES 2013 253
287
James Radford, M.D.
As I write this in October 2014, we have just completed our 15th year of involvement in the cancer clinical trial process at Pardee. Those 15 years have been very productive ones, of which all of us involved in cancer clinical research can be justly proud. They have seen approvals of dozens of new treatments for a wide variety of types of cancer, including cancers that have been among the most difficult to treat including melanoma (a dangerous form of skin cancer), pancreatic cancer and lung cancer. There have also been major advances in the treatment of such common cancers as breast cancer, prostate cancer and colon cancer. Those 15 years have also witnessed major changes in our understanding of what cancer is, and what makes cancer cells different from normal cells. This knowledge is quickly leading us into the era of so-called “targeted therapy,” in which anti-cancer medications are specifically designed to target the vulnerable growth pathways on which an individual cancer patient’s cancerous cells depend for survival. This approach promises, and in some cases has already delivered, anti-cancer drugs which are more effective and less toxic than the conventional chemotherapy drugs on which we have depended for over 40 years. The involvement of the Pardee Cancer Research Program in this process has been anything but trivial. In the past 12 months ending on June 30, 2014, we enrolled 43 patients on 45 separate trials. This represents approximately 9 percent of the number of new cancer patients
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seen during this interval, easily exceeding the 2 percent benchmark set by the American College of Surgeons for a Comprehensive Cancer Center, and easily exceeding the 4 - 5 percent of patients estimated to be enrolled on cancer clinical trials nationally. Since our program’s inception in 1999, more than 600 of our cancer patients have been enrolled on, what I believe must now be, more than 100 separate cancer clinical trials. This numerical success is due in no small part to the dedication of our staff of research nurses: Karen Morris, Cathy Jenkins, and the newest member of the group, Lynn Jones, as well as the administrator of our Institutional Review Board, Marcia Cage. These nurses, as well as the entire cancer team, can be proud that our program has brought new treatments to hundreds of our patients that otherwise would only have been available to them had they been willing (and able) to travel hundreds of miles to a university medical center for treatment. We can also be proud that the involvement of our medical community and our patients is helping in a very direct way to improve cancer treatment for everyone. Just last month, for example, the results of one of the studies in which our center, and our patients, participated-the TEXT (Tamoxifen and Exemestane Trial) study--were reported in the New England Journal of Medicine, establishing the new treatment used in that study as the new standard of care in the treatment of younger breast cancer patients. It is often said that the only constant is change. Just as cancer treatment changes as the result of scientific advances, so is the cancer clinical trial system itself changing. In an era of limited resources,
the National Cancer Institute (NCI) has totally redesigned the national cancer clinical trials system to focus on “fewer, larger, faster� clinical trials. The idea is to utilize resources, including not only dollars, but also patients enrolled on clinical trials, more efficiently. The stimulus for this change, probably better described as an upheaval, is a substantial reduction in constant-dollar terms in the NCI’s research budget over the past 10 years. Unfortunately, even if the NCI is able to realize some efficiencies from the reorganization of the cancer research enterprise, the bottom line will still be a contraction in cancer research activity, with the NCI itself projecting that in coming years, the number of patients enrolled nationally on cancer clinical trials may decline by up to 50 percent. Locally, this change has led to the merger of the cancer research organization to which Pardee belongs, the Southeast Cancer Control Community Clinical Oncology Program (CCOP) with the Upstate CCOP based in Greenville, SC, to form the Southeast Clinical Oncology Research Consortium. The combined organization competed very successfully this year for a shrinking number of NCI research grants; nevertheless, the members of the consortium, including Pardee, will receive far fewer research dollars beginning this year. As is often the case in politics, we are seeking short-term cost savings, at a real cost, in lives and happiness lost, to be borne by future generations. I hope that this pendulum will eventually swing back to a more reasonable and stable middle ground.
CANCER ANNUAL REPORT
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As the Breast Center Task Force was developing the Elizabeth Reilly Breast Center it was obvious that there was no device, drug or procedure that we could offer that would be superior to what other centers possessed. However, we could offer something superior, and something that my wife had experienced a few years earlier. My wife, Susan, went in for a routine screening mammogram, and then extra views. She had a biopsy that showed a malignancy, and was immediately scheduled for surgery, chemotherapy and radiation therapy. Her friends said, “You’re lucky, you’re a doctor’s wife, you got through the system very quickly.” They were right. I knew every physician in town and how the process worked so she could be treated promptly and efficiently. It was because of this that we determined that we would offer personal, caring, prompt service that other breast centers were lacking. In short, we would treat every patient as if she were a doctor’s wife.
Charles A. Albers, M.D.
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We all know that waiting for results after a mammogram or a biopsy can be difficult, so we notify patients about their results as soon as possible. Our goal is to have each step of a patient’s diagnosis, planning and treatment proceed quickly and efficiently. Of course, we never want the patient to feel rushed. There is nothing medically wrong with waiting a few weeks, but most patients want to get started on their cancer plan as soon as possible.
Kristy Capps, RN, our Breast Care Navigator, meets with patients before their biopsy and then calls the patient with results as soon as they are available. If the results indicate further action to take place, she meets with the patient again and begins to arrange the steps of her cancer plan. Kristy also offers support groups for breast cancer patients and survivors, and even caregivers, which assist patients and their families through the difficult times as they continue on their journey. Upon survivorship, the STAR (Survivorship, Training and Rehabilitation) Program assesses and addresses patients’ physical and psychological challenges, helping to lessen the impact on their everyday lives. This may include occupational therapy, physical therapy, nutritional assessments and psychosocial assistance. We not only want to treat our patients, but for them to feel “whole” again. Patients expect expert medical care, which we certainly offer, but it is the little personal touches that we pride ourselves on including prompt biopsies and results to patients, and assistance every step of the way, that sets the Elizabeth Reilly Breast Center apart from other centers. It is the way my wife, and how you and your family would want to be treated.
HYPOFRACTIONATED (CANADIAN REGIMEN) WHOLE BREAST RADIATION THERAPY AS PART OF BREAST CONSERVATIVE TREATMENT IN PATIENTS WITH EARLY STAGE BREAST CANCER For women with noninvasive breast cancer (ductal carcinoma in situ) or with early stage invasive breast cancer (size < 5 cm. and lymph node negative, i.e. T1N0M0 or T2N0M0), breast conservation with lumpectomy and sentinel lymph node evaluation plus radiation therapy to the whole breast is equivalent in outcomes to mastectomy. This has been shown in many randomized trials, including the National Surgical Adjuvant Breast and Bowel Project clinical trials (Fisher, et al.) that were published in the 1990s and early 2000s where the radiation doses were typically 50 Gy (5000 cGy) given over a period of five weeks. Operative bed boost data was later published that showed an even further decrease in recurrences when an additional 10-16 Gy (10001600cGy) was given over a period of an additional one to two weeks. Therefore, the standard of care in the United States has been to give five to seven weeks of radiation treatments to the whole breast after lumpectomy.
Eligibility criteria include: 1. Early stage, node negative breast cancer (tumors <5 cm.) 2. Clear surgical margins (no cancer cells at the inked margin) Kristi N. Owens, M.D. 3. Width of tissue treated must be < 25 cm. on the isocenter CT slice, measuring from the posterior borders of the tangential fields 4. No prior chemotherapy
In Canada and the United Kingdom, shorter courses of radiation therapy have been used to treat early stage breast cancers for many years. In the New England Journal of Medicine February 11, 2010, issue (Whelan, et al.) published their data from several Canadian institutions, they compared 50 Gy in 25 fractions given over a period of 35 days, to 42.5 Gy in 16 fractions given over a period of 22 days. The cosmetic outcomes were equivalent and local recurrence was the same: 6 percent at 10 years.
Unlike accelerated partial breast irradiation, which is given in only 10 treatments, the level I axillary lymph nodes are included in the whole breast tangential fields. Treating with shorter courses of whole breast irradiation is both, more convenient for patients and less costly. Treating the whole breast to include the first echelon lymph nodes also results in fewer local recurrences.
Here at Pardee Radiation Oncology, Dr. McCollough and I have adopted this hypofractionated regimen into our practice for patients who are eligible and who desire to undergo a shorter course of treatment. Since 2010, we have treated 30 patients with this shorter course regimen, including a boost to the operative bed when surgical margins are close, which adds three to four days of treatment.
The 30 patients that we have treated here (from Oct, 2010 to April, 2014) with this hypofractionated regimen have short-term follow-up times since we implemented this short course regimen into our practice about four years ago. To date, we have seen no local recurrences and very good patient tolerance with good cosmetic outcomes.
CANCER ANNUAL REPORT
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EDUCATION, PREVENTION, SCREENING & EARLY DETECTION The Comprehensive Cancer Center at Pardee has made it a priority to focus our attention to our community this year with screenings, educational opportunities and prevention programs. Early detection is the key to helping patients survive longer, and because of that, we have put even more of an emphasis on our community-based programs including screening tests that can detect cancer in its earliest stages.
years. Our screening in September offered men the opportunity to speak with a Pardee urologist, and receive both an exam and PSA blood test.
We provide community education through the telemedicine program with UNC Chapel Hill. This interactive program is held monthly at lunchtime, and covers various cancer topics. Speakers from UNC and Pardee are alternated each month, and at the end of the session, cancer patients, This year we held several screenings at our caregivers and community members alike, may ask Signature Care Center and Rehab & Wellness questions of the presenters either in person or by Center, with growing attendance at each screening. telemedicine equipment. Speakers from UNC also In the spring, we held an oral, head and neck cancer provide their contact information so that attendees screening with physicians throughout the community can continue to communicate and ask questions. specializing in the ear, nose and throat participating. Our first year offering this series was successful, and The incidence of oral, head and neck cancers has we look forward to continuing this unique program. been increasing in recent years, so our focus was to raise awareness of these types of cancers as well as Our cancer support groups also serve as offering an examination. educational platforms with physicians and other hospital team members volunteering to speak Pardee general surgeons, along with family practice to patients and their caregivers. This is a great residents, led a skin cancer screening at the Pardee forum for discussion and is a very comfortable Signature Care Center. Screening for skin cancer environment for the participants as they are very is important, as these are very common types of close to the other survivors in the groups. cancer. With non-melanoma skin cancers occurring more frequently, it is critical that people are The earlier we find cancers, the easier they are screened for melanoma as well as basal cell and to treat and the longer people survive. Our squamous cell cancers. cancer program will continue to focus on offering education, screenings and prevention, and we hope Prostate cancer screening is a popular discussion our efforts can make a difference in many lives topic recently, as the prostate-specific antigen (PSA) within our community. blood test is not as widely used as in previous
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Carol Brown, CTR, ABA
Lori Hart, MSPT, STAR Program Coordinator The STAR (Survivorship Training and Rehab) Program, which is housed at Pardee Rehab & Wellness Center, has seen 75 patients this year. The STAR Program is a comprehensive cancer survivor healing assistance program that focuses on patientsâ&#x20AC;&#x2122; physical and emotional well being. We assist patients by increasing their mobility, decreasing swelling or lymphedema, regaining functional mobility to perform activities of daily living, and work on their swallowing and voice function. In addition, we also address fatigue, balance and gait issues. The program has recently added a gentle pose yoga series for cancer patients at Pardee Rehab & Wellness Center. This fall, we will be incorporating a progressive relaxation with music element for patients to decrease stress, decrease pain and lower anxiety. We are also reaching out to patients in the South Buncombe and North Henderson areas at our new Fletcher location of Rehab & Wellness Center at the Mission Pardee Health Campus. Upon completion of their therapy, patients may join a medical wellness program at our Hendersonville facility, and if appropriate, we also refer patients to the Livestrong program at the YMCA. We will continue to provide this critical service to our patients with the ultimate goal of helping them regain maximal function before, during or after cancer treatments so they can regain independence and enjoy feeling well again.
CANCER ANNUAL REPORT
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The cancer program at Pardee Hospital works very hard to provide patients in and around our community with the very best cancer care possible. In our effort to provide excellence, we have become a Commission on Cancer (CoC) accredited facility. What this means to patients is that they will receive the same quality of care here at Pardee as they would at a large, academic center elsewhere. The CoC is always looking for ways to improve cancer care across the country. Most recently, their focus has been patient-centered care. They have found that it is extremely beneficial for patients to be an active part of their cancer care team, and to have barriers eliminated so they can access care and focus on healing. They also see great value in addressing the patient as a whole, not just the disease. As a result, they have mandated new standards for all CoC accredited facilities to implement by 2015. Pardee has worked tirelessly to respond to the CoCâ&#x20AC;&#x2122;s recommendations and provide seamless, coordinated care. Navigation has been an integral part of the breast cancer program here at Pardee for over seven years. In 2013, we expanded the navigation program to offer the same outstanding service that breast cancer patients receive to all cancer patients. Cancer navigators, Kristy Capps, RN, and Leann Noakes, RN, serve as easily accessible, expert resources for newly diagnosed cancer patients and their families. Our navigators take time to educate patients about their particular diagnosis and any treatments they may receive. In addition, they screen for any barriers to care and work hard to eliminate those barriers by utilizing local and national resources. Most importantly, the navigators ensure patients never go through cancer treatment alone. A task force was created to tackle the issue of psychosocial distress. This team has developed a screening program in which newly diagnosed cancer patients are screened for physical and emotional distress at a pivotal time in their cancer treatment. The nurses, navigators and physicians work closely together to decrease, and hope to eliminate each patientâ&#x20AC;&#x2122;s source of distress.
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Cancer care has improved so much over the past decades that patients are living longer after they are diagnosed. As a result, we have developed a more comprehensive survivorship program. In this program, we are providing patients with a treatment summary at the completion of their initial cancer treatment. This includes all treatments given, as well as signs and symptoms to watch for, and general healthy living tips. This comprehensive care plan serves as a communication tool for patients as well as providers that may care for them in the future. Other divisions of our survivorship program include STAR (Survivorship Training and Rehabilitation), support groups for patients and families, and the Livestrong program in partnership through the YMCA.
Kristy Capps, RN, CBPN-IC Breast Care Navigator
From initial diagnosis through survivorship, our navigators provide ongoing support, advocacy and encouragement.
Leann Noakes, RN, CCRP Cancer Care Navigator
SUPPORT GROUPS Between Friends at Pardee Too: Every 1st Thursday
This group is open to anyone that is a caregiver to a cancer patient or survivor. Meets at Pardee Signature Care Center in the Blue Ridge Mall. Call (828) 698-7317 for more information.
Breast Friends Forever Too: Every 2nd Tuesday
Open to anyone who has had breast cancer as well as their support person, friend or greatest cheerleader. Meets at Elizabeth Reilly Breast Center. Call (828) 698-7334 for more information.
Between Friends at Pardee: Every 3rd Thursday This group is open to any person diagnosed with cancer who has been treated or is currently undergoing cancer treatment. Meets at Pardee Signature Care Center in the Blue Ridge Mall. Call (828) 698-7317 for more information.
Breast Friends Forever: Every 4th Thursday
REPORT Only open to ladies with breast cancer. Meets at Elizabeth Reilly Breast Center. Call (828) CANCER 698-7334 ANNUAL for more information.
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CANCER CENTER
(828) 698-7334 (828) 696-1341
CANCER RESEARCH
(828) 696-4716
CANCER NAVIGATORS BREAST CANCER GENERAL CANCER
(828) 698-7334 (828) 698-7317
HENDERSONVILLE HEMATOLOGY AND ONCOLOGY AT PARDEE
(828) 692-8045
MAMMOGRAPHY SERVICES
(828) 696-1305
RADIATION ONCOLOGY
(828) 696-1330
BREAST CENTER
800 North Justice Street Hendersonville, NC 28791 9020-275 (12/8/2014)